Seasonality of birth in patients with mood disorders in Japan

BACKGROUND

Findings about seasonality of birth in individuals with mood disorders have been inconsistent.

METHODS

Data were collected from the governmental statistics, the Patient Survey in Japan in 1996. The number of patients with mood disorders was 13,969. We obtained information about each patient's date of birth, sex, and diagnosis according to ICD-10. Distributions of monthly birth numbers of patients with mood disorders were compared to those of the general population.

RESULTS

Birth excess was observed from winter to early-spring in both sexes, compared to births of the general population. The magnitude of the excess was larger in females than in males. Although the same tendencies were observed in patients with bipolar disorder and depressive disorder, the differences were more marked in females.

LIMITATIONS

Insufficient birth data in the general population before 1940 and hospital diagnosis.

CONCLUSION

Among Japanese patients with mood disorders, there are excess births from winter to early-spring, compared to the general population. This difference is more marked in females than in males.

Intra-uterine physical growth in schizophrenia: evidence confirming excess of premature birth

BACKGROUND

Many studies have suggested a possible aetiological role for obstetric complications in the development of schizophrenia. We focused on prenatal physical growth in schizophrenia, a contentious issue in the literature.

METHODS

We compared gestational age at birth, birth weight (BW) and birth head circumference (BHC) between 312 schizophrenics and 517 controls, and between 187 schizophrenics and their matched healthy siblings. Information on obstetric histories was obtained from the Maternal and Child Health Handbooks (i.e. contemporaneous records).

RESULTS

Gestational age at birth was significantly earlier in the schizophrenics than in the controls (P = 0.017). Pre-term birth (gestational age of 36 weeks or less) was more common in schizophrenics than in controls (8.0% v. 3.4%, P = 0.005, odds ratio 2.5). Low BW (2500 g or less) was more frequent in schizophrenics than in controls (9.6% v. 4.6%, P = 0.005, odds ratio 2.2). The schizophrenics had significantly lighter BW (P = 0.0003) and tended to have smaller BHC (P = 0.081) compared with controls. However, multiple regression analysis showed that there was no significant difference in BW or BHC between the schizophrenics and controls when gestational age and maternal weight were controlled. There was no significant difference in BW or BHC between schizophrenics and their siblings, although the schizophrenics tended to be born at earlier gestational age than their siblings.

CONCLUSIONS

Our results suggest that prematurity at birth is associated with a risk of developing schizophrenia in adulthood. When gestational age and maternal body weight were allowed for, there was no evidence that schizophrenics tend to have lower mean BW or smaller BHC.

No relationship between schizophrenic birth and influenza epidemics in Japan

The finding that influenza epidemics are associated with an increased risk of adult schizophrenia has been controversial. Data was obtained from Japan's governmental statistics, the Patient Survey. Index years were defined as 1957/1958, 1962, and 1965, and comparison years were defined 2 years before and 2 years after the index year. Subjects were patients with schizophrenia who were born in the index years of influenza epidemics. Periods 5 months after the influenza epidemics were defined as exposed months. Proportions of patients born during the exposed period in the index years were compared with those of patients born in the corresponding months in the comparison years. The proportions of patients born in the exposed months in the index years were not significantly different from those born in the corresponding months in the comparison years, with odds ratios around 1 in the whole country, the Kanto area, and the Shikoku/Kyushu area where a remarkable influenza epidemic was observed in 1957. No difference was observed in analyses stratified by sex. In Japan, there was no relationship between influenza epidemics and schizophrenic birth.

