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Hatta K.,Juntendo University | Otachi T.,Gunma Psychiatric Medical Center | Sudo Y.,Tosa Hospital | Kuga H.,National Hospital Organization Hizen Psychiatric Center | And 11 more authors.
Psychiatry Research | Year: 2012

We examined whether augmentation with olanzapine would be superior to increased risperidone dose among acute schizophrenia patients showing early non-response to risperidone. We performed a rater-blinded, randomized controlled trial at psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. Early response was defined as Clinical Global Impressions-Improvement Scale score ≤ 3 following 2 weeks of treatment. Early non-responders were allocated to receive either augmentation with olanzapine (RIS + OLZ group) or increased risperidone dose (RIS + RIS group). The 78 patients who completed 2 weeks of treatment were divided into 52 early responders to risperidone and 26 early non-responders to risperidone (RIS + OLZ group, n=13; RIS + RIS group, n=13). No difference in the achievement of ≥ 50% improvement in Positive and Negative Syndrome Scale total score was observed between RIS + OLZ and RIS + RIS groups. Although time to treatment discontinuation for any cause was significantly shorter in the RIS + RIS group (6.8. weeks [95% confidence interval, 5.2-8.4]) than in early responders to risperidone (8.6. weeks [7.9-9.3]; P=0.018), there was no significant difference between the RIS + OLZ group (7.9. weeks [6.3-9.5]) and early responders to risperidone. Secondary outcomes justify the inclusion of augmentation arms in additional, larger studies comparing strategies for early non-responders. © 2012 Elsevier Ltd.


Shiina A.,Chiba University | Fujisaki M.,Chiba University | Nagata T.,National Center Hospital of Neurology and Psychiatry | Oda Y.,Chiba Psychiatric Medical Center | And 4 more authors.
Annals of General Psychiatry | Year: 2011

Background: In Japan, hospitalization for the assessment of mentally disordered offenders under the Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity (the Medical Treatment and Supervision Act, or the MTS Act) has yet to be standardized.Methods: We conducted a written survey that included a questionnaire regarding hospitalization for assessment; the questionnaire consisted of 335 options with 9 grades of validity for 60 clinical situations. The survey was mailed to 50 Japanese forensic mental health experts, and 42 responses were received.Results: An expert consensus was established for 299 of the options. Regarding subjects requiring hospitalization for assessment, no consensus was reached on the indications for electroconvulsive therapy (ECT) or for confronting the offenders regarding their offensive behaviors.Conclusions: The consensus regarding hospitalization for assessment and its associated problems were clarified. The consensus should be widely publicized among practitioners to ensure better management during the hospitalization of mentally disordered offenders for assessment. © 2011 Shiina et al; licensee BioMed Central Ltd.


Hatta K.,Juntendo University | Otachi T.,Gunma Psychiatric Medical Center | Fujita K.,Okehazama Hospital | Morikawa F.,Asahikawa Keisenkai Hospital | And 13 more authors.
Schizophrenia Research | Year: 2014

