The Road Traffic Law stipulates that mental illness which is a relative disqualification of obtaining a driver’s license. Furthermore, in June 2014, the revised Road Traffic Act has been enacted that stipulates penalties for false answers to questionnaires concerning illness. In reality most people who have these diseases acquire a driver’s license properly and are driving a car. However, when it turns out that the patient has a mental illness at the time of accident or license renewal, the subject is required to receive a medical examination of the attending physician. The certificate that is received by the person describes his or her current driving aptitude and future prognosis. What is making the problem even more serious is the existence of “a punishment method for death or injury resulting from driving a car”. This law includes provisions that impose heavy penalties when driving and recognizing that “normal operation may be hindered” due to the influence of a disease specified by a Cabinet Order such as epilepsy / psychiatric disorders, etc. . These law revisions pose a serious threat to the patient, but for psychiatrists as well, knowledge and judgment on the law, such as explanation obligation and description of medical certificate, are necessary.

In Japan, as a result of the growing proportion of drivers aged 65 years and older, it is expected that the number of elderly drivers with dementia is increasing. Since June 2002, demented drivers have been prohibited driver’s license by Public Safety Commission in Japan. However, we have no consensus guidelines for demented drivers. Following the law, the authority introduced a cognitive function assessment for the renewal when the driver is 75 years or older. They further started a policy in which physicians can voluntarily report their patients’ medical conditions, including dementia. Despite these law and policy improvements and the high expectations to the medical professionals regarding aging drivers, the current role of physicians is merely diagnosing dementia or not, and is lacking the guidance on safe driving for the drivers and their families. This paper suggests that several important medical and social factors might be considered for the management of drivers with dementia. Consensus medical guideline for demented drivers has to be developed.

In Japan, people with epilepsy (PWE) are thought to have fitness to drive when their seizures are 1) free for five years or over, 2) free for two years or over and the physician in charge have approved, 3) simple partial seizures only, and 4) seizures restricted during sleep. In 2014, the amended Road Traffic Act, including new roles such as penalty for false statement in a disease condition declaration form, new voluntary notification system for a doctor who is aware that a person is at high risk for traffic accident and in possession of a driver license, and the other new provisions was enacted. Additional resolutions to examine in the future including review of the law after five years, consideration so as not to create discrimination due to diseases, etc are decided. At the same time, the new Criminal Law Act, including prison sentence of up to 15 years for persons, who under the influence of specific diseases or drugs, causing death or injury to other persons by driving a motor vehicle, was also enacted. In many developed countries, shorter period of seizure freedom, usually one year, is required for the fitness to drive for PWE. In 2015, the Japan Epilepsy Society and the National Police Agency conducted together an actual condition survey on traffic accidents by PWE. The results showed that the accident ratio of PWE was 1.16, which is lower than that of young male and of geriatric people. The data shows that the severe requirement for the fitness to drive for PWE in Japan should be reexamined.

For many Japanese people, combinations of drugs and driving bring to mind sensational reckless driving accidents caused by users of new psychoactive substances. These substances cause impaired consciousness, muscle rigidity, akinesia, and convulsions, affecting the inhibitory system, as well as intense excitation and hallucination-delusions involving the excitable system. Combined use of multiple substances is more dangerous than the use of a single substance. Stimulants excite the central nervous system, causing hallucination-delusion reactions, and increase the incidence of fatal accidents by 5.61 times. Many reports indicate that sedatives, mainly benzodiazepines, increase the rate of traffic accidents. Cannabis impairs motor function and also causes hallucinations or perceptual distortions, increasing the incidence of fatal accidents by 1.83 times. Drug abuse has a substantial adverse effect on driving performance and causes serious accidents. Drug addiction is characterized by the inability to control drug use and consistently carries a risk of accidents. Addiction is a disease. Punishing addicts does not solve but rather exacerbates the problem. Condemnation will not lead to resolution. For the treatment of drug addiction, it is essential to build a relationship of trust with addicts and to motivate them. If they are only forced to abstain from drugs or prohibited from driving, they will drop out of treatment, and accidents will actually increase. To prevent traffic accidents, it is important for healthcare providers to offer appropriate addiction treatment based on a relationship of trust.

The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. A previous study by the international research team found that a large increase in sunlight was associated with a lower age of onset. This study extends the analysis with more collection sites at diverse locations including locations in Japan. It also includes family history and polarity of first episode, and investigates whether the hours of daylight at the birth location affect the age of onset. Data from about 4000 patients with bipolar Ⅰdisorder were collected at 36 collection sites in 23 countries. Solar insolation values at the onset locations and the hours of daylight values at the birth location were obtained from the USA National Aeronautics and Space Administration (NASA) Surface Meteorology and Solar Energy (SSE) database. Generalized Estimating Equations (GEE) models were used to estimate the effect of solar insolation on the age of onset. There was a large, significant inverse relationship between maximum monthly increase in solar insolation and the age of onset. The effect was reduced by half if there was no family history and by one-third for initial episodes of mania than depression. More hours of daylight at the birth location during early life was associated with an older age of onset, suggesting reduced vulnerability to the future circadian challenge of the springtime increase in solar insolation at the onset location. Further research into the effects of the duration, intensity, timing and wavelength of sunlight is needed to better understand bipolar disorder.

Adverse childhood experiences (ACEs), including childhood abuse and trauma, have long-term negative effects on health. The purpose of this study was to examine the prevalence and cumulative number of ACEs in psychiatric inpatients (N=53, mean age of 53.1). In addition, we examined associations between the cumulative numbers of ACEs and the onset of psychiatric disorder. We used the ACE checklist of eight items, including parental divorce or separation and childhood abuse. We investigated ACEs at baseline and after 10-14 weeks. Of the study participants, 68% had schizophrenia or a schizotypal and delusional disorder (F2) and 17% had mood (affective) disorders (F3); 58.5% reported at least one ACE, with the mean cumulative number of 1.2. Participants reports regarding the experience of an ACE were consistent over 10-14 weeks (κ=0.87). Similarly, the cumulative number of ACEs was stable (κ=0.73). Participants who had experienced ACEs had earlier ages of first visit and hospitalization than those who without ACEs. These findings were consistent with those in previous studies. It is important that clinicians should routinely assess and consider information about ACEs.

After suicidal attempt, a patient is transported to emergency department. We discussed about the suicidal patients who visited Advanced Medical Emergency and Clinical Care Center of Yamaguchi University Hospital for three years. A majority were patients with a diagnosis of F4, including adjustment disorder. In F4 group, the patients with a history of suicidal attempt were significantly younger compared to the patients with no history of suicide. Young patients with a diagnosis of F4, especially with adjustment disorder, may be at high risk for suicidal attempt and early intervention may prevent repetition of suicidal attempt in these patients.