Alcohol Consumption or Excessive Use of Psychotropic Medication Prior to Suicidal Self-injury in Patients with Adjustment Disorder, Depression, and Schizophrenia: A Cross-sectional Study

The use of alcohol or drug(s) prior to self-injury is a possible inducing factor for suicidal self-injuries among patients with adjustment disorder. We analyzed the cases of 175 individuals who were admitted to the intensive care unit (ICU) of Tokyo Medical and Dental University Medical Hospital for suicidal self-injury to determine whether alcohol consumption or an excessive use of prescribed psychotropic medications prior to self-injury is more common in patients with adjustment disorder. During a 7-year period (July 2006 to June 2013) following their deliberate self-injuries, 971 patients were admitted to the ICU. Our study sample (n=175) was restricted to patients with adjustment disorder (n=48), major depressive disorder (n=90), or schizophrenia (n=37). The outcome variable was alcohol consumption or excessive use of medications prior to suicidal self-injury. A logistic regression analysis revealed that the patients with adjustment disorder more commonly showed alcohol consumption or excessive medication use prior to their suicidal self-injury compared to those with schizophrenia (odds ratio: 8.10; 95%CI: 2.97-24.60). To inhibit suicidal self-injury among patients with adjustment disorder, it is important to continue efforts to provide psychoeducation about alcohol use and to instruct the patients to take their prescribed medication(s) only as directed by their physician

The degree of social difficulties experienced by cancer patients and their spouses

Abstract Background Although recent studies have increasingly reported physical and psychological problems associated with cancer and its treatment, social problems of cancer patients and their families have not been sufficiently elucidated. The present study aimed to identify cancer-associated social problems from the perspectives of both patients and their spouses and to compare and analyze differences in their problems. Methods This was a cross-sectional internet-based study. Subjects were 259 patients who developed cancer within the previous five years and 259 patients’ spouses; the data were derived from two surveys in 2010 (patients) and 2016 (spouses) whose participants were not part of the same dyad but matched by propensity scores, estimated for age, sex, and the presence or absence of recurrence. We investigated the social difficulties of cancer patients and patients’ spouses. Regarding social difficulties experienced by cancer patients and spouses, the 60 patient survey items were categorized into 14 labels by the Jiro Kawakita (KJ) method, which is a qualitative synthesis method developed by Kawakita to classify categorical data. Results Although patients had higher scores on most subcategories, young spouses aged 39 or younger and female spouses had difficulty scores as high as the corresponding patients on many subcategories. Conclusion Health care providers should show sufficient concern for both patients and their spouses, particularly young and female spouses

Characteristics of the study participants.

<p>Characteristics of the study participants.</p

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

<div><p>Objectives</p><p>Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course.</p><p>Methods</p><p>We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables.</p><p>Results</p><p>Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin^®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60–5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines).</p><p>Conclusion</p><p>These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.</p></div

Flow diagram for inclusion in the study.

<p>Flow diagram for inclusion in the study.</p

Major classes of overdose.

<p>Major classes of overdose.</p

Psychiatric diagnoses.

<p>Psychiatric diagnoses.</p

An in-person survey of the influence of the COVID-19 pandemic on physical function, functional capacity, cognitive function, and mental health among community-dwelling older adults in Japan from 2016 to 2022

Abstract Background The COVID-19 outbreak might have had several effects on older adults; however, much of the previous research only included self-report, cross-sectional, and online-survey data in the early stage of the pandemic. We conducted a face-to-face survey before and after the COVID-19 pandemic and investigated the influence of the pandemic on several functions to distinguish between changes due to aging and changes due to the pandemic using a linear mixed model. Methods A total of 8 longitudinal surveys were conducted from 2016 to 2022. Physical function was assessed by weight, body mass index, body fat percentage, skeletal muscle mass index, calf circumference, grip strength, knee extension strength, the 5-times chair stand test, the timed up & go test and 5-m walking test. Functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology index of competence, cognitive function was measured using the Trail Making Test - A, and mental health was measured using the Geriatric Depression Scale. Results Of a total of 73 participants, 51 (69.9%) were female. The mean age at first participation was 71.82 years (SD = 4.64). The results of the linear mixed model showed that lower-limb muscle strength and body fat percentage and cognitive function changed significantly before and after the pandemic, while grip strength, functional capacity, and mental health did not. Conclusions The changes in these functions between before and after the pandemic might be attributed to the diminished opportunities for the independent older individuals to go out and engage in activities. Although functional capacity did not change, lower-limb muscle strength is important for functional independence. This decline might influence the functional capacity of these individuals in the future

Machine learning judged neutral facial expressions as key factors for a “good therapist” within the first five minutes: An experiment to simulate online video counselling

Objective: Machine learning models were employed to discern patients' impressions from the therapists' facial expressions during a virtual online video counselling session. Methods: Eight therapists simulated an online video counselling session for the same patient. The facial emotions of the therapists were extracted from the session videos; we then utilized a random forest model to determine the therapist's impression as perceived by the patients. Results: The therapists' neutral facial expressions were important controlling factors for patients' impressions. A predictive model with three neutral facial features achieved an accuracy of 83% in identifying patients' impressions. Conclusions: Neutral facial expressions may contribute to patient impressions in an online video counselling environment with spatiotemporal disconnection. Innovation: Expression recognition techniques were applied innovatively to an online counselling setting where therapists' expressions are limited. Our findings have the potential to enhance psychiatric clinical practice using Information and Communication Technology