Post-Disaster Community Transition of Psychiatric Inpatients: Lessons from the Fukushima Nuclear Accident.

This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20-29), and those with physical diagnoses of the circulatory (I00-95) and digestive (K00-93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential.

Knowledge Engineering Framework for IoT Robotics Applied to Smart Healthcare and Emotional Well-Being.

Social companion robots are getting more attention to assist elderly people to stay independent at home and to decrease their social isolation. When developing solutions, one remaining challenge is to design the right applications that are usable by elderly people. For this purpose, co-creation methodologies involving multiple stakeholders and a multidisciplinary researcher team (e.g., elderly people, medical professionals, and computer scientists such as roboticists or IoT engineers) are designed within the ACCRA (Agile Co-Creation of Robots for Ageing) project. This paper will address this research question: How can Internet of Robotic Things (IoRT) technology and co-creation methodologies help to design emotional-based robotic applications? This is supported by the ACCRA project that develops advanced social robots to support active and healthy ageing, co-created by various stakeholders such as ageing people and physicians. We demonstra this with three robots, Buddy, ASTRO, and RoboHon, used for daily life, mobility, and conversation. The three robots understand and convey emotions in real-time using the Internet of Things and Artificial Intelligence technologies (e.g., knowledge-based reasoning).

Effect of the Temporal Window of Integration of Speech Sound on Mismatch Negativity.

Speech-sound stimuli have a complex structure, and it is unclear how the brain processes them. An event-related potential (ERP), known as mismatch negativity (MMN), is elicited when an individual's brain detects a rare sound. In this study, MMNs were measured in response to an omitted segment of a complex sound consisting of a Japanese vowel. The results indicated that the latency from onset in the right hemisphere was significantly shorter than that in the frontal midline and left hemispheres during left ear stimulation. Additionally, the results of latency from omission showed that the latency of stimuli omitted in the latter part of the temporal window of integration (TWI) was longer than that of stimuli omitted in the first part of the TWI. The mean peak amplitude was found to be higher in the right hemisphere than in the frontal midline and left hemispheres in response to left ear stimulation. In conclusion, the results of this study suggest that would be incorrect to believe that the stimuli have strictly the characteristics of speech-sound. However. the results of the interaction effect in the latencies from omission were insignificant. These results suggest that the detection time for deviance may not be related to the stimulus ear. However, the type of deviant stimuli on latencies was found to be significant. This is because the detection of the deviants was delayed when a deviation occurred in the latter part of the TWI, regardless of the stimulation of the ear.

Post-evacuation return of psychiatric hospital inpatients evacuated to hospitals outside the Fukushima prefecture after the nuclear accident: A Retrospective Cohort Study.

BACKGROUND: Post-evacuation return after mandatory hospital evacuation due to complicated disasters is often overlooked and not well-discussed. AIMS: In this study, we explored the factors which are related to the ease or difficulty of the post-evacuation return to Fukushima prefecture of psychiatric inpatients who had been evacuated to hospitals outside the prefecture because of the Great East Japan Earthquake (GEJE) and subsequent Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. METHOD: This retrospective cohort study included evacuated psychiatric hospital inpatients who were registered in the Matching Project for Community Transition (MPCT) and had been traced until July 31, 2019. A total of 531 patients were included for the analyses. Univariable and multivariable analysis were conducted to detect the patients' traits including their psychiatric/physical backgrounds which were associated with their outcome - the time from GEJE to the date of return to Fukushima. RESULTS: Over half of the patients returned to Fukushima. In the multivariable analysis, the patients' gender (male), age (older), and psychiatric diagnoses of schizophrenia, schizotypal and delusional disorders (ICD-10, F20-29) showed lower hazard ratio (HR) and statistically significant association with the difficulties of post-evacuation return. Meanwhile, disorders of psychological development (F80-89), diseases of the nervous (G00-99, except G40-41) and genitourinary (N00-99) systems showed higher HR and statistically significant association with the ease of return. CONCLUSIONS: The specific characteristics of the psychiatric inpatients including their psychiatric and physical status are associated with their post-evacuation return to their hometown. These results indicated that the evacuated hospitals' practitioners and staffs from the MPCT understood the necessity of the earlier return of inpatients to their hometown. Moreover, clinicians should pay more attention to some symptoms unique to psychiatric patients which contributed to their difficulties in returning safely or expressing their hope to return.

