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The debate regarding the need for hospital evacuation and the evacuation distance remains rather chaotic. Furthermore, the relationship between hospital evacuation and the prognoses of psychiatric inpatients has not yet been investigated. We aimed to reveal the association between the long-term prognosis of psychiatric inpatients evacuated immediately following the Fukushima Daiichi Nuclear Power Plant accident and their backgrounds. In this retrospective cohort study, 777 psychiatric inpatients who were immediately evacuated from their hospitals following the accident were included for analysis. Survival time was the primary outcome. We conducted univariable and multivariable analyses to examine the associations between mortality and linear distance of evacuation and different backgrounds, including psychiatric/physical traits. Univariable analysis showed that the estimated survival time among patients was significantly associated with their evacuation distance. A multivariable analysis showed that a longer evacuation distance had a significantly lower hazard ratio (HR) and resulted in lower mortality. In contrast, older patients with physical complications of respiratory disease (International Statistical Classification of Diseases and Related Health Problems 10th revision, J00–99) and genitourinary disease (N00–99) showed a significantly higher HR and had a higher mortality than patients without these complications. To prevent death among elderly psychiatric inpatients with physical comorbidities during disasters, the evacuation destination should be determined taking into consideration the evacuees’ tolerance for long-distance transportation and the availability of post-evacuation care in the destination hospitals.

Following the Great East Japan Earthquake on March 11, 2011, the nuclear disaster at the Fukushima Daiichi Nuclear Power Plant has continued to affect the mental health status of residents in the evacuation zone. To examine the mental health status of evacuee after the nuclear accident, we conducted the Mental Health and Lifestyle Survey as part of the ongoing Fukushima Health Management Survey. We measured mental health status using the Kessler 6-item psychological distress scale (K6) in a total of 73,569 (response rate: 40.7%) evacuees aged 15 and over who lived in the evacuation zone in Fukushima Prefecture. We then dichotomized responders using a 12/13 cutoff on the K6, and compared the proportion of K6 scores ≥13 and ≤12 in each risk factor including demographic information, socioeconomic variables, and disaster-related variables. We also performed bivariate analyses between mental health status and possible risk factors using the chi-square test. Furthermore, we performed multivariate regression analysis using modified Poisson regression models. The median K6 score was 5 (interquartile range: 1-10). The number of psychological distress was 8,717 (14.6%). We found that significant differences in the prevalence of psychological distress by almost all survey items, including disaster-related risk factors, most of which were also associated with increased Prevalence ratios (PRs). Additionally, we found that psychological distress in each evacuation zone was significantly positively associated with the radiation levels in their environment (r = 0.768, p = 0.002). The earthquake, tsunami and subsequent nuclear accident likely caused severe psychological distress among residents in the evacuation zone in Fukushima Prefecture. The close association between psychological distress and the radiation levels shows that the nuclear accident seriously influenced the mental health of the residents, which might be exacerbated by increased risk perception. To provide prompt and appropriate support, continued psychosocial intervention for evacuees is strongly recommended.

After disasters, people are often forced to reconstruct or move to new residences. This study aimed to reveal the association between the types of reconstructed residences and psychosocial or psychiatric conditions among the population. A total of 1071 adult residents in a coastal town, whose houses were destroyed by the tsunami caused by the Great East Japan Earthquake, enrolled in the study five years after the disaster. The type of reconstructed post-disaster residences (reconstructed on the same site/disaster-recovery public condominium/mass-translocation to higher ground/privately moving to remote areas) and the current psychosocial indicators were investigated. The results revealed that individuals living in public condominiums showed significantly worse scores on the Lubben Social Network Scale-6 (p < 0.0001) and the Center for Epidemiologic Studies Depression Scale (p < 0.0001), and slightly worse scores on the Kessler Psychological Distress Scale (p = 0.035) and the Impact of Event Scale-Revised (p = 0.028). Lower psychosocial indicator scores in the public condominium group were more remarkable in younger adults aged < 65 years. Insomnia evaluated using the Athens Insomnia Scale was not different among the four residential types. In summary, residents moving into disaster-recovery public condominiums are likely to have less social interaction, be more depressed, and may need additional interventions.

