Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[How to Use Presentations and Leaflets from Pharmaceutical Companies].
Nango E
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721072
Presentations and leaflets from pharmaceutical companies are still a major source of information for physicians in Japan. Most physicians trust them and base their clinical practice on them. Such products from pharmaceut...
Presentations and leaflets from pharmaceutical companies are still a major source of information for physicians in Japan. Most physicians trust them and base their clinical practice on them. Such products from pharmaceutical companies are just advertising, because they are profit-making enterprises. Gifts from pharmaceutical companies to health care providers introduce bias when prescribing medicine. Thus, it is important that health care providers who receive this information from pharmaceutical companies, interpret it correctly. There are several methods for information supplements used by pharmaceutical companies. The range of the vertical axis on a survival curve may not be the full range, and differences between treatment groups are expanded in graphs. Sometimes the shape of the survival curve is artificial. The treatment effects should be interpreted based on various indicators such as raw incidence, relative risk or the number needed to treat. A composite endpoint is often used in mega-studies because each individual outcome which comprises the composite endpoint has a small event rate that is not enough to reach statistical significance, whether outcomes are important for patients or not. Evidence-based medicine is a formulated method of clinical reasoning from evidence used to make decisions. We should consider not only the evidence, but also a patient's clinical state and circumstances, a patient's preferences and actions, and the clinical expertise of the health care providers. Although pharmaceutical companies seduce health care providers, they have to recognize the true magnitude of the effects of their products and recommend their use for patients carefully.
[Differential Diagnosis of ADHD from Personality Disorders].
Ushijima S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721071
The author discussed some points regarding the process of differentially diagnosing ADHD from antisocial personality disorder with antisocial behaviors, such as the use of amphetamines, theft, and violence, and borderlin...
The author discussed some points regarding the process of differentially diagnosing ADHD from antisocial personality disorder with antisocial behaviors, such as the use of amphetamines, theft, and violence, and borderline personality disorder with eating disorder, self-harming, overdose, and domestic violence. Firstly, the characteristics of ADHD are a lack of interest in criminal activity, cunning, cruelty, or coming from a broken home, which are frequently observed in cases of conduct disorder. The second point concerns the main anxieties and conflicts of those with ADHD and borderline personality disorder. ADHD patients usually do not have anxieties regarding sensitiveness in interpersonal relationships, which borderline patients are likely to have. The characteristic anxieties of ADHD patients usually involve self-reproach, self-deprecation, and self-hatred derived from various kinds of mistake associated with ADHD symptoms, such as a short attention span, restlessness, and impulsiveness. Finally, the author points out that we also have to be aware of the various kinds of identity problem, even in the case of patients with typical symptoms of ADHD.
[Diagnosis and Treatment of Adult ADHD Comorbid with Mood or Anxiety Disorders].
Okada T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721070
Adult ADHD is often comorbid with psychiatric disorders: depressive or bipolar disorders, anxiety disorders, other destructive disorders, or nicotine dependency. Although the pathological backgrounds of these comorbiditi...
Adult ADHD is often comorbid with psychiatric disorders: depressive or bipolar disorders, anxiety disorders, other destructive disorders, or nicotine dependency. Although the pathological backgrounds of these comorbidities are diverse, some of them, except bipolar disorder, are partly secondary to difficulties associated with ADHD. Many adults with ADHD visit psychiatrists with psychiatric symptoms. Focusing on the growth history and difficulties in daily life persisting after the remission of mood or anxiety disorders enables psychiatrists to diagnose adult ADHD. However, the diagnosis of adult ADHD is sometimes difficult, because ADHD symptoms can be regarded as symptoms of psychiatric disorders. There exist, however, slight differences in symptoms of adult ADHD and psychiatric disorders. There is some evidence on psychopharmacological interventions. In adult ADHD comorbid with bipolar disorders, it is important to stabilize mood change before treating ADHD symptoms. On the other hand, in adult ADHD comorbid with depressive disorders, it is acceptable to treat depressive and ADHD symptoms at the same time. In adult ADHD with anxiety disorders, atomoxetine can reduce anxiety as well as ADHD symptoms. In the diagnosis and treatment of adults, it is essential to assess their history from childhood to adulthood, and examine and intervene multidimensionally, including from the viewpoint of psychosocial aspects.