Mood disorders and influenza epidemics in Japan

The finding that influenza epidemics are associated with an increased risk of adult mood disorder has been controversial. In this study, data were collected from governmental statistics, the Patient Survey in Japan, in 1996. Index years were defined as 1957/58, 1962, and 1965, and comparison years were defined as 2 years before and 2 years after the index year. The subjects were 361 patients with mood disorders who were born in the index years of influenza epidemics. In order to isolate patients exposed to an influenza epidemic during their second prenatal trimester, the months of birth 5 months after the influenza epidemics were defined as risk exposure months. The proportions of patients born during the exposure period in the index years were compared with those of patients born in the corresponding months in the comparison years. The same procedures were conducted for the periods 2 and 8 months after the epidemics. For female inpatients only, the proportion of patients born in the A2 influenza-exposure months in 1965 with second-trimester exposure was smaller than that of patients born in the corresponding months in the comparison years; the same phenomenon was observed for third-trimester exposure in 1957-58. However, no differences were observed in other comparisons. These findings suggest that prenatal exposure to influenza might decrease the risk for adult mood disorders in females. However, whether there is a causal relationship is still unproven.

Schizophrenia: is it time to replace the term?

The attitudes of Japanese psychiatrists toward their patients who suffer from schizophrenia were investigated. We were concerned specifically with whether the psychiatrists inform their patients of the suspected diagnosis. We discuss how the term 'schizophrenia' may influence a psychiatrist's decision to inform his patients of the diagnosis. A self-reported questionnaire was distributed to 150 executive board members of the Japanese Society of Psychiatry and Neurology and analysis of the data obtained from 110 respondents was carried out. The results showed that the concepts that psychiatrists use when they give a diagnosis of schizophrenia vary considerably. Fifty-nine per cent of the respondents informed their patients of a diagnosis of schizophrenia on a case-by-case basis, while 37% informed only the patients' families. A tree analysis showed that the most important predictors for informing the patients of the diagnosis were assumptions about the public image of schizophrenia and a negative impression of the term schizophrenia, translated as 'Seishin Bunretsu Byou' in Japanese. The results revealed that the Japanese term for schizophrenia influences a psychiatrist's decision to inform patients of the diagnosis and that, by changing the term to a less stigmatized one, the disclosure of information about schizophrenia to patients would be promoted.

Community-based care for the mentally disordered in Kawasaki City: experiences from Kawasaki City Psychiatric Rehabilitation Center

The basic aims of Kawasaki City Psychiatric Rehabilitation Center are: (i) taking some measures for the hospitalized patients unable to leave because of residential problems; (ii) providing a daily program for the discharged from psychiatric hospital; (iii) developing vocational rehabilitation for the mentally disordered; and (iv) developing a support network for the mentally disordered in the community. To fulfill these aims and to meet the various needs of our users, we have provided a very comprehensive program composed of a ward, outpatient section, day care groups, vocational service and half-way house. According to the program, various services such as medical treatment in a narrow sense, basic training of social skills and human relations, vocational training system that meets the various needs and work abilities of the users, and after care services that enable them to support themselves living in the community are available. These services give them great comfort to live in the community; however, they might serve to increase their dependency on the center. Our future task is to cooperate with various social resources such as workshops, group homes and places to stay and rest during the day, which are being developed in Kawasaki City. By supporting those facilities, we expect to refer our members to them and we put more weight on the indirect service than the direct one, which would hopefully enable us to cover and care for more people in need.

[Public health center based educational approach for families of the mentally disabled in Japan]

In order to evaluate a public health center based educational approach for families of the mentally disabled, questionnaires were sent to all public health centers in Japan. Out of 852 public health centers, 742 responded satisfactorily. At 68.6% of the 742 public health centers, some form of educational programs for families of the mentally disabled have been conducted. In a structured educational program, public health nurses and mental health counselors participated as the main staff. Training seminars for the staff were conducted by prefectural mental health centers or Zenkaren, The National Federation of Families with the Mentally Ill. In order to develop an educational program at the public health centers, the following three elements are required: 1) information transmitted through training seminars and publications, 2) trained staff members including mental health welfare counselors and public health nurses specialized in mental health, and 3) a sufficient budget. Further development of the program is considered crucial for a functional improvement of the public health centers.