Recent global movement on mental health

The Mental Health Gap Action Programme (mhGAP) proposed by the World Health Organization (WHO) is a planned action that aims at providing uniform medical care, especially mental health care and services, to all people worldwide, regardless of economic status. Because not only the levels of medical care, but also the political and economic situations vary among countries, it is extremely difficult for a plan to be successfully implemented in every country with standardized methodology, even if the directionality is ethically correct and ideal. Against this background, authorized personnel provide mental health care activities across the globe, and they report on activities and promote mutual understanding at the WHO mhGAP Forum, an informal meeting convened yearly in Geneva. The 5th mhGAP meeting was attended by 48 member states and 58 partner organizations. From Japan, 5 professionals attended the meeting and presented different viewpoints. Among various policies proposed at the Forum, one in particular about training and recruiting health professionals for low-income countries has gained a special consensus. In addition, the importance of training medical professionals who are not specialized in psychiatry and the importance of developing educational programs for educators were emphasized. It is important for Japan to proactively participate in mhGAP to contribute to global mental health initiative

Psychotic-like experiences and poor mental health status among Japanese early teens

Epidemiological studies of psychotic-like experiences (PLEs) have reported that people who had PLEs during childhood or adolescence have higher incidences of schizophrenia spectrum disorders or other psychiatric disorders later in life than people who have not had PLEs. Previous work has shown that approximately 15% of children in the city of Tsu had PLEs. In this study, we sought to confirm the prevalence of PLEs in early teens living in Nagasaki and to elucidate the associations between PLEs and other psychopathological items. To this end, we used a self-report questionnaire to sample approximately 5,000 students (aged 12-15 years) in public junior high schools. Similar to the results of previous studies, the prevalence of PLEs was 16.4%. There was a significant association between PLEs and poor mental health status, which was estimated using a 12-item General Health Questionnaire. Moreover, after controlling for confounding factors, we found a significant association between PLEs and a lack of satisfaction with family relationships and several other psychosocial problems. These results suggest that a relatively large proportion of children with PLEs have behavioral, social, or familial problems, which may facilitate future schizophrenic symptoms

Nagasaki Schizophrenia Study: Relationship Between Ultralong-term Outcome (after 28 years) and Duration of Untreated Psychosis

Objective: Numerous studies have shown a relationship between the duration of untreated psychosis (DUP) in schizophrenia and short-termoutcome. However, few studies have investigated the relationships between DUP and the medium-term and long-term outcomes. Furthermore,we are unaware of any reports regarding the relationship between DUP and the ultralong-term outcome. This study aimed to investigate therelationship between DUP and ultralong-term outcome at 28 years in patients with schizophrenia.Method: Patients with schizophrenia completed an interview survey 28 years after their initial psychiatric examination during the period 1979-1980. It was possible to conduct the survey using suitable assessment scales in 31 patients in whom DUP was confirmed. These patients weredivided into a short DUP group and a long DUP group on the basis of the median DUP, and the outcomes of these two groups were compared.Results: Longer DUP correlated significantly with poorer symptomatic outcome; degree of social adjustment; and, global functioning. Multiplelinear regression analysis found no changes in these results even after controlling for various factors, including gender, age at onset, mode ofonset, diagnostic subtype, and premorbid adjustment.Conclusion: DUP adversely affected ultralong-term outcome of schizophrenia after 28 years. This finding supports the need to establish asystem to enable early detection and appropriate intervention for patients with schizophrenia to reduce the risk of a deleterious outcome aftermore than 25 years

Epidemiological survey of first-episode psychosis in Nagasaki, Japan: Is the incidence rate of schizophrenia changing?

The Determinants of Outcome of Severe Mental Disorders (DOSMeD) study, a global epidemiological study led by the World Health Organization, reported the annual incidence rate of schizophrenia from 1979 to 1980. In 2011, approximately 30 years later, we conducted a large-scale epidemiological study to investigate the incidence rate of first-episode schizophrenia in Nagasaki using the same method as the DOSMeD study. A telephone survey was conducted by researchers daily at 52 psychiatric hospitals, clinics, and institutes in Nagasaki. When a subject was confirmed, the researcher visited the medical facility in person to evaluate the patient’s symptoms. Of 441,706 people in Nagasaki City, 131 people were surveyed in the way, resulting in the diagnosis of psychosis in 25 patients, 20 of whom were determined to have schizophrenia. These data were used to calculate the incidence rates of psychosis (1.00 per 10,000 population; 95% confidence interval [CI], 0.54-1.46) and schizophrenia (0.80 per 10,000 population; 95% CI, 0.38-1.21). The 95% CI for the incidence rate of psychosis did not include the incidence rate for psychosis (broad definition) reported in the DOSMeD study (2.02). However, the 95% CI for the incidence rate of schizophrenia did include the incidence rate for schizophrenia (restrictive definition) reported in the DOSMeD study (1.01). Although the incidence rate of psychosis appeared to be decreasing, no significant change was found in the incidence rate of schizophrenia, comparing the present findings with those of the survey conducted 30 years ago. The incidence rate of schizophrenia is said to vary with changes in gender differences, racial differences, urbanization, and immigration; we therefore considered this possibility. In the future, it is necessary to carry out longer-term surveys covering multiple cities using the same methods

Impact of half-day clinical training in outpatient psychiatry on perception of mental illness by postgraduate interns

