Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[rTMS (Repetitive Transcranial Magnetic Stimulation) for the Treatment of Depression].
Ukai S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30629356
The clinical introduction of rTMS for the treatment of depression is now progressing in Japan. On the basis of the successful results of a large-scale RCT, the US FDA approved an rTMS device in 2008, and four rTMS device...
The clinical introduction of rTMS for the treatment of depression is now progressing in Japan. On the basis of the successful results of a large-scale RCT, the US FDA approved an rTMS device in 2008, and four rTMS devices are now approved and used in several countries and the EC. The results of the meta-analysis of RCTs and the real-world naturalistic observa- tional studies show beneficial effects on treatment-resistant depression. The rTMS is generally well-tolerated and safe, but has a risk of seizure, with an estimated rate of approximately one in 1,000 patients. The rTMS is thought to be an effective treatment for those unable to benefit from initial antidepressant medication.
[Tokyo Metropolitan Dementia-related Disease Medical Center and Current Problems of Outreach project for Early-stage Dementia].
Shibata N
Seishin Shinkeigaku Zasshi · 2016 · PMID 30629355
There are twelve dementia-related disease medical centers including psychiatric hospitals in the Tokyo Metropolitan Area. Few psychiatric hospitals or long-term care hospitals exist in our area (Bunkyo, Chiyoda, Taito, M...
There are twelve dementia-related disease medical centers including psychiatric hospitals in the Tokyo Metropolitan Area. Few psychiatric hospitals or long-term care hospitals exist in our area (Bunkyo, Chiyoda, Taito, Minato, and Chuo wards) and we receive requests for hospital transfer of demented patients. Since the Tokyo Metropolitan Government estimates that the numbers of aged persons will increase rapidly, a project for detecting and diagnosing early-stage dementias, the 'outreach project', has started. We visit people who show some cognitive symptoms and evaluate their cognitive functions and mental and physical status. Then, we support them to undergo medical examinations or receive appropriate care if needed. Most of the people we visited were women living alone who did not receive any care. Several cases were detected as early-stage dementia based on our evaluations. On the other hand, there were some cases suggested to be psychiatric diseases, such as schizophrenia, with people showing some social or behavioral problems. Psychiatrists hope to attentively work for dementia patients with co-medicals in local areas.
Issues in Initial-phase Intensive Support Team for Dementia Experience in Kobe City.
Maeda K, Kajita H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30629354
We report the activity of the initial-phase intensive support team for dementia in Kobe City. The severity of dementia of the people who received the support was moderate in two-thirds of them. It took more than one year...
We report the activity of the initial-phase intensive support team for dementia in Kobe City. The severity of dementia of the people who received the support was moderate in two-thirds of them. It took more than one year for over 50% of the people to receive support from the initial identification of dementia to involvement by the support team. Approximately three- quarters of the individuals were admitted to long-term care services facilities after receiving the service provided by the support team. A diagnosis of dementia was obtained for only about half of the people. Although there are many issues regarding the support team, we concluded that this activity is very beneficial for dementia people and their families, and it should be extended everywhere in Japan.
[The Role of Psychiatric Clinics in Dementia Care].
Ohsawa M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30629353
On June 18, 2012, a project team for dementia care in the Ministry of Health, Labour and Welfare released a report on future approaches in medical care for dementia. Based on this report, the "5-year plan for promoting d...
On June 18, 2012, a project team for dementia care in the Ministry of Health, Labour and Welfare released a report on future approaches in medical care for dementia. Based on this report, the "5-year plan for promoting dementia measures ("Orange Plan")" was published on September 5. At the beginning of the report, they present an ideal society where patients can continue to live in the community after being diagnosed with dementia. I think this direction exactly shows "the Community-based Integrated Care". For this, the role of psychiatric clinics in the health care of people with dementia is to help avoid admission to psychiatric hospitals. Therefore, as psychiatrists, we must provide a diagnosis of dementia, drug therapy, and non-drug therapy for BPSD. Furthermore, in my clinic, I provide body management and the treatment of physical complications. Also, interprofessional work is essential for these things to be done effectively.
[New Horizon of the Five-Year Plan for Promotion of Dementia Measures].
Awata S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30629352
In 2012, the Japanese government announced the Five-Year Plan for Promotion of Demen- tia Measures (Orange Plan). This plan was developed in the context of the realization of a community-based integrated care system to s...
