Okayama Psychiatric Medical Center

Okayama-shi, Japan

Okayama Psychiatric Medical Center

Okayama-shi, Japan
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Yoshimura B.,Okayama Psychiatric Medical Center | Yoshimura B.,Okayama University of Science | Yada Y.,Okayama Psychiatric Medical Center | So R.,Okayama Psychiatric Medical Center | And 2 more authors.
Psychiatry Research | Year: 2017

Previous studies have suggested that a delay in initiating clozapine is one of the predictors of outcomes in treatment-resistant schizophrenia (TRS). However, whether there is a critical treatment window of clozapine in TRS and the duration of that window remain unclear. We conducted a secondary analysis of a previously published observational study using a retrospective chart review of 105 patients with TRS who were treated with clozapine. We included 90 patients who remained on clozapine for at least 3 months. The delay in initiating clozapine was an independent contributor to symptomatic improvement based on treatment with clozapine by multiple linear regression analysis. A receiver operating characteristic curve analysis (area under the curve: 0.78) confirmed 2.8 years was the best predictive cut-off value of delay in initiating clozapine for responses in patients treated with clozapine (sensitivity: 0.66, specificity: 0.84). In patients with a delay in initiating clozapine of ≤2.8 years and a delay in initiating clozapine of >2.8 years, the response rates were 81.6% and 30.8% (risk ratio=2.65; 95% confidence interval, 1.80, 3.63), respectively. Clinicians should reduce the delay in initiating clozapine to less than 3 years to improve symptomatic outcomes in TRS and to prevent clozapine-resistant schizophrenia. © 2017 Elsevier Ireland Ltd

Komoto Y.,Kurihama Medical and Addiction Center | Komoto Y.,Okayama Psychiatric Medical Center
International Journal of Mental Health and Addiction | Year: 2014

Pathological gambling can lead to a number of deleterious consequences, including bankruptcy and suicide. The present study examined the correlation between clinical characteristics of pathological gamblers and history of bankruptcy and suicide attempts. Subjects (141; 124 male) were outpatients at a psychiatric hospital from 2007 to 2010. Demographic and medical variables including age, gender, age of gambling onset, psychiatric complications, suicide attempts, and bankruptcy were assessed. Positive correlations were observed between suicide attempt and female gender, family history of addiction, and unemployment (p < 0.05). Similar variables correlated with bankruptcy (p < 0.05). Multivariate analysis revealed that a family history of addiction was the strongest independent predictor of suicide and bankruptcy. Results suggest that treatment for pathological gambling should address the patient's past experience with addict family members, especially if the patient reports a history of bankruptcy or suicidal ideation. © 2014 The Author(s).

PubMed | Yura Hospital, Kawada Hospital, Sekizen Hospital, Kurashiki Shinkeika Hospital and 14 more.
Type: Journal Article | Journal: Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society | Year: 2016

Artificial nutrition, including tube feeding, continues to be given to dementia patients in numerous geriatric facilities in Japan. However, the clinical characteristics of patients receiving artificial nutrition have not been fully investigated. Therefore, we tried to evaluate the clinical features of those patients in this study.Various clinical characteristics of all inpatients at 18 of 20 psychiatric hospitals in Okayama Prefecture, Japan, with a percutaneous endoscopic gastrostomy tube, nasogastric tube, or total parenteral nutrition were evaluated.Two hundred twenty-one patients (5.4% of all inpatients) had been receiving artificial nutrition for more than 1 month, and 187 (130 women, 57 men; 84.6% of 221 patients) were fully investigated. The mean age was 78.3 years old, and the mean duration of artificial nutrition was 29.8 months. Eighty-four patients (44.7% of 187 patients) were receiving artificial nutrition for more than 2 years. Patients with Alzheimers disease (n = 78) formed the biggest group, schizophrenia (n = 37) the second, and vascular dementia (n = 26) the third.About one-fifth of the subjects receiving artificial nutrition were in a vegetative state. More than a few patients with mental disorders, including schizophrenia, also received long-term artificial nutrition. We should pay more attention to chronic dysphasia syndrome in mental disorders.

PubMed | Kobe University, Kurashiki Central Hospital, University of California at San Francisco, Okayama Psychiatric Medical Center and The Zucker Hillside Hospital
Type: Case Reports | Journal: General hospital psychiatry | Year: 2015

There are prior reports describing a diagnostic delay in medical emergencies in patients with schizophrenia. To our knowledge, this is the first case report demonstrating the risk of diagnostic delay of acute meningitis due to reduced pain perception as well as other factors related to schizophrenia and its treatment.We report a case of meningitis in a patient suffering from chronic schizophrenia and poor treatment response despite high doses of antipsychotics. Potential difficulties and pitfalls when suspecting or diagnosing meningitis as a physical comorbidity in patients with schizophrenia are discussed.A 33-year-old man with chronic and treatment-resistant schizophrenia developed acute meningitis. The definite diagnosis was delayed because the cardinal symptoms other than fever were not clearly elicited by physical examination. The characteristic symptoms of meningitis were concealed by reduced pain perception, rigidity due to the administration of antipsychotics, disorganized thinking and potentially diminished communication with health care professionals as commonly seen in patients with schizophrenia.Meningitis should not be dismissed as a possibility in patients with fever of unknown origin just because a patient with schizophrenia does not present with cardinal features of meningitis other than fever.

