Yoshio Hirayasu’s research while affiliated with Yokohama City University and other places

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Publications (220)


Changes in health-related quality of life in patients admitted to emergency departments for attempted suicide: Findings from a large longitudinal study
  • Article

November 2023

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16 Reads

Journal of Affective Disorders

Kenji Narita

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Chiaki Kawanishi

shows results of the Cox analysis in women. Significant factors in
Predictive factors for recurrent suicide attempts: Evidence from the ACTION‐J study
  • Literature Review
  • Full-text available

June 2022

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35 Reads

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4 Citations

Aim Risk factors for attempted suicide have been widely studied. However, there is limited evidence on predictive factors for suicide reattempts. We aimed to identify these in suicide attempters admitted to emergency departments. Methods This is the second analysis from a randomized controlled multicenter trial, ACTION‐J. Patient characteristics were extracted from baseline demographic data and clinical data of participants. Predictive factors for a recurrent suicide attempt in each gender were examined using Cox proportional hazards regression analysis. Dependent variables were months from trial entry to the first reattempt. Independent variables were characteristics regarded as potential predictive factors. Results The study included 914 adults (400 men and 514 women). A visit to a psychiatrist within a month of the suicide attempt was significantly associated with reattempts in men (hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21–5.25). Substance‐related disorders (HR 3.65, 95% CI 1.16–7.9.60), drinking alcohol less than once per month (HR 0.42, 95% CI 0.17–0.88), previous suicide attempts (HR 2.28, 95% CI 1.40–3.87), and taking a drug overdose for the first suicide attempt (HR 1.82, 95% CI 1.14–3.01) were significantly associated with reattempts in women. Conclusion Our data highlight the importance of visits to a psychiatrist a short time before the first suicide attempt in men and substance‐related disorder, previous suicide attempts, and drug overdose in the first suicide attempt in women as predictive factors for future suicide reattempts.

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Thirty-one adolescent patients with anorexia nervosa showed significant reductions of gray matter volumes (line A), white matter volumes (line B), and cortical thickness (line C) compared with the 18 healthy control subjects at the baseline acute phase. Abbreviations: L, left; R, right
Sixteen weight-recovered adolescent patients with anorexia nervosa demonstrated significant reductions in gray matter in the left hippocampus (line A) and in white matter in the pons (line B) compared with the 13 healthy control subjects at the follow-up scan. Abbreviations: L, left; R, right
Structural brain abnormalities in adolescent patients with anorexia nervosa at both the acute and weight-recovered phase

June 2022

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73 Reads

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4 Citations

Brain Imaging and Behavior

Previous cross-sectional studies have reported that adolescent patients with anorexia nervosa (AN) showed global gray matter volume (GMV) reductions at the acute phase which were restored at the weight-recovered phase, compared with healthy controls (HC). However, few studies have investigated white matter volume (WMV) or cortical thickness in the context of AN, and results have been inconsistent. Voxel-based morphometry analyses for GM and WM, and cortical thickness analyses for GM were conducted in 31 adolescent patients with AN (vs. 18 HC) in the acute phase, and 16 patients with AN (vs. 13 HC) in the follow-up weight-recovered phase, over an approximately 1-year follow-up interval. At the acute phase, the AN patients showed significant reductions of GMVs and cortical thickness in widespread brain regions, compared with HC. Significant WMV reductions were identified in the bilateral superior longitudinal fascicle, superior thalamic radiation, corona radiata, and fornix, pons, and medulla in the patients. At the weight-recovered phase, the AN patients showed a significant GMV reduction in the left hippocampus, and a WMV reduction in the pons, compared with the HC. There was no difference in cortical thickness between two groups at the weight-recovered phase. In conclusion, the widespread volumetric reductions in GM and WM, and reduced cortical thickness observed in AN patients in the acute phase were not evident in the follow-up weight-recovered phase. The volume reductions observed in the hippocampus and pons in the weight-recovered phase could potentially reflect delayed neurogenesis or recovery from starvation in the AN patients.