Purpose: We examined whether augmentation with olanzapine would be superior to switching to olanzapine among early non-responders (ENRs) to risperidone, and whether augmentation with risperidone would be superior to switching to risperidone among ENRs to olanzapine.We performed a rater-blinded, randomized clinical trial at psychiatric emergency sites. Eligible patients were newly admitted patients with acute schizophrenia. ENRs to the initial antipsychotic (Clinical Global Impressions-Improvement Scale: ≥. 4 at 2. weeks) were allocated to receive either augmentation with or switching to the other antipsychotic (RIS. +. OLZ vs. RIS-OLZ; OLZ. +. RIS vs. OLZ-RIS). Results: Sixty patients who completed 2. weeks of risperidone treatment were divided into 33 early responders (RIS-ER) and 27 ENRs (RIS. +. OLZ, n. =. 14; RIS-OLZ, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in RIS. +. OLZ group (54.1. days [95% confidence interval, 41.3-67.0]) than in RIS-ER group (68.7 [61.2-76.2]; P=. 0.050), it was not significantly shorter in RIS-OLZ group (58.5 [43.1-73.9]) than in RIS-ER group (P=. 0.19). Sixty patients who completed 2. weeks of olanzapine treatment were divided into 36 early responders (OLZ-ER) and 24 ENRs (OLZ. +. RIS, n. =. 11; OLZ-RIS, n. =. 13). Although time to treatment discontinuation for any cause was significantly shorter in OLZ-RIS group (56.1. days [40.7-71.5]) than in OLZ-ER group (74.9 [68.5-81.3]; P=. 0.008), it was not significantly shorter in OLZ. +. RIS group (64.6 [49.6-79.6]) than in OLZ-ER group (P=. 0.20). Conclusion: Despite the lack of pharmacokinetic investigation of dose adequacy in this study, it is possible that switching to olanzapine among ENRs to risperidone might have a small advantage over augmentation with olanzapine, while augmentation with risperidone might have a small advantage over switching to risperidone among ENRs to olanzapine. Further research is required before it would be appropriate to modify routine practice in the direction of these findings. © 2014.


Kimura H.,Chiba University | Kanahara N.,Chiba University | Komatsu N.,Dowa kai Chiba Hospital | Ishige M.,Satsuki kai Sodegaura satsukidai Hospital | And 18 more authors.
Schizophrenia Research | Year: 2014

Objective: Dopamine supersensitivity psychosis (DSP) is considered to be one cause of treatment-resistant schizophrenia (TRS). The authors investigated the efficacy of risperidone long-acting injections (RLAI) in patients with TRS and DSP. Method: This is a multicenter, prospective, 12-month follow-up, observational study that included unstable and severe TRS patients with and without DSP. 115 patients with TRS were recruited and divided into two groups according to the presence or absence of DSP which was judged on the basis of the clinical courses and neurological examinations. RLAI was administered adjunctively once every 2. weeks along with oral antipsychotics. We observed changes in scores for the Brief Psychiatric Rating Scales (BPRS), Clinical Global Impression-Severity of Illness (CGI-S), Global Assessment of Functioning Scale (GAF), and Extrapyramidal Symptom Rating Scale (ESRS) during the study. Of the assessed 94 patients, 61 and 33 were categorized into the DSP and NonDSP groups, respectively. Results: While baseline BPRS total scores, CGI-S scores and GAF scores did not differ, the ESRS score was significantly higher in the DSP group compared with the NonDSP group. Treatment significantly reduced BPRS total scores and CGI-S scores, and increased GAF scores in both groups, but the magnitudes of change were significantly greater in the DSP group relative to the NonDSP group. ESRS scores were also reduced in the DSP group. Responder rates (≥. 20% reduction in BPRS total score) were 62.3% in the DSP group and 21.2% in the NonDSP group. Conclusions: It is suggested that DSP contributes to the etiology of TRS. Atypical antipsychotic drugs in long-acting forms, such as RLAI, can provide beneficial effects for patients with DSP.Clinical trials registration: UMIN (UMIN000008487). © 2014 The Authors.


Suzuki T.,Chiba University | Suzuki T.,Koutoku kai Sato Hospital | Kanahara N.,Chiba University | Yamanaka H.,Chiba University | And 5 more authors.
Psychiatry Research | Year: 2015

There may be subtypes in treatment-resistant schizophrenia (TRS), and one of the subtypes may be related to dopamine supersensitivity psychosis (DSP). In developing strategies for prevention and treatment TRS, it is important to clarify the role of DSP in TRS. TRS patients were recruited from 3 hospitals for the present study. Through chart reviews, all patients were judged as either TRS or not, and then possible TRS patients were investigated about their past/present histories of DSP episode(s) by direct interviews. We then compared each factor between the groups with and without DSP episode(s). Out of 611 patients screened, 147 patients met the criteria for TRS and were included in the present analysis. These were divided into groups with and without DSP, comprising 106 (72.1%) and 41 patients (27.9%), respectively. Clinical characteristics in the two groups were similar, except for drug-induced movement disorders (DIMDs), which were significantly more important in DSP patients. Of the DSP patients, 42% and 56% experienced rebound psychosis and tolerance to antipsychotic effects, respectively. The present study revealed that approximately 70% of TRS patients experienced one or more DSP episodes, which may have a strong impact on the long-term prognosis of patients with schizophrenia. © 2015 Elsevier Ireland Ltd.


