Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica最新文献

As a part of the medical assistance project for Okinawa, where the land and their people were devastated by the Pacific War, the Japanese Government launched a program to dispatch medical doctors. The dispatch of psychiatrists started in 1964, and lasted for 13 years. During this period, a total of 83 doctors joined this project. Their term was 3-6 months. To promote the smooth implementation of this program, the Japanese Society of Psychia- try and Neurology (JSPN) established the Committee of Mental Health Care for Okinawa (CMHCO) and supported their activities. This support included : 1) supporting medical care in hospitals/counseling in public health centers, 2) activities for promoting mental health/com- munity-based psychiatric treatment, 3) guidance and advice for local medical workers, and 4) sharing opinions with Ryukyu and Japanese governments. The CMCHO's activities contributed to improve the mental health care condition in Oki- nawa. Now, the qualities of facilities and human resources are above the national average. Rates of the isolation and restraint of inpatients, which indicate the quality of care, are low. The CMCHO's activities have written a significant page in the history of JSPN as well as Oki- nawa's mental health care.

This paper reviews part of an educational lecture at the 111th Annual Meeting of the Jap- anese Society of Psychiatry and Neurology (JSPN), under the identical title by the author. First, current victim support and treatment for victims at psychiatric services in Japan are reviewed. Second, introducing a case report of a rape victim diagnosed as PTSD, comments are made on symptoms, such as avoidance and emotional numbing as part of dissociation. It is common for clinicians, even for patients themselves, to fail to notice these symptoms. How to detect and treat these covert symptoms appropriately are discussed.

According to the nationwide survey of the National University students in Japan, the annual suicide rate in 2012 was 15.7 per 100,000 undergraduate students. In many universities, suicide prevention is an important issue regarding mental health measures, and each university is actively examining this. The current situation concerning measures for suicide prevention in the Japanese National Universities was investigated in 2009. In 2010, the "college student's suicide prevention measures guideline, 2010" was established based on the results of this investigation. This guideline refers to the basic philosophy of suicide prevention in Chapter 1, risk factors for suicide in Chapter 2, and systems and activities for suicide prevention in Chapter 3. The Health Service Center, Okayama University plays central roles in mental health and suicide prevention measures on the Medical Campus. The primary prevention includes a mini-lecture on mental health, classes on mental health, and periodic workshops and lectures for freshmen. The secondary prevention includes interviews with students with mental health disorders by a psychiatrist during periodic health check-ups and introducing them to a hospital outside the university. The tertiary prevention includes support for students taking a leave of absence to return to school, periodic consultation with such students with mental disorders, and postvention following a suicide. We believe that for mental health measures on the university campus, it is important to efficiently make use of limited resources, and that these efforts will eventually lead to suicide prevention.

As one of the treatments for developmental disorders, psychosocial treatment has attracted attention. Because of the advances in support for children and adults with develop- mental disorders in terms of health, education, and welfare, comprehensive and long-term treatment may have become demanded along with medical treatment, called the spread of medication therapy for ADHD. I introduced our investigation with the child psychiatric practice organization after having spoken about the trend in support for developmental disorders in Japan in this report. Next, parent training (PT) and social skills training (SST), recommended by both domestic and foreign diagnosis treatment guidelines, gave an outline and particularly emphasized the need for a basic platform of PT. Furthermore, I suggested the aim of psychosocial treatment after having given examples of environmental adjustment at home, at school, and in the workplace.

Both biological and psychological interventions are important in the treatment of Alzheimer's disease(AD). Although there is no curative therapy for AD, current interventions that focus mainly on their cognitive functions are neither sufficient nor effective. More atten- tion should be paid to their self-efficacy in daily life. When people develop AD, they will lose their self-respect and social role or relationships. The aim of the treatment for AD is simply to regain these, which will not be successful unless their daily lives become the target of sharp focus. Behavioral and psychological symptoms of dementia (BPSD) are also strongly associated with patients'daily life rather than with their cognitive function. Upon medical examinations, psychiatrists should not only listen to patients' caregivers, but also provide psychotherapy for the AD patients themselves, despite their being cognitively more or less impaired. Psychiatrists have to inform caregivers about the loneliness AD patients feel and the importance of respecting their feelings. Regarding pharmacotherapy, discussion concerning the best for each patient's condition among the four kinds of current anti-dementia drugs would not be useful, as each patient's condition, inclusive of BPSD, does not only depend on their neurological impairment. General function of the brain is largely normal in AD patients at early stage, therefore rarely causing BPSD. What may well cause BPSD are the patients' circumstances including social interaction between caregivers and themselves in their daily life. Thus, psychi- atrists need to keep in mind both biological and psychological factors in the treatment of AD.

In this article, I discuss the adaptation of antidementia drugs for Behavioral and Psycho- logical Symptoms of Dementia (BPSD). During the last few years, a large body of evidence has been accumulated to support the use of antidementia medication for BPSD in both Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) patients. On the selection of antidemen- tia drugs for BPSD, the following 3 factors should be considered : 1) the type of dementia the patients have (AD or DLB), 2) the type of drugs to be selected (cholinesterase inhibitors or memantine), and 3) the type of BPSD to be treated (such as delusions, hallucinations, agitation, and apathy). Cholinesterase inhibitors should be used for the treatment of people with DLB, especially BPSD. On the other hand, in AD patients with severe BPSD such as agitation and hallucinations, memantine should be initially considered. Pharmacological treatment of wander- ing and disinhibition in patients with dementia remains a challenge. As BPSD can cause marked distress for both the patient and caregiver, clinicians are required to treat the symptoms effectively. The consensus statement focuses on the fact that pharmacotherapy and psychological interventions can be effective both for cognitive dysfunc- tion and BPSD. Total care for BPSD involves the combination of pharmacotherapy with a non- pharmacological approach.

