Comparative Empirical Analysis of Challenging Inpatients under the Medical Treatment and Supervision Act and the Mental Health and Welfare Act

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  • SAITOH Katsuhito
    Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital
  • SASAYAMA Daimei
    Department of Psychiatry, Shinshu University School of Medicine
  • YOSHIZAWA Tomonari
    Department of Psychiatry, Suwa Red Cross Hospital
  • SUZUKI Mio
    Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital
  • MURASUGI Kenji
    Department of Psychiatry, National Hospital Organization, Komoro Kogen Hospital
  • WASHIZUKA Shinsuke
    Department of Psychiatry, Shinshu University School of Medicine

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Background : Psychotic symptoms leading to self-harm and harm to others are a critical concern in treatment. This study aimed to investigate the characteristics and treatment methods of difficult-to-treat patients under the Medical Treatment and Supervision Act (MTSA) and long-term involuntary inpatients under the Mental Health and Welfare Act and assess the impact of the MTSA on psychiatric treatment.<br>Methods : Data were collected from 233 inpatients (179 men and 44 women) under the MTSA and 65 inpatients (58 men and 7 women) who were involuntarily hospitalized for >18 months due to the risk of self-harm or harm to others under the Mental Health and Welfare Act. We compared basic demographics and pharmacotherapy between the 102 inpatients under the MTSA and 53 inpatients under the Mental Health and Welfare Acts with psychotic disorders.<br>Results : Difficult-to-treat cases under the MTSA included 82 grievous bodily harm cases (35％), 80 murder cases (34％), 48 arson cases (21％), and cases of other offenses. Psychotic disorders were the most frequent primary diagnosis (85％), and comorbid psychiatric disorders were present in 68 cases (25.8％). In contrast, long-term hospitalizations under the Mental Health and Welfare Act were predominantly due to schizophrenia (80％). Comparative analysis of pharmacotherapy revealed higher usage of clozapine in the MTSA group and antipsychotic and anti-parkinsonian medications in the Mental Health and Welfare Act group.<br>Conclusion : These findings suggest that the MTSA encourages a reduction in the use of multiple antipsychotics and the adoption of clozapine in treatment regimens.

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