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Drug overdose is a serious public health issue and fatal cases have been reported from various fields of medicine. This case-control analysis assessed the comparison between fatal overdose cases in the special wards of Tokyo Metropolitan area and prescribed psychotropic drugs in Tokyo in 2009-2010. It was suggested that the prescribed drugs serve as a direct cause of death in overdose cases. Furthermore, pentobarbital calcium, chlorpromazine-promethazine-phenobarbital, levomepromazine and flunitrazepam were identified as drugs with a high risk of fatal overdose. It is encouraged to prudently verify the intended application and usage of such psychotropic drugs in each case upon their prescription. This is the first study in Japan to identify psychotropic drugs with a high risk of fatal overdose by case-control study.

In Japan, few psychiatric institutions provide rehabilitation for drug dependence, since dependence on illicit drugs including methamphetamine has generally been regarded as a crime and not an illness by Japanese psychiatrists. However, partial revisions of the Penal Code (the Partial Stays of Execution System) are going to be enforced in 2016, and it has been predicted that many illicit drug-dependent convicts will be treated in the community. Accordingly, the expansion of support resources in the community, including psychiatric institutions, is an urgent requirement. The Serigaya Methamphetamine Relapse Prevention Program ("SMARPP"), which consists of once-a-week groups sessions including motivational interviewing attitudes, and cognitive behavioral therapy for relapse prevention following the Matrix model, is expected to be one of the community resources for drug-dependent convicts. This paper introduces the principle and contents of the "SMARPP".

Context: Despite evidence of an increase in the number of young patients receiving mental health treatment, most psychotropic medications have not been approved for the treatment of children and adolescents by the Ministry of Health, Labour and Welfare. There is little data available on psychotropic medication use in children and adolescents in Japan.To establish the prevalence of psychotropic medications and multiclass psychotropic polypharmacy in outpatients aged 18 years or younger in Japan between 2002 and 2010.We used the national insurance claims database from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance in Japan.Prevalence of psychotropic prescription and psychotropic polypharmacy.Our study dataset comprised 233,399 outpatient visits. Among patients aged 6-12 years between 2002-2004 and 2008-2010, there was a significant increase in the prevalence of ADHD medications (Odds Ratio [OR] 1.84; 95% Confidence Interval [CI] 1.33, 2.56) and antipsychotics (OR 1.58 95% CI 1.06, 2.34), and a significant decrease in the prevalence of sedative-hypnotics (OR 0.67; 95% CI 0.46, 0.99). Among patients aged 13-18 years, there was a significant increase in the prevalence of ADHD medications (OR 2.49; 95% CI 1.34, 4.62), anti-psychotics (OR 1.43 ; 95% CI 1.20, 1.70), and antidepressants (OR 1.37; 95% CI 1.09, 1.72). Medications that were most frequently involved used in combination of two or more psychotropic agents were mood stabilizer (93%), followed by antidepressants (77%), sedative-hypnotics (62%), antipsychotics (61%), and ADHD medications (17%).Our study revealed an increase in the use of off-label antipsychotics and antidepressants among children and adolescents. Therefore, there is an urgent need for clinical trials to evaluate the efficacy of psychotropic medications for use in children and adolescents, and the development of a clinical database to monitor the associated long-term risks and benefits.

In this paper, we review Western studies on the prevalence of comorbid attention-deficit/ hyperactivity disorder (AD/HD) in individuals with drug abuse/dependence, and the associations of drug abuse/dependence with AD/HD. Additionally, we introduce our studies on the associations between adulthood drug abuse/dependence and the childhood AD/HD tendency in Japan, using a self-rating questionnaire to assess childhood AD/HD tendencies, the Japanese version of the Wender Utah Rating Scale. Our studies suggested that, while adulthood drug abuse/dependence may be closely associated with the childhood AD/HD tendency, as many Western studies have indicated, the abused substances most commonly chosen by drug abusers with a childhood AD/HD tendency were not methamphetamines but organic solvents, unlike in several Western studies. Our results did not support the findings of some Western studies: "preferences to choose a stimulant as "self-medication" to directly improve AD/HD symptoms. However, organic solvents appeared to be chosen as "self-medication" to cope with secondary/peripheral symptoms derived from AD/HD.

