Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: A 24-week randomized controlled trial.

AIM: Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. METHODS: This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. RESULTS: A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. CONCLUSION: Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.

[Approach of Private Hospitals to Support Individuality-respected Community Living].

The government has taken a variety of measures to actualize the basic philosophy of the policy for"shifting medical treatment under hospitalization to regional medical treatment". The problems associated with mental disorders requiring long-term psychiatric treatment and reducing psychiatric beds have been discussed from various viewpoints. Although the transfer of psychiatric medical treatment to regional medical treatment is taking place, it is true that some large barriers exist. According to research on the actual situation in 1954, 1,300,000 psychiatric disorders were estimated, including 350,000 disabilities requiring hospitalization, and mental beds available increased up to a maximum of 350,000 with government subsidies. In 1987, mental bed availability was controlled according to the local healthcare program. As a result, periods of psychiatric hospitalization became prolonged due to factors including social prejudice and the inadequacy of rehabilitation centers; it was called "social hospitalization". Nevertheless, it is true that private psychiatric hospitals have successfully provided various psychiatric medical services in order for people with disabilities to be able to live in the community. The Program for Dissolution of Social Hospitalization of Psychiatric Disabilities in 2000 started in Osaka. The Ministry of Health, Labour and Welfare started the Program for Hospital Discharge Promotion of Psychiatric Disabilities as a model program in 2003. This program was included in the Regional Life Support Program in Prefectural and City Governments, and expanded throughout Japan in 2006. The Regional Shift Support Special Action Program of Psychiatric Disabilities was started in 2008. The report of the "Symposium for Ideal Future Psychiatric Medical Welfare" as compiled in September 2009, and the target value was indicated there. Various measures were implemented in order to promote the basic philosophy for "shifting medical treatment under hospitalization to living in the community". In 2012, the Japan Psychiatric Hospitals Association, joined by the private psychiatric hospitals responsible for medical treatment under hospitalization, set forth their basic polity for "shifting medical treatment under hospitalization to regional medical treatment and medical care" as part of "Future Vision of Psychiatric Medical Treatment".

Japanese Project for Telepsychiatry Evaluation during COVID-19: Treatment Comparison Trial (J-PROTECT): Rationale, design, and methodology.

INTRODUCTION: The COVID-19 pandemic has had a profound impact on the mental health of people around the world. Anxiety related to infection, stress and stigma caused by the forced changes in daily life have reportedly increased the incidence and symptoms of depression, anxiety disorder and obsessive-compulsive disorder. Under such circumstances, telepsychiatry is gaining importance and attracting a great deal of attention. However, few large pragmatic clinical trials on the use of telepsychiatry targeting multiple psychiatric disorders have been conducted to date. METHODS: The targeted study cohort will consist of adults (>18 years) who meet the DSM-5 diagnostic criteria for either (1) depressive disorders, (2) anxiety disorders, or (3) obsessive-compulsive and related disorders. Patients will be assigned in a 1:1 ratio to either a "telepsychiatry group" (at least 50% of treatments to be conducted using telemedicine, with at least one face-to-face treatment [FTF] within six months) or an "FTF group" (all treatments to be conducted FTF, with no telemedicine). Both groups will receive the usual treatment covered by public medical insurance. The study will utilize a master protocol design in that there will be primary and secondary outcomes for the entire group regardless of diagnosis, as well as the outcomes for each individual disorder group. DISCUSSION: This study will be a non-inferiority trial to test that the treatment effect of telepsychiatry is not inferior to that of FTF alone. This study will provide useful insights into the effect of the COVID-19 pandemic on the practice of psychiatry. TRIAL REGISTRATION: jRCT1030210037, Japan Registry of Clinical Trials (jRCT).

[Reliability and validity of a new assessment of the burden on caregivers (ABC-16)].

The aim of this study was to evaluate the reliability and validity of a newly developed self-administered assessment of the burden on caregivers (ABC-16) in 82 caregivers (21 men: 61 women, mean age 61 +/- 13 years) including 51 family members caring for patients after stroke with physical impairments, and 31 family members caring for patents with chronic schizophrenia. The ABC-16 consists of 16 items and is designed to cover 4 domains (burden of troubles with care receivers, burden of loss of social life, financial burden, burden of impairment of caregiver's health). The internal consistency was high (alpha=0.854) and significant correlations among the four dimensions were found (P < 0.0001). Factorial analysis showed 5 latent factors and a multiple regression analysis showed the strong correlations between the ABC-16 and care giving during the night (P = 0.0045), which strongly suggested excellent validation. The mean and standard deviation of the total score of the ABC-16 was 14.66 +/- 7.87 (burden of troubles with care receivers; 4.10 +/- 2.36, burden of loss of social life; 4.21 +/- 2.54, financial burden; 2.93 +/- 2.65, burden of impairment of caregiver's health; 3.43 +/- 2.32). The results indicated that the ABC-16 was a tool assess care burden with high reliability and validity, and was carried out easily and quickly by all participants without complex explains.