Background The Japanese government recently announced the ‘Five‐Year Plan for Promotion of Measures Against Dementia (Orange Plan)’ to promote people with dementia living in their communities. To achieve this, it is imperative that patients hospitalized with behavioural and psychological symptoms of dementia (BPSD) are helped to return to their own homes. The aim of the present study was to identify predictors of home discharge among patients hospitalized for BPSD. Methods A single‐centre chart review study was conducted on consecutive patients hospitalized from home between April 2006 and March 2011 for the treatment of BPSD. The frequency of discharge back to home was examined in relation to a patient's active behavioural problems and demographics at the time of admission. Diagnoses of dementia were made on the basis of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies. Results In all, 391 patients were enrolled in the study. Of these patients, 163 (42%) returned home. Multiple logistic regression analysis identified high Mini‐Mental State Examination and Nishimura‐style senile activities of daily living scores as significant independent predictors of home discharge. In contrast, living alone and manifestation of aggressiveness at the time of admission were negatively associated with home discharge. Conclusions Few patients hospitalized for BPSD are discharged home, and this number is affected by a patient's clinical and demographic characteristics at the time of admission. These findings should be considered in designing and implementing optimal management and care strategies for patients with BPSD.
In recent years, it has been noticed that adolescent and adult patients with autism spectrum disorder (ASD) sometimes visit psychiatric medical institutions. In some cases, these patients commit an act of violence and are dealt with by psychiatric emergency and forensic psychiatric services. In this report, we present two cases with ASD who visited a psychiatric emergency service because of the 'time slip' phenomenon, and discuss the clinical significance of this phenomenon.Key words: autism spectrum disorders, forensic psychiatry, mental recall, psychiatric emergency service, violence. D R SUGIYAMA, A pediatric psychiatrist in Japan, examined a specific recollection phenomenon seen in patients with high-functioning autism spectrum disorder (HFASD), naming it the 'time slip' phenomenon (TS) and reported it in the Japanese medical literature in 1994.1 This phenomenon is characterized by the clear recall of trivial events, which occurred many years earlier, and the re-experience of the events, including the feelings that were experienced, as if they were occurring in the present. Sugiyama claimed that this phenomenon is a characteristic symptom of autism spectrum disorder.In this report, we present two typical patients who visited a psychiatric emergency service because of the TS, and discuss the clinical significance of TS. Informed consent to publish the details of these two cases was obtained from the patients and their parents. CASE 1Case 1, a male patient, was 16 years old at the time of his first visit to our hospital. He had not shown any delay in language development but had been isolated and unable to make friends since his infancy. In addition, he was extremely clumsy. He was extremely afraid of developing liver dysfunction. He had been bullied by a classmate when he was in the 8th grade; thereafter he refused to go to school and began to stay indoors. One day, he clearly recalled the bullying incident that had occurred a few years earlier and re-experienced the feelings of fear and frustration as if he were once again experiencing that event. Thereafter, he often had similar experiences, even though he did not purposely intend to recall the event, and he became strongly distressed. He and his family stated that the recalled content was always the same. He thought that the distress could only be relieved by obtaining revenge on the boy who had bullied him, and he visited the boy's house with a knife. He was subsequently admitted to the emergency ward of our hospital.Our hospital collected detailed information on his developmental history from his parents. The patient's 'Maternal and Child Health Handbook' and report cards for elementary and junior high school were used as major information sources. We confirmed
Optimization of pharmacologic treatment during hospitalization could reduce the use of antipsychotics and improve the subsequent clinical course in DLB.
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