Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica最新文献

Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification systems until the publication of the diagnostic and statistical manual for mental disorders, third edition (DSM-III) in 1980. Initially considered a residual category to be used when no other diagnosis could be made. The term GAD is not accepted as a distinct diagnostic category yet. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R, DSM-IV and DSM-5 classifica- tions have slightly redefined this disorder. The classification is fluid. This article reviews the development of diagnostic criteria for defining GAD from Freud to DSM-5. Excessive worry- ing impairs the individual's capacity to do things quickly and efficiently, whether at home or at work. The worrying takes time and energy; associated symptoms of feeling keyed up or edge, tiredness, difficulty concentrating, and depression. Individuals whose presentation meets crite- ria for GAD are likely to have met, or currently meet, criteria for unipolar depressive disor- ders. Comorbid depression are common in GAD and negatively impact treatment outcome.

The system of the specialty certification of psychiatry of the Japanese Society of Psychiatry and Neurology (JSPN) was established in 2005, and certification examination has been conducted since 2009. The Japanese Medical Specialty Board was established in 2014 in order to develop a new common specialty certification system encompassing 19 medical fields, and the training under the new system will be initiated in 2017. Under the new system, a core medical institution heads a group of medical institutions that consist of some hospitals and clin- ics for the specialty training program, and the core institution is responsible for the training and education of each resident. The committee of the certification examination of psychiatry in JSPN is responsible for administration of the examination. The aims of the examination, consisting of written and oral tests, are to assess knowledge, skills, and the attitude as a psychiatrist and decide whether or not an examinee meets the standards. Because the missions of the specialists are to treat severe and serious cases appropriately as well as to provide people with standard treatment, the role of the oral examination to assess clinical skills is important. However, there is not enough time or manpower to enrich the oral examination under the existing circumstances. Therefore, it is indispensable to assess the skills and attitudes of residents regu- larly and objectively in the training program. We need to discuss the specialty certification examination thoroughly in order to gain an image of the future of psychiatry in Japan.

Now, the psychiatric departments of general hospitals are unpopular workplaces for psy- chiatrists in Japan. However, I think there is a constant need for psychiatric departments of general hospitals, because the number of psychiatric departments of general hospitals with no psychiatric beds is increasing, even though the number of psychiatric departments of general hospitals with psychiatric beds is decreasing. Recently, there has been a trend of reevaluating psychiatry in medical care, such as in the medical treatments fees or in health care planning, so we cannot talk about medical care without involving psychiatry. The participation of gen- eral hospital psychiatry with a medical cooperation function is necessary for psychiatric reform from hospital-based to community-based psychiatry, as well as for the promotion of self-suffi- cient medical care in local communities based on medical cooperation. For psychiatry corre- sponding to high-grade acute medical care, the existence of general hospital psychiatry is nec- essary which has close contact with medical care and has a psychiatric acute care function, and adequate measures should be adopted in the national medical care fee and medical policies for the enhancement of general hospital psychiatry.

Various classes of antidepressants have been used in the treatment of major depressive disorder (MDD) ; however, treatment efficacy is inadequate, as 30-40% of patients do not expe- rience response even after sufficiently long treatment period with adequate dose of antidepressant. For the treatment-resistant patient to the therapy based on the generalized evidence, is it possible to provide an appropriate and improved treatment based on personalized medicine, taking into account predictable candidates such as sub-symptoms of depression and genetic factors instead? There is only little evidence for this in Japanese MDD, and consequently we use the evidence of Caucasians as reference, however, could we use the evidence of the popu- lation whose genetical, social, and cultural background are very different from Japanese popu- lation? In this review, I will refer to our randomized controlled studies that have some predict- able candidates including genetic factors designed for personalized medicine in MDD patients, and present an overview of procedures for making predictions of current treatment and pro- ceeding towards personalized medicine.

Drug combination therapy is sometimes used in clinical situations. CYP has been intensely studied numerous times ; thus, its pharmacokinetic interactions have been predicted to some extent. Basically, a drug interaction is defined as competitive inhibition of an enzyme by two drugs. We are concerned that fluvoxamine may have a drug interaction with paroxetine. Flu-voxamine inhibits CYPlA2 and CYP2C9 activity, and paroxetine inhibits CYP2D6 activity. However, recently, new drug targets have been identified, such as P-glycoprotein, a drug transporter. Fluvoxamine and paroxetine inhibit not only CYP but also P-glycoprotein. Additionally, there is an increased risk of upper gastrointestinal tract bleeding with the combination of a SSRI and NSAIDs. There are also individual differences in the pharmacokinetics of drugs due to genetic factors and individual differences in drug receptors, which have not yet been investigated for fluvoxamine or paroxetine. Obtaining clinical diagnoses of drug interactions is necessary in all patients.

