Seishin Shinkeigaku Zasshi [JOURNAL]
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200 papers
[What Lessons Should We Learn from the Death of Patients on Xeplion?].
Fujii Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514053
From the launch of the long-acting injectable antipsychotic paliperidone palmitate (XEPLION) on November 19, 2013, 32 fatal cases had been reported up to May 18, 2014 (estimated number of users is approximately 11,000 pa...
From the launch of the long-acting injectable antipsychotic paliperidone palmitate (XEPLION) on November 19, 2013, 32 fatal cases had been reported up to May 18, 2014 (estimated number of users is approximately 11,000 patients) in the Early Post-marketing Phase Vigilance. The most common cause of death was sudden death (12 cases were sudden death defined by ICD-10 codes 96.0 and 96.1 and 4 cases suspected sudden death), followed by suicide (7 cases), and neuroleptic malignant syndrome (4 cases). Several deaths occurred involving patients with serious somatic disorder, such as a malignant tumor or pneumonia. The risk of all-cause mortality on XEPLION was not high in comparison with other investigations; the sudden death risk on XEPLION may be higher than on ZODIAC. According to many reports from foreign countries, mortality rates associated with schizophrenia are two to three times higher than those of the general population, corresponding to a 10-25-year reduction in life expectancy. Natural deaths account for about 60% of the excess mortality of schizophrenia patients, and such patients are more likely to die from ischemic heart disease. Since it has been suggested that more than half of sudden deaths in schizophrenic patients have a cardiac origin, sudden cardiac deaths are chiefly responsible for their reduced life expectancy. This sudden death-related problem of patients with schizophrenia has been forgotten or ignored in the psychiatric care of Japan. Taking advantage of this opportunity, we should tackle this problem seriously, and make an effort to reduce the mortality gap.
[The Problems with Domestic Introduction of rTMS from the Three Viewpoints of Scientific Evidence, Specialty and Social Responsibility].
Shinosaki K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514052
The domestic introduction of rTMS is expected as a new treatment option for treatment-resistant depression. I discussed some problems with the introduction from three viewpoints : scientific evidence, specialty, and soci...
The domestic introduction of rTMS is expected as a new treatment option for treatment-resistant depression. I discussed some problems with the introduction from three viewpoints : scientific evidence, specialty, and social responsibility. I surveyed scientific evidence for rTMS regarding the action mechanism, effectiveness, side effects, and its positioning in the treatment guidelines. To secure the quality of rTMS treatment, I proposed rTMS guidelines, nurturing of the specialists, and a center hospital plan, and pointed out some medium-term problems after its introduction and the consistency of rTMS treatment and standard depression treatment. From the viewpoint of social responsibility, rTMS treatment should be a medical service covered by health insurance to avoid its misuse. We should prepare to overcome the public suspicion of brain stimulation treatment for mental disease.
[Toward the Introduction of Repetitive Transcranial Magnetic Stimulation in Japan to Treat Antidepressant-resistant Depression].
Mikuni M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514051
Treatment of major depressive disorder (MDD) can include a variety of biopsychosocial approaches. In medical practice, antidepressant drugs are the most common treatment for moderate to severe depressive episodes; howeve...
Treatment of major depressive disorder (MDD) can include a variety of biopsychosocial approaches. In medical practice, antidepressant drugs are the most common treatment for moderate to severe depressive episodes; however, their efficacy is limited. Many depressed patients are considered treatment-resistant, with 33% failing to achieve remission after ≥ 3 treatment trials. A systemic review and meta-analysis revealed that repetitive transcranial magnetic stimulation (rTMS) may be reasonably considered for patients with MDD and ≥ 2 prior failures of antidepressant treatment. No rTMS devices have been approved by the Japanese Pharmaceuticals and Medical Devices Agency, which has resulted in its off-label use; therefore, to offer better care for cases of treatment-resistant MDD, we should continue efforts to seek the introduction of rTMS to Japan.
[What are Considerations for Clinical Investigation of New Drugs and Treatment Techniques for Major Depressive Disorders?].