Long-term observation of mortality among inpatients evacuated from psychiatric hospitals in Fukushima prefecture following the Fukushima nuclear disaster.

The debate regarding the need for hospital evacuation and the evacuation distance remains rather chaotic. Furthermore, the relationship between hospital evacuation and the prognoses of psychiatric inpatients has not yet been investigated. We aimed to reveal the association between the long-term prognosis of psychiatric inpatients evacuated immediately following the Fukushima Daiichi Nuclear Power Plant accident and their backgrounds. In this retrospective cohort study, 777 psychiatric inpatients who were immediately evacuated from their hospitals following the accident were included for analysis. Survival time was the primary outcome. We conducted univariable and multivariable analyses to examine the associations between mortality and linear distance of evacuation and different backgrounds, including psychiatric/physical traits. Univariable analysis showed that the estimated survival time among patients was significantly associated with their evacuation distance. A multivariable analysis showed that a longer evacuation distance had a significantly lower hazard ratio (HR) and resulted in lower mortality. In contrast, older patients with physical complications of respiratory disease (International Statistical Classification of Diseases and Related Health Problems 10th revision, J00-99) and genitourinary disease (N00-99) showed a significantly higher HR and had a higher mortality than patients without these complications. To prevent death among elderly psychiatric inpatients with physical comorbidities during disasters, the evacuation destination should be determined taking into consideration the evacuees' tolerance for long-distance transportation and the availability of post-evacuation care in the destination hospitals.

Effects of benzodiazepine and orexin receptor antagonist on cognitive function revealed by auditory event-related potentials.

BACKGROUND: Cognitive decline after oral administration of sedatives, such as benzodiazepines, is a serious side effect. Suvorexant, an orexin receptor antagonist, has a favorable tolerability and a limited side-effect profile. AIM: The purpose of this study was to estimate the cognitive decline 1 day after oral medication with lormetazepam, a benzodiazepine, and suvorexant by comparing mismatch negativity (MMN) and P300 reflecting auditory discrimination function. METHODS: Sixty healthy subjects (42 males) were randomly assigned to three groups receiving suvorexant 20 mg, lormetazepam 2 mg, or placebo in this double-blind, randomized control study. Event-related potential recordings during an auditory oddball task and a digit symbol substitution test (DSST) were performed 1 day after oral administration. RESULTS: MMN, on the day after oral administration, was significantly attenuated in the lormetazepam group compared with the other two groups, but there was no difference between the suvorexant and placebo groups. No significant difference was found in P300 amplitudes and DSST scores among the three groups. CONCLUSION: These findings suggest that suvorexant, unlike benzodiazepine, is not associated with cognitive deficits, as revealed by MMN but not P300. This study shows a neurophysiological difference in the effects of suvorexant and benzodiazepine on cognitive function.

Effects of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant accident on behavioural and psychological symptoms of dementia among patients.

