Publications by authors named "Hisateru Tachimori"

105 Publications

Epilepsy surgery in children under 3 years of age: surgical and developmental outcomes.

J Neurosurg Pediatr 2021 Aug 13:1-9. Epub 2021 Aug 13.

6Epilepsy Centre Bethel Japan, Iwanuma, Miyagi, Japan.

Objective: Pediatric epilepsy surgery is known to be effective, but early surgery in infancy is not well characterized. Extensive cortical dysplasia, such as hemimegalencephaly, can cause refractory epilepsy shortly after birth, and early surgical intervention is indicated. However, the complication rate of early pediatric surgery is significant. In this study, the authors assessed the risk-benefit balance of early pediatric epilepsy surgery as relates to developmental outcomes.

Methods: This is a retrospective descriptive study of 75 patients who underwent their first curative epilepsy surgery at an age under 3 years at the authors' institution between 2006 and 2019 and had a minimum 1-year follow-up of seizure and developmental outcomes. Clinical information including surgical complications, seizure outcomes, and developmental quotient (DQ) was collected from medical records. The effects of clinical factors on DQ at 1 year after surgery were evaluated.

Results: The median age at surgery was 6 months, peaking at between 3 and 4 months. Operative procedures included 27 cases of hemispherotomy, 19 cases of multilobar surgery, and 29 cases of unilobar surgery. Seizure freedom was achieved in 82.7% of patients at 1 year and in 71.0% of patients at a mean follow-up of 62.8 months. The number of antiseizure medications (ASMs) decreased significantly after surgery, and 19 patients (30.6%) had discontinued their ASMs by the last follow-up. Postoperative complications requiring cerebrospinal fluid (CSF) diversion surgery, such as hydrocephalus and cyst formation, were observed in 13 patients (17.3%). The mean DQ values were 74.2 ± 34.3 preoperatively, 60.3 ± 23.3 at 1 year after surgery, and 53.4 ± 25.1 at the last follow-up. Multiple regression analysis revealed that the 1-year postoperative DQ was significantly influenced by preoperative DQ and postoperative seizure freedom but not by the occurrence of any surgical complication requiring CSF diversion surgery.

Conclusions: Early pediatric epilepsy surgery has an acceptable risk-benefit balance. Seizure control after surgery is important for postoperative development.
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http://dx.doi.org/10.3171/2021.4.PEDS21123DOI Listing
August 2021

Contemporary patterns of the management of truncus arteriosus (primary versus staged repair): outcomes from the Japanese National Cardiovascular Database.

Eur J Cardiothorac Surg 2021 Jul 30. Epub 2021 Jul 30.

Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.

Objectives: Although primary repair in early infancy has for decades been the prevalent strategy for management of truncus arteriosus (TA), recent concerns about the levels of morbidity and mortality have led to consideration of a staged surgical approach. Our goal was to describe recent patterns of management, to characterize patients who underwent primary or staged repair and to evaluate risk factors associated with operative mortality in a contemporary multicentre cohort.

Methods: In the Japanese Cardiovascular Surgery Database, we identified all cases of TA undergoing an initial surgical procedure from 2008 to 2018. Operative mortality was defined as death within 30 days of an operation or in-hospital death regardless of the length of hospital stay. The hospital volume was defined by the average volume of TA repairs per year.

Results: The total number of patients undergoing initial surgery for TA was 286. Sixty-eight (24%, 68/286) underwent primary repair (primary repair group). The remaining 218 (76%, 218/286) underwent initial bilateral pulmonary artery banding as part of a planned staged approach (staged repair group). One hundred sixty-two patients out of 218 initially banded patients underwent the repair of TA during this study period. Concomitant diagnoses in the entire cohort included interrupted aortic arch repair in 36 patients and truncal valve regurgitation in 32. No centres handling an average of ≥2 truncus cases/year of the repair of TA were identified in this cohort. A total of 30% (85/286) of the cases were performed at centres that handled an average of ≥1 and <2 cases/year. The remaining 70% were at centres with <1 case/year. Overall, 37 patients (12.9%; 37/286) died. The operative mortality rates in the primary and staged repair groups were similar: that for the primary repair group was 16.2% (11/68) versus 11.9% for the staged repair group (26/218; P = 0.41). With multivariable logistic regression analysis, the factors most strongly associated with operative mortality were preoperative heart failure requiring catecholamine support (odds ratio, 4.18; 95% confidence interval 1.96-8.96) and the repeat bilateral pulmonary artery banding (odds ratio, 3.89; 95% confidence interval 1.08-14.07).

Conclusions: The staged repair of TA has emerged as the preferred option for surgical timing at most of the centres participating in the Japanese Cardiovascular Surgery Database. The management outcomes of the patients with TA were favourable, even for the patients at low-volume centres.
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http://dx.doi.org/10.1093/ejcts/ezab348DOI Listing
July 2021

Perilla Oil and for Alleviating Fear of Cancer Recurrence in Breast Cancer Survivors: Study Protocol for a Three-Arm Phase II Randomized Controlled Study (POB Study).

Methods Protoc 2021 Jul 6;4(3). Epub 2021 Jul 6.

Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.

