Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan.

BACKGROUND: Japanese forensic mental health services for patients with psychiatric disorders under the Medical Treatment and Supervision Act was initiated in 2005; however, the prognosis of those patients is not well-known, particularly regarding mortality and suicide. This study aimed to evaluate the all-cause mortality and suicide rate in forensic psychiatric outpatients who had been discharged from forensic psychiatric wards in Japan. METHODS: Participants included 966 patients who had been discharged from forensic psychiatric wards. Data were collected from July 15, 2005 to July 15, 2018 at 29 of the 33 forensic psychiatric wards in Japan. Only the patients who provided written informed consent were included. We and collaborators at each forensic psychiatric ward identified demographic data of participants from the medical records for the inpatient treatment period. The reintegration coordinators, who belonged to the Ministry of Justice, investigated the prognosis of the participants during the outpatient treatment order period. We then connected demographic data and participants' prognosis for analysis. The crude rates (CRs) and standardized mortality ratios (SMRs) were calculated to analyze all-cause mortality and suicide rates. Univariate analysis was performed to examine the factors associated with all-cause mortality and suicide rates using the Cox proportional hazards ratio model. RESULTS: The participants included 3.3 times as many men (n=739) compared to women (n=227), and their combined mean age was 47.3 (SD=12.9). The most common primary psychiatric diagnosis was psychotic disorders (81.3%). The mean follow-up period was 790.2 days (SD=369.6). The total observation period was 2091.2 person-years. The CR for all-cause death was 812.9 per 100,000 person-years (95% CI [426.5, 1199.4]), while the SMR for all-cause death was 2.2 (95% CI [1.3, 3.5]). The CR for completed suicide was 478.2 per 100,000 person-years (95% CI [181.8, 774.6]). The suicide SMR was 17.9 (95% CI [8.6, 32.9]) overall, 7.7 (95% CI [2.5, 18.0]) for men, and 79.4 (95% CI [25.8, 185.2]) for women. Univariate analysis showed that women had higher completed suicide risk than men (hazard ratio=3.599, 95% CI [1.041, 12.445]). CONCLUSION: The all-cause mortality and completed suicide rates were higher in participants than observed in the general population consistent with the results of previous international studies.

Mentally disordered offenders discharged from designated hospital facilities under the medical treatment and supervision act in Japan: Reoffending and readmission.

BACKGROUND: Current Japanese forensic mental health legislation (Medical Treatment and Supervision Act [MTSA]) was enacted in 2003. Little is known, however, about the actual outcomes for the offender patients detained within hospitals under this provision. AIM: This study aimed to quantify reoffending and readmission following patients' discharge from forensic psychiatric hospital units across Japan and explore related risk factors. METHODS: We followed up 526 offenders with mental disorder who had been detained under the MTSA and who were subsequently discharged from any of the 28 hospitals nationwide between 2007 and 2015. RESULTS: The total cumulative reoffence rate was found to be 2.5% (1.1-3.9%) after 1 year and 7.5% (4.6-10.4%) after 3 years. The rate of serious reoffending was 0.4% (-0.18% to 0.99%) after 1 year and 2.0% (0.4-3.6%) after 3 years. The cumulative admission rate to local psychiatric hospitals following a discharge was 21.8% after 6 months and 37.6% after 1 year. Patients who had been discharged from their MTSA order but transferred to a general psychiatric hospital before open community residence-because it was necessary to build community supports-were more likely to reoffend than those discharged directly to the community. Patients who had been diagnosed with a substance use disorder (F10-F19) and had one subsequent admission were at higher risk of further readmissions. CONCLUSIONS: The low reoffending rates could be attributed to the intensive treatment and care plans required by the MTSA. The high rate of readmission to psychiatric hospitals may indicate shortcomings in community mental health services in Japan.

Phosphorus uptake commences at the earliest stages of seedling development in rice.

