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Denis Völker JS, Micluția IV, Vinași RC. Investigating Cannabidiol's potential as a supplementary treatment for schizophrenia: A narrative review. Eur J Pharmacol 2024; 979:176821. [PMID: 39068976 DOI: 10.1016/j.ejphar.2024.176821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
Schizophrenia presents a complex mental health challenge, often inadequately addressed by existing antipsychotic treatments, leading to persistent symptoms and adverse effects. Hence, developing alternative therapeutic approaches is crucial. Cannabidiol (CBD), a nonpsychoactive compound in Cannabis sativa, has been extensively explored for its therapeutic potential in treating psychiatric disorders, including schizophrenia. CBD exhibits antipsychotic, anxiolytic, and neuroprotective effects. However, distinguishing the individual effects of CBD and THC remains challenging. Therefore, this review aims to critically analyze the potential role of CBD as an adjunctive therapy in schizophrenia treatment. The therapeutic action of CBD may involve activating the 5-hydroxytryptamine 1A receptors and suppressing the G-protein-coupled receptor 55, thereby affecting various neurotransmitter systems. Additionally, the anti-inflammatory and antioxidative effects of CBD may contribute to alleviating neuroinflammation linked to schizophrenia. Compared to typical antipsychotics, CBD demonstrates a lower incidence of side effects and it exhibited favorable tolerability in clinical trials. A 2012 clinical trial demonstrated the efficacy of CBD in reducing both positive and negative symptoms of schizophrenia, presenting a safer profile than that of traditional antipsychotics. However, further research is needed to fully establish the safety and efficacy of CBD as an adjunctive treatment. Future research directions encompass exploring detailed antipsychotic mechanisms, long-term safety profiles, interactions with current antipsychotics, optimal dosing, and patient-specific factors such as genetic predispositions. Despite these research needs, the potential of CBD to enhance the quality of life and symptom management positions it as a promising candidate for innovative schizophrenia treatment approaches.
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Affiliation(s)
- Jes Sebastian Denis Völker
- Department of Clinical Psychiatry Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
| | - Ioana Valentina Micluția
- Department of Clinical Psychiatry Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
| | - Ramona-Cristina Vinași
- Department of Clinical Neurosciences (DCN) Spitalul Clinic Judeţean de Urgenţă Cluj (Cluj County Emergency Clinical Hospital), Cluj-Napoca, Romania.
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Adhikari K, Kamal KM, Jeun KJ, Nolfi DA, Ashraf MN, Zacker C. Real-World Effectiveness, Economic, and Humanistic Outcomes of Selected Oral Antipsychotics in Patients with Schizophrenia: A Systematic Review Evaluating Global Evidence. CLINICOECONOMICS AND OUTCOMES RESEARCH 2024; 16:621-645. [PMID: 39257455 PMCID: PMC11385900 DOI: 10.2147/ceor.s469024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/03/2024] [Indexed: 09/12/2024] Open
Abstract
Background Schizophrenia is a complex, chronic mental health disorder that confers a substantial disease burden globally. Oral antipsychotic treatments (OATs) are the mainstay for treating early and advanced stages of schizophrenia. Our systematic review aimed to synthesize literature describing real-world effectiveness, economic, and humanistic outcomes of OATs (asenapine, brexpiprazole, cariprazine, iloperidone, lumateperone, lurasidone, olanzapine/samidorphan, paliperidone, and quetiapine) for successful management of the disease. Methods PubMed, American Psychological Association PsycINFO (EBSCOhost), and Cumulative Index of Nursing and Allied Health Literature were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting real-world effectiveness, costs, humanistic, behavioral (eg, interpersonal relations, suicide ideation), medication adherence, and product-switching outcomes for selected OATs published in English from January 2010 to March 2022 were identified and evaluated qualitatively. Results We included 48 studies with different designs providing extensive evidence on schizophrenia. All studies were conducted in countries outside of the United States. In most studies, antipsychotic medications were more effective than placebo, suggesting their value in the management of schizophrenia. Sixteen studies measured the economic outcomes of OATs. Eight studies assessed humanistic outcomes, while one reported behavioral outcomes in three second-generation antipsychotics. Medication adherence was described in two studies, while five studies evaluated product switching. Non-adherence was commonly reported for OATs. Medication non-adherence and treatment discontinuation were predominant factors contributing to the economic burden of schizophrenia. Conclusion Our research showcased a significant knowledge gap across OATs spanning the humanistic and behavioral outcomes and medication adherence and switching, suggesting a need for robust evidence generation to help clinicians and payers make informed decisions regarding treatment opportunities and cost-effective strategies for patients with schizophrenia.