[Clinical Picture of Adult Attention-Deficit/Hyperactivity Disorder].
Iida J
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721069
Attention-deficit/hyperactivity disorder (ADHD) is conventionally considered a children's disorder in which the symptoms naturally disappear with age. However, in reality, the functional remission rate is about 10% even...
Attention-deficit/hyperactivity disorder (ADHD) is conventionally considered a children's disorder in which the symptoms naturally disappear with age. However, in reality, the functional remission rate is about 10% even in adulthood, and we have come to understand that 75% of people with ADHD in childhood experience a continuation of symptoms through adolescence. Epidemiological studies have reported a global prevalence of 3.4% for adult ADHD. The central distinctive feature of adult ADHD is attention deficit, while hyperactivity and impulsivity weaken or manifest differently over time. Additionally, since symptoms continue from childhood, the characteristics of ADHD become part of the personality of the individual, making it difficult to think of traits as symptoms. Therefore, with adult ADHD and its traits in mind, diagnosis should be made with due care and attention, especially as some of the symptoms of ADHD can also be seen in a number of other mental illnesses. Caution should be exercised in the differential diagnosis of ADHD in order to avoid over-diagnosis.
[Appropriate Adult Attention Deficit Hyperactivity Disorder Based on DSM-5].
Saito T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721068
The purpose of this article is to discuss the recent proposals for the revision of the diagnostic criteria in DSM-5 by the American Psychiatric Association. The previous DSM-IV-TR ADHD diagnosis had several conceptual pr...
The purpose of this article is to discuss the recent proposals for the revision of the diagnostic criteria in DSM-5 by the American Psychiatric Association. The previous DSM-IV-TR ADHD diagnosis had several conceptual problems, and this revision has long been expected to resolve those problems. However, the revised DSM-5 ADHD diagnosis was not necessarily welcomed by all psychiatrists. The major concerns with the current diagnostic criteria for ADHD and, hence, the main suggestions for change, focused on the general structure and organization of subtypes or specifiers, the number, content, and distribution of criteria, the age of onset criteria, and the cross-situationality and exclusion criteria for ASD. The revised DSM-5 adult ADHD diagnosis is controversial. However, clinical research and expert consensus guidelines over the past decade have increasingly clarified the most effective approaches for the diagnosis and treatment of the disorder. Hence, the purpose of this article is to provide psychiatrists with the most up-to-date, evidence-based information on the assessment and diagnosis of adult ADHD.
[Recent Trends in Medical Education Administration in Japan, with a Focus on Postgraduate Education].
Hirako T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721067
Abstract loading — click title to view on PubMed.
[The Role of Undergraduate Education in Graduate School Education].
Matsushita T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721066
As recent medical residents tend to be more enthusiastic toward obtaining board certification rather than a doctorate of research, many graduate schools have made various attempts to ensure the number of enrollees. This...
As recent medical residents tend to be more enthusiastic toward obtaining board certification rather than a doctorate of research, many graduate schools have made various attempts to ensure the number of enrollees. This paper considers the role of undergraduate education in graduate school education. The practice of medical research is part of the curriculum in many medical schools. Although such a program is useful for providing an opportunity to experience actual research for all students, the most important purpose is to identify students who have an aptitude and motivation for medical research. Continuous support based on a selective curriculum, such as long-term research practice, may guide these students toward research activities after graduation. In undergraduate education, it is also important to expose students to favorable role models who elicit students' admiration. Students firstly experience a clinical setting in their clerkship, and see their faculty while working as a physician. Exposure to favorable role models in the clinical clerkship makes students long to become the role model and choose their career. It is therefore important to have good researchers as role models and suggest the career path of a researcher to students in undergraduate education.
[Differences between Graduate School Systems between Japan and the United States].
Sasaki T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721065
The differences in graduate school systems and their curriculum between Japan and the United State stem from their objectives, which are adjusted toward needs in each society. To encourage Japanese MDs to enter graduate...
The differences in graduate school systems and their curriculum between Japan and the United State stem from their objectives, which are adjusted toward needs in each society. To encourage Japanese MDs to enter graduate school, two approaches are needed: improving the quality of graduate education, and foster interest in research and career in academia while students are in medical school.