PubMed | Gifu University, Japan National Cardiovascular Center Research Institute, Okayama Psychiatric Medical Center, Osaka University and 14 more.
Type: Journal Article | Journal: Biological psychiatry | Year: 2016

Clozapine-induced agranulocytosis (CIA)/clozapine-induced granulocytopenia (CIG) (CIAG) is a life-threatening event for schizophrenic subjects treated with clozapine.To examine the genetic factor for CIAG, a genome-wide pharmacogenomic analysis was conducted using 50 subjects with CIAG and 2905 control subjects.We identified a significant association in the human leukocyte antigen (HLA) region (rs1800625, p = 3.46 10(-9), odds ratio [OR] = 3.8); therefore, subsequent HLA typing was performed. We detected a significant association of HLA-B*59:01 with CIAG (p = 3.81 10(-8), OR = 10.7) and confirmed this association by comparing with an independent clozapine-tolerant control group (n = 380, p = 2.97 10(-5), OR = 6.3). As we observed that the OR of CIA (OR: 9.3~15.8) was approximately double that in CIG (OR: 4.4~7.4), we hypothesized that the CIG subjects were a mixed population of those who potentially would develop CIA and those who would not develop CIA (non-CIA). This hypothesis allowed the proportion of the CIG who were non-CIA to be calculated, enabling us to estimate the positive predictive value of the nonrisk allele on non-CIA in CIG subjects. Assuming this model, we estimated that 1) ~50% of CIG subjects would be non-CIA; and 2) ~60% of the CIG subjects without the risk allele would be non-CIA and therefore not expected to develop CIA.Our results suggest that HLA-B*59:01 is a risk factor for CIAG in the Japanese population. Furthermore, if our model is true, the results suggest that rechallenging certain CIG subjects with clozapine may not be always contraindicated.

Kobayashi K.,Okayama University of Science | Yorifuji T.,Okayama University of Science | Yamakawa M.,Okayama University of Science | Oka M.,Okayama University of Science | And 4 more authors.
Brain and Development | Year: 2015

Objective: Behavioral problems are often associated with poor sleep habits in children. We investigated whether undesirable toddler-age sleep schedules may be related to school-age behavioral problems. Methods: We analyzed the data of a nationwide longitudinal survey with available results from 2001 to 2011. The participants were 41,890 children. The predictors were waking time and bedtime at 2. years of age, and the outcomes were assessed by determining the presence or absence of three attention problems and four aggressiveness problems at 8. years of age. In logistic regression models with adjustments for confounding factors, we estimated odds ratios (ORs) and confidence intervals (CIs) for the association between toddler sleep schedules and behavior during primary-school age years. Results: The outcomes of attention problems and aggressiveness problems were observed in 1.7% and 1.2% of children, respectively, at 8. years of age. The OR of an irregular or late morning waking time at 2. years of age with the outcome of aggressiveness problems was 1.52 (95% CI, 1.04-2.22) in comparison to an early waking time. The OR of an irregular or late bedtime with attention problems was 1.62 (95% CI, 1.12-2.36), and the OR of an irregular or late bedtime with aggressiveness problems was 1.81 (95% CI, 1.19-2.77) in comparison to an early bedtime. Conclusion: Poor toddler-age sleep schedules were found to predict behavioral problems during primary-school age years. Thus, good and regular sleep habits appear to be important for young children's healthy development. © 2014 The Japanese Society of Child Neurology.

Yorifuji T.,Okayama University of Science | Kubo T.,National Hospital Organization | Yamakawa M.,Okayama University of Science | Kato T.,Hiroshima University | And 4 more authors.
Journal of Pediatrics | Year: 2014

Objective To prospectively examine the prolonged effect of breastfeeding on behavioral development. Study design We used a large, nationwide Japanese population-based longitudinal survey that began in 2001. We restricted participants to term singletons with birth weight >2500 g (n = 41 188). Infant feeding practice was queried at age 6-7 months. Responses to survey questions about age-appropriate behaviors at age 2.5 and 5.5 years were used as indicators of behavioral development. We conducted logistic regression analyses, controlling for potential child and parental confounding factors, with formula feeding as the reference group. Results We observed a dose-response relationship between breastfeeding status and an inability to perform age-appropriate behaviors at both ages. With a single exception, all ORs for outcomes for exclusive breastfeeding were smaller than those for partial feeding of various durations. The protective associations did not change after adjustment for an extensive list of confounders or in the sensitivity analyses. Conclusion We observed prolonged protective effects of breastfeeding on developmental behavior skills surveyed at age 2.5 and 5.5 years. Beneficial effects were most likely in children who were breastfed exclusively, but whether a biological ingredient in breast milk or extensive interactions through breastfeeding, or both, is beneficial is unclear. © 2014 The Authors.

