Need for education of psychiatric evaluation of offenders with mental disorders:A questionnaire survey for Japanese designated psychiatrists

BACKGROUND The management of offenders with mental disorders has been a significant concern in forensic psychiatry.In Japan,the introduction of the Medical Treatment and Supervision Act in 2005 addressed the issue.However,numerous psychiatric patients at risk of violence still find themselves subject to the administrative involuntary hospitalization(AIH)scheme,which lacks clarity and updated standards.AIM To explore current as well as optimized learning strategies for risk assessment in AIH decision making.METHODS We conducted a questionnaire survey among designated psychiatrists to explore their experiences and expectations regarding training methods for psychiatric assessments of offenders with mental disorders.RESULTS The findings of this study’s survey suggest a prevalent reliance on traditional learning approaches such as oral education and on-the-job training.CONCLUSION This underscores the pressing need for structured training protocols in AIH consultations.Moreover,feedback derived from inpatient treatment experiences is identified as a crucial element for enhancing risk assessment skills.

Serum Levels of Brain-Derived Neurotrophic Factor in Patients with Obsessive-Compulsive Disorder in a Japanese Population

A role of lower brain-derived neurotrophic factor (BDNF) content in the pathogenesis of several mental illnesses has been suggested, especially in major depression. It is not known whether BDNF is involved in the pathogenesis of obsessive-compulsive disorder (OCD). Herein, we assessed the serum BDNF content and its correlation with symptom severity in a Japanese population with OCD. The serum BDNF levels of OCD patients (n = 39) and healthy controls (n = 37) were measured by ELISA. The severity of OCD symptoms was assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Beck Depression Inventory (BDI). The OCD patients’ BDNF levels were significantly higher than those of the controls (17.5 ± 7.3 vs. 12.7 ± 4.7) (p < 0.01). No correlation was observed between the OCD patients’ BDNF levels and their OCD symptoms as scored by the Y-BOCS. For all 76 subjects, the BDI scores were significantly negatively correlated with the serum BDNF levels. Our findings revealed that contrary to previous reports, the serum BDNF content in OCD patients could be higher than that of healthy subjects.

Outcomes of administrative involuntary hospitalization: A national retrospective cohort study in Japan

BACKGROUND Treatment for offenders with mental disorders is a key concern in public mental health.Provision of adequate psychiatric treatment is important for the offender and their community.An approach used in Japan to address this issue is administrative involuntary hospitalization.Under this scheme,a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital.However,this scheme does not include tracking of these patients after discharge.Although some data for administrative involuntary hospitalizations are available,it remains unclear what happens to these patients after discharge.AIM To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.METHODS We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations.Questionnaires were distributed to 939 facilities across Japan.The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30,2010(census date),and the prognoses of each patient on a specified date in 2011 and 2012.We also asked about the treatment provided to each patient.We stratified patients by prognosis(good or poor),and used logistic regression analysis to examine the relationship between treatment and prognosis.RESULTS We received completed questionnaires from 292 facilities(response rate 31.1%);105 facilities had no relevant patients.Our analysis included data for 394 patients with valid data.Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30,2012,meaning the capture rate was 27.2%.Approximately a fourth(104/394)at 1 year,and a third(137/294)at 2 years after the census had unknown prognosis.Treatment content included multi-disciplinary team meetings(78.2%of patients),counseling by public workers(59.9%),and discussion with external specialists(32.5%).Overall,116 patients were categorized as having a good prognosis at 1 year,and 168 had a poor prognosis.At the 2-year point,102 patients had a good prognosis and 150 had a poor prognosis.“Discussion with external specialists”was positively associated with a good prognosis at both 1 year(P=0.016)and 2 years(P=0.036).CONCLUSION We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily.Discussion with external specialists is associated with a good prognosis.