In 2012, the Japanese government announced the Five-Year Plan for Promotion of Demen- tia Measures (Orange Plan). This plan was developed in the context of the realization of a community-based integrated care system to support the lives of persons with dementia and their family caregivers. The community-based integrated care system allows various services to be provided in an integrated manner, and is created in each community in accordance with the local circumstances and participation of local residents. The first pillar of the Orange Plan is the development and popularization of the standard Integrated Care Pathway (ICP) for dementia. Although few municipalities have developed ICP for dementia to date, the philosophy such as "Dementia-friendly Community" could be shared among residents and professionals in the process of development. Under the second pillar "Early Diagnosis and Intervention", the Initial- phase Intensive Support Team for Dementia (IPIST) was introduced and three types of Medical Center for Dementia were developed. However, to realize quality diagnosis and post- diagnostic integrated care throughout Japan each prefecture and municipality should consider the service-providing system for dementia depending on the local circumstances along with utilization of the national system. In 2015, Tokyo Metropolitan Government planned to deploy the MCD in all municipalities. Dementia Support Coordinators were also deployed in each municipality to facilitate access to diagnosis and provide post-diagnostic support in collabora- tion with the Dementia Outreach Team arranged at each MCD. In 2015, the government revised the Orange Plan and introduced the Comprehensive Strategy to Accelerate Dementia Measures (New Orange Plan). The most important point of this plan is to prioritize the standpoint of persons with dementia and their families when creating measures. Now we are enter- ing a new stage of the National Dementia Strategy.
[Issues of Special Research's Guideline on the Usage of Psychotropic Drugs to Manage BPSD for Family Doctors: A Critical Study on the Guideline for the Management of BPSD].
Oda H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30623636
Abstract loading — click title to view on PubMed.
[Psychiatric Emergency/Acute Care Wards in Japan Present and Future Perspectives].
Hirata T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620864
The prospective payment system in the psychiatric acute care ward began in 1996 in Japan. This was up-graded to the psychiatric emergency ward in 2002. Chiba Psychiatric Med- ical Center, the model institute of these war...
The prospective payment system in the psychiatric acute care ward began in 1996 in Japan. This was up-graded to the psychiatric emergency ward in 2002. Chiba Psychiatric Med- ical Center, the model institute of these wards, has been leading the transformation from asylums to therapeutic apparatus. Although emergency/acute care wards occupy only 8% of the total psychiatric beds in Japan, they cover 41% of annual admissions onto psychiatric wards because of their high bed turnover rate. Therefore, they contributed to reduce the aver- age length of stay to two-thirds, and for the numbers of inpatients to decrease by 11% up until 2012. The Ministry of Health, Labor and Welfare presented an image of future types of psychi- atric bed-emergency, acute, recovery, and severe chronic beds, and a plan to reduce long- stay patients. Outcomes and improvements of patients with severe mental illness in the emer- gency/acute care wards may be a determinant of the future design. We propose three plans to turn it into reality: increasing the number of psychiatric emergency wards/units in general hospitals, requiring some residency program in emergency wards to become a certified psychi- atric specialist, and limiting new admissions onto psychiatric emergency wards to involuntarily hospitalized patients. These plans could facilitate deinstitutionalization in Japan, sustaining the provision of continuous and responsible care.
[Role of Departments of Psychiatry in University Hospitals as a Developer, Provider, and Educator of Innovative Clinical Psychiatry].
Kasai K, Kanehara A, Satomura Y … +5 more , Suga M, Taniguchi G, Ichihashi K, Kano Y, Kondo S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620863
The roles of university hospital psychiatric departments are: 1) the development and pro- vision of advanced psychiatric treatments unique to university hospitals, 2) the provision of psychiatric intervention models for...