Electroencephalography (EEG) is widely used to assess prognosis in patients with disorders of consciousness (DoC). Visual assessments by physicians and quantitative EEG (qEEG) are commonly used; however, only a few studies have directly compared their predictive accuracy. Therefore, in this study, we aimed to compare the prognostic value of visual EEG classification versus that of qEEG-based spectral analysis for survival and neurological outcomes in patients with impaired consciousness. In this retrospective study, we examined 97 patients with impaired consciousness admitted to the Emergency and Critical Care Center of Fukushima Medical University Hospital between April 2018 and December 2023. Visual EEG grading was performed using a conventional grading system based on established criteria. Receiver operating characteristic (ROC) curves were used to compare predictive performance. Multivariate logistic regression models were developed incorporating qEEG and clinical prognostic factors (Scarpino score, rehabilitation status, and age). The incremental predictive value of clinical variables was assessed using DeLong's test. Visual EEG assessment showed moderate predictive accuracy [area under the curve (AUC) = 0.77 for survival; 0.677-0.725 for neurological outcomes]. qEEG-based models showed comparable performance to visual EEG classification, with slightly higher AUC values that were not statistically significant. The addition of clinical factors significantly improved predictive accuracy, particularly for neurological recovery (AUC improved from 0.729 to 0.936; < 0.001). Combining qEEG features and clinical prognostic factors provided a comprehensive approach for outcome prediction in patients with DoC. These findings support the potential of a multimodal prognostic framework integrating objective EEG metrics and physician-derived evaluations, although further prospective validation is required.

Aim As it is difficult to examine the mental health of disaster victims immediately after a disaster through the rigorous procedures required for academic papers, the overall mental state of victims immediately after a disaster is not well understood. Therefore, this study aimed to investigate the actual mental health needs of victims during the transition from the acute and subacute phases to the chronic phase of the 2024 Noto Peninsula earthquake (NPE). Methods We obtained Emergency Medical Information System (EMIS) data for a period of ∼1 month during Disaster Psychiatric Assistance Team support from outside the prefecture in Suzu City and Noto Town. We then extracted the following variables of the supportees from the EMIS data: age, consultation stage, content of response, psychiatric treatment history, and diagnostic classification. We compared the variables between the 2 weeks immediately after the disaster (Phase 1) and the following 2 weeks (Phase 2). Results New consultations started mostly in Phase 1 and dropped in Phase 2. Consultations were initially dominated by victims with existing psychiatric disorders, but those on dementia‐related problems and direct stress reactions to the disaster increased over time. Conclusion Information accumulated in the EMIS was useful for providing an overview of the mental state of communities affected by the 2024 NPE. The extracted findings may be useful for planning mental health measures for affected communities and preparing for future disasters, which may improve community resilience in affected areas. We investigated the actual mental health needs of victims during the transition from the acute and subacute phases to the chronic phase of the 2024 Noto Peninsula earthquake by using Emergency Medical Information System data for a period of ∼1 month during Disaster Psychiatric Assistance Team support. We compared the variables between the 2 weeks immediately after the disaster (Phase 1) and the following 2 weeks (Phase 2) and found that consultations were initially dominated by victims with existing psychiatric disorders, but those on dementia‐related problems and direct stress reactions to the disaster increased over time. These findings may be useful for planning mental health measures for affected communities and preparing for future disasters, which may improve community resilience in affected areas.

