Profiling psychiatric inpatient suicide attempts in Japan.

Suicide is an adverse event that can occur even when patient are hospitalized in psychiatric facilities. This study delineates the demographic characteristics of suicide attempts in mental hospitals and psychiatric wards of general hospitals in Japan, a country where the suicide rate is remarkably high. Analyses of incident reports on serious suicide attempts in psychiatric inpatients were performed using prefectural incident records between April 1, 2001, and December 31, 2012. Suicide reports were included for 35 incidents that occurred over 11 years, and demonstrated that 83% of patients (n = 29) committed suicide and 17% (n = 6) survived their attempt with serious aftereffects, such as cognitive impairment or persistent vegetative state. The male/female ratio of inpatient suicide was 1.5:1. The mean age of the attempters was 50.5 years (SD = 18.2). The most common psychiatric diagnoses for those with suicide incident reports were schizophrenia spectrum disorders (51.4%) and affective disorders (40%). Hanging (60%) was the most common method of suicide attempt, followed by jumping in front of moving objects (14.3%) and jumping from height (11.4%). Fifty-four percent of suicides (n = 19) occurred within hospital sites and the remainder (46%; n = 16) occurred outside hospital sites (e.g., on medical leave or elopement) while they were still inpatients.

[An autopsy case report of adenosquamous cell carcinoma of the duodenal papilla with multiple liver and lung metastases].

A 63-year-old man was admitted to Saitama-Kyodo Hospital for the management of obstructive jaundice. Gastrointestinal endoscopy revealed a tumor of the duodenal papilla, and tumor biopsy suggested adenosquamous cell carcinoma. Computed tomography revealed multiple tumors in both the liver and lung, and these were diagnosed as metastases using bronchoscopy-guided lung biopsy and ultrasound-guided liver biopsy, respectively. The patient was treated with gemcitabine therapy after successful management of the jaundice by percutaneous transhepatic cholangiodrainage. However, he died three months after hospitalization. Autopsy confirmed a tumor of the duodenal papilla that had invaded both the pancreas and bile duct; moreover, multiple liver and lung metastases were observed. The pathological diagnoses were adenosquamous cell carcinoma. Histopathological findings revealed a mixture of adenocarcinoma and squamous cell carcinoma and promotion of multiplication of the adenocarcinoma. Adenosquamous cell carcinoma of the duodenal papilla is rare and preoperative diagnosis is challenging. Our case is unique because biopsy suggested the diagnosis before treatment.

Tai Chi exercise versus rehabilitation for the elderly with cerebral vascular disorder: a single-blinded randomized controlled trial.

BACKGROUND: Cerebral vascular disorder (CVD) might result in a quantifiable decrease in quality of life, which is determined not only by the neurological deficits but also by impairment of cognitive functions. There are few studies that report on the cognitive effect of Tai Chi exercise (Tai Chi) on the elderly with CVD. The purpose of the present study was to examine the cognitive effect of Tai Chi on the elderly with CVD using P300 measurement, in addition to the General Health Questionnaire (GHQ) and Pittsburgh Sleep Quality Index (PSQI). METHODS: A total of 34 patients with CVD were recruited from outpatient Akistu-Kounoike Hospital and randomly assigned to receive Tai Chi (n= 17) or rehabilitation (n= 17) in group sessions once a week for 12 weeks. To examine the time courses of each score (P300 amplitude, P300 latency, GHQ score and PSQI score), repeated-measures analysis of variance was carried out with groups and time as factors. RESULTS: For the time courses of P300 amplitudes and latencies, there were no significant effects of interaction between group and time. However, significant time-by-group interactions were found for Sleep Quality (P= 0.006), GHQ total score (P= 0.005), anxiety/insomnia score (P= 0.034), and severe depression score (P= 0.020). CONCLUSIONS: Tai Chi might therefore be considered a useful non-pharmacological approach, along with rehabilitation, for the maintenance of cognitive function in the elderly with CVD and might be a more useful non-pharmacological approach for the improvement of sleep quality and depressive symptoms in the elderly with CVD than rehabilitation.