Nakabayashi T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514050
Major depressive disorder treatments remain unsatisfactory, and the development of novel antidepressants is continuing. Therefore, not only the establishment of therapeutic strategies to accumulate evidence on existing t...
Major depressive disorder treatments remain unsatisfactory, and the development of novel antidepressants is continuing. Therefore, not only the establishment of therapeutic strategies to accumulate evidence on existing therapies, but also the development of novel therapies is required in order to improve the medical standards. In principle, parallel, double-blind, randomized, placebo-controlled trials are necessary to assess new compounds for the treatment of major depressive disorders from a scientific perspective. To provide unambiguous evidence of antidepressant activity, well-controlled studies with adequate designs must show efficacy with a statistically significant effect on a clinically meaningful endpoint. For this purpose, it is important to examine all aspects of factors that adversely affect the efficacy and safety assessment in the planning stage of clinical trials and reduce these factors. There are several specific characteristics of clinical trials for neuropsychiatric disorders. Some typical features are as follows: 1) a high and variable response, 2) impact on the effect of the baseline severity of disorders, 3) high dropout rates, 4) biases related to subjective measures of clinical symptoms. In this paper, considerations for the planning and performing of clinical trials for major depressive disorders will be discussed based on these features.
[Clinical Application and Safety of rTMS in Japan and Overseas].
Kito S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514049
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that can stimulate the cerebral cortex and alter cortical and subcortical activities, and it has been approved to treat depression in the US...
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that can stimulate the cerebral cortex and alter cortical and subcortical activities, and it has been approved to treat depression in the USA, Australia, and Europe. In Japan, several manufacturers have focused on obtaining approval for rTMS. In terms of the safety and tolerability of rTMS, headache, stimulation pain, and discomfort occur at relatively high frequencies during rTMS, but these events usually improve rapidly as the number of treatment days increases. The induction of seizures is the most severe side effect of rTMS, and its rate is less than approximately 0.1%. In the practice of rTMS, it is critically important to check for medications known to modify the seizure threshold and any metal in the body, and to assess the risk of seizures.
[Clinical Introduction of Repetitive Transcranial Magnetic Stimulation for Major Depression in Japan].
Nakamura M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514048
Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) have long been awaited for not only neurological but also psychiatric disorders as a low-invasive transcranial brain stimulation. In 2008, t...
Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) have long been awaited for not only neurological but also psychiatric disorders as a low-invasive transcranial brain stimulation. In 2008, the Food and Drug Administration (FDA) of the United States finally approved repetitive transcranial magnetic stimulation (rTMS) for medication-resistant patients with major depression. More recently, at the beginning of 2013, a deep TMS device with the H-coil received FDA approval as the second TMS device for major depression. In Japan, it is estimated that more than 200,000 patients with medication-resistant major depression could be candidates for rTMS treatment. To promote the clinical introduction of rTMS for major depression, joint discussion has been ongoing including the Japanese Society of Psychiatry and Neurology (JSPN), the Japanese Ministry of Health, Labour, and Welfare (MHLW), and the Pharmaceutical and Medical Devices Agency (PMDA). On the other hand, some corporate efforts have begun to get MHLW/PMDA approval for a few types of rTMS device. In 2013, the JSPN established a new committee in order to discuss the introduction of neuromodulation methods such as rTMS in Japan. The committee has been discussing how rTMS should be introduced appropriately with expedition, considering the MHLW regulations for the expedited introduction or provisional use of advanced medical technology. Also, the MHLW has required related psychiatric societies to formulate clinical guidelines of rTMS for major depression in order to avoid any potential overuse or misuse. A number of controversies are ongoing, such as standards for the appropriate clinical application of rTMS, a suitable position of rTMS within the comprehensive treatment algorithm of major depression, and bioethical standards for brain stimulation (neuroethics). Moreover, there are some pragmatic issues. For instance, the Japanese Society of Clinical Neurophysiology (JSCN) has restricted repetitive TMS administration to medical doctors due to safety concerns. In order to disseminate rTMS in Japan, it should be discussed how to reduce the work-load of psychiatrists who administer rTMS on a daily basis. For this purpose, standards should be established by the JSCN to qualify non-MD rTMS operators under the supervision of psychiatrists. In this paper, recent progress in the clinical introduction of rTMS for major depression in Japan is reported, in order to facilitate future discussion about how rTMS should be introduced for patients with major depression in Japan.
