Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[The International Study of Burnout Syndrome among Psychiatric Trainees (BoSS International) : Findings from Statistical Analysis of the Japanese Data (BoSS Japan)].
Tateno M, Kato TA, Uehara-Aoyama K … +15 more , Umene-Nakano W, Nakamae T, Uchida N, Naoki Hashimo, Kikuchi S, Yosuke Wake, Fujisawa D, Ikari K, Otsuka K, Takahashi K, Okugawa G, Watanabe N, Shirasaka T, Jovanovic N, Beezhold J
Seishin Shinkeigaku Zasshi · 2017 · PMID 30620843
BACKGROUND: Burnout is a psychological condition that may occur after being exposed to excessive and prolonged work-related stresses. Previous studies have demonstrated that the rate of burnout among physicians may be hi...
BACKGROUND: Burnout is a psychological condition that may occur after being exposed to excessive and prolonged work-related stresses. Previous studies have demonstrated that the rate of burnout among physicians may be higher compared to other occupations ; and espe- cially psychiatric trainees would have a higher risk of burnout because of limited clinical expe- rience, the burden of heavy duties and longer work-hours etc. In this study, we report the findings from Japanese data obtained as part of the international study of burnout syndrome among psychiatric trainees (BoSS International). METHODS: This study was initiated by members of the European Federation of Psychiatric Trainees (EFPT) and the European Psychiatric Association-European Early Career Psychia- trists (EPA-EECP). The total number of participating nations was 22 countries. A national coordinator recruited study collaborators all over Japan and psychiatric trainees working at their medical institutes were invited to participate in BoSS International by e-mail. The sub- jects were requested to answer the on-line questionnaire anonymously. Consent was obtained when making a list of potential participants at each institute and reconfirmed on the first page of the on-line questionnaire. Answering the questionnaire was deemed to constitute consent. RESULTS: Total number of participants to BoSS International was 7,525 from 22 countries and regions. Of them, 1,980 psychiatric trainees fully completed answering the questionnaire (response rate (RR) 26.0%) including 95 Japanese trainees (RR 41.5%). The mean age of 95 Japanese psychiatric trainees (male rate 67.4%) enrolled in BoSS International was 31.8?4.8 year-old. Their mean clinical experience was 2.9 ?4.4 years. The mean weekly working hours were 72.3?27.1, which was the longest of the 22 participating countries/regions ; while weekly clinical supervision by a mentor was only 3.8?9.0 hours. Regarding the severity of burnout, assessed by using the Maslach Burnout Inventory-General Survey (MBI-GS) consisting of three factors (emotional exhaustion, cynicism, and low sense of professional efficacy): 41 Japanese psychiatric trainees (42.0%) meet the criteria of severe burnout syndrome in this study ; with emotional exhaustion scores of 2.20 and higher, and cynicism of 2.00 and higher. Signifi- cant differences were found on the PHQ-9 score and mean length of supervision between those participants with presence and absence of severe burnout syndrome by using Student's t-test. CONCLUSION: Statistical analyses of the whole data (n=1,980) revealed that the risk of burnout was higher for trainees who were younger, without children, and had not opted for psychiatry as a first career choice. Further analyses after adjustment for socio-demographic characteristics and country difference still demonstrated severe burnout was associated with long working hours, less supervision, and not having regular rest. The analyses of Japanese data showed similar tendencies, although statistical significance was not observed. Burnout among psychiatry trainees may be linked to drop-out from the training program and malprac- tice in clinical settings. We should be aware of the higher risk of burnout in residents and the importance of regular and sufficient supervision to prevent burnout.
[National Guidelines and Useful Guidance for Psychiatrists When Cooperating with Companies].
Inoue K
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192791
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 t...
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.
[Mental Health and Prevention of Suicide in Japanese Workplaces Based on a Pilot Study of Job Stress and Suicide Ideation].
Sakagami Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192790
The Japanese suicide rate is still high compared with other countries. Worker suicide especially leads to marked social and economic losses and severely affects the bereaved. There is an urgent need to devise a system to...