The fear of cancer recurrence (FCR) is the most common and most severe unmet need among cancer survivors. Safe treatments for the FCR that are easily disseminated are greatly needed. Our primary aim is a preliminary evaluation of the efficacy and effect size of perilla oil, which is rich in omega-3 fatty acids, and , a probiotic, on FCR in breast cancer survivors after the completion of chemotherapy. This study has been planned as an exploratory clinical study (phase II) and will be conducted as a three-arm, 12-week parallel group, masked-rater randomized controlled trial. Fifteen participants will be randomized with 1:1:1 allocation to receive plus perilla oil, alone, or no intervention (control). Interventions will end within 12 weeks after the random allocation of each participant. The participants will be outpatients with invasive breast cancer aged 20 years or older whose chemotherapy was completed at least 6 months before registration; hormone therapy may be ongoing. The primary outcome will be severity of FCR at 12 weeks assessed by masked raters using the 4-item Concerns about Recurrence Scale concerning overall fear of recurrence. The study protocol for the current study is registered in the Japan Registry of Clinical Trials (jRCTs031200029).
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http://dx.doi.org/10.3390/mps4030046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293445PMC
July 2021

Soluble APP-α and APP-β in cerebrospinal fluid as potential biomarkers for differential diagnosis of mild cognitive impairment.

Aging Clin Exp Res 2021 Jul 20. Epub 2021 Jul 20.

National Center Hospital, NCNP, Kodaira, Tokyo, Japan.

Objectives: Concentrations of soluble amyloid precursor proteins-α (sAPPα) and -β (sAPPβ) in cerebrospinal fluid (CSF) may reflect the neuropathology of Alzheimer's disease (AD). We previously reported that the concentrations of both sAPPα and sAPPβ were significantly higher in patients with mild cognitive impairment (MCI) due to AD (MCI-AD) than in control subjects without cognitive impairment. The present study analyzed whether these sAPPs are useful in the differential diagnosis of MCI.

Methods: A modified and sensitive method was used to analyze concentrations of sAPPα and sAPPβ in CSF of patients with MCI-AD (n = 30) and MCI due to other causes (MCI-others) (n = 24). Phosphorylated tau (p-tau) and amyloid β-protein 42 (Aβ42) were also analyzed using standard methods.

Results: CSF concentrations of sAPPα and sAPPβ were significantly higher in the MCI-AD than in the MCI-others group (p < 0.001). Furthermore, concentrations of both sAPPα and sAPPβ were highly correlated with the concentration of p-tau, consistent with our previous report.

Conclusions: Measurement of both sAPPs in CSF using sensitive methods can be helpful in the precise differential diagnosis of patients with MCI.
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http://dx.doi.org/10.1007/s40520-021-01935-7DOI Listing
July 2021

Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009-2016.

PLoS One 2021 1;16(7):e0253434. Epub 2021 Jul 1.

Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.

Background: Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation.

Methods And Findings: The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016.

Conclusion: Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253434PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248737PMC
July 2021

Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study.

BMC Psychiatry 2021 05 5;21(1):235. Epub 2021 May 5.

Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan.

Background: Consultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.

Methods: We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.

Results: Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).

Conclusions: Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.
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http://dx.doi.org/10.1186/s12888-021-03241-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097923PMC
May 2021

Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe.

World J Pediatr Congenit Heart Surg 2021 May;12(3):312-319

Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland.

Objectives: The Japan Cardiovascular Surgery Database-Congenital section (JCVSD-Congenital) and the European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) share the same nomenclature. We aimed at comparing congenital cardiac surgical patterns of practice and outcomes in Japan and Europe using the JCVSD-Congenital and ECHSA-CHSD.

Methods And Results: We examined Japanese (120 units, 63,365 operations) and European (96 units, 90,098 operations) data in JCVSD-Congenital and ECHSA-CHSD from 2011 to 2017. Patients' age and weight, periprocedural times, mortality at hospital discharge, and postoperative length of stay were calculated for ten benchmark operations. There was a significantly higher proportion of ventricular septal defect closures and Glenn operations and a significantly lower proportion of coarctation repairs, tetralogy of Fallot repairs, atrioventricular septal defect repairs, arterial switch operations, truncus repairs, Norwood operations, and Fontan operations in JCVSD-Congenital compared to ECHSA-CHSD. Postoperative length of stay was significantly longer following all benchmark operations in JCVSD-Congenital compared to ECHSA-CHSD. Mean STAT mortality score (Society of Thoracic Surgeons European Association for Cardio-Thoracic Surgery mortality score) was significantly higher in JCVSD-Congenital (0.78) compared to ECHSA-CHSD (0.71). Mortality at hospital discharge was significantly lower in JCVSD-Congenital (4.2%) compared to ECHSA-CHSD (6.0%, < .001).

Conclusions: The distribution of the benchmark procedures and age at the time of surgery differ between Japan and Europe. Postoperative length of stay is longer, and the mean complexity is higher in Japan compared to European data. These comparisons of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.
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http://dx.doi.org/10.1177/2150135120988634DOI Listing
May 2021

Risk analysis for patients with a functionally univentricular heart after systemic-to-pulmonary shunt placement.

Eur J Cardiothorac Surg 2021 07;60(2):377-383

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: To investigate risk factors for mortality after systemic-to-pulmonary (SP) shunt procedures in patients with a functionally univentricular heart using the Japan Cardiovascular Surgery Database registry.

Methods: Clinical data from 75 domestic institutions were collected. Overall, 812 patients with a functionally univentricular heart who underwent initial SP shunt palliation were eligible for analysis. Patients with pulmonary atresia with an intact ventricular septum and patients with a SP shunt as part of the Norwood procedure were excluded. Risk factors for 30- and 90-day mortalities were analysed using a logistic regression model.

