Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica最新文献

The concept of traumatic grief was once maintained by Prigerson in the late 1990s to be soon replaced by various concepts such as persistent grief or complicated grief, to cause a con- fusion of diagnostic criteria, the common element across those concepts being the psychological disturbance caused by the loss of a beloved one. Most contemporary psychotherapy for compli- cated grief put an emphasis upon the cognitive restructure of the meaning of the loss reflect- ing the prevailing understanding that the basis of the pathogenesis of the disorder is the loss of attachment and that the intrusion symptom is actually the yearning for the deceased. In those cases, however, where the loss of attachment is complicated by the comorbid symptoms of PTSD, caused by the death due to accident or murder, contradictory psychological processes are generated by the desire to forget the traumatic nature of the event but to maintain the vivid image of the deceased. The trauma-focused treatment is often necessary for those cases and the concept of traumatic grief, grief caused by trauma, would be clinically beneficial and should be further verified through clinical practice and research.

The Psychiatric Board System under the Japanese Society of Psychiatry and Neurology was started in 2004. Over the last 10 years, psychiatrists who had worked in the field of psy- chiatry and were recognized as having the necessary training took the board examination, and 10,498 psychiatrists acquired the Psychiatric Specialty Board certification. On the other hand, new psychiatrists who trained according to a special curriculum for more than 3 years took the board examination, and 762 psychiatrists obtained certification through the Psychiatric Specialty Board. According to principle of this system, the Psychiatric Board System should resolve several issues, such as the kind of training facility, issues with medical teaching staff and training pro- grams, the examination system, and the renewal system. An outline of the New Board System under the Japanese Medical Specialty Board is pro- vided, and this system is expected to improve the Psychiatric Board System and may promote the quality of psychiatrists.

The Japanese Medical Specialty Board is now reforming the medical specialist system. This article describes the requirements of training facilities, comprising one of the biggest modifications to the current medical specialty standard. The new medical specialty standard which the Japanese Medical Specialty Board is aiming to create has been designed based on psychiatric characteristics while considering other specialty fields. The major distinction from the old specialist system is that training is not completed at only one institution but at several, with the main training facility and some partner facilities making up a group. The new medical specialty standard is described in the text, which the Japanese Society of Neurology and Psy- chiatry (JSPN) medical specialty training facility committee drew up, and it has already been approved by the Japanese Medical Specialty Board. There are seven conditions a main training facility is expected to fulfill and three conditions for a partner training facility to meet the stan- dards. This paper introduces new requirements of training facilities and groups of training facilities for the new standards. Details on the new medical specialty standard are being posted on the JSPN website, and I strongly recommend that you view the site and gain a thorough understanding of the new medical specialty standard.

The Japanese Society of Psychiatry and Neurology (JSPN) decided to establish the new board certification system in June 2015 under the guidelines proposed by the Japanese Medical Specialty Board (JMSB). After repeated consultations with the JMSB, the JSPN released the new rules and bylaws of the New Board Certification System in November 2015. The new certification system will be implemented in April 2017, in which 4-500 trainees will start the new three-year training in psychiatry under the new program. The first accredi- tation of the qualified trainees will be approved by the JMSB in 2020. From then, all fellows approved by the JSPN are expected to renew their qualification under the guidelines proposed by the JMSB. I regard designing the board certification system as one of the most important endeavors of the JSPN, and the ad hoc committee has worked toward the goal of designing a new certifica- tion system acceptable to the JMSB, which will stimulate and promote the improved training and education of psychiatrists. In this paper, I report the present situation of the new certification system as of February 2016.

