[Show abstract][Hide abstract] ABSTRACT: In cases of untreated schizophrenia, the patients' entourage often does not recognize the psychotic symptoms of the patient and the possibility that the patient may attempt suicide. The aim of this study was to investigate the discrepancies between the subjective experiences and observed behaviors in near-fatal suicide attempters with untreated schizophrenia.
A semi-structured interview was carried out with seven near-fatal suicide attempters with untreated schizophrenia to examine the subjective experiences at the time of the suicide attempt. The families of the patients were also interviewed to determine their recognition of the patients' psychotic symptoms and the suicidal ideation. The interview data were analyzed qualitatively.
Six subjects were undergoing exacerbation of the psychotic symptoms at the time of exhibiting the suicide-related ideation. One subject had been in a prolonged depressive state before attempting suicide. Although all the patients experienced severe distress due to psychotic symptoms and depressive mood, they all exhibited only low level or no help-seeking behavior, and six of seven families had not recognized the change in the patient's mental condition.
Appropriate information about schizophrenia should be provided to the general public so that any help-seeking by the patients with this disease is not overlooked. In addition, accessible early intervention services for psychosis should be established.
Preview · Article · Dec 2015 · Annals of General Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Recently, shortening of the duration of untreated psychosis (DUP) and intensive treatment within the critical period are taken as determinants of a favorable prognosis, and various service systems and treatment approaches for early intervention in schizophrenia have been proposed in the world. At the Toho University Omori Medical Center, Early Psychosis Unit "Il Bosco" was established as an intervention service from the viewpoint of preventing full-blown psychosis at the prodromal stage, where cognitive training for a direct therapeutic approach to brain function and psychosocial treatment for patients at puberty and adolescence are administered. In this article, we introduce the practice at "Il Bosco" and consider future prospects.
No preview · Article · May 2013 · Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
[Show abstract][Hide abstract] ABSTRACT: Early detection of, and intervention for, schizophrenia improve the social and functional outcome of the schizophrenia patient. A shorter duration of untreated psychosis (DUP) is an indication of a good prognosis for schizophrenia, but the DUP in Japan is comparatively long. There are some reports which have suggested shortening the DUP, for example, the Buckingham project and TIPS. They show early intervention services reduce the rate of onset of schizophrenia, and improve functions of schizophrenia patients. Intervention for patients with At Risk Mental State (ARMS) may stop or delay the onset of schizophrenia. Furthermore, intensive cares for patients in the critical period can also induce better clinical and functional outcomes. A shorter DUP and an intensive and comprehensive approach within the critical period are eagerly awaited in Japan.
No preview · Article · Apr 2013 · Nippon rinsho. Japanese journal of clinical medicine
[Show abstract][Hide abstract] ABSTRACT: Aims:
It remains debatable whether early intervention for psychosis is capable of meeting the needs of at-risk subjects. The aims of this study were to describe the actual impact of interventions on subjective difficulties and to explore the factors that may be associated with a poor outcome.
Participants were help-seeking outpatients at a university hospital who met the Criteria of Prodromal Syndromes. Changes in the symptoms, subjective experience and current insight were assessed using the Scales of Prodromal Symptoms, the Subjective Well-being under Neuroleptics, and the Scale to Assess Unawareness of Mental Disorder, respectively. Global functioning, social functioning and subjective quality of life were evaluated using the Global Assessment of Functioning Scale, the Social Functioning Scale, and the WHO-Quality of Life 26, respectively. These measures were assessed both at baseline and after 1 year.
Forty-six patients agreed to participate. Of the 27 patients who completed the reassessment at the follow-up point, 13 patients (48%) showed little improvement in their positive/negative symptoms, subjective well-being or awareness of their symptoms. Additionally, less severe negative symptoms, more severe general symptoms and lower subjective well-being at baseline significantly predicted a deterioration of positive/negative symptoms after 1 year.
Our findings suggest that the current strategy for reducing psychosis risk based on positive symptoms should be reappraised.
No preview · Article · Jan 2013 · Early Intervention in Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Early intervention for psychosis in Japan has lagged behind that in western countries, but has rapidly begun to attract attention in recent years. As part of a worldwide trend, a multi-dimensional treatment centre for early psychosis consisting of a Youth Clinic, which specialises in young individuals with an at-risk mental state for psychosis, and Il Bosco, a special day-care service for individuals with early psychosis, was initiated at the Toho University Omori Medical Center in Japan in 2007. The treatment centre aims to provide early intervention to prevent the development of full-blown psychosis in patients with an at-risk mental state and intensive rehabilitation to enable first-episode schizophrenia patients to return to the community. We presently provide the same programmes for both groups at Il Bosco. However, different approaches may need to be considered for patients with an at-risk mental state and for those with first-episode schizophrenia. More phase-specific and need-specific services will be indispensable for early psychiatric interventions in the future.
[Show abstract][Hide abstract] ABSTRACT: The largest task for psychiatry in Japan today is the deinstitutionalization of patients with psychiatric disorders. In Japan, all citizens are covered by a national health plan, and about 70% of the total cost is covered by the national health insurance scheme. At present, however, there is still no category for early intervention in the national health reimbursement schedule. Recent research has shown that the mean duration of untreated psychosis (DUP) at seven university hospitals in Japan was 17.6 months. We present data using case vignettes suggesting that pharmacotherapy might be overused in prodromal cases. The concept of an At-Risk Mental State (ARMS)/prodromal state might not yet be widely recognized among Japanese psychiatrists. We outline early intervention initiatives in Japan; The Japanese Society for Prevention and Early Intervention in Psychiatry (JSEIP), and a representative early intervention facility for young people is the “Il Bosco” in Tokyo. There are several leading centers for early intervention research and practice in Japan. Most of them are driven by university departments of psychiatry with respect to both research and clinical activities. The development of services for early intervention is expected to reduce stigmatization, prevent suicide among young persons, and promote general knowledge about mental health. There are several common or similar issues among Asian countries, including service systems, community attitudes to psychiatric illness including stigma, and dependence on pharmacotherapy.