A case of Parkinson’s disease that gabapentin improved both visual hallucination and pain

Visual hallucinations (VH) and pain are common non-motor symptoms in Parkinson's disease (PD). VH are present in about 25% and pain in 40% of the PD patients. Although dopaminergic dysfunction has traditionally been considered as the main cause of these symptoms, another neuronal pathways involved in generation of VH and pain are not yet well understood. Conventional treatment, a decrease in dopamine agonists and the use of antipsychotic medications, often leads to an exacerbation of motor symptoms and excessive sedation. Alternative treatments to alleviate these symptoms have been expected.  Gabapentin (GPT) is an anti-epilepsy drug, which affects the glutamic acid neuron system and the gamma-amino butyric acid (GABA) neuron system. It also has an analgesic effect, which is presumed to be brought about by its inhibitory effect on the release of glutamate in the central nervous system.  Here we report that GPT improved both VH and pain in a patient with PD. In this case, VH and pain persisted even after the conventional treatment. Moreover, an exacerbation of motor symptoms and excessive sedation hindered further treatment. After we administered GPT, VH disappeared in addition to the pain, without any adverse effects. VH and pain in PD might be associated with non-dopaminergic pathways based on the pharmacological results. Patient: 81 years old Japanese male Chief Compliment: VH of insects and pain caused by these insects Past Medical History & Family History: Nothing particular. Social History: Normal growth and development. University degree. Got married and had two children in his 30's. Had worked at a trading company for 40 years. Habits: Drinking-2 glasses of wine (60 years), Smoking-5 cigarettes (60years) History of Present Illness: His medical history started with a slight resting tremor in his left hand at the age of 63. Since he was diagnosed with PD at the age of 67, he had been managed well with the following anti-Parkinson drugs: levodopa/carbidopa (300mg), pergolide (5mg), cabergoline (2mg) and amantadine (100mg). He remained able to play golf until he exhibited gait disorder, postural instability at the age of 78. He developed VH of insects when he was 79 years old and complain of obstinate pain, which was, as he described, caused by these insects invading his body through his urethra and anus. His doctor withdrew amantadine and switched from pramipexole to ropinirole, but VH and pain remained. Therefore, he was referred to our hospital. Findings at Admission: Physical examination-Dropped head and camptocormia were obsereved. Normal hip range of mortion. Neurological findings-(Mental status) consciousness alert. (Cranial nerves) intact. (Motor) Manual Muscle Test; full, Unified Parkinson's Disease Rating Scale Part III: 44pt, Hoehn and Yahr staging scale: IV, wearing-off: none, dyskinesia: none, akathisia: none, (Sensory) pinprick, temperature, vibration: WNL. Pain: worm-crawling sensation in his left inguinal region and his left leg. (Deep tendon reflexes) WNL, (Coordination) WNL, (Autonomic nervous function) constipation (+), pollakiuria (+), orthostatic hypotension (+), (Cognitive function) slightly fluctuated, Mini Mental State Examination score: 25/30. (Psychiatric status) A portly Japanese male, appearing as old as his age. The speed and the length of his response proper and his speech is concise. He gestures as if he were picking out or brushing away worms. He also complains about the pain caused by invasion of the worms he sees. This complaint is persistent regardless of his cognitive status. Test findings: Laboratory test findings: Nothing particular. X-ray photographs: Nothing particular in his chest, abdomen, hip joint and spine. Head MRI (figure 1) : Diffuse mild cerebral atrophy, no white matter changes. IMP-SPECT (figure 2) : Diffuse hypoperfusion, most remarkable in the right parietal lobe and right occipital lobe. Striatal dopamine transporter imaging using ioflupane (123 I) (figure 3) : Marked reduction in the dopaminergic neurons of the striatal region. MIBG myocardial scintigraphy: Low uptake and an increased washout rate. The heart mediastinum ratio: 1.42 (early), 1.22 (late). The washout rate: 55.5%. Medication: levodopa (300mg), cabergoline (2mg), rotigotine (4.5mg), ropinirole (4mg) Progress after Admission: Considering such a high dosage of anti-Parkinson drugs, we first reduced ropinirole to 2mg, but there was no change in VH and a resting tremor appeared. We then administered quetiapine (12.5mg), however, VH persisted and an excessive sedation hindered further treatment. GPT was administered for an anticipated analgesic effect. After increasing the dosage to 600mg (twice daily), the frequency and duration of painful sensations decreased day by day, and coincidentally VH disappeared. Neither excessive sedation nor exacerbation of motor symptoms was observed. He has been managed without recurrence of VH, pain or any adverse effects for 10 months since he was discharged from our hospital.



