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186Shinpuku et al. reported that many victims were found to be talkative and cheerful and that depressive patients developed manic conditions after the Great Hanshin-Awaji Earthquake10. This phenomenon of symptomatic exacerbation in bipolar patients after catastrophic disasters has been reported overseas1, and attention should be paid to worsening symptoms, even if the patient has been stable for years. Furthermore, if there is even a slight deterioration of symptoms, patients may benefit from early-stage treatment, such as mood stabilizers, or admission. 2) The fear of radiation exposure as a possible cause of psychiatric admissionOf the patients who were admitted during the study period, the number of patients whose admissions were associated with the fear of radiation exposure was 74 (12.1%), and those whose admission was possibly associated with the fear of radiation exposure was 75 (12.3%), which accounted for 24.4% of total admissions. In this case, whether the fear of radiation was a cause for deterioration in clinical status leading to admission was subjectively evaluated by the doctor in charge. Thus, the analysis of this phenomenon lacked objectivity, which should be taken into account when drawing a conclusion.The radiation dose rate in Fukushima Prefecture largely varies depending by each area. As shown in Figure 4, the ratio of patients whose admissions were associated with the fear of radiation exposure was higher in Soso and Iwaki. However, the areas with high radiation dose rates are not Iwaki, but rather Fukushima City, Nihonmatsu, Kenpoku (Northern Fukushima) including Koriyama, and Kenchu (Central Fukushima). Thus, the degree of fear of radiation exposure may not be correlated with actual radiation dose rates.In comparison to the trend of all admitted patients, the most common condition of patients whose admissions were associated with the fear of radiation exposure was hallucinations or delusions (37.8%), while depression (10.8%) was the least. The most common diagnosis of patients whose admissions were associated with the fear of radiation exposure was schizophrenia spectrum (48.6%). The fear of radiation exposure may have acted as an exacerbating factor for various disorders, particularly schizophrenia spectrum. A repercussion of a nuclear disaster is the continuous exposure to vague but strong stresses due to the lack of information and uncertain outcomes. The so-called “radiophobia” (radiation phobia) was first recognized around 1950 in relation to the atomic bombings in Hiroshima and Nagasaki9, and became more widely known after the Chernobyl nuclear disaster8. Some patients whose admissions were associated with the fear of radiation exposure may have developed a condition of radiophobia. However, over-diagnosing radiophobia should be carefully avoided as it may distort the reality of the effects of radiation exposure.It was suspected that those with schizophrenia spectrum or who were vulnerable to stress, a negative factor inducing schizophrenia, developed excessive fear toward the health hazards of radiation exposure. This places them under continuous stress leading to the exacerbation of symptoms. Further follow-up study is required to investigate the degree of association of the fear of radiation exposure with patient admission. 5. ConclusionThis study discussed the status of new psychiatric admissions after the Fukushima nuclear accident. It showed that compared with admissions under normal circumstances, there were higher numbers of admissions in a manic state and admissions associated with the fear of radiation exposure. Despite various methodological limitations, this data serves as an important foundation for future follow-up studies. AcknowledgmentsWe greatly appreciate contributions by all doctors at Fukushima Medical University, Department of Neuropsychiatry and the hospitals registered under of the Association of Psychiatric Hospitals of Fukushima. They diligently supported our study while working hard under strenuous conditions after the earthquake. We also sincerely thank those at the Association of Psychiatric Hospitals of Fukushima, Welfare Division, Fukushima Prefecture, for their assistance in compiling this report. Reference 1) Aronson TA, Shukla S : Life events and relapse in bipolar disorder: the impact of a catastrophic event. Acta Psychiatr Scand 75 : 571-576, 19872) Bromet EJ, Havenaar JM : Psychological and per­ceived health effects of the Chernobyl disaster : a 20-year review. Health Phys 93 : 516-521, 20073) Havenaar J, Rumyantzeva G, Kasyanenko A et al : Health effects of the Chernobyl disaster ; illness or illness behavior? A comparative general heal­th survey in two former Soviet regions. Environ Heal­th Perspect 105(Suppl 6) : 1533-1537, 19974) Kario K, Matsuo T, Ishida T et al : “White coat” hypertension and the Hanshin-Awaji earthquake. Lancet 345 : 1365, 19955) Kario K, Matsuo T, Shimada K : Follow-up of white-coat hypertension in the Hanshin-Awaji earthquake. Lancet 347 : 626-627, 19966) Loganovsky KN, Loganovskaja TK : Schizophrenia Lessons from Fukushima: Psychiatric Care after Radiation Exposure

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