Gap between patients with schizophrenia and their psychiatrists on the needs to psychopharmacological treatment: A cross-sectional study.

AIM: Psychopharmacological treatment is indispensable in patients with schizophrenia but data on needs, preferences, and complaints about their medications are limited. Moreover, there has been no study to assess the degree of awareness of their psychiatrists (gap in needs) regarding these issues. METHODS: Ninety-seven Japanese patients with schizophrenia (ICD-10) were asked to fill in the questionnaire consisting of multiple-choice questions regarding (a) their needs and complaints about psychopharmacological treatment that they were receiving, and (b) their preference of dosage form, dosing frequency, and timing of dosing. Additionally, their psychiatrists in charge were asked to predict their patients' response to the above questions. RESULTS: Both the most frequently endorsed need and complaints about the current psychopharmacological treatment were "nothing in particular" (n = 14, 16.7% and n = 17, 20.2%); merely 23.1% and 15.4% of their psychiatrists correctly predicted these responses, respectively. "Once a day" (n = 56, 65.1%), "at bedtime" (n = 53, 61.6%), and "tablet" (n = 51, 59.3%) were the patients' most favorite dosing frequency, timing, and dosage form, respectively; 59.8% (n = 49), 54.9% (n = 45), and 64.6% (n = 53) of their psychiatrists predicted them. CONCLUSIONS: These findings suggest that there is substantial room for improvement on the side of psychiatrists to capture their patients' needs and complaints about psychopharmacological treatment.

Is it possible to implement community care based on mental health in Japan? A comparison between decade ago and present on Duration of Untreated Psychosis (DUP).

INTRODUCTION: In recent years, the early detection and treatment of the first episode of schizophrenia (FES) has attracted worldwide attention. In Japan, psychiatric care has changed to an open and accessible framework over the past decade. Therefore, the duration of untreated psychosis (DUP) is thought to have been shortened. The purposes of this study were to investigate whether recent DUP periods are shorter than they were 10 years ago and whether the DUP at present differs among psychiatric facilities. We investigated the recent DUP at a psychiatric hospital and its satellite clinic. MATERIAL AND METHODS: We examined the differences in DUP, age, sex, referral pathway, living companions, social participation, and schooling history among 3 groups of FES patients: (i) a psychiatric hospital during 1999-2001 and (ii) during 2009-2011, and (iii) a psychiatric clinic during 2009-2011. RESULTS: The average DUP was 14.3 (SD = 17.5) months for the psychiatric hospital during 1999-2001, 16.0 (SD = 18.7) months for the psychiatric hospital during 2009-2011, and 24.4 (SD = 30.0) months for the psychiatric clinic during 2009-2011. No significant differences were found in the DUP for each facility and during this decade. Also, the differences in the DUP could not be attributed to factors such as living companions or social participation. DISCUSSION: Increases in the numbers of patients and psychiatric clinics have not led to the early detection of FES. To shorten the DUP in the future, closer cooperation among the medical field, the educational field, and the health and welfare will be needed.

Successful aging in individuals with schizophrenia dwelling in the community: a study on attitudes toward aging and preparing behavior for old age.

AIM: 'Successful aging' in individuals with schizophrenia has been attracting attention. We examined two forward-looking factors of successful aging among schizophrenia patients: 'attitude toward aging' and 'preparing behavior for old age'. METHODS: Fifty-seven middle-aged and elderly schizophrenia patients with successful aging were identified using the Attitude toward Aging Scale, the Preparing Behavior for Old Age Scale, and assessments of their cognitive function, psychiatric symptoms, social functioning and quality of life. A multiple regression analysis was used to detect determinants of attitude toward aging/preparing behavior for old age at that time ('present': community dwelling). We also analyzed predictors of successful aging using demographic/clinical data assessed 3 years previously ('past': residential care). RESULTS: The multiple regression analysis revealed that quality of life was a significant determinant: a higher quality of life was related to a more positive attitude toward aging and less active preparing behavior. The significant predictors of preparing behavior were quality of life and the length of the hospital stay: a longer hospital stay and a higher quality of life were related to less active preparing behavior. CONCLUSION: Quality of life and the length of the hospital stay significantly contributed to forward-looking factors of successful aging. Avoiding long hospitalization periods for patients with schizophrenia may lead to more active preparing behavior, but the improvement of quality of life may not be a sufficient condition. As schizophrenia patients have an optimistic attitude and insufficient preparing behavior, support to prepare such individuals for old age is required as part of community-based psychiatric care strategies.