BACKGROUND: The Great East Japan Earthquake triggered accidents at the Fukushima Daiichi Nuclear Power Plant, becoming the first complex disaster that included both a natural and a nuclear power disaster. This study examines how complex disasters affect patients with dementia. METHODS: Participants included the 331 people diagnosed with dementia out of the 2482 new patients (between January 2008 and December 2015) at a psychiatric hospital located in the indoor sheltering zones nearby mandatory evacuation zones. Medical records were retrospectively examined to identify the number of new patients with dementia, the severity, their chief complaints, and the behavioural and psychological symptoms of dementia (BPSD) types. BPSD were classified into the hyperactive BPSD group and the hypoactive BPSD group. The hyperactive BPSD group was further subdivided into the hyperactivity-impulsivity-irritability-disinhibition-aggression-agitation group, which exhibited agitation, disinhibition, and irritability, and the psychosis group, which exhibited delusions and hallucinations. The hypoactive BPSD group included depression, inactivity, apathy, and anxiety. Results were divided into the period before the complex disaster (2008-2010) and after (2012-2015) and were compared. In addition, the post-complex-disaster period was subdivided into the early phase (2012-2013) and the late phase (2014-2015). RESULTS: The proportion of new patients with dementia increased significantly after the disaster. Although there was no change in patients' age and the disease's severity, the proportion of patients whose chief complaint was BPSD increased significantly after the disaster. Furthermore, there was a significant increase in the hyperactivity-impulsivity-irritability-disinhibition-aggression-agitation group in the early post-complex-disaster phase and a significant increase in the psychosis group in the late post-complex-disaster phase. CONCLUSION: This complex disaster caused increased consultations from patients with dementia and increased BPSD. Additionally, it increased participants' symptoms of agitation and irritability in the early post-complex-disaster phase and the proportion of hallucinations and delusions in the late post-complex-disaster phase.

Effect of oxytocin nasal spray on auditory automatic discrimination measured by mismatch negativity.

RATIONALE: As a treatment for cognitive dysfunction in schizophrenia, oxytocin nasal sprays potentially improve social cognition, facial expression recognition, and sense of smell. Mismatch negativity (MMN) is an event-related potential (ERP) reflecting auditory discrimination while MMN deficits reflect cognitive function decline in schizophrenia. OBJECTIVES: To determine whether oxytocin nasal spray affects auditory MMN METHODS: We measured ERPs in healthy subjects during an auditory oddball task, both before and after oxytocin nasal spray administration. Forty healthy subjects were randomly assigned to either the oxytocin or placebo group. ERPs were recorded during the oddball task for all subjects before and after a 24 international unit (IU) intranasal administration, and MMN was compared between the two groups. RESULTS: Participants who received oxytocin had significantly shorter MMN latencies than those who received a placebo. Oxytocin had no significant effect on the Change in MMN amplitude. CONCLUSIONS: The shortened MMN latencies that were observed after oxytocin nasal spray administration suggest that oxytocin may promote the comparison-decision stage.

Omission mismatch negativity of speech sounds reveals a functionally impaired temporal window of integration in schizophrenia.

OBJECTIVE: We hypothesized that sensory memory associated with the temporal window of integration (TWI) would be impaired in patients with schizophrenia, an issue that had not been evaluated using omission mismatch negativity (MMN) of complex speech sounds. We aimed to assess the functional changes in auditory sensory memory associated with the TWI in patients with schizophrenia by investigating the effect of omission of complex speech stimuli on the MMN. METHODS: In total, 17 patients with schizophrenia and 15 control individuals participated in the study. The MMN in response to omission deviants of complex speech sounds was recorded, while the participants were instructed to ignore the series of speech sounds. RESULTS: The MMN latency in patients with schizophrenia was significantly prolonged by deviant stimuli to omissions corresponding to the early and late parts of the temporal TWI. There were no significant group differences in the amplitude of the MMN to omissions at different time points across the TWI. CONCLUSIONS: Our results suggested that sensory tracing function in patients with schizophrenia is impaired in the early and the later half of the TWI. SIGNIFICANCE: We showed that certain MMN abnormalities in patients with schizophrenia may be caused by an impaired TWI.

Characteristics of Disaster-Related Suicide in Fukushima Prefecture After the Nuclear Accident.