Use of the so-called "dappou herb," a street drug typically produced by mixing herbs with synthetic cannabinoid (estimated to be the pharmacologically effective ingredient), has recently spread to young people in Japan who consider it a new recreational drug. It is not legally regulated because no illicit ingredients have been detected in the drug by conventional screening tests. It is easily obtained via the Internet or from street vendors. As the population abusing this drug has grown, medical problems such as psychosis, disturbances of consciousness caused by acute intoxication, and social problems such as traffic accidents while under the influence of the drug have been increasingly reported. However, few psychiatric symptoms associated with it have been identified, and little is known about the psychosocial features of abusers. The purpose of the present study was to examine the clinical and psychosocial features of outpatients with dappou herb use disorder.Subjects were 15 male outpatients with dappou herb use disorder who had their first medical examination at the Drug Dependence Clinic in the Center Hospital, National Center of Neurology and Psychiatry between November 2009 and April 2012. The control group comprised 28 age-matched oupatients who had methamphetamine use disorder, the most serious drug-related problem in Japan since the 1950s. They underwent their first medical examination at the same clinic during the same time frame as the study subjects. Clinical and psychosocial information on subjects and controls including life histories (educational, occupational, and criminal) and clinical information (history of psychoactive substance use, access to the mainly abused drug, and DSM-IV diagnoses of substance use disorder and comorbid psychiatric disorders) were collected from medical records. These variables were compared between the two groups.Analyses revealed differences in the life history and clinical characteristics between the subjects and controls. The subjects had a higher level of education, more work experience, and a less marked history of anti-social behavior other than illicit drug use and possession than the controls. However, a clinical history of psychiatric disorders, other than substance-related disorders, before drug abuse began was more frequently found in the subjects than in the controls.The present study demonstrates that patients with dappou herb use disorder may differ from those with methamphetamine use disorder in terms of their background, psychosocial factors, and clinical features. These findings suggest that the dappou herb may be creating a new type of drug abuser in Japan. Our study also indicates that some patients abusing this herb may have been "self-medicating" for symptoms of other psychiatric disorders such as depression or anxiety, given that they were more likely to have received psychiatric treatment before the start of drug abuse. This suggests that the legal regulation of this drug as well as early comprehensive intervention for adolescents with mental health problems may be required to prevent abuse of the dappou herb. Two limitations of this study should be noted. The definition of the dappou herb was vague because the ingredients are still unclear. In addition, the sample size of this study was very small. However, no studies using larger samples have been reported in Japan. Future studies that overcome these limitations are needed.

Since the promulgation of the Basic Act for Suicide Prevention, suicide prevention in Japan has developed rapidly. In order to further reinforce such activities, it is necessary to balance universal, selective, and indicated prevention. For the revision of the General Principles of Suicide Prevention Policy, the Center for Suicide Prevention announced this recommendation with 29 societies. We hope that it will promote suicide prevention in Japan and lead to expansion of the suicide prevention network by academic organizations, NGOs, as well as local and central government.

Recently self-injurious behavior including wrist-cutting among youth has been a serious problem in Japan. Self-injury is the act to injure oneself deliberately without a suicidal intent, by a nonfatal method, predicting a nonfatal consequence. It is frequently repeated to cope with distress, for instance, to reduce an intolerable and painful feeling. Self-injury is the act to be differentiated from suicide, and often cause a negative attitude in mental health professionals, although many previous studies reveal that individuals with self-injury are more likely to death by suicide than those without, and that self-injury may be one of the important risk factors predicting future suicide. In this paper, the author gives an outline of understanding and treating self-injury, and indicates that to support and care self-injuring youth by mental health professionals may contribute to suicide prevention in adolescence.