(Introduction) Pneumonia is a well-known major physical complication that can occur in the course of treatment for severe psychiatric disorders and antipsychotic treatment. However, there are few reports indicating the differences between pneumonia in the field of psychiatric medicine and the more commonly encountered type of pneumonia. In the present study, we examined the specific characteristics of in-hospital pneumonia in psychiatric wards and factors influencing the aggravation of this infection. (Methods) We retrospectively analyzed 22 patients in the psychiatric ward of Jichi Medi- cal University Hospital, which also has general wards, in whom pneumonia developed during hospitalization. We extracted occurrence, outcome, and sputum culture test results as charac- teristics. Severity of pneumonia was classified using the Pneumonia Severity Index (PSI) as follows : classes I -III, minor group (MG : 15 patients) and classes IV-V, moderate to severe group (MSG: seven patients). We examined the following factors related to the aggravation of pneumonia: body mass index (BMI), length of psychiatric treatment, number of hospital admis- sions, Global Assessment of Functioning (GAF) score, dose of antipsychotics, dose of benzodi- azepines (chlorpromazine and diazepam equivalent doses), and dose of antiparkinsonian agents (biperiden equivalent dose). (Results) Aspiration occurred prior to the onset of pneumonia in one patient, and one patient required ventilator management. There were no patient deaths. Streptococcus pneu- moniae and Staphylococcus aureus were detected in five and four patients, respectively. Nei- ther methicillin-resistant Staphylococcus aureus nor Pseudomonas aeruginosa was detected. In comparison with MG patients, MSG patients had significantly lower BMI (18.3 ?2.6 vs. 21.2? 3.5), significantly higher numbers of hospital admissions (3.4?i3.3 times vs. 1.1+?L1.4 times), and a significantly higher ratio of GAF scores of 30 or less (85.7% VS 33.3%). The doses of benzo- diazepines and antiparkinsonian agents were significantly higher for MSG patients in comparison with MG patients (benzodiazepines : 2.3?2.4 mg vs. 0.4?i1.1 mg; antiparkinsonian agents: 2.3?2.4 mg vs. 0.4? 1.1 mg). No significant differences were observed in the doses of antipsy- chotics. Sputum culture tests were performed in 18 patients. (Conclusion) Outcomes were comparatively favorable and the results of bacterial culture tests tended to show no antibiotic-resistant bacteria, differing in that regard from hospital- acquired pneumonia. In fact, the characteristics of cases of pneumonia in hospitalized psychiatric patients were similar to those of community-acquired pneumonia. Low BMI, multiple psychiatric ward admissions, and GAF scores of 30 or less all reflect poor mental control. The results of the present study suggest a relationship between the severity of pneumonia and both insufficient psychiatric treatment and the use of benzodiazepines and antiparkinson

The Okinawa Psychiatric Committee, which was established as a part of the Japanese Society of Psychiatry and Neurology, has been cooperating in securing psychiatric medicine in Okinawa by sending psychiatrists to the region as well as assisting in other ways. The Committee, however, was disbanded in 1967 after its final meeting in Kanazawa. The Okinawa Psy- chiatric Committee was newly launched in 1971 to replace the previous committee, and I was appointed the Director in charge of this concern, along with Nagasaki University Professor Ryo Takahashi, who was serving as the Committee Chairperson. Since then, I have been involved with the matter of dispatching psychiatrists to Okinawa. Specifically, we began our activities by visiting Okinawa to gain a grasp of the actual sta- tus of various problems affecting dispatched psychiatrists, and to draw up future plans. We made an investigatory trip to Okinawa on December 21-27, 1971. On the main island of Oki- nawa, we visited the then Ryukyu government office, the Japanese government's local office, public and private mental hospitals, almost all public health centers, as well as the Ryukyu Mental Health Association. We also visited relevant facilities on Miyako and Ishigaki islands. Through visits such as these, we made an effort to find out on the actual status of local psychiatric medicine at the time, and the roles that the dispatched psychiatrists had played up to that point. We also worked on learning to what extent the people concerned in Okinawa were aware of the current situation, and what they hoped to gain from our Society. We tried to hold as many meetings as possible with our Society's local members as well as those who were already working as dispatched psychiatrists, and set up opportunities to exchange opinions. What became clear through our visits was that the dispatched psychiatrists were eager to go out and practice in the field, as needed, without being tied down to treating patients inside hospitals. Based on local inspections such as these, we drew up a written report that helped to resume and re-establish the system of sending psychiatrists to Okinawa. Besides playing the public role described above, I took a personal interest in the system of resident nurses, which had disappeared after the return of Okinawa to mainland Japan, as I felt, that they had played a significant role. In any event, I feel it worth mentioning that the system of sending psychiatrists to Okinawa not only helped support psychiatric medicine in Okinawa, but also became a model for volunteer activities in the wake of earthquakes that occurred later on in other areas of Japan.

