Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica最新文献

Robert P. Liberman introduced "Personal Support Specialists" as a role of psychiatrists who support patients' lives and help them discover the meaning of life, as well as helping with daily activities and personal difficulties. They need to have multiple perspectives on medical, subjective, social, and life recoveries. Important areas to help patients practically are job-assis- tance, supporting love and marriage, and independent living in the community. I usually use Seikatsu-Rinsho (The way of Living Learning), cognitive behavioral therapy, and Seikatsu-ryouhou (Life-centered Therapy) by Hiroshi Utena as basic principles in my practice. Recently, I shed light on an -individual value system to evolve these principles. Reflecting on two recovery stories I co-encountered, contents of psychiatric interviews and roles of psychiatrists are discussed. There remain many difficulties which modern psychiatry has not resolved, such as negative symptoms and marked disabilities in social life. We as psy- chiatrists should know how to evolve and maintain hope and intrinsic motivation to support a patient's life.

Good coordination between the principal doctor and companies will benefit workers with mental health disorders, and for that reason a common understanding is required. Companies seeks to preserve a workers' health from the viewpoint of obligation of security, while "caseness", being the trouble in the companies, is undesirable from the viewpoint of risk management. The principal doctor needs to understand that the companies reaction sets the caseness above the illness. There are various national guidelines and forms of guidance for workers' mental health."Guidelines for the Promotion of Workers' Mental Health at Work"was indicated in 2000 for the development of an organizational framework, and the "Manual on Workplace Reentry Support for Workers Returning from Leave Due to Mental Health Issues" was indicated in 2004. "Certification Criteria for Mental Disorders Caused by Psychological Stress" was also indicated in 2011 and, in which, harassment was recognized as an injury of workers. In many cases, companies consider employees with mental health disorders with these guidelines and guidance in mind to avoid lawsuits, and principal doctors are similarly expected to share a common understanding, promoting favorable coordination.

There are twelve dementia-related disease medical centers including psychiatric hospitals in the Tokyo Metropolitan Area. Few psychiatric hospitals or long-term care hospitals exist in our area (Bunkyo, Chiyoda, Taito, Minato, and Chuo wards) and we receive requests for hospital transfer of demented patients. Since the Tokyo Metropolitan Government estimates that the numbers of aged persons will increase rapidly, a project for detecting and diagnosing early-stage dementias, the 'outreach project', has started. We visit people who show some cognitive symptoms and evaluate their cognitive functions and mental and physical status. Then, we support them to undergo medical examinations or receive appropriate care if needed. Most of the people we visited were women living alone who did not receive any care. Several cases were detected as early-stage dementia based on our evaluations. On the other hand, there were some cases suggested to be psychiatric diseases, such as schizophrenia, with people showing some social or behavioral problems. Psychiatrists hope to attentively work for dementia patients with co-medicals in local areas.

The symptomatic drugs used for the treatment of Alzheimer disease (AD) are considered to exert their effect by suppressing the progression of dementia symptoms. Although clinical trials conducted on the drugs in Japan have revealed statistically significant differences in assessments of change in cognitive function, three of the four drugs have not shown any statis- tically significant differences in the clinician's global impression. There are many overseas reports indicating the efficacy of these drugs, whereas many other reports also indicate that the assessment procedures themselves are difficult and have many limitations. In order to determine the efficacy of the drugs in clinical practice, physicians need to determine whether the progression of dementia symptoms is inhibited. However, AD symptoms vary and are affected by the patient's living environment, personal relationships, and other factors. Although there are certain trends in the time of symptom onset according to disease stages, the symptoms progress by the year and greatly vary among patients. Comparison of progression rates to the average rate is a primary requirement for measurement of the drugs' inhibitory effects on progression. However, because progression rates greatly vary among patients, it is difficult to determine the average rate. In principle, drug therapy should be discontinued if it is not effective. However, because it is difficult to determine whether the drugs are effective, they are likely to be unnecessarily prescribed even when there is a lack of efficacy. The typical adverse effects of cholinesterase inhibitors (ChEIs) include gastrointestinal, neuropsychiatric, extrapyramidal, and cardiovascular symptoms. Transdermal patch formulations of ChEIs may cause pruritus. N-methyl-D-aspartic acid receptor antagonists may also cause various adverse effects. Patients with AD often have impaired ability to recognize psychosomatic changes and to inform people around them of the changes. Thus, detection of adverse effects is likely to be delayed. If the somatic symptoms caused by adverse effects appear as a lack of animation or irritation, the changes due to adverse effects will be likely misunderstood as symptoms caused by progression of AD, behavioral and psychological symptoms. Since the four symptomatic drugs became available, there have been more opportunities to discuss how the use of the drugs can be differentiated. However, the need for using these drugs should be reevaluated before differentiation of their use.

