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ABSTRACT: Suicide is associated not only with primary psychiatric disorders but also with physical disorders. Physicians' education on suicide prevention contributes to reducing suicide. Therefore, medical residents, who contact patients daily and who eventually become primary physicians in each specialty, might be the most appropriate candidates for intervention. In this article, we introduce our newly developed suicide intervention program among medical residents.
We developed a 2-hour suicide intervention program among medical residents, based on the Mental Health First Aid (MHFA), which had originally been developed for the public. The program contains a 1-hour lecture and a 1-hour role-play session. As the first pilot trial, we conducted the program among 44 first-year medical residents at a university hospital and evaluated its effectiveness. Changes in confidence, attitudes and behavior toward suicidal people were evaluated using self-reported questionnaires before, immediately after, and 6 months after the program.
Participants' confidence and attitudes significantly improved after the program. The total mean score (standard deviation) of the Suicide Intervention Response Inventory improved from 18.4 (2.0) before the intervention to 19.4 (2.0) immediately after the intervention. However, the effectiveness was limited after 6 months. In the course of 6 months, the participants learned to apply the MHFA principles in their daily clinical practice.
Our newly developed brief suicide intervention program demonstrating its effectiveness among medical residents should be modified in order to be more effective in the long term. The next trial with a control group ought to be conducted to evaluate our developed program.
Psychiatry and Clinical Neurosciences 10/2010; 64(5):531-40. · 2.13 Impact Factor
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ABSTRACT: Suicidality in patients with schizophrenia is high. To clarify the characteristics of suicidal behavior in patients with schizophrenia, we investigated suicide attempters with schizophrenia spectrum disorders in comparison with patients with mood disorders. One hundred patients with schizophrenia spectrum disorders and 155 patients with mood disorders admitted to an emergency department after a suicide attempt were interviewed in detail on items concerning 1) demographic characteristics, 2) previous suicidal behavior, and 3) index suicidal behavior. Differences between the two groups were subsequently analyzed. Patients with schizophrenia spectrum disorders showed a lower incidence of previous deliberate self-harm, and a higher incidence of a subsequent suicide attempt more than 1 year after the previous suicide attempt as well as a higher lethality of index suicide attempt compared to patients with mood disorders. Furthermore, the most common motive for making a suicide attempt in patients with schizophrenia spectrum disorders was having a mental problem. This study revealed the factors associated with suicide attempts among Japanese patients with schizophrenia spectrum disorders, and the nature of these factors makes it difficult to predict future attempts. This makes clear the importance of continuous long-term follow-up with careful attention to the mental symptoms and psychological burden for such patients.
Psychiatry Research 10/2010; 188(1):78-82. · 2.52 Impact Factor
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ABSTRACT: Some reports have suggested the involvement of the D2 dopaminergic function in the expression of suicidal behavior. Here, we examined associations between suicide attempts and two kinds of functional polymorphisms in the dopamine D2 receptor (DRD2) gene, namely, TaqIA and -141C Ins/Del.
Subjects included 120 suicide attempters and 123 unrelated volunteers. Those who attempted suicide were severely injured and were transferred to the emergency unit in our university hospital. To determine each genotype, we performed polymerase chain reaction and restriction fragment length polymorphism analyses.
We found significant differences in genotypic and allelic frequencies of -141C Ins/Del and TaqIA polymorphisms between suicide attempters and healthy controls (-141C Ins/Del, p = 0.01; TaqIA,p = 0.036). The Ins allele of -141C Ins/Del was significantly more frequent in suicide attempters (p = 0.011), as well as the A2 allele of TaqIA (p = 0.017). Haplotype analysis revealed no significant linkage disequilibrium between -141C Ins/Del and TaqIA polymorphisms (D' = 0.226, r(2) = 0.016, p = 0.10).
These findings suggest that DRD2 gene polymorphisms may be involved in the biological susceptibility to suicide.
Neuropsychobiology 05/2009; 59(2):130-4. · 2.67 Impact Factor
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ABSTRACT: Family history of suicide attempt is one of the risks of suicide. We aimed at exploring the characteristics of Japanese suicide attempters with and without a family history of suicide attempt.
Suicide attempters admitted to an urban emergency department from 2003 to 2008 were interviewed by two attending psychiatrists on items concerning family history of suicide attempt and other sociodemographic and clinical information. Subjects were divided into two groups based on the presence or absence of a family history of suicide attempt, and differences between the two groups were subsequently analyzed.
Out of the 469 suicide attempters, 70 (14.9%) had a family history of suicide attempt. A significantly higher rate of suicide motive connected with family relations (odds ratio 2.21, confidence interval 1.18-4.17, p < .05) as well as a significantly higher rate of deliberate self-harm (odds ratio 2.51, confidence interval 1.38-4.57, p < .05) were observed in patients with a family history of suicide compared to those without such history. No significant differences were observed in other items investigated.
The present study has revealed the characteristics of suicide attempters with a family history of suicide attempt. Further understanding of the situation of such individuals is expected to lead to better treatment provision and outcomes, and family function might be a suitable focus in their treatment.