Major depressive disorder (MDD) has consistently been regarded as the most frequently diagnosed comorbid disorder in patients with obsessive-compulsive disorder (OCD). More than half of OCD patients have the lifetime comorbidity of MDD, which is more likely to develop after the onset of OCD. MDD may occur in response to the chronic distress and functional impairments associated with OCD, resulting in either a negative impact on the quality of life of these patients or poor responses to treatments and unfavorable prognoses. However, obses- sions, particularly aggressive obsessions, and excessive anxiety have been identified as contrib- uting factors to the occurrence of comorbid MDD, which may support the possible role of an altered relationship between the orbitofrontal cortex and amygdala/parahippocampal region in the development of lifetime MDD in OCD patients. Thus, based on the heterogeneity of OCD, the cognitive (typical) type of OCD, which is characterized by the presence of obsessions or cognitive processes resulting in provoked anxiety and compulsions, is more likely to develop comorbid MDD than the motoric type of OCD that accompanies compulsions to alleviate tension related to sensory phenomena such as feelings of incompleteness and urges to reach a specific sensation of feeling "just right". Even though comorbid MDD does not markedly impact on the phenomenological or psychopathological features of OCD, bidirectional interactions between these disorders need to be considered in order to establish adequate treatment strategies for such OCD patients. Pre- ceding pharmacotherapies such as SSRI are indispensable in these treatments because of the possible refractoriness associated with such a concurrently depressive condition to CBT. Fur- thermore, SSRI augmentations with antidepressants that enhance noradrenergic function may sometimes be effective in the treatment of OCD with comorbid MDD. The influences of environmental factors and/or personality pathology need to be evaluated in order to assess the addition of further treatment options such as environmental manipulations, family-focused interventions, cognitive therapies, or interpersonal psychotherapy, especially for OCD patients with treatment-refractory MDD.

Human disease structure has constantly changed in close association with the times and society. Nowadays, there are so many"brain and mind problems"against a background of social issues. In developed countries including Japan, mental illnesses have seriously affected the lives and health of patients and their families. It is historically clear that stigma towards mental ill- nesses and a fragile mental health service have led to the existing situation. Therefore, to achieve the development of psychiatry in the future, we need to ruminate over the possibility of prevention, early intervention, and treatment and recovery to reduce stigma towards mental illnesses while regarding them as brain diseases. Based on the point of view that cognitive impairment could largely influence social functioning, and by introducing schizophrenia as a representative cognitive illness, we would like to discuss the remaining problems and future directions of psychiatry.

Medical specialists certified by the Japanese Medical Specialty Board are defined as medi- cal doctors who have been appropriately and extensively trained, provide standard medical care, and are trusted by patients, responding to citizens' needs to receive standard and safe treatment. In accordance with this definition, a committee of the Japanese Society of Psychiatry and Neurology has discussed the criteria for renewal since late 2014 so that the new criteria will not be markedly different from the previous ones. The major changes include the following: 1) adoption of the credit-based system in place of the point-based system, 2) making part of the courses mandatory, and 3) requiring five instead of two clinical reports as proof of clinical practice. The credits needed to renew certification as a Japanese Board-Certified Psychiatrist are calculated based on proof of clinical practice, across-specialty courses, psychiatry-specific courses, academic achievements, and activities other than clinical practice. In total, 50 credits in 5 years are required to renew the certification. In the case of exceptional circumstances where renewal in a timely manner is not possible (e.g., studying abroad for research, taking sick leave, taking maternity leave, caring for a fam- ily member, etc.), there are two options to choose from: one is to declare a state of suspension, whereby one's certification is temporarily unused, and the other is to use substitutional means, such as using self-learning in place of clinical practice. The committee intends to adopt measures as effectively as possible in order to avoid con- fusion regarding the new criteria among psychiatrists about to renew their certification, and also to minimize the discrepancy between the renewal process for the Board-Certified Psychi- atrists as stipulated by the Japanese Society of Psychiatry and Neurology and the require- ments for Medical Specialists.

This article was adapted from the presentation of a debate session at the 111th annual meeting of the Japanese Society of Psychiatry and Neurology. It addresses the pros and cons of long-acting injectable antipsychotics (LAI), and the author of this article suppored the use of LAIs on the basis of their efficacy. Based on randomized controlled trials (RCTs), LAIs were similar to oral antipsychotics in terms of relapse prevention. However, in the RCTs, selection bias and alterations in treatment ecology have to be taken into consideration, in that patients in the RCTs are more likely to be adherent. For example, various treatment experiences in RCTs, such as reminders, assessments, and/or incentives, could have improved patients' adher- ence. In contrast, mirror image studies, which compare the equivalent duration before and after the initiation of a new treatment, may reflect the effectiveness of LAIs in real-world clini- cal settings. In mirror image studies, the hospitalization risk and rate significantly decreased after the introduction of LAIs. LAIs as a treatment option should be discussed with patients, especially those who have adherence problems and/or who prefer LAIs.