Results: Median age and body weight at SP shunt placement were 41 days and 3.6 kg, respectively. Modified Blalock-Taussig shunt, central shunt and other types of SP shunts were applied in 689 (84.9%), 94 (11.8%) and 30 (3.7%) patients, respectively. Cardiopulmonary bypass was utilized in 410 patients (51%) for 128 min (median, 19-561). There were 411 isolated SP shunt procedures. Median hospital stay was 27 days, and 742 (91.4%) patients were discharged. The 30- and 90-day mortality rates were 3.4% and 6.0%, respectively. Placement of a central shunt was identified as a risk factor for 30-day mortality, while lower body weight, preoperative ventilator support, right atrial isomerism and coexistence of major aortopulmonary collateral arteries and an unbalanced atrioventricular septal defect were identified as risk factors for 90-day mortality.

Conclusions: SP shunt carries a high mortality rate in patients with a functionally univentricular heart when it is performed in smaller patients with complex cardiac anomalies.
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http://dx.doi.org/10.1093/ejcts/ezab077DOI Listing
July 2021

Stent Implantation for Congenital Heart Diseases in Japan - Comprehensive Analysis From the Japanese Society of Congenital Interventional Cardiology Registry.

Circ J 2021 Aug 11;85(9):1517-1524. Epub 2021 Mar 11.

Division of Medical Devices, National Institute of Health Sciences.

Background: Stent implantation for vascular stenosis associated with congenital heart diseases is commonly performed as an off-label procedure in Japan because there is no officially approved stent for any congenital heart disease.Methods and Results:We analyzed data from the Japanese Society of Congenital Interventional Cardiology Registry collected from January 2016 to December 2018. Patients who underwent stent implantation were enrolled in the present analysis. During the study period, there were 470 procedures, 443 sessions, and 391 cases. Of 443 sessions, 427 (96.4%) succeeded procedurally. There were no differences in the procedural success rates among age groups. In all, 416 sessions (367 patients; 94%) resulted in survival to 30 days after catheter intervention. Of 392 admissions, 357 patients (91%) survived to discharge. Only 4 deaths were directly related to stent implantation. Some in-hospital complications were observed during 55 of 443 sessions. Both hospital deaths and serious complications were significantly more frequent in the group with various preoperative risk factors.

Conclusions: Although not officially approved for congenital heart diseases in Japan, stent implantation in congenital heart diseases has been widely and routinely performed for many years with safety and efficacy. The aim of stenting was variable and broad because of many different applications and morphological variations. These data may facilitate approval of such an important device in Japan.
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http://dx.doi.org/10.1253/circj.CJ-20-0915DOI Listing
August 2021

Resilience building for mood disorders: Theoretical introduction and the achievements of the Re-Work program in Japan.

Asian J Psychiatr 2021 Apr 17;58:102580. Epub 2021 Feb 17.

National Center of Neurology and Psychiatry, Tokyo, Japan. Electronic address:

Mood disorders are common, tend to recur, cause sickness absence, and lead to economic loss. Since past experiences of mood disorder episodes often increase future vulnerability, it is imperative to assist those mood disorder patients who want to resume working to build resilience to prevent relapse. Paralleling efforts in the West, a resilience-building program utilizing the principles of the Illness Management and Recovery program was first developed in Japan in 1997. The purpose of this survey is to introduce the concept and theory behind the Re-Work program and to review studies that report on program assessment, content, effects and associated factors, and prognosis of participants. A literature search performed with PubMed and Igaku chuou zasshi (Ichushi) identified 30 relevant studies. One of these reported on a tool developed to assess readiness for returning to work. Concerning program content, a group therapy setting and cognitive behavioral therapy were found to be effective. Physical exercise and relaxation techniques may be useful as secondary program components. Several studies report on program effects, but there may be factors that limit these effects. The prognosis for relapse prevention after the resumption of work may be better for Re-Work program participants than for a control group. Further research in this area is needed to confirm program effectiveness and related factors.
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http://dx.doi.org/10.1016/j.ajp.2021.102580DOI Listing
April 2021

Psychotic Experiences and Hikikomori in a Nationally Representative Sample of Adult Community Residents in Japan: A Cross-Sectional Study.

Front Psychiatry 2020 29;11:602678. Epub 2021 Jan 29.

Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

Psychotic experiences (PEs) may be associated with hikikomori. In the present study, we analyzed interview data from a community-based representative sample ( = 1,616) in Japan to know the association of PEs over a life time, as well as the two components, hallucinatory experiences (HEs) and delusional experiences (DEs), with lifetime experience of hikikomori (severe social withdrawal). Logistic regression analysis was used to estimate the association between any PE, any HE, and any DE; and hikikomori, adjusting for socio-demographics and other psychopathologies (mental disorder in the past 12 months or having autistic spectrum disorder trait). Any PE was significantly associated with hikikomori [odds ratio (OR) =3.44, 95% CI = 1.14-10.33] after adjustment for sociodemographic factors, although the association attenuated after adjusting for other psychopathologies. Any DE remained significantly associated with hikikomori, even after adjustment for all the covariates (OR = 10.50, 95% CI = 1.57-70.29). Any HE was not significantly associated with hikikomori. DEs may be associated with hikikomori. However, because the study sample was small and the temporal association between DEs and hikikomori was unclear, a future study is needed to examine a causal relationship between DEs and hikikomori.
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http://dx.doi.org/10.3389/fpsyt.2020.602678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878546PMC
January 2021

Risk factors for low adherence to methylphenidate treatment in pediatric patients with attention-deficit/hyperactivity disorder.

Sci Rep 2021 01 18;11(1):1707. Epub 2021 Jan 18.

Department of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita-city, Akita, 010-8543, Japan.

