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   2019| October-December  | Volume 33 | Issue 4  
    Online since December 23, 2019

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A History of Mental Health Care in Japan:International Perspectives
Naotaka Shinfuku
October-December 2019, 33(4):179-191
Background: Japan has continuously received influences from foreign countries to improve care for patients suffering from mental diseases throughout its history. But an article documenting on the foreign influences on Japanese mental health (MH) care is not readily available. Methods: The author reviewed the published books, papers, and government documents on the MH care in Japan. For comparisons, the publications on MH and psychiatric care, especially those in the United States of America, the United Kingdom, as well as countries of the Organization for Economic Co-operation and Development, were also reviewed. The author also recounted his personal observations on the MH care over his own life. Results: Before the Meiji Restoration, Buddhism and temples played a major rôle in taking care of persons with mental illness. Kampo (Chinese medicine and medicinal herbs) was prescribed during the Edo era (1603–1867). After the Meiji Restoration in 1867, the Meiji government adopted Western medicine. German medicine was introduced as an exemplified model. Before World War II (WWII), Japanese psychiatry was under the heavy German influence. After WWII, American psychiatry was introduced. At the same time, the Japan Private Hospital Association (Nisseikyo) was formed, and it contributed to build MH care system. From 1955 to 1993, Japan continuously increased the number of private hospital beds, financed through public funds. The scandals at several private hospitals helped enact the Mental Health Law in 1987, making clear to change hospital-centered services to community-based MH services and improve the human rights of inpatients in Japan. Since then, efforts have been carried out to promote community-based MH care. But Japan nowadays is still characterized by hospital-centered MH care. Conclusion: At present, Japan has more than 1,000 psychiatric hospitals with 300,000 psychiatric beds. Japan has the largest number of psychiatric bedsthat is on the top among all countries in the world. In this review, the author expresses his own personal viewpoints on MH care for the mentally ill in Japan with focus on its international influences.
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A levothyroxine-related paresthesia in a middle-aged female patient after receiving hemithyroidectomy
Horng-Maw Chen
October-December 2019, 33(4):222-224
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Long-term safety, efficacy, treatment satisfaction, and impact on healthcare service use of paliperidone palmitate one-month intramuscular formulation in patients with recent-onset schizophrenia in taiwan: A subgroup analysis of an asia-pacific, 18-month, phase 3b study
Tze-Chun Tang, Ming-Hong Hsieh, Chen-Chung Liu, Nan-Ying Chiu, Fong-Lin Jang, Chih-Lin Chiang, Tung-Ping Su
October-December 2019, 33(4):198-203
Objectives: In this study, the authors intended to evaluate the efficacy and safety of paliperidone palmitate 1-month injection (PP1M) in patients with recent-onset schizophrenia (SCH). Methods: A subgroup analysis was done for patients enrolled in Taiwan in an Asia-Pacific, Phase 3b study (ClinicalTrials.gov identifier NCT01051531). Patients were switched from oral antipsychotics to intramuscular PP1M. Results: We included 61 patients (age: 31.2 ± 8.8 years). The Positive and Negative Syndrome Scale scores were significantly decreased, with the largest effect size observed in positive, disorganized, and depressive factors (Cohen's d = 0.52, 0.52, and 0.79, respectively). Most symptoms stabilized within six months, whereas stabilization of functional improvement required 1–1.5 years of PP1M treatment, especially for employment/academic status. PP1M treatment was well-tolerated, with over 70% of treatment satisfaction rate, and significantly reduced the average days of hospitalization (43.3–7.1/person-years). Conclusion: Switching to PP1M improved treatment outcome and satisfaction as well as reduced healthcare service use in patients with recent-onset SCH.
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Autoimmune psychosis needs an early immune-modulating therapy
Ruu-Fen Tzang, Chuan-Hsin Chang, Yue-Cune Chang, Hsien-Yuan Lane
October-December 2019, 33(4):175-178
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Risk of developing migraine among patients with posttraumatic stress disorder: A nationwide longitudinal study
Mao-Hsuan Huang, Yee-Lam E Chan, Ju-Wei Hsu, Ya-Mei Bai, Kai-Lin Huang, Shih-Jen Tsai, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Tzeng-Ji Chen, Mu-Hong Chen
October-December 2019, 33(4):192-197
Objective: We intended to investigate the risk of developing migraine among patients with posttraumatic stress disorder (PTSD). Methods: With the Taiwan's National Health Insurance Research Database, we examined 5,644 patients with PTSD and 22,576 age- and sex-matched controls between 2002 and 2009 and followed them to the end of 2011. Individuals who developed migraine during the follow-up period were identified. Results: Patients with PTSD had a significantly higher incidence of developing migraine (5.74 vs. 1.22 per 1,000 person-years, p < 0.001) during the follow-up period than the controls. We did Cox regression analysis with adjustments of demographic data and medical comorbidities and found that patients with PTSD were more likely to develop migraine (hazard ratio [HR] = 3.83, 95% confidence interval [CI] = 2.82–5.20) than the control group. Sensitivity analyses after excluding the 1st year (HR = 2.89; 95% CI = 2.04–4.08) or the first 3 years (HR = 2.07; 95% CI = 1.32–3.24) of observation showed consistent findings. Moreover, a high frequency of psychiatric clinics visiting for PTSD was associated with an increased risk of developing migraine. Conclusion: Patients with PTSD had a higher risk of migraine than the controls. The symptom severity of PTSD may be associated with an increased risk of migraine. Further studies are required to investigate the underlying pathophysiology between PTSD and migraine.
