Psychometric properties of the Japanese version of the Geriatric Anxiety Inventory for community-dwelling older adults.

BACKGROUND: This study developed a Japanese version of the Geriatric Anxiety Inventory (GAI-J) and its short form (GAI-J-SF) to evaluate anxiety in older adults in Japan and assess these measures' psychometric properties with a cross-sectional design. METHODS: Participants (N = 400; mean age: 75 years) were community-dwelling older adults who answered a set of self-report questionnaires. They were recruited from a community centre for older persons in the Kanto region of Japan. Of the respondents, 100 participated in a follow-up survey to evaluate test-retest reliability. Item response theory was adopted to evaluate item parameters. RESULTS: Confirmatory factor analysis with categorical data suggested that, as with the original Geriatric Anxiety Inventory, the GAI-J/GAI-J-SF had a unifactor structure. Test-retest correlation and internal consistency analyses indicated that these scales had high reliability. Item response theory results showed that both measures' item parameters were acceptable. Correlations with the Penn State Worry Questionnaire, State Trait Anxiety Inventory-State Only, Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were mostly consistent with our hypotheses. This supports the high convergent validity of the GAI-J/GAI-J-SF. CONCLUSIONS: The findings indicate that the GAI-J and the GAI-J-SF have robust psychometric properties for assessing late-life anxiety in older Japanese adults. Future GAI-J studies in clinical groups are needed.

Acceptability and feasibility of a Japanese version of STrAtegies for RelaTives (START-J): A manualized coping strategy program for family caregivers of relatives living with dementia.

The rising older population in Japan is associated with a rise in cases of dementia. Support for the increased number of family caregivers of people living with dementia is crucial, as caring may negatively affect a family caregiver's health. This study seeks to evaluate the feasibility and applicability of a recently developed Japanese version of START (STrAtegies for RelaTives). START is a psychosocial coping intervention program developed in the United Kingdom that has been shown to improve caregivers' mood and quality of life in a randomized controlled trial. We made changes to START (e.g., idioms, linguistic nuance, and providing care insurance information suited for Japan) to make it culturally appropriate. Fourteen Japanese female family caregivers of relatives with mild dementia (n = 10) or mild cognitive impairment (n = 4) were referred to the study, but six were excluded owing to illness and busyness. This single-arm study had a before-after trial evaluating psychological outcomes including depression, anxiety, quality of life, and subjective care burden. The acceptance retention and satisfaction rate suggest the feasibility and acceptability of the START program; 8/14 (>55%) eligible, prospective participants consented and were included in this study, all (8/8) of whom completed all START sessions. The mean program satisfaction score was 30.25 (standard deviation = 2.25) out of a potential 32. The results suggest that it is feasible and acceptable to deliver START in Japanese and based on the results of analysis using a linear mixed model, there is initial indication that the intervention improved family caregivers' quality of life, depressive symptoms, and care burden.

Cognitive Behavioral Therapy for Improving Mood in an Older Adult with Mild Cognitive Impairment: A Case Report.

This study investigated the feasibility of a cognitive behavioral therapy (CBT) program for improving mood and quality of life in an older woman with mild cognitive impairment (MCI), depression, and anxiety. The program comprised eight 30-minute weekly sessions; interventions included behavioral activation, relaxation, and cognitive reconstruction, in which the patient's caregiver also participated. The patient's condition was assessed before and immediately after the intervention. After 3 and 12 months, the caregiver reported the patient's behavioral and psychological symptoms by using self-reported psychological scales for depression, anxiety, and quality of life. Although CBT helped to improve mood and quality of life in the short term (3 months), the results were not sustained over the long term (12 months). Even though improvement in psychological symptoms did not persist and only one patient with MCI was evaluated, these results suggest that CBT is a feasible nonpharmacological treatment option and provide preliminary support for wider use of CBT in Japan. CBT programs should be tailored to the needs of patients with MCI and dementia, and regular follow-up sessions should be used to evaluate program feasibility and improvement in patient mental health.

