Primary obsessive slowness in a young woman who benefited from continuous psychoeducation and modeling with video recordings during hospitalization: a case report.

BACKGROUND: Obsessive slowness, a symptom of obsessive-compulsive disorder (OCD), is characterized by compulsive behavior and significant slowness of movement. Primary obsessive slowness (POS) is defined as a condition in which a series of actions are segmented, and the patient spends an unlimited amount of time performing each action while checking each action, resulting in cessation or slowness of movement. It is often difficult to treat POS with exposure and response prevention, which is considered effective in general OCD, and no treatment has been established. Here, we discuss the effectiveness of psychoeducation and modeling using video recordings in the treatment of POS. CASE PRESENTATION: We report a case of POS in a 19-year-old woman. Each action was subdivided and ordered, and the patient could not proceed to the next action without confirming that the previous step had been performed. Therefore, she could not live her daily life independently; for instance, toileting and bathing required more than 1 h, even with assistance. After more than 5 months of long-term treatment, including pharmacotherapy, psychoeducation, and modeling with video recordings, she recovered to live her daily life independently. CONCLUSION: Psychoeducation and behavioral therapy can effectively treat POS. Particularly, modeling with video recordings would be an easy-to-use option for POS treatment.

Feasibility, acceptability, and preliminary efficacy of cognitive processing therapy in Japanese patients with posttraumatic stress disorder.

Cognitive processing therapy (CPT) is one of the most widely tested evidence-based treatments for posttraumatic stress disorder (PTSD). However, most studies on CPT have been conducted in Western cultural settings. This open-label, single-arm trial investigated the feasibility, acceptability, and preliminary efficacy of CPT for treating Japanese patients with PTSD. A total of 25 outpatients underwent 12 CPT sessions. The primary outcome was the assessment of PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV); secondary outcomes included the assessment of subjective PTSD severity, depressive and anxiety symptoms, trauma-related cognitions, and subjective quality of life. All outcomes were evaluated at pretreatment (i.e., baseline), posttreatment, and 6- and 12-month follow-ups. On average, participants attended 13 sessions of CPT (SD = 1.38), with a completion rate of 96.0%. One serious adverse event (hospitalization) occurred. Significant within-subjects standardized mean differences in CAPS-IV scores were found from baseline to treatment completion, g = -2.28, 95% CI [-3.00, -1.56]; 6-month follow-up, g = -2.95, 95% CI [-3.79, -2.12]; and 12-month follow-up, g = -2.15, 95% CI [-2.89, -1.41]. Moderate-to-large effects, gs = -0.77 to -2.45, were found on secondary outcomes. These findings support the feasibility, acceptability, and preliminary efficacy of CPT in a Japanese clinical setting.

Cognitive Behavioral Therapy Reduces Benzodiazepine Anxiolytics Use in Japanese Patients with Mood and Anxiety Disorders: A Retrospective Observational Study.

PURPOSE: Benzodiazepines (BZDs) are prescribed to treat psychiatric diseases. However, many guidelines recommend limiting the use of BZDs because of side effects and lack of evidence regarding long-term efficacy. Moreover, reducing BZDs' use is difficult because of dependency and the severity of withdrawal symptoms. The efficacy of cognitive behavioral therapy (CBT) for mood and anxiety disorders has been demonstrated. However, there is scant evidence that CBT has effectively reduced BZDs use, especially in Japan, where the BZDs prescription rate is high. Therefore, we sought to examine the impact of CBT on reducing BZDs use in a Japanese psychiatric setting. PATIENTS AND METHODS: Participants were outpatients with mood and anxiety disorders who were prescribed BZD anxiolytics. We retrospectively reviewed changes in BZD anxiolytics prescription dosages during CBT (66 patients; mean number of CBT sessions, 14.6) from our hospital record between April 2015 and September 2017. We checked prescriptions at four time points: at first interview for judging adaptation of CBT (baseline), at the first CBT session, at the last CBT session, and 3 months after the last CBT session. RESULTS: A total of 13 of 66 patients discontinued BZD anxiolytics during CBT, and 21 of 66 reduced their prescribed dosage by 50%. The association between discontinuation and dose-reduction and assessment period was modeled simultaneously using Bayesian hierarchical hurdle model. Results from the modeling showed a significant discontinuation at post-CBT and at 3 months post-CBT session compared to baseline (estimated median odds ratio [OR] post-CBT = 9.79 [95% CI: 4.65-20.45]; OR at 3 months post-CBT = 11.53 [95% CI: 6.06-22.33]). Moreover, a significant dose reduction was observed post-intervention (estimated median relative risk = 0.845 [95% CI: 0.729-0.982]), with a median reduction of 1.7 mg (diazepam conversion) in BZD use. CONCLUSION: Our results suggest that CBT possibly aids in reducing and discontinuing BZD anxiolytics use for Japanese patients.

