Stigmatized attitudes of medical staff toward people who use drugs and their determinants in Japanese medical facilities specialized in addiction treatment.

AIM: Stigma within healthcare settings significantly impact the lives of people who use drugs (PWUD). Given the lack of quantitative data on stigma toward PWUD in healthcare settings and the unknown factors that contribute to it in the Japanese context, this study aimed to investigate the current status of stigma toward PWUD and its determinants. METHODS: We conducted a survey in five specialized addiction medical facilities across three prefectures in Japan. The survey included questions related to stigmatizing attitudes toward PWUD, knowledge about illicit drug use, and personal and professional interactions with PWUD. RESULTS: A substantial portion of respondents rejected the notion that drug addiction can be overcome through sheer willpower or attributed it solely to moral failings. However, the majority still considered them untrustworthy and viewing drug use as unacceptable and incomprehensible. Many respondents perceived PWUD as dangerous, despite the limited occurrence of hostile behavior from PWUD in clinical practice. A considerable proportion of respondents did not seek support for their own or their relatives' drug-related issues, and less than half had collaborated with recovered PWUD, which serves as potential indicators of reduced stigma. While healthcare professionals recognized that involving law enforcement does not contribute to the recovery of PWUD, a considerable number still believed it was necessary to report them to the authorities. CONCLUSION: Healthcare professionals in specialized addiction medical facilities demonstrate strong stigmatizing attitudes toward PWUD. Comprehensive educational programs and large-scale awareness campaigns are necessary to address and mitigate stigma in this context.

Factors influencing stigma among healthcare professionals towards people who use illicit drugs in Japan: A quantitative study.

Aim: Stigma among healthcare professionals toward people who use drugs (PWUDs) must be addressed for recovery. However, research on this topic is limited in Japan, therefore we developed a brand-new scale through coproduction with PWUDs to measure stigma and conducted a survey using the developed scale to examine what influences stigma towards PWUDs in Japanese healthcare settings. Methods: Based on interviews with PWUDs and their families, we developed a survey containing 24 questions on stigma toward PWUDs. The survey was sent to healthcare professionals working in the public sector. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to determine the factor construct. Generalized linear mixed model (GLMM) analyses with each factor of the stigma questions set as a dependent variable were conducted to discover the specific contribution of each variable to professionals' stigma. Results: The six factors suggested by the EFA showed a good fit, as confirmed by the CFA of the stigma questions. GLMM discovered that "currently providing treatment services to PWUDs," "having PWUDs close to themselves," and "experiencing violence by the client when providing treatment services" were significantly associated with higher stigma scale scores. "Experience in receiving support," "attending self-help groups," and "using peer-based recovery support with PWUDs" were significantly associated with lower stigma scale scores. Conclusion: The scale coproduced with local PWUDs can be a reliable tool to measure the stigma PWUDs face in Japan. Further results indicate that interaction with recovered PWUDs should be promoted.

Gambling and Gambling Problem Perception Questionnaire as a tool to evaluate professionals' attitudes towards problem gamblers and training programmes in Japan.

Aim: To develop and measure the psychometric properties of the Gambling and Gambling Problem Perception Questionnaire (GGPPQ); a scale to evaluate professionals' attitudes towards people with problem gambling in the Japanese context. Data collection: We held 12 workshops in Japan targeted at mental health professionals who consult people with gambling problems. Participants completed the survey before the workshop. Some were also asked to complete the survey after the workshop to measure workshop influence. Setting: Public and private healthcare facilities in all 47 prefectures of Japan. Participants: Medical doctors, nurses, social workers, clinical psychologists, and other professionals working in the aforementioned facilities (n = 653, response rate = 98.5%). Measurements: licence; knowledge about gambling and gambling problems (questionnaire); self-rating of knowledge and general confidence for helping problem gamblers; years of practice; frequency of working with clients; experience in attending workshops; overall satisfaction with the workshop. Results: A five-factor structure extracted by exploratory factor analysis showed a good fit by confirmatory factor analysis (CFI = .973, TLI = .967, RMSEA = .060, AIC = 28913.6, BIC = 29110.8). The GGPPQ showed good internal consistency and good concurrent validity with participants' self-rating of their knowledge, general confidence, frequency of working with clients who have gambling problems, and experience in attending workshops. The workshop had a positive influence on participants' attitudes. Japan's unique gambling industry and lack of training opportunities on problem gambling were assumed to have influenced the psychometric properties of the measurement tool. Conclusion: The GGPPQ is a valid tool to measure the attitudes of healthcare professionals towards people with gambling problems, as well as workshop effectiveness in Japan.

Internet-based behavioural activation to improve depressive symptoms and prevent child abuse in postnatal women (SmartMama): a protocol for a pragmatic randomized controlled trial.