Correlation between attenuated psychotic experiences and depressive symptoms among Japanese students.

AIMS: To examine the emergence of attenuated psychotic experiences, self-disturbance or affective symptoms among younger subjects in the general population and to investigate the intergroup differences on each symptom between adolescents and post-adolescents. METHODS: A total of 781 participants, 496 university students (mean age: 19.3 +/- 1.1 years) and 285 high school students (mean age: 16.0 +/- 0.3 years), were administered self-reported questionnaires. Psychotic prodromal symptoms were evaluated using the PRIME Screen-Revised (PS-R), a 12-item self-reported questionnaire. To measure the cognitive, emotional and physical symptoms associated with depression, the Zung Self-rating Depression Scale (ZSDS), a 20-item self-reported questionnaire, was administered. RESULTS: There were no intergroup differences on the factor score of the PS-R, except the self-demarcation factor (post-adolescents > adolescents), whereas there were significant differences in the factor score of the ZSDS, except for the anxiety factor. Among the post-adolescents, the factors of the PS-R showed a moderate correlation to the cognitive factor on the ZSDS; among the adolescents, the PS-R factors showed a greater correlation to the anxiety factor on the ZSDS than other factors. There were no differences in the distribution of each item of the PS-R between the two groups. CONCLUSIONS: The disturbance of self results in difficulty to precisely objectify, especially among adolescents, which would induce more primitive reactions such as agitation, irritability or anxiety; probably, the self disturbance would become an explicit symptom from an implicit experience with advancing age of the subject. Although these data are only preliminary, they could explain the pathway of progression prior to the onset of psychosis, from disturbance within the self to exaggerated self-absorption.

Clinical and social determinants of a longer duration of untreated psychosis of schizophrenia in a Japanese population.

AIM: To measure the duration of untreated psychosis (DUP) among patients with schizophrenia in a Japanese population and to investigate clinical and social determinants of the DUP. METHODS: A multicentre, retrospective study at seven medical centres in three cities (Tokyo, Toyama and Kochi) was performed. In total, 150 consecutive patients (78 men) with neuroleptic-naïve first-episode schizophrenia were investigated; their DUP and demographic, clinical and social variables were obtained from their medical charts and analysed. RESULTS: The intraclass correlation coefficient for the DUP was quite good (ICC = 0.849). The mean DUP of all the subjects attending the seven psychiatric services was 20.3 months, and the median DUP was 6.0 months. Fourteen patients (9.3%) had a DUP of more than 60 months, and 47 patients, or about one-third, had a DUP of more than 24 months. No significant differences in the mean DUPs were observed among the three cities. Patients who were employed or who were students had a significantly shorter DUP (14.3 months). The median DUP for those with an insidious onset of psychosis (n = 85) was 18.0 months, compared with a median of 2.0 months for those with a sudden and acute onset (n = 61). However, no other clinical or social variables examined in this study were associated with differences in the DUP. CONCLUSIONS: The DUP of patients with schizophrenia is relatively long in Japan. The provision and modification of psychiatric services for easy access and a system for the early recognition and detection of mental illness are needed.

Cognitive training for divergent thinking in schizophrenia: a pilot study.

Individuals with schizophrenia demonstrate deficits in divergent thinking. This ability is indispensable for generating creative solutions and navigating the complexities of social interactions. In a pilot study, seventeen stable schizophrenia outpatients were randomly assigned to a training program for divergent thinking or a control program on convergent thinking. After eight weeks of training, participants in the divergent thinking program had significantly greater improvements on measures of idea fluency, negative symptoms, and interpersonal relations than did participants receiving the control program. These preliminary results suggest that interventions for divergent thinking in schizophrenia may lead to improvements in patients' social functioning.

Effects of aripiprazole on insight and subjective experience in individuals with an at-risk mental state.