Schizophrenia is a multifactorial disorder, the genetic architecture of which remains unclear. Although many studies have examined the etiology of schizophrenia, the gene sets that contribute to its symptoms have not been fully investigated. In this study, we aimed to identify each gene set associated with corresponding symptoms of schizophrenia using the postmortem brains of 26 patients with schizophrenia and 51 controls. We classified genes expressed in the prefrontal cortex (analyzed by RNA-seq) into several modules by weighted gene co-expression network analysis (WGCNA) and examined the correlation between module expression and clinical characteristics. In addition, we calculated the polygenic risk score (PRS) for schizophrenia from Japanese genome-wide association studies, and investigated the association between the identified gene modules and PRS to evaluate whether genetic background affected gene expression. Finally, we conducted pathway analysis and upstream analysis using Ingenuity Pathway Analysis to clarify the functions and upstream regulators of symptom-related gene modules. As a result, three gene modules generated by WGCNA were significantly correlated with clinical characteristics, and one of these showed a significant association with PRS. Genes belonging to the transcriptional module associated with PRS significantly overlapped with signaling pathways of multiple sclerosis, neuroinflammation, and opioid use, suggesting that these pathways may also be profoundly implicated in schizophrenia. Upstream analysis indicated that genes in the detected module were profoundly regulated by lipopolysaccharides and CREB. This study identified schizophrenia symptom-related gene sets and their upstream regulators, revealing aspects of the pathophysiology of schizophrenia and identifying potential therapeutic targets.

Mice with the C3H background show greater behavioral propensity for schizophrenia, including lower prepulse inhibition (PPI), than C57BL/6 (B6) mice. To characterize as‐yet‐unknown pathophysiologies of schizophrenia, we undertook proteomics analysis of the brain in these strains, and detected elevated levels of Mpst, a hydrogen sulfide (H 2 S)/polysulfide‐producing enzyme, and greater sulfide deposition in C3H than B6 mice. Mpst ‐deficient mice exhibited improved PPI with reduced storage sulfide levels, while Mpst ‐transgenic (Tg) mice showed deteriorated PPI, suggesting that “sulfide stress” may be linked to PPI impairment. Analysis of human samples demonstrated that the H 2 S/polysulfides production system is upregulated in schizophrenia. Mechanistically, the Mpst‐ Tg brain revealed dampened energy metabolism, while maternal immune activation model mice showed upregulation of genes for H 2 S/polysulfides production along with typical antioxidative genes, partly via epigenetic modifications. These results suggest that inflammatory/oxidative insults in early brain development result in upregulated H 2 S/polysulfides production as an antioxidative response, which in turn cause deficits in bioenergetic processes. Collectively, this study presents a novel aspect of the neurodevelopmental theory for schizophrenia, unraveling a role of excess H 2 S/polysulfides production. Synopsis This study proposes a novel concept that excess hydrogen sulfide production (sulfide stress) underlies a schizophrenia pathophysiology in the realm of neurodevelopmental hypothesis of the disease. Targeting the metabolic pathway of hydrogen sulfide provides a novel therapeutic approach. Mpst‐deficient mice exhibited improved prepulse inhibition (PPI), a typical schizophrenia‐relevant endophenotype, with reduced sulfide levels, while Mpst‐transgenic mice showed deteriorated PPI. Postmortem brains and iPS‐derived cells from a subset of schizophrenia patients displayed evidence for sulfide stress. Sulfide stress condition stemmed from insults in developing brain in mouse models and elicited dampened energy metabolism. MPST expression level in hair follicles has a potential to stratify schizophrenia patients with sulfide stress. Graphical Abstract This study proposes a novel concept that excess hydrogen sulfide production (sulfide stress) underlies a schizophrenia pathophysiology in the realm of neurodevelopmental hypothesis of the disease. Targeting the metabolic pathway of hydrogen sulfide provides a novel therapeutic approach.

