Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica最新文献

In Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Gender dysphoria (GD) is defined as a marked incongruence between one's experienced/expressed gender and assigned gender. Clinical pictures of GD in children show marked diversity. Because of their limited ability to express themselves verbally, children with GD might not be able to describe their discomfort or distress about this incongruence. In contrast to GD in adulthood, GD in children could be alleviated in the natural course. Thus, the clinical diagnosis of GD in children should be made carefully. Distortion of gender identity is equal to prominent confusion of identity, and has a huge psychological burden on children with GD. In addition to the distress due to dysphoria about gender, children with GD could suffer from bullying at school, loneliness among school peers or even in their family, and feelings of disgust about their physical appearance that could cause decreased self-esteem and a sense of worthlessness. In 2015, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) in Japan encouraged all school teachers to provide appropriate support at school to sexual minor- ity students, including students with GD. Furthermore, MEXT published a manual for school teachers to promote necessary interventions for such students at school. There are several papers reporting child cases of GD and comorbid psychiatric disorders. Among them, autism spectrum disorder (ASD) is one of the common comorbidities. Reflecting these conditions, recent review articles discuss possible associations between GD and ASD. In this paper, based on the first author's clinical experience, we describe the clinical symp- toms and diagnosis of GD in children, the relationship between GD and ASD, gender-related manifestations observed in ASD, and practical support for children with GD entering primary school.

In this thesis, the historic circumstancs of enactment of and the forthcoming issues related to "the Certified Public Psychologists Act" are reported."The Certified Public Psychologists Act" was established thanks to the united efforts of a great number of the persons concerned, and the Act is scheduled to take effect in September 2017."The Certified Public Psychologist" is an occupational register: it is a qualification without which a person is allowed to deliver relevant services, but not permitted to feign a "Certified Public Psychologist". And since the Certified Public Psychologist is a general qualification, psychologists with the qualification are allowed to work in various fields such as educational area, medical/clinical area, forensic/criminal area, and industrial/occupational area. Mental problems in the modern society arise, in many cases, from various multidimensional factors which are intertwined and mutually related. Psychologists, in offering professional support in actual settings, need to be aware of their accountability that theories and skills are right for the supports. In addition, a sense of balance is required in collaboration, or team approach. It is emphasized that enhancing the systems for training and education is an urgent issue because continuous exertion to improve the compre- hensive capacity as professionals for future is indispensable.

Our study mainly focused on summarizing the history and issues of the Sports for People with Mental Health Problems in Japan. Since it had been shifted from inpatients activity to a community based sport activity, it was the matter of great urgency for us to expand and rein- force its organizational foundation. The first competition of volleyball for people with mental health problems was held on 2001, and since 2008 the Sports for People with Mental Health Problems was officially admitted to participate in the National Sports Festival for People with an Impairment. The basic principal required protecting participants' privacy at the same level of other disabilities. We needed clearly define the qualification for participants, such as restricting participants only with disability certification issued by Japan Federation for Mental Health and Welfare. Furthermore, the first International Symposium/Meeting on Sport for People with Mental Health Problems was held in Tokyo in 2013, and the first international sports competi- tion for people with mental health problems was held in Japan, which was a milestone for the internationalization of World sport championship for people with mental health problems. For the upcoming the Japan Olympic and Paralympic in 2020, we recognize the public interests for sports for people with mental health problems. It is the great opportunity for us to trigger to popularize it. Since the activities with all three types of disability will grow not only in sports but also in other fields, it is very important to bring information together.

The legally defined certified psychologist is going to enter into the medical care system in 2019. In Germany, where the medical insurance is obligatory like in Japan, the authorized psy- chological psychologists are already functioning. There are similarities and differences between these psychological practitioners. German psychological psychologists are permitted both to have their own practices and to work in hospitals. Patients are allowed to visit them directly to be treated if they wish. The psychological psychologists are also authorized to claim medical treatment fee on medical insurance. The amount of their medical treatment fee is so much as that of psychiatric specialists on the whole. They are neither permitted to prescribe medicines nor to issue a medical certificate. They must ask them to a medical doctor. Like German's, neither prescription nor issue of a medical certificate are included in the authority of Japanese certified psychologists. They are not permitted to have a practice. It seems to be reasonable that every doctor can give them orders of psychotherapeutic treat- ments, as mentally sick patients are increasing in every field of clinical medicine. However it may probably be only psychiatrists who can understand and evaluate their profession appro- priately, therefore it would be suitable that psychiatrists participate somewhere in this order- ing and evaluating system. The medical treatment fee should be paid enough to the certified psychologists.

In 2010, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) in Japan strongly recommended that students with gender identity disorder (GID) who had behavioral health concerns should consult a professional in their schools. Furthermore, in 2015, MEXT subsequently announced that it is important for sexual minority students, including students with GID, to receive more support from professionals through cooperation with medical institutions. However, there has been no nationwide clinical research done on sexual minority youth, so little is known about how to optimally care for them in medical practice. This study assessed the current status of medical care for children and adolescents with GID and other atypical sexual development. The authors surveyed certifying physicians and councilors (315 people in total) of The Japanese Society for Child and Adolescent Psychiatry. The question obtained basic demographic and practice information and allowed for free responses on topics such as opinion on consultation and medical care for GID and atypical sex- ual development in childhood and adolescence. One hundred twenty-seven, or 40.3%, of those surveyed responded. The average number of years of total clinical experience was 23.9, and the average number of years of child psychiatric clinical experience was 18.8 years. The number of child psychiatrists who provided con- sultation for GID and other sexual development including transvestism and gender dysphoria were 88 (68.5%) and 105 (81.9%), respectively. The consultants' most frequent clients, in descending order, were: individuals, parents, and school officials. Seventy-four (57.5%) child psychiatrists provide medical care for patients with GID. In the preschool and elementary school age groups, consultants served many more (assignment) males than (assignment) females with GID, whereas in the higher elementary school and later ages, consultants served more females than males with GID equally often. In junior high school and later ages, consultants served more females than males with GID. Eighty-seven (67.7%) of the child psychiatrists provided medical care for patients with other sexual development. Before and during the mid- dle elementary school ages and in the high school ages, consultants served more males than females with other typical development, whereas in higher grade elementary and junior high school ages, consultants served more females than males with other typical development. The free response sections revealed a diversity of opinions, clinical course, and cooperation with other institutions. At present, among child psychiatrists, there are many different perspectives on clinical care for GID and other sexual development. Therefore, it will be necessary to systematically examine current scientific evidence and to establish consensus on best practices for clinical management.

