Longitudinal effects of disaster-related experiences on mental health among Fukushima nuclear plant workers: The Fukushima NEWS Project Study.

BACKGROUND: The Fukushima Nuclear Energy Workers' Support (NEWS) Project Study previously showed that experiences related to the Fukushima nuclear disaster on 11 March 2011 had a great impact on psychological states, including post-traumatic stress response (PTSR) and general psychological distress (GPD), among the Fukushima nuclear plant workers. To determine the causal relationship between disaster-related experiences and levels of psychological states, we conducted a 3-year longitudinal study from 2011 to 2014. METHOD: PTSR and GPD of the nuclear plant workers were assessed by annual questionnaires conducted from 2011 to 2014. The present study included a total of 1417 workers who provided an assessment at baseline (2011). A total of 4160 observations were used in the present analysis. The relationship between disaster-related experiences and psychological states over time was analysed using mixed-effects logistic regression models. RESULTS: A declining influence of disaster-related experiences on PTSR over time was found. However, the impact on PTSR remained significantly elevated even 3 years after the disaster in several categories of exposure including the experience of life-threatening danger, experiences of discrimination, the witnessing of plant explosion, the death of a colleague and home evacuation. The associations between GPD and disaster-related experiences showed similar effects. CONCLUSIONS: The effects of disaster-related experiences on psychological states among the nuclear plant workers reduced over time, but remained significantly high even 3 years after the event.

The longitudinal mental health impact of Fukushima nuclear disaster exposures and public criticism among power plant workers: the Fukushima NEWS Project study.

BACKGROUND: The Fukushima Daiichi and Daini Nuclear Power Plant workers experienced multiple stressors as both victims and onsite workers after the 2011 Great East Japan Earthquake and subsequent nuclear accidents. Previous studies found that disaster-related exposures, including discrimination/slurs, were associated with their mental health. Their long-term impact has yet to be investigated. METHOD: A total of 968 plant workers (Daiichi, n = 571; Daini, n = 397) completed self-written questionnaires 2-3 months (time 1) and 14-15 months (time 2) after the disaster (response rate 55.0%). Sociodemographics, disaster-related experiences, and peritraumatic distress were assessed at time 1. At time 1 and time 2, general psychological distress (GPD) and post-traumatic stress response (PTSR) were measured, respectively, using the K6 scale and Impact of Event Scale Revised. We examined multivariate covariates of time 2 GPD and PTSR, adjusting for autocorrelations in the hierarchical multiple regression analyses. RESULTS: Higher GPD at time 2 was predicted by higher GPD at time 1 (ß = 0.491, p < 0.001) and discrimination/slurs experiences at time 1 (ß = 0.065, p = 0.025, adjusted R 2 = 0.24). Higher PTSR at time 2 was predicted with higher PTSR at time 1 (ß = 0.548, p < 0.001), higher age (ß = 0.085, p = 0.005), and discrimination/slurs experiences at time 1 (ß = 0.079, p = 0.003, adjusted R 2 = 0.36). CONCLUSIONS: Higher GPD at time 2 was predicted by higher GPD and discrimination/slurs experience at time 1. Higher PTSR at time 2 was predicted by higher PTSR, higher age, and discrimination/slurs experience at time 1.

[Pharmacokinetics of haloperidol in patients on hemodialysis].

Psychotic symptoms among patients receiving hemolytic dialysis (HD) are quite common, while studies showing pharmacokinetics and clearances of neuroleptics in such patients are few. In such instances, previous studies recommended a single administration of neuroleptics with about 1/3 to 1/2 of the normal dose for patients without renal failure. We made a study of 4 cases of delirious patients receiving HD and investigated the relationship between a daily dose of haloperidol (HP), its blood concentration and changes of delirium symptoms before and after HD. Oral or intravenous doses of HP (12-24 mg) were required for the improvement of delirium. Blood concentration increased in proportion to the HP dosage in all patients, and its average was significantly higher than that of the control group. Approximately 25% of clearance was found before and after HD. These studies suggest that the HP dosage for HD patients needs to be larger than previously assumed. Changes in the pharmacokinetics of HP in HD patients seemed to be influenced by a variety of factors such as binding rate with blood serum albumin and HP, metabolic pathway of HP, and sensitivity of HP in the brain.

[Successful treatment using high-dose amoxapine for a depressive patient].

We present a case of successful treatment of a patient with depression who showed remarkable improvement with a high-dose treatment of amoxapine. The case involved a 59-year old in-patient male who suffered severe depression. While a variety of medications, including anti-depressants, mood stabilizers, and anti-psychotics, were tried, none were successful. However, after starting amoxapine and increasing the dose to 375 mg/day, symptoms significantly improved. The patient underwent continued therapy with same dose, and no relapse was seen until it occurred about the same time poor compliance was observed. The case suggests that, while the patient seemed "treatment-resistant" at first, a higher dose and/or elongation of medication, led to improvement. It also suggests that anti-depressant treatment with a sufficient dose and period, should be continued for patients with treatment-resistant depression.

Evaluation of the first Medical Psychiatry Unit in Japan.

The first Medical Psychiatry Unit (MPU) in Japan was established in 1990. The clinical experience during the first 4 years of this unit is presented, and the characteristics of the Unit between its first 2 years and its latter 2 years are compared. The number of patients, the average length of stay, the primary psychiatric disorders, the combined physical diseases and their outcomes are presented. The data suggest that while the experience of the MPU is limited, it plays an important role in Japan as (i) an appropriate clinical setting for patients with combined medical and psychiatric illness, (ii) a strategic model for dealing with psychiatric patients in the general hospital, (iii) an educational setting for psychiatric residents to become more familiar with medicine and surgery, and (iv) an opportunity for non-psychiatric residents to become familiar with psychiatric illnesses and treatments.

Telepsychiatry: assessment of televideo psychiatric interview reliability with present- and next-generation internet infrastructures.

OBJECTIVE: We assessed the reliability of remote video psychiatric interviews conducted via the internet using narrow and broad bandwidths. METHOD: Televideo psychiatric interviews conducted with 42 in-patients with chronic schizophrenia using two bandwidths (narrow, 128 kilobits/s; broad, 2 megabits/s) were assessed in terms of agreement with face-to-face interviews in a test-retest fashion. As a control, agreement was assessed between face-to-face interviews. Psychiatric symptoms were rated using the Oxford version of the Brief Psychiatric Rating Scale (BPRS), and agreement between interviews was estimated as the intraclass correlation coefficient (ICC). RESULTS: The ICC was significantly lower in the narrow bandwidth than in the broad bandwidth and the control for both positive symptoms score and total score. CONCLUSION: While reliability of televideo psychiatric interviews is insufficient using the present narrow-band internet infrastructure, the next generation of infrastructure (broad-band) may permit reliable diagnostic interviews.