Yoshimura B.,Okayama Psychiatric Medical Center | Yoshimura B.,Okayama University | Hirota T.,Vanderbilt University | Takaki M.,Okayama University | Kishi Y.,Okayama Psychiatric Medical Center
Neuropsychiatric Disease and Treatment | Year: 2013

Purpose: We aimed to determine which antipsychotic is most effective for the treatment of acute schizophrenia with catatonic stupor. Patients and methods: Data were obtained from the medical records of 450 patients with the diagnosis of schizophrenia, who had received acute psychiatric inpatient treatment between January 2008 and December 2010 at our hospital. Among them, 39 patients (8.7%) met the definition of catatonic stupor during hospitalization. The diagnoses of schizophrenia in all 39 patients were reconfirmed during the maintenance phase. We retrospectively reviewed the medical records of these 39 patients to investigate which antipsychotics were chosen for treatment during the period from admission to recovery from catatonia, at the time of discharge, and 12 and 30 months after discharge. Results: As compared to other antipsychotics, it was found out that use of quetiapine had better outcomes and hence was used more often. A total of 61.5% of patients were on quetiapine at the time of recovery from catatonia and 51.3% of patients were on quetiapine at the time of discharge as compared to only 17.9% of patients on quetiapine on admission. However, at 12 and 30 months after discharge, the rates had decreased to 38.4% and 25.6%. Similarly, of 29 patients who were not administered electroconvulsive therapy, quetiapine was used at significantly higher rates at the time of recovery from catatonia (48.3%) than at the time of admission (17.2%). All 39 patients had received an antipsychotic as the first-line treatment and some antipsychotics might have contributed to the development of catatonia. Conclusion: This study suggests that quetiapine is a promising agent for the treatment of schizophrenia with catatonic stupor during the acute phase. © 2013 Yoshimura et al.

Yasunobu K.,Okayama Psychiatric Medical Center
Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence | Year: 2013

The present study investigated the effectiveness of topiramate (TPM) treatment for decreasing alcohol consumption in alcoholics. Alcoholics of outpatients, relapsed repeatedly, were included in this study. The study was conducted over 24 weeks. Subject characteristics (e.g., gender) and medical variables (e.g., age of onset) were recorded. Autistic features were determined using the Autism - Spectrum Quotient (>or=27 points). The average daily alcohol consumption was assessed at the start of the study and at 4, 12, and 24 weeks after its start. The five-step alcohol consumption scale of the Obsessive-Compulsive Drinking Scale (OCDS) was used. The extent of the change between the first assessment and subsequent assessment was considered the primary evaluation point. Responders were defined as subjects showing an improvement of at least two steps in the score. Patients not treated with TPM were retrospectively selected according to the same criteria on the basis of their medical records and were used as controls. The TPM group was further subdivided into responders and nonresponders. Of the 31 subjects who consented to TPM therapy, 11 stopped or discontinued TPM, and they were considered nonresponders. The average TPM maintenance dosage (standard deviation) was 62.9 (38.1) mg. Alcohol consumption scores significantly decreased at each assessment point in the study. The percentage of responders in the TPM group (n = 31) was significantly higher than that in the control group (n = 41) at the 24-week assessment point (45.2% vs. 19.5%, p=0.0193). A significant difference was observed between responders (n = 14) and nonresponders (n = 17) only in well-educated and autistic subjects (50% vs. 5.9%, p = 0.0109). Conclusion: TPM decreased the amount of alcohol consumption in alcoholics. In addition, a correlation between autistic features and TPM treatment response was suggested.

Komoto Y.,Okayama Psychiatric Medical Center
Nihon Arukōru Yakubutsu Igakkai zasshi = Japanese journal of alcohol studies & drug dependence | Year: 2011

It is important to evaluate and classify individual features of patients to select an appropriate treatment for alcoholism. In this study, we classified alcoholism types according to strength/weakness of autism features and investigated how these features were associated with onset, course, and especially continuation of abstinence. The subjects were 102 man outpatients diagnosed with alcoholism. The investigations were made on 3 areas: 1. Basic background including age, family and occupational information, 2. Medical variables including the number of years since the first visit, with/without juvenile onset, psychiatric complications, hospital admission history, self-help group participation, and the longest abstinence period, and 3. Autism-spectrum Quotient (AQ) scores. The AQ test is a self-administered test of autism features on a maximum scale of 50 points, based on the concept of "autism spectrum". The mean (standard deviation) of AQ scores of 102 subjects was 22.6 (7.18) with normal distribution. 78 subjects who had been followed-up for more than 2 years were classified into the low score (0-15) group of 11 subjects, the average score (16-29) group of 51 subjects, and the high score (30-50) group of 16 subjects, according to their AQ scores. No significant difference was observed in terms of patients' background and medical variables, but the number of subjects with stable abstinence (more than 2 years) was higher in the high score group compared to the average and low score groups (p = 0.0208). At least for men, it was presumed that continuation of alcohol abstinence was more difficult in the average score group (general type) and the low score group (over-empathy type) compared to the high score group (autism type) (odds ratio: 5.76); treatment approaches should be managed appropriately for these 3 types. It was also shown that the AQ test was a useful indicator for abstinence prognosis.

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