Risk factors for early-phase clozapine discontinuation: A nested case-control study.

OBJECTIVES: Safe and efficient methods for introducing clozapine to patients with treatment-resistant schizophrenia (TRS) are needed. We investigated risk factors for clozapine discontinuation in the early phase of its introduction. METHODS: We conducted a nested case-control study at 14 psychiatric hospitals in Chiba, Japan. Data from pre-registered TRS patients were collected at 7 time points within 12 weeks before and after the start of clozapine introduction. We examined the demographic data, prior and concomitant psychotropic drugs, strategies for switching from prior antipsychotics, and blood test and Global Assessment of Function results. The Clinical Global Impression-Severity Scale was retrospectively scored at 12 weeks before and after clozapine introduction. RESULTS: Of 228 patients, clozapine treatment was continued in 213 (93.4 %) and discontinued in 15 (6.6 %) patients within 12 weeks. Clinical symptoms were improved to mild symptoms with a response rate of 14.9 %. Prior antipsychotics and concomitant psychotropic drugs except for mood stabilizers were significantly decreased. Histories of smoking (OR = 3.32, 95 %CI: 1.11-9.93) and antipsychotic treatment at chlorpromazine-equivalent doses <1200 mg within the past 5 years (OR = 3.93, 95 %CI: 1.24-12.50), but not antipsychotic switching strategy, were associated with clozapine discontinuation. Eosinophilia was the most frequent reason for discontinuation (n = 3, 20 %) and was associated with concomitant valproate at 4 weeks after the introduction. CONCLUSION: Clozapine is an effective option for TRS patients (especially those treated with higher doses of prior antipsychotics) in Japan. Clinicians should be cautious about concomitant valproate in the early phase of clozapine introduction due to a high risk of eosinophilia.

Risk Factors of a Suicide Reattempt by Seasonality and the Method of a Previous Suicide Attempt: A Cohort Study in a Japanese Primary Care Hospital.

Suicide has a great impact on the individual whose life is lost and the bereaved family members. The risk of a suicide reattempt is particularly high during the first 12 months after a suicide attempt. In this cohort study, risk factors for a suicide reattempt were explored among 291 patients at suicide risk. Clinical and demographic data were collected from a Japanese primary care hospital. Past psychiatric history and multiple diagnoses were associated with suicide reattempts in both genders. Drug overdose, past psychiatric history, and the summer season were linked to suicide reattempts among males. Past psychiatric history and multiple diagnoses were linked to suicide reattempts among females. Appropriate assessment of past psychiatric history, season and method of suicide attempt, gender, and diagnosis may play a role in preventing suicide.

[Enrichment of the functions of the psychiatric department in a general hospital and collaboration within the area].

Psychiatric disease has been included in the five main diseases, and a medical care plan is required. In it, there are many problems, for example, physical complications and which general hospital should chiefly deal with it. Here, we present a way to cope with these problems on the basis of achievements in the psychiatric department of Kameda General Hospital. Specifically, we would like to assert that creating a consultation-liaison team and enriching the section of clinical psychiatry are very important and effective. The activities of the consultation-liaison team, created to address various issues after establishing a psychiatric ward, have led to the possibility of a psychiatric department in a general hospital. Experience to date indicates that, in the context of a general hospital with a psychiatric inpatient unit, the existence of a multidisciplinary liaison team working across departmental boundaries is crucial to determining and managing the treatment of patients with psychiatric emergencies, as well as patients with psychiatric issues and physical complications. Additionally, in order to increase the effectiveness of the hospital liaison team, it is critical to realize seamless, prompt collaboration with facilities outside the hospital. In this respect, the role of a patient care coordinator is expected to become increasingly important. Additionally, enriching and guarding activities of clinical psychologists have contributed to the growth of psychiatric departments in general hospitals and proved to be effective in combination with activities of the consultation-liaison team.

Impact of the great East Japan earthquake on caregiver burden: a cross-sectional study.