Poor adherence is a major concern in the treatment of attention-deficit/hyperactivity disorder (ADHD). The objective of this study was to evaluate factors linked to early interruption of and low adherence to treatment with osmotic-release oral system methylphenidate hydrochloride (OROS-MPH) in pediatric patients with ADHD. A total of 1353 young people (age 6-17 years) with a diagnosis of ADHD who newly started OROS-MPH were extracted from the pharmacoepidemiological data of 3 million people in Japan. The cohort was retrospectively surveyed every month for 12 months. Ten possible risk factors were extracted from the data and analyzed by multivariable logistic regression. Sensitivity analysis was conducted to ensure the robustness of the analysis. The results revealed that treatment adherence was generally poor, with a tendency for discontinuation in the early stage. Multivariable logistic regression results showed that adherence is reduced by female sex, lower starting dose, and concomitant atomoxetine or hypnotics. These findings may help clinicians to predict the risk of poor adherence in the early stage of treatment and improve not only patients' symptoms, but also their quality of life.
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http://dx.doi.org/10.1038/s41598-021-81416-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7814069PMC
January 2021

Pathologic Features of Anti-Mi-2 Dermatomyositis.

Neurology 2021 01 4;96(3):e448-e459. Epub 2020 Dec 4.

From Department of Neuromuscular Research (J.T., M.I., S. Hayashi, S.N., I.N.), National Institute of Neuroscience, Departments of Genome Medicine Development (J.T., M.I., S. Hayashi, S.N., I.N.) and Clinical Genome Analysis (I.N.), Medical Genome Center, and Department of Clinical Epidemiology (S. Hirakawa, H.T.), Translational Medical Center, National Center of Neurology and Psychiatry; Department of Neurology (S.S.), Keio University School of Medicine, Tokyo; Department of Dermatology (N.O., M.F.), Faculty of Medicine, University of Tsukuba, Ibaraki; and Department of Dermatology (M.F.), Graduate School of Medicine, Osaka University, Japan.

Objective: To identify the characteristic pathologic features of dermatomyositis (DM) associated with anti-Mi-2 autoantibodies (anti-Mi-2 DM).

Methods: We reviewed 188 muscle biopsies from patients (1) pathologically diagnosed with DM through the sarcoplasmic expression for the myxovirus-resistant protein A and (2) serologically positive for 1 of 5 DM-specific autoantibodies (DMSAs) (anti-Mi-2, n = 30; other DMSAs, n = 152) or negative for all 5 DMSAs (n = 6). We then compared the histopathologic and immunohistochemical features of patients with anti-Mi-2 DM to those with non-Mi-2 DM and patients with anti-synthetase syndrome (ASS) (n = 212) using the test, Fisher exact test, and a logistic regression model.

Results: Patients with anti-Mi-2 DM showed significantly higher severity scores in muscle fiber and inflammatory domains than non-Mi-2 DM patients. The presence of perifascicular necrosis, increased perimysial alkaline phosphatase activity, and sarcolemmal membrane attack complex deposition was more frequent in patients with anti-Mi-2 DM ( < 0.01). After Bonferroni correction, there were no significant differences in the percentages of the features mentioned above between the patients with anti-Mi-2 DM and those with ASS ( > 0.01).

Conclusion: Perifascicular necrosis and perimysial pathology, features previously reported in ASS, are common in patients with anti-Mi-2 DM. Our findings not only assist in differentiating anti-Mi-2 DM from other DM subtypes but also suggest the possibility of an overlapping mechanism between anti-Mi-2 DM and ASS.

Classification Of Evidence: This study provides Class II evidence that the muscle biopsies of DM patients with anti-Mi-2 autoantibodies are more likely to demonstrate higher severity scores in muscle fiber and inflammatory domains.
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http://dx.doi.org/10.1212/WNL.0000000000011269DOI Listing
January 2021

Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in Northeast Japan: comparisons with the general population.

BMC Public Health 2020 Aug 20;20(1):1271. Epub 2020 Aug 20.

Department of Psychiatry, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA.

Background: People living in temporary housing for long periods after a disaster are at risk of poor mental health. This study investigated the post-disaster incidence and remission of common mental disorders among adults living in temporary housing for the 3 years following the 2011 Great East Japan Earthquake.

Methods: Three years after the disaster, face-to-face interviews were conducted with 1089 adult residents living in temporary housing in the disaster area, i.e., the shelter group, and a random sample of 852 community residents from non-disaster areas of East Japan. The World Health Organization Composite International Diagnostic Interview was used to diagnose DSM-IV mood, anxiety, and alcohol use disorders. Information on demographic variables and disaster experiences was also collected.

Results: Response rates were 49 and 46% for the shelter group and the community residents, respectively. The incidence of mood/anxiety disorder in the shelter group was elevated only in the first year post-disaster compared to that of the general population. The rate of remission for mood and anxiety disorders was significantly lower in the shelter group than in the community residents. The proportion seeking medical treatment was higher in the shelter group.

Conclusions: The onset of common mental disorders increased in the first year, but then levelled off in the following years among residents in temporary housing after the disaster. Remission from incident post-disaster mental disorders was slower in the shelter group than in the general population. Post-disaster mental health service could consider the greater incidence in the first year and prolonged remission of mental disorders among survivors with a long-term stay in temporary housing after a disaster.
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http://dx.doi.org/10.1186/s12889-020-09378-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7441677PMC
August 2020

Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database.

Crit Care 2020 07 29;24(1):470. Epub 2020 Jul 29.

Department of Acute Critical Care and Disaster Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.

Background: Thyroid storm is a life-threatening disease with a mortality rate of over 10%. Although glucocorticoids have been recommended as a treatment option for thyroid storm, supportive evidence based on a large-scale clinical research is lacking. The objective of the current study was to evaluate the beneficial effects of glucocorticoids in the treatment of patients with severe thyroid storm.

