Clozapine-induced inflammation, such as myocarditis and pneumonia, can occur during initial titration and can be fatal. Fever is often the first sign of severe inflammation, and early detection and prevention are essential. Few studies have investigated the effects of clozapine titration speed and concomitant medication use on the risk of clozapine-induced inflammation.

We evaluated the risk factors for clozapine-associated fever, including titration speed, concomitant medication use, gender and obesity, and their impact on the risk of fever and the fever onset date.

We conducted a case-control study. The medical records of 539 Japanese participants with treatment-resistant schizophrenia at 21 hospitals in Japan who received clozapine for the first time between 2010 and 2022 were retrospectively investigated. Of these, 512 individuals were included in the analysis. Individuals were divided into three groups according to the titration rate recommended by international guidelines for East Asians: the faster titration group, the slower titration group and the ultra-slower titration group. The use of concomitant medications (such as antipsychotics, mood stabilisers, hypnotics and anxiolytics) at clozapine initiation was comprehensively investigated. Logistic regression analysis was performed to identify the explanatory variables for the risk of a fever of 37.5°C or higher lasting at least 2 days.

Fever risk significantly increased with faster titration, male gender and concomitant use of valproic acid or quetiapine. No increased fever risk was detected with the use of other concomitant drugs, such as olanzapine, lithium or orexin receptor antagonists. Fever onset occurred significantly earlier with faster titration. Multivariate analysis identified obesity as being a factor that accelerated fever onset.

A faster titration speed and concomitant treatment with valproic acid and quetiapine at clozapine initiation increased the risk of clozapine-associated fever. Clinicians should titrate clozapine with caution and consider both the titration speed and concomitant medications.

There is concern that hydroxyzine exacerbates delirium, but a recent preliminary study suggested that the combination of haloperidol and hydroxyzine was effective against delirium. This study examined whether the concomitant use of hydroxyzine and haloperidol worsened delirium in patients with cancer.

This retrospective, observational study was conducted at 2 general hospitals in Japan. The medical records of patients with cancer who received haloperidol for delirium from July to December 2020 were reviewed. The treatments for delirium included haloperidol alone or haloperidol combined with hydroxyzine. The primary outcome was the duration from the first day of haloperidol administration to the resolution of delirium, defined as its absence for 2 consecutive days. The time to delirium resolution was analyzed to compare the haloperidol group and hydroxyzine combination group using the log-rank test with the Kaplan–Meier method. Secondary outcomes were (1) the total dose of antipsychotic medications, including those other than haloperidol (measured in chlorpromazine-equivalent doses), and (2) the frequencies of detrimental incidents during delirium, specifically falls and self-removal of drip infusion lines. The unpaired t-test and Fisher’s exact test were used to analyze secondary outcomes.

Of 497 patients who received haloperidol, 118 (23.7%) also received hydroxyzine. No significant difference in time to delirium resolution was found between the haloperidol group and the hydroxyzine combination group (log-rank test, P = 0.631). No significant difference between groups was found in either chlorpromazine-equivalent doses or the frequency of detrimental incidents.

This study showed that the concomitant use of hydroxyzine and haloperidol did not worsen delirium in patients with cancer.

This study aims to evaluate the long-term impact of living in postdisaster prefabricated temporary housing on social interaction activities and mental health status.

A total of 917 adult residents in a coastal town, whose residences were destroyed by the tsunami caused by the Great East Japan Earthquake (GEJE), were enrolled for the assessment held 5 y after the disaster. They answered questions about their experience and consequence of living in prefabricated temporary housing after the disaster. Their present scores on 5 types of self-reported measures regarding the psychosocial or psychiatric status and their present and recalled social interaction activities were cross-sectionally collected.

A total of 587 (64.0%) participants had a history of living in prefabricated temporary housing, while the other 330 (36.0%) had not. The prevalence of social interaction activities significantly decreased after the GEJE. However, the experience of living in prefabricated temporary housing did not adversely affect the subsequent social interaction activities or mental conditions of the participants 5 y after the disaster.