No preview · Article · Mar 2012 · Asian Journal of Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Relationships between deficits in verbal fluency and poor social functioning have been revealed in patients with schizophrenia. In previous studies, we demonstrated that deficits in idea fluency, which is ranked as a more complex type of verbal fluency and reflects divergent thinking ability, were more closely related to social dysfunction than deficits in simple word fluency. Although functional neuroimaging studies have provided detailed data regarding prefrontal dysfunction during word fluency tasks, the regions that relate to deficits in fluency of ideas and thoughts have not yet been clarified in schizophrenia patients. The purpose of the present study was to identify the prefrontal sub-regions responsible for deficits in idea fluency using near-infrared spectroscopy (NIRS), which is more practical than other imaging methods, and to investigate the relationships between lesions and idea fluency deficits and social dysfunction in patients with schizophrenia. Eighteen outpatients with schizophrenia and 16 healthy subjects were recruited for this case-controlled study. Using 24-channel NIRS, we measured changes in hemoglobin concentration in the prefrontal cortical surface area during idea and letter fluency tests. The analyses revealed that schizophrenia patients generally exhibited a smaller increase in the concentration of oxyhemoglobin in the frontopolar region than the controls during both the tests. However, the areas in which reduced activations were demonstrated in the patients differed remarkably between the idea and letter fluency tests: reduced activations were observed in the ventral region during the former test and in the dorsal region of the frontopolar cortex during the latter test. The reduced activations in each sub-region appeared to affect the related cognitive impairment, since the patients showed significant poorer performances than the controls on both the tests. Moreover, hypoactivity during idea fluency was significantly correlated with poor social functioning as assessed using the Global Assessment of Functioning (GAF) in the patient group. The results of the present study suggest that the ventral region within the frontopolar cortex is responsible for divergent thinking, which is associated with poor social functioning in patients with schizophrenia.
No preview · Article · Oct 2010 · Progress in Neuro-Psychopharmacology and Biological Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Current magnetic resonance imaging techniques demonstrated MR findings of Dyke-Davidoff-Masson syndrome in a 44-year-old man. Statistical parametric mapping analysis of the T1-weighted images showed focal atrophy in the basal ganglia. Three-dimensional white matter fibers of corticospinal tracts, corpus callosum and cingulate bundle were demonstrated using diffusion tensor data correlated to the patient's clinical conditions.
[Show abstract][Hide abstract] ABSTRACT: Although medication with antipsychotic for the psychosis prodrome has often caused some ethical issues, recent studies have shown that some novel antipsychotics are safer and more tolerable for young people. This study aimed to investigate whether the administration of aripiprazole would not only relieve the prodromal symptoms but also be tolerable for prodromal subjects and to evaluate the effect of medication on improvements in insight and subjective well-being.
The Structured Interview for Prodromal Syndromes was performed for patients identified as having the psychosis prodrome. Psychiatric measures included the Scale of Prodromal Symptoms. Clinical insight was measured using the Scale to Assess Unawareness of Mental Disorder, and changes in subjective experience were assessed using the Subjective Well-being Under Neuroleptics, Short version. The time frame was the first 8 weeks after beginning study medication.
Thirty-six treatment-seeking prodromal patients (men, 42%; mean [SD] age, 23.4 [5.6] years) were enrolled. At the 12-week follow-up point, 30 participants (83%) remained in the trial. Improvements on the Scale of Prodromal Symptoms and Scale to Assess Unawareness of Mental Disorder scores were statistically significant at end point. Although the Subjective Well-being Under Neuroleptics, Short version total scores improved significantly at 4 weeks, however, they did not change significantly from baseline at 8 weeks.
This trial suggests that aripiprazole not only produces a clinical benefit in prodromal subjects but also results in a high adherence to medication with immediate improvements in insight and subjective well-being. Although further placebo-controlled studies are needed, aripiprazole might be a first-line treatment for individuals at imminent risk for psychosis.
No preview · Article · Nov 2009 · Journal of clinical psychopharmacology
[Show abstract][Hide abstract] ABSTRACT: To describe clinical practice and research activities for early psychiatric intervention in Japan, a country with a huge number of psychiatric beds and a history of long-stay, hospital-based psychiatry.
The characteristics, methods and activities of early intervention studies and implementation at four leading institutions in Japan are described.
The Tokyo Youth Club (Tokyo), the Department of Neuropsychiatry of Toyama University Hospital (Toyama), the Sendai At-risk Mental State and First Episode (SAFE) service (Sendai), and the Il Bosco of Toho University Omori Medical Center (Tokyo) have unique and active psychiatric programmes. Eachcentre has its own clinical research programme and treatment strategies. The Japanese Society for the Prevention of Psychiatric Disorders, founded in 1996, has made a steady contribution to psychiatric care by providing a forum for members to promote best practices for early intervention and by hosting annual meetings to discuss research and treatment.
The Japanese psychiatry service is continuing its transition from hospital-based psychiatry to community-based psychiatry. Despite these difficult circumstances, the publication of data on the duration of untreated psychosis in Japan along with evidence that early detection determines outcome has encouraged new attempts to promote early psychiatric intervention.
No preview · Article · Feb 2009 · Early Intervention in Psychiatry