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Objective We conducted a retrospective study on the epidemiological and clinical features of patients with acute caffeine poisoning in Japan. Methods Letters requesting participation were sent to 264 emergency departments of hospitals, and questionnaires were mailed to those that agreed to participate. Patients Participants were patients transported to emergency departments of hospitals between April 2011 and March 2016 after consuming large or massive amounts of caffeinated supplements and/or energy drinks (caffeine dose ≥1.0 g). Results We surveyed 101 patients from 38 emergency departments. Since April 2013, the number of patients has markedly increased. Of these young patients (median age, 25 years), 53 were men, and 97 had consumed caffeine in tablet form. Estimated caffeine doses (n=93) ranged from 1.2 to 82.6 g (median, 7.2 g). Serum caffeine levels on admission (n=17) ranged from 2.0 to 530.0 μg/mL (median level, 106.0 μg/mL). Common abnormal vital signs and laboratory data on admission included tachypnea, tachycardia, depressed consciousness, hypercreatinekinasemia, hyperglycemia, hypokalemia, hypophosphatemia, and hyperlactatemia. Common signs and symptoms in the clinical course included nausea, vomiting, excitement/agitation, and sinus tachycardia. Seven patients (6.9%) who had consumed ≥6.0 g of caffeine, or whose serum caffeine levels on admission were ≥200 μg/mL, developed cardiac arrest. Ninety-seven patients (96.0%) recovered completely, but 3 patients (3.0%) died. Conclusion The present analysis of data from more than 100 emergency patients revealed clinical features of moderate to fatal caffeine poisoning. We recommend highlighting the toxicity risks associated with ingesting highly caffeinated tablets.

The aim of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients. We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicide intent admitted to emergency departments and with a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management or enhanced usual care. The primary outcome measure was the incidence of a first recurrent suicide attempt within 6 months. This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444). There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group. The incidence of a first recurrent suicide attempt within 1 and 3 months was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period. Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group. Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.

This study explored the current implementation status of and opinions and concerns regarding suicide education at schools of social work in Japan. We conducted a survey of faculty members who taught at least one of the social work subjects. About half the respondents had given a lecture of some kind on suicide, and more than 80% agreed that suicide is an important topic to include in social work program curricula. However, more than half indicated they did not have enough knowledge or skills to teach students about suicide, and more than 60% were concerned about adverse psychological effects of suicide education on students. Our findings highlight the importance of providing faculty members with guidelines for teaching students about suicide.

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.

In Japan, fatalities among patients who experienced an acute reaction following self-administration of novel psychoactive substances (NPS) have been more frequently reported since June 2014.This survey aimed to document and analyze trends in NPS consumption in emergency patients.We conducted a multicenter retrospective survey of patients who were transported to emergency facilities after consuming NPS-containing products between January 2013 and December 2014. Letters requesting participation were sent to 467 emergency facilities, and questionnaires were mailed to facilities that agreed to participate.We surveyed 589 patients from 85 (18.2%) facilities. Most patients were male (89.6%) and young (median age, 30 years), and inhaled (88%) NPS contained in herbal products (80.5%). Harmful behavior was observed at the scene of acute reaction, including violence (6.9%), traffic accidents (4.9%), and self-injury or suicidal attempts (1.1%). Other than neuropsychiatric and physical symptoms, many patients also had physical complications such as rhabdomyolysis (17.5%), liver injury (12.4%), acute kidney injury (9%), and physical injury (1.9%). Of the 256 patients (43.5%) admitted to hospitals, 35 (5.9%) were hospitalized for seven or more days. Most patients (93.2%) completely recovered, although a few (1.4%) died. However, synthetic cannabinoids and synthetic cathinones were only detected in the blood of five patients.Consumption of NPS-containing products have been associated with harmful behaviors such as violence and traffic accidents, physical complications (e.g., rhabdomyolysis, liver injury), death, or physical and neuropsychiatric symptoms. Compared to a previous survey (2006-2012), the present survey revealed more severe toxicity.