[Efficacy of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP): for patients with drug use disorder: A study on factors influencing 1-year follow-up outcomes].

PURPOSE: The purpose of this study was to evaluate the efficacy of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP), which is the workbook-based group therapy for individuals with drug dependence, through investigating 1-year follow-up outcomes. METHOD AND SUBJECTS: The sample was drawn from 231 outpatients diagnosed as DSM-IV substance use disorder, who had firstly consulted the drug dependence clinic of the Center Hospital, National Center of Neurology and Psychiatry between September 2009 and June 2013. Of the 231 potential subjects, 79 had participated in SMARPP at least once, and finally 37 who had continued contact this clinic for more than 1 year after due-day of finishing the first SMARPP course were determined as the subjects. We collected the outcome information retrospectively based on clinical records. RESULT: At the 1-year follow-up point, 67.6% of the subjects had continued abstinent at least for a month, and 60% of them had continued full-abstinent for more than 1 year. One of the factors which influenced their abstinence was "having no experience of using new psychoactive substances" (p = 0.029). As for 70.3% of subjects, drug-use frequency decreased and the only factor for their improvement was "participating in SMARPP many times" (p = 0.040). Of the subjects, 23 patients corresponded to methamphetamine use disorder, and 65.2% of them had continued abstinent at least for a month at the 1-year follow-up point. Additionally, 60% of them had continued full-abstinent for more than 1 year. DISCUSSION AND CONCLUSION: Our study demonstrated possible effectiveness of SMARPP for patients with drug use disorder, especially methamphetamine-use-disorder. The factors of abstinence or decrease of drug-use frequency may be to participate in SMARPP many times, not to abuse "not illegal" drugs such as new psychoactive substances or hypnotics/anxiolytics and to continue treatment for more than 1 year after due-day of finishing the program.

Evaluation of a relapse-prevention program for methamphetamine-dependent inmates using a self-teaching workbook and group therapy.

AIM: The aim of this study was to evaluate the effect of a relapse-prevention program for methamphetamine (MAP)-dependent inmates in a prison. METHODS: Participants were 251 male inmates with MAP-abuse problems. We compared scores on the Self-efficacy Scale for Drug Dependence (SSDD) and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) before and after intervention with a self-teaching workbook and group therapy. RESULTS: For all participants, only SSDD scores increased during the pre-intervention period. SOCRATES-8D scores increased after the start of the intervention using the self-teaching workbook, and both SSDD and SOCRATES-8D scores increased when group therapy was implemented. Changes in scores in participants with moderate and high MAP dependence were considerably different from the scores of those with low dependence during the pre-intervention and the self-teaching workbook periods. CONCLUSION: Intervention using a self-teaching workbook and group therapy in prisons might be effective for inmates with more than moderate severity of MAP abuse.

[Response to treatment of patients abusing the "dappou drug" who participated in a group relapse prevention program: a comparison with patients abusing methamphetamine].

In this study, we compared the efficacy of a group relapse prevention program using the cognitive behavioral therapy-based workbook, Serigaya Methamphetamine Relapse Prevention Program (SMARPP), between patients abusing the so-called "dappou drugs" (designer drug in Japan, and those abusing methamphetamine (MAP). Both groups participated in the SMARPP at the Center Hospital, National Center of Neurology and Psychiatry. Results showed that, no significant differences were found in the rates of participation in the program or self-reported frequency of drug or alcohol use between the patients abusing "dappou drugs" or MAP. However, patients using "dappou drugs" reported no significant increase in their confidence in their ability to resist the temptation to use drugs on the self- report drug abuse scales after the SMARPP intervention, while patients abusing MAP reported a significant positive difference in their ability to resist temptation. In addition, insight into substance abuse problems and motivation to participate in further treatment slightly declined in those using "dappou drugs," while there was a significant increase reported by the patients using MAP. These results suggested that the SMARPP might not be as effective for patients abusing "dappou drugs" as for those abusing MAP. The development of a relapse prevention program specifically designed for patients abusing "dappou drugs" is required.

Possible effectiveness of intervention using a self-teaching workbook in adolescent drug abusers detained in a juvenile classification home.

AIMS: The purpose of the present study was to examine whether the possible effectiveness of the juvenile version of the Serigaya Methamphetamine Relapse Prevention Program (SMARPP-Jr.) self-teaching workbook we developed for relapse prevention of drug abuse depends on the severity of the subject's drug-related problems. METHODS: Subjects were 85 adolescent drug abusers who were detained in a juvenile classification home. We compared changes between the subjects' scores on rating scales administered both before and after interventions with the self-teaching workbook, and we examined associations between the effectiveness of the intervention and the severity of the subjects' drug-related problems. RESULTS: Regardless of the severity of their drug-related problems, the subjects' rating scale scores were significantly different after the intervention, which suggests that use of the workbook increased their awareness of the problems caused by drug dependence and their motivation to obtain treatment. However, use of the workbook did not significantly change their confidence in their capacity to resist drug craving. CONCLUSION: Although the self-teaching workbook is a convenient intervention tool that can increase subject awareness and motivation for treatment, it is likely that continuous community-based support systems are required to prevent relapse.