The purpose of the present study was to examine the current situation regarding sedative (mainly benzodiazepines)-related disorder in Japan and the clinical characteristics of Japanese patients with this disorder.Subjects were 671 drug-related disorder patients diagnosed according to the ICD-10 classification as "F1: mental and behavioural disorders due to psychoactive substance use," who abused psychoactive substances other than alcohol. Of all the psychiatric hospitals in Japan between September and October 2010, these drug-related disorder patients had consecutively consulted or were admitted to 153 psychiatric hospitals.The present study was conducted by means of a mail survey. Subjects' clinical information, including history of psychoactive substance use, means of access to the primary drug of abuse, other ICD-10 diagnoses including the F1 subcategory and comorbid psychiatric disorders, and recent history of self-destructive behavior, were collected from the attending psychiatrists of each subject. The data thus gathered concerning sedative-related disorder patients were compared with those of patients with methamphetamine-related disorder, which has been the most serious drug-related problem in Japan since the 1950s.Out of the 671 subjects, 119 patients mainly abusing sedatives (SRD group) were identified, while 361 patients were identified as mainly abusing methamphetamine (MRD group). The MRD group was the largest population (53.8% of the total subjects), followed by the SRD group (17.7%), and then the inhalant-related disorder group with 56 patients (8. 3%). Compared with the MRD group, the SRD group was younger, contained more female patients, and had a lower incidence of a history of involvement with anti-social societies and anti-social behavior. Patients in the SRD group were more likely to have started abusing drugs with the intention of reducing the unpleasant symptoms of insomnia (42.9%), anxiety (26.1%), and depression (16.0%), and to acquire the drugs they abused from medical institutions such as psychiatric or primary care clinics (82.1%), while patients in the MRD group were more likely to have started out of curiosity (35.1%) or in response to peer pressure (47. 1%), and to acquire their drugs from a "pusher" (32.8%). Additionally, in the SRD group, the ICD-10 F1 subcategory diagnoses that were the clinically most important were "dependence syndrome" (64.0%), "harmful use" (16.2%), and "acute intoxication" (16.2%), while the most important subcategory diagnosis in the MRD group was "psychotic disorder" (34.3%) and "residual disorder and late-onset psychotic disorder" (32.9%). Further, comorbid psychiatric disorders were more frequently found in the SRD group than in the MRD group; notably, co-occurrence of mood disorder was found in 45.0% of the SRD group in contrast to the MRD group (11.9%). Recent episodes of deliberate self-harm behavior were also more frequently found in the SRD group than the MRD group (33.6 vs. 10.5%, respectively) ; the major means by which these patients harmed themselves was by overdosing on prescribed drugs (23.5 vs. 4.7%, respectively).The present study suggests that sedative-related disorder is an important clinical issue in the field of drug-related disorders in Japan today, and that SRD patients may represent a distinct type of drug abuser whose clinical characteristics are different from those of MRD patients. The development and spread of treatment programs for "dependence syndrome" and "harmful use" will help SRD patients, and educating psychiatrists about SRD will help prevent future sedative abuse.

Substance-seeking behavior appears to be compulsive because of unclear motivation, and also appears to be impulsive because of difficulty to be predicted. Compulsivity and impulsivity of substance-dependent individuals are common in unaccountability. This unaccountability is the result form craving for psychoactive substance. If a therapist does not understand it, a treatment session is likely to be punished, not psychotherapeutic. This paper reviews the pharmacotherapies conducted in foreign countries, and suggests the pharmacotherapies which are expected to be introduced into Japan. One of the reasons why psychiatrists tend to be reluctant to treat substance-dependent patients is that there have been no available pharmacotherapies in Japan. Accordingly, pharmacotherapies for substance dependence are required to be developed and established.

In Japan, national suicide countermeasures have been promoted since enactment of the "Basic Act on Suicide Countermeasures" in 2006, and the "Comprehensive Suicide Prevention Initiative" in 2007. The key element of the Japanese countermeasures is expressed by the word "comprehensive," which indicates that suicide prevention should not only be implemented through mental health approaches, but should also be addressed via other measures, including changes in administrative practices. This is an appropriate policy, although the mental health measures appear to be too simplistic, inclining toward psychiatric treatment using pharmacotherapy for the classic type of "depression." This paper presents the findings of a psychological autopsy study which was recently conducted in Japan, and stipulates that mental health measures, including psychiatric treatments, need to be made more comprehensive.

In this paper, we firstly reviewed the hypotheses of etiologies concerning high prevalence of comorbidity of eating disorder (ED) and substance use disorder (SUD). Secondary, our previous studies on comorbidity of ED and SUD were presented, which suggested that female patients with both of ED and SUD were likely to have clinical features of "multi-impulsive bulimia," while they might select the substance abuse for body-weight control. Finally, we discussed clinical implications of comorbidity of ED and SUD in the view of suicide prevention.

Alcohol abuse is a well-known risk factor for suicide, as alcohol-related problems can deteriorate the medical and psychosocial conditions of individuals. Furthermore, the pharmacological effect of alcohol can cause impulsive behavior. However, few studies have investigated the association of alcohol-related problems with suicide or suicide-related mental health problems in a Japanese population. This study aimed to investigate suicidal behavior and factors influencing the mental health of people with alcohol-related problems. We conducted a self-reporting survey of members of alcohol abstinence self-help groups in Japan, "Danshu-kai". Of those members who attended meetings held during April and June 2009, 4,616 (rate of consent, 85.1%; 4064 males, 518 females, and 34 undetermined; mean age +/- SD, 60.2 +/- 10.9 years) participated in our study. The questionnaire sought the following information: gender, age, living with someone, marriage, jobs, present family relationships, health condition, history of attending the Danshu-kai meeting, family histories of alcohol-related problems, duration of abstinence, and history of suicide-related phenomena. A total of 44.2% of the subjects reported they had experienced suicidal thoughts, 24.6% had planned suicide, with 21.6% having attempted suicide. Seventy parcent of these phenomena occurred before participation in Danshu-kai. We also collected Kessler 10 (K10) scores, the self reporting scale for screening depressive and anxiety disorders. We classified subjects into two groups, those with a poor or favorable mental health according to the total K10 score cutoff, and analyzed factors predicting the present mental health condition. Multivariate logistic regression analyses demonstrated that age, physical health, and parental histories of alcohol-related problems were significantly associated with the present mental health condition in both genders. However, jobs, present family relationships, history of attending the Danshu-kai meeting, and duration of abstinence were also significantly associated, but only in males. In conclusion, it is important to cooperate with self help groups such as Danshu-kai to highlight the association between alcohol-related problems and suicide. Furthermore, early intervention for individuals with alcohol-related problems before there is progression of any medical and/or psychosocial damage may prevent future suicides among alcoholics.

Non-fatal self-injurious behavior such as cutting oneself is often performed without suicidal intent to cope with emotional distress, although it is well-known to have a close association with future suicidal behavior. However, it is unclear what kinds of clinical features are presented by such self-injuring patients with a higher suicidal tendency. In the present study, we conducted a three-year follow-up study of female self-injuring patients to examine the risk factors of "near-fatal" deliberate self-harm behavior (DSH). The subjects were 81 female outpatients who had cut themselves at least once, and who had consulted a psychiatric clinic from June 2004 to July 2004. Initial assessments included traumatic life events, clinical features of self-cutting, histories of self-poisoning, alcohol abuse (Alcohol Use Disorders Identification Test: AUDIT), impulsivity (Barratt Impulsiveness Scale, 11th version: BIS-11), symptoms of bulimia nervosa (Bulimia Investigatory Test, Edinburgh: BITE), dissociation (Adolescent Dissociative Experience Scale: ADES), Global Assessment of Functioning (GAF) score, and axis I diagnosis of DSM-IV (Diagnostic and Statistical Manual, 4th version). After three years, we investigated whether the subjects had committed fatal DSH during the follow-up term. We obtained information on fatal DSH from 67 subjects during the follow-up term. Fifteen of the 67 (22.4%) had committed near-fatal DSH at least once, and one subject committed suicide by fatal DSH. Monovariate analysis revealed that in the initial assessment, the subjects with near-fatal DSH episodes more frequently reported a history of victimization by rape in adulthood and a history of OTC (over-the-counter) drug self-poisoning, and had higher scores on the BITE and AUDIT than those without near-fatal DSH episodes. Further, multivariate analysis demonstrated that only the BITE score was a significant factor in predicting future near-fatal DSH. In conclusion, symptoms of bulimia nervosa may have important clinical implications. The BITE may be a useful tool to assess future suicidal behavior in female self-cutting patients.