In Japan, healthcare professionals and healthcare workers typically practice a culture of self-assessment when it comes to managing their own health. Even where this background leads to instances of mental health disorders or other serious problems within a given organization, such cases are customarily addressed by the psychiatrists or psychiatric departments of the facilities affected. Organized occupational mental health initiatives for professionals and workers within the healthcare system are extremely rare across Japan, and there is little recognition of the need for such initiatives even among those most directly affected. The author has some experience designing and operating a comprehensive health management system to support students and faculty at a university in the Tokyo Metropolitan Area that contains a medical school and university hospital. At this university, various mental health-related problems were routinely being allowed to develop into serious cases, while the fundamental reforms required by the health management center and the mental health management scheme organized through the center had come to represent a challenge for the entire university. From this initial situation, we undertook several successive initiatives, including raising the number of staff in the health management center and its affiliated organizations, revising and drafting new health management rules and regulations, launching an employment support and management system, implementing screenings to identify people with mental ill-health, revamping and expanding a counselling response system, instituting regular collaboration meetings with academic affairs staff, and launching educational and awareness-raising activities. This resulted in the possibility of intervention in all cases of mental health crisis, such as suicidal ideation. We counted more than 2,400 consultations (cumulative total number; more than half of consultations was from the medical school, postgraduate medical course, or hospitals) on a campus comprising 8,700 people, in which our problem-solving approach was able to achieve a certain degree of success in a majority of cases. Amid the increasing prevalence of mental ill-health and signs of worsening mental health problems in all areas of society, I look forward to the establishment of occupational mental health systems that are suited to medical institutions.

A deliberately crafted setting of intensive Naikan therapy has its base in traditional Japa- nese culture that attaches importance to practical and procedural knowledge. Whereas a ratio- nal explanation by using descriptive knowledge is valued in western society, Japanese society tends to value procedural knowledge. The contrast between these two values can be explained by a difference in understanding transcendent existences. In Western society, it has been understood in relation to logos related to logical orderliness. On the other hand, it has been understood in relation to WAZA, which has to do with a magical or hands-on knowledge. Both types of knowledge involve two phases in a process of development; construction and deconstruction. The deconstructive phase in which reformation and renovation of knowledge is induced consists of intuitive and holistic experience, which in Western Christian society is related to hypostasis-persona of the Trinity, while it is related to "sumu" from Shintoism in Japan. Both are symbols of the Creation, coming from the precipitative phenomenon, symbolized in liquid. Insight in psychotherapy is one with a person's experience of deconstructing procedural knowledge. Max Weber has discussed over these two kinds of knowledge and its construction/deconstruction moments. Reconsidering Weber's theory from a psychotherapeutic viewpoint will therefore give us a new key to understand the core of legitimacy of domination and a Tenno system of Japan.

Shared decision making (SDM) is being considered increasingly important in today's medical practice. This approach should also be promoted in the field of mental health. We developed a question prompt sheet (QPS) for persons with schizophrenia as a decision aid to empower them with autonomy. We published it on the website as a free download available to the general public. The therapeutic relationships respecting otherness between mental health service users and professionals can be the basis of recovery-oriented support. This article aims to introduce the background and process of making a QPS and to rethink recovery and growth from the viewpoint of dialogism.

Context: Children and adolescents with intellectual disability often have various mental disorders and behaviour problems. Despite the limited evidence on the efficacy and safety of psychotropic medication use to children and adolescents with intellectual disability, clinicians often prescribes psychotropic medications for the management of problem behaviours.

Objective: We aimed to clarify the psychotropic prescribing practices for children and adolescents with intellectual disability.

Design: We conducted a 1-year cohort study of patients with intellectual disability aged 3-17 years using a large health insurance claims database in Japan.

Outcome measures: Psychotropic prescription, prescription duration, polypharmacy, and average dosage.

Results: Of 2,035 patients, the most prevalently prescribed psychotropic medications were antipsychotics (12.5%), anxiolytics/hypnotics (12.4%), stimulants (4.8%), mood stabilizers (2.4%), and antidepressants (1.8%). The prescription prevalences of anxiolytic/hypnotic and antipsychotics increased with age. Patients aged 6 years or older had around 2-fold higher prescription duration of antipsychotics (median duration of over 300 days per year) than those aged 3 to 5 years. The likelihood of polypharmacy and excessive dosage (defined as chlorpromazine equivalents of >300 mg/day) of antipsychotics increased with age.

Conclusion: We observed a higher prescription prevalences of anxiolytics/hypnotics and antipsychotics and a longer prescription duration of antipsychotics in the present study than those in previous studies. Our results suggest a need for developing clinical practice guidelines for the management of problem behaviours among children and adolescents with intellectual disability.

About half of inpatients in psychiatric hospitals in Japan are over 65 years old. Most of them are long-term inpatients with schizophrenia. The number of beds in psychiatric hospitals will probably decrease in 10-15 years. Local shift means that those long-term inpatients leave hospital and spend their lives more fully and more comfortably. Most of them are over 65 years old. However, the motivation of the government and mental hospitals to promote this local shift seems to be low. Most men- tal hospitals in Japan are private, and so such a shift may be against their interests. The gov- ernment wants to decrease the number of beds in mental hospitals due to international criti- cism and for financial reasons. But I'm afraid some may think that in 10-15 years, regardless of whether local shift goes good or bad, many long-term inpatients eventually die and beds at mental hospitals will subsequently decrease. So local shift is a 'time limited problem'. However, if many long-term inpatients leave mental hospitals, they will use mental clinics or other community-based mental health care. Also, cooperation with other agencies will be very important. If such community support fails, a revolving door phenomenon will develop.