Feasibility of applying the psychosocial intervention STrAtegies for RelaTives to family caregivers of patients with dementia: a case report.

As the number of people with dementia in Japan continues to rise, family caregivers are experiencing an increasing care burden. Previous research has shown that this care burden can affect family caregivers' physical and mental health. Therefore, providing support for caregivers of family members with dementia has become an urgent issue in the country. The purpose of this study was to investigate the feasibility of applying STrAtegies for RelaTives (START), a psychosocial intervention programme developed in the UK to improve caregivers' moods and quality of life, to Japanese family caregivers. Specifically, in this paper, we provide a detailed description of the application of the Japanese version of START to a female caregiver. Our investigation found that the Japanese version of START is a feasible option for alleviating the mental and physical burden on family caregivers of patients with dementia. This result provides preliminary support for the wider application of START in Japan, as it can decrease care burden and improve the daily lives of caregivers of people with dementia. It also supports the development and implementation of other systems that can provide similar services for other caregivers.

[Side Effects of Rogerian Psychotherapy and Counseling].

Rogerian psychotherapy relies on a patient's potential for self-healing and assumes that the patient will show desirable personality changes if the psychotherapist is satisfied with necessary and sufficient demands. Rogerian psychotherapy is usually not considered intrusive because of its supportive features. However, there is no treatment without side effects. Insufficient informed consent for psychotherapy, the risk of dependence, regression, traumatic stress caused by probing too deeply, and missing the chance to perform suitable medical treatment are discussed.

Treatment for female patients with eating disorders in the largest medical prison in Japan.

The number of offenders with eating disorders in women's prisons in Japan has grown annually over the last 15 years. Women's prisons have experienced significant difficulties in the management of patients with eating disorders who have body-critical complications arising from low body weight, in addition to behavioral problems. Patients in Japan's 185 correctional facilities who display high refractoriness or who present a physical risk are transferred to the Hachioji medical prison, a national specialty hospital operated by the Ministry of Justice. The medical prison must manage any psychosomatic problems necessary for the safety of inmates regardless of a patient's wishes. The most common conviction resulting in imprisonment of women with eating disorders was shoplifting (n = 44; 63%), with the second most common being drug-offenses (n = 17; 24%). While shoplifting is of concern in relation to eating disorders, a causal relationship remains unclear. Most patients in the shoplifting group did not have histories of antisocial and/or impulsive behaviors such as drug abuse, sexual deviation, self-injury, or other criminal activity. Instead, shoplifting appears to be an obsessive-compulsive behavior deeply rooted in the psychopathology of severe eating disorder patients. Patients in this group tended to have histories of relatively high education and steady employment, although most also had histories of prolonged eating disorders and unstable treatment. Although adherence to treatment was poor among patients with eating disorders in the medical prison, body weight and behavioral problems improved following treatment in the special compulsory environment, without severe sequelae or patient death. The Ministry of Justice recently established another specialized ward for the care for female patients with eating disorders. If greater emphasis is placed on early-stage, protective, medical treatment, the number of patients with eating disorders in prisons may decrease. Further research is required to investigate the relationship between shoplifting and eating disorders.

Early identification of cognitive impairment and dementia: Results from four years of the community consultation center.