Background Dementia care practitioner training is essential for professional caregivers to acquire medical knowledge and care skills for dementia patients. We investigated the significance of training in stress management by evaluating caregivers' job stress and coping style before and after they have completed training. Methods The subjects included 134 professional caregivers (41 men, 93 women) recruited from participants in training programmes held in Kanagawa Prefecture from August 2008 to March 2010. A survey using a brief job stress questionnaire and a coping scale was carried out before and after they completed their training. A t-test and multiple regression analysis were performed to evaluate the effects of the training. Result After the training, the scores of modifiers on the job stress scale and of the coping scale increased, whereas the scores of stress reactions on the job stress scale decreased. However, there were no changes in participants' subjective cognition concerning their workplace environment. Furthermore, the change in stress reaction score tended to correlate with the change in consultation score in all participants and with the change in problem-solving and consultation in male participants. Among female participants, the change in stress reaction score tended to correlate with change in support from superiors and colleagues as modifiers. The factors that correlated to the change in stress reaction score differed between genders. Conclusion The findings suggest that training caregivers improves their stress reaction and coping skills.

Objective We conducted a multicenter retrospective survey of patients poisoned by synthetic chemicals (SCs) in Japan. Methods Letters were sent to 467 emergency facilities requesting participation in the study, and questionnaires were mailed to facilities that agreed to participate. Patients The study participants were patients who were transported to emergency facilities between January 2006 and December 2012 after consuming SC-containing products. Results We surveyed 518 patients from 60 (12.8%) facilities. Most patients were male (82.0%), in their 20s or 30s (80.5%), and had inhaled SCs (87.5%) contained in herbal products (86.0%). Harmful behavior was observed at the scene of poisoning for 56 patients (10.8%), including violence to others or things in 32, traffic accidents in seven, and self-injury or suicide attempts in four. Other than physical and neuropsychiatric symptoms, some patients also had physical complications, such as rhabdomyolysis (10.0%). Of the 182 patients (35.1%) admitted to hospitals, including 29 (5.6%) who needed respirators, all of the 21 (4.1%) hospitalized for at least seven days were male, and 20 had physical complications (rhabdomyolysis, 12; liver dysfunction, 5; renal dysfunction, 11; and physical injuries, 3). Most patients (95.6%) completely recovered, although 10 (1.9%) were transferred to a psychiatric department or hospital, and three (0.6%) were handed over to the police due to combative or violent behavior. SCs such as synthetic cannabinoids, synthetic cathinones, or methoxetamine were detected in 20 product samples. Conclusion Consuming products containing SCs can result in physical complications, including rhabdomyolysis, injuries, and physical or neuropsychiatric symptoms, which may require active interventions, such as respirator use or prolonged hospitalization.

In Japan, suicide by inhaling hydrogen sulfide (H2S) by mixing commercial products escalated into a nationwide trend in April 2008.We conducted a multicenter retrospective survey on the demographics, clinical features, treatments, and outcomes of patients exposed to H2S suicide attempts.Subjects included patients transported to emergency facilities in Japan from January 2005 to December 2011 following H2S suicide attempts. Among 277 facilities to which a letter requesting data collection was sent, questionnaires were sent to and filled out by the 47 (18%) facilities that agreed to provide data. Questionnaires were collected and data were extracted at Kitasato University.A total of 156 patients were included in this survey. Patients involved in an H2S suicide attempt increased from 1 in 2007 to 51 in 2008, and gradually decreased from 44 in 2009 to 37 in 2010 and 23 in 2011. Ninety-two patients attempted H2S suicide (primary exposure group), and 64 were secondarily affected by the suicide attempt (secondary exposure group). Patients in the primary exposure group were young (mean, 30.3 years (10.9)), and male patients (n = 62) were approximately two times more likely to attempt H2S suicide than females (n = 30). Forty-eight patients in cardiopulmonary arrest at the scene did not survive. Five non-cardiopulmonary arrest patients died, and five patients who presented with a Glasgow coma scale (GCS)8 and lactic acidosis had neurological or cardiac signs or symptoms at discharge. Antidote therapy was performed on 26 of the primary group patients, but with poor outcomes. None of the secondary group patients were in cardiopulmonary arrest at the scene, five received antidotal therapy after arriving at the hospital, and all completely recovered from H2S exposure.Mortality (58%) among patients who attempted H2S suicide was very high, likely resulting from inhaling high concentrations of H2S after mixing commercial products in a sealed and confined space.

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.