BMC Psychiatry 01/2009; 9:32. · 2.55 Impact Factor
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ABSTRACT: Suicide attempt is a potent risk factor of subsequent suicide. Understanding the characteristics of suicide attempters is important for preventing suicide. The authors investigated aggression in medically serious suicide attempters at an emergency department. Trait aggression was evaluated in 55 suicide attempters and 71 healthy individuals as a control group using the Japanese version of the Buss-Perry Aggression Questionnaire (BAQ). Total BAQ scores (t = 2.782, P = 0.006) and the hostility scores (t = 3.735, P < 0.001) were significantly higher in the suicide attempters than the controls. It suggested that to focus on aggression and its management is one of the key components for preventing suicide.
Psychiatry and Clinical Neurosciences 06/2008; 62(3):352-4. · 2.13 Impact Factor
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Daisuke Fujisawa,
Naoki Hashimoto,
Yayoi Masamune-Koizumi,
Kotaro Otsuka,
Masaru Tateno,
Gaku Okugawa,
Atsuo Nakagawa, Ryoko Sato,
Toshiaki Kikuchi,
Eita Tonai,
Kosuke Yoshida,
Takatoshi Mori,
Hidehiko Takahashi,
Soichiro Sato,
Hiroyasu Igimi,
Yoshibumi Waseda,
Takefumi Ueno,
Ippei Morokuma,
Katsuyoshi Takahashi,
Norman Sartorius
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ABSTRACT: This study examines pathways to psychiatric care in Japan using the same method as the collaborative study carried out in 1991 under the auspices of the World Health Organization.
Thirteen psychiatric facilities in Japan were involved. Of the 228 patients who contacted psychiatric facilities with any psychiatric illness, eighty four visiting psychiatric facilities for the first time were enrolled. Pathways to psychiatric care, delays from the onset of illness to treatment prior to reaching psychiatrists were surveyed.
Thirty three patients (39.4%) directly accessed mental health professionals, 32 patients (38.1%) reached them via general hospital, and 13 patients (15.5%) via private practitioners. The patients who consulted mental health professionals as their first carers took a longer time before consulting psychiatrists than the patients who consulted non-mental health professionals as their first carers. The patients who presented somatic symptoms as their main problem experienced longer delay from the onset of illness to psychiatric care than the patients who complained about depressive or anxiety symptoms. Prior to the visit to mental health professionals, patients were rarely informed about their diagnosis and did not receive appropriate treatments from their physicians. Private practitioners were more likely to prescribe psychotropics than physicians in general hospitals, but were less likely to inform their patients of their diagnosis.
This first pathway to psychiatric care study in Japan demonstrated that referral pathway in Japan heavily relies on medical resources. The study indicates possible fields and gives indications, underlining the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders presenting with somatic and depressive symptoms in the general health care system and by private practitioners.
International Journal of Mental Health Systems 02/2008; 2(1):14.
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Nippon rinsho. Japanese journal of clinical medicine 08/2007; 65 Suppl 7:115-9.
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Tomoki Yamada,
Chiaki Kawanishi,
Hana Hasegawa, Ryoko Sato,
Akiko Konishi,
Daiji Kato,
Taku Furuno,
Ikuko Kishida,
Toshinari Odawara,
Mitsugi Sugiyama,
Yoshio Hirayasu
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ABSTRACT: The incidence of suicide has increased markedly in Japan since 1998. As psychological autopsy is not generally accepted in Japan, surveys of suicide attempts, an established risk factor of suicide, are highly regarded. We have carried out this study to gain insight into the psychiatric aspects of those attempting suicide in Japan.
Three hundred and twenty consecutive cases of attempted suicide who were admitted to an urban emergency department were interviewed, with the focus on psychosocial background and DSM-IV diagnosis. Moreover, they were divided into two groups according to the method of attempted suicide in terms of lethality, and the two groups were compared.
Ninety-five percent of patients received a psychiatric diagnosis: 81% of subjects met the criteria for an axis I disorder. The most frequent diagnosis was mood disorder. The mean age was higher and living alone more common in the high-lethality group. Middle-aged men tended to have a higher prevalence of mood disorders.
This is the first large-scale study of cases of attempted suicide since the dramatic increase in suicides began in Japan. The identification and introduction of treatments for psychiatric disorders at emergency departments has been indicated to be important in suicide prevention.
BMC Psychiatry 02/2007; 7:64. · 2.55 Impact Factor
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ABSTRACT: Aims Education of those involved in general and psychosocial patient care can contribute greatly to suicide prevention. We administered a questionnaire to psychiatric nurses, psychiatric social workers and nursing students to examine their knowledge about the current situation relating to suicide in Japan, and their attitudes toward suicide victims. Countermeasures against suicide are urgently needed in Japan where a high suicide rate has been observed.Method Seventy psychiatric nurses, 47 psychiatric social workers and 116 nursing students participated in the study. The questionnaire developed by the authors included both multiple-choice and open-ended questions. Responses to questions were compared between subject groups including medical students who had been questioned previously.Results Overall, participants showed insufficient knowledge about suicide including the current increase in Japan. Risk factors for suicide were not correctly identified, and responses overrated economic problems. Regarding attitudes, we observed resignation, unconcern or criticism in the responses of 19.1-30.2% of participants.Conclusions All physicians and others involved in direct patient care are in a position to act as gatekeepers for suicide prevention interventions. The present study confirmed the necessity of educating these students and workers about characteristics of suicide and its victims.