Methods: A retrospective nationwide cohort study was conducted using a Japanese national administrative claims database. Patients admitted to intensive care units due to severe thyroid storm between the financial years 2013 and 2017 were included in the study. The primary outcome was in-hospital mortality; secondary outcomes were mortality within 30 days and insulin administration during hospitalization. Generalized linear mixed model (GLMM) with maximum likelihood estimation (MLE) and Bayesian estimation using Markov chain Monte Carlo methods (MCMC), in addition to propensity score matching (PSM), were used for statistical analysis.

Results: A total of 811 patients were included in the study, of which 600 patients were treated with glucocorticoids, and 211 patients were treated without glucocorticoids. The early administration of glucocorticoids was not associated with a significant improvement in the in-hospital mortality of patients with thyroid storm [adjusted odds ratio (95% confidence interval) = 1.77 (0.95-3.34), 1.44 (1.14-1.93), and 1.46 (0.72-3.00) in the GLMM (MLE), GLMM (MCMC), and PSM, respectively]. The results of mortality within 30 days were almost identical to the results of in-hospital mortality. However, insulin use was significantly higher in the glucocorticoid group.

Conclusions: This analysis of a nationwide administrative database indicates that the administration of glucocorticoids does not improve the survival of patients with thyroid storm.
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http://dx.doi.org/10.1186/s13054-020-03188-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391822PMC
July 2020

Development and validation of risk models for mortality and morbidity in 12 major pediatric surgical procedures: A study from the National Clinical Database-Pediatric of Japan.

J Pediatr Surg 2020 Oct 12;55(10):2064-2070. Epub 2020 Apr 12.

Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan; National Clinical Database Committee and (l)) Pediatric Surgical Database Committee, The Japanese Society of Pediatric Surgeons, Tokyo, Japan.

Purpose: To establish and validate risk models of mortality and morbidity associated with 12 major pediatric surgical procedures using the National Clinical Database-Pediatric (NCD-P) data.

Methods: We used the NCD-P data for the development and validation datasets. By using multivariate logistic regression to analyze the development dataset, we created a prediction model for 30-day mortality and morbidity in 12 major pediatric surgical procedures, including tracheoplasty, pneumonectomy, fundoplication, total/subtotal excision of malignant tumor, and surgeries for Hirschsprung disease, anorectal malformation, biliary atresia, choledocal cyst, midgut volvulus, funnel chest, gastrointestinal perforation, and intestinal obstruction. We selected variables that were almost identical to those used in the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P). The primary outcomes were 30-day mortality and composite morbidity. We assessed the obtained models using the C-indices of the development and validation datasets.

Results: Overall, 10 and 21 variables were identified for mortality and morbidity, respectively. C-indices of mortality were 0.940 and 0.924 in the development and validation datasets, respectively. C-indices of morbidity were 0.832 and 0.830 in the development and validation datasets, respectively.

Conclusions: Based on the NCD-P data, we developed satisfactory risk models for mortality and morbidity prediction in major pediatric surgeries.

Level Of Evidence: Level I (Prognosis Study).
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http://dx.doi.org/10.1016/j.jpedsurg.2020.03.031DOI Listing
October 2020

Association of Dermatomyositis Sine Dermatitis With Anti-Nuclear Matrix Protein 2 Autoantibodies.

JAMA Neurol 2020 07;77(7):872-877

Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.

Importance: Reports on dermatomyositis (DM) sine dermatitis (DMSD) are scarce, and the concept of the disease has not been widely accepted.

Objective: To confirm the existence of DMSD, determine its prevalence, and characterize its serologic features.

Design, Setting, And Participants: This is a cohort study that reviewed clinical information, laboratory data, and muscle pathology slides from January 2009 to August 2019. We further assessed the follow-up data of 14 patients with DMSD. The median (interquartile range) follow-up period was 34 (16-64) months. Muscle biopsy samples, along with clinical information and laboratory data, were sent to a referral center for muscle diseases in Japan for diagnosis. Of patients whose myopathologic diagnosis was made at the National Center of Neurology and Psychiatry between January 2009 and August 2019, 199 patients were eligible for inclusion. These patients underwent full investigation for DM-specific autoantibodies (against transcriptional intermediary factor γ, Mi-2, melanoma differentiation-associated gene 5, nuclear matrix protein 2 [NXP-2], and small ubiquitin-like modifier activating enzyme ); however, 17 patients were excluded because their muscle fibers did not express myxovirus resistance protein A, a sensitive and specific marker of DM muscle pathology.

Main Outcomes And Measures: Diagnosis of DMSD was based on the absence of a skin rash at the time of muscle biopsy.

Results: Of the 182 patients, 93 were women (51%) and 46 were children (25%) (<18 years). Fourteen patients (8%) had DMSD and none were clinically diagnosed with DM. Among the 14 patients with DMSD, 12 (86%) were positive for anti-NXP-2 autoantibodies, while the remaining 2 were positive for anti-transcriptional intermediary factor γ and anti-Mi-2 autoantibodies, respectively. Only 28% of patients (47 of 168) with a skin rash were positive for anti-NXP-2 autoantibodies, indicating a significant association between anti-NXP-2 autoantibodies and DMSD (86% [12 of 14] vs 28% [47 of 168]; P < .001). This association was also supported by multivariable models adjusted for disease duration (odds ratio, 126.47; 95% CI, 11.42-1400.64; P < .001).