[Optical Topography as an Auxiliary Laboratory Test for Differential Diagnosis of Depressive State: Clinical Application of Near-infrared Spectroscopy (NIRS) as the First Trial for Approved Laboratory Tests in Psychiatry].
Fukuda M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514047
The lack of clinical laboratory tests is a major obstacle in the reliable diagnosis and quantitative treatment assessment and prevention of psychiatric disorders and in the development of patient-centric psychiatric prac...
The lack of clinical laboratory tests is a major obstacle in the reliable diagnosis and quantitative treatment assessment and prevention of psychiatric disorders and in the development of patient-centric psychiatric practices. Optical topography has been approved as an insurance-covered auxiliary laboratory test for differential diagnosis of depressive state by Ministry of Health, Labour and Welfare in Japan since 2014. Near-infrared spectroscopy (NIRS), theoretical basis of optical topography, is one of functional neuroimaging techniques that has been increasingly employed in psychology and psychiatry. Because NIRS can detect only cerebral cortex reactivities with low spatial resolution and may suffer from contaminating signals from skin and skull, its data should be interpreted as a global index of cerebral cortex reactivities. Within these limitations, the advantages of NIRS over fMRI such as complete non-invasiveness, small measurement apparatus, high time resolution, and natural examination setting lead it to one of the preferred methods in studies of brain substrates of psychiatric disorders. Two-thirds of the original articles on NIRS application in psychiatry have been published by Japanese researchers. NIRS examination of major depressive disorder, bipolar disorder, and schizophrenia using a verbal fluency task of only three minutes demonstrated diagnosis-specific characteristics of frontal lobe function. These characteristics have been established as suggesting potential diagnosis of bipolar disorder or schizophrenia in clinically diagnosed major depressive disorder. In order to establish the application of NIRS as clinically useful laboratory tests in psychiatry, auxiliary nature of NIRS examination for differential diagnosis should be properly recognized both by patients and psychiatrists.
[Drug Interactions and Pharmacokinetics of Psychotropic Drugs].
Suzuki E
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514046
Pharmacokinetics is the field dedicated to investigating the absorption, distribution, metabolism and excretion of drugs. Absorption of drugs is affected when they are taken together with a meal. Depending on the drug, t...
Pharmacokinetics is the field dedicated to investigating the absorption, distribution, metabolism and excretion of drugs. Absorption of drugs is affected when they are taken together with a meal. Depending on the drug, the area under the concentration curve is affected by whether a medication is taken before or after a meal. Combined use of drugs with a high plasma protein binding fraction may be dangerous, since drug efficacy is impacted by efficiency, which in turn is affected by the degree to which it binds to proteins. Even more significant is the issue of "drug/drug" interactions that arise due to inhibition of the cytochrome P450 (CYP) hepatic microsomal enzyme system. Some antidepressants, such as paroxetine and fluvoxamine, are strong inhibitors of the CYP system. In the case of a medication that depends on renal clearance for elimination, caution is required when taking such a drug if it influences renal function. When a medicinal effect changes, pharmacodynamic changes must also be considered.
[Evidence for the Efficacy of Behavioral Activation against Depressive Disorder: A Literature Review].
Kuroki T, Ishibashi H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514045
A growing body of evidence suggests the significant efficacy of behavioral activation therapy (BA) for the treatment of depression, although BA had formerly been regarded as only a part of the techniques for cognitive-be...