Clinical evidence that a dysregulated master neural network modulator may aid in diagnosing schizophrenia

August 2021

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124 Reads

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6 Citations

Proceedings of the National Academy of Sciences

Significance There are no biomarkers for schizophrenia (SCZ), a disorder of dysfunctional neural networks. We demonstrate that a master regulator of cytoskeleton (“CRMP2”) and, hence, neural circuitry, may form the basis for such a biomarker because its activity is uniquely imbalanced in SCZ patients. We show that SCZ patients are characterized by an excess of active CRMP2 not only in their brains (where it is correlated with dendritic abnormalities) but also in their peripheral blood lymphocytes. The abundance of active CRMP2 and insufficiency of opposing inactive p-CRMP2 likely disrupts neuronal function. Because peripheral blood CRMP2 appears to reflect intracerebral processes, it could form the basis of a rapid, minimally invasive, sensitive, and specific clinical diagnostic aid for SCZ in young patients.


Effectiveness of assertive case management for patients with suicidal intent

July 2021

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18 Reads

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5 Citations

Psychiatry Research

The aim of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicide intent admitted to emergency departments and with a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management or enhanced usual care. The primary outcome measure was the incidence of a first recurrent suicide attempt within 6 months. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group. The incidence of a first recurrent suicide attempt within 1 and 3 months was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period. Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group. Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.


Automated delineation of the hippocampal subfields. Left: coronal slice. Right: sagital slice. Abbreviations: CA, Cornu Ammonis; DG, Dentate Gyrus
Relative volumes of the right hippocampal subfield Cornu Ammonis (CA) 2/3 in patients with panic disorder and healthy control subjects. P < .004
Smaller volume of right hippocampal CA2/3 in patients with panic disorder

February 2021

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49 Reads

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10 Citations

Brain Imaging and Behavior

The hippocampus is thought to play an important role in conveying contextual information to the amygdala as the neural basis of panic disorder (PD). Previous studies have revealed functional abnormalities in the hippocampus in patients with PD compared with healthy control subjects (HC), but no study has reported volume abnormalities in the hippocampus or evaluated minute structural changes in the hippocampus in such patients. We thus investigated volume abnormalities in the subfields of the hippocampus to better understand the neurobiological basis of PD. The hippocampus was extracted from structural brain magnetic resonance images obtained from 38 patients with PD and 38 HC and then segmented into six subfields. The relative volume of each subfield was compared between the two groups. The severity of symptoms was assessed using the Panic Disorder Severity Scale (PDSS) and social functioning was assessed using the Global Assessment of Functioning (GAF) scale. Our results revealed that patients with PD had a significantly smaller volume of the right cornu ammonis (CA) 2/3 hippocampal subfield compared with HC. No significant associations were found between the volumes of the right CA 2/3 and the PDSS or GAF scores in correlation analyses. In conclusion, CA2/3 is thought to be related to contextual memory function, and our results suggest that this particular hippocampal subfield plays a role in the development of PD symptoms.