Yamanaka H.,Chiba University | Yamanaka H.,Chiba Psychiatric Medical Center | Kanahara N.,Chiba University | Suzuki T.,Chiba University | And 7 more authors.
Schizophrenia Research | Year: 2016

Background: Although a variety of factors are known to be significantly related to poor prognosis in schizophrenia, their interactions remain unclear. Dopamine supersensitivity psychosis (DSP) is a clinical concept related to long-term pharmacotherapy and could be one of the key factors contributing to the development of treatment-resistant schizophrenia (TRS). The present study aims to explore the effect of DSP on progression to TRS. Methods: Two-hundreds and sixty-five patients were classified into either a TRS or Non-TRS group based on retrospective survey and direct interview. The key factors related to prognosis, including the presence or absence of DSP episodes, were extracted, and each factor was compared between the two groups. Results: All parameters except for the duration of untreated psychosis (DUP) were significantly worse in the TRS group compared to the Non-TRS group. In particular, the TRS group presented with a significantly higher rate of DSP episodes than the Non-TRS group. Regression analysis supported the notion that DSP plays a pivotal role in the development of TRS. In addition, deficit syndrome was suggested to be a diagnostic subcategory of TRS. Conclusions: Our data confirmed that the key predicting factors of poor prognosis which have been established would actually affect somehow the development of TRS. In addition, the occurrence of a DSP episode during pharmacotherapy was shown to promote treatment refractoriness. © 2016 Elsevier B.V.


PubMed | Chiba University and Chiba Psychiatric Medical Center
Type: Journal Article | Journal: Schizophrenia research | Year: 2016

Although a variety of factors are known to be significantly related to poor prognosis in schizophrenia, their interactions remain unclear. Dopamine supersensitivity psychosis (DSP) is a clinical concept related to long-term pharmacotherapy and could be one of the key factors contributing to the development of treatment-resistant schizophrenia (TRS). The present study aims to explore the effect of DSP on progression to TRS.Two-hundreds and sixty-five patients were classified into either a TRS or Non-TRS group based on retrospective survey and direct interview. The key factors related to prognosis, including the presence or absence of DSP episodes, were extracted, and each factor was compared between the two groups.All parameters except for the duration of untreated psychosis (DUP) were significantly worse in the TRS group compared to the Non-TRS group. In particular, the TRS group presented with a significantly higher rate of DSP episodes than the Non-TRS group. Regression analysis supported the notion that DSP plays a pivotal role in the development of TRS. In addition, deficit syndrome was suggested to be a diagnostic subcategory of TRS.Our data confirmed that the key predicting factors of poor prognosis which have been established would actually affect somehow the development of TRS. In addition, the occurrence of a DSP episode during pharmacotherapy was shown to promote treatment refractoriness.


Nakanishi M.,Tokyo Metropolitan Institute of Medical Science | Niimura J.,Tokyo Metropolitan Institute of Medical Science | Tanoue M.,Tokyo Medical and Dental University | Yamamura M.,Tokyo Metroplitan University | And 2 more authors.
International Journal of Mental Health Systems | Year: 2015