A growing body of evidence suggests the significant efficacy of behavioral activation therapy (BA) for the treatment of depression, although BA had formerly been regarded as only a part of the techniques for cognitive-behavioral treatment (CBT). The aim of this article is to review the effectiveness, indications, and limitations of BA for the psychosocial treatment of depression. The research group of Washington University in St. Louis, who previously suggested the marked efficacy of BA based on component analysis of CBT, performed a large-scale study to compare the effect of BA and cognitive therapy (CT) or antidepressant medication on the acute phase of depression. As the results, BA was superior to CT and comparable to antidepressant medication in acute-phase treatment for a subgroup of patients with relatively severe depression. Moreover, a long-term follow-up study revealed a benefit of BA compared to pharmacological treatment in regard to the persistence of the effect and cost-effectiveness. More recently, a number of meta-analyses have indicated no significant difference among BA and other psychotherapies regarding their efficacy for the treatment of depression. Because BA does not require patients or therapists to learn complex skills and is also time-efficient, it is recommended as the first-line treatment for mild or moderate depression. However, further studies are needed to consider indications, the timing of induction, and variation in BA techniques if it is applied for the treatment of depression in a general clinical setting in Japan.
[Morita Therapy to Treat Depression: When and How to Encourage Patients to Join Activities].
Nakamura K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514044
The author discusses how Morita therapy is used to treat depression, illustrated with a clinical case, and makes comparisons between Morita therapy and behavioral activation (BA). The author further examines the issue of...
The author discusses how Morita therapy is used to treat depression, illustrated with a clinical case, and makes comparisons between Morita therapy and behavioral activation (BA). The author further examines the issue of when and how to encourage patients to join activities in clinical practice in Japan. Both Morita therapy and BA share at least a common view that it is effective to activate patients' constructive behavior at a certain point in depression treatment. However, BA therapists, compared to Morita therapists, seem to pay less attention to the necessity of resting and the appropriate timing for introducing behavioral activation. There may be some contextual differences between depressive patients in Japan and those in North America. In the case of Japanese patients, exhaustion from overwork is often considered a factor triggering the development of depression. At the same time, the Morita-based pathogenic model of depression seems different from BA's model of the same disorder. BA's approach to understanding depression may be considered a psychological (behavioristic) model. In this model, the cause of depression lies in: (a) a lack of positive reinforcement, and (b) negative reinforcement resulting from avoidance of the experience of discomfort. Therefore, the basic strategy of BA is to release depressive patients from an avoidant lifestyle, which serves as a basis for negative reinforcement, and to redirect the patients toward activities which offer the experience of positive reinforcement BA is primarily practiced by clinical psychologists in the U. S. while psychiatrists prescribe medication as a medical service. On the other hand, the clinical practice of treating depression in Japan is based primarily on medical models of depression. This is also true of Morita therapy, but in a broad sense. While those who follow medical models in a narrow sense try to identify the cause of illness and then remove it, Morita therapists pay more attention to the recovery process rather than the pathogeneses of depression, and attempt to foster patients' natural healing power and resilience. Therefore, it may be more appropriate to refer to the model used in Morita therapy as "a health-recovery model." Moreover, the Moritian model of depression partially incorporates a psychological model because patients' dogmatic thinking (e. g., perfectionistic self-expectations and high demands on self) is regarded as a factor hindering their recovery, which Morita therapists try to modify. In conclusion, it is recommended that we reconsider the importance of incorporating psychological help which is compatible with the initial treatment principle based on resting and pharmacotherapy in clinical practice in Japan.
[Practice of Behavioral Activation in Cognitive-behavioral Therapy].
Kitagawa N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514043
An approach focusing on behavioral activation (BA) was adopted in the cognitive therapy of A. T. Beck, and it came to be considered that BA can play an important role in cognitive-behavioral therapy (CBT) for depression....
