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Di Lorenzo R, D’Amore J, Amoretti S, Bonisoli J, Gualtieri F, Ragazzini I, Rovesti S, Ferri P. Group Therapy with Peer Support Provider Participation in an Acute Psychiatric Ward: 1-Year Analysis. Healthcare (Basel) 2023; 11:2772. [PMID: 37893846 PMCID: PMC10606331 DOI: 10.3390/healthcare11202772] [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: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Group psychotherapy improves therapeutic process, fosters identification with others, and increases illness awareness; (2) Methods: In 40 weekly group sessions held in an acute psychiatric ward during one year, we retrospectively evaluated the inpatients' participation and the demographic and clinical variables of the individuals hospitalized in the ward, the group type according to Bion's assumptions, the main narrative themes expressed, and the mentalization processes by using the Mentalization-Based Therapy-Group Adherence and Quality Scale (MBT-G-AQS); (3) Results: The "working" group was the prevailing one, and the most represented narrative theme was "treatment programs"; statistically significant correlations were found between the group types according to Bion's assumptions and the main narrative themes (Fisher's exact, p = 0.007); at our multivariate linear regression, the MBT-G-AQS overall occurrence score (dependent variable) was positively correlated with the number of group participants (coef. = 14.87; p = 0.011) and negatively with the number of participants speaking in groups (coef. = -16.87, p = 0.025); (4) Conclusion: our study suggests that the group shows consistent defense mechanisms, relationships, mentalization, and narrative themes, which can also maintain a therapeutic function in an acute ward.
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Affiliation(s)
- Rosaria Di Lorenzo
- Mental Health Department and Drug Abuse, AUSL-Modena, 41125 Modena, Italy
| | - Jessica D’Amore
- Nursing Programme, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Sara Amoretti
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.A.); (J.B.); (F.G.); (I.R.)
| | - Jessica Bonisoli
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.A.); (J.B.); (F.G.); (I.R.)
| | - Federica Gualtieri
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.A.); (J.B.); (F.G.); (I.R.)
| | - Ilaria Ragazzini
- School of Specialization in Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.A.); (J.B.); (F.G.); (I.R.)
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.R.); (P.F.)
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy; (S.R.); (P.F.)
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Berardelli I, Sarubbi S, Rogante E, Erbuto D, Cifrodelli M, Giuliani C, Calabrò G, Lester D, Innamorati M, Pompili M. Exploring risk factors for re-hospitalization in a psychiatric inpatient setting: a retrospective naturalistic study. BMC Psychiatry 2022; 22:821. [PMID: 36550540 PMCID: PMC9783999 DOI: 10.1186/s12888-022-04472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The reduction of multiple psychiatric hospitalizations is an important clinical challenge in mental health care. In fact, psychiatric re-hospitalization negatively affects the quality of life and the life expectancy of patients with psychiatric disorders. For these reasons, identifying predictors of re-hospitalization is important for better managing psychiatric patients. The first purpose of the present study was to examine the readmission rate in a large sample of inpatients with a psychiatric disorder. Second, we investigated the role of several demographical and clinical features impacting re-hospitalization. METHOD: This retrospective study enrolled 1001 adult inpatients (510 men and 491 women) consecutively admitted to the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome between January 2018 and January 2022. To identify risk factors for psychiatric re-hospitalization, we divided the sample into 3 subgroups: the Zero-Re group which had no readmission after the index hospitalization, the One-Re group with patients re-admitted only once, and the Two-Re with at least two re-admissions. RESULTS: The groups differed according to previous hospitalizations, a history of suicide attempts, age at onset, and length of stay. Furthermore, the results of the regression model demonstrated that the Two-Re group was more likely to have a history of suicide attempts and previous hospitalizations. DISCUSSION These results indicate the importance of assessing risk factors in psychiatric hospitalized patients and implementing ad hoc prevention strategies for reducing subsequent re-hospitalizations.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189, Rome, Italy.
