Aim:Open Dialogue (OD), developed in Finland, has gained attention in psychiatric care for its emphasis on human rights. However, quantitative research remains limited, and its implementation in Japan is still at an early stage. Reflecting, originally developed in Norway, is a core element of OD's dialogical practice and has shown promise, yet studies on its mechanisms remain scarce. Methods:This study examined how reflecting is associated with changes in the tense structure of client utterances. Audio from outpatient sessions was transcribed, and utterances were categorized into four tense types: future, present, recent past, and past. Changes before and after reflecting were analyzed using repeated measures ANOVA and Wilcoxon tests. Results:Results showed that past-oriented utterances significantly increased in the reflecting group, while no significant changes occurred in the individual consultation group. Conclusion:These findings suggest that reflecting may be associated with increased references to past experiences, which may be related to self-reflection as one aspect of a deepening dialogical process.
Background:Supportive psychotherapy (SP) is widely practiced, yet its constituent techniques have never been systematically identified or classified. Authors and manuals describe overlapping but non-identical sets in varying terminology, and the boundary between SP and supportive-expressive psychotherapy (SEP) remains unclear, impeding training, research, and comparison. This review aims to identify and classify supportive techniques across the SP and SEP literature and develop a consolidated taxonomy, mapping SEP-specific expressive techniques separately to clarify the supportive-expressive boundary. Methods:This systematic review protocol, applying qualitative content analysis across study designs, follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). We will search MEDLINE (PubMed), APA PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from inception, with backward and forward citation searches. Eligible sources are peer-reviewed publications of any design describing at least one specific SP or SEP technique, plus prespecified key texts and manuals. Two reviewers will independently screen, extract data at source and technique levels (verbatim), and appraise quality with the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Qualitative content analysis will consolidate synonymous descriptions and build the taxonomy through a hybrid inductive-deductive approach. Results:We expect to produce a consolidated, hierarchically organized taxonomy of supportive techniques, with a boundary mapping of SEP-specific expressive techniques and a characterization of consensus and divergence across both literatures. Conclusions:Such a taxonomy would provide a common language for clinicians and researchers, support precise specification of SP in trials, and facilitate structured training.
Narcolepsy is a chronic neurologic sleep disorder associated with excessive daytime sleepiness, cataplexy, and a higher prevalence of cardiovascular and psychiatric comorbidities. While these factors may predispose individuals to adverse events, observational studies evaluating mortality in narcolepsy have yielded inconsistent results. This systematic review and meta-analysis aimed to quantify the all-cause mortality risk in patients with narcolepsy compared to matched controls. A systematic literature search of PubMed, Embase, Scopus, and Web of Science was conducted up to February 2026 for studies reporting quantitative mortality metrics (Risk Ratios [RR] and Hazard Ratios [HR]) in narcolepsy. Pooled effect estimates were calculated using random- and fixed-effects models. We also performed sensitivity analyses and subgroup analyses based on geographic region (Western vs. Asian) and age (Pediatric vs. Adult/Mixed) to explore heterogeneity. Five studies comprising 212,596 patients with narcolepsy and 526,688,615 controls were included in the primary analysis. The overall pooled RR for mortality was 1.25 (95% CI: 0.98 to 1.61; P = 0.08), demonstrating no statistically significant increase in risk, albeit with substantial heterogeneity (I 2 = 83%). A sensitivity analysis excluding one heavily weighted outlier (Ohayon et al., 2014) reduced heterogeneity (I 2 = 8%; RR = 1.09, 95% CI: 0.95 to 1.24; P = 0.22), showing that the results depend heavily on a single administrative dataset rather than proving narcolepsy carries no mortality risk. Furthermore, the pooled HR for mortality over time across three studies was 1.20 (95% CI: 0.82 to 1.76; P = 0.34). Subgroup analyses revealed no significant variation in mortality risk between Western and Asian populations (P = 0.55) or between pediatric and adult cohorts (P = 0.36). Current evidence does not prove narcolepsy carries a normal life expectancy. Instead, all-cause mortality risk remains uncertain due to fragile data and a lack of cause-specific findings. Because narcolepsy involves serious cardiometabolic, psychiatric, accident, and medication risks, ongoing patient risk management is required.
