記述言語：英語   掲載種別：研究論文（学術雑誌）  

Painless thyroiditis, which is rare in children, exhibits the characteristic sequence of hyperthyroidism, including aggressive and disruptive behaviors. Unlike subacute thyroiditis or Graves' disease, painless thyroiditis is challenging to diagnose because of its mild symptoms and minimal or absent physical findings. Moreover, aggressive and disruptive behaviors in children with psychiatric disorders may be misconstrued as exacerbation of underlying symptoms. The present patient was a 16-year-old male with adjustment disorder who presented to a pediatric psychiatric clinic for assessment of irritability. After 4 months, he developed aggressive and disruptive behaviors that prompted initiation of risperidone but without improvement. After 1 month, he reported palpitations and dyspnea. His neck was supple and non-tender without thyroid enlargement. Thyroid studies revealed elevated free T4 and T3 levels and suppressed thyroid-stimulating hormone level, suggesting hyperthyroidism. A radioactive iodine uptake test revealed a barely visible thyroid gland, consistent with thyroiditis. Painless thyroiditis, without thyroid tenderness, was diagnosed. We describe a case of painless thyroiditis in an adolescent patient with aggressive and disruptive behaviors that were initially attributed to worsening of an underlying adjustment disorder. Even when minimal or no signs of hyperthyroidism are present, painless thyroiditis should be considered in the differential diagnosis of children with aggressive and disruptive behaviors. Awareness of potential anchoring bias is also recommended to prevent its delayed diagnosis of such behaviors.

DOI： 10.1272/jnms.JNMS.2025_92-302

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Although alcohol consumption is known to be a trigger for suicide, the extent to which acute alcohol consumption influences suicide attempts in Japan is unclear. We investigated the actual state and background of alcohol-induced suicide attempts, that is, suicide attempts induced by acute alcohol consumption, in patients with severe suicide attempts admitted to the emergency department. METHODS: The subjects were suicide attempters over 20 years old who were admitted to the emergency department between 2010 and 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives of suicide attempts were retrospectively examined from medical records. We compared differences in the characteristics of data obtained from males and females with and without alcohol-induced suicide attempts, and used logistic regression analysis to evaluate the influence of those factors on alcohol-induced suicide attempts. RESULTS: Among the 801 suicide attempters over 20 years old during 2010 to 2021, 130 (16.2%) were alcohol-induced suicide attempters: 61 (18.9%) of 323 male suicide attempters and 69 (14.4%) of 478 female suicide attempters. Substance-induced disorders in both males and females, in addition to marital relations in males and living alone and personality disorders in females, had significant influence on alcohol-induced suicide attempts. CONCLUSION: Acute alcohol consumption was found to be a trigger in approximately one in six suicide attempts and alcohol-induced suicide attempts were not unique in terms of substance dependence. We believe that focusing on those factors that seemed to influence alcohol-induced suicide attempts in the present study could provide clues regarding the prevention of alcohol-induced suicide attempts.

DOI： 10.1002/pcn5.70086

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Teenage suicide-related behaviors have been highlighted in Japan in recent years, but the background factors and characteristics of these behaviors have not been clarified. Therefore, we investigated the characteristics of teenage suicide attempters who were admitted to an emergency room. METHODS: The subjects were suicide attempters in their teens and twenties who were admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010 and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives for suicide attempts were retrospectively examined from medical records. Teenage suicide attempters were compared to those in their twenties in regard to the acquired data, and logistic regression analysis was conducted to evaluate the influence on teenage suicide attempts by the aspects that have been shown to be closely associated with teenage suicides. RESULTS: Among 860 suicide attempters between 2010 and 2021, 59 (6.9%) were teenage suicide attempters and 216 (25.1%) were suicide attempters in their twenties. The large number of females, the history of self-harm, the great number of drug overdoses as a means of attempting suicide, and the large number of individuals with psychiatric disorders, especially with mood disorders and personality disorders, were commonly shared by suicide attempters both in their teens and twenties. On the other hand, family problems, school problems and autism spectrum disorder significantly influenced mostly teenage suicide attempters. CONCLUSIONS: It was suggested that teenage suicide attempters may have attempted suicide due to environmental difficulties and conflicts about not being able to escape from them. It has become clear that teenage suicide attempters have unique characteristics and background factors, and that it is important to take these into account when taking measures to prevent teenage suicides.

DOI： 10.1186/s12888-024-06234-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The decreasing trend in the number of young suicides in Japan changed to a flat/increasing trend in 2017. To identify how this change was reflected in young suicide attempters, we investigated changes in the characteristics of young suicide attempters admitted to our emergency room. METHODS: The subjects were suicide attempters younger than 30 years admitted to the Critical Care Medical Center of Nippon Medical School Hospital between January 1, 2010, and December 31, 2021. The means of suicide attempt, sociodemographic data, psychiatric diagnoses, and causes and motives of suicide attempts were retrospectively examined from medical records. We compared post-2017 to pre-2017 suicide attempts and performed a statistical analysis. RESULTS: The proportion of suicide attempters younger than 30 years was 27.9% (143 of 513) before 2017 and 38.0% (132 of 347) after 2017, a significant increase. From 2017 to 2021, there was a significant increase in the number of female suicide attempters younger than 30 years and in the percentage of drug overdoses. CONCLUSIONS: The proportion of suicide attempters younger than 30 years was significantly higher after the start of 2017 than before 2017, possibly because of an increase in drug overdoses.

DOI： 10.1272/jnms.JNMS.2024_91-514

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Connecting individuals in need of psychiatric treatment with adequate medical services has been a major strategy for suicide prevention in Japan. By investigating serious suicide attempters admitted to our Critical Care Medical Center (CCM), we aimed to examine longitudinal changes in the psychiatric treatment status of high-risk suicidal individuals, and to explore the association between any improvement in psychiatric treatment status and suicide decline. METHODS: Subjects from two periods, 2006-2011 and 2012-2017, were enrolled. We collected the data of 32,252 suicides in Tokyo from police reports and the data of 942 suicide attempters admitted to CCM from medical records. Data were annually collected by both age and gender for the number of suicide completers, the number of suicide attempters, and the psychiatric treatment rates, respectively. ANOVA and t-test were used to examine whether there were differences in the number of suicides and attempers between the two periods. The difference in psychiatric treatment rate between the two periods was examined by chi-square test. Additionally, we used Pearson's correlation coefficient to analyze any correlation between annual treatment rate and the number of suicide completers in subgroups with altered psychiatric treatment rates. RESULTS: The number of suicide attempters in the 20-39-year age group of decreased together with the number of suicides. Psychiatric treatment rates of male attempters aged 20-59 years improved significantly from 48.7 to 70.6% and this improvement correlated with a decrease in suicides. However, psychiatric treatment rates in the elderly, which have the highest number of suicides in both genders, did not improve and remain low. CONCLUSIONS: The number of suicide attempters, as well as that of suicides, decreased in Tokyo. Improvement of psychiatric treatment status in high-risk suicidal male adults may have contributed to the reduction of suicides in Tokyo. However, the continuing low rate of psychiatric treatment in the elderly is a pressing issue for future suicide prevention.

DOI： 10.1186/s12888-022-03866-7

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