Seed phosphorus (P) reserves are essential for seedling development; however, we hypothesise that the quantity of P in seeds will lose importance in cultivars that rapidly acquire it via their roots. Our objective in this study was therefore to investigate the onset of seedling P uptake in rice (Oryza sativa). This was addressed through 33P-labelled supply and through measuring P depletion in combination with the detection of P transporter activity in the root tissue of three rice cultivars during early development. 33P supplied to roots 4 d after germination (DAG) was detected in shoots 2 d later, indicating that P was taken up and translocated to shoots during early seedling development. Measurements of P depletion from the growth medium indicated that uptake occurred even at 2 DAG when roots were only 3 cm long. By day 3, P depletion was rapid and P transporter activity was detected in roots, regardless of the levels of seed P reserves present. We conclude that P uptake commences at the earliest stages of seedling development in rice, that the amount taken up will be limited by root size, and that genotypes with more rapid root development should more rapidly complement seed-P reserves by root uptake.

Infection and inflammation in schizophrenia and bipolar disorder.

The present study investigated the relationship between exposure to infectious agents and inflammation markers in individuals with schizophrenia (SZ), bipolar disorder (BP), and controls without a psychiatric disorder. We measured plasma levels of antibodies and innate immune markers and correlated them with clinical symptoms and cognitive function. In both SZ and BP, we found an increase in soluble CD14, and in BP an increase in C-reactive protein, IgM class antibodies against cytomegalovirus (CMV), and IgG class antibodies against herpes simplex virus 2. Furthermore in BP, we observed a negative relationship between IgG antibodies against CMV and scores for cognitive function.

The relationship between positive and negative automatic thought and activity in the prefrontal and temporal cortices: a multi-channel near-infrared spectroscopy (NIRS) study.

BACKGROUND: Recently, neurobiological studies of the cognitive model of depression have become vastly more important, and a growing number of such studies are being reported. However, the relationship between the proportion of positive and negative automatic thought and activity in the prefrontal and temporal cortices has not yet been explored. We examined the relationship between brain activity and the proportion of positive and negative automatic thought in patients with major depressive disorder (MDD), using multi-channel near-infrared spectroscopy (NIRS). METHODS: We recruited 75 individuals with MDD (36 females; mean age=39.23 ± 12.49). They completed the Hamilton Rating Scale for Depression, Automatic Thoughts Questionnaire-Revised, Japanese version of the National Adult Reading Test, and the State-Trait Anxiety Inventory. Brain activation was measured by 52-channel NIRS. RESULTS: We found that activation in the vicinity of the right superior temporal gyrus is related to a deviation to negative of the proportion of positive and negative thoughts in individuals with MDD. Left dorsolateral prefrontal cortex activity was higher in the group with comparatively frequent positive thought. LIMITATIONS: Our participants were patients taking antidepressant medication, which is known to influence brain activity. Second, the poor spatial resolution of NIRS increases the difficulty of identifying the measurement position. CONCLUSIONS: We found that activation of the prefrontal and temporal cortices is related to the proportion of automatic thoughts in the cognitive model of depression.

Frontal and right temporal activations correlate negatively with depression severity during verbal fluency task: a multi-channel near-infrared spectroscopy study.

Multi-channel near-infrared spectroscopy (NIRS) is a noninvasive, on-the-spot, functional neuroimaging technique allowing detection of the spatiotemporal characteristics of brain activity. Previous NIRS studies indicated the oxy-hemoglobin (oxy-Hb) increase during a verbal fluency task (VFT) is attenuated in patients with major depressive disorder (MDD) as compared with healthy controls. However, the possible relationship between depression symptom severity and oxy-Hb change on NIRS has not yet been elucidated. To examine this relationship, we recruited 30 patients with MDD and 30 age-, gender- and intelligence quotient-matched controls. All underwent NIRS during VFT. As expected, the oxy-Hb increase during the task was significantly smaller in patients than in controls. After false discovery rate correction using 31 channels, the mean increase in oxy-Hb during the task showed a significant negative correlation with the total score of the Hamilton Rating Scale for Depression 21-item version (ch25: rho = -.56; FDR-corrected p: .001). When each item of the HAM-D21 was examined individually, insomnia early in 9 channels (rho = -.63 to -.46; FDR corrected p: .000-.014), work and activity in 2 channels (rho = -.61 to -.57; FDR corrected p: .001 to .003) and psychomotor retardation in 12 channels (rho = -.70 to -.44; FDR corrected p: .000-.018) showed significant negative correlations with the mean oxy-Hb increase in the right frontal temporal region. Although it is possible that our results were affected by medication, these data suggest reduced right frontal temporal activation on NIRS during VFT is related to the symptom severity of MDD.