PCN reports : psychiatry and clinical neurosciences最新文献

Aim: Clinicians face difficulties in making treatment decisions for unspecified anxiety disorder due to the absence of any treatment guidelines. The objective of this study was to investigate how familiar and how often primary care physicians use pharmacological and nonpharmacological approaches to manage the disorder.

Methods: A survey was conducted among 117 primary care physicians in Japan who were asked to assess the familiarity of using each treatment option for unspecified anxiety disorder on a binary response scale (0 = "unfamiliar," 1 = "familiar") and the frequency on a nine-point Likert scale (1 = "never used," 9 = "frequently used").

Results: While several benzodiazepine anxiolytics were familiar to primary care physicians, the frequencies of prescribing them, including alprazolam (4.6 ± 2.6), ethyl loflazepate (3.6 ± 2.4), and clotiazepam (3.5 ± 2.3), were low. In contrast, certain nonpharmacological options, including lifestyle changes (5.4 ± 2.3), coping strategies (5.1 ± 2.7), and psychoeducation for anxiety (5.1 ± 2.7), were more commonly utilized, but to a modest extent. When a benzodiazepine anxiolytic drug failed to be effective, primary care physicians selected the following management strategies to a relatively high degree: differential diagnosis (6.4 ± 2.4), referral to a specialist hospital (5.9 ± 2.5), lifestyle changes (5.2 ± 2.5), and switching to selective serotonin reuptake inhibitor (5.1 ± 2.4).

Conclusion: Primary care physicians exercise caution when prescribing benzodiazepine anxiolytics for unspecified anxiety disorder. Nonpharmacological interventions and switching to SSRI are modestly employed as primary treatment options and alternatives to benzodiazepine anxiolytics. To ensure the safe and effective treatment of unspecified anxiety disorder in primary care, more information should be provided from field experts.

Aim: Little is known about the mental health status of children in Japan whose roots are in foreign countries. The differences in language that are used every day may be a factor that makes adaptation difficult for these children. The aim of the present study, therefore, was to examine the mental health status of children who use foreign languages at home via a cross-sectional survey in a large cohort.

Methods: The survey was conducted among children who attended public elementary and junior high schools in a large city in Japan. Data were received from 20,596 elementary school-aged (above 4th grade) and 19,464 junior high school-aged children. We compared mental health status evaluated by the Patient Health Questionnaire-4 in the group based on language usage at home (only Japanese, only foreign languages, and both languages).

Results: We found that children who used foreign languages at home exhibited worse mental health status than children who used only Japanese at home. In addition, mental health status was slightly better among junior high school-aged children who used only foreign languages at home than among elementary school-aged children. This tendency was not observed in the group of children who used both languages at home.

Conclusion: Our results suggest that children in Japanese society who use foreign languages at home have worse mental health, therefore there is a need for support for these children living in Japan.

Aim: An assertive case management intervention program, ACTION-J, proved effective for preventing suicide attempters from reattempting suicide within 6 months. The ACTION-J randomized trial was conducted as part of the "National Strategic Research Projects." The program has been covered by the national medical payment system of Japan since 2016. The aim of the Post-ACTION-J Study (PACS) was to examine the current implementation status of assertive case management in a real-world clinical setting.

Methods: PACS was a prospective, multicenter registry cohort study. The participants were suicide attempters admitted to the emergency departments of 10 participating medical facilities from October 2016 to September 2018. The assertive case management intervention developed by the ACTION-J Study was offered to all patients, and the primary outcome was the duration and frequency of use of the intervention at 6 months.

Results: A total of 1159 patients were admitted to emergency departments after a suicide attempt during the study period, 144 of whom were included in our analysis. The proportion of participants who received the intervention for 6 months was 72.2% (104/144), and 63.9% (92/144) of the patients completed ≥7 case management interviews within 6 months.

Conclusion: The findings of this study indicate successful implementation of an assertive case management intervention program based on the ACTION-J Study in a real-world clinical setting, following its integration with the national medical payment scheme in Japan. The study provided the useful information that could improve the implementation of assertive case management interventions in future.

Background: In Japan, there is a tendency to view COVID-19 infection as one's own responsibility, which may result in more feelings of guilt than in other countries. During the COVID-19 pandemic, the curfew imposed by COVID-19 restricted social behavior and increased anxiety and loneliness, which may have increased the risk of suicide among young women, especially mothers who were highly stressed regarding COVID-19 infection in their children.

