Data resource profile of an online database system for forensic mental health services.

This paper introduces a forensic psychiatry database established in Japan and discusses its significance and future issues. The purpose of this Database, created under the Medical Treatment and Supervision Act (MTSA) Database Project, is to improve the quality of forensic psychiatry treatment. It can collect monthly data on "basic information," "Orders and hospitalizations under the MTSA," "Treatment process," "Criminal and medical treatment history," and "problematic behavior in the unit." The online system has accumulated data on more than 8,000 items in 24 broad categories. Medical data are exported from the medical care assisting system of 32 designated inpatient facilities in XML format and then saved on USB memory sticks. The files are imported into the Database system client, which sends the data to the Database server via a virtual private network. This system minimizes errors and efficiently imports patient data. However, there is a limitation that it is difficult to set items that need to be analyzed to solve everyday clinical problems into the database system because they tend to change over time. By evaluating the effectiveness of the Database, and collecting appropriate data, it is expected to disseminate a wide range of knowledge that will contribute to the future development of mental health and welfare care.

Associations between readmission and patient-reported measures in acute psychiatric inpatients: a study protocol for a multicenter prospective longitudinal study (the ePOP-J study).

BACKGROUND: Several previous observational studies have reported the risk factors associated with readmission in people with mental illness. While patient-reported experiences and outcomes have become increasingly important in healthcare, only a few studies have examined these parameters in terms of their direct association with readmission in an acute psychiatric setting. This project will investigate multiple factors associated with readmission and community living in acute psychiatric patients in Japan. This study will primarily investigate whether patient-reported experiences at discharge, particularly quality of life (QoL), are associated with future readmission and whether readmission after the index hospitalization is associated with changes in patient-reported outcomes during the study period. Here, we describe the rationale and methods of this study. METHODS: This multicenter prospective cohort study is being conducted in 21 participating Japanese hospitals, with a target sample of approximately 600 participants admitted to the acute psychiatric ward. The study has four planned assessment points: time of index admission (T1), time of discharge (from the index admission) (T2), 6 months after discharge from the index admission (T3), and 12 months after discharge from the index admission (T4). Participants will complete self-reported measures including a QoL scale, a subjective disability scale, and an empowerment- and self-agency-related scale at each assessment point; additionally, service satisfaction, subjective view of need for services, and subjective relationships with family members will be assessed at T2 and T3. We will assess the participants' hospitalization during the study period and evaluate several potential individual- and service-level factors associated with readmission and patient-reported experiences and outcomes. Multivariate analyses will be conducted to identify potential associations between readmission and patient-reported experiences and outcomes. DISCUSSION: The present study may produce evidence on how patient-reported experiences at discharge influence readmission and on the influence of readmission on the course of patient-reported outcomes from admission to community living after discharge. The study may contribute to improving care for both patients' subjective views of their own health conditions and their community lives in an acute psychiatric setting.Trial registration University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) UMIN000034220. Registered on September 20, 2018.

Motor and cognitive development of children with Down syndrome: The effect of acquisition of walking skills on their cognitive and language abilities.

OBJECTIVE: This study investigated the relationship between motor and cognitive/language development in children with Down syndrome (DS). We also tested the hypothesis that acquisition of walking skills facilitates later cognitive/language development. METHODS: Participants were 156 children with DS who were less than 48 months old and had undergone a health checkup by medical doctors and received rehabilitation treatment between April 2013 and March 2017 in Yokohama, Japan. To assess their development, the Kyoto Scale of Psychological Development (KSPD) 2001 was used, which measures development in three subdomains: Posture-Motor (P-M), Cognitive-Adaptive (C-A), and Language-Social (L-S). To investigate the relationship between motor and cognitive/language development, partial correlation analyses were conducted that controlled for participants' age. To test the effect of achieving walking skills, regression analyses were conducted using only data from participants who took the KSPD at least twice and could not walk at the initial test. RESULTS: P-M developmental age (DA) was significantly and positively correlated with both C-A DA and L-S DA in children 1-3 years old. The relationship strengthened with increased age. Acquisition of walking skills had a significant positive effect on both the C-A DA and L-S DA at the second test when controlling for the C-A DA and L-S DA at the first test and age at the second test. CONCLUSION: Motor development was correlated with both cognitive and language development in young children with DS. Results also suggested that achievement of walking could facilitate later cognitive/language development in children with DS.