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Antidepressant prescription patterns and associated factors among the elderly with psychiatric illnesses
Shu-Wen Cheng, Hung-Yu Chan
October-December 2019, 33(4):204-210
Objectives: The prevalence of antidepressant prescriptions for elder patients with psychiatric illnesses is increasing over the world. No studies exist to focus on the prescription patterns and trend of antidepressant use for the elderly in psychiatric hospitals of Taiwan. Methods: In this retrospective study for all outpatients equal or over 65 years of age in a psychiatric hospital, we collected related study variables from the study hospital from 2006 to 2015. Reviewing data of the electronic medical information system, we extracted both patients' demographic data (information for sex, age, and insurance status) and their clinical variables (psychiatric diagnosis and prescriptions of antidepressants). Results: In this study, we found that the proportion of antidepressant prescriptions was increased at around 7.85% (from 39.79% in 2006 to 42.92% in 2015, p < 0.001). We also found that the proportions of some antidepressants (selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, norepinephrine–dopamine reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants) were increased, but some antidepressants (tricyclic antidepressants [TCAs] as well as serotonin antagonist and reuptake inhibitors) were decreased over the study period. TCAs were decreased in their use from 2.52% to 1.72%. The logistic regression showed that female gender, younger age, affective disorders, and neurotic disorders were found to be associated with a higher chance of antidepressant prescriptions. Conclusion: The result of this study is similar to the conclusion of other previous studies. But the decreased trend of TCA prescriptions is different from that in other studies. Future research should focus on the treatment indications, associated factors, off-label use, adverse effects, and safety of antidepressants in the elderly population.
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No association between craving levels, personality traits, and treatment outcomes in patients with methamphetamine use disorder under deferred prosecution status
Tsung-Yu Tsai, Tzu-Yun Wang, Huai-Hsuan Tseng, Kao Chin Chen, Shih-Hsien Lin, Po See Chen, I Hui Lee, Yen Kuang Yang, Ru-Band Lu
October-December 2019, 33(4):211-218
Objective: Few studies have examined the outcome predictors in methamphetamine (MA) use disorder patients referred from the justice system. Craving and personality trait, such as novelty seeking (NS) and harm avoidance (HA), have important rôles in developing and sustaining addiction. Therefore, we investigated whether craving severity and personality traits are correlated with the MA use disorder treatment outcomes in those under the deferred prosecution status. Methods: We measured craving levels and personality traits of NS and HA at the beginning of a one-year treatment program for MA use disorder. We monitored urinary MA/amphetamine results during the one-year treatment program. Multiple linear regressions were used to examine the correlation between craving severity, personality traits, and MA use disorder treatment outcomes. Results: We first enrolled 98 patients, but only 56 patients completed the end-of-treatment assessments. We did not find any association between craving severity, personality traits, and MA treatment outcomes in those populations. But we found that age and percentage of positive urine MA/amphetamine results were significantly related to treatment completion (p < 0.05). Higher percentages of positive urine MA/amphetamine results were also significantly associated with shorter treatment duration (p = 0.01). In addition, positive urine results at baseline were significantly associated with higher percentages of positive urine tests in the following treatment course (p = 0.001). Conclusion: Our study data did not find that craving severity and personality traits were associated treatment outcomes in this special population. But urine MA/amphetamine results were more related with completion of programs. Further studies to evaluate the treatment outcomes and other potential outcome predictors in those were referred from the justice system are needed.
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Interpersonal therapy group for middle-aged depressive patients: A pilot study
Chan-Hen Tsai, Chiung-Wen Chang, Hui-Ying Lee, Shih-Ming Li
October-December 2019, 33(4):219-221
Objective: In this pilot study, we intended to evaluate the efficacy of the interpersonal therapy group (IPT-G) in middle-aged adult patients with major depressive disorder. Methods: Patients with the diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, who were aged between 40 and 65 years, were recruited to participate in receiving IPT-G while all participants kept all existing antidepressants. The participants were assessed using the Beck Depression Inventory-II (BDI-II) for depression at baseline and immediately after the final treatment session. Results: Totally, 10 patients from an outpatient clinic of a community hospital participated in this 14 weekly 90-min sessions IPT-G while they all kept taking their prescribed antidepressants. Five of them completed the whole course of sessions. The BDI-II scores (means ± standard deviation) of five participants were significantly decreased between sessions 1 and 14 (30.6 ± 19.9 vs. 17.4 ± 15.9) using the Wilcoxon signed-rank test (Z = −2.031, p < 0.05). According to the in-depth interview data of two participants, social and practice dimensions were the main factors responsible for changes in the group. Conclusion: In this pilot study, we demonstrated that antidepressant-medicated middle-aged patients can benefit from IPT-G. But this pilot study result needs to be duplicated with a larger number of study participants to strengthen the study finding.
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Enhanced treatment response of clozapine after febrile infection
Yu-Ming Chen, Tiao-Lai Huang
October-December 2019, 33(4):225-226
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The potential use of using the psychological side effects of antidepressants in treating cancer patients
Fong-Lin Jang, Pei-Hsin Kao
October-December 2019, 33(4):227-228
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