Minds (Medical Information Network Distribution Service) is an information service provided by the Japan Council for Quality Health Care (JCQHC), a public interest incorporated foundation. The Minds guide for developing clinical practice guidelines was published in 2014. The aim of the Minds project is to help medical practitioners fully utilize information related to evidence-based medicine (EBM) in their practice. Minds also provides patients and the public with information to help understand the basics of diseases and share up-to-date evi- dence with doctors, on which modern medical practices are based. Overall, clinical practice guidelines are made up as follows : 1) a three-layered structure of guideline committees con- sisting of a managing committee, guideline creation team, and a systematic review team, 2) a clear description of the basis for an individual's judgment and COI, 3) evaluation of the body of evidence summarized for every outcome and study design in all selected research reports for each Clinical Question (CQ), and 4) not only the "benefit" but also the "harm" in the patient outcome caused by intervention are to be included in the evaluation. According to the Minds method, the Japanese Society of Neuropsychopharmacology has created a "Guidelines for Pharmacological Therapy of Schizophrenia." These guidelines were introduced to explain the characteristics of the Minds method in this paper. The Effectiveness of GUIdelines for Dissemination and Education in psychiatric treatment project (EGUIDE proj- ect) was also introduced to disseminate and evaluate these guidelines.

The certified psychologist is a cross-disciplinary profession ; thus, the qualification test and curriculum should cover not only medical but also non-medical areas. The number of men- tal health professionals working in medical areas is high. Knowledge and skills in the health care area are necessary for certified psychologists and candidates. Knowledge covers laws and systems of medical services, including medical safety and infection control, and medical knowledge at the non-professional/patient level. In the general medical area, skills of: 1) having multilevel perspectives, 2) understanding dynamics and collaborating, and 3) facilitating com- munication with difficulties, are necessary. When going down the clinical river, holding an OAR [Open, Available, Responsible] is significant, not only for those who working in the medical area but for everyone, because every certified psychologist is obligated to cooperate.

It is considered that professionalism is a virtue as a personal attribute, competency is an observable behavior, and professional identity formation is a form of socialization. Social accountability is believed to be an important attribute of medical professionalism. A true professional struggles with complicated and/or ambiguous clinical problems of our modern society, and he/she grows up in the course of managing such difficult cases with iterative reflection. A reflective practitioner is someone who can practice in such a way. A reflective practitioner dealing with social problems is a true professional. Significant Event Analysis (SEA) is one of most valuable learning strategies to become a reflective practitioner.

22q11.2 deletion syndrome (22q11.2 DS) is characterized by cardiac defects, abnormal facial features, thymic hypoplasia, cleft palate, and hypocalcemia, including DiGeorge syndrome (DGS), velocardiofacial syndrome (VCFS), and conotruncal anomaly face (CTAF) syndrome. Psychiatric symptoms were recently shown to be very common in patients with 22q11.2 DS, prompting greater interest in this syndrome. Early diagnosis during childhood based on a con- stellation of physical features is optimal ; however, as some patients remain undiagnosed until the presentation of other symptoms in adult life, psychiatrists are well advised to familiarize themselves with basic information concerning 22q11.2 DS. A 25-year-old woman presenting with auditory hallucinations was referred to A hospital for examination and treatment. Her family history revealed both paternal and maternal rela- tives with schizophrenia. At birth, she presented a cleft palate and ventricular septum defect. She first became ambulatory at age 4 and became verbal a year later. Her intelligence quotient was estimated at around 40 and mental retardation (DSM-IV) with autistic features was diag- nosed at age 7. After graduating from a special high school, she obtained fulltime employment in a workshop. However, auditory hallucinations began disrupting her life from 22 years of age. Although olanzapine temporarily alleviated her symptoms, the resultant extrapyramidal symp- toms worsened and she was referred to A hospital again at age 25. The patient presented with micrognathia and a flat nasal root and spoke a maximum of 3 words per sentence in a very high and indistinct tone. A cardiac defect (ventricular septal defect), scoliosis, and low platelets were also observed. The diagnosis of 22qll.2 DS was confirmed using fluorescence in situ hybridization (FISH). The patient and her family were subsequently introduced to a 22q11.2 DS patients' support group. Careful genetic counseling is paramount, but the diagnosis of 22q11.2 DS can make updated information, official aid, and access to support groups available to patients and their family. Emergency complications such as seizures due to hypocalcemia can also be anticipated. The comparatively late diagnosis of 22q11.2 DS in our patient, which went undetected until the presentation of auditory hallucinations, in the context of mental retardation with autis- tic features (DSM-IV) underscores the importance of detailed clinical observation. "One rare variant" possibly points out the essence of psychiatric pathophysiology. Moreover, 22q11.2 DS has been listed as an intractable disease in Japan since 2015. When patients present with neurodevelopmental disorders and schizophrenic symptoms, we should carefully observe their physical features for clues to the possible diagnosis of 22q11.2 DS.