[Evaluation of the Relapse Prevention Guidance for drug-dependent inmates: the intervention using self-teach workbook and group therapy in a "Private Finance Initiative" prison --the second report].

BACKGROUND: There has been no relapse prevention program for drug dependent inmates in Japanese prisons. Recently, "Relapse Prevention Guidance" program is provided to the adult male inmates in Harima Rehabilitation Program Center (HRPC), one of the newly founded "Private Finance Initiative" prisons. AIMS: To evaluate the effectiveness of the program by comparing the outcomes between groups of inmates with different severity level of dependence. METHODS: The program was provided to 89 subjects in HRPC. Inmates were classified into 4 groups according to the severity measured by the Drug Abuse Screening Test (DAST). After a month of waiting period, self-teaching workbook was provided to each inmate for 4 weeks. The educational program consisting of 8 weekly psychoeducational group therapies was then provided to each group of 10 inmates. The evaluation was conducted both at the beginning and at the end of the workbook and the educational program intervention by administering 2 self-reporting questionnaires; the Self-efficacy Scale for drug dependence (SES), and the 8th version of the Stages of Change Readiness and Treatment Eagerness Scale for drug dependence (SOCRATES-8D). RESULTS: Only the "mild" group showed significant increase in SES during waiting period. After the workbook intervention, "moderate" group showed significant decrease in SES, and increase in the recognition and the ambivalence subscale of the SOCRATES-8D. The same increase in the subscales of SOCRATES-8D was noted in "Severe" group. Educational program produced increase in the recognition and the taking steps subscales of SOCRATES-8D in "mild" group, increase in SES score and the taking steps subscale in "moderate", increase in SES score and total score of SOCRATES-8D in "severe" group. No significant change was noted in "very severe" group in any of the interventions. CONCLUSION: The "Relapse Prevention Guidance" is sufficiently effective, improving self-efficacy and motivation for change in drug dependent adult male inmates.

[Factor structure and validity of the Japanese version of SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) in adolescent delinquents placed in detention home].

OBJECTIVE: Assessment of the degree of motivation for change in drug abusers is important in determining the optimal treatment modality for each patient. The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is a 19 item instrument designed by Miller and Tonigan to provide quantitative assessment of the motivation for change in substance abusers. The object of the present study is to examine the factor structure and validity of the Japanese version of SOCRATES-8D (version 8 for drug abusers). METHODS: One hundred and five adolescent delinquents (81 male and 24 female) in a detention home were included in the study. The most frequently abused drug was cannabis in 43 percent of the delinquents, followed by methamphetamine in 20 percent and organic solvent in 18 percent. Exploratory factor analysis and validity analysis was performed to determine the factor structure and criterion-related validity. RESULTS: The two factor structure of the 13 item Japanese version was confirmed, namely 6 item "Ambivalence" and 7 item "Taking steps". Internal consistency was acceptable with the value of a over 0.85. Criterion-related validity was confirmed with significant negative correlation between the Self-Efficacy Scale (Morita et al.) and "Ambivalence" factor, and significant positive correlation with "Taking steps" factor. Also, there was significant positive correlation between the Japanese version of the Drug Abuse Screening Test (Skinner) and "Ambivalence" factor. The external validity of "Recognition" factor was not confirmed. Presumably the factor related to the recognition of oneself as an addict was absorbed in "Ambivalence" factor, due to the relatively less severe degree of drug dependence that is characteristic of the juvenile delinquents in detention homes. CONCLUSION: The 13 item Japanese version of the SOCRATES-8D is valid and applicable to the substance abusing juvenile delinquents in detention homes. Further research with the inclusion of adult samples from addiction clinics is necessary to confirm the generalizability of the version.

[Efficacy of the treatment program for substance use disorder under the Medical Treatment and Supervision Act in Japan].

