[Pathways from initial symptoms to psychiatric treatment in patients with schizophrenia].

Early intervention is essential for improving the long-term prognosis of schizophrenic patients. With the objective of contributing to early treatment in communities in the future, we retrospectively investigated patient data, including the pathway to psychiatric care, the course prior to consultation, and initial symptoms. An interview survey was conducted involving a total of 125 patients receiving treatment for a diagnosis of schizophrenia and 74 family members using two questionnaire sheets to collect data on the pathway to psychiatric care, age at onset, time between onset and the initiation of treatment, initial symptoms, and the necessary information. For the pathway to psychiatric care, facilities were classified into : psychiatric clinic, psychiatric hospital, psychiatric department of a general hospital, and general practices, and tendencies were investigated. As for the initial symptoms, differences between those recognized by the patients themselves and their families were investigated. The results showed that approximately 80% of patients had first visited medical facilities, while the remaining patients had consulted psychologists, school nurses, teachers, or public health centers. The mean time from onset to initial psychiatric consultation was 24.7 ± 3.3 months, with a median period of 6.0 months. This duration was particularly long among patients who first visited general practitioners. As the initial symptoms, 70% of patients had psychiatric symptoms as subjective symptoms, and more than 70% of family members equally noticed psychiatric symptoms. On the other hand, 40% of patients had positive symptoms, but only 20% of family members had noticed the positive symptoms. A total of 30% of patients had been aware of somatic symptoms, and these patients were significantly more likely to initially visit physicians in a department other than the psychiatric department. As for delay in consultation, patients who had onsets at an early age tended to take longer to make the initial visit. The above findings confirmed the necessity of disease education at schools, given that onset can occur in school-age children, as well as the establishment of a mental health network, understanding of psychiatric diseases among primary care physicians and their cooperation with psychiatrists, and increased public awareness regarding psychiatric diseases.

A randomized cross-over study of a traditional Japanese medicine (kampo), yokukansan, in the treatment of the behavioural and psychological symptoms of dementia.

The effectiveness and safety of yokukansan (TJ-54), a traditional Japanese medicine (kampo) for the treatment of the behavioural and psychological symptoms of dementia (BPSD), were evaluated in 106 patients diagnosed as having Alzheimer's disease (AD) (including mixed-type dementia) or dementia with Lewy bodies. Patients were randomly assigned to group A (TJ-54 treatment in period I and no treatment in period II; each period lasting 4 wk) or group B (no treatment in period I and TJ-54 treatment in period II). BPSD and cognitive functions were evaluated using the Neuropsychiatric Inventory (NPI) and the Mini-Mental State Examination (MMSE), respectively. Activities of daily living (ADL) were evaluated using Instrumental Activities of Daily Living (IADL) in outpatients and the Barthel Index in in-patients. For the safety evaluation, adverse events were investigated. Significant improvements in mean total NPI score associated with TJ-54 treatment were observed in both periods (Wilcoxon test, p=0.040 in period I and p=0.048 in period II). The mean NPI scores significantly improved during TJ-54 treatment in groups A and B (p=0.002 and p=0.007, respectively) but not during periods of no treatment. Among the NPI subscales, significant improvements were observed in delusions, hallucinations, agitation/aggression, depression, anxiety, and irritability/lability. The effects of TJ-54 persisted for 1 month without any psychological withdrawal symptoms in group A. TJ-54 did not show any effect on either cognitive function or ADL. No serious adverse reactions were observed. The present study suggests that TJ-54 is an effective and well-tolerated treatment for patients with BPSD.