BACKGROUND: Child abuse and postnatal depression are two public health problems that often co-occur, with rates of childhood maltreatment highest during the first year of life. Internet-based behavioural activation (iBA) therapy has demonstrated its efficacy for improving postnatal depression. No study has examined whether the iBA program is also effective at preventing child abuse. This study aims to investigate whether iBA improves depressive symptoms among mothers and prevents abusive behaviours towards children in postpartum mothers in a randomized controlled trial, stratifying on depressive mood status. The study also evaluates the implementation aspects of the program, including how users, medical providers, and managers perceive the program in terms of acceptability, appropriateness, feasibility, and harm done. METHODS: The study is a non-blinded, stratified randomized controlled trial. Based on cut-off scores validated on Japanese mothers, participants will be stratified to either a low Edinburgh Postnatal Depression Scale (EPDS) group, (EPDS 0-8 points) or a high EPDS group (EPDS ≥9 points). A total of 390 postnatal women, 20 years or older, who have given birth within 10 weeks and have regular internet-access will be recruited at two hospitals. Participants will be randomly assigned to either treatment, with treatment as usual (TAU) or through intervention groups. The TAU group receives 12 weekly iBA sessions with online assignments and feedback from trained therapists. Co-primary outcomes are maternal depressive symptoms (EPDS) and psychological aggression toward children (Conflict Tactic Scale 1) at the 24-week follow-up survey. Secondary outcomes include maternal depressive symptoms, parental stress, bonding relationship, quality of life, maternal health care use, and paediatric outcomes such as physical development, preventive care attendance, and health care use. The study will also investigate the implementation outcomes of the program. DISCUSSION: The study investigates the effectiveness of the iBA program for maternal depressive symptoms and psychological aggression toward children, as well as implementation outcomes, in a randomized-controlled trial. The iBA may be a potential strategy for improving maternal postnatal depression and preventing child abuse. TRIAL REGISTRATION: The study protocol (issue date: 2019-Mar-01, original version 2019005NI-00) was registered at the UMIN Clinical Trial Registry (UMIN-CTR: ID UMIN 000036864 ).

Cardiogenic cerebral embolism caused by a severe hypoglycemic attack†:†a case report.

The direct relationship between a hypoglycemic attack and cerebral infarction remains unknown. It has been reported that a hypoglycemic attack can result in takotsubo syndrome, leading to cerebral infarction. We report a case of a cardiogenic cerebral embolism caused by a hypoglycemic attack, with additional literature review. A 71-year-old woman was admitted to our hospital in a semi-comatose state due to a severe hypoglycemic attack ; she developed hemiplegia one day after admission. Magnetic resonance imaging revealed cerebral infarction in the area supplied by the left middle cerebral artery. Takotsubo syndrome was suspected based on echocardiography. We diagnosed cerebral embolism due to takotsubo syndrome, caused by the hypoglycemic attack. J. Med. Invest. 67 : 362-364, August, 2020.

Exploring suicide risk factors among Japanese individuals: The largest case-control psychological autopsy study in Japan.

This case-control psychological autopsy study explored suicide risk factors among Japanese individuals. We targeted 102 suicide completers over 20 years of age and 334 living controls matched to suicide cases by gender, age, and residential municipality in Japan. After controlling for other factors, we found significant associations between suicide and mental disorders, sleeping problems, and verbal communication of one's own death. We discuss the importance of sensitive responses to verbal expressions of suicidal ideation.

Female suicides: Psychosocial and psychiatric characteristics identified by a psychological autopsy study in Japan.

AIM: Although the female suicide rate in Japan is one of the highest among OECD countries, little has been done to assess the psychosocial and psychiatric characteristics of Japanese female suicide completers. This study aimed to examine sex differences in psychosocial and psychiatric characteristics of suicide completers using a psychological autopsy study method, and to identify female suicide factors and intervention points to prevent female suicides. METHODS: A semi-structured interview was conducted with close family members of adult suicide completers. The interview included questions regarding sociodemographic factors, suicide characteristics, previous suicidal behaviors and a family history of suicidal behaviors, financial problems, and physical/psychiatric problems. Fisher's exact test and the Student's t-test were used to explore sex differences in these survey items, and individual descriptive information of female suicide cases was also examined. RESULTS: Of the 92 suicide completers, 28 were female and 64 were male. Females had a significantly higher prevalence of a history of self-harm/suicide attempts (P < 0.001). The prevalence of eating disorders was significantly higher among females than males (P < 0.01). CONCLUSION: The findings of this study highlight the importance of providing psychological and social support to caregivers of those who repeatedly attempt suicide and express suicidal thoughts, and to suggest the need to improve community care systems to be aware of suicide risk factors among female suicide attempters.

Suicide risk among individuals with sleep disturbances in Japan: a case-control psychological autopsy study.