The treatment of Alzheimer's disease (AD) can be roughly divided into Disease-modifying Drugs (DMD) and Symptomatic Drugs (SD). Major strategies of DMD are the amyloid vaccine therapy and β/γ-secretase inhibitors, which have been developed with high expectations as fundamental treatments for AD. As SD, donepezil, galantamine, rivastigmine, and memantine are now usable. While memantine is an NMDA receptor inhibitor, the remaining three agents are cholinesterase inhibitors. The inhibitory mechanisms of the four agents exhibit some differ- ences. Although they may offer tips for proper use, the SD guidelines have so far stated that there are no significant differences among SD. The guidelines also state that no SD can stop the progression of AD and that their use for MCI should not be encouraged. There are some criticisms about the use of SD because they are not root treatments. In contrast, there are some reports that SD delay AD progression, preserve ADL, reduce the care burden and have an effect on BPSD. Therefore, in proper combination with non-drug treat- ments, the use of SD is considered to be valuable.

Newer antidepressants and anxiolytics can be used easily as these drugs have fewer side effects which could markedly influence the quality of life compared with other types of psycho- tropic drugs. When symptoms do not remit with antidepressants, the following factors should be focused on : reconsideration of the diagnosis, assessment of side effects, comorbidity, psychoso- cial factors, therapeutic alliance and adherence, and reconsideration of dose settings from the viewpoint of pharmacodynamics. As shown in the major treatment guidelines, it is recom- mended to start with monotherapy and, if it does not work, a switch is recommended, but after this step, we have to depend on augmentation or combination with the burden of side effects. Once polypharmacy is initiated, putting closely categorized antidepressants into one and being careful to minimize withdrawal symptoms and risk factors are the ways to make the prescrip- tion simple. Regarding anxiolytics, clinicians should be aware of factors which could lead to depen- dence, such as short half-life and high-potency drugs used pro re nata, and these factors could result in poly- and high-dose pharmacy as well. Moreover, it will be difficult to reduce doses, as these drugs are associated with withdrawal symptoms. These factors could lead to long use and dependence. To prevent dependence and polypharmacy, administer the lowest effective dose and avoid using them aimlessly. Using booklets to help educate patients to reduce doses gradually, safe discontinuation will be achievable.

Disease burden from psychiatric disorders is an important public health issue worldwide, and should be addressed proactively. Because the development of psychiatric disorders involves both genetic and environmental factors, as well as their interactions, lifestyle interven- tion is a feasible treatment and prevention strategy. The human brain uses a substantial por- tion of the body's total energy and nutrient intake. Nutrients strongly influence both brain structure and function, and nutrition also affects neurodevelopment and neurotrophic function. It has been recognized in recent years that diet and nutrition may be an important factor con- tributing to psychiatric morbidity, and that prevention or treatment of psychiatric disorders could be conducted by addressing diet and nutrition. Against this background, in 2013 we founded the International Society for Nutritional Psychiatry Research (ISNPR). The aim of the present paper is to provide a set of practical recommendations for the prevention and treat- ment of depression based on the ISNPR statement and the review by Opie et al. Here, we introduce Opie's five key dietary recommendations and state our hypotheses for improving mental health: (1) follow traditional dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet (2) increase consumption of fruits, vegetables, legumes, whole-grain cereals, nuts, and seeds; (3) consume higher amounts of foods rich in omega-3 fatty acids; (4) replace unhealthy foods with wholesome nutritious foods ; (5)limit intake of processed foods, fast foods, commercial baked goods, and sweets ; and (6) be mindful of probiotic gut bacteria. The pos- sible biological mechanisms by which nutrition might affect mental state are not known in depth, and full associations between nutrition and mental disorders have not been examined in randomized controlled trials. However, the existing evidence suggests that a combination of healthy dietary practices may reduce the risk of developing depression. As dietary practices and lifestyle can be changed by individuals at any time, new integrated approaches to mental health from the viewpoint of diet and nutrition-that is, nutritional psychiatry-could be appli- cable to a wide population. Gathering the findings of high-quality studies and implementing nutritional psychiatry within clinical practice are important tasks for the future.