INTRODUCTION: Although medication with antipsychotic for the psychosis prodrome has often caused some ethical issues, recent studies have shown that some novel antipsychotics are safer and more tolerable for young people. This study aimed to investigate whether the administration of aripiprazole would not only relieve the prodromal symptoms but also be tolerable for prodromal subjects and to evaluate the effect of medication on improvements in insight and subjective well-being. METHODS: The Structured Interview for Prodromal Syndromes was performed for patients identified as having the psychosis prodrome. Psychiatric measures included the Scale of Prodromal Symptoms. Clinical insight was measured using the Scale to Assess Unawareness of Mental Disorder, and changes in subjective experience were assessed using the Subjective Well-being Under Neuroleptics, Short version. The time frame was the first 8 weeks after beginning study medication. RESULTS: Thirty-six treatment-seeking prodromal patients (men, 42%; mean [SD] age, 23.4 [5.6] years) were enrolled. At the 12-week follow-up point, 30 participants (83%) remained in the trial. Improvements on the Scale of Prodromal Symptoms and Scale to Assess Unawareness of Mental Disorder scores were statistically significant at end point. Although the Subjective Well-being Under Neuroleptics, Short version total scores improved significantly at 4 weeks, however, they did not change significantly from baseline at 8 weeks. CONCLUSIONS: This trial suggests that aripiprazole not only produces a clinical benefit in prodromal subjects but also results in a high adherence to medication with immediate improvements in insight and subjective well-being. Although further placebo-controlled studies are needed, aripiprazole might be a first-line treatment for individuals at imminent risk for psychosis.

Clinical practice and research activities for early psychiatric intervention at Japanese leading centres.

AIM: To describe clinical practice and research activities for early psychiatric intervention in Japan, a country with a huge number of psychiatric beds and a history of long-stay, hospital-based psychiatry. METHODS: The characteristics, methods and activities of early intervention studies and implementation at four leading institutions in Japan are described. RESULTS: The Tokyo Youth Club (Tokyo), the Department of Neuropsychiatry of Toyama University Hospital (Toyama), the Sendai At-risk Mental State and First Episode (SAFE) service (Sendai), and the Il Bosco of Toho University Omori Medical Center (Tokyo) have unique and active psychiatric programmes. Eachcentre has its own clinical research programme and treatment strategies. The Japanese Society for the Prevention of Psychiatric Disorders, founded in 1996, has made a steady contribution to psychiatric care by providing a forum for members to promote best practices for early intervention and by hosting annual meetings to discuss research and treatment. CONCLUSIONS: The Japanese psychiatry service is continuing its transition from hospital-based psychiatry to community-based psychiatry. Despite these difficult circumstances, the publication of data on the duration of untreated psychosis in Japan along with evidence that early detection determines outcome has encouraged new attempts to promote early psychiatric intervention.

A self-reported instrument for prodromal symptoms of psychosis: testing the clinical validity of the PRIME Screen-Revised (PS-R) in a Japanese population.

OBJECTIVE: Early intervention for psychosis requires an easy, useful assessment instrument to identify subjects with prodromal symptoms at an early stage. The aim of this study was to test the clinical validity of the PRIME Screen-Revised (PS-R), a 12-item self-reported instrument for prodromal symptoms of psychosis, by comparing the results for a non-clinical population with those for a clinical population. METHOD: The PS-R was administered to 1,024 subjects (496 students and 528 outpatients). Of the 528 patients, 115 were randomly recruited and tested using the Structured Interview for Prodromal Syndromes (SIPS) to determine the concordant validity of the PS-R. The predictive validity of the PS-R was measured by determining the transition rate to psychosis during a 6-month follow-up period. RESULTS: The specificity and sensitivity of the PS-R, using the SIPS as a gold standard, were 0.74 and 1.00. The concordant validity of the PS-R against the SIPS was 0.43. The predictive validity of the PS-R and the SIPS, defined as the transition rate to psychosis, were 0.11 and 0.25, respectively. None of the patients with negative PS-R results developed psychosis. CONCLUSIONS: Our findings showed that the PS-R was highly valid and that its usage is feasible in both general practice and clinical settings. This self-reported instrument represents a useful screening tool for alerting clinicians to subjects with psychotic prodromal symptoms.

Association between duration of untreated psychosis, premorbid functioning, and cognitive performance and the outcome of first-episode schizophrenia in Japanese patients: prospective study.