| | - Salvatore Sarubbi
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università, 30, 00185 Rome, Italy
| | - Elena Rogante
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale Dell’Università, 30, 00185 Rome, Italy
| | - Denise Erbuto
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Mariarosaria Cifrodelli
- grid.7841.aPsychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Psychiatry Unit, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Carlotta Giuliani
- grid.7841.aPsychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea Hospital, Psychiatry Unit, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - Giuseppa Calabrò
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
| | - David Lester
- grid.262550.60000 0001 2231 9854Psychology Program, Stockton University, Galloway, NJ USA
| | - Marco Innamorati
- grid.459490.50000 0000 8789 9792Department of Human Sciences, European University of Rome, Via Degli Aldobrandeschi 190, 00163 Rome, Italy
| | - Maurizio Pompili
- grid.7841.aDepartment of Neurosciences, Faculty of Medicine and Psychology, Suicide Prevention Centre, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, Via Di Grottarossa, 1035, 00189 Rome, Italy
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3
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Zanato S, Miscioscia M, Traverso A, Gatto M, Poli M, Raffagnato A, Gatta M. A Retrospective Study on the Factors Associated with Long-Stay Hospitalization in a Child Neuropsychiatry Unit. Healthcare (Basel) 2021; 9:1241. [PMID: 34575015 PMCID: PMC8465245 DOI: 10.3390/healthcare9091241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
The past twenty years have seen a rapid increase in acute psychiatric symptoms in children and adolescents, with a subsequent rise in the number of psychiatric hospitalizations. This paper aims to: (a) describe the epidemiology of hospitalizations and some of the clinical and sociodemographic characteristics of pediatric patients admitted to a regional referral Complex Operative Child Neuropsychiatry Hospital Unit in Northeast Italy and (b) identify potential factors correlated with the length of hospital stay. METHODS 318 (M = 12.8 years; SD = 3.11; 72% Female) patients hospitalized for mental health disorders from 2013 to 2019. RESULTS Around 60% of hospital admissions occurred via the emergency room, mostly due to suicidal ideation and/or suicide attempts (24%). Affective disorders were the most frequent discharge diagnosis (40%). As for factors correlated with length of hospital stay, we found significant links with chronological age, way of hospital admission, cause of admission, discharge diagnosis, presence of psychiatric comorbidity, family conflict, and psychiatric family history. CONCLUSIONS These results provide information about global characteristics associated with the length of psychiatric hospital stays in pediatric patients and provide a basis on which specific precautions can be hypothesized with the aim of developing more focused treatments.
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Affiliation(s)
- Silvia Zanato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Annalisa Traverso
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Miriam Gatto
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Mikael Poli
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
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Restellini A, Kherad O, Kaiser S. The impact of implementing a psychiatric emergency hotline on the reduction of acute hospitalizations in a Swiss tertiary hospital. BMC Psychiatry 2021; 21:425. [PMID: 34465305 PMCID: PMC8406028 DOI: 10.1186/s12888-021-03431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission. METHODS This pre-post intervention quality improvement study compared changes in the management of psychiatric patients' admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners. Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments' costs. Fisher's Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student's t-test for continuous variables and Fishers's Exact test for proportions. RESULTS Among 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days). CONCLUSION Implementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.
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Affiliation(s)
- Aurélio Restellini
- Division of Psychiatry, Geneva University hospitals and University of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
| | - Omar Kherad
- Department of Internal Medicine, La Tour Hospital and University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Division of Psychiatry, Geneva University hospitals and University of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Geneva, Switzerland
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Pedersen SH, Bergman H, Berlin J, Hartvigsson T. Perspectives on Recruitment and Representativeness in Forensic Psychiatric Research. Front Psychiatry 2021; 12:647450. [PMID: 34220570 PMCID: PMC8247569 DOI: 10.3389/fpsyt.2021.647450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/18/2021] [Indexed: 01/07/2023] Open
Abstract
Participant representativeness and statistical power are crucial elements of robust research with human participants, both of which relate to the successful recruitment of research participants. Nevertheless, such core features may often not be fully reported or duly considered in psychiatric research. Building on our experiences of collecting data in the context of forensic mental health services, we discuss issues regarding participant recruitment and representativeness in our field with its particular characteristics. A quick sampling and brief overview of the literature in four specialized forensic mental health journals is presented, demonstrating that published manuscripts rarely describe the data in sufficient detail for the reader to assess sample representativeness and statistical power. This lack of transparency leads not only to difficulties in interpreting the research; it also entails risks relating to the already meager evidence base of forensic mental health services being relevant only to a subset of patients. Accordingly, we provide suggestions for increased transparency in reporting and improved recruitment of research participants. We also discuss the balance of ethical considerations pertinent to the pursuit of increased participation rates in forensic mental health research.