Conclusions And Relevance: Dermatomyositis sine dermatitis does exist and accounts for 8% of patients with DM confirmed with muscle biopsy. Dermatomyositis sine dermatitis is significantly associated with anti-NXP-2 autoantibodies, which contrasts with anti-MDA5 DM, which is typically clinically amyopathic in presentation. It is essential to distinguish DMSD from other types of myositis because DM-specific therapies that are currently under development, including Janus kinase inhibitors, may be effective for DMSD.
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http://dx.doi.org/10.1001/jamaneurol.2020.0673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171574PMC
July 2020

Effects of brief family psychoeducation for caregivers of people with schizophrenia in Japan provided by visiting nurses: protocol for a cluster randomised controlled trial.

BMJ Open 2020 04 9;10(4):e034425. Epub 2020 Apr 9.

Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.

Introduction: Development of a support system for families caring for people with schizophrenia in routine psychiatric care settings is an important issue worldwide. Regional mental health systems are inadequate for delivering effective services to such family members. Despite evidence that family psychoeducation (FPE) alleviates the burden of schizophrenia on families, its dissemination in routine clinical practice remains insufficient, suggesting the need for developing an effective and implementable intervention for family caregivers in the existing mental health system setting. In Japan, the visiting nurse service system would be a practical way of providing family services. Visiting nurses in local communities are involved in the everyday lives of people with schizophrenia and their families. Accordingly, visiting nurses understand their needs and are able to provide family support as a service covered by national health insurance. The purpose of this study is to discover whether a brief FPE programme provided by visiting nurses caring for people with schizophrenia will alleviate family burden through a cluster randomised controlled trial (cRCT).

Methods And Analysis: The study will be a two-arm, parallel-group (visiting nurse agency) cRCT. Forty-seven visiting nurse agencies will be randomly allocated to the brief FPE group (intervention group) or treatment as usual group (control group). Caregivers of people with schizophrenia will be recruited by visiting nurses using a randomly ordered list. The primary outcome will be caregiver burden, measured using the Japanese version of Zarit Burden Interview. Outcome assessments will be conducted at baseline, 1-month follow-up and 6-month follow-up. Multiple levels of three-way interactions in mixed models will be used to examine whether the brief FPE programme will alleviate the burden on caregivers relative to treatment as usual.

Ethics And Dissemination: The Research Ethics Committee of the Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Japan (No 2019065NI) approved this study. The results will be published in a scientific peer-reviewed journal.

Trial Registration Number: UMIN000038044.
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http://dx.doi.org/10.1136/bmjopen-2019-034425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170625PMC
April 2020

Risks of seizure with fatal traffic crash at wheel in people with epilepsy.

Seizure 2020 Feb 6;76:110-115. Epub 2020 Feb 6.

Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.

Purpose: The Japanese authorities require a 2-year seizure-free period for a driver's license in people with epilepsy. To evaluate the stringency of the criteria, we calculated the risk of fatal traffic crashes by epileptic seizure and compared that to the risk of fatal traffic crashes among the general population.

Methods: Nation-wide questionnaire surveys to physicians and their patients with epilepsy were conducted to determine the rate of seizure recurrence after given seizure-free periods, average driving time and the rate of traffic crashes by epileptic seizures. The risk of fatal traffic crashes by epileptic seizures was calculated using the method proposed by the Driving License Committee of the EU. The risk of fatal traffic crashes among subgroups of the general population was calculated using the national statistics available.

Results: Valid answers were obtained from a total of 548 patients of 138 epilepsy-specialists and 102 non epilepsy-specialist physicians. The relative risks of fatal traffic crashes in people with epilepsy with 1-year and 2-year seizure-free periods were 1.22 and 1.15, compared to the general population, while the ones in males in their twenties, people aged 60 and over, people aged 65 and over, and people aged 75 and over among the general population were 1.71, 1.31, 1.52 and 2.69, respectively.

Conclusion: The risk of fatal traffic crashes in people with epilepsy for 1-year and 2-year seizure-free periods was estimated to be lower than that of some age groups in the general population. The increased risk in 1-year seizure freedom from that in 2-year seizure freedom was relatively small.
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http://dx.doi.org/10.1016/j.seizure.2020.02.002DOI Listing
February 2020

Association Between the Use of Antidepressants and the Risk of Type 2 Diabetes: A Large, Population-Based Cohort Study in Japan.

Diabetes Care 2020 04 12;43(4):885-893. Epub 2020 Feb 12.

Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan

Objective: This study aimed to reveal the associations between the risk of new-onset type 2 diabetes and the duration of antidepressant use and the antidepressant dose, and between antidepressant use after diabetes onset and clinical outcomes.

Research Design And Methods: In this large-scale retrospective cohort study in Japan, new users of antidepressants (exposure group) and nonusers (nonexposure group), aged 20-79 years, were included between 1 April 2006 and 31 May 2015. Patients with a history of diabetes or receipt of antidiabetes treatment were excluded. Covariates were adjusted by using propensity score matching; the associations were analyzed between risk of new-onset type 2 diabetes and the duration of antidepressant use/dose of antidepressant in the exposure and nonexposure groups by using Cox proportional hazards models. Changes in glycated hemoglobin (HbA) level were examined in groups with continuous use, discontinuation, or a reduction in the dose of antidepressants.

Results: Of 90,530 subjects, 45,265 were in both the exposure and the nonexposure group after propensity score matching; 5,225 patients (5.8%) developed diabetes. Antidepressant use was associated with the risk of diabetes onset in a time- and dose-dependent manner. The adjusted hazard ratio was 1.27 (95% CI 1.16-1.39) for short-term low-dose and 3.95 (95% CI 3.31-4.72) for long-term high-dose antidepressant use. HbA levels were lower in patients who discontinued or reduced the dose of antidepressants ([2,49] = 8.17; < 0.001).