The Japanese suicide rate is still high compared with other countries. Worker suicide especially leads to marked social and economic losses and severely affects the bereaved. There is an urgent need to devise a system to prevent suicide at a very early stage. Generally, it is considered very difficult to intervene and prevent suicide in cases in which individuals kill themselves suddenly. However, according to some studies on suicide attempts, even those who killed themselves suddenly had experienced some kind of conflict or a desire to die for a long period. Therefore, it is essential to analyze the risk factors at an early stage when individuals have vague thoughts of suicide. This will help reduce the risk of suicide in such cases. In this article, I first survey the data related to workers' mental health in Japan. Second, I introduce the results of our pilot study in which we investigated mental health issues related to suicide among workers who have taken leave from work for more than two months. In this study, workers who do not exhibit help-seeking behavior are suggested to be a high-risk group for suicide. It is speculated that this behavior is related to several factors such as the sex, age, social status, education, personal stigma, and perceived stigma. Therefore, we must focus on both clinical and social solutions for the prevention of suicide. I believe that psychiatrists will come to play a more important role as liaisons between workplaces and social resources for the prevention of suicide.
[Designing and Operating a Comprehensive Mental Health Management System to Support Faculty at a University That Contains a Medical School and University Hospital].
Kawanishi C
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192789
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 disorde...
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.
[Suicide Prevention and Mental Health Measures for Japanese University Students].
Ohnishi M, Koyama S, Senoo A … +2 more , Kawahara H, Shimizu Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192788
According to the nationwide survey of the National University students in Japan, the annual suicide rate in 2012 was 15.7 per 100,000 undergraduate students. In many universities, suicide prevention is an important issue...
According to the nationwide survey of the National University students in Japan, the annual suicide rate in 2012 was 15.7 per 100,000 undergraduate students. In many universities, suicide prevention is an important issue regarding mental health measures, and each university is actively examining this. The current situation concerning measures for suicide prevention in the Japanese National Universities was investigated in 2009. In 2010, the "college student's suicide prevention measures guideline, 2010" was established based on the results of this investigation. This guideline refers to the basic philosophy of suicide prevention in Chapter 1, risk factors for suicide in Chapter 2, and systems and activities for suicide prevention in Chapter 3. The Health Service Center, Okayama University plays central roles in mental health and suicide prevention measures on the Medical Campus. The primary prevention includes a mini-lecture on mental health, classes on mental health, and periodic workshops and lectures for freshmen. The secondary prevention includes interviews with students with mental health disorders by a psychiatrist during periodic health check-ups and introducing them to a hospital outside the university. The tertiary prevention includes support for students taking a leave of absence to return to school, periodic consultation with such students with mental disorders, and postvention following a suicide. We believe that for mental health measures on the university campus, it is important to efficiently make use of limited resources, and that these efforts will eventually lead to suicide prevention.
[Management of Common-law Marriage in Hospitalization for Medical Care and Protection Procedure after Abolishment of Guardianship System].
Ibaraki T
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192787
Abstract loading — click title to view on PubMed.
[Identification of Psychotropic Drugs Attributed to Fatal Overdose--A Case-control Study by Data from the Tokyo Medical Examiner's Office and Prescriptions].
Hikiji W, Okumura Y, Matsumoto T … +4 more , Tanifuji T, Suzuki H, Takeshima T, Fukunaga T
Seishin Shinkeigaku Zasshi · 2016 · PMID 27192786
Drug overdose is a serious public health issue and fatal cases have been reported from various fields of medicine. This case-control analysis assessed the comparison between fatal overdose cases in the special wards of T...
