[Individually Safe and Realistic Correction of Antipsychotic Polypharmacy and High-dose Regimens in Japanese Patients with Chronic Schizophrenia: The SCAP method].

Compared with other countries, Japan exhibits prominent levels of antipsychotic polypharmacy and high-dose regimens. In view of these circumstances, the Safe Correction of Antipsychotic Polypharmacy and high-dose regimens (SCAP) method was developed based on previous findings as a realistic way to reduce medication consumption in patients already experiencing polypharmacy and high-dose regimens. In the SCAP method, "clinicians can reduce medications one by one, gradually, with occasional breaks permitted.

Evaluation of the individual safe correction of antipsychotic agent polypharmacy in Japanese patients with chronic schizophrenia: validation of safe corrections for antipsychotic polypharmacy and the high-dose method.

Background: Polypharmacy for schizophrenia treatment is not justified by the available clinical evidence. We evaluated a treatment reduction approach that reduces the dose and number of antipsychotic medications simultaneously prescribed to patients.

Methods: In a randomized open study of the Safe Correction of Antipsychotic Polypharmacy and High-Dose Prescriptions program funded by the Japanese Ministry of Health, Labour, and Welfare, we evaluated a drug reduction method consisting of a dose reduction intervention performed on 163 patients with schizophrenia for twelve or 24 weeks.

Study protocol: safety correction of high dose antipsychotic polypharmacy in Japan.

Background: In Japan, combination therapy with high doses of antipsychotic drugs is common, but as a consequence, many patients with schizophrenia report extrapyramidal and autonomic nervous system side effects. To resolve this, we proposed a method of safety correction of high dose antipsychotic polypharmacy (the SCAP method), in which the initial total dose of all antipsychotic drugs is calculated and converted to a chlorpromazine equivalent (expressed as milligrams of chlorpromazine, mg CP). The doses of low-potency antipsychotic drugs are then reduced by ≤ 25 mg CP/week, and the doses of high-potency antipsychotics are decreased at a rate of ≤ 50 mg CP/week.

[Implementation of appropriate administration of antipsychotics--measures to reduce high-dose multiple antipsychotics].

In Japan, multiple antipsychotic drugs are administered at a high dose to schizophrenia patients. Many patients suffer from side effects, among which extrapyramidal and autonomic side effects frequently occur. We suggest a method in which antipsychotic drugs are slowly reduced as follows: for low potency drugs, the dose is decreased with 25 mg or lower of a chlorpromazine-equivalent dose per week, and, for high potency drugs, the dose is decreased with 50mg or lower of a chlorpromazine-equivalent dose per week.

[Measures to reduce high-dose multiple antipsychotics in Japan].

In Japan, multiple antipsychotic drugs are administered at a high dose to schizophrenia patients, which is rare in other countries. Many of such patients suffer from side effects, among which extrapyramidal and autonomic side effects frequently occur. Many anticholinergic agents and cathartics are concomitantly used for schizophrenia patients, and their vital prognoses are likely to be poor.

Fluid-attenuated inversion-recovery MR imaging in schizophrenia-associated with idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome).

Background: Patients with schizophrenia show a significantly higher frequency of hyperbilirubinemia the patients suffering from other psychiatric disorders and the general healthy population. The objective of the current study was to determine whether patients with schizophrenia-associated idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome, GS) have specific changes in signal intensities on fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images.

Methods: Axial 5-mm-thick FLAIR MR images from schizophrenia patients with GS (n=18) and schizophrenia patients without GS (n=18), all diagnosed according to DSM-IV criteria, were compared with age- and sex-matched non-psychiatric controls (n=18).

Urinary excretion of biopyrrins, oxidative metabolites of bilirubin, increases in patients with psychiatric disorders.

Several authors have suggested that psychological stress induces the production of reactive oxygen species (ROS). Several studies have supported the idea that bilirubin exerts antioxidative effects in vivo, and it was reported psychological stress provokes bilirubin oxidation in vivo [Yamaguchi T., Shioji I.

Late-onset persistent visual hallucinations with epileptiform discharge.

We report the case of a 58-year-old female without a history of psychosis or epilepsy presenting with abrupt late-onset persistent visual hallucinations that had prominent epileptiform discharges with a diffuse sharp and slow wave complex on electroencephalography. Except for the visual hallucinations, other psychotic symptoms and epileptic seizures, such as disturbance of consciousness and convulsion, were not observed. The epileptiform discharge disappeared within 20 days after initiation of treatment with sodium valproate.

Proton magnetic resonance spectroscopy (1H-MRS) of hippocampus, basal ganglia, and vermis of cerebellum in schizophrenia associated with idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome).

Objective: Whether patients with schizophrenia-associated idiopathic unconjugated hyperbilirubinemia (Gilbert's syndrome, GS) have specific changes in brain metabolism was examined in this study.

Method: This study applied proton magnetic resonance spectroscopy (1H-MRS) to the hippocampus, basal ganglia, and vermis of the cerebellum of schizophrenic patients with GS (n=15) or without GS (n=15), all diagnosed according to DSM-IV criteria, and healthy subjects (n=15).

Results: In the hippocampus, schizophrenic patients with GS showed a significant decrease of N-acetyl aspartate/creatine-phosphocreatinine (NAA/Cr) and myoinositol/creatine-phosphocreatinine (mI/Cr) ratios compared to healthy subjects and schizophrenic patients without GS, while schizophrenic patients without GS showed only a significant decrease of NAA/Cr compared to healthy subjects.

Sleep disturbances and depression in the elderly in Japan.

Unlabelled: The purpose of the present study was to evaluate the relationship between sleep disturbances and depression in the Japanese elderly.

Methods: These investigations in the Japanese elderly were carried out with the Geriatric Depression Scale, the Pittsburgh Sleep Quality Index, and questions on restless legs syndrome and nocturnal eating disorder. A total of 2023 people (male: 1008; female: 1015; average age: 74.

Successful treatment of nocturnal eating/drinking syndrome with selective serotonin reuptake inhibitors.

Nocturnal eating/drinking disorder (NE/DS) is a rare syndrome that includes disorders of both eating and sleeping. It is characterized by awakening in the middle of the night, getting out of bed, and consuming large quantities of food quickly and uncontrollably, then returning to sleep. This may occur several times during the night.