OBJECTIVE: After the great East Japan earthquake of 2011, residents with intellectual disabilities and their caregivers in Fukushima were evacuated to the prefecture of Chiba. We investigated the impact of the earthquake on the caregivers' burden. METHODS: Between August 2011 and January 2012, 46 caregivers evacuated from Fukushima and 46 caregivers at similar facilities in Chiba who were not forced to evacuate completed a survey including the 12-item General Health Questionnaire (GHQ-12) and additional questions. A logistic regression analysis and median tests were performed. RESULTS: The evacuation was linked to GHQ-12 global scores ≥3, indicating psychiatric morbidity (relative risk [RR]=2.81), as well as to scores ≥8, indicating a more severe condition (RR=3.57). There was a trend for evacuated caregivers to have more social dysfunction than psychological distress. CONCLUSIONS: A statistically significant difference in emotional stress was observed among caregivers who were forced to evacuate after the earthquake.

Delayed recovery of caregivers from social dysfunction and psychological distress after the Great East Japan Earthquake.

BACKGROUND: In April 2011, two hundred and eighty residents who were suffering from intellectual disabilities and their eighty caregivers at nine facilities in Fukushima were evacuated and moved to Chiba, Japan after the Great East Japan Earthquake. We investigated the impact of the evacuation after the earthquake on the caregiver burden. METHOD: There were 41 participants from Chiba as a reference group and 32 participants from Fukushima as a case group included. Data were collected regarding their demographics and the General Health Questionnaires 12 (GHQ-12) score for both groups in two different points. RESULTS: The evacuation was linked to a follow-up GHQ-12 global score ≥ 3 (RR=4.52, 95%CI; 1.32-15.47). There was no significant improvement of the GHQ-12 global score in the case group from Fukushima for the follow-up data compared to the baseline data. Social dysfunction had continued in the case group from the baseline data (p<0.01) during the follow-up period (p<0.001). A statistically significant difference was noted for the case group from Fukushima regarding psychological distress in the follow-up data (p<0.01), which was not found in the baseline data (p=0.07). LIMITATIONS: The sample size was limited to a non-randomized and unmasked sample of 73 patients. No causal relationship could be determined due to the cross-sectional nature of the study. CONCLUSIONS: The caregivers from Fukushima exhibited more psychiatric morbidity, which persisted for the duration of their evacuation after the earthquake. It is important to provide long-term support for such caregivers who have been evacuated after a major disaster.

[Mental health support at general hospital--from a counselor's point of view].

At Kameda Medical Center, clinical psychologists and personnel department have been managing "Self-care Support Center" to assist employee's mental health care since 2008. From our activities up to now, we found some characteristic aspects have affected to our mental health care activities. We recommend the followings to make this activity effective; 1. To find and use resources at workplace. 2. To keep trying to get the support from the managers of each department. 3. To cooperate with each department with help from personnel department. 4. To create the procedure to help and support the employees who have mental problems.

Symptomatological structure of volatile solvent-induced psychosis: is "solvent psychosis" a discernible syndrome?

Solvent-induced psychosis has been clinically identified among patients suffering from dependence on volatile solvents and those in psychotic state due to chronic solvent use. To clarify the symptomatological difference between solvent-induced psychosis and schizophrenia, the principal component analysis with VARIMAX rotation was applied to the point and duration estimates of symptoms observed among the solvent group and among the schizophrenic group. There were no significant group differences in age and family history of any psychosis. The study findings are as follows: (1) It is difficult to distinguish two groups based on the prevalence rates of symptoms alone. (2) However, the principal component VARIMAX rotation analysis of the prevalence and duration observing among the solvent group revealed seven factors consisting of "amotivation", "intoxication", "emotional instability", "delusion", "hallucination", "disinhibition" and "memory". The seven factors explained 75.4% of the variance of the symptoms in this group. (3) The same analysis applied to the data from the schizophrenic group showed six factors consisting of "thought progression", "emotional instability", "amotivation (or negative symptoms)", "delusion", "hallucination" and "anxiety". These factors explained 62.9% of the variance in the data of the schizophrenic group. These results support clinical observations the "amotivational syndrome" may be a characteristic feature of patients suffering from solvent-induced psychosis. The results also suggest "solvent psychosis" is a discernible syndrome, and is distinctive from psychotic symptoms of typical schizophrenia.