The community consultation center was established as the core facility for a project entitled "Community Support Network for Citizens with Mild Cognitive Impairment (MCI) and Dementia." This study reports on our center's activity and user outcomes. Users consulted with medical staff regarding their memory problems and were self-screened using a touch-panel computer assisted screening tool (TPST). Dementia was suspected when the TPST score was 12 points or below, and the Mini-Mental State Examination (MMSE) was conducted by our onsite clinical psychologists, which served as the gold standard. All reports were provided to user's primary care physicians, or a nearby medical institute if users did not have a primary care physician. Patient outcomes were obtained from participating medical institutes. Informed consent was obtained for all users. In the four-year period, 2802 users visited the center. Of them, 1565 registered (men/women=519/1046; mean age, 74 years). Of 1354 people who used TPST, 622 (45.9%) scored 12 points or below. 409 confirmed diagnoses from the medical institutes revealed MCI in 11.2%, Alzheimer's disease in 37.1%, and vascular dementia in 8.0%. Among the 207 users who had no primary care physicians at consultation, 43 (20.8%) were diagnosed with MCI or dementia. Approximately half of the users who took the TPST were suspected of dementia following interview by a clinical psychologist. Both MCI and dementia were confirmed by the medical institutes in 59.6% of users. We conclude that our consultation center plays a pivotal role in early diagnosis of MCI and dementia.

Eating disorders among patients incarcerated only for repeated shoplifting: a retrospective quasi-case-control study in a medical prison in Japan.

BACKGROUND: Shoplifting is a serious problem among patients with eating disorders. For more than a decade, we have treated many patients with eating disorders incarcerated in Hachioji Medical Prison only for repeated shoplifting. METHODS: We analyzed the prison records and medical records of female psychiatric patients transferred to Hachioji Medical Prison between 2002 and 2011. Based on the offense listed at the time of sentencing, we extracted a shoplifting group and a drug-offense group from among all patients with eating disorders. One patient from the former group who had used substances and two from the latter group who had never shoplifted were excluded from the study. The groups had 41 and 14 patients, respectively. A control group comprised patients with other mental disorders (n = 34). We compared eating disorder histories and subtypes, weight changes, comorbidities, life histories, past behavioral problems, and clinical behavioral problems among the three groups. RESULTS: The shoplifting group exhibited less impulsive behavior, substance abuse, antisocial features, borderline personality disorder, and past bulimia than did the drug-offense and control groups. The shoplifting group had higher educational achievement and steadier employment; however, their eating disorder histories and interpersonal dysfunction were more severe, and they had a higher psychiatric treatment dropout rate. There were also significant relationships with low body weight, anorexia nervosa-restricting type, obsessive-compulsive behaviors, and obsessive-compulsive personality disorder in the shoplifting group. During the clinical course, food refusal, excessive exercise, food hoarding, and falsification of dietary intake amounts were more frequently observed in the shoplifting group. Conversely, drug requests and occurrences of self-harm were less frequent in the shoplifting group than in the drug-offense group. CONCLUSIONS: Although these results may be associated with specific characteristics of patients with eating disorders in the medical prison setting, we concluded that the repeated shoplifting by these patients is unrelated to antisocial or impulsive characteristics but is deeply rooted in these patients' severe and undertreated eating disorder psychopathology. Strong supportive treatment should be considered for patients with eating disorders who develop shoplifting behaviors. Further research is required to elucidate the mechanisms responsible for the relationship between shoplifting and eating disorders.

Roles of consultation organizations in the early detection of dementia: from the practices of the Community Consultation Center for Citizens with Mild Cognitive Impairment and Dementia, Nippon Medical School.

BACKGROUND: As society ages, early detection of dementia is becoming increasingly important. Many hospitals have opened memory-loss clinics, and various new approaches for early examination and appropriate diagnosis are being tried. However, these memory-loss clinics are ultimately part of the hospital establishment, implying that, in addition to the burdens of time and effort to undergo examinations and consultations, patients might have a certain psychological resistance. With a grant from the Ministry of Education, Culture, Sports, Science and Technology, the Institute of Development and Aging Science at Nippon Medical School has opened a center called the Community Consultation Center for Citizens with Mild Cognitive Impairment and Dementia, which is a dementia-related center outside the regular hospital. This center has been developing a system that makes consultations easier. We performed a retrospective follow-up study that aimed to determine how much this approach contributes to the early detection of dementia compared with outpatient visits to university hospitals. METHODS: Persons who were found to have organic brain syndrome (defined as organic diseases related to dementia, including mild cognitive impairment) after visiting the Consultation Center during the survey period were referred to as the Consultation Center group, and persons who were found to have organic brain syndrome after an initial visit to the Department of Neurology at Nippon Medical School Musashi Kosugi Hospital were referred to as the Hospital group. We compared the groups in terms of sex, age, Mini-Mental State Examination (MMSE) score, and subclassification by means of the t-test and χ(2) test. RESULTS: Both the mean MMSE score (p<0.001) and percentage of subjects with an MMSE score of 24 points of higher (p=0.007) were significantly higher in the Consultation Center group than in the Hospital group. CONCLUSIONS: Consultations can be made more casually at the Consultation Center than at hospitals. Our results suggest that more casual consultations contribute to the early detection of dementia.