Drug overdose is a serious public health issue and fatal cases have been reported from various fields of medicine. This case-control analysis assessed the comparison between fatal overdose cases in the special wards of Tokyo Metropolitan area and prescribed psychotropic drugs in Tokyo in 2009-2010. It was suggested that the prescribed drugs serve as a direct cause of death in overdose cases. Furthermore, pentobarbital calcium, chlorpromazine-promethazine-phenobarbital, levomepromazine and flunitrazepam were identified as drugs with a high risk of fatal overdose. It is encouraged to prudently verify the intended application and usage of such psychotropic drugs in each case upon their prescription. This is the first study in Japan to identify psychotropic drugs with a high risk of fatal overdose by case-control study.
[Adverse Sensory Input of Childhood Maltreatment Modified by Early Experience Ascertaining the Neural Basis of Neurodevelopmental and Attachment Disorders].
Tomoda A
Seishin Shinkeigaku Zasshi · 2015 · PMID 26901893
Childhood maltreatment, which markedly increases the risk of psychopathology such as depression, PTSD, and reduced cognitive abilities, is associated with structural and functional brain differences. Our earlier studies...
Childhood maltreatment, which markedly increases the risk of psychopathology such as depression, PTSD, and reduced cognitive abilities, is associated with structural and functional brain differences. Our earlier studies elucidated potential discernible effects on the brain morphology of childhood maltreatment on the gray matter volume or cortical thickness. Further, our preliminary studies revealed a significantly reduced gray matter volume (GMV) in the left primary visual cortex (Brodmann area 17) in the reactive attachment disorder (RAD) group compared to the typically developed group. These visual cortex GMV abnormalities may also be associated with such visual stimulus-induced emotion regulation impairments of RAD, leading to an increase in the risk of future psychopathology. Brain regions that process and convey the adverse sensory input of the abuse might be modified specifically by such experiences, particularly in subjects exposed to a single type of maltreatment. Thus, exposure to multiple types of maltreatment is more commonly associated with morphological alterations in corticolimbic regions.
[Monitoring and Care of Expectant Mothers with Epilepsy].
Watanabe M, Honda M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26901892
Women with epilepsy are exposed to social stigma, and they have anxiety and lose self-confidence in their social role as a woman. Psychiatrists, especially female psychiatrists, are able to support them. Important consid...
Women with epilepsy are exposed to social stigma, and they have anxiety and lose self-confidence in their social role as a woman. Psychiatrists, especially female psychiatrists, are able to support them. Important considerations are: 1) Pre-pregnant counseling; Physicians give appropriate advice and guidance. We need to provide the latest information on the teratogenicity of AEDs, and replace them with a safer combination of AEDs BEFORE pregnancy. Folate supplementation is also recommended. 2) Management during pregnancy: Patients are advised to adhere to taking AEDs as instructed, which prevents not only seizures during pregnancy but also reduces the risk of miscarriage and premature delivery. Doses of AED are to be increased after the second trimester. 3) Collaborating with obstetricians at delivery: Obstetricians are also nervous when faced with women with epilepsy. Basically, patients can deliver spontaneously, and the correct way to deal with unexpected seizures during labor should be fully understood. 4) Parental care: women with epilepsy can breastfeed. Physicians advise other family members on how to bottle feed at night to help mothers avoid a lack of sleep due to breastfeeding. Childcare is one of the most precious experiences in life. Patients with epilepsy, especially women, have a lower self-esteem; however, once they experience delivery, they act positively and become even-tempered. Physicians should be aware that childcare fosters a profound insight into their lives, allowing them to mature as a person.
[Supporting the Love, Marriage, and Child-Rearing of Persons with Schizophrenia].
Ikebuchi E
Seishin Shinkeigaku Zasshi · 2015 · PMID 26901891
Persons with schizophrenia and their families have strong interests and hopes for love, marriage, pregnancy, and child-rearing. These experiences often lead to recovery from schizophrenia. There are many partners with sc...