We conducted a study on "anger" seen in obsessive-compulsive disorder (OCD). Subjects were 40 men and women (age range: 20-58 years) admitted to the Jikei University Center for Morita Therapy who had been diagnosed with OCD (DSM-IV-TR) and undergone inpatient Morita therapy. The Japanese version of the Structured Clinical Interview for DSM-IV (SCID) (DSM-IV Axis I and Axis II diagnoses), the Yale-Brown Obsessive Compulsive Scale (Y- BOCS) (changes in OCD severity), the State-Trait Anger Expression Inventory (STAXI-2) using "anger" as the indicator, and the State-Trait Anxiety Inventory (STAI) using "anxiety" as the indicator were used, and the data were subjected to statistical analysis. Improvements were seen in the Y-BOCS for all of the following : total score, obsessional idea, compulsive act, insight, and avoidance. These results indicate that inpatient Morita ther- apy improves OCD. In the STAI, improvements were seen for both state anxiety and trait anxiety. Improvement of trait anxiety may be considered an indicator of the cultivation of a hypochondriacal temperament. In the STAXI-2, improvements were seen for anger reaction and anger expression-in, which are both aspects of the obsessive-compulsive style (Salzman, L.). Improvements in these items therefore indicate that inpatient Morita therapy improves aspects of the obsessive-compulsive style. A correlation with the degree of OCD improvement was observed for the insight level. Poor insight was a factor associated with poor outcomes of inpatient Morita therapy. Furthermore, two cases were presented, and the actual condition of treatment for OCD and "anger" in inpatient Morita therapy was elucidated.

Social anxiety disorder (SAD ; also known as social phobia) is a prevalent disorder with an onset mostly in childhood or adolescence. Furthermore, SAD was found to be a predictor of the subsequent development of depressive disorder. There is a possibility that early interven- tion for SAD may prevent the subsequent development of depressive disorder. SSRI treatment may benefit patients with primary SAD and comorbid depressive disorder. Moreover, it is important to pay attention to depressive symptoms showing atypical features or bipolarity. Clearly, much more work is needed to establish the treatment of patients with SAD who fail to respond to SSRI.

I have previously published a paper in this journal that described my mother's schizo- phrenia, how I became a patient and the process by which I subsequently became a psychia- trist. After that paper, I began to think that my mother made a strong recovery. I no longer see my mother as an 'unfortunate person'. This change in perspective has also altered my values and internal strength, and I have begun to see the course of my own recovery. It is directed toward my 'recovery as a psychia- trist' ; it involves my contribution to psychiatric care and the social activities that I can par- ticipate in as a patient's family member and as a patient myself. For one of these activities, I administered a questionnaire survey directed toward patients and their family members throughout the country on 'psychiatrists' communication abilities' in June 2015. This survey is based on my frustrating experience of being unable to speak hon- estly with my attending physician when my mother and I were receiving psychiatric care. From my own experiences, I realised that recovery represents subjective improvement. Being subjective, it changes throughout life ; therefore, it is not something that can be defi- nitely ended, as in 'recovered'. I feel that recovery is similar to constantly 'climbing up a hill'. Sometimes, encounters and events in life may make us feel that we have fallen down. Dur- ing such times, we need people who can support us to climb 'the hill of recovery'. I believe that a psychiatric specialist is an important person who supports 'recovery according to the patient' by the side of the hill, firmly grounded in medical knowledge but also based on a sub- jective viewpoint of the patient and his/her family. In my description of these changes, I hope that this article can depict how I am climbing the hill to'recovery as a psychiatrist' and serve as a reference for the readers' clinical practice.

Major depressive disorder is a debilitating disease that imposes significant social and eco- nomic burdens due to its 10% life-time prevalence and 15% association with suicide, and so urgent measures are needed. However, not all individuals benefit from antidepressant treat- ment, and some patients poorly respond or develop side effects. It would be helpful to identify a biomarker that could indicate the best therapeutic tool that is likely to be effective and toler- able for each patient In this context, a marked effort has been directed toward the search for genetic predictors of drug efficacy in mood disorders over the last few years. However, the present evidence from pharmacogenomic studies does not match those expectations. So, how far is "personalized medicine" for depression from clinical use? It is important to translate the results of such pharmacogenomic studies to better treatment in clinical practice. Here, I pro- vide an overview of pharmacogenomic research results with both a genome-wide approach and candidate approach, and suggest possible ways to apply pharmacogenomic results in clini- cal settings.

On June 18, 2012, a project team for dementia care in the Ministry of Health, Labour and Welfare released a report on future approaches in medical care for dementia. Based on this report, the "5-year plan for promoting dementia measures ("Orange Plan")" was published on September 5. At the beginning of the report, they present an ideal society where patients can continue to live in the community after being diagnosed with dementia. I think this direction exactly shows "the Community-based Integrated Care". For this, the role of psychiatric clinics in the health care of people with dementia is to help avoid admission to psychiatric hospitals. Therefore, as psychiatrists, we must provide a diagnosis of dementia, drug therapy, and non-drug therapy for BPSD. Furthermore, in my clinic, I provide body management and the treatment of physical complications. Also, interprofessional work is essential for these things to be done effectively.