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Affiliation(s)
- Sven H. Pedersen
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Bergman
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Berlin
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Research and Development, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Thomas Hartvigsson
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- School of Philosophy and Art History, Faculty of Humanities, University of Essex, Colchester, United Kingdom
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6
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Arthur SA, Hirdes JP, Heckman G, Morinville A, Costa AP, Hébert PC. Do premorbid characteristics of home care clients predict delayed discharges in acute care hospitals: a retrospective cohort study in Ontario and British Columbia, Canada. BMJ Open 2021; 11:e038484. [PMID: 33550224 PMCID: PMC7925855 DOI: 10.1136/bmjopen-2020-038484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Improved identification of patients with complex needs early during hospitalisation may help target individuals at risk of delayed discharge with interventions to prevent iatrogenic complications, reduce length of stay and increase the likelihood of a successful discharge home. METHODS In this retrospective cohort study, we linked home care assessment records based on the Resident Assessment Instrument for Home Care (RAI-HC) of 210 931 hospitalised patients with their Discharge Abstract Database records. We then undertook multivariable logistic regression analyses to identify preadmission predictive factors for delayed discharge from hospital. RESULTS Characteristics that predicted delayed discharge included advanced age (OR: 2.72, 95% CI 2.55 to 2.90), social vulnerability (OR: 1.27, 95% CI 1.08 to 1.49), Parkinsonism (OR: 1.34, 95% CI 1.28 to 1.41) Alzheimer's disease and related dementias (OR: 1.27, 95% CI 1.23 to 1.31), need for long-term care facility services (OR: 2.08, 95% CI 1.96 to 2.21), difficulty in performing activities of daily living and instrumental activities of daily living, falls (OR: 1.16, 95% CI 1.12 to 1.19) and problematic behaviours such as wandering (OR: 1.29, 95% CI 1.22 to 1.38). CONCLUSION Predicting delayed discharge prior to or on admission is possible. Characteristics associated with delayed discharge and inability to return home are easily identified using existing interRAI home care assessments, which can then facilitate the targeting of pre-emptive interventions immediately on hospital admission.
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Affiliation(s)
- Stella A Arthur
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne Morinville
- Medicine, Centre Hospitalier de l'Université de Montréal Bibliothèque, Montreal, Québec, Canada
| | - Andrew P Costa
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paul C Hébert
- Medicine, Centre Hospitalier de l'Université de Montréal Bibliothèque, Montreal, Québec, Canada
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7
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Kinoshita H, Kuroki N, Okada T. Violent Behavior Prior to Admission Is Not a Factor in Further Prolonged Length of Stay: A Retrospective Cohort Study in a Japanese Psychiatric Hospital. Front Psychiatry 2021; 12:600456. [PMID: 34290626 PMCID: PMC8287124 DOI: 10.3389/fpsyt.2021.600456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background: This study assessed the hypothesis that violent behavior prior to admission prolongs psychiatric hospitalization and evaluated the likelihood of hospital discharge to a community care setting based on demographic and clinical factors, with an emphasis on violent behavior. Methods: We retrospectively selected 362 patients who were involuntarily admitted to a psychiatric hospital in Japan from December 1, 2015 to November 30, 2017, stayed longer than planned, and underwent review by a multidisciplinary team. We assessed (a) education and marital status and history of substance abuse, (b) the presence/absence and type of violent behavior that led to hospital admission, and (c) the discharge criteria. We divided the subjects into groups according to whether they had demonstrated violent behavior prior to admission and compared demographic and clinical variables between the groups using bivariate analysis. We also analyzed data using the Cox proportional hazard model, defining discharge to the community as the outcome. Age, sex, and variables that were significant at a level of P < 0.05 based on Cox univariate analysis were included in the multivariate models using the forced entry method. Results: The Violent group included 94 patients (26%). There were no significant between-group differences in age, sex, educational background, marital history, career history, or the history of substance abuse. However, hospitalization was significantly longer in the Non-violent group. The Cox proportional multivariate hazard ratios revealed that violent behavior prior to admission resulted in a higher probability of hospital discharge. Conclusion: Violent behavior prior to admission did not significantly contribute to prolonged hospitalization in patients who deviated from the treatment plan and had exceeded the planned hospitalization duration. Our findings recommend caution when using violence and impulsiveness observed during the acute stage to predict the difficulty of long-term treatment.
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Affiliation(s)
- Hidetoshi Kinoshita
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Forensic Mental Health Unit, Department of Psychiatry and Behavioral Sciences, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriomi Kuroki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Takayuki Okada
- Forensic Mental Health Unit, Department of Psychiatry and Behavioral Sciences, Division of Cognitive and Behavioral Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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