Current situation and future tasks for psychiatric services in Japanese prisons.

I outline the current situation and future tasks for psychiatric services in Japanese prisons. I describe the provision of facilities specializing in psychiatric services, preparation of legal aspects related to involuntary treatment, provision of therapeutic educational programs regarding addictive crimes, and the measures required for continuation of treatment after release from prison. I also discuss how, in the current system, under the "Act on Mental Care and Treatment for Persons who have Caused Serious Cases under the Condition of Insanity," unfairness arises in the treatment of mentally disordered offenders, requiring a division between medical care and justice (correctional institutions).

Adsorption behavior of metal ions onto a bovine serum albumin (BSA) membrane monitored by means of an electrode-separated piezoelectric quartz crystal.

The interaction between metal ions and bovine serum albumin (BSA) was studied by using a piezoelectric quartz crystal (PQC) arranged in the electrode-separated configuration. A silanized surface of the PQC was coated with a BSA membrane via a coupling reaction with glutaraldehyde. The frequency shifts obtained from PQC coated with a BSA membrane suggested that various kinds of metal ions could be adsorbed onto the BSA membrane from aqueous solutions containing a low concentration of metal ions (2 or 10 micromol dm(-3)), only when the BSA was denatured with an alkaline solution. Anionic species of Pt(IV) and Au(III) were adsorbed onto the denatured BSA membrane from an acetic acid solution at pH 2.2, and cationic species of Cd(II), Zn(II), Co(II), Ni(II), Cu(II), and Ag(I), and cations, such as Ca2+, Ba2+, and Mg2+, were adsorbed from ammonia buffer at pH 9.5, whereas Al(III), Cr(III), Fe(III), Hg(II), and Pb(II) were hardly adsorbed. The adsorption mechanisms of these metal ions are discussed, based on the electrostatic interaction between the metal ions and the denatured BSA membrane, and complex formation between the metal ions and amino acid residues of the denatured BSA. Further, the PQC coated with a denatured BSA membrane was applied to the determination of Pt and Cd, using large frequency shifts for Pt(IV) and Cd(II).

Silver-selective sensor using an electrode-separated piezoelectric quartz crystal modified with a chitosan derivative.

Silver(I) adsorbed selectively onto a quartz plate modified with N-(2-pyridylmethyl)chitosan in an ammonium chloride buffer solution containing EDTA, and the frequency of the quartz plate increased. It was supposed that the increasing frequency was caused by the desorption of adsorbed water on the chitosan derivative, which was induced from the reaction of silver(I) with the chitosan derivative. The concentration of the buffer, pH, temperature, conductivity and eluent affected the frequency shift resulting from the adsorption of silver(I). The frequency decreased at a conductivity lower than 2.2 mS/cm, and increased with increasing conductivity above this value. The frequency shifts caused by the adsorption of silver(I) were proportional to the concentration over the range 10-80 nM of silver(I), and the correlation coefficient was 0.9969. The detection limit and the relative standard deviation at 50 nM for five times were 6 nM and 3.4%, respectively. The proposed method was simple while showing higher sensitivity and selectivity.