Persons with schizophrenia and their families have strong interests and hopes for love, marriage, pregnancy, and child-rearing. These experiences often lead to recovery from schizophrenia. There are many partners with schizophrenia who enjoy fruitful lives even with their disability. However, only some persons can enter into such lives in the real world in Japan and other countries. This leads persons with schizophrenia to develop a discouraged and disappointed attitude, and also causes professionals of mental health to develop indifference or pessimism about these issues. Schizophrenics are thought to have interests in love and sexual behavior just as strong as the general population. I discuss with my patients about these issues and working life early in the course of treatment. Because they lose their chance to learn adult behavior in social lives with peers due to the beginning of schizophrenia, they need an opportunity to participate in a social situation to learn knowledge and skills of dating and related behaviors, and systematic education such as psycho-education and social skills training should be provided. Continuing married life and child-rearing require more support from experts with rich experience and knowledge. Psychiatrists are required to participate in shared decision-making about medication during pregnancy and breast-feeding, as well as provide knowledge on the benefits and risks of antipsychotics. Net-working with the family, professionals of child welfare, and the community is necessary to support child-rearing. Urakawa Bethel's House was introduced as a pioneering concept to support love, marriage, and child-rearing. Finally, professionals' negative or indifferent attitudes toward these issues are discussed in the setting of treatment. I hope that professionals of mental health will think about these issues from the standpoints of persons with schizophrenia and their families.
[Perinatal Depression: The Meaning of the Paradigm Shift from "Postnatal" to "Perinatal"].
Kamo T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26901890
Psychiatry regarding pregnancy, childbirth, and child-rearing is changing rapidly. In this paper, the meaning of the paradigm shift from postnantal to perinatal depression along with the changing treatment are discussed....
Psychiatry regarding pregnancy, childbirth, and child-rearing is changing rapidly. In this paper, the meaning of the paradigm shift from postnantal to perinatal depression along with the changing treatment are discussed. Since the late 20 century, several large-scale epidemiological surveys on the incidence and outcomes of postnatal depression have concluded not only that postpartum depression is likely to occur at a high frequency, such as 10-15%, but that the subsequent maternal mortality rate as the number of deaths from suicide is higher than deaths due to obstetric medical conditions. Additionally, evidence of the negative impact of a mother's depression on the physical and mental development of children has been accumulated as well. Several studies regarding depression during pregnancy, such as on the relatively high frequency of prenatal depression or negative consequence of interrupted pharmacological treatment, should also be highlighted. These movements seemed to reflect the change in special attributes of depressive disorders and bipolar disorders, in that the term perinatal onset came to be preferred instead of postnatal, used in DSM-IV. Comprehensive treatment guidelines for depression applicable for all women with the potential for pregnancy, delivery, and lactation are needed as the next step.
[A Case with Multiple Comorbidities of Obsessive-Compulsive and Related Disorders].
Arikawa A, Mito H, Motoyama M … +4 more , Yamanishi K, Hayashida K, Maebayashi K, Matsunaga H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26901889
Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-...
Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), skin picking disorder (SPD), and hair pulling disorder (HPD), which share core clinical features such as preoccupation or recurrent thoughts and/or repetitive behaviors. Repetitive behaviors in BDD and HD can be differentially characterized by the presence of cognitive components associated with preceding anxiety from those in SPD or HPD, which are only observed as motoric components that regulate emotions or alleviate tension. Thus, the validity of the OCRD category and specific interrelationships between each OCRD remain uncertain. In the present study, therefore, we presented a case of multiple comorbidities of OCRDs in order to discuss the nature of the OCRD category. Our patient was a 20-year-old female university student. At the age of 11 years old, she started picking at acne on her face. The psychopathological, and treatment features observed in this case indicated possible interrelationships among OCRDs, especially between cognitive and motoric OCRDs, which supported the clinical utility and continuous nature of this category.
[Molecular Biology on the Mechanisms of Autism Spectrum Disorder for Clinical Psychiatrists].
Makinodan M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827412
While, in general, a certain number of clinical psychiatrists might not be familiar with molecular biology, the mechanisms of mental illnesses have been uncovered by molecular biology for decades. Among mental illnesses,...