Aim: Lack of contact with patients with mental illness may contribute to mental health stigma. We conducted a half-day training program in the outpatient psychiatry clinic of a rural general hospital for postgraduate interns in Nagasaki University Hospital. Our study investigated the effectiveness of this program in reducing stigma toward mental illness. It also examined the association between an intern’s perception of mental illness and their consideration of psychiatry as a career.Methods: Participants were 12 interns at Nagasaki University Hospital who competed a pre- and post- training questionnaire. The questionnaire assessed perceptions of mental illness using a semantic differential scale and measured consideration of psychiatry as a career on a 7 point Likert scale. Paired t-tests were used to compare mean pre- and post-training scores on the semantic differential scale. Pearson’s correlation was used to examine associations between semantic differential scores and consideration of psychiatry as a career.Results: Post-training scores were higher than pre-training scores on the items “warm” (P = 0.003), “clean” (P = 0.009), “bright” (P = 0.001), and “calm” (P = 0.003) as associated with mental illness. Consideration of psychiatry as a career significantly correlated with post-training score on “warm” (r = 0.587, P = 0.045).Conclusion: Interns can develop positive perceptions of mental illness after a half-day training program in a psychiatry outpatient clinic. Perceptions of mental illness as “warm” after training correlated with consideration of psychiatry as a career

Mental health conditions in Korean atomic bomb survivors: a survey in Seoul

More than 60 years have elapsed since the atomic bombings to Hiroshima and Nagasaki, and since all of the atomic bomb survivors have become old, the importance of caring their mental health has become increasing in Japan. Although approximately 70% of overseas atomic bomb are living in Korea, there have been quite few studies on their mental health. The objectives of the present study were to elucidate whether the mental health conditions of atomic bomb survivor in Korea are similar to those in Japan. The subjects were 181 Korean atomic bomb survivors living in Korea (cases) and 209 outpatients of a hospital in Seoul who were not exposed to atomic bombs (controls). Interviewers administered them at the hospital a questionnaire with Impact of Event Scale-Revised, General Health Questionnaire 12 (GHQ-12), Korean version of short form Geriatric Depression Scale and the K scale of the Minnesota Multiphasic Personality Inventory. Excluding subjects with incomplete responses we analyzed 162 cases and 189 controls. The proportion of subjects with high score of GHQ-12 ( 4) was significantly higher in cases (78/162 or 48.1%) than in controls (42/189 or 22.2%) (p < 0.0001, Fisher\u27s exact test). The present results, though preliminary, indicate that atomic bomb survivors in Korea have also mental health problems similar to those observed in Japanese atomic bomb survivors, indicating the necessity of a larger study

Subjective achievement from psychiatry rotation in the Japanese postgraduate residency system: a longitudinal questionnaire study

Background: Psychiatry rotation has been mandatory in the Japanese postgraduate residency system since 2020. Some psychiatry-related competency items are stipulated as mandatory for residents. The current study aimed to clarify whether psychiatry rotation affected residents’ subjective achievement of these competency items.Methods: This longitudinal study was conducted among postgraduate residents who completed a rotation in the psychiatry department at Nagasaki University Hospital across two academic years (2020–2021). The survey was administered at the start and at the end of the psychiatry rotation. Residents evaluated their subjective understanding and confidence regarding initiating treatment for these competency items using a six-point Likert scale. The average scores for each item were compared between pre-rotation and post-rotation.Results: In total, 99 residents (91.7%) responded to this survey. Residents had significantly higher scores at postrotation compared with pre-rotation in all psychiatry-related competency items in both subjective understanding and confidence in initiating treatment. Additionally, strong effect sizes were found for many items.Conclusion: Residents improved learning about psychiatry-related competency items through psychiatry rotation. This finding suggests that it is reasonable for psychiatry rotation to be mandatory in the current Japanese postgraduate residency system. The importance of psychiatry is likely to increase in both undergraduate and postgraduate medical education in the future. It is necessary to continuously update educational strategies to meet changing social needs over time. As this study was conducted at a single institution, a multi-center study is needed to expand the current findings

Antifibrotic effects of CXCR4 antagonist in bleomycin-induced pulmonary fibrosis in mice

Circulating fibrocytes had been reported to migrate into the injured lungs, and contribute to fibrogenesis via chemokine-chemokine receptor systems including CXCL12-CXCR4 axis. Here we hypothesized that blockade of CXCR4 might inhibit the migration of fibrocytes to the injured lungs and the subsequent pulmonary fibrosis. To explore the antifibrotic effects of blockade of CXCR4, we used a specific antagonist for CXCR4, AMD3100, in bleomycin-induced pulmonary fibrosis model in mice. Administration of AMD3100 significantly improved the loss of body weight of mice treated with bleomycin, and inhibited the fibrotic lesion in subpleural areas of the lungs. The quantitative analysis demonstrated that treatment with AMD3100 reduced the collagen content and fibrotic score (Aschcroft score) in the lungs. Although AMD3100 did not affect cell classification in bronchoalveolar lavage fluid on day 7, the percentage of lymphocytes was reduced by AMD3100 on day 14. AMD3100 directly inhibited the migration of human fibrocytes in response to CXCL12 in vitro, and reduced the trafficking of fibrocytes into the lungs treated with bleocmycin in vivo. These results suggest that the blockade of CXCR4 might be useful strategy for therapy of patients with pulmonary fibrosis via inhibiting the migration of circulating fibrocytes