Clinical trials that targeted self- poisoning.
Baseline characteristics.
Effects on rst recurrent episodes after attempted suicide in intervention and control groups.
Effectiveness of Assertive Case Management for Patients with Suicidal Intent Admitted to Emergency Departments Following Attempted Suicide by Self-Poisoning: A Secondary Analysis of the ACTION-J Study

June 2020

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146 Reads

Background: Self-poisoning is commonly observed in individuals as a component of suicide attempts and self-harm. The effectiveness of interventions for self-poisoning is unclear. The objective of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. Methods: We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicidal intent who were admitted to emergency departments and who had a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management (intervention group) or enhanced usual care (control group). The primary outcome measure was the incidence of a first recurrent suicidal attempt within 6 months after group assignment. Results: There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group (risk ratio [RR]: 0.473, 95% confidence interval [CI]: 0.284 to 0.788). The incidence of a first recurrent suicidal attempt within 1 and 3 months after group assignment was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period (incidence rate ratio [IRR]: 0.711, 95% CI: 0.582 to 0.866). Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group than in the control group. Conclusion: Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients. Trial Registration: This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444).


Citations (78)


... 13 The secondary analysis also elucidated the importance of visits to a psychiatrist a short time before the first suicide attempt in men and in women with substance-related disorder, previous suicide attempts, and drug overdose in the first suicide attempt as predictive factors for future suicide reattempts. 14 The results of the present study indicated successful implemen- whether an assertive outreach intervention could reduce the frequency of subsequent suicide attempts relative to standard treatment. 16 In that study, five of 123 participants in the intervention group did not actually receive the intervention, because they withdrew from the study (even though the intervention schedule was flexible). ...

Reference:

Implementations of an evidence‐based assertive case management intervention for suicide attempters: Post‐ACTION‐J Study (PACS)
Predictive factors for recurrent suicide attempts: Evidence from the ACTION‐J study

... In this study, we did not find significant differences in the bilateral whole hippocampal GMV between individuals with AN and HCs. This finding contrasts with previous research suggesting a reduction in total hippocampal volume among patients with AN [16,43,44]. Regarding the hippocampal subfields, the study indicated decreased GMV in the right HATA among AN patients. ...

Structural brain abnormalities in adolescent patients with anorexia nervosa at both the acute and weight-recovered phase

Brain Imaging and Behavior

... CRMP2 activity is also regulated by the mammalian target of rapamycin (mTOR), a kinase which mediates translation efficiency of CRMP2 by phosphorylating translation initiation proteins that bind to a 5' Terminal OligoPyrimidine (TOP) motif in the 5' untranslated region (UTR) of CRMP2 mRNA [12][13][14]. Disruptions in the expression and regulation of CRMP2 have been documented in numerous psychiatric and neurological disorders, including schizophrenia [2,10,12,[15][16][17][18][19], bipolar disorder [2,15,16,19], Alzheimer's disease [20][21][22], autism spectrum disorder [23], intellectual disability [24], major depressive disorder [2,16], Down's syndrome [2,25], neurofibromatosis [2], multiple sclerosis [2,26,27], and amyotrophic lateral sclerosis [2,26]. Variation in CRMP2 phosphorylation was recently determined to be altered in the blood and brain of patients with bipolar disorder and schizophrenia [19], indicating that CRMP2 may be a novel biomarker that could aid diagnosis. ...

Clinical evidence that a dysregulated master neural network modulator may aid in diagnosing schizophrenia

Proceedings of the National Academy of Sciences

... In the 29 included reviews, 87 relevant primary papers were identified, reporting on 82 primary 310 studies. 32 (39.0%) primary studies were conducted in the USA , 22 (26.8%) in the UK 311 (80, , 4 (4.9%) in Ireland (137)(138)(139)(140), 4 (4.9%) in Germany (141-144), 4 (4.9%) in France (145-312 148), 3 (3.7%) in Canada (149-151), 3 (3.7%) in Switzerland (152-154), 2 (2.4%) in Australia 313 (155,156), and 1 (1.2%) each in New Zealand (157), French Polynesia (158), Japan (159), Taiwan 314 (160), South Korea (161), Spain (162,163), and Italy (164). One study (1.2%) had sites in Brazil, India, 315 Sri Lanka, Iran and China (165,166). ...