An approach focusing on behavioral activation (BA) was adopted in the cognitive therapy of A. T. Beck, and it came to be considered that BA can play an important role in cognitive-behavioral therapy (CBT) for depression. Therefore, in recent years, BA based on clinical behavior analysis has been developed as a new treatment (Martell, et al.). The core characteristics are as follows: 1) focusing attention on context in daily life to promote the behavior control of patients and avoidance of a hatred experience ; 2) breaking the vicious circle; 3) promoting the behavior according to the purpose that the patients originally expect; 4) recognizing a relationship between behavior and the situation (contingency), thereby recovering self-efficacy tied to the long-term results that one originally expects. This does not increase pleasant activity at random when the patient is inactive, or give a sense of accomplishment. We know that depression is maintained by conducting functional analysis of detailed life behavior, and encourage the patients to have healthy behavior according to individual values. We help them to complete schedules regardless of mood and reflect on the results patiently. It is considered that those processes are important. BA may be easy to apply in clinical practice and effective for the chronic cases, or the patients in a convalescent stage. Also, in principle in the CBT for major depression, it may be effective that behavioral activation is provided in an early stage, and cognitive reconstruction in a latter stage. However, an approach to carry out functional analysis by small steps with careful activity monitoring is essential when the symptoms are severe. Furthermore, it should be considered that the way of psychoeducation requires caution because we encourage rest in the treatment of depression in our country. In particular, we must be careful not to take an attitude that an inactive behavior pattern is unproductive only based model cases.
[Behavioral Activation for Depression: Theory and Practice].
Nakao T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514042
Behavioral activation (BA) has recently attracted marked attention. While cognitive therapy focuses on the cognitive distortion of patients with depression and asks them to change their behaviors as the process of alteri...
Behavioral activation (BA) has recently attracted marked attention. While cognitive therapy focuses on the cognitive distortion of patients with depression and asks them to change their behaviors as the process of altering the cognitive distortion, BA pays attention to behavior to avoid an unpleasant situation or social situation as a key symptom that leads to persistence of the depression. Avoidance behaviors are often seen during every process of depression, from onset to recurrence. Avoidance behaviors, a decrease in pleasant phenomena, or increase in unpleasant phenomena, result in reinforcing a depressive mood. If patients can set appropriate behavioral targets and achieve them, the beneficial behaviors will be further promoted with positive feed-back. The behavioral change, as-a consequence, will result in improvement of the mood, cognition, and depression itself. In this manuscript, the author presents two clinical cases, in which BA assisted the patients in recovering from their depression. The first case was a male in his thirties who repeatedly took sick leave from his work because of maladjustment, which resulted in persistent depression. The second case was a female in her thirties who suffered from OCD and then became maladjusted to her place of work, depressive, and emotionally unstable. In both cases, avoidant behaviors caused their conditions to persist. Appropriate activities formed by BA improved their moods, and their self-efficacies were gradually regained. It was suggested that BA is markedly effective, especially in patients whose avoidant behaviors mainly cause the persistence of their depressive symptoms.
[A Proposal for Natural Resilience Theory in Psychopharmacotherapy: To Deter High-dose Antipsychotic Polypharmacy].
Yagi G, Suzuki T, Uchida H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26514041
Abstract loading — click title to view on PubMed.
[One-carbon Metabolism and Schizophrenia].
Kinoshita M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502713
One-carbon metabolism is a process whereby folate transters one-carbon groups in a range of biological processes, including DNA methylation and homocysteine metabolism. We have focused on and examined the potential roles...
One-carbon metabolism is a process whereby folate transters one-carbon groups in a range of biological processes, including DNA methylation and homocysteine metabolism. We have focused on and examined the potential roles of this one-carbon metabolism in the pathology of schizophrenia. Firstly, we revealed that aberrant DNA methylation in schizophrenia occurred across the whole genome in peripheral leukocytes by conducting genome-wide DNA methylation profiling. Secondly, we demonstrated that plasma total homocysteine was associated with DNA methylation in patients with schizophrenia at specific genes. Thirdly, we demonstrated that blood homocysteine levels were significantly higher in patients with schizophrenia than in non-psychiatric controls by conducting meta-analysis of previous observational studies. Fourthly, we demonstrated a causal relationship between blood homocysteine and schizophrenia by conducting Mendelian randomization analysis. Finally, we demonstrated that the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which causes reduced enzyme activity and higher homocysteine levels, was a risk factor for developing schizophrenia in a Japanese population by conducting meta-analysis of previous genetic association studies. These results will add new insights into the pathology and treatment of schizophrenia.
[Democratizing the Privileges of Psychiatrists].
Fukuda M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502712
Psychiatrists are endowed with many privileges in their clinical practices. These include privileges to engage with personally and socially important disorders, those stemming from the role of psychiatrists as medical pr...