In Japan, the Medical Treatment and Supervision Act (MTSA) has been in effect since 2005 as a new system for treating mentally disordered offenders. This system was anticipated to aim at treating schizophrenia, while preparing no treatment programs for Substance use disorder (SUD). However, unexpectedly 30% of the inpatients, who a court judged to be treated in this system, have co-occurring SUD in addition to mental disorders. This is the reason why we have provided the inpatients under the MTSA with the treatment program for SUD (TPSUD). The purpose of the present study is to evaluate efficacies of the TPSUD provided in the MTS Award of the Center Hospital, National Center of Neurology and Psychiatry. Subjects were the 15 inpatients admitting to this ward, who participated in had the TPSUD due to co-occurrence of SUD. A self-reporting questionnaire, which consisted of the Self-Efficacy Scale for Drug Dependence (SESDD), and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), and some clinical information, was administered before and after the program. Consequently, the subscale score of the SOCRATES, "recognition," was significantly elevated after the TPSUD in alcohol related problems, while the subscale score of the SESDD, "global change of self-efficacy for drug dependence," was significantly elevated in drug-related problems. Additionally, either rate of the subjects who started to the anti-alcohol drugs or who manifested to participate in self-help groups for SUD was also significantly elevated. Our findings suggest that the TPSUD may be effective to SUD which co-occur in mentally disordered offenders, and that this program may involve some clinical implication in forensic psychiatry practices under the MTSA.

[Development and evaluation of a relapse prevention tool for drug-abusing delinquents incarcerated in a juvenile classification home: a self-teaching workbook for adolescents, the "SMARPP-Jr].

AIMS: The purpose of the present study is to develop a relapse prevention tool for drug-abusing delinquents incarcerated in a juvenile classification home, and to evaluate effectiveness of the tool. METHODS: We prepared a self-teaching workbook for drug-abusing adolescents named "SMARPP-Jr." referring to the workbook used in the "SMARPP (Serigaya Methamphetamine Relapse Prevention Program)", and consulted about the contents of the workbook to the director, the medical doctor, and the psychologists of a juvenile classification home. After establishing the final version, we provided 59 drug-abusing delinquents incarcerated in the juvenile classification home with a relapse prevention program by this workbook, and conducted pre- and post-evaluations by the Self-efficacy Scale for Drug Dependence and the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). RESULTS: The scores of SOCRATES were remarkably elevated after finishing the self-teaching workbook, while those of the Self-efficacy Scale for Drug Dependence were hardly changed. Additionally, over 60% of the participants reported that the contents of the workbook were not difficult to be understood, and approximately 90% of them also answered that this workbook was useful. CONCLUSION: The findings of the present study suggest that intervention in drug-abusing delinquents incarcerated in a juvenile classification home using the self-teaching workbook "SMARPP-Jr." may be effective to obtain insights of their drug-abuse problems and to become aware of necessity of treatment for their drug abuse.

Comparative study of the prevalence of suicidal behavior and sexual abuse history in delinquent and non-delinquent adolescents.

The present study examined the prevalence of suicidal behavior and sexual abuse history in delinquent and non-delinquent adolescents aged 15-17 years. Results showed that delinquent adolescents, particularly girls, more frequently reported histories of suicidal behavior and sexual abuse than non-delinquent adolescents.

Analgesia during self-cutting: clinical implications and the association with suicidal ideation.

The present study examined the association of suicidal ideation in self-cutters with clinical features of self-cutting, using a sample of subjects from juvenile correctional institutions. Multivariate analysis revealed that male self-cutters and analgesia during self-cutting were significantly associated with a history of suicidal ideation. These results suggest that male analgesic self-cutters should be regarded as a high-risk subgroup for suicide.

Prevalences of lifetime histories of self-cutting and suicidal ideation in Japanese adolescents: differences by age.

We examined differences in the prevalence of a lifetime history of self-cutting and suicidal ideation by age among junior and senior high-school students. Histories of self-cutting and suicidal ideation were reported by 9.9% and 40.4% of the students. Among early teens, females were more likely to report suicidal ideation than males, and among late teens, females were more likely than males to report self-cutting.

Self-injury in Japanese junior and senior high-school students: Prevalence and association with substance use.

The present study examined the prevalence of self-injury and its association with substance abuse in 2974 junior and senior high-school students, by self-reporting questionnaires. Consequently, 9.9% of students (boys, 7.5%; girls, 12.1%) reported an experience of self-injury at least once. Significant differences were found in substance use-related problems including alcohol abuse, smoking, and illicit drug use (P < 0.001) between students with and without an experience of self-injury. The results also suggest that self-injuring students may more easily gain access to illicit drugs even if they had not yet experienced the use of illicit drugs. Self-injury in adolescence may be associated with substance use and is considered to be a risk factor predicting future illicit drug use.

Association between childhood attention-deficit-hyperactivity symptoms and adulthood dissociation in male inmates: preliminary report.

The present study examined associations between childhood attention-deficit-hyperactivity disorder (ADHD) symptoms and adulthood dissociation in 799 male inmates using self-reporting questionnaires. Consequently, 33% of the subjects reported childhood physical abuse, and 11.8% reported childhood sexual abuse. A significant association was found between childhood ADHD symptoms and current dissociative tendency (r = 0.51, P < 0.001). Clinical implications of intervention focusing on dissociation in correctional/forensic practices for adult offenders are discussed.