The roles of university hospital psychiatric departments are: 1) the development and pro- vision of advanced psychiatric treatments unique to university hospitals, 2) the provision of psychiatric intervention models for patients with physical diseases, and 3)the provision of real- world environments for young psychiatrists to learn the principles and experience the practice of such innovative care. As for 1), our facility offers a hospitalization for examination program, which uses near-infrared spectroscopy as a biomarker useful for the auxiliary diagnosis of psy- chiatric disease and selection of the treatment method. University psychiatric departments also play a major role in neuropsychiatry, such as through the use of Epilepsy Monitoring Units (EMU) to differentiate between epilepsy and psychogenic non-epileptic seizures (PNES). Additionally, hospitalizations for examination programs are being implemented for psychosocial and employment support for psychiatric patients, and the diagnosis and evaluation of develop- mental disorders. With regard to 2), our facility has a psychiatric liaison-consultation team. In addition to providing consultation for all departments on delirium, anxiety, and depression, they are actively committed to various transplant treatments. There is also a strong cooperative relationship between the critical care center and psychiatric department. Of the patients hospi- talized for physical conditions and emergencies, over ten percent require psychiatric support, and without the psychiatric department, many patients with severe physical diseases cannot be treated. As such, the medical fees for psychiatric departments in universities and general hospitals should be evaluated appropriately. We would like to propose an "Advanced Psychiat- ric Treatment Development Management Center" (tentative name) to manage the following cycle : a) every university psychiatric department will develop and offer model projects utiliz- ing their respective expertise and specialties ; b) after collecting information on best practices, they will establish evidence through multicenter research, Diagnosis Procedure Combination (DPC) data, and others ; c) they will progress to advanced medical treatments and insurance coverage ; and d) they will continue to improve quality. Finally, I emphasize the role of univer- sity psychiatric departments as the center of education where young psychiatrists learn the principles and experience the practice of such an advanced care model, which will innovate and reform future mental health care.
[The Current Status of the Department of Neuropsychiatry at Osaka Medical College].
Kinoshita S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620862
Since there is a growing need for psychiatric treatment in general hospitals, the decreas- ing number of treatment beds has become a marked problem in Japan. One of the financial reasons is a difference in the reimbursem...
Since there is a growing need for psychiatric treatment in general hospitals, the decreas- ing number of treatment beds has become a marked problem in Japan. One of the financial reasons is a difference in the reimbursement of medical fees between medical treatments in physical departments of the same hospital. Our neuropsychiatry department has accepted patients with psychiatric disorders suffering from various physical complications in order to meet local or hospital demand ; however, it is the case that the psychiatric ward has been required to decrease the number of beds from the aspect of management rationalization. According to the comparative analysis of four practical cases treated on our ward, the reim- bursement of medical fees was much lower than medical fees for the same treatment if patients had been treated on general physical wards. This result is considered to show one of the difficulties of maintaining psychiatric wards in general hospitals. It is essential to improve the reimbursement of medical fees for psychiatric wards. Moreover, we propose introducing the DPC (Diagnostic Procedure Combination) into treatment, especially on psychiatric wards. The demand for psychiatric treatment at general hospitals will increase in the future due to Japan having the world's most rapidly aging society. Maintaining a clinical budget equal to the available resources will help avoid a decreasing number of beds.
[Future Images of General Hospital Psychiatry].
Sato S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620861
Now, the psychiatric departments of general hospitals are unpopular workplaces for psy- chiatrists in Japan. However, I think there is a constant need for psychiatric departments of general hospitals, because the number...
Now, the psychiatric departments of general hospitals are unpopular workplaces for psy- chiatrists in Japan. However, I think there is a constant need for psychiatric departments of general hospitals, because the number of psychiatric departments of general hospitals with no psychiatric beds is increasing, even though the number of psychiatric departments of general hospitals with psychiatric beds is decreasing. Recently, there has been a trend of reevaluating psychiatry in medical care, such as in the medical treatments fees or in health care planning, so we cannot talk about medical care without involving psychiatry. The participation of gen- eral hospital psychiatry with a medical cooperation function is necessary for psychiatric reform from hospital-based to community-based psychiatry, as well as for the promotion of self-suffi- cient medical care in local communities based on medical cooperation. For psychiatry corre- sponding to high-grade acute medical care, the existence of general hospital psychiatry is nec- essary which has close contact with medical care and has a psychiatric acute care function, and adequate measures should be adopted in the national medical care fee and medical policies for the enhancement of general hospital psychiatry.
[The Report of the Survey to the Members of the Society about the Functional Dissociation of the Psychiatric Hospital beds].
Matsubara S, Anzai N, Ota J … +9 more , Ohmori T, Kodaka A, Sato S, Sano I, Hatou K, Mikuni M, Yamanouchi Y, Yoshizumi A, Watanabe Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620860
In 2014, Japanese Ministry of Health, Labour and Welfare published the guideline on the policy of the psychiatric hospitals. We executed a survey to the members of "The Japanese Society of Psychiatry and Neurology" about...