[Development of Human Resources to Solve Psychiatric Issues].
Ozaki N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721064
Psychiatric research is important to answer daily clinical questions, clarify the etiopathology, and develop diagnostic methods and treatments based on the etiopathology. Therefore, the goal of departments of psychiatry...
Psychiatric research is important to answer daily clinical questions, clarify the etiopathology, and develop diagnostic methods and treatments based on the etiopathology. Therefore, the goal of departments of psychiatry in universities is to train the next generation of leaders in psychiatry who can promote innovative and personalized care for patients. In terms of the development of research-oriented human resources, it is necessary to emphasize the importance of prioritizing patients' demands and education regarding the following points:1) After the critical appraisal of papers, we have to elucidate what we know and what we do not know to clearly determine the purpose of research (Social or scientific value). 2) We have to use accepted methods, including statistical techniques, to produce reliable and valid data (Scientific validity). In addition, we should introduce ethical considerations into clinical research, including informed consent. The development of research-oriented human resources is indispensable for future research focused on the needs of psychiatric patients and their families.
[Discharge Dynamics and Related Factors of Long-stay Patients in Psychiatric Hospitals].
Kono T, Shiraishi H, Tachimori H … +3 more , Koyama A, Naganuma Y, Takeshima T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721063
A longstanding challenge in Japan is prolonged psychiatric hospitalization and the associated difficulty of discharge, lost opportunities for patients' social participation, and stagnant reallocation of medical resources...
A longstanding challenge in Japan is prolonged psychiatric hospitalization and the associated difficulty of discharge, lost opportunities for patients' social participation, and stagnant reallocation of medical resources. Although the length of stay has been shortened recently on average, its distribution tends to be polarized into high-turnover and long-stay groups. To resolve these problems, we must understand the discharge dynamics of long-stay patients. Three questionnaires were sent to 733 randomly selected psychiatric hospitals (response rate: 24.3%; 178 hospitals, 2,480 patients). One questionnaire was on hospitalized patient numbers for one-year or longer stays as at the end of June 2007, recording each combination of Group (A or B), diagnosis, and hospitalization type. Group A referred to patients continuously hospitalized as at the end of June 2008; Group B referred to those discharged between July 2007 and June 2008. The second questionnaire was on hospital characteristics (founder, bed number, medical function, etc.), and the third questionnaire was on detailed patient characteristics (residential setting post-discharge, etc., for each Group B patient; a maximum of 20 patients per hospital consecutively in order of discharge). Valid data were obtained from 171 hospitals and 2,419 patients, with the latter increasing to 3,543 after weighting. The annual discharge rate (ADR; B/[A+B]) for the entire sample was 16.3%. Regarding the diagnosis, dementia showed the highest ADR (27.8%) and schizophrenia the lowest (13.5%). The ADRs for depression, bipolar disorder, and alcoholism were 23.9, 20.6, and 23.7% respectively. Regarding the hospitalization type, voluntary hospitalization (16.0%) and hospitalization for medical care and protection (16.8%) showed similar ADRs. Regarding the district, ADRs were high in Kinki (19.9%) and Kyushu (18.8%), and low in Kanto (14.1%) and Chugoku/Shikoku (14.2%). Multivariate analyses revealed that discharge within one year was significantly correlated with the diagnosis, district, hospital founder, and presence of psychiatric emergency or acute-phase treatment (acute-phase-type) wards in hospitals, but not with the hospitalization type, presence of psychiatric long-term care wards, or presence of senile dementia wards. The probability of discharge (odds ratio [95% confidence interval]) regarding the diagnosis was higher in dementia (2.47 [2.23-2.74]), alcoholism (2.09 [1.71-2.55]), depression (2.07 [1.65-2.59]), and bipolar disorder (1.70 [1.35-2.16]) than in schizophrenia (reference). Regarding the district, the probability was higher in Kinki (1.32 [1.12-1.54]) and Kyushu (1.27 [1.14-1.42]) than Kanto (reference). The probability was also lower in private hospitals (0.58 [0.51-0.66]) than in public/university hospitals (reference), and higher in hospitals with acute-phase-type wards (1.24 [1.14-1.35]) than in those without them (reference). The most common residential setting post-discharge for the total sample of weighted Group B patients was temporary hospitalization in another department prearranging psychiatric readmission (THAD, 35.8%), followed by death (18.2%), living with families/relatives (LF/R, 11.3%), a residential care facility for the aged (RCF-A, 9.5%), residential care facility for the disabled (RCF-D, 8.6%), hospitalization in another psychiatric hospital (7.4%), living alone (LA, 4.3%), permanent hospitalization in another department (PHAD, 4.3%), and others (0.7%). In dementia, death was common (31.0%) ; LF/R (1.8%) and LA (0.0%) were rare. As the age increased, the proportions of LF/R, LA, RCF-D, RCF-A, PHAD, and death changed; particularly, LA decreased and death increased markedly with age. Additionally, THAD amounted to approximately 40% in every age class of 40 years or older, contrasting with 11.4% in those under 40 years. The study's limitations include a low response rate, the elapsed time after the survey, and lack of attention paid to symptom severity. Nevertheless, it provides valuable insights into long-stay patients, including that discharge is least likely in schizophrenia and most likely via transfer or death for dementia. These results may encourage the efficient promotion of discharge and prevention of prolonged hospitalization according to patients' demographic, clinical, and social conditions.