Case presentation: This is a case report of two Japanese mothers who developed feelings of guilt following infection with COVID-19, leading to suicide attempts. They feared stigma or denial due to the infection, which they were unable to explain to others, leading to a heightened sense of self-blame and suicide attempts. In addition, Japanese women have a heavy burden of housework, despite their dual roles at home and at work; the pandemic's behavioral restrictions led to increased time at home and stress. These women were also more affected by the economic crisis in the early stages of the pandemic than men. Relatedly, neuropsychiatric symptoms that persisted after recovering from COVID-19, such as depression, anxiety, fatigue, and pain, namely postacute COVID-19 syndrome or long COVID, may have precipitated the suicidal ideation in these cases. Moreover, the complication of bipolar disorder by COVID-19 could have led to suicide attempts caused by infection-related neuropsychiatric symptoms and the exacerbation of the bipolar disorder by restrictions imposed during the pandemic.

Conclusion: Suicide prevention measures need to be taken more seriously among mothers during or after the COVID-19 pandemic.

Aim: Transient epileptic amnesia (TEA) is a type of mesial temporal lobe epilepsy characterized by recurrent amnesia attacks. In 1998, Zeman et al. proposed the following diagnostic criteria for TEA: (1) recurrent, witnessed episodes of amnesia (TEA attacks); (2) other cognitive functions remain intact during attacks; and (3) evidence of epilepsy. It was also reported that patients with TEA often demonstrate two other types of memory symptoms: accelerated long-term forgetting (ALF) and autobiographical amnesia (AbA). Both ALF and AbA are persistent memory disorders, but transient epileptic seizures are not.

Methods: We encountered two cases of TEA associated with two types of amnesia attacks. Therefore, we reviewed TEA cases in the literature to clarify the type of TEA attacks that occurred.

Results: Based on the extracted TEA cases, including our two cases, we found that there are two main types of TEA attacks, and we discussed their clinical features.

Conclusion: We propose two main types of TEA attacks; that is, pure amnesia-type and partial amnesia-type seizures. Furthermore, we also propose that topographical amnesia mainly manifests as a type of amnesia attack, rather than as a chronic memory disturbance, such as ALF or AbA.

This paper attempts to provide an overview of the history of Japanese psychopathology by presenting concise portraits of the second generation of Japanese psychopathologists, whose era is considered to be the heyday of Japanese psychopathology. Meanwhile, we also consider the historical background of the psychiatric reform movement in Japan that influenced many second-generation psychopathologists. First, the paper briefly discusses the emergence of the first-generation of psychopathologists through the adoption of German-centered psychiatry after the Meiji era. In general, the first-generation can be said to have laid the foundation for the independent development of psychopathology in Japan. Then came the second generation, at a time when the psychiatric reform movement was gaining momentum, with the Academic Chair System of the Faculty of Medicine (Ikyoku Kōzasei) heavily criticized, and psychiatric research itself halted temporarily. In order to continue the hampered academic research, workshops on "Psychopathology of Schizophrenia" were organized by the second-generation psychopathologists, whose major figures include Takeo Doi, Yomishi Kasahara, Hiroshi Yasunaga, Tadao Miyamoto, Bin Kimura, and Hisao Nakai. The invaluable contributions of the second-generation psychopathologists are essential to the development of Japanese psychopathology, and their close relationship with the psychiatric reform movement is worth reexamining, as it could be argued that the political tensions generated by the movement were the driving force behind their high-quality work.

In the 1960s and 1970s, there was widespread discussion in Japan about the pathological experience of "unpleasant odors emanating from one's body." This symptom is called "Jikoshu," and this term was used in combination with various words, such as "Genkaku" (hallucination) and "Moso" (delusion), reflecting its symptomatological ambiguity. The best-known term in the English-language literature is Jikoshu-Kyofu (Jikoshu phobia). By further abstracting this symptom and viewing it as a delusion-like experience of "something leaking out of me," egorrhea syndrome (Fujinawa) was proposed, which was considered to be partly a pathology of schizophrenia. Similar cases were characteristically observed during adolescence, and a study emerged suggesting that the syndrome was "adolescent paranoia" (Murakami), distinct from schizophrenia. However, the terms "Jikoshu-Taiken" (Jikoshu experience; Kasahara et al.) and "Jikoshu-Sho" (Jikoshu syndrome; Miyamoto) were proposed to emphasize the nosological ambiguity. Considered a culture-bound syndrome unique to Japan or East Asia, Jikoshu received little attention in the English-language literature apart from a 1971 study of olfactory reference syndrome (Pryse-Phillips), which presents with similar symptoms. In recent years, research has placed this disorder within the obsessive-compulsive spectrum, and it has been adopted as an ICD-11 disorder under the term "olfactory reference disorder."