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Affiliation(s)
- Keyuri Adhikari
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Khalid M Kamal
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - Ki Jin Jeun
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
| | - David A Nolfi
- Gumberg Library, Duquesne University, Pittsburgh, PA, USA
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Ishigooka J, Nakagome K, Ohmori T, Iwata N, Inada K, Iga JI, Kishi T, Fujita K, Kikuchi Y, Shichijo T, Tabuse H, Koretsune S, Terada H, Terada H, Kishimoto T, Tsutsumi Y, Ohi K. Randomized open-label study of second-generation antipsychotics for the treatment of schizophrenia: 104-week final results of the JUMPs study assessing treatment discontinuation, remission, and social functioning. BMC Psychiatry 2024; 24:600. [PMID: 39237918 PMCID: PMC11376064 DOI: 10.1186/s12888-024-06031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND We report the final results of treatment with aripiprazole, blonanserin, and paliperidone from the Japan Useful Medication Program for Schizophrenia (JUMPs), a 104-week naturalistic study. METHODS JUMPs was an open-label, three-arm, randomized, parallel-group, 104-week study. Patients aged ≥ 20 years with schizophrenia requiring antipsychotic treatment or a switch from previous therapy were enrolled. The primary endpoint was treatment discontinuation rate over 104 weeks. Secondary endpoints included remission rate, Personal and Social Performance (PSP), safety, Positive and Negative Syndrome Scale (PANSS), and quality of life (QOL; EuroQol-5 dimension). RESULTS In total, 251 patients received aripiprazole (n = 82), blonanserin (n = 85), or paliperidone (n = 84). Treatment discontinuation rates (aripiprazole, 80.5%; blonanserin, 81.2%; paliperidone, 71.4%) were not significantly different (p = 0.2385) among the treatment groups at 104 weeks; comparable outcomes were observed for endpoints, including remission (42.9%, 46.7%, and 45.8%), PANSS, and safety. In the overall cohort, while the improvement in the PSP total score at Week 104 was not significantly different from baseline, a significant improvement (p < 0.05) in QOL and total PANSS scores (including all subscales) was observed at Week 104 compared with baseline. Multivariable analysis identified a shorter disease duration and a higher chlorpromazine-equivalent antipsychotic dosage level (≥ 1000 mg) before switching to monotherapy as predictors of treatment discontinuation. CONCLUSIONS The 104-week treatment outcomes were comparable between groups; the overall trend of improvement in remission rate, safety, and QOL suggests the importance of continued treatment. CLINICAL TRIAL REGISTRATION UMIN-Clinical Trials Registry UMIN000007942 (public release date: 14/05/2012).
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Affiliation(s)
- Jun Ishigooka
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
- Present address: Institute of CNS Pharmacology, 4-26-11 Sendagaya, Shibuya-ku, Tokyo, 151-0051, Japan.
| | - Kazuyuki Nakagome
- Department of Psychiatry, National Center of Neurology and Psychiatry, 4 Chome-1-1 Ogawahigashicho, Kodaira, Tokyo, 187-8551, Japan
| | - Tetsuro Ohmori
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, 3-18- 15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Ken Inada
- Department of Psychiatry, School of Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Present address: Department of Psychiatry, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0374, Japan
| | - Jun-Ichi Iga
- Department of Psychiatry, Tokushima University Graduate School of Biomedical Sciences, 3-18- 15, Kuramoto-cho, Tokushima, 770-8503, Japan
- Present address: Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kiyoshi Fujita
- Okehazama Hospital Fujita Kokoro Care Center, Minamiyakata, Sakaecho Toyoake, Aichi, 470-1168, Japan
| | - Yuka Kikuchi
- Department of Psychiatry, Akita University Hospital, Hasunuma-44-2 Hiroomote, Akita, 010- 0041, Japan
- Present address: Heart-Care Clinic Omachi, 1-2-7 Omachi, Akita, 010-0921, Japan
| | - Toshiaki Shichijo
- Mental Clinic Minami, 4 Chome-3-2 Honcho, Iwatsuki Ward, Saitama, 339-0057, Japan
| | - Hideaki Tabuse
- Department of Psychiatry, Holy Cross Hospital, 2431-160 Kujiri, Izumi-cho, Toki-shi, Gifu, 509-5142, Japan
| | - Shotatsu Koretsune
- Kokorono Clinic Narimasu, 3-3-15 Narimasu, Itabashi-ku, Tokyo, 175-0094, Japan
| | - Hiroshi Terada
- Aoi Clinic, 679-1 Okitsunakacho, Shimizu Ward, Shizuoka, 424-0204, Japan
| | - Haruko Terada
- Aoi Clinic, 679-1 Okitsunakacho, Shimizu Ward, Shizuoka, 424-0204, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634-8521, Japan
- Present address: Akitsu-Kounoike Hospital, 1064 Ikenouchi, Gose-shi, Nara, 639-2273, Japan
| | - Yuichiro Tsutsumi
- Department of Psychiatry, Ongata Hospital, 105 Nishiterakatamachi, Hachioji, Tokyo, 192- 0153, Japan