While, in general, a certain number of clinical psychiatrists might not be familiar with molecular biology, the mechanisms of mental illnesses have been uncovered by molecular biology for decades. Among mental illnesses, even biological psychiatrists and neuroscientists have paid less attention to the biological treatment of autism spectrum disorder (ASD) than Alzheimer's disease and schizophrenia since ASD has been regarded as a developmental disorder that was seemingly untreatable. However, multifaceted methods of molecular biology have revealed the mechanisms that would lead to the medication of ASD. In this article, how molecular biology dissects the pathobiology of ASD is described in order to announce the possibilities of biological treatment for clinical psychiatrists.
[Impact of DSM-5: Application and Problems Based on Clinical and Research Viewpoints on Anxiety Disorders].
Shioiri T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827411
In Japan, the impact of DSM-5 has been greater than we had imagined. The Japanese Society of Psychiatry and Neurology organized a group for translation and the members spent many hours in this volunteer effort over a 2-y...
In Japan, the impact of DSM-5 has been greater than we had imagined. The Japanese Society of Psychiatry and Neurology organized a group for translation and the members spent many hours in this volunteer effort over a 2-year period. This highlights the significance of and expectations for DSM-5 in clinical practice in Japan. Regarding anxiety disorders, the highlights of changes from DSM-IV-TR to DSM-5 are as follows. Firstly, the DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder(which are included with trauma- and stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them. Secondly, in DSM-IV, selective mutism and separation anxiety disorder were classified in the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence." They are now classified as an anxiety disorder. Through these two changes, at the beginning of the chapter, it can be clearly noted that anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Thirdly, panic disorder and agoraphobia are not associated in DSM-5. Thus, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without a history of panic disorder are now replaced by two diagnoses, panic disorder and agoraphobia, each with separate criteria. The co-occurrence of panic disorder and agoraphobia is now coded with two diagnoses. This change recognizes that a marked number of individuals with agoraphobia do not experience panic symptoms. For the present, this change ends the. controversy over the hierarchy between panic disorder and agoraphobia. The diagnostic criteria for agoraphobia are derived from the DSM-IV descriptors for agoraphobia, although the clarification of fears from two or more agoraphobia-related situations is now required, because this is a robust means for distinguishing agoraphobia from specific phobias. Also, the criteria for agoraphobia are now extended to be consistent with criteria sets for other anxiety disorders (e.g., a clinician's judgment of the fears as being out of proportion to the actual danger in the situation, with a typical duration of 6 months or more). From the above, these changes from DSM-IV-TR to DSM-5 in anxiety disorders make our judgments faster and more efficient in clinical practice, and DSM-5 is more useful to elucidate the pathology. In this manuscript, we discuss the application and problems based on clinical and research viewpoints regarding anxiety disorders in DSM-5.
[The Schizophrenia Spectrum and Other Psychotic Disorders in DSM-5].
Kanazawa T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827410
Characteristic changes to schizophrenia in DSM-5 are the downgrading of Schneiderian first-rank symptoms and the elimination of subtypes in schizophrenia. Since dimensional evaluation was officially suspended, schizophre...
Characteristic changes to schizophrenia in DSM-5 are the downgrading of Schneiderian first-rank symptoms and the elimination of subtypes in schizophrenia. Since dimensional evaluation was officially suspended, schizophrenia with a flat face has been described in DSM-5. Recent genomic research, especially involving CNV analysis, has revealed that the categories in DSM are not based on biological information. Because "schizophrenia" was initially just a temporary diagnosis before the clarification of its biological basis, it will be divided when a clear etiology or causal genetic information is found in the future. Meanwhile, we have to follow its changes in a clinical setting due to the lack of alternatives to DSM. Since the practical "perspective" on the disorder is different from research to clarify its etiology, it is impossible, to set one diagnostic criterion to satisfy the requirements from these two perspectives. It will be necessary to use the RDoC in future research for effective categorization.
[Bipolar Disorder and Major Depressive Disorder in DSM-5: How to Manage in Clinical and Research Fields].