OBJECTIVE: The aim of the present study was to identify the relationship between duration of untreated psychosis (DUP), premorbid functioning, and cognitive dysfunction and the outcome of first-episode schizophrenia. METHOD: Thirty-four neuroleptic-naïve patients who consulted hospitals in Tokyo and who were treated by psychiatrists for the first time were evaluated with regard to DUP, premorbid functioning, psychiatric symptoms, and global functioning. The neuropsychological test battery consisted of the Letter Cancellation Test, Trail-Making Test, Digit Span and Verbal Fluency Test. One year later, 24 of the subjects were reassessed for psychiatric symptoms, global functioning, and social functioning, and the relationships between DUP, premorbid functioning, and cognitive performance and the outcome was investigated. RESULTS: Short DUP, good premorbid functioning, and good Letter Cancellation Test, Digit Span and Verbal Fluency Test scores were significantly associated with good outcome. CONCLUSIONS: The present results in a Japanese sample are consistent with previous international evidence that delay of initial treatment, premorbid functioning, and cognitive deficits are associated with outcome. A major limitation of the present study was the small size of the subject group. But because the subjects were relatively homogeneous and not influenced by psychoactive substances, the results reflect the essence of the disorder.

Reducing the dose of antipsychotic agents ameliorates visual hypersensitivity attack: an ideal treatment option in terms of the adverse effect.

There are sporadic reports of antipsychotic-induced visual hypersensitivity attack (VHA). VHA is characterized by hypersensitivity of perception mainly in the visual modality and sometimes accompanied by an oculogyric crisis. However, some researchers regard VHA as a schizophrenia symptom. To determine whether VHA is an adverse effect of antipsychotic agents, we examined the effect of dose reduction on VHA. This was an open-label 36-week study. We randomized 34 patients with VHA to a reduced-dose group and a fixed-dose group. Primary outcome measures were the frequency and duration of VHA, assessed with patients' self-reports, and the Clinical Global Impressions (CGI). Assessment also included the Drug-induced Extrapyramidal Symptoms Scale for extrapyramidal symptoms, the Positive and Negative Syndrome Scale (PANSS) for schizophrenia, and the CGI for other diagnoses. Data were collected from August 2000 to April 2005 at 4 psychiatric hospitals in Tokyo.VHA diminished in 16 patients (94.1%) in the reduced-dose group in the CGI score, the frequency (number of episodes per week), and the duration of the episodes (from 4.06 to 1.77, P < 0.001; from 2.59 to 0.82, P = 0.001; and from 1.92 to 0.66 hours, P = 0.007, respectively), but there were no changes in the fixed-dose group. There were no changes in the underlying illness as measured by the PANSS in both groups. Reducing the dose of antipsychotic agents ameliorates VHA and represents the ideal treatment option for patients with VHA.

Duration of untreated psychosis and pathways to psychiatric services in first-episode schizophrenia.

The aim of the present study was to examine the duration of untreated psychosis (DUP) in first-episode schizophrenia patients in Japan and to investigate the available pathways to psychiatric services. Eighty-three patients who visited Keio University Hospital (n = 54) or Oizumi Mental Hospital (n = 29) were evaluated retrospectively with regard to their DUP, living situation, social participation level, referral pathway, reason for seeking treatment, and their global assessment of functioning (GAF) score. The mean DUP was 13.7 months (median, 5.0 months) overall. No significant difference in DUP was found between subjects living alone and those living with others; however, employed patients had a significantly shorter DUP (8.1 months) than unemployed patients (18.7 months). Pathways to psychiatric services were totally different between the two institutions. Fifty-two subjects (62.7%) came to the services directly: 40 patients (74.1%) came to the university hospital and 12 patients (41.4%) came to the mental hospital. At the mental hospital, nine patients (31.0%) had been admitted because of a legal obligation, and six (20.7%) had been referred through public health centers. None of the patients had been referred to either of the services by general practitioners. The main reason for seeking treatment was psychiatric symptom aggravation (59.3%) at the university hospital and acting out (64.3%) at the mental hospital. Some universal psychosocial factors appear to influence the DUP but the characteristics of specific psychiatric services may also affect treatment delays.