| | - Kazutaka Ohi
- Department of Neuropsychiatry, Kokubu Hospital, 4-672 Asahigaoka, Kashiwara-shi, Osaka, 582-0026, Japan
- Present address: Department of Psychiatry and Psychotherapy, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1112, Japan
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Nakagome K, Tachimori H, Endo S, Murakami K, Azekawa T, Hongo S, Niidome K, Kojima Y, Yamada S, Oi H, Sumiyoshi T. A multicenter, single-arm, open-label interventional study of adherence to brexpiprazole during switching from previous antipsychotic drugs in patients with schizophrenia or schizoaffective disorder. Neuropsychopharmacol Rep 2024; 44:187-196. [PMID: 38253334 PMCID: PMC10932803 DOI: 10.1002/npr2.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
The rate of medication persistence was examined in patients with schizophrenia or schizoaffective disorder during switching from previously administered antipsychotics to brexpiprazole, a new dopamine D2 receptor partial agonist. A multicenter, single-arm, open-label 24-week interventional study was conducted, consisting of two 12-week consecutive periods: an initial switch (by plateau cross-titration) with the subsequent period, followed by a second maintenance period. Prior antipsychotics were olanzapine or risperidone/paliperidone. The primary and secondary outcome measures were medication persistence rates after the first 12 weeks and changes from baseline in the Specific Levels of Functioning Scale (SLOF), Subjective Well-being under Neuroleptic drug treatment Short form (SWNS), and Positive and Negative Syndrome Scale (PANSS) scores, respectively. In total, 79 patients were administered brexpiprazole and the medication persistence rate at 12 weeks was 78.5%, which was significantly higher than the predefined threshold of 65%. Regarding the prior medication, the persistence rate at 12 weeks was 84.6% for olanzapine and 72.5% for risperidone/paliperidone. Significant improvements from baseline were observed in the SLOF, SWNS, and PANSS scores. There were no adverse events of concern. Thus, brexpiprazole appeared to be a suitable antipsychotic on switching from olanzapine, risperidone, or paliperidone.
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Affiliation(s)
- Kazuyuki Nakagome
- National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
| | - Shiro Endo
- Fujimidai Hospital, Hiratsuka-shi, Kanagawa, Japan
| | | | | | - Seiji Hongo
- Ichigaya Himorogi Clinic, Tokyo, Japan
- Nanko Kokorono Clinic, Shirakawa-shi, Fukushima, Japan
| | | | | | - Sakiko Yamada
- Medical Affairs, Otsuka Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Hideki Oi
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira-shi, Tokyo, Japan
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Bo Q, Wang X, Liu X, Sang H, Xun Z, Zhang R, Yang X, Deng H, Li K, Chen J, Sun M, Zhao G, Liu X, Cai D, Zhan G, Li J, Li H, Wang G. Effectiveness and safety of blonanserin in young and middle-aged female patients with schizophrenia: data from a post-marketing surveillance. BMC Psychiatry 2023; 23:115. [PMID: 36810039 PMCID: PMC9945355 DOI: 10.1186/s12888-023-04598-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND A post-marketing surveillance of blonanserin has been ongoing since September 2018. The aim of this study was to assess the effectiveness and safety of oral blonanserin in Chinese young and middle-aged female patients with schizophrenia in real clinical settings, using the data from the post-marketing surveillance. METHODS A 12-week, prospective, multi-center, open-label, post-marketing surveillance was conducted. Female patients aged 18-40 years were included in this analysis. The Brief Psychiatric Rating Scale (BPRS) was used to evaluate the effectiveness of blonanserin in improving psychiatric symptoms. The incidence of adverse drug reactions (ADRs) such as of extrapyramidal symptoms (EPS), prolactin elevation and the weight gain were used to evaluate the safety profile of blonanserin. RESULTS A total of 392 patients were included both in the safety and full analysis sets, 311 patients completed the surveillance protocol. The BPRS total score was 48.8 ± 14.11 at the baseline, decreasing to 25.5 ± 7.56 at 12 weeks (P < 0.001, compared with baseline). EPS (20.2%) including akathisia, tremor, dystonia, and parkinsonism were found as the most frequent ADRs. The mean weight gain was 0.27 ± 2.5 kg at 12 weeks from the baseline. Four cases (1%) of prolactin elevation were observed during the period of surveillance. CONCLUSION Blonanserin significantly improved the symptoms of schizophrenia in female patients aged 18-40 years; the drug was well tolerated and had a low tendency to cause metabolic side effects, including prolactin elevation in these patients. Blonanserin might be a reasonable drug for the treatment of schizophrenia in young and middle-aged female patients.