[Issues in Psychiatric Care as Observed in Recent Legal Proceedings Involving Medical Treatment].
Kinomoto N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26721062
Among recent court cases involving medical treatment (medical litigation), civil proceedings focused on compensation claims began clearly trending upward around 1999. This trend peaked in 2004, after which the number of...
Among recent court cases involving medical treatment (medical litigation), civil proceedings focused on compensation claims began clearly trending upward around 1999. This trend peaked in 2004, after which the number of cases declined slightly and remained mostly flat. Over the past year or two, however, cases seem to be on the rise once again. Fluctuations in the volume of medical litigation have been attributed to various factors, but there is little doubt that careless medical errors and incidents of serious medical malpractice, as well as media coverage, are major factors in the recent increase. Although there has been no significant change in the actual number of lawsuits involving psychiatric care, it is possible to identify risk resulting from circumstances unique to psychiatry (prejudice surrounding psychiatric care, etc.). In this paper, the author will illustrate current trends in medical litigation and important aspects of judicial decisions related to health care. Furthermore, based on his many years of experience acting for the defense in psychiatric care litigation, the author will offer suggestions for promoting mutual understanding between psychiatry and the law that will, in turn, contribute to both "advocacy for legitimate psychiatric care" and "the quest for ideal psychiatric care".
[The Current Issues of Crime Victim Support from a Clinical Point of View].
Konishi T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653894
This paper reviews part of an educational lecture at the 111th Annual Meeting of the Jap- anese Society of Psychiatry and Neurology (JSPN), under the identical title by the author. First, current victim support and treat...
This paper reviews part of an educational lecture at the 111th Annual Meeting of the Jap- anese Society of Psychiatry and Neurology (JSPN), under the identical title by the author. First, current victim support and treatment for victims at psychiatric services in Japan are reviewed. Second, introducing a case report of a rape victim diagnosed as PTSD, comments are made on symptoms, such as avoidance and emotional numbing as part of dissociation. It is common for clinicians, even for patients themselves, to fail to notice these symptoms. How to detect and treat these covert symptoms appropriately are discussed.
[The Role of Psychiatrists as Personal Support Specialists].
Ikebuchi E
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653893
Robert P. Liberman introduced "Personal Support Specialists" as a role of psychiatrists who support patients' lives and help them discover the meaning of life, as well as helping with daily activities and personal diffic...
Robert P. Liberman introduced "Personal Support Specialists" as a role of psychiatrists who support patients' lives and help them discover the meaning of life, as well as helping with daily activities and personal difficulties. They need to have multiple perspectives on medical, subjective, social, and life recoveries. Important areas to help patients practically are job-assis- tance, supporting love and marriage, and independent living in the community. I usually use Seikatsu-Rinsho (The way of Living Learning), cognitive behavioral therapy, and Seikatsu-ryouhou (Life-centered Therapy) by Hiroshi Utena as basic principles in my practice. Recently, I shed light on an -individual value system to evolve these principles. Reflecting on two recovery stories I co-encountered, contents of psychiatric interviews and roles of psychiatrists are discussed. There remain many difficulties which modern psychiatry has not resolved, such as negative symptoms and marked disabilities in social life. We as psy- chiatrists should know how to evolve and maintain hope and intrinsic motivation to support a patient's life.