Background: Suicide is a major concern after the 2011 earthquake and nuclear accident in Fukushima. Aims: This study delineates characteristics of the disaster-related suicides in Fukushima. Method: Data provided by the Fukushima Prefectural Police and data published by the Fukushima or Japanese Government were analyzed. Numbers of disaster-related suicides and evacuees were compared among the three prefectures affected. Age, sex, occupation, and means for disaster-related suicides in Fukushima were compared with overall suicides in Fukushima or Japan. History of medical treatment, changes in job and family structure after the disaster, and signs of contemplation were examined within the disaster-related suicides of Fukushima. Results: While other prefectures have experienced a drop in disaster-related suicides, Fukushima has not. Age-standardized disaster-related suicide rates were remarkably higher in men than in women. Moreover, disaster-related suicide rates in Fukushima were higher in women in their 50s and 80s as compared with overall suicide rates in Fukushima or Japan. Limitations: No detailed comparisons were made between disaster-related and non-disaster-related suicides. Conclusion: Disaster-related suicide rates were higher in men than in women. Also, it was found that the disaster-related suicide rates of elderly women were higher compared with overall suicide rates in Japan and Fukushima. In addition, many who died by suicide showed signs of contemplation before the attempt and had started psychiatric treatment. Improvement of suicide risk assessment skills for mental health professionals and gatekeeper training among residents will be essential to prevent disaster-related suicides.

Estimation of frequency difference at which stream segregation precedes temporal integration as reflected by omission mismatch negativity.

Both stream segregation and temporal integration are considered important for auditory scene analysis in the brain. Several previous studies have indicated that stream segregation may precede temporal integration when both processes are required. In the present study, we utilized mismatch negativity (MMN)-which reflects automatic change detection-to systematically estimate the threshold of the frequency difference at which stream segregation occurs prior to temporal integration when these functions occur together during a state of inattention. Electroencephalography (EEG) data were recorded from 22 healthy Japanese men presented with six blocks of alternating high pure tones (high tones) and low pure tones (low tones). Only high tones were omitted with 5 % probability in all blocks. Our results indicated that stream segregation should cancel temporal integration of close sounds, as indicated by omission-MMN elicitation, when the frequency difference is 1000 Hz or larger.

Do tone duration changes that elicit the mismatch negativity also affect the preceding middle latency responses?

The human brain can automatically detect sound changes. Previous studies have reported that rare sounds presented within a sequence of repetitive sounds elicit the mismatch negativity (MMN) in the absence of attention in the latency range of 100-250 ms. On the other hand, a previous study discovered that occasional changes in sound location enhance the middle latency response (MLR) elicited in the latency range of 10-50 ms. Several studies have reported an increase in the amplitude of the MLR within the frame of oddball paradigms such as frequency and location changes. However, few studies have been conducted on paradigms employing a duration change. The purpose of the present study was to examine whether the peak amplitudes of the MLR components are enhanced by a change in duration. Twenty healthy Japanese men (age: 23.9 ± 2.9 years) participated in the present study. We used an oddball paradigm that contained standard stimuli with a duration of 10 ms and deviant stimuli with a duration of 5 ms. The peak amplitudes of the MLR for the deviant stimuli were then compared with those for the standard stimuli. No changes were observed in the peak amplitude of the MLR resulting from a duration change, whereas a definite MMN was elicited. The amplitude of the MLR was increased within the frame of oddball paradigms such as frequency and location changes. By contrast, the amplitude of the MLR was not changed within the duration change oddball paradigm that elicited the MMN.

Effects of cognitive remediation on cognitive and social functions in individuals with schizophrenia.