Primary Care Mental Health. 11/2006; 4(4):285-292.
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ABSTRACT: Japan has one of the highest suicide rates in the world. Suicides numbered 32,863 in 1998 and have exceeded 30,000 in every subsequent year. Education of those involved in general and psychosocial patient care can contribute greatly to suicide prevention. The authors administered a brief knowledge and attitude assessment questionnaire concerning suicide to students in their first, third, and fifth years at a Japanese medical school. Participants numbered 160 (94 men with a mean age of 21.8 years, SD = 3.01, and 66 women with a mean age of 21.2 years, SD = 2.64); 59 first year, 52 third year, and 49 in their fifth year. The questionnaire consists of eight multiple-choice questions asking knowledge of suicide and one open-ended question asking attitude. In the knowledge part, only about half of the items were answered correctly (mean score was 4.21, SD = 1.28). A significant difference was observed in prevalence of attitudes as categorical variables between student years (P = 0.001). Sympathetic comments increased along with student years, while critical comments decreased. Given the frequent and interventional opportunities of primary-care medical contacts, poor understanding of suicide from the medical viewpoint was of concern. Moreover, judgmental attitudes were common, especially in earlier school years. Better informed, more understanding physicians and other health professionals could contribute greatly to prevention.
Psychiatry and Clinical Neurosciences 11/2006; 60(5):558-62. · 2.13 Impact Factor
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Nippon rinsho. Japanese journal of clinical medicine 01/2006; 63 Suppl 12:301-7.
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ABSTRACT: Statins are widely prescribed and are established as first-line therapy for the primary and secondary prevention of coronary heart disease. Response to treatment varies considerably from person to person; however, inherited traits (genetic variability) may play a central role in this inter-individual variation. The purpose of this review is to summarize recent progress in the research for exploring genetic determinants of clinical efficacy and safety of statin therapy.
In addition to 41 previous studies of 19 genes, the results of 17 pharmacogenomic studies investigating the relationship between common genetic variants and response to statin therapy in terms of lipid responses, clinical outcomes, and adverse events have been reported since January 2004 - 15 candidate genes related to pharmacodynamics and three to pharmacokinetics of statins. These reported data suggest that genetic variations influencing intestinal cholesterol absorption, cholesterol production, and lipoprotein catabolism may all play a role in modulating responsiveness, as well as genes involved in drug metabolism of statins. They also suggest that combined analysis of multiple variants in several genes, all of which have possible functional relations, is more likely to give significant results, especially when being performed with a larger number of participants.
Pharmacogenomic studies of statin therapy will provide a better picture as to who is most likely and least likely to benefit from treatment, which results in more individualized management of coronary artery disease.
Current Opinion in Lipidology 01/2006; 16(6):606-13. · 6.09 Impact Factor
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ABSTRACT: Despite statin therapy being effective in the primary and secondary prevention of coronary heart disease, the benefit of treatment varies between individuals. Interindividual variations in pharmacokinetics play a central role in the cause of variability of drug disposition, and, in turn, the drug's clinical efficacy. Exploring genetic variations that influence pharmacokinetics may lead clinicians to apply the most efficient and safe drug therapy. So far, variants in eight candidate genes related to pharmacokinetics of statins have been investigated as the potential determinant of drug responsiveness or adverse event risk. All reported data remains inconclusive, but it has been suggested that combined analysis of more than two different polymorphisms, or a combination of genetic association and studies using in vitro recombinant expression techniques, may be more informative in predicting the specific phenotype of a genetic variant. Future studies using these approaches could provide more striking evidence, which may be sufficient to justify genetic analysis regarding pharmacokinetic variants in the clinical practice of statin therapy.
Expert Opinion on Pharmacotherapy 08/2005; 6(8):1291-7. · 3.20 Impact Factor
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ABSTRACT: To find the clinical variables associated with atorvastatin's effects on bone metabolism markers, 35 patients with heterozygous familial hypercholesterolemia were treated with atorvastatin for 24 weeks, and the levels of bone formation markers (bone-specific alkaline phosphatase and osteocalcin) and resorption marker (urine collagen type-1 cross-linked N-telopeptide) were determined. Pretreatment vitamin D levels showed significant and positive associations with changes in 2 bone formation markers. The serial changes in 3 markers were favorable-increased bone formation markers and unchanged bone resorption marker-but the changes occurred only in patients with pretreatment vitamin D levels >50 pg/ml.
The American Journal of Cardiology 11/2003; 92(9):1113-6. · 3.37 Impact Factor