Background:Autoimmune encephalitis in children may present with predominant psychiatric and behavioral symptoms, creating diagnostic challenges, particularly in patients with pre-existing autism spectrum disorder. Seronegative forms are especially difficult to recognize because neuronal autoantibodies are not detected, and diagnostic overshadowing may delay consideration of immune-mediated etiologies. Case Presentation:We report the case of an 11-year-old boy of Turkish background living in France, with autism and normal intelligence, who developed severe subacute behavioral and cognitive regression. Symptoms included explosive aggression, self-injurious behavior, obsessive-compulsive-like behavioral loops, psychotic-like features, agitated catatonic deterioration from baseline, loss of adaptive skills, and marked functional decline. The condition was resistant to intensive psychiatric care and multiple psychotropic treatments. Etiological assessment revealed focal epilepsy, cerebrospinal fluid abnormalities, and abnormal brain fluorodeoxyglucose positron emission tomography (FDG-PET) findings, while extensive work-up excluded infectious, metabolic, genetic, systemic autoimmune, and oncological causes. Neuronal autoantibodies were negative in serum and cerebrospinal fluid. A cautious diagnosis of probable seronegative autoimmune encephalitis was retained based on the clinical course, focal epilepsy, serial FDG-PET abnormalities, follow-up cerebrospinal fluid findings, exclusion of alternative etiologies, and expert consensus. Intravenous immunoglobulin therapy was associated with progressive but partial clinical improvement, and rituximab was introduced after a response plateau. Conclusion:This case highlights the risk of diagnostic overshadowing in children with autism presenting with severe, treatment-resistant behavioral or catatonic regression. Immune-mediated etiologies should be considered even in the absence of detectable autoantibodies. Serial FDG-PET may support diagnostic reasoning and follow-up, while remaining nonspecific and insufficient as diagnostic proof in isolation.
Aim:Few studies in Japan have described young patients presenting to emergency departments after dextromethorphan overdose in detail. Therefore, we aimed to investigate the demographic characteristics and psychosocial backgrounds of patients who presented to emergency departments in Japan after dextromethorphan overdose. Methods:This was a multicenter, prospective, observational study with nonconsecutive enrollment. A standardized questionnaire regarding dextromethorphan overdose and the Drug Abuse Screening Test-20 (DAST-20) were administered in eight emergency departments in Japan. Continuous variables are presented as medians and interquartile ranges. Results:In total, 78 patients were included. The median age was 20 years (17.0-22.0), and 64 patients (82.1%) were female. Fifty-six (71.8%) patients engaged in social activities. Fifty-one patients (65.4%) stated that the purpose of the overdose was suicide/self-harm. The number of patients who reported that the source of information on dextromethorphan overdose was social networking services and internet searches was 27 (35.1%) and 29 (37.7%), respectively. Fifty-eight patients (74.4%) reported that dextromethorphan was purchased from a retail store. Among 66 respondents, 40 (60.6%) had moderate or higher DAST-20 scores. On comparing the younger group aged 10-19 years (n = 38) and the older group aged ≥20 years (n = 40), the number of patients who indicated that the source of information on dextromethorphan overdose was internet searches in the former group (19, 50.0%) was significantly higher than that in the latter group (10, 25.0%). Conclusion:Dextromethorphan overdose predominantly involved young women, and drug-related problems were common.
Aim:To describe nationally representative trends in overall and product-specific tobacco use, including cigarettes, heated tobacco products (HTPs), and electronic cigarettes (e-cigarettes), in Japan from 2017 to 2025. Methods:Data came from repeated cross-sectional nationwide surveys of the Japanese population using stratified two-stage random sampling. Self-administered questionnaires assessed tobacco use. Past-30-day prevalence of overall, product-specific, and multiple-product use was estimated using survey-weighted logistic regression, with marginal predicted prevalence standardized to the 2025 age-sex structure. Results:Among 16,499 participants, overall past-30-day tobacco use declined from 24.3% (95% confidence interval [CI]: 22.6-26.0%) in 2017 to 21.0% (CI: 19.4-22.7%) in 2025. Cigarette use decreased from 20.7% (CI: 19.0-22.3%) to 12.3% (CI: 11.1-13.6%), whereas HTP use increased from 5.3% (CI: 4.4-6.1%) to 11.7% (CI: 10.3-13.0%). e-cigarette use remained low, ranging from 0.7% to 1.3%. The most common multiple-product pattern was concurrent cigarette and HTP use, increasing from 2.5% (CI: 1.9-3.1%) to 4.1% (CI: 3.3-4.9%). Conclusion:Overall tobacco use in Japan declined modestly during 2017-2025, alongside a marked decrease in cigarette use and an increase in HTP use, while e-cigarette use remained limited. These findings suggest a shift in tobacco use, with increased HTP use partially offsetting reductions in cigarette smoking.