[A study of the rehabilitation support system for illegal substance use disorder patients from the viewpoint of the designated hospital. 4 case studies focusing on judicial treatment and drug urine monitoring].

This study was designed to reveal the current status of the rehabilitation support system for patients with Illegal Substance Use Disorder (ISUD). From among 465 patients who had been admitted to a psychiatric hospital in Tokyo within the past 10 years by order of the prefectural governor, 65 patients with ISUD were selected for inclusion in this study. Based on whether or not the person was arrested at the time of discharge, whether or not urine drug monitoring was ordered, and the results of the monitoring, each subject was classified into one of the following four types: 1) Arrested; 2) Not arrested and no urine drug monitoring; 3) Not arrested and positive urine drug monitoring results; and 4) Not arrested and negative urine drug monitoring results. In Group 1, every subject underwent urine drug monitoring prior to an involuntary examination; however, even though 10 percent of the subjects in this study were found to have positive results on urine drug monitoring, none of them were arrested. Moreover, 40 percent of the study subjects were not subjected to urine drug monitoring, and about 30 percent of non-arrested subjects were shown not to have used any illegal substances. Based on these results, it appears to be ideal for patients in Group 1 to apply to a diversion program, followed by medical treatment for addiction. To avoid the elimination of patients from medical services due to the vagueness of the classifications, whether or not judicial administration is required at the time of police intervention should be clearly and appropriately clarified for patients in Groups 2 and 3. Patients in Group 4 may experience a relapse of psychiatric symptoms, even if they do not use illegal substances; therefore, it is necessary for designated hospitals to perform medical treatment interventions responsibly for both endogenous psychosis and substance abuse, and to collaborate with appropriate social support facilities within the community regarding the medical discharge of such patients.

Gas-forming liver abscess associated with rapid hemolysis in a diabetic patient.

We experienced a case of liver abscess due to Clostridium perfringens (CP) complicated with massive hemolysis and rapid death in an adequately controlled type 2 diabetic patient. The patient died 6 h after his first visit to the hospital. CP was later detected in a blood culture. We searched for case reports of CP septicemia and found 124 cases. Fifty patients survived, and 74 died. Of the 30 patients with liver abscess, only 3 cases survived following treatment with emergency surgical drainage. For the early detection of CP infection, detection of Gram-positive rods in the blood or drainage fluid is important. Spherocytes and ghost cells indicate intravascular hemolysis. The prognosis is very poor once massive hemolysis occurs. The major causative organisms of gas-forming liver abscess in diabetic patients are Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli). Although CP is relatively rare, the survival rate is very poor compared with those of K. pneumoniae and E. coli. Therefore, for every case that presents with a gas-forming liver abscess, the possibility of CP should be considered, and immediate aspiration of the abscess and Gram staining are important.

[Investigation of community support measures for patients with comorbid substance use disorder and psychotic disorder: nationwide survey of drug addiction rehabilitation centers].

In psychiatric care practice, patients are often seen who have difficulty with their social lives due to protracted psychiatric symptoms despite years without drug abuse. The difficulty of dealing with such cases and the lack of preparedness of the legal system leave circumstantial care as the only option. Western.countries have recently begun using the name 'concurrent disorder' as a diagnosis for patients deemed unable to recover solely through such treatment for drug addiction, signifying the presence of both a substance use disorder (SUD) and a mental health disorder. Various assessment and intervention methods are being investigated, and many studies have been reported. Based on the hypothesis that Drug Addiction Rehabilitation Center (DARC) are partly involved in supporting those with psychotic concurrent disorders (PSCD) in Japan, we conducted a survey to clarify the actual support for PSCD patients at DARC and the challenges they face. Surveys were administered to DARC-related institutions all over Japan (44 governing organizations and 66 institutions). Complete responses from 86 full-time employees and 445 DARC users were analyzed. DARC users were divided into two groups: psychiatric concurrent disorders (PSCD group, n = 178) and those without such symptoms (SUD group, n = 267), with the PSCD group accounting for 40% of the DARC users surveyed. Compared to the SUD group, the PSCD group was significantly less satisfied with their lifestyle and interpersonal relations at the DARC and a significantly higher proportion of the PSCD group requested assistance in communicating with others. When employees were presented with a hypothetical PSCD case and asked what was needed to deal with it, some responses were, "an institution that can treat both drug addiction and other mental health disorders," "a psychiatric care institution that provides 24-hour care," and "sufficient manpower and training." In the future, a treatment system must be established based on public medical institutions with a dedicated PSCD program that can provide medical care under legal observation.