Effectiveness of assertive case management for patients with suicidal intent
  • Citing Article
  • July 2021

Psychiatry Research

... Schizophrenia has been suggested to be a language-related disorder (Little et al., 2019;Nakamura et al., 2021;Strik et al., 2017) with structural abnormalities in language network constituting an important role in the pathophysiological mechanism (Li et al., 2012;Moberget et al., 2018;van Erp et al., 2018). Our observation implicating the superior temporal and inferior frontal gyrus, the core regions of the language network, along with the premotor cortex, the frontal operculum, the middle temporal gyrus, and the angular gyrus, is consistent with prior studies of cortical thinning (Massey et al., 2017;Nakamura et al., 2021) and structural dysconnectivity (Das et al., 2020;Palaniyappan et al., 2020Palaniyappan et al., , 2023. ...

Illness management and recovery program induced neuroprotective effects on language network in schizophrenia
  • Citing Article
  • September 2020

Schizophrenia Research

... And, in the Japanese sample, we found more articles without lost-to-follow-up participants [26,28,35,42,43]. In both samples, most studies were non-randomized for the convenience of accessible patient groups, except for four studies in the Spanish sample [24,34,44,45] and eight in the Japanese sample [37,38,[46][47][48][49][50][51]. Finally, as to the characteristics of the samples of the articles, they are explained in detail in the following section. ...

Effect of assertive case management intervention on suicide attempters with comorbid Axis I and II psychiatric diagnoses: secondary analysis of a randomised controlled trial

BMC Psychiatry

... Two questionnaire forms were designed by our center's psychiatrist based on the Beck Hopelessness and SI scale, which were filled through a direct interview with the patients [10]. All the patients who filled out the forms had gone through at least 6 months of both out-patient and in-patient chemotherapy. ...

Hopelessness is associated with repeated suicidal behaviors after discharge in patients admitted to emergency departments for attempted suicide
  • Citing Article
  • May 2020

Journal of Affective Disorders

... Darby et al. [15] proposed a novel concept to reconcile these inconsistencies. In contrast to traditional assumptions that disease-associated abnormalities should be consistently localized to specific brain regions [16,17], they proposed that brain abnormalities associated with neuropsychiatric diseases are more likely localized within common brain networks [18,19]. This theory has been validated in a variety of neurology and psychiatry diseases, such as migraine [20], major depressive disorder [21], and transdiagnostic psychiatric disorders [22], using "coordinate network mapping" (CNM), a validated method derived from lesion network mapping [23] in which the coordinates of abnormalities from neuroimaging studies are mapped to independently defined networks [15]. ...

Structural abnormalities in nucleus accumbens in patients with panic disorder
  • Citing Article
  • April 2020

Journal of Affective Disorders

... Not only that, excess cortisol can contribute to the development of anxiety by damaging hippocampal neurons [48]. An imaging study revealed that PD patients had a significantly smaller volume of the right cornu ammonis 2/3 hippocampal subfield compared to controls [49], and antidepressant treatment can counteract the reduction in hippocampal volume [50]. These results may contribute to our understanding of the effects of escitalopram on neuroendocrine hormones in PD patients. ...

Smaller volume of right hippocampal CA2/3 in patients with panic disorder

Brain Imaging and Behavior

... To this end, many psychiatric structures have initiated a deinstitutionalization movement defined as "a complex process in which a reduction in psychiatric beds is associated with the implementation of community-based alternatives aimed at avoiding the internment of individuals suffering from psychological pathologies" (4). Within a structure dedicated to day care, outpatient mental health services or through supported housing (often supported by the work of a psychosocial rehabilitation team), many individuals have been able to benefit from support anchored in the social fabric, the benefits of which have been commented on in the scientific literature (3,(5)(6)(7)(8)(9)(10). ...

Clinical and Brain Structural Effects of the Illness Management and Recovery Program in Middle‐aged and Older Patients with Schizophrenia
  • Citing Article
  • July 2019

Psychiatry and Clinical Neurosciences