Possible effect of blonanserin on gambling disorder:A clinical study protocol and a case report

BACKGROUND Gambling disorder is characterized by excessive and recurrent gambling and can have serious negative social consequences.Although several psychotherapeutic and pharmacological approaches have been used to treat gambling disorder,new treatment strategies are needed.Growing evidence suggests that dopamine D3 receptor plays a specific role in the brain reward system.AIM To investigate if blonanserin,a dopamine D3 receptor antagonist,would be effective in reducing gambling impulses in patients with gambling disorder.METHODS We developed a study protocol to measure the efficacy and safety of blonanserin as a potential drug for gambling disorder,in which up to 12 mg/d of blonanserin was prescribed for 8 wk.RESULTS A 37-year-old female patient with gambling disorder,intellectual disability,and other physical diseases participated in the pilot study.The case showed improvement of gambling symptoms without any psychotherapy.However,blonanserin was discontinued owing to excessive saliva production.CONCLUSION This case suggests that blonanserin is potentially an effective treatment for patients with gambling disorder who resist standard therapies,but it also carries a risk of adverse effects. Further studies are needed to confirm the findings.

Predictors of Discontinuation of Antipsychotic Therapy in Patients with Acute Schizophrenia: A 1-Year Observational Study with More Than 1000 Patients

Discontinuation of antipsychotic therapy has been a significant clinical issue among patients with schizophrenia, since the patients who discontinued antipsychotic treatment showed worse clinical and functional outcomes, and higher risks of relapse of schizophrenia symptoms and hospitalization. We conducted a post-hoc analysis of a post-marketing research with a 12-month follow-up period to identify the predictors for discontinuation of antipsychotic monotherapy in Japan. This is a prospective, naturalistic multicenter observational study, designed to evaluate the discontinuation rates of olanzapine monotherapy and non-olanzapine antipsychotic monotherapy in Japanese adult patients with acute schizophrenia. Patients were treatment-naive, or had switched from other antipsychotics or from poly-pharmacotherapy to oral antipsychotic monotherapy. We analyzed the correlation of discontinuation of antipsychotic monotherapy with baseline characteristics of patients. A total of 1089 patients (578 patients treated with olanzapine and 511 with non-olanzapine antipsychotics) were eligible for analysis. By the end of the 12-month study period, 614 patients (56.4%) discontinued antipsychotic therapy. Multivariate logistic regression analyses indicated significantly lower discontinuation rates in all patients treated with antipsychotics: older age (Odds ratio [OR], 0.871;95% confidence interval [CI], 0.797 to 0.953;p = 0.003), outpatient status (OR, 0.508;95% CI, 0.383 to 0.675;p < 0.001), prior use of antipsychotics (OR, 0.693;95% CI, 0.516 to 0.930;p = 0.015), and olanzapine group showed lower discontinuation rate than that of non-olanzapine group (OR, 1.416;95% CI, 1.086 to 1.846;p = 0.010). The present study indicated that the outpatient status, older age, and prior use of antipsychotics have better adherence to antipsychotic treatment. In addition to these factors, use of anti-parkinson agents showed lower discontinuation rates in the olanzapine monotherapy group.

Differences between British and Japanese perspectives on forensic mental health systems:A preliminary study

AIM To clarify the differences in views on forensic mental health(FMH) systems between the United Kingdom and Japan.METHODS We conducted a series of semi-structured interviews with six leading forensic psychiatrists. Based on a discussion by the research team, we created an interview form. After we finished conducting all the interviews, we qualitatively analyzed their content. RESULTS In the United Kingdom the core domain of FMH was risk assessment and management; however, in Japan, the core domain of FMH was psychiatric testimony. In the United Kingdom, forensic psychiatrists were responsible for ensuring public safety, and psychopathy was identified as a disease but deemed as not suitable for medical treatment. On the other hand, in Japan, psychopathy was not considered a mental illness. CONCLUSION In conclusion, there are considerable differences between the United Kingdom and Japan with regard to the concepts of FMH. Some ideas taken from both cultures for better FMH practice were suggested.

Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan

AIM: To clarify the components of hospitalization for assessment(HfA) and the management changes from the beginning of the scheme to the present.METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires(facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the Hf A cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer(public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through Hf A during the survey period. The case questionnaire was then used to collect data of the patients under Hf A based on the Medical Treatment and Supervision(MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during Hf A, information regarding seclusion and restraint during the Hf A, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of Hf A patients from July 15, 2005(the date the MTS Act was enforced) to January 15, 2007.RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the Hf A. The frequency of injection was decreased in 2013(χ2 = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013(χ2 = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the Hf A facility to which the patient was hospitalized(χ2 = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013(χ2 = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed.CONCLUSION: Although the management of HfA has improved in recent years, structural problems remain.

Effect of educational intervention on attitudes toward the concept of criminal responsibility

AIM To evaluate the effect of educational intervention on individuals' knowledge of and attitudes toward forensic mental health.METHODS We conducted a questionnaire regarding attitudes toward various ideas about forensic mental health. The respondents attended a 1-h seminar regarding forensic mental health after answering the questionnaire. On completion of the seminar, the respondents answered another questionnaire containing many of the same questions as contained in the pre-seminar questionnaire.RESULTS A total of 86 individuals attended the seminar, and 78 responded to the questionnaire. Only 13(18.8%) participants were supportive of the concept of criminal responsibility initially, and there was a statistically significant increase in those who became more supportive after the seminar, with 22(33%) being supportive after the seminar(Wilcoxon signed-rank test, P < 0.001). Logistic regression analysis revealed that participants who were skeptical about forensic mental systems and those with fewer opportunities to see media reports regarding psychiatry were likely to become supportive of criminal responsibility after the intervention.CONCLUSION These results suggest that public attitudes toward criminal responsibility and mental health can be influenced via educational interventions.

No change of attitude toward forensic psychiatry: 5 years after the Medical Treatment and Supervision Act in Japan

Objective: The forensic mental health system in Japan changed dramatically with the enforcement of the “Act on Medical Care and Treatment for the Persons Who Had Caused Serious Cases under the Condition of Insanity” or MTS Act, in 2005. The aim of this study is to evaluate the changes in attitude and behavior of general psychiatrists, towards forensic psychiatry. Methods: We conducted a questionnaire survey in 2010 on forensic psychiatry for Japanese psychiatrists, mirroring a previous study from 2007. Results: Comparing the results from both questionnaires, it is not evident that awareness of forensic mental health has improved among psychiatrists in the intervening three years. Conclusion: Further education about forensic mental health needs to be considered inJapan.

Differences in Baseline Characteristics of Patients Treated with Olanzapine or Other Antipsychotics in Japanese Patients with Acute Schizophrenia: A 1-Year Observational Study under Routine Clinical Practice in Japan

Objective: Baseline characteristics of acute schizophrenia patients were analyzed to identify differences in the baseline characteristics of patients treated with olanzapine monotherapy compared with those treated with other antipsychotic monotherapies. Methods: This prospective, naturalistic observational study was designed to evaluate discontinuation rates of olanzapine and non-olanzapine antipsychotic monotherapy in Japanese adult patients with acute schizophrenia. Results: A total of 1089 patients were assessed: 578 patients were treated with olanzapine, 487 with non-olanzapine atypical antipsychotics, and 24 with typical antipsychotics. The mean Clinical Global Impression-Severity (CGI-S) Schizophrenia, Brief Psychiatric Rating Scale (BPRS) total, and BPRS positive scores were higher in patients treated with olanzapine compared with most of the non-olanzapine treated patients. The majority of patients with a CGI-S Schizophrenia score of 7 (29/41 patients) as well as patients with a BPRS total score of 90 or higher (14/18 patients) were treated with olanzapine. On the other hand, physicians tended to prescribe antipsychotics other than olanzapine for patients with heavier body weight or diabetes mellitus. Conclusion: The present study demonstrated that olanzapine was more likely to be prescribed to patients with more severe schizophrenia symptoms. However, further studies are warranted to reach a definite conclusion.