Psychiatrists are endowed with many privileges in their clinical practices. These include privileges to engage with personally and socially important disorders, those stemming from the role of psychiatrists as medical professionals, and those given by their situation in the context of a social psychiatric system. These privileges allow psychiatrists to attain profound insight into the significance and value of life. Psychiatrists must inculcate a mission to be aware of and to make use of these privileges for advances in psychiatry and clinical practices. One of the most important privileges of psychiatrists is to share their feeling of self-respect obtained by devoting themselves to "the most important medicine for humans" with their patients, families, and colleagues.
[Treatment of Anorexia Nervosa Patients in General Hospitals with Psychiatric Wards Current Situation and Establishment of a Treatment System].
Wada Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502711
Patients with anorexia nervosa (AN) exhibit physical and psychiatric symptoms, in addition to their behavioral problems, and often require admission to a general hospital with a psychiatric ward. There are only a few gen...
Patients with anorexia nervosa (AN) exhibit physical and psychiatric symptoms, in addition to their behavioral problems, and often require admission to a general hospital with a psychiatric ward. There are only a few general hospitals with psychiatric wards available, and patients with AN tend to be concentrated in a small number of such institutions. Thus, it is difficult to provide adequate support for the treatment of patients with AN. In Kyoto, the number of general hospitals with a psychiatric ward is small. Patients with AN tend to be treated at the two university hospitals. However, our University Hospital cannot accept all patients with AN, especially the emergency admissions. Therefore, with respect to the inpatient treatment of AN, we established a cooperation agreement with other psychiatric hospitals. We are planning to divide the inpatient treatment of AN between our university hospital and other psychiatric hospitals, depending on the stage of AN and the severity of the patients' physical condition. With respect to the treatment of AN, it is necessary to establish a treatment system with each hospital playing a role.
[Limitations and Problems with Treatment of Eating Disorders in a Psychiatric Hospital].
Amayasu H, Okubo M, Itai T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502710
Treating patients who have eating disorders in psychiatric hospitals is difficult for several reasons. The first reason is that there is a shortage of qualified psychiatrists. For each psychiatrist, there are approximate...
Treating patients who have eating disorders in psychiatric hospitals is difficult for several reasons. The first reason is that there is a shortage of qualified psychiatrists. For each psychiatrist, there are approximately thirty hospitalized patients. In addition to this limited number of psychiatrists, funding in psychiatric hospitals only provides for a limited number of other medical staff when compared with funding available for general hospitals. The second reason is that there is a problem with the national medical treatment fee system. Specifically, in the current system, patients are not permitted to stay in hospitals long-term; outpatient treatment is preferred. The third reason is that psychiatric hospitals are not equipped to deal with patients who have physical illnesses. The following two case studies highlight the problems and limitations associated with treating patients who have eating disorders. Ways in which psychiatric hospitals can collaborate with other organizations, including low enforcement officials, are also considered. Although it is clear that an integrated and collaborative approach is necessary, implementation of such a system is still a long way from being realized, and greater effort is needed to provide patients suffering from eating disorders with the best possible treatment.
[A Comprehensive Care System for Children with Anorexia Nervosa in Pediatric Practice].
Watanabe H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502709
Against the backdrop of rapid industrialization and westernization after the World War II, there has been an ever increasing number of children with anorexia nervosa (AN) in pediatric practice, making it one of the most...