[Historical Re-evaluation of the System of Sending Psychiatrists to Okinawa and the Activities of the Japanese Society of Psychiatry and Neurology].
Nishizono M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653892
The Okinawa Psychiatric Committee, which was established as a part of the Japanese Society of Psychiatry and Neurology, has been cooperating in securing psychiatric medicine in Okinawa by sending psychiatrists to the reg...
The Okinawa Psychiatric Committee, which was established as a part of the Japanese Society of Psychiatry and Neurology, has been cooperating in securing psychiatric medicine in Okinawa by sending psychiatrists to the region as well as assisting in other ways. The Committee, however, was disbanded in 1967 after its final meeting in Kanazawa. The Okinawa Psy- chiatric Committee was newly launched in 1971 to replace the previous committee, and I was appointed the Director in charge of this concern, along with Nagasaki University Professor Ryo Takahashi, who was serving as the Committee Chairperson. Since then, I have been involved with the matter of dispatching psychiatrists to Okinawa. Specifically, we began our activities by visiting Okinawa to gain a grasp of the actual sta- tus of various problems affecting dispatched psychiatrists, and to draw up future plans. We made an investigatory trip to Okinawa on December 21-27, 1971. On the main island of Oki- nawa, we visited the then Ryukyu government office, the Japanese government's local office, public and private mental hospitals, almost all public health centers, as well as the Ryukyu Mental Health Association. We also visited relevant facilities on Miyako and Ishigaki islands. Through visits such as these, we made an effort to find out on the actual status of local psychiatric medicine at the time, and the roles that the dispatched psychiatrists had played up to that point. We also worked on learning to what extent the people concerned in Okinawa were aware of the current situation, and what they hoped to gain from our Society. We tried to hold as many meetings as possible with our Society's local members as well as those who were already working as dispatched psychiatrists, and set up opportunities to exchange opinions. What became clear through our visits was that the dispatched psychiatrists were eager to go out and practice in the field, as needed, without being tied down to treating patients inside hospitals. Based on local inspections such as these, we drew up a written report that helped to resume and re-establish the system of sending psychiatrists to Okinawa. Besides playing the public role described above, I took a personal interest in the system of resident nurses, which had disappeared after the return of Okinawa to mainland Japan, as I felt, that they had played a significant role. In any event, I feel it worth mentioning that the system of sending psychiatrists to Okinawa not only helped support psychiatric medicine in Okinawa, but also became a model for volunteer activities in the wake of earthquakes that occurred later on in other areas of Japan.
[Background of Okinawa's Acceptance of Dispatched Physicians and Its Current Status].
Nakayama I
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653891
In response to the Japanese government's decision to dispatch psychiatrists to Okinawa to improve a significant delay in the establishment of psychiatry there following World War II, the Okinawa Psychiatric Care Cooperat...
In response to the Japanese government's decision to dispatch psychiatrists to Okinawa to improve a significant delay in the establishment of psychiatry there following World War II, the Okinawa Psychiatric Care Cooperation Committee (former Okinawa Psychiatric Care Committee) was established by the Japanese Society of Psychiatry and Neurology to ensure the stable dispatch of physicians. A total of 83 psychiatrists were dispatched to Okinawa, and they markedly contributed to the development of psychiatry in the prefecture. Shigeo Shima, one of the physicians dispatched to Okinawa, decided to stay there, and provided psychiatric treatment for twenty years. He established a basis for and promoted normalization in Okinawa.
[Medical Dispatch to Okinawa and following Period].
Yoshizumi A
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653890
I was dispatched to Okinawa Ishigaki Island in 1976 and, then after about thirty years, to Touhoku to provide medical aid due to a shortage of psychiatrists. On Ishigaki, I participated in outreach activities for local i...
I was dispatched to Okinawa Ishigaki Island in 1976 and, then after about thirty years, to Touhoku to provide medical aid due to a shortage of psychiatrists. On Ishigaki, I participated in outreach activities for local islands and was deeply impressed by the public health nurses and community mental health services. I also recognized important points of view about culture and psychiatry. I spent five years in Touhoku and then the East Japan Disaster hit area. At that time, many psychiatrists from throughout Japan supported our hospital, and we supported the disaster area. I describe my experiences in both places. I hope someday that young psychiatrists will join medical dispatch programs to such areas.