Dopamine- and cAMP-regulated phosphoprotein of molecular weight 32 kDa (DARPP-32) integrates dopaminergic signaling into that of several other neurotransmitters. Calcineurin (CaN), located downstream of dopaminergic pathways, inactivates DARPP-32 by dephosphorylation. Despite several studies have examined their expression levels of gene and protein in postmortem patients’ brains, they rendered inconsistent results. In this study, protein expression levels of DARPP-32 and CaN were measured by enzyme-linked immunosorbent assay (ELISA) in the prefrontal cortex (PFC), and nucleus accumbens (NAc) of 49 postmortem samples from subjects with schizophrenia, bipolar disorder, and normal controls. We also examined the association between this expression and genetic variants of 8 dopaminergic system-associated molecules for 55 SNPs in the same postmortem samples. In the PFC of patients with schizophrenia, levels of DARPP-32 were significantly decreased, while those of CaN tended to increase. In the NAc, both of DARPP-32 and CaN showed no significant alternations in patients with schizophrenia or bipolar disorder. Further analysis of the correlation of DARPP-32 and CaN expressions, we found that positive correlations in controls and schizophrenia in PFC, and schizophrenia in NAc. In PFC, the expression ratio of DARPP-32/CaN were significantly lower in schizophrenia than controls. We also found that several of the aforementioned SNPs may predict protein expression, one of which was confirmed in a second independent sample set. This differential expression of DARPP-32 and CaN may reflect potential molecular mechanisms underlying the pathogenesis of schizophrenia and bipolar disorder, or differences between these two major psychiatric diseases.

Background Celiac disease (CD) is an autoimmune‐mediated systemic disorder triggered by the ingestion of gluten. While it typically presents with gastrointestinal symptoms, it is also associated with various neuropsychiatric manifestations, including depression, migraine, developmental disorders, and epilepsy. In Asia, particularly in Japan, CD remains underdiagnosed, potentially delaying appropriate diagnosis and treatment for early intervention. Case Presentation We report the case of a 16‐year‐old girl who presented with long‐standing behavioral issues, including repeated theft and rule violations since elementary school. She was diagnosed with attention‐deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder, but responded poorly to psychiatric treatment. In light of her coexisting physical symptoms, including chronic gastrointestinal complaints and unexplained laboratory abnormalities, further evaluation, including a duodenal biopsy, was conducted. The diagnosis of CD was confirmed, and a gluten‐free diet was initiated. Following dietary intervention, both her psychiatric and physical symptoms improved significantly, and no recurrence was observed during follow‐up. Conclusion This case highlights the importance of considering CD as a differential diagnosis in adolescents with treatment‐resistant psychiatric symptoms, especially when accompanied by physical signs suggestive of systemic disease. Early recognition and intervention with a gluten‐free diet may improve both psychiatric and physical outcomes.

Abstract Previous studies have indicated associations between several OLIG2 gene single-nucleotide polymorphisms (SNPs) and susceptibility to schizophrenia among Caucasians. Consistent with these findings, postmortem brain and diffusion tensor imaging studies have indicated that the schizophrenia-risk-associated allele (A) in the OLIG2 SNP rs1059004 predicts lower OLIG2 gene expression in the dorsolateral prefrontal cortex (DLPFC) of schizophrenia patients and reduced white matter (WM) integrity of the corona radiata in normal brains among Caucasians. In an effort to replicate the association between this variant and WM integrity among healthy Japanese, we found that the number of A alleles was positively correlated with WM integrity in some fiber tracts, including the right posterior limb of the internal capsule, and with mean blood flow in a widespread area, including the inferior frontal operculum, orbital area, and triangular gyrus. Because the A allele affected WM integrity in opposite directions in Japanese and Caucasians, we investigated a possible association between the OLIG2 gene SNPs and the expression level of OLIG2 transcripts in postmortem DLPFCs. We evaluated rs1059004 and additional SNPs in the 5′ upstream and 3′ downstream regions of rs1059004 to cover the broader region of the OLIG2 gene. The 2 SNPs (rs1059004 and rs9653711) had opposite effects on OLIG2 gene expression in the DLPFC in Japanese and Caucasians. These findings suggest ethnicity-dependent opposite effects of OLIG2 gene SNPs on WM integrity and OLIG2 gene expression in the brain, which may partially explain the failures in replicating associations between genetic variants and psychiatric phenotypes among ethnicities.