Against the backdrop of rapid industrialization and westernization after the World War II, there has been an ever increasing number of children with anorexia nervosa (AN) in pediatric practice, making it one of the most common diseases in children. With a severe lack of AN specialists in Japan, pediatricians need to face the daunting task of treating AN on their own. Malnutrition overlooked during periods of growth and development yields a risk of death, growth disturbance and an intractable conditions with secondary disorders of brain atrophy, osteoporosis, infertility, maltreatment and childrearing failures, mental disorders and others, which can last for life. Prevention is the best and a must for AN, and an early detection and treatment need to be in place to mitigate its progress and aggravation. It is crucial that an effective care is provided in early, treatable stage to assist the patient back to a healthy developmental trajectory. In 1993, the Department of Pediatrics, School of Medicine, Keio University (hereafter PKU) appointed a child psychiatrist as its fulltime staff and has included inpatient treatment of AN as a compulsory item of its postgraduate training program. Over the past twenty years, PKU has developed a comprehensive treatment system of AN (Scientific Report of Ministry of Welfare and Labor 2006). In the primary care of AN, a screening tool using simple physical measurement of weight on growth chart combined with pulse proves effective. When a weight on growth chart reveals an unhealthy weight loss and is combined with bradycardia, it detects AN at sensitivity of 83% and specificity of 93%. In the secondary care of AN, 40 pediatric institutions affiliated with PKU implemented early treatment of AN with the support of the Mental Health Division of PKU. In the tertiary care for severely emaciated AN patients, an around-the-clock intensive treatment program, called Anorexia Nervosa Intensive Care Unit (ANICU) was instituted. The gist of ANICU is to enhance the patient's awareness of the danger of catabolism and her incentive to overcome AN through active commitment to the treatment. This treatment program harbors principles of integrity, structure and persistence; starting with a complete bed rest and regular small-step provision of nutrition and steady enhancement of daily activities, it steadily and systematically converts the body's metabolism from catabolism to anabolism. In this treatment program, more than one hundred patients' lives were saved without a single fatal case. Trainees in PKU were provided with firsthand experience of providing comprehensive care, including taking on a role of feeding the AN patients three times a day. Around three hundred trainees were trained at PKU over the past twenty years, many of whom now treat AN in their affiliated hospitals. This collaborative care, comprised of a pediatric team, family and school, supported by a specialist, will become the most reliable way of treating AN in the coming days. We hope to decrease the sufferings of children with AN through spreading this comprehensive care system for children with AN in Japan.
[A Case of Anorexia Nervosa with Chewing and Spitting Improved by Treatment with Selective Serotonin Reuptake Inhibitors].
Inoue K, Matsubara T, Matsuo K … +1 more , Watanabe Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26502708
Chewing and spitting (CHSP) is the symptom of chewing and spitting out food without swallowing. CHSP is fairy common among patients with eating disorders, but no report has been published on drug treatment for it. We rep...
Chewing and spitting (CHSP) is the symptom of chewing and spitting out food without swallowing. CHSP is fairy common among patients with eating disorders, but no report has been published on drug treatment for it. We report a patient with anorexia nervosa showing extreme weight loss due to CHSP. After admission, CHSP was improved by treatment with Selective Serotonin Reuptake Inhibitors, leading to marked recovery of the body weight CHSP may represent a marker for illness severity, so its early treatment is critical to prevent the increasing severity of eating disorders.
[Psychotherapeutic considerations regarding medication treatment for refractory cases].
Kuroki T
Seishin Shinkeigaku Zasshi · 2014 · PMID 25711120
The aim of this paper is to consider the psychotherapeutic approach to refractory cases in a psychiatric clinic. Although standardized, formulated psychotherapies, i. e., CBT and IPT, have a limited efficacy against anti...
The aim of this paper is to consider the psychotherapeutic approach to refractory cases in a psychiatric clinic. Although standardized, formulated psychotherapies, i. e., CBT and IPT, have a limited efficacy against antidepressant-resistant or chronic depression, psychotherapy and medication treatment may complement each other in combination. However, the first step in the psychotherapeutic consideration of refractory depression is to give up seeking "a specific medicine" which does not exist. On the other hand, a doctor should give his/her patient new hope for recovery and stimulate their motivation for treatment. In the dialogue between a doctor and patient, the following points are to be focused on : 1) The essential part of treatment is not medicine but the patient him-/herself. 2) Recommendation of medication should not further reduce the patient's pride. 3) It should be clear that medication treatment is a collaborative activity between patients and doctors. It is preferable for topics of an interview to extend from a reconsideration of the prescription contents to reconstruction of the daily life. It may be helpful for patients to obtain detailed advice on basic lifestyle aspects, such as sleep, meals, and daily activities.
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