Kato M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827409
A brief overview of the changes from DSM IV to DSM-5 about "mood disorders" could be: "1. Change of diagnostic category", "2. Addition of new specifiers", and "3. Suggestion of severity assessment tools". The main impact...
A brief overview of the changes from DSM IV to DSM-5 about "mood disorders" could be: "1. Change of diagnostic category", "2. Addition of new specifiers", and "3. Suggestion of severity assessment tools". The main impact of 1. Change of diagnostic category could be that the "mood disorder" category has disappeared and it has been divided into bipolar disorder and major depressive disorder (MDD). This change was based on the evidence that MDD is distinct from bipolar disorder in the light of genetic and brain structures compared to schizo- phrenia. Some risk-associated genes have been detected related to bipolar disorder and schizophrenia but not to MDD. This could be due to low inter-rater reliability regarding MDD. Furthermore, the specificity of MDD diagnostic criteria is low and various other depression-like disorders that are pathophysiologically different from MDD could be included in the criteria as a phenocopy. Diagnosis from a dimensional point of view with new specifiers and severity assessment tools, described above as points "2" and "3", added to DSM-5 could characterize MDD in more detail and solve this problem related to low inter-rater reliability. A dimensional approach could not only identify specific phenotypes in further research but also clinically provide valuable information to put evidence to practical use. In this review, I would like to focus on the significance of the changes in DSM-5 and provide some suggestions on how we should use DSM-5 in clinical and research settings.
[Deceased Schizophrenic Patients--Focus on QT Prolongation].
Matsuda K, Kase K, Hara K … +6 more , Asai Y, Asai K, Sakurai S, Yumoto T, Takayama K, Shuno T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827408
We retrospectively evaluated factors affecting the lifespan of schizophrenic patients, who are known to have a shorter life expectancy than healthy people, focusing on the relationship with QT prolongation associated wit...
We retrospectively evaluated factors affecting the lifespan of schizophrenic patients, who are known to have a shorter life expectancy than healthy people, focusing on the relationship with QT prolongation associated with antipsychotics. In a total of 406 patients who died at Asai Hospital the mean age at death was compared between schizophrenic patients and nonpsychiatric patients. In deceased schizophrenic patients, drug-related factors, hematology results, and electrocardiographic findings for 3 years before death were compared with those for the same period in age-matched surviving schizophrenic patients. In addition, QT values in schizophrenic patients and healthy controls were evaluated by age group. The mean age at death was significantly younger in schizophrenic patients (63.4 +/- 2.63 years) than in nonpsychiatric patients (84.0 +/- 0.57 years) (p<0.001). Bivariate analysis between deceased and surviving schizophrenic patients showed significant differences in QT values at 2 years, 1 year, and 0.5 years before death and in AST and ALT values at 0.5.years before death. The incidence of QT prolongation in deceased schizophrenic patients (52.0%) was about twice as high as that in surviving schizophrenic patients (24.5%). Multiple logistic regression analysis suggested that the proportion of deceased patients was higher when QT intervals were longer and ALT values were relatively higher, even if within the normal range. In both schizophrenic patients and medical checkup examinees, QT values were positively correlated with the age (R2 = 0.9061 and 0.9276, respectively), and QT intervals in schizophrenic patients were significantly longer in the 30- to 70-year age groups. In both schizophrenic patients and medical checkup examinees, QT values were positively correlated with the age, and QT intervals in schizophrenic patients were significantly longer than those in medical checkup examinees in the same age groups. Deceased schizophrenic patients showed significantly longer QT intervals from 2 years before death than age-matched surviving schizophrenic patients. QT prolongation may influence the lifespan of schizophrenic patients, which are shorter than those of nonpsychiatric patients. This highlights the importance of following electrocardiographic findings and hematology results of schizophrenic patients over time.
[A Case with the Increased PT-INR after the Addition of Mirtazapine to Warfarin Therapy].
Nishimura H, Kawakami M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26827407
OBJECTIVE: To report a case of warfarinization involving a patient who developed nasal bleeding and an elevated prothrombin time-international normalized ratio (PT-INR) after taking 15 mg of mirtazapine. CASE SUMMARY: A...