Living in postdisaster prefabricated temporary housing may not negatively impact subsequent psychosocial conditions or social interaction activities 5 y later.

We aimed to investigate the association between types of housing and allergic symptoms at 3–4 years following the Great East Japan Earthquake.

Our study was based on the ToMMo Child Health Study conducted in 2014 and 2015, a cross-sectional survey of public school children in Miyagi Prefecture, Japan. Of the 46 648 invited schoolchildren in the 2nd to 8th grades, 9884 were included. Presence of eczema, wheezing, and mental health symptoms was defined with questionnaires. To calculate odds ratios (ORs) and 95% CIs for the associations between types of housing and eczema or respiratory symptoms, we fitted generalized linear mixed models, included a random effect for municipality of residence, and adjusted for sex, school grade, survey year, and mental health symptoms.

Prefabricated temporary housing was significantly associated with eczema symptoms (OR, 1.46; 95% CI, 1.06–2.02). Even after adjusting for the presence of mental health symptoms, our analysis produced similar results (OR, 1.42; 95% CI, 1.03–1.96). Conversely, it was not significantly associated with respiratory symptoms (OR, 0.97; 95% CI, 0.61–1.54).

Children living in prefabricated temporary housing had a higher prevalence of eczema symptoms; however, prevalence of respiratory symptoms was not significantly higher.

This study examined the association between psychological distress and the risk of withdrawing from hypertension treatment (HTTx) 1 year after the earthquake disaster in the coastal area affected by the Great East Japan Earthquake (GEJE).

Using cross-sectional data from 2012, we studied people over 20 years of age living in Shichigahama Town, Miyagi, on the northeastern coast of Japan, which had been severely inundated by the tsunami that followed the GEJE in 2011. A total of 1014 subjects were categorized as in need of HTTx. Withdrawing from HTTx was assessed by using a self-reported questionnaire.

Subjects with a higher degree of psychological distress (Kessler-6 [K6] score ≥ 13) exhibited a significantly higher risk of withdrawing from HTTx, compared with subjects with a lower degree of psychological distress (K6 score ≤ 12; odds ratio=4.0; 95% confidence interval: 1.3-10.6, P<0.01).

This study indicated that psychological distress is a risk factor for withdrawing from HTTx in post-disaster settings. Our data suggested that the increased risk of withdrawing from HTTx associated with post-disaster psychological distress may underlie the increased prevalence of vascular diseases after the earthquake disaster in coastal areas affected by the tsunami. (Disaster Med Public Health Preparedness. 2017;11:179–182)

Physical disease patients are known to experience high levels of psychological distress. This study examined the association between the medical treatment of physical diseases and psychological distress in the coastal area affected by the Great East Japan Earthquake.

Using cross-sectional data, we studied 3032 individuals aged ≥40 years who lived in Shichigahama, Miyagi, Japan. We examined the associations between 8 medical treatments for physical diseases and psychological distress, defined as Kessler Psychological Distress scale score ≥13 of 24 points. To investigate the associations, we performed multiple logistic regression analyses.

There were statistically significant associations between psychological distress and medical treatments for myocardial infarction/angina pectoris (odds ratio [OR]=1.8, 95% confidence interval [CI]=1.0-3.0) and liver disease (OR=3.1, 95% CI=1.0-7.7). The other 4 medical treatments for physical diseases had ORs of 1.3 or higher and were positively associated with psychological distress: cancer, hyperlipidemia, kidney disease, and diabetes mellitus. The degree of damage to homes did not affect the association between most of the medical treatments for physical diseases and psychological distress.

In the disaster area, most of the medical treatments for physical diseases had positive associations with psychological distress, irrespective of the degree of damage to homes. (Disaster Med Public Health Preparedness. 2015;9:374–381)