Conclusions: Long-term antidepressant use increased the risk of type 2 diabetes onset in a time- and dose-dependent manner. Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.
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http://dx.doi.org/10.2337/dc19-1175DOI Listing
April 2020

Association of response rate and prevalence estimates of common mental disorders across 129 areas in a nationally representative survey of adults in Japan.

Soc Psychiatry Psychiatr Epidemiol 2020 Oct 11;55(10):1373-1382. Epub 2020 Feb 11.

Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.

Objective: To investigate the association of area response rate with prevalence estimates of mental disorders in the 2nd World Mental Health Survey (WMHJ2).

Methods: The sample of the WMHJ2 was selected from community residents in 129 areas from three regions of Japan. The surveys were conducted between 2013 and 2015, and 2450 (43.4%) responded. Mental disorders as well as three disorder classes (mood, anxiety, and substance use disorders) were identified using the WHO CIDI/DSM-IV. Response rates and 12-month and lifetime prevalences were calculated for each area. A generalized linear mixed model analysis was conducted to associate area response rate with the prevalence of mental disorders, controlling for sex, age, urbanity, and geographical region.

Results: Area response rates ranged from 0.05 to 0.80 across the 129 areas. Area response rate was not significantly associated with 12-month or lifetime prevalence of mental disorder. Lifetime prevalences of substance use disorder were significantly lower in a survey with a higher response rate than a survey of the same area with a lower response rate.

Conclusion: Response rate may not strongly affect the prevalence estimates of mental disorders in a community-based survey of the prevalence of common mental disorders during a particular time frame. However, a lower response rate could be associated with overestimation of lifetime prevalence of substance use disorder. This needs further elucidation.
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http://dx.doi.org/10.1007/s00127-020-01847-3DOI Listing
October 2020

Expectations and anxieties of Duchenne muscular dystrophy patients and their families during the first-in-human clinical trial of NS-065/NCNP-01.

Brain Dev 2020 Apr 25;42(4):348-356. Epub 2020 Jan 25.

Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan; National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.

Duchenne muscular dystrophy (DMD) is a recessive X-linked genetic disease caused by a mutation in the dystrophin gene. The new drug NS-065/NCNP-01 utilizing exon-skipping therapy targeting specific deletions has been used in a first-in-human trial for the treatment of DMD. We surveyed 10 pairs of DMD participants and their parents within this clinical trial via an iPad survey form and through interviews regarding their understanding of the trial, expectations, anxieties, and reasons for participating in the trial. Approximately half of the participants actively decided to participate of their own volition, and none considered quitting the trial. This indicates that participants participated more positively in this clinical trial than previously expected. However, some potential concerns were also revealed, with one being that the desire to please those around them might be more important to the DMD participants than the effects of the drug. Another issue is the possibility of biased information originating from the study subjects' parents; while seven out of 10 of the parents told their children that the study drug might work, only four of these parents also explained that it might not work. Only two study participants received an explanation concerning the drug's side effects from their parents. This result implies that caution should be taken when family expectations are high, and there is a possibility that subjects will be given biased information from their parents.
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http://dx.doi.org/10.1016/j.braindev.2020.01.001DOI Listing
April 2020

The epidemiology of alcohol use disorders cross-nationally: Findings from the World Mental Health Surveys.

Addict Behav 2020 03 16;102:106128. Epub 2019 Sep 16.

National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan.

Background: Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities.

Methods: Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0.

Results: Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence.

Conclusions: Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns.
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http://dx.doi.org/10.1016/j.addbeh.2019.106128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416527PMC
March 2020

Long-term use of hypnotics: Analysis of trends and risk factors.

Gen Hosp Psychiatry 2020 Jan - Feb;62:49-55. Epub 2019 Nov 24.

Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; International Institute for Integrative Sleep Medicine, Tsukuba, Japan. Electronic address:

Objective: Patients with chronic insomnia are prone to long-term use of hypnotics. Reported risk factors include aging, female sex, and comorbid psychiatric disorders. However, most previous studies have been cross-sectional cohort studies.

Method: We conducted a retrospective cohort study using medical service payment data for 330,000 people to determine the duration of prescription of hypnotics and the risk factors for long-term use. We followed up 3981 patients (2382 M, 1599 F, age 40.3 ± 12.4 years) who were prescribed hypnotics for the first time between April 2005 and March 2008.

Results: Of these 3981 patients, 59.6% were prescribed hypnotics for only 1 month, 11.3% were prescribed hypnotics for 2 consecutive months, and 10.1% of patients continued receiving prescriptions for the entire 12-month observation period. In multiple logistic time-dependent Cox analyses, use of antidepressants, mean dose of hypnotics, and advanced age were significantly associated with long-term use of hypnotics (p < 0.01). In an analysis of the association between long-term use of hypnotics and prescribed dosage, high monthly dose, advanced age, and department of first visit were significantly associated with long-term use (p < 0.01).

Conclusion: These clinical indicators may be effective for early identification of patients with insomnia who are at high risk of developing physical dependence on hypnotics.
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http://dx.doi.org/10.1016/j.genhosppsych.2019.11.008DOI Listing
November 2020

Psychological distress with and without a history of depression: Results from the World Mental Health Japan 2nd Survey (WMHJ2).

J Affect Disord 2020 03 13;265:545-551. Epub 2019 Nov 13.

Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. Electronic address:

Background: Psychological distress is prevalent and heterogenous. Checking a history of depression may contribute to identifying those who need intensive preventive support, but few studies have examined how different the dysfunction of people with and without a history of depression among those with psychological distress are. The study aimed to compare the two groups in physical health problems, level of social and familial support.

Methods: The World Mental Health Japan 2nd Survey (WMHJ2), a cross-sectional, nationally representative face-to-face survey of residents aged 20-75 years old, was conducted from 2013 to 2015. We defined psychological distress as a K6 score of 5 or more. A history of major depressive disorder (MDD) was assessed by the WHO Composite International Diagnostic Interview version 3.0. Multinomial logistic regression analysis was used to examine the associations of sociodemographic characteristics, physical health problems, social support and mental health service use among those with no psychological distress, with psychological distress having no history of MDD, and with psychological distress having a history of MDD, adjusted for sociodemographic characteristics.

Results: Unemployment, physical health problems, and lack of social support were much more common among those with psychological distress without a history of MDD than those with no psychological distress, and were largely comparable with those with psychological distress having a history of MDD.

Limitations: The relatively low response rate might limit generalizability.

Conclusions: The dysfunction in psychological distress without a history of MDD was largely equivalent to that seen in distress with a history of MDD.
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http://dx.doi.org/10.1016/j.jad.2019.11.089DOI Listing
March 2020

Seven-day shared decision making for outpatients with first episode of mood disorders among university students: A randomized controlled trial.

Psychiatry Res 2019 11 30;281:112531. Epub 2019 Aug 30.

Department of Neuropsychiatry, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka-shi, Tokyo 181-8611, Japan. Electronic address:

Providing appropriate treatment to patients with a first episode of mood disorders is crucial for recovery from the disorders. Although shared decision making (SDM) has been proposed as a promising model in psychiatric practice, an appropriate SDM approach has not yet been established. The aim of the current study was to evaluate the effects of an originally developed seven-day SDM program for outpatients with a first episode of mood disorders among university students. University students with a first episode of mood disorders were randomly allocated into two arms: SDM and control. The participants in the SDM arm received the seven-day SDM program, which included option presentation consultation, external deliberation with a decision aid booklet, decision coaching by a nurse, and decision-making consultation. The control arm received usual care. The primary outcome was patient-perceived involvement. We enrolled 88 participants. Compared with usual care, the SDM program significantly improved patient-perceived involvement in treatment decision making without taking up clinicians' time. The program did not lead to worse symptoms of mood disorders. In conclusion, sharing treatment decision making with university students with a first episode of mood disorders is feasible.
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http://dx.doi.org/10.1016/j.psychres.2019.112531DOI Listing
November 2019

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

Crim Behav Ment Health 2019 Jun;29(3):157-167

Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan.

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.
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http://dx.doi.org/10.1002/cbm.2117DOI Listing
June 2019

The epidemiology of drug use disorders cross-nationally: Findings from the WHO's World Mental Health Surveys.

Int J Drug Policy 2019 09 28;71:103-112. Epub 2019 Jun 28.

Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia.

Background: Illicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative involves a standardised method for assessing mental and substance use disorders via structured diagnostic interviews in representative community samples of adults. We conducted cross-national comparisons of the prevalence and correlates of drug use disorders (DUDs) in countries of varied economic, social and cultural nature.

Methods And Findings: DSM-IV DUDs were assessed in 27 WMH surveys in 25 countries. Across surveys, the prevalence of lifetime DUD was 3.5%, 0.7% in the past year. Lifetime DUD prevalence increased with country income: 0.9% in low/lower-middle income countries, 2.5% in upper-middle income countries, 4.8% in high-income countries. Significant differences in 12-month prevalence of DUDs were found across country in income groups in the entire cohort, but not when limited to users. DUDs were more common among men than women and younger than older respondents. Among those with a DUD and at least one other mental disorder, onset of the DUD was usually preceded by the 'other' mental disorder.

Conclusions: Substantial cross-national differences in DUD prevalence were found, reflecting myriad social, environmental, legal and other influences. Nonetheless, patterns of course and correlates of DUDs were strikingly consistent. These findings provide foundational data on country-level comparisons of DUDs.
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http://dx.doi.org/10.1016/j.drugpo.2019.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370948PMC
September 2019

Urbanization and Internet addiction in a nationally representative sample of adult community residents in Japan: A cross-sectional, multilevel study.

Psychiatry Res 2019 03 30;273:699-705. Epub 2019 Jan 30.

Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. Electronic address:

This study examines the relationship between urbanization and Internet addiction (IA) and association with other psychopathology and social support, in a nationally representative sample in Japan. Data from the World Mental Health Japan Second Survey were used. There were 2450 survey respondents, with an average response rate of 43.4%. Respondents' living areas were divided into three groups on the basis of urbanization (operationalized as city size). IA was measured using the Compulsive Internet Use Scale (CIUS). Three variables - psychological distress, past-12-month mental disorder, and social support - were measured using established instruments. A multilevel model was conducted to clarify the association between urbanization and IA (continuous scores and prevalence), before and after adjusting for possible individual-level and area-level variables and demographic variables. CIUS scores were significantly higher in large cities than in small municipalities before adjusting for psychological distress, social support, and past-12-month mental disorder. After adjustment, these associations attenuated substantially: urbanization was no longer significantly associated with odds of mild/severe IA, while the relationship held for continuous CIUS scores. Thus, residence in large cities is associated with higher odds of IA in Japan; psychological distress, social support, and past-12-month mental disorder partly explain this association.
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http://dx.doi.org/10.1016/j.psychres.2019.01.094DOI Listing
March 2019
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