An accessory thyroid gland that presented tumor-like images.

A 26-year-old woman presented with right breast pain and itching. Incidentally, a firm, non-tender, movable mass (3 cm in diameter) located in the lower right part of the neck was identified by palpation. Ultrasonography revealed a clearly demarcated dumbbell-shaped mass with homogenous hypo- (cranial side) and hyper-echogenicity (caudal side) compared with the thyroid gland. Computed tomography scan and magnetic resonance imaging presented images that were different from thyroid gland substance. The right thyroid lobe was strongly compressed by the mass. Hyperparathyroidism was ruled out by laboratory testing. The patient solicited resection of the mass despite recommendations for core needle biopsy, and it was removed surgically. The mass was surrounded by a thin capsule and was not connected with the thyroid gland. Pathological examinations revealed normal thyroid gland tissue. The final diagnosis was an accessory thyroid gland. Accessory thyroid glands should be considered as a possible diagnosis when nodules around the main thyroid gland are encountered.

[A nationwide questionnaire survey of medical experts in mental health evaluation].

A nationwide questionnaire survey was conducted to clarify the current status of medical experts in mental health evaluation and their needs (recovery rate: 66.6%). The data were simply tabulated and then statistically analyzed with respect to past experiences of serving as expert witnesses or judges as defined by the Medical Treatment and Supervision Act and past clinical experience. The results showed that 201 respondents (53.0%) had served as medical experts an average of 2.8 +/- 2.4 times, while 173 respondents (45.6%) had not served as such experts, and that 284 respondents (74.9%) had served as judges an average of 3.0 +/- 2.5 times, while 86 respondents (22.7%) had not served as judges. Although about 70% of the respondents who had served as expert witnesses felt that their experiences were burdensome, mostly due to time-related concerns, most had favorable views of the legal process. More than 70% of the respondents indicated that they would continue to serve as expert witnesses despite their sense of burden, thus suggesting a correlation between a past experience of serving as an expert witness and a willingness to do so again in the future. Furthermore, the results indicate that medical experts in mental health evaluation who have not served as expert witnesses are more hesitant, and since physicians employed at institutions for forensic psychiatric examination are more likely to serve as expert witnesses, a relatively small group of medical experts in mental health evaluation repeatedly serve as expert witnesses. On the other hand, when compared to serving as medical experts, serving as judges was psychologically more stressful for many respondents. Since physicians are not used to being judges, they may experience feelings of resistance or burden. Also, judges are somewhat bound by expert testimony, and the fact that there is no written policy for questioning testimony adds to their stress. Therefore, it will be necessary to clarify the positioning of expert evidence and the decisions made by judges. What medical experts in mental health evaluation needed to improve their knowledge varied depending on the type and duration of work and clinical experience. Therefore, it is necessary to provide information matching the experience, skills, and information related to the practical aspect of the Medical Treatment and Supervision Act. Moreover, the results suggest the necessity for medical experts in mental health evaluation to acquire a wide range of expert knowledge in forensic psychiatry beyond that required for the Medical Treatment and Supervision Act.

[Actual condition of involuntary admission by order of the prefectural governor: focus on the effects of the Medical Treatment and Supervision Act].