[The Situation of Psychiatric Medicine and the System of Dispatching Medical Doctors Half a Century Ago in Okinawa].
Meguro K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653889
This article describes the situation of psychiatric medicine and the system of dispatching medical doctors half a century ago in Okinawa, based on the author's knowledge and experi- ence gained as an expert participating...
This article describes the situation of psychiatric medicine and the system of dispatching medical doctors half a century ago in Okinawa, based on the author's knowledge and experi- ence gained as an expert participating in the mental health survey of Okinawa in 1966 (herein- after referred to as the Okinawa survey) and as the responsible officer of the Ministry of Health and Welfare in Japan in charge of dispatching medical personnel from mainland Japan to Okinawa. The Okinawa survey adopted the same high-level statistical methods as its counterpart mental health surveys in Japan. The survey clearly illustrated the situation of psychiatric dis- orders and psychiatric medicine in Okinawa, and influenced subsequent psychiatric medicine in Okinawa. After rejoining mainland Japan in 1972, the situation of psychiatric medicine in Okinawa changed markedly. In the Okinawa survey, the prevalence of mental disorders was 25.7 per 1,000 of the popu- lation, and the number of persons with mental disorders was estimated to be 24,060. Approximately 17,000 persons (71%) with mental disorders did not receive treatment or guidance. In 1966, mental institutions in Okinawa consisted of five mental hospitals and one clinic. The num- ber of psychiatric beds was 915. The Ryukyu Mental Health Law came into effect in Okinawa before rejoining mainland Japan. The characteristics of this law were the confinement of per- sons with mental disorders in private residences and the waiver of psychiatric medical fees using public resources. After rejoining mainland Japan, the confinement of persons with mental disorders in private residences was discontinued, but the waiver of psychiatric medical fees was continued. The Okinawa Mental Health Association contributed to psychiatric medicine and mental health services in Okinawa before rejoining mainland Japan. Taking the opportunity of the Okinawa survey, officers in charge of mental health services and public health nurses started mental health activities in public health centers. The dispatch of medical doctors is one of the medical supports for Okinawa. Psychiatrists are dispatched mainly from public mental hospitals such as the Shimofusa National Mental Hospital. Compared with 1966, the present situation regarding the quantity of psychiatric medicine, in Okinawa, such as the number of beds, has improved. It is expected hereafter that comprehensive psychiatric rehabilitation and stress care sys- tems will improve psychiatric medicine in Okinawa.
[Dispatch of Psychiatrists to Okinawa and their Activities].
Ogura C
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653888
As a part of the medical assistance project for Okinawa, where the land and their people were devastated by the Pacific War, the Japanese Government launched a program to dispatch medical doctors. The dispatch of psychia...
As a part of the medical assistance project for Okinawa, where the land and their people were devastated by the Pacific War, the Japanese Government launched a program to dispatch medical doctors. The dispatch of psychiatrists started in 1964, and lasted for 13 years. During this period, a total of 83 doctors joined this project. Their term was 3-6 months. To promote the smooth implementation of this program, the Japanese Society of Psychia- try and Neurology (JSPN) established the Committee of Mental Health Care for Okinawa (CMHCO) and supported their activities. This support included : 1) supporting medical care in hospitals/counseling in public health centers, 2) activities for promoting mental health/com- munity-based psychiatric treatment, 3) guidance and advice for local medical workers, and 4) sharing opinions with Ryukyu and Japanese governments. The CMCHO's activities contributed to improve the mental health care condition in Oki- nawa. Now, the qualities of facilities and human resources are above the national average. Rates of the isolation and restraint of inpatients, which indicate the quality of care, are low. The CMCHO's activities have written a significant page in the history of JSPN as well as Oki- nawa's mental health care.
[A Survey and Suggestions Regarding Prefectures' Mental Disorder Medical Care Plans].
Japanese Society Of Psychiatry And Neurology PCAMHAWSC
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653887
The Psychiatric Care and Mental Health and Welfare System Committee surveyed the contents of mental disorder medical care plans established by the 47 prefectures in Japan. Based on the "opinions of the Japanese Society o...