OBJECTIVE: To report a case of warfarinization involving a patient who developed nasal bleeding and an elevated prothrombin time-international normalized ratio (PT-INR) after taking 15 mg of mirtazapine. CASE SUMMARY: A 70-year-old Japanese man with anxiety and irritation was admitted to the ER of our hospital with nasal bleeding. His medical history included atrial fibrillation, treated with warfarin at 3.0 mg a day, hypertension, and diabetus mellitus. He had also been taking mirtazapine at 15 mg. He experienced nasal bleeding 4 days after the initiation of therapy with mirtazapine. His PT-INR markedly elevated from 1.21 before therapy to 7.93 after therapy. Both mirtazapine and warfarin were immediately discontinued by his cardiologist. One week later, PT-INR had normalized (1.00) and the nasal bleeding had resolved. DISCUSSION: The metabolism of warfarin involves several cytochrome P450 isoenzymes, including CYP1A2, CYP2C9, CYP2C19, and CYP3A4. Mirtazapine is metabolized primarily by CYP2D6 and CYP3A4, with lesser contributions by CYP1A2. A competitive enzyme inhibition may occur, with CYP3A4 metabolizing the two drugs. No drug interaction was seen with his other medications. CONCLUSION: The coadministration of mirtazapine and warfarin can result in an increase in the anticoagulant effect of warfarin. This case shows the need to closely monitor potential drug interactions in the elderly, especially those taking mirtazapine and warfarin.
[Conflict of Interest Guidelines of the Japanese Society of Psychiatry and Neurology: Current Status and Considerations in the Area of Psychiatry].
Miyaoka H, Kurihara C
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721074
In 2011, the Japanese Society of Psychiatry and Neurology released the Guidelines on Conflict of Interest(COI) in Clinical Research and detailed regulations. According to the Guidelines, the COI Committee has been engage...
In 2011, the Japanese Society of Psychiatry and Neurology released the Guidelines on Conflict of Interest(COI) in Clinical Research and detailed regulations. According to the Guidelines, the COI Committee has been engaged in COI management for a one-year trial period. The members of the Society have to disclose their COIs at the time of presentations, manuscript submissions, and publications; the board and committees members have to disclose their COIs to the President of the Society; and the President reports these COI disclosures to the COI Committee. In this article, we provide a summary of this year's COI disclosures: among the 455 board and committees members, 297 were without COIs (68.5%); 98 (excluding the following two problematic cases) disclosed COIs (23.1%, excluding the following two cases); two cases were discussed regarding whether or not they were problematic (0.44%); 11 (2.4%) cases have not yet been reviewed because of a delay in disclosure; and 25 cases have yet to be disclosed (5.5%). Responding to serious COI-related affairs in other disease areas, public interest in the COI ssue has been increasing. Additionally, the Japanese Pharaceutical Manufacturers Association (JPMA) implemented Transparency Guidelines, and companies are disclosing their payments for lectures or manuscript fees to individual researchers. We should foster a deeper understanding of the concept of COI and discuss COI management in society more extensively.
[Promotion of Occupational Mental Health with Psychiatrists].
Tanaka K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721073
The promotion of occupational mental health is stipulated by laws and precedents, including the Labor Standards Act, Industrial Safety and Health Act, and Labor Contract Act. These laws and precedents are used to formula...
The promotion of occupational mental health is stipulated by laws and precedents, including the Labor Standards Act, Industrial Safety and Health Act, and Labor Contract Act. These laws and precedents are used to formulate actual mental health activities and responses to individuals with mental health disorders to some extent. Among mental health-related undertakings, the most important role that occupational health staff should play as healthcare professionals is to support business operators' obligations regarding safety. This role is to prevent health problems in the workplace, not to manage corporate risk. However, the health and safety obligations imposed on business operators under the current precedents are far beyond the levels that non-specialists can handle. The active participation of psychiatrists is needed to promote workplace mental health today.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe