Association between long-term hospitalization for mental illness and locomotive syndrome.

BACKGROUND: Patients in psychiatric care wards face serious problems in terms of declining physical function due to aging and long-term hospitalization. This study aimed to determine the current status of locomotive syndrome (LS) in long-term inpatients in psychiatric care wards and to clarify the factors associated with LS risk severity. METHODS: The study included 84 patients admitted to psychiatric care wards who underwent the LS stage test. We investigated the participants' age, length of stay, antipsychotic drug use, body mass index, and activities of daily living were assessed and analyzed the correlations between the LS stage test and each assessment item. RESULTS: The participants' mean age was 60.0 ± 13.6 years, with those aged ≥60 years comprising nearly 60% of the sample. The participants' mean length of stay was 10.5 ± 12.0 years, and over half of the patients stayed >5 years: 17.9% stayed between 5 and 10 years, while 36.9% stayed ≥10 years. Nearly 90% of participants stayed for >1 year. The LS stage test showed that 60.7% of the participants were stage 3, 21.4% were stage 2, 14.3% were stage 1, and 3.6% had no risk. The results of the LS stage indicated significant correlations with age, length of stay, and the Barthel Index scores. CONCLUSIONS: Patients who stay in a psychiatric care unit for a long period experience declining physical function, which is associated with aging and long-term hospitalization and might affect their activities of daily living.

Analysis of water-soluble paper for forensic discrimination.

Water-soluble paper (WSP), which easily dissolves in water, has been found in criminal gang hideouts as evidence in crimes including bank transfer fraud, phone fraud, and grandparent scams, i.e. identity fraud to steal money. Distinguishing WSP products used in crimes is required in forensic investigations to link fraud groups with paper evidence or prove connections among fraud groups. In this work, we investigate distinguishing WSP products. White sheets of six WSP products available in Japan were analyzed by measuring the grammage and thickness, determining additive compounds by X-ray diffraction (XRD), X-ray fluorescence (XRF), and scanning electron microscopy (SEM)/energy dispersive X-ray spectrometry (EDX), and performing fiber analysis by transmitted light microscopy. The six products were categorized into three groups by grammage and thickness. XRD, XRF, and SEM/EDX analysis provided elemental information about additive compounds and their distribution on the surface. Pulp analysis by Graff "C" stain provided the composition and morphology of the pulp. The six products could be distinguished in a similar way to plain paper by these analyses. Our results demonstrate that conventional analytical methods used for plain paper analysis can also be used to discriminate WSP in forensic investigations.

Patterns in Psychiatrists' Prescription of Valproate for Female Patients of Childbearing Age With Bipolar Disorder in Japan: A Questionnaire Survey.

BACKGROUND: Accumulating evidence has shown that valproate has the greatest teratogenic potential for increasing the risk of major congenital malformations, such as neural tube defects, cleft palate, and neurodevelopmental disability. Although valproate is a pharmacological option for acute mania and is used as a stabilization drug for patients with bipolar disorder, some global guidelines state that valproate should not be used for girls or women of childbearing age with bipolar disorder. We investigated patterns in psychiatrists' prescription of valproate for bipolar female patients of childbearing age in Japan. METHODS: From March to May 2018, we conducted a questionnaire survey among psychiatrists from all prefectures in Japan on psychiatric practice as it relates to major depression and bipolar disorder throughout women's life. The questionnaire had two parts: (1) assessment of participating psychiatrists' backgrounds and attitudes toward patients and (2) their patterns of prescription of psychotropics for female patients with mood disorders across generations and periods of pregnancy. Each question item had four response options: "not at all," "rarely," "sometimes," and "frequently." We examined patterns of prescription for childbearing-aged women (late adolescence/young adulthood aged 18-24 years, childbearing-age, older adults aged 25-49 years) and pregnant women. RESULTS: In total, 571 psychiatrists (427 males, 123 females, and 21 unknowns) responded appropriately to the questionnaire, including 320 who examined at least one or more late adolescence/young adulthood bipolar women. Approximately 70% of psychiatrists answered that they frequently or sometimes prescribed valproate for bipolar women of childbearing age [late adolescence/young adulthood: not at all, n = 23 (7.5%); rarely, n = 69 (22.5%); sometimes, n =116 (37.8%); and frequently, n = 99 (32.2%); childbearing-age, older adults: not at all, n = 13 (2.7%); rarely, n = 67 (13.8%); sometimes, n = 185 (38.1%); and frequently, n = 220 (45.4%)]. The proportion of general hospital psychiatrists who answered "not at all" or "rarely" to the frequency of their valproate prescriptions was higher than that of psychiatrists working in other medical facilities (χ 2(3) = 18.2, p < 0.001). CONCLUSION: Most psychiatrists frequently or sometimes prescribe valproate for women of childbearing age in Japan.

Survey to Identify Substandard and Falsified Tablets in Several Asian Countries with Pharmacopeial Quality Control Tests and Principal Component Analysis of Handheld Raman Spectroscopy.

The World Health Organization has warned that substandard and falsified medical products (SFs) can harm patients and fail to treat the diseases for which they were intended, and they affect every region of the world, leading to loss of confidence in medicines, health-care providers, and health systems. Therefore, development of analytical procedures to detect SFs is extremely important. In this study, we investigated the quality of pharmaceutical tablets containing the antihypertensive candesartan cilexetil, collected in China, Indonesia, Japan, and Myanmar, using the Japanese pharmacopeial analytical procedures for quality control, together with principal component analysis (PCA) of Raman spectrum obtained with handheld Raman spectrometer. Some samples showed delayed dissolution and failed to meet the pharmacopeial specification, whereas others failed the assay test. These products appeared to be substandard. Principal component analysis showed that all Raman spectra could be explained in terms of two components: the amount of the active pharmaceutical ingredient and the kinds of excipients. Principal component analysis score plot indicated one substandard, and the falsified tablets have similar principal components in Raman spectra, in contrast to authentic products. The locations of samples within the PCA score plot varied according to the source country, suggesting that manufacturers in different countries use different excipients. Our results indicate that the handheld Raman device will be useful for detection of SFs in the field. Principal component analysis of that Raman data clarify the difference in chemical properties between good quality products and SFs that circulate in the Asian market.

Hospital readmission in first-time admitted patients with schizophrenia: smoking patients had higher hospital readmission rate than non-smoking patients.

OBJECTIVES: To consider smoke-free policies for the patients with schizophrenia, the present study examined how smoking behavior is related to hospital readmission among patients with schizophrenia. METHODS: A retrospective study was conducted in 2007 on 460 discharged patients with schizophrenia who voluntarily admitted in the participating psychiatric hospitals at first time. We reviewed smoking status, readmissions, and other variables including socio-demographic characteristics, process of care, and social functioning at discharge using the Global Assessment of Functioning scale (GAF). RESULTS: The rate of cigarette smoking in this study was 42.2%. The rate of smoking was significantly higher in males (56.1%) than in females (26.2%). Mean GAF score at discharge was slightly higher in smoking patients than non-smoking patients (g = 0.18). Cox proportional hazard model revealed that hospital readmission rate was significantly higher in smoking patients than non-smoking patients after controlling for all other variables (HR = 1.78). CONCLUSIONS: Non-smoking patients had fewer hospital readmissions than smoking patients. This finding could be a reason to promote cessation of smoking which might provide positive influences on prognosis of schizophrenia.

Prevalence of diabetes and antipsychotic prescription patterns in patients with schizophrenia: a nationwide retrospective cohort study.

INTRODUCTION: Despite an increasing concern that atypical antipsychotics seem to have a stronger diabetogenic risk than conventional antipsychotics, little information is available on the prevalence of diabetes among schizophrenia patients, and prescription patterns for patients with comorbid schizophrenia and diabetes in Japan. OBJECTIVES: To compare the prevalence of diabetes between schizophrenia patients and the general population and to investigate whether diabetes status correlates the prescription patterns of antipsychotics at hospital discharge. METHODS: Schizophrenia patients who were discharged between April 2004 and March 2005 and who continued to receive outpatient treatment from 526 hospitals were included in this retrospective open cohort study. We collected information about the doctor diagnosis of diabetes during hospitalization, and drug prescriptions for schizophrenia at hospital discharge using medical charts. RESULTS: The overall prevalence of diabetes was 8.6% among patients with schizophrenia. Compared with the general population, the estimates of diabetes prevalence in the schizophrenia population were 2.6-10.8 percentage point higher among males aged 30-49 years, and 1.9-9.9 percentage point higher among females aged 40-59 years. The odds of being prescribed conventional antipsychotics were about 2 times higher among patients with diabetes than without diabetes, relative to atypical and combination of conventional and atypical antipsychotics. These results were robust across various sensitivity analyses. CONCLUSION: When treating schizophrenia patients with preexisting diabetes, psychiatrists need to monitor the occurrence of diabetes regularly regardless of antipsychotic class, strike a balance, and provide the most efficacious antipsychotic medication.