In 2014, Japanese Ministry of Health, Labour and Welfare published the guideline on the policy of the psychiatric hospitals. We executed a survey to the members of "The Japanese Society of Psychiatry and Neurology" about the impression of this guideline, especially about "The functional differentiation of psychiatric hospital beds". Nine questions were notified on the home page of the society. 862 answers (5.3% of the members) were corrected by website from 1st to 30th of May in 2015. Attribution of the answers : doctors working at the psychiatric hospitals (70.9%), the psychiatric clinics (20%), the others (9.1%). The questions which more than 80% of the answers agreed were "The reduction of the psychiatric beds should be stepwise under the rule of check & balance in the improvement of the psychiatric community treatment", "Improve the function of the recovery phase treatment" and "The adequate treat- ment for the patients of the severe and chronic phases". The questions more than 55% of the answers agreed were "The reduction of the chronic phase beds for the improvement of the function of the acute phase beds". The questions which opposites exceeded (almost 47%) were "The assessment of the psychiatric symptoms in the patients of the chronic phase should be done by the third party" and "The facility for social skill treatment should be placed in the community". We could know the mind of the members about the revolution of the psychiatric.
[Securing Houses for People with Mental Disorders -From Experiences of Supporting Destitute Individuals-].
Takiwaki K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620859
The Home Association (NPO) mainly supports single destitute individuals, and there are many with dementia or disabilities among its service recipients. Also, Home Co., Ltd. has helped people transition from facilities or...
The Home Association (NPO) mainly supports single destitute individuals, and there are many with dementia or disabilities among its service recipients. Also, Home Co., Ltd. has helped people transition from facilities or hospitals into the community when they cannot obtain approval for housing from surety companies. In the meantime, surety business has faced problems as their clients age and associated accident rates rise. On the other hand, the land- lords have also aged themselves and management of their properties has become increasingly difficult. In light of this situation, we started what we call the "drawing-close community project," where we draw close to the anxious landlords, focus on the vacant houses as a resource, combine housing issues and livelihood support, and provide a community salon where people can get together. This project explores the possibility of landlords and real estate business people taking the lead in the project and also playing a major role in rebuilding the commu- nity. In order to realize the slogan "live in a familiar land until the last moment, even with dementia," livelihood support prevents functional impairment from impairing people's lives and promotes life in the community where residents' connections are valued. Energy to live is enhanced when life is based on mutual support and the residents feel the reassurance of being "protected" and take pride in "protecting" others and the community. The community salon facilitates mutual support in the community, as well as provides employment opportunities for those with unsteady employment and those who have been socially withdrawn. It also helps reduce the risks commonly seen in the community, such as domestic nursing and growing pov- erty. In order for landlords and property businesses to provide vacant houses without concerns, "livelihood support" must be socially credible and its quality must be maintained at a high level. We have proposed to administrative bodies that livelihood support should be recognized and they support, financially or otherwise, the employee training, thereby officially authorizing the livelihood support activities. Housing and livelihood support also works closely with other professional services, such as medicine, nursing and prevention. If "transition to the community and reduction of hospital beds" are to be promoted, we should acknowledge that it is an important issue how livelihood support and medical services can closely cooperate with each other, while being considerate toward each other.
[The Local Shift of Long-term Inpatients and Bed Reduction as Viewed by a Mental Health Clinic].
Tagawa S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620858
About half of inpatients in psychiatric hospitals in Japan are over 65 years old. Most of them are long-term inpatients with schizophrenia. The number of beds in psychiatric hospitals will probably decrease in 10-15 year...
About half of inpatients in psychiatric hospitals in Japan are over 65 years old. Most of them are long-term inpatients with schizophrenia. The number of beds in psychiatric hospitals will probably decrease in 10-15 years. Local shift means that those long-term inpatients leave hospital and spend their lives more fully and more comfortably. Most of them are over 65 years old. However, the motivation of the government and mental hospitals to promote this local shift seems to be low. Most men- tal hospitals in Japan are private, and so such a shift may be against their interests. The gov- ernment wants to decrease the number of beds in mental hospitals due to international criti- cism and for financial reasons. But I'm afraid some may think that in 10-15 years, regardless of whether local shift goes good or bad, many long-term inpatients eventually die and beds at mental hospitals will subsequently decrease. So local shift is a 'time limited problem'. However, if many long-term inpatients leave mental hospitals, they will use mental clinics or other community-based mental health care. Also, cooperation with other agencies will be very important. If such community support fails, a revolving door phenomenon will develop.
[Historical Development of Symptomatology in Psychosis with Reference to Pathogenesis].