Aim:Anxious distress is a clinically important specifier associated with adverse outcomes in mood disorders. This study aimed to compare the prevalence of anxious distress and overall depressive symptoms between patients with major depressive disorder (MDD) and bipolar disorder (BD) using validated self-report measures. Methods:This cross-sectional study included 202 psychiatric outpatients (133 MDD and 69 BD) recruited from seven outpatient clinics in Japan. Participants completed the Clinically Useful Depression Outcome Scale supplemented with the DSM-5 anxious distress specifier (CUDOS-A) and the Quick Inventory of Depressive Symptomatology, Self Report (QIDS-SR). Anxious distress was operationally defined using the CUDOS-A items corresponding to the DSM-5 anxious distress specifier. Group differences in prevalence and mean scores were examined using chi-square tests and independent samples t-tests, respectively. Results:The prevalence of anxious distress was 42.9% in patients with MDD and 43.4% in those with BD, with no significant difference between groups (p = 0.95). No significant differences were observed in the mean CUDOS-A total scores (28.0 ± 19.9 vs. 27.0 ± 17.7, p = 0.57) or the QIDS-SR total scores (13.6 ± 7.6 vs. 12.1 ± 7.4, p = 0.18). Furthermore, all individual items of the CUDOS-A showed no significant differences between the two groups. Conclusions:Both anxious distress and overall depressive symptom severity assessed by self-report measures appear to be comparable between MDD and BD. Although the diagnostic utility of anxious distress for differentiating between the two disorders has not been established, its high prevalence in both groups underscores its clinical significance and supports the need for routine assessment in mood disorders.
Aim:To evaluate sensory processing in school-aged children born preterm with and without attention-deficit/hyperactivity disorder (ADHD), focusing on sensory processing patterns and sensory and behavioral sections of the Sensory Profile-2 (SP-2). Methods:Forty-eight school-aged children born preterm were enrolled. The mean age was 7.9 years, and 62.5% were boys. Participants were divided into an ADHD group (n = 38) and a non-ADHD group (n = 10) and were assessed using the SP-2. Results:Thirty-two participants (66.7%) showed overall sensory scores outside the typical range, of whom 28 (87.5%) had ADHD. Non-parametric analyses revealed significantly higher scores in the Sensitivity quadrant, the Auditory section, and the Conduct and Attention behavioral sections among children with ADHD. Conclusion:Children without ADHD showed fewer sensory processing difficulties than those with ADHD, suggesting that ADHD may be associated with more pronounced sensory processing difficulties among children born preterm.
Aim:We examined whether rurality was associated with psychiatric standardized claim ratios computed using medical-institution location, and how these patterns related to area deprivation and residence-based suicide mortality in Japan. Methods:We conducted a nationwide ecological study of 335 secondary medical areas. Rurality, measured with the Rurality Index for Japan, and a census-based Area Deprivation Index were population-weighted from municipalities. Psychiatric specialty therapy claims (April 2023 to March 2024) from Japan's national health-insurance claims open data were expressed as standardized claim ratios: observed claims billed by institutions in each area divided by national age-sex expected claims. Suicide deaths (April 2022 to March 2025) were expressed as age-sex standardized mortality ratios. Ecological rate-ratio trends were estimated with quasi-Poisson models. Results:Outpatient claim ratios were lower in rural than urban areas but non-monotonic (most urban, 108.4; fourth quintile, 76.9; and most rural, 81.3). Inpatient ratios peaked in the second quintile, and suicide mortality rose with rurality. Per 10-point higher rurality score, outpatient volume was lower (rate ratio, 0.939; 95% confidence interval, 0.921-0.956) and remained lower after including deprivation (0.919; 0.896-0.942); the rurality-suicide association attenuated. Nearest-three-area pooling raised the most rural median outpatient ratio from 62.2 to 101.1. Conclusion:More rural areas had lower outpatient psychiatric claim volume billed by local institutions relative to national age-sex benchmarks, but this contrast narrowed after nearest-area pooling, consistent with cross-boundary care. These institution-location ratios should prompt local review with residence-based and capacity data, not be read as evidence of under-provision.