Individuals with schizophrenia exhibit cognitive impairments, which are related to impairments in social functions. This study investigated the effects of cognitive remediation on cognitive, social, and daily living impairment. Participants were individuals with schizophrenia between 20 and 60 years old (N = 44). Participants were randomly assigned to two groups: a cognitive remediation intervention group and a non-intervention control group. The control group was provided with conventional drug therapy and either day care or occupational therapy. The intervention group was provided with the "neuropsychological educational approach to cognitive remediation" developed by Medalia and co-workers. We assessed cognitive functions using the brief assessment of cognition in schizophrenia (BACS), and evaluated social and daily living functions using the global assessment of functioning (GAF) scale. Significant group by time interaction effects indicated that verbal memory, working memory, attention, and executive function showed significantly greater improvement at post-intervention for the intervention group than the control group. Social and daily living function also improved in the intervention group and improvements were maintained one year after intervention. These preliminary findings indicate that the combination of cognitive remediation and psychiatric rehabilitation is effective for facilitating improvements in cognitive function and social and daily living functions in individuals with schizophrenia.

The Relationship between Mismatch Negativity and the COMTVal108/158Met Genotype in Schizophrenia.

Mismatch negativity (MMN) is a component of auditory event-related potentials that reflects automatic change detection in the brain, showing qualities of endophenotypes in schizophrenia. MMN deficiency is one of the robust findings in patients, and it reflects both cognitive and functional decline. Catechol-o-methyltransferase (COMT) is a key enzyme involved in regulating dopamine transmission within the prefrontal cortex. A preliminary study suggested that the COMTVal108/158Met genotype (rs4680) is related to cognitive function in schizophrenia. Both the COMTVal108/158Met genotype and MMN are related to cognitive function, but no studies have reported on the relationship between MMN and the COMTVal108/158Met genotype in schizophrenia. This study therefore examined the relationship between COMTVal108/158Met genotype and MMN. The duration of MMN was measured, and the COMTVal108/158Met polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism in 49 Japanese schizophrenia patients (Val/Val, n = 21; Met carriers, n = 28). Amplitude and latency of MMN were compared between Val/Val and Met carriers.

Assistive robots for socialization in elderly people: results pertaining to the needs of the users.

BACKGROUND/AIM: Technological solutions can support the elderly, improve their quality of life and reduce isolation and loneliness. The Euro-Japan ACCRA (Agile Co-Creation for Robots and Aging) project has the objective of building a reference co-creation methodology for the development of robotic solutions for ageing. The aim of this study is to provide a pilot qualitative analysis of the real needs of elderly people and their caregivers when exposed to conversational activities with robots and to identify priority needs that should be developed from end-user perspectives. METHODS: A qualitative research design was adopted to define a pre-structured questionnaire that was administered to the elderly taking part in the piloting sessions. Three groups of end-users were included: subjects with an age ≥ 60 years, informal caregivers and formal caregivers. RESULTS: The interviews were carried out in Italy and Japan. A total of 17 elderly and 36 caregivers were recruited. Common needs in the two sites were categorized into 3 groups: Communication; Emotion Detection and Safety. General robot acceptance level is good and perception is positive among participants in the pilot sites. CONCLUSION: A positive perception of the elderly on the application of a robotic solution was found and many are the needs that could be addressed by an appropriate and careful robotic development taking into account the real needs and capabilities of the involved subjects.

Agile Co-Creation for Robots and Aging (ACCRA) Project: new technological solutions for older people.

INTRODUCTION: Worldwide population is getting older. The older persons want to stay independent and wish to increase their engagement in social activities to tackle loneliness, depression, and isolation. Starting from these assumptions, we developed the ACCRA project (Agile Co-Creation for Robots and Aging) with the aim to enable the development of advanced ICT Robotics-based solutions for extending active and healthy aging in daily life by defining, developing and demonstrating an agile co-creation development process. METHODS: ACCRA robotics solutions will be designed and developed to be tested in three different domains: mobility, daily life, socialization support in four countries (i.e., France, Netherlands, Italy, and Japan). The proposed approach identifies four different phases: (1) needs analysis, (2) agile co-creation, (3) experimentation, and (4) sustainability analysis. Currently, the first two phases were almost completed. For the needs phase, we have used the following recruitment criteria: (1) for mobility: age ≥ 60 years, the and presence of mobility issues assessed by Older Mobility Scale (EMS) with a score > 13; (2) for daily life: age ≥ 60 years, and the presence of difficulties engaging in housework assessed by Autonomie Gérontologie Groupes Iso-Ressources (AGGIR) with a GIR score ≥ 4; (3) for socialization support: age ≥ 60 years, and the absence or mild level of cognitive impairment assessed by Mini Mental State Examination (MMSE) with a score ≥ 24. RESULTS: The needs analysis and first co-creation sessions focus attention on the experience of older in the four countries. Preliminary results showed how, in all the pilot sites, many expectations were raised from older, formal and informal caregivers about the application of the technology into their life. Minor concerns existed about privacy, real efficacy and modularity in a real-world environment. Overall, a good attitude was recorded towards the use of technologies to support life and promote independent living. Moreover, the older engaged in our studies showed a great interest to be actively involved in the developing phase of something built based on their needs. CONCLUSIONS: The availability of new solutions to increase independence and quality of life in a sustainable manner appears to be mandatory in the actual society considering the actual socio-economic situation over the industrial countries.

DNA methylation of ANKK1 and response to aripiprazole in patients with acute schizophrenia: A preliminary study.

Epigenetic modification including DNA methylation may affect pathophysiology and the response to antipsychotic drugs in patients with schizophrenia. The objective of the present study was to investigate the effect of the DNA methylation of ANKK1 (ankyrin repeat and kinase domain containing 1) on the response to aripiprazole and plasma levels of monoamine metabolites in antipsychotic-free acute schizophrenia patients. The subjects were 34 Japanese patients with schizophrenia who had been treated with aripiprazole for 6 weeks. Comprehensive DNA methylation of ANKK1 was determined using a next-generation sequencer. DNA methylation levels at CpG site 387 of ANKK1 were higher in responders to treatment with aripiprazole and correlated with the changes in Positive and Negative Syndrome Scale scores, although the associations did not remain significant after Bonferroni correction. In responders, methylation at all CpG sites was significantly correlated with plasma levels of homovanillic acid (r = 0.587, p = 0.035) and 3-methoxy-4hydroxyphenylglycol (r = 0.684, p = 0.010) at baseline. Despite our non-significant results after multiple correction, our preliminary findings suggest that methylation levels at CpG site 387 of ANKK1 may be associated with treatment response to aripiprazole. Furthermore, methylation of ANKK1 may affect dopaminergic neural transmission in the treatment of schizophrenia, and may influence treatment response. Caution is needed in interpreting these findings because of the small sample size, and further studies are needed to confirm and expand our preliminary results.

The efficacy of antipsychotics for prolonged delirium with renal dysfunction.

AIM: Delirium is commonly encountered in daily clinical practice. To identify predictors influencing outcomes, we retrospectively examined the characteristics of inpatients with delirium who required psychiatric medication during hospitalization. METHODS: We extracted all new inpatients (n=523) consulted for psychiatric symptoms at Fukushima Medical University Hospital between October 2011 and September 2013. We selected 203 inpatients with delirium diagnosed by psychiatrists. We analyzed data from 177 inpatients with delirium who received psychiatric medication. We defined an "early improvement group" in which delirium resolved in ≤3 days after starting psychiatric medication, and a "prolonged group" with delirium lasting for >3 days. Among the 83 inpatients with renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2), we defined an "early improvement group with renal dysfunction" in which delirium resolved in ≤3 days after starting psychiatric medication and a "prolonged group with renal dysfunction" with delirium lasting for >3 days. We then examined differences between groups for different categorical variables. RESULTS: Dose of antipsychotic medication at end point was significantly lower in the prolonged group with renal dysfunction than in the early improvement group with renal dysfunction. CONCLUSION: The results suggest that maintaining a sufficient dose of antipsychotics from an early stage may prevent prolongation of delirium even in inpatients with renal dysfunction.