Kurachi M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620857
The role of mental symptomatology is to describe various clinical symptoms without refer- ring to their pathogenesis. This may be because of the influence of K. Jasper's General Psycho- pathology. However, from the mid-1...
The role of mental symptomatology is to describe various clinical symptoms without refer- ring to their pathogenesis. This may be because of the influence of K. Jasper's General Psycho- pathology. However, from the mid-19th to early 20th century, when modern psychiatry was estab- lished, some excellent hypotheses concerning the pathogenesis of mental symptoms were pro- posed, although it was difficult to verify these hypotheses because of technical limitations. The purpose of this article was to review the historical development of symptomatology in psycho- sis with reference to the pathogenesis. W. Griesinger (1845, 1861) distinguished between the etiology and pathogenesis of a disease, and stated that every mental disease is a manifestation of brain disease. Subsequent investigators elaborated on this view : C. Wernicke (1894, 1906) proposed the disconnection of the association tracts, and P. Flechsig (1894, 1920) regarded the late myelinating "association areas"' (this term was from Flechsig) as the field of the mind. J. H. Jackson (1895) proposed the evolutionary and hierarchical organization of the nervous system. E. Kraepelin (1913) speculated on the hypoactivity of the frontal cortex-the highest cerebral centers according to Jackson's terminology-and hyperactivity of the temporal speech cortex as the pathogenesis of psychotic symptoms in dementia praecox, which were found to be the case based on neuroimaging methods over sixty years later. Currently, the pathogenesis of mental symptoms is being investigated from the viewpoint of the dysfunctions of neural cir- cuits, such as cortico-limbic, cortico-thalamic, or cortico-striatal circuitry.
[The Role of Psychiatric Hospitals in Community Cure for Dementia Patients].
Taguchi M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620842
Through their activities with the Japan Psychiatric Hospitals Association, the author has tackled the dissemination of the regional cooperation pass "orange note," and, through manage- ment of the Regional Dementia-relat...
Through their activities with the Japan Psychiatric Hospitals Association, the author has tackled the dissemination of the regional cooperation pass "orange note," and, through manage- ment of the Regional Dementia-related Disease Medical Center, regional cooperation for dementia. The role of psychiatric hospitals in dementia is often spoken of as being limited to inpa- tient treatment, however in reality they work not only with the hardware aspects, such as out- patient care, severe dementia day care, and dementia-related disease medical centers (herein- after abbreviated as "Centers") and the like, but there are many hospitals that also handle care facilities in a psychiatric hospital or home-base related services, making them resources for the region. Meanwhile, on the software side of things, there are human services professionals such as medical and psychiatric welfare workers and social workers including dementia specialists, nurses, pharmacists, clinical psychologists, occupational therapists, physical therapists, etc. with the ability to function cooperatively with interdisciplinary counterparts in each area. Presently, at the author's hospital, the possibility of effectively utilizing a regional coopera- tion pass coordinated by the center as a regional cooperation tool is being explored. Addition- ally, rather than capturing the opposing concepts of community and hospitalization, it is thought that hospitalizing patients within their lives in the community will lead to shortening the length of hospital stays as a result. Up to this point, regarding regional cooperation, operation with a roundtable way of think- ing had been imagined, however unfortunately, it is thought that it has fallen into "meetings with the goal of meeting." It is felt that perhaps a multilayer structure with shades of gray is necessary. A four-layer structure with a "stable condition, does not specifically require coop- eration" group, a "requires loose cooperation" group (using a paper-based regional cooperation pass), a "slightly close cooperation, able to intervene when necessary" group (using a regional cooperation pass (ICT)), and a "conduct care conferences dealing with various problems, requires strong information exchange" group has been proposed. Additionally, at present, there is misperception with the concepts of the dementia model and the Alzheimer's dementia model, they are confused as being the same despite the fact that Alzheimer's dementia is a subcategory of dementia. In particular, I proposed my plan with the thought that it is necessary by this point to organize an alternative, with more rigid BPSD and cognitive symptoms assuming the symptomology of Alzheimer's dementia.
[Suggestions Obtained from the J-CATIA Study (Japan Consortium for Antipsychotics Treatment in Alzheimer's Disease)].
Arai H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620841
The mortality risk of long-term and new antipsychotic drug use in Alzheimer's disease (AD) patients in Japan was studied to determine improved treatment protocols. One of the main findings was that newly prescribed users...