Aim:Residential treatment camps for problematic internet use (PIU) may influence adolescents' behaviors and parental mental health and parenting attitudes. This secondary analysis examined the effects of a residential treatment camp on parents of adolescents with PIU. Methods:This secondary analysis included 20 parents (3 fathers and 17 mothers) of adolescents who participated in a residential treatment camp for PIU. Parents were assessed employing the General Health Questionnaire-12 (GHQ-12), Positive and Negative Parenting Scale (PNPS), and State-Trait Anxiety Inventory Form JYZ (STAI-JYZ). Qualitative analysis was conducted using free-response questionnaires regarding perceptions of adolescents' internet and gaming use. These evaluations were performed at baseline, after the intervention, and at the 3-month follow-up. Results:The GHQ-12 scores demonstrated significant changes throughout the study period. They improved significantly after the intervention but deteriorated significantly at follow-up compared with after the intervention. No significant changes were identified in STAI-JYZ scores or PNPS positive parenting scores. The PNPS (negative attitude) showed significant changes between baseline and follow-up and between after the intervention and follow-up. Text mining results showed a transition from restrictive terms such as "protect" and "reduce" at baseline to autonomy-related terms including "myself," "decide," and "freedom" after the intervention and at follow-up. Conclusion:A residential treatment camp intervention for adolescents with PIU did not produce any significant long-term effects on their parents' mental health. However, text mining results suggested a shift in parental perspectives from restrictive control toward greater respect for adolescents' autonomy.
Aim:To clarify the status of visitor and telephone restrictions and the factors associated with these restrictions among patients hospitalized for the treatment of mental disorders. Methods:This study included 1,998 patients hospitalized for the treatment of mental disorders at the Department of Psychiatry, Kitasato University Hospital, and the Department of Psychiatry, Kitasato University East Hospital between January 1, 2014 and December 31, 2021. The visitor and telephone restriction ratios of the participants were calculated, and their associations with demographic and clinical data and psychiatric diagnosis were comparatively examined. Results:Of the 1998 participants, 434 (21.7%) experienced visitor restrictions and 631 (31.6%) experienced telephone restrictions. Multivariate logistic regression analysis suggested that young age, involuntary admission, seclusion, physical restraint, schizophrenia spectrum disorders, and manic episodes of bipolar I disorder were associated with visitor restrictions. Additionally, young age, hospitalization days, involuntary admission, seclusion, physical restraint, and manic episodes of bipolar I disorder were associated with telephone restrictions. Conclusions:The visitor and telephone restriction ratios were 21.7% and 31.6%, respectively. Age, involuntary admission, seclusion, physical restraint, schizophrenia spectrum disorders, and manic episodes of bipolar I disorder were associated with visitor restrictions, and age, hospitalization days, involuntary admission, seclusion, physical restraint, and manic episodes of bipolar I disorder were associated with telephone restrictions. Further research is required to clarify the factors related to visitor and telephone restrictions and their impact on patients to minimize their use.
Aim:This study aimed to compare social participation and physical activity in patients with craniopharyngioma or central nervous system germ cell tumor (CNS germ cell tumor) with those of healthy participants and examine their associations with social behavioral disorders. Methods:We recruited adult patients with either childhood- or adult-onset conditions who received treatment at the Kyoto University Hospital and healthy participants. Social participation and physical activity were assessed using the Community Integration Questionnaire (CIQ) and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Social behavioral disorders, including apathy, were evaluated using the Frontal Systems Behavior Scale (FrSBe). Data were analyzed using the Mann-Whitney U test and Spearman's rank correlation. Results:A total of 20 patients (mean age 35.15 ± 14.00 years), comprising 14 with craniopharyngioma and 6 with CNS germ cell tumor, along with 25 healthy participants (mean age 35.52 ± 15.28 years), were recruited. The patients' total scores (CIQ) and total physical activity (IPAQ-SF) were significantly lower than those of healthy participants (p < 0.001 and p = 0.021, respectively). Significant negative correlations were found between patients' productivity (CIQ) and total scores (FrSBe), and between productivity and apathy (FrSBe) (ρ = -0.449, p = 0.047 and ρ = -0.572, p = 0.008, respectively). Conclusion:Patients with craniopharyngioma or CNS germ cell tumor had lower levels of social participation and physical activity than healthy participants, and greater apathy was linked to reduced productivity. These findings suggest that joint activity planning and encouragement from caregivers may promote social participation in patients with apathy.