Background: The aim of the present study was to investigate predictive factors of quality of life (QOL) in home caregivers of patients with dementia. Methods: A total of 118 home caregivers (48 male, 70 female) were asked to complete the World Health Organization (WHO) Quality of Life 26 (WHO/QOL-26) questionnaire, the Pines Burnout Measure (BM), and the Beck Depression Inventory, second edition (BDI-II). Patient demographics and clinical data regarding cognitive impairment, neuropsychiatric symptoms, and dementia severity were obtained from medical records. Results: Spearman rank correlation coefficients revealed that caregiver QOL was significantly correlated with patients' neuropsychiatric symptoms (r=−0.19; P < 0.05), as well as depressive symptoms (r=−0.59, P < 0.01) and burnout (r=−0.59, P < 0.01) in caregivers. Stepwise multiple regression analysis revealed that depressive symptoms in caregivers was the strongest predictor for caregiver QOL (R2= 0.37, P < 0.001) and that caregiver QOL was best predicted by the combination of depressive symptoms, burnout, and the cognitive impairment of patients (R2= 0.46, P < 0.05). Conclusion: The results of the present study demonstrate that subjective experiences of caregivers are more strongly correlated with caregiver QOL than patient-related variables and are thus powerful determinants of caregiver QOL. These findings suggest that caregiver intervention, which aims to increase QOL, may benefit from the incorporation of strategies to reduce depressive symptoms and burnout.

ObjectiveThe objective of this study was to explore factors associated with hara-kiri as a method of suicide and suicidal behavior in contemporary Japan.MethodsA retrospective study was conducted on medical records of 421 patients (174 male; 247 female) who were considered suicidal and treated at the Kitasato University Hospital Emergency Medical Center in Japan between January 2006 and March 2008. We compared hara-kiri and all other methods regarding sociodemographics and clinical features of all suicidal patients.ResultsInstances of hara-kiri suicide attempt had the highest proportion of males (63%) among all suicide and suicidal behavior. One-way analysis of variance revealed significant differences between hara-kiri and other suicide attempt methods in the age of the suicidal patients. Result of multiple logistic regression analysis indicated that those who attempted hara-kiri suicide were likely to be male, be diagnosed with schizophrenia, survive, and be married.ConclusionOur findings indicate that hara-kiri as a method of suicide and suicidal behavior remain prevalent in Japan, and the study findings also suggest that both clinical and cultural factors might play a role in hara-kiri as a method of suicide and suicidal behavior.

A multicenter retrospective survey of patients poisoned by herbicides containing glyphosate salts in Japan was conducted to identify differences in symptoms and outcome of poisoning.Participants were patients who were transported to emergency facilities between October 2006 and March 2014 after consuming herbicides containing glyphosate potassium salt (GlyK(+)) (the K-group) or other glyphosate salts (the O-group). Questionnaires were mailed to 38 emergency facilities that agreed to participate in the study.Serum potassium levels upon arrival were significantly higher (p0.01), and abnormal electrocardiogram findings were significantly more common (p0.01) in the K-group (n = 55) than in the O-group (n = 62). Conversely, acute lung injury (ALI) including acute respiratory distress syndrome (ARDS) (p = 0.05) and liver injury (LI) (p0.01) were significantly more common during hospitalization in the O-group, although no significant differences in the duration of hospital stay (p = 0.92) or outcomes (p = 0.95) were observed between the two groups.The ingestion of products containing glyphosate isopropylamine or ammonium salts, and polyoxyethyleneamine (POEA) as a surfactant, can cause severe organ injury. Physicians should note that the ingestion of products containing glyphosate potassium salt and surfactants other than POEA can cause hyperkalemia, potentially leading to fatal arrhythmias or cardiac arrest.

Caregivers of patients with dementia often experience chronic and emotional strains, which may lead to emotional exhaustion and burnout. The objective of this study was to examine the relationships between burnout, depression, and quality of life in home caregivers of patients with dementia. The participants were 84 home caregivers (39 male; 45 female), and they were asked to complete three questionnaires: the Beck Depression Inventory Second Edition (BDI-II), the WHO Quality of Life 26 (WHO-QOL26), and the Pines Burnout Measure (BM). Results from a bivariate correlation showed that BM scores significantly correlated with the scores on BDI-II and WHO-QOL26. Results from ANOVA comparing the level of burnout with the scores on BDI-II and WHO-QOL26 revealed that there were differences between the burnout groups and the scores on BDI-II and WHO-QOL26. The higher levels of burnout were found to correspond to higher levels of depressive symptoms and lower QOL. These findings suggest that caregiver intervention to reduce burnout might benefit from strategies to reduce depression and increase QOL.