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Affiliation(s)
- Qijing Bo
- grid.24696.3f0000 0004 0369 153XThe National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders & Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing, 100088 China
| | - Xijin Wang
- Department of Psychiatry, The First Psychiatric Hospital of Harbin, Harbin, Heilongjiang 150010 China
| | - Xuejun Liu
- Department of Psychiatry, Brain Hospital of Hunan Province, Changsha, Hunan 410007 China
| | - Hong Sang
- Mental Health Center, Changchun Sixth Hospital, Changchun, Jilin 130052 China
| | - Zhiyuan Xun
- grid.440287.d0000 0004 1764 5550Department of Psychiatry, Tianjin Anding Hospital, Tianjin, Tianjin, 300222 China
| | - Ruiling Zhang
- Department of Psychiatry, Henan Mental Hospital, Xinxiang, Henan 453002 China
| | - Xiaodong Yang
- grid.452754.5Department of Psychiatry, Shandong Mental Health Center, Jinan, Shandong 250014 China
| | - Huaili Deng
- Department of Psychology, Psychiatric Hospital of Taiyuan City, Taiyuan, Shanxi, 030000 China
| | - Keqing Li
- Department of Psychiatry, Hebei Provincial Mental Health Center, Baoding, Hebei 071000 China
| | - Jindong Chen
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011 China
| | - Meijuan Sun
- Department of Pharmacy, Daqing Third Hospital, Daqing, Heilongjiang 163712 China
| | - Guijun Zhao
- Department of Psychiatry, Guangyuan Mental Health Center, Guangyuan, Sichuan 628001 China
| | - Xianglai Liu
- Institute of Mental Health, Hainan Provincial Anning Hospital, Haikou, Hainan, 570206 China
| | - Duanfang Cai
- Department of Psychiatry, The Fifth People’s Hospital of Zigong, Zigong, Sichuan 643020 China
| | - Guilai Zhan
- Department of Psychiatry, Xuhui Mental Health center, Shanghai, 200232 China
| | - Juhong Li
- grid.517561.1Department of Psychiatry, The Fourth People’s Hospital of Chengdu, Chengdu, Sichuan 610036 China
| | - Haiyun Li
- Medical Affairs, Sumitomo Pharma (Suzhou) Co., Ltd, Shanghai, 200025 China
| | - Gang Wang
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100088, China. .,The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China.
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Okada Y, Inada K, Akazawa M. Comparative effectiveness of long-acting injectable antipsychotics in patients with schizophrenia in Japan. Schizophr Res 2023; 252:300-308. [PMID: 36706475 DOI: 10.1016/j.schres.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/31/2022] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To compare the effectiveness of different long-acting injectable antipsychotics (LAIs) (aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol) in patients with schizophrenia in Japan. METHODS We conducted a retrospective cohort study using two administrative claims databases. The study population consisted of outpatients with schizophrenia who initiated LAIs between May 1, 2015, and November 30, 2019. We directly compared the risk of psychiatric hospitalization and LAI discontinuation among the LAIs based on hazard ratios (HRs) using Cox proportional hazards regression models. RESULTS The numbers of eligible patients who initiated aripiprazole, paliperidone, risperidone, and fluphenazine/haloperidol were 303, 124, 73, and 123, respectively. Regarding psychiatric hospitalization, aripiprazole and paliperidone were associated with significantly lower risk compared to fluphenazine/haloperidol (HR of aripiprazole: 0.47, 95 % CI: 0.28-0.78, HR of paliperidone: 0.50, 95 % CI: 0.28-0.89); HR of risperidone showed the same trend as the aripiprazole and paliperidone. Regarding LAI discontinuation, aripiprazole and paliperidone were associated with significantly lower risk of LAI discontinuation compared to fluphenazine/haloperidol (HR of aripiprazole: 0.53, 95 % CI: 95 % CI: 0.35-0.80, HR of paliperidone: 0.57, 95 % CI: 0.35-0.92). Aripiprazole was also associated with a significantly lower risk compared to risperidone (HR: 0.56, 95 % CI: 0.32-0.98). CONCLUSION Our study suggests that aripiprazole and paliperidone are superior to fluphenazine/haloperidol in the risk of psychiatric hospitalization and LAI discontinuation. Aripiprazole is superior to risperidone in the risk of LAI discontinuation.
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Affiliation(s)
- Yusuke Okada
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Kanagawa, Japan
| | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan.
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