The Psychiatric Care and Mental Health and Welfare System Committee surveyed the contents of mental disorder medical care plans established by the 47 prefectures in Japan. Based on the "opinions of the Japanese Society of Psychiatry and Neurology Board of Directors following the official recognition of mental disorders as important diseases under the Medical Service Law's medical care plan" (September 28, 2011), investigations were conducted focusing on three aspects : locations of medical care plan discussions, public awareness of medical care information, and target values. Medical care plans of the 47 prefectures were collected. A ques- tionnaire regarding the mental disorder care plan decision process was sent to each prefecture, and answers were received from -those in charge of each jurisdiction. Among the 45 prefec- tures that responded, the mental disorder care planning groups held an average of 3 meetings. The largest number of meetings held was 7 (in 3 prefectures), and 2 meetings or fewer were held in 15 prefectures. No meeting was held in 7 prefectures. Locations in which the promotion of regional medical care cooperation regarding mental disorders was discussed were recorded by less than half of the medical care plans. The names of the medical facilities that were recorded in many of the medical care plans included various functions, such as "facilities for emergency psychiatric care" and "dementia medical centers." However, medical care functions specific to various mental disorders and medical facility names including these functions were only recorded in approximately half of the medical care plans. Regarding target values for promoting medical care plans, the vast majority of prefectures recorded that the "average in- patient discharge rates occurred in under 1 year."A relatively large number of prefectures also recorded "suicide mortality rates". and the "number of dementia medical centers" ; however, there were hardly any records concerning "rates of in-patient hospitalization for medical care and protection lasting more than 1 year." Moreover, there were few records regarding the "number of patients (per 100,000 of population) hospitalized for medical care and protection each year" and the "percentage of patients receiving care in protective room isolation." While prefectural medical care plan contents are varied, definite improvements of psychiatric care through medical care planning are finally underway. Mental disorder medical care plans based on the Medical Service Law operate together with related documents such as the guideline based on the Mental Health and Welfare Act, Article 41 ; disability welfare plans based on the Comprehensive Support for Persons with Disabilities Act ; and long-term care plans based on the Long-term Care Insurance Act. Further implementation and assessment, and continued revision based on this assessment, are needed with regard to these related plans and guidelines.
[History and Current Status of Birth Cohort Studies in the UK, and Feasibility in Japan].
Koike S, Cable N, Richards M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30653886
Birth cohort studies are conducted by prospectively following the participants with a spe- cific characteristic background from their birth or prenatal birth, and can explore the causal relationship of various factors wi...
Birth cohort studies are conducted by prospectively following the participants with a spe- cific characteristic background from their birth or prenatal birth, and can explore the causal relationship of various factors with outcomes. In the UK, birth cohort studies with long-term follow-ups have been launched every ten years, which have provided many significant results and related useful policy recommendation. However, these have not necessarily intended to be launched as the national project with long-term observations, rather existing birth cohorts are accept to continue because of the excellent results and survey condition. In 1990s, birth cohort studies have been revalued as national resources, and widely used by domestic and international researchers. As the contribution to psychiatry and mental health, most of the cohort studies have been conducted to identify risk factors for onset of psychiatric diseases such as schizophrenia. Nowadays, broader studies were conducted and highly evaluated for the relationships between physical and psychological illnesses, and biological studies. Recent cohort studies also showed that cognitive abilities in childhood or adolescence was similar between those who later developed schizophrenia and those who experienced psychotic symptoms, sug- gesting that a spectrum in psychiatric diseases would be useful for elucidating the pathophysiology. In Japan, birth cohort studies which findings could be reflected on policy implications have been required as national resources. However, as there have been no birth cohort studies that have conducted for long-term follow-ups, there are little techniques and knowledge for launching and continuing a birth cohort study with low attrition, and providing evidences to society. It is necessary to establish these techniques and knowledge by learning from the UK cases within the cultural and social contexts in Japan. High quality routine studies including examination have been implemented in Japan in various fields such as perinatal and infant care, schools, work places, medical care, and the central and local governments. Supplementation of those data will be needed for high quality birth cohort studies. Until now, there has been no relevant law to conduct any data linkage between the data from various fields in research settings and it is necessary to be prepared.
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