Aim:While "controlled drinking" as a treatment goal for alcohol use disorder (AUD) has recently become accepted in Japan, knowledge regarding the clinical characteristics and drinking patterns of patients with AUD remains limited. This study aimed to describe the gender-stratified baseline clinical characteristics and drinking patterns of treatment-seeking patients with AUD using baseline data from the Alcohol Longitudinal Prognosis Study in Japan (ALPS-J), a multicenter cohort study conducted at 15 facilities nationwide. Methods:The diagnosis and severity of AUD were assessed using the Structured Clinical Interview for DSM-5 Research Version (SCID-5-RV). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Sleep quality was assessed using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). Drinking patterns were assessed using an original questionnaire. Results:A total of 354 participants were analyzed; 83.1% were male, the mean age was 51.9 ± 11.2 years, and 85.0% were inpatients. Overall, 80.8% met the diagnostic criteria for severe AUD. Treatment was started approximately 5 years after the onset of drinking problems. Comorbid depressive symptoms were observed in 44.7% of participants, and 74.3% reported poor sleep quality. The mean daily pure alcohol consumption was 110.4 g. The most commonly consumed type of alcoholic beverage was chu-hai with 9% alcohol by volume, a high-alcohol beverage commonly sold in Japan and often referred to as "strong-style" chu-hai. Conclusion:Patients with AUD treated in specialized addiction treatment facilities often present with severe and complex clinical profiles, highlighting the need for earlier engagement in care and integrated treatment approaches.
Aim:Attention-deficit/hyperactivity disorder (ADHD) is a recognized related factor for gambling problems. Although ADHD frequently co-occurs with autism spectrum disorder (ASD) and adverse childhood experiences (ACEs), the interaction of these factors on gambling has not been fully explored in a large general population sample. We aimed to investigate the associations of ADHD traits, ASD traits, and ACEs with problem gambling. Methods:Using data from an internet survey that includes 32,000 Japanese participants, we evaluated the associations of ADHD traits, ASD traits, ACEs scores, and their interaction with problem gambling ratio through multivariable logistic regression analysis controlling for 14 confounders. We used the Problem Gambling Severity Index to assess problem gambling, the Japanese version of the Adult ADHD Self-Report Scale (ASRS) to assess ADHD traits, the ten-item Japanese version of the Autism-Spectrum Quotient (AQ-10) to assess ASD traits, and the ten-item Japanese version of the questionnaire to assess ACEs. Results:Problem gamblers exhibited significantly higher weighted rates of ASRS positive, AQ-10 positive, and high ACEs score. The weighted multivariable logistic regression analysis showed that ASRS positive, AQ-10 positive, and high ACEs score were significantly associated with problem gambling. Additionally, a significant interaction between ASRS positive and AQ-10 positive was observed. Conclusion:ADHD traits, ASD traits, and high ACEs scores were associated with higher odds of problem gambling. The co-occurrence of ADHD traits and ASD traits showed a negative multiplicative interaction on the odds ratio of problem gambling.
Aim:Schizophrenia imposes significant economic and social burdens, often resulting in prolonged inpatient length of stay (LOS), particularly for treatment-resistant cases. This study aimed to identify clinical, demographic, and social factors associated with prolonged LOS in a Canadian tertiary schizophrenia inpatient unit to highlight modifiable drivers and inform targeted interventions. Methods:A retrospective chart review of 120 consecutive discharges from January 2021 to May 2023 was conducted. Data on demographics, clinical history, and discharge delays were analyzed using ANOVA and t-tests to identify factors associated with prolonged LOS. Prolonged LOS was examined while differentiating between discharge delays and extended hospital stays. Results:The mean LOS was 200.43 days (SD = 285.67, median = 100 days). Fifty percent of patients (n = 60) experienced discharge delays, defined as >10 days between readiness and actual discharge. Housing instability was the leading cause (56.67%, n = 34), including patients seeking housing (40%) or awaiting long-term care (16.67%). Longer illness duration (p = 0.048) and treatment-resistant schizophrenia (TRS, indicated by clozapine use; p = 0.011) were significantly associated with length of delayed discharge. Sex, relationship status, and family or community support were not significantly associated with length of delayed discharge. Illness complexity/severity was the primary reason for extended hospital stay in all cases (100%, n = 12). Conclusion:This exploratory study highlights distinct clinical and system-level contributors to prolonged hospitalization. Housing instability, chronic illness, and TRS are key contributors to delays in discharge. Early discharge planning, enhanced housing support, and specialized TRS care pathways are essential to reduce LOS and optimize inpatient care.