OBJECTIVE: This case-control psychological autopsy study aimed to explore a relationship between sleep disturbances and suicide among Japanese, as well as determine the importance and usability of screening for sleep disturbances in suicide prevention. METHODS: A semi-structured interview was conducted with the close family members of 49 adult suicide completers and 145 gender-, age-, and residential municipality-matched living controls. The survey included sections on demographics, sleep disturbances, and mental disorders. Conditional logistic regression analyses were performed to compare sleep disturbance prevalence between the two groups. RESULTS: A significantly higher prevalence of sleep disturbances was found among the suicide group (75.5%) compared to the controls (11.0%) (odds ratio [OR]=21.6, p<0.001). The association remained significant after adjusting for mental disorders (OR=12.7, p<0.001). The population attributable risk percent of suicide associated with sleep disturbances and mental disorders was estimated to be 56.4% and 35.3%, respectively. CONCLUSIONS: The study confirmed that sleep disturbances are an important risk factor of suicide, independent of mental disorders. Sleep disturbances accounted for a greater proportion of suicide cases than did mental disorders in the Japanese population given the higher prevalence, and could thus be considered an important target in suicide prevention in Japan.

The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment.

BACKGROUND: Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS. METHODS: Participants in this study were 175 middle-aged and elderly Japanese male patients who met the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge. RESULTS: Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS. CONCLUSIONS: The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.

[Rapid recurrence of chronic subdural hematoma by CSF entrapment].

A case of chronic subdural hematoma with multiple rapid recurrences is reported. A 41-year-old woman was admitted to hospital because of a traumatic subarachnoid hemorrhage and an intracerebral hematoma in the left frontal lobe. Both regions were conservatively treated, and she was discharged with no neurological deficit. Four months after this injury, she was readmitted to our clinic with complaints of severe headache and mild left hemiparesis. A CT scan showed a right chronic subdural hematoma. A burr hole and irrigation was performed, and the hematoma cavity disappeared on the following day. However, a deterioration of consciousness and left hemiparesis appeared ten days after the first operation. A second CT scan showed the recurrence of a left chronic subdural hematoma, so a second operation was performed. The patient showed a good postoperative course, and once again the hematoma cavity disappeared on the day following the operation. Nevertheless, a deterioration of consciousness and left hemiparesis appeared eight days after the second operation. A CT scan showed a second recurrence with low-density findings. Intraoperative findings during the third operation showed an almost water-like subdural fluid, and entrapment of cerebrospinal fluid by the inner membrane was suspected. A craniotomy and the removal of the outer and inner membranes were performed. Macroscopically, the inner membrane was intact and showed no signs of injury. No further recurrences occurred after the craniotomy. The suspected cause of the multiple subdural hematomas was the flow and entrapment of cerebrospinal fluid in some area of the inner membrane.

Assessing multidimensional cognitions of drinking among alcohol-dependent patients: development and validation of a drinking-related cognitions scale (DRCS).

The aim of this study is to develop and validate the Drinking-Related Cognitions Scale (DRCS). The DRCS is a brief measure designed to assess multidimensional cognitions of drinking, including perception of drinking problems, perception of impaired drinking control, readiness to change, decisional balancing, and self-efficacy in alcohol-dependent patients. This study was carried out in Japan, with 132 alcohol-dependent patients (mean age (SD): 49.4 (7.5) years) admitted to an inpatient treatment program. On the basis of prior studies of the rating scales of drinking-related cognitions, DRCS items were selected. Factor analysis was carried out to assess the selection of DRCS items and the factor structure. The factor analysis of the 15 DRCS items showed three factors, "expectancy and resignation," "perception of impaired control," and "perception of drinking problem." The DRCS showed good reliability (Cronbach's alpha-coefficients for the entire scale and subscales were 0.80 or higher, and the analysis of variance intraclass correlation coefficient for the test-retest method was 0.81 for the total score). The total DRCS and subscale scores predicted abstinence status at a 3-month follow-up, and the DRCS was considered to have satisfactory predictive validity. It was suggested that the DRCS would be useful for the easy measurement of multidimensional cognitions of drinking in alcohol-dependent patients.

[Introduction of cognitive-behavioral therapy for alcoholic inpatients at Kurihama National Hospital].

A new inpatient treatment program for alcoholism based on cognitive-behavioral therapy was introduced at Kurihama National Hospital in March 2000. We have classified the dysfunctional cognitions frequently exhibited by alcoholics into eight categories. The therapy is premised on the notion that the presence of one or more of the dysfunctional cognitions can trigger worsening of an alcoholic's drinking problem. We have devised a cognitive model in which the patients themselves examine their dysfunctional cognitions and recover from the vicious cycle of alcoholism. Cognitive-behavioral therapy is conducted at Kurihama National Hospital based on these hypotheses. The cognitive-behavioral therapy employed at Kurihama National Hospital is administered in group therapy in an inpatient treatment setting. Since the treatment is provided on an inpatient basis, dropouts from the program as a result of the patient starting to drink again can be prevented. Furthermore, since group therapy are used, cognitions of alcohol are examined not just in the context of the relationship between patient and therapist, but also in the context of the relationships among patients. It thus becomes easier to examine dysfunctional cognitions from a multifaceted perspective. It will be easier for patients to examine their future drinking behavior concretely through the introduction of cognitive-behavioral therapy, and improvements in outcome should be achieved. However, the relationship between change in cognitions and prognosis needs to be studied in the future.