A survey was conducted involving 664 individuals admitted to a public psychiatric hospital in Tokyo Prefecture between July 15, 2004 and July 14, 2007 as a result of involuntary admission by order of the prefectural governor (hereafter, involuntarily admitted patients). The characteristics of patients with a focus on the effects of the Medical Treatment and Supervision Act were investigated in 656 patients, excluding eight patients for whom information at the time of involuntary admission was unclear. The proportion of patients in the present survey who had been reported by prosecutors was markedly low compared to nationwide and previous surveys. This was thought to be a result of the fact that the proportion of patients reported by the police, which tend to include emergency cases, was high due to the characteristics of the present hospital as well as the regional characteristics of Tokyo Prefecture. The characteristics of involuntarily admitted patients tended to be similar to those observed in previous surveys on involuntarily admitted patients at the present and other hospitals in Tokyo Prefecture. Comparison of the characteristics of involuntarily admitted patients and problem behaviors that instigated admission before and after implementation of the Medical Treatment and Supervision Act showed no clear differences, indicating that the act had no marked effect on involuntary admission by order of the prefectural governor. In addition, only a small proportion of patients with problem behaviors corresponding to actions described in the Medical Treatment and Supervision Act were reported by prosecutors, suggesting that such patients were mostly reported by the police. In cases where patients faced involuntary admission by order of the prefectural governor after being reported by the police, the prosecutor may have either been unaware of the patient or, if aware, had not filed a petition. Issues may include clues for investigation in addition to the roles of judicial police officers and prosecutors in investigation procedures in the former case, and the discretion of prosecutors in the latter case. While opinions on the appropriateness of actively applying the Medical Treatment and Supervision Act to these patients vary depending on the interpretation of the act's legal characteristics, it appeared that involuntary admission by order of the prefectural governor was at present not clearly distinguished from the Medical Treatment and Supervision Act. Involuntary admission by order of the prefectural governor and the Medical Treatment and Supervision Act are systems that have significant implications for patients with mental disorders, who are likely to cause injury to themselves or others. In order to facilitate the provision of appropriate medical care, it is important to clarify the systematic relationships within the legal system.

A case of solitary intraductal papilloma of the breast coexisting with ductal carcinoma in situ (DCIS).

A 54-year-old woman was referred to this institution because of spontaneous bloody discharge from the nipple of her left breast in July 2003. Physical examination revealed no mass, but minimal pressure on the mammary gland exuded a bloody discharge from the nipple. No lymph node swelling was recognized in the axillary or subclavicular regions. Mammography and magnetic resonance imaging revealed mastopathy. Ultrasonography on the immersion method demonstrated a dilated duct with an irregular, solid, hypoechoic mass immediately behind the nipple. Fine-needle aspiration cytology showed the mass to be an intraductal tumor. Carcinoembryonic antigen (CEA) concentration of the nipple discharge was 400 ng/ml. Preoperatively, she was diagnosed as intraductal solitary papilloma, and endoscope-assisted microdochectomy was carried out under general anesthesia. The tumor was 10.5-10.6 mm in diameter and had developed from the posterior wall of the duct adjacent to the nipple. The tumor contained a small solid area in which a two-cell layer of epithelium was missing, and thus solitary papilloma coexisting with ductal carcinoma in situ (DCIS) was diagnosed. Solitary intraductal papilloma coexisting with carcinoma is rare; cases of DCIS are exceptionally rare. Follow-up for 3 years has revealed no evidence of recurrence.

Current status of rehabilitation medicine in Asia: a report from New Millennium Asian Symposium on Rehabilitation Medicine.

With the aim of promoting rehabilitation medicine in Asian countries, where the number of persons with disability occupies a significant proportion in the world, New Millennium Asian Symposium on Rehabilitation Medicine was held in February 2001 in Tokyo, under the sponsorship of the Japanese Association of Rehabilitation Medicine. Twenty-three guest speakers from 14 Asian countries and regions participated in the 2-day meeting. With a structured questionnaire that was sent to the participants beforehand, demographic data related to rehabilitation practice and information on training and certification in rehabilitation medicine in the participating countries were collected, and presented at the meeting. Based on these data, the current status of rehabilitation medicine in Asia was summarized. The symposium marked an important step forward for the promotion of rehabilitation medicine in Asia.