Background: Japan has introduced an acute psychiatric care unit to the public healthcare insurance program, but its requirement of a shorter length of stay could lead to discharges without proper discharge planning. The aim of this study was to examine the association between the implementation of discharge planning and the length of stay of acute psychiatric inpatients in Japan. Methods: This retrospective cross-sectional study included 449 patients discharged from the 'psychiatric emergency ward' of 66 hospitals during a two-week period from March 7 to 20, 2011. The assigned nurse or nursing assistant for each patient provided information on the implementation of discharge planning in the hospital stay. Results: Approximately one quarter of the 449 patients (n = 122) received no support for coordination with post-discharge community care resources. The 122 patients who had received no support for community care coordination had a significantly lower mean age at admission, a shorter length of stay, and a higher rate of either no follow-up or unidentified post-discharge outpatient service than the other 327 patients. Multilevel linear regression analysis demonstrated a significantly greater length of stay among patients who were older, those who had a primary diagnosis of schizophrenia, those who were admitted compulsorily, those who received hospital outpatient services, and those who received community care coordination support from the assigned nurse or nursing assistant. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. Conclusion: Patients to whom the assigned nurse or nursing assistant provided support on community care coordination experienced a significantly greater length of hospital stay. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. The mental health policy should increase focus on discharge planning in the acute psychiatric setting to enhance a link between psychiatric inpatient care and post-discharge community care resources. © Nakanishi et al.


Watari M.,Nippon Medical School | Hamazaki K.,University of Toyama | Hirata T.,Chiba Psychiatric Medical Center | Hamazaki T.,University of Toyama | Okubo Y.,Nippon Medical School
Psychiatry Research | Year: 2010

Many reports suggest that n-3 polyunsaturated fatty acids (PUFAs) influence the symptoms of psychiatric disorders. Moreover, it has also been reported that n-3 PUFAs control aggression and hostility. Acute symptoms of schizophrenia such as aggression can be a formidable clinical problem resulting in hospitalization. However, few investigations have determined the relationships between acute symptoms of drug-free schizophrenia and n-3 PUFAs. We recruited 75 inpatients with acute drug-free schizophrenia admitted to Chiba Psychiatric Medical Center, an emergency psychiatric hospital. Blood was sampled immediately after admission. The red blood cell (RBC) fatty acid composition and hostility score of Positive and Negative Syndrome Scale (PANSS) scores were measured. Multiple regression analysis showed that the concentrations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the ratio of EPA/arachidonic acid (AA) in RBC showed significant negative correlations with the hostility score of PANSS scores after adjustment for age and sex. AA, on the other hand, showed significant positive correlations. The tissue n-3 PUFA and n-6 PUFA levels were negatively and positively associated with the hostility score of PANSS scores, respectively, suggesting possible effects of PUFA levels on hostile behavior in patients with schizophrenia. © 2010 Elsevier Ltd.


PubMed | Tokyo Metroplitan University, Tokyo Medical and Dental University, Tokyo Metropolitan Institute of Medical Science and Chiba Psychiatric Medical Center
Type: | Journal: International journal of mental health systems | Year: 2015

Japan has introduced an acute psychiatric care unit to the public healthcare insurance program, but its requirement of a shorter length of stay could lead to discharges without proper discharge planning. The aim of this study was to examine the association between the implementation of discharge planning and the length of stay of acute psychiatric inpatients in Japan.This retrospective cross-sectional study included 449 patients discharged from the psychiatric emergency ward of 66 hospitals during a two-week period from March 7 to 20, 2011. The assigned nurse or nursing assistant for each patient provided information on the implementation of discharge planning in the hospital stay.Approximately one quarter of the 449 patients (n=122) received no support for coordination with post-discharge community care resources. The 122 patients who had received no support for community care coordination had a significantly lower mean age at admission, a shorter length of stay, and a higher rate of either no follow-up or unidentified post-discharge outpatient service than the other 327 patients. Multilevel linear regression analysis demonstrated a significantly greater length of stay among patients who were older, those who had a primary diagnosis of schizophrenia, those who were admitted compulsorily, those who received hospital outpatient services, and those who received community care coordination support from the assigned nurse or nursing assistant. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission.Patients to whom the assigned nurse or nursing assistant provided support on community care coordination experienced a significantly greater length of hospital stay. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. The mental health policy should increase focus on discharge planning in the acute psychiatric setting to enhance a link between psychiatric inpatient care and post-discharge community care resources.

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