Purpose: Relatively few ADHD drugs are available in Japan, but psychotropics are often used for the comorbidity of ADHD. We aimed to compare juvenile and adult patients in terms of drugs used for ADHD. Methods: We retrospectively surveyed the circumstances of prescriptions for atomoxetine and concurrent medications for ADHD patients (36 men, 39 women) using electronic medical records from a single-department psychiatric hospital in rural Japan. Mean dosage, period and rate of administration continuation, side effects, reasons for cessation, comorbid diagnoses, and use of concurrent medication were statistically compared between juvenile (<18 years old) and adult (≥18 years old) groups using the t-test and χ² test. Results: Continuation rate was significantly higher in the adult group (43.5%) than in the juvenile group (20.7%; p=0.043). In the juvenile group, 65.5% received monotherapy and 34.5% received combination therapy, compared to monotherapy for 37.0% and combination therapy for 63.0% in the adult group. Combination therapy was significantly more frequent in the adult group (p=0.015). Discussion: These findings were attributed to differences in motivations for medical treatment and care-receiving patterns between groups. Since juvenile people often start treatment for ADHD as a primary condition, rather than as a comorbidity, concomitant medications are less frequent. Juvenile patients tend to drop out because of poor subjective symptoms. Among adults, treatment for ADHD often begins as treatment of comorbidity, so concomitant medications and maintenance therapy are more frequent than among juvenile patients.

Purpose: Recently, we reported that lithium levels in drinking water were significantly and positively associated with hyperthymic temperament scores, whereas latitude was significantly and negatively associated with the scores, suggesting that lithium in drinking water may positively maintain hyperthymic temperament and that latitude may negatively maintain it. In the present study, from the viewpoint of psychopharmacology, we investigated the other 4 affective temperaments in reference to lithium in drinking water with adjustment for latitude, temperature, and sunshine. Methods: We re-examined our previous dataset consisting of temperament data of 609 residents in Sapporo, Obihiro, Takaoka, Koshigaya, and Oita cities, in addition to the lithium levels in drinking water and climatic data of the five cities. Multiple regression analyses via the forced entry method were performed, whereby the individual temperament scores were dependent factors, and age, gender, the other four affective temperaments, lithium in drinking water, latitude, temperature, and sunshine were independent factors. Results: The multiple regression analysis revealed that lithium levels in drinking water were significantly and negatively associated with depressive temperament scores. The other three temperaments (i.e. irritable, cyclothymic and anxious temperaments) were not significantly associated with lithium levels in drinking water. Discussion: In conclusion, the present findings suggest that lithium in drinking water may be negatively associated with depressive temperament.

Purpose: To evaluate the long-term efficacy and safety of aripiprazole and blonanserin in Japanese patients with schizophrenia.

Methods: In this 52-week, randomized, flexible-dose, open-label study, patients diagnosed with schizophrenia were randomized to receive aripiprazole (n=14) or blonanserin (n=12). The efficacy and safety of the drugs were evaluated using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Severity Scale (CGI-S). The Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) was administered at baseline and 4, 12, 26, and 52 weeks after the initiation of treatment.

Results: Twelve patients (aripiprazole, n=7; blonanserin, n=5) completed this study. No significant differences in gender, episode, age, or PANSS total score were observed between the two groups at baseline. Both groups showed significant improvements during the study, with reductions in the total PANSS score (two-way repeated-measures ANOVA, both p < 0.01).

Discussion: In Japanese schizophrenia patients, aripiprazole and blonanserin showed comparable efficacy and tolerability during the 52-week study period. Both drugs showed good efficacy for treating schizophrenia, and the long-term therapeutic effect was maintained. Due to the high dropout rates, however, any conclusions must be considered preliminary and in need of replication.

(Clinical trial registration: UMIN000012729)

Purpose: Oxidative stress contributes to the development of schizophrenia and metabolic abnormalities among schizophrenia patients. This study investigated whether the oxidative stress-related genes polymorphisms affected the risk for metabolic abnormalities among schizophrenia patients or not.

Methods: A cross-sectional analysis was conducted among 256 schizophrenia patients and 194 age- and gender-matched controls. The effects of the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) (rs1801133, C677T; rs1801131, A1298C) and glutathione S-transferase (GST) T1 null, GSTM1 null, GSTK1 (rs1917760, G-1308T) on the risk for metabolic abnormalities were investigated by structural equation modeling.

Results: Among the female schizophrenia patients, the MTHFR rs1801133 T/T genotype increased the risk of overweight, and this genotype effect was associated with a risk of metabolic abnormalities. Among the schizophrenia patients with current-smoking status, the MTHFR rs1801133 T/T genotype also increased the risk of overweight, thus affecting the risk of metabolic abnormalities. The effects of GSTK1 T allele carriers and GSTM1 null genotypes on the increased risk of overweight were confirmed in the male schizophrenia patients and/or the patients with current-smoking status. In contrast, no association between the polymorphisms and risk of metabolic abnormalities was observed in control subjects.

Discussion: These findings suggest that the polymorphisms of oxidative stress-related genes, including MTHFR, may be a significant risk factor for overweight-related metabolic abnormalities among schizophrenia patients in relation to gender differences and/or smoking status. This information regarding the effect of high-risk genotypes may be used to prevent overweight and metabolic abnormalities.

Purpose: Several treatment guidelines recommend periodic monitoring (i.e., once per year) of side-effects in patients taking psychotropic agents. However, the actual frequency of side-effects monitoring is unclear. Accordingly, we investigated the frequency of side-effects monitoring in Japanese patients.

Methods: We used the national insurance claim database to identify patients prescribed with psychotropic agents for more than 3 years. Among these patients, we identified those who had undergone electrocardiogram, liver or kidney function, serum lipid level, blood glucose level, and serum prolactin level assessment at least once per year for 3 years of treatment. We classified these patients into adults and children and compared the frequency of each examination between the two groups.

Results: A total of 8822 patients were included in the analysis. The frequencies of electrocardiogram, blood glucose level, serum lipid level, liver or kidney function, and serum prolactin level monitoring were <0.1%, 16.4%, 16.5%, 20.6%, and 1.1%, respectively. In patients taking antipsychotic agents, children were significantly less frequently screened for blood glucose level, serum lipid level, and liver or kidney function compared with adults (p < 0.01).

Conclusion: Our data suggest that the frequency of side-effects monitoring in persistent users of psychotropic agents in Japan was lower than that recommended by several guidelines.

Purpose: To measure the lithium levels of mineral waters and compare those of Japanese mineral waters to foreign ones. Methods: The lithium levels of Japanese mineral waters, foreign mineral waters, and Japanese tap waters were compared using the Kruskal-Wallis test due to a skewed distribution. Results: As a whole, there was a significant difference between the 3 groups. Post hoc comparison by Bonferroni correction revealed that the lithium levels of foreign mineral waters were significantly higher than Japanese mineral waters and tap waters, though there was no significant difference between Japanese mineral waters and tap waters. Discussion: The present findings indicate that foreign mineral waters may have higher lithium levels than Japanese mineral waters and tap waters. In future studies, it is desirable to consider which type of mineral waters (Japanese or foreign) the residents drink, for adjustment of the analytic data of any potential lithium effect on suicide rates and other mental states.

We showed a 36-year-old male patient suffering from acute pelvic pain responding to escitalopram but not to anti-inflammatory drugs. To our knowledge, this is the first report showing the effects of escitalopram on acute pelvic pain. Further studies are required to substantiate the present findings.