The mortality risk of long-term and new antipsychotic drug use in Alzheimer's disease (AD) patients in Japan was studied to determine improved treatment protocols. One of the main findings was that newly prescribed users showed increased mortality. Therefore, the new use of antipsychotic drugs represents a distinct mortality risk, while those on long-term anti- psychotic therapy are suggested to be relatively safe.
[From "Guidelines for Medical Treatment and Its Safety in the Elderly 2015"].
Mizukami K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620840
"Guidelines for medical treatment and its safety in the elderly 2015" are the guidelines that position safety as the principal objective when a non-specialist performs medical therapy for elderly persons older than 75 ye...
"Guidelines for medical treatment and its safety in the elderly 2015" are the guidelines that position safety as the principal objective when a non-specialist performs medical therapy for elderly persons older than 75 years old, or an elderly person who is frail or needs nursing care younger than 75 years. When the guidelines were announced in April 2015, many public comments were received from patients, caregivers, care staff, medical doctors, and the medical society. The majority of the comments were regarding behavioral and psychological symptoms of dementia (BPSD). Many opinions about antipsychotics were from non-specialists, such as primary care doctors. This suggests that many non-specialists treat severe BPSD using antipsychotics, and that the further promotion of cooperation between non-specialists and psychiatrists is necessary.
[BPSD from the Perspective of the New Orange Plan].
Tamai A
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620839
I have discussed BPSD, especially who should treat BPSD and who can treat them, from the viewpoint of the New Orange Plan. It is desirable for all the doctors to have extensive knowledge about dementia and engage in trea...
I have discussed BPSD, especially who should treat BPSD and who can treat them, from the viewpoint of the New Orange Plan. It is desirable for all the doctors to have extensive knowledge about dementia and engage in treatment in cooperation with other departments and, more comprehensively, with nursing-care insurance fields. During the period when a patient has mild BPSD and the burden on caretakers is light, it is possible for his or her family doctor to treat BPSD. However, when a patient has severe BPSD and is in a situation where care is difficult, non-drug therapy often becomes the first choice for the treatment and drug therapy second. In the case that neither of them are effective enough for treatment, short- term hospitalization on a dementia treatment ward (closed ward) in the psychiatric depart- ment is necessary. The doctors who are specialists in dementia consist mainly of psychiatrists, neurophysicians, brain surgeons, geriatricians, and doctors who belong to the Department of General Medicine. If we consider the characteristics of the role psychiatrists play in treating dementia, it can be said that psychiatrists are specialists in treating psychic symptoms, which constitute the core of BPSD. Since psychiatrists use antipsychotics far more often than doctors in other departments, they are specialized in prescribing an antipsychotic according to the symptom. In the case of severe BPSD, psychiatrists can hospitalize the patient on a closed ward and give treatment to him or her if necessary but at the minimum. In other words, psy- chiatrists are in an important position in treating dementia that is different from doctors of other departments, and a psychiatric department seems to be the only department which can follow dementia patients through all the stages of their dementia. I strongly hope that not only dementia-specialized doctors but also all other doctors will develop an interst in dementia, and that dementia patients can access effective services any- where in Japan. The problem of dementia concerns not only people engaged in medical and care businesses but also all people in the community, and I think that it is the most important for the whole of society to try to treat dementia.
[Psychotropic Prescribing Practices for Children and Adolescents with Intellectual Disabilities: A Cohort Study Using a Large-scale Health Insurance Database].
Inoue Y, Okumura Y, Fujita J
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620838
CONTEXT: Children and adolescents with intellectual disability often have various mental disorders and behaviour problems. Despite the limited evidence on the efficacy and safety of psychotropic medication use to childre...
CONTEXT: Children and adolescents with intellectual disability often have various mental disorders and behaviour problems. Despite the limited evidence on the efficacy and safety of psychotropic medication use to children and adolescents with intellectual disability, clinicians often prescribes psychotropic medications for the management of problem behaviours. OBJECTIVE: We aimed to clarify the psychotropic prescribing practices for children and adolescents with intellectual disability. DESIGN: We conducted a 1-year cohort study of patients with intellectual disability aged 3-17 years using a large health insurance claims database in Japan. OUTCOME MEASURES: Psychotropic prescription, prescription duration, polypharmacy, and average dosage. RESULTS: Of 2,035 patients, the most prevalently prescribed psychotropic medications were antipsychotics (12.5%), anxiolytics/hypnotics (12.4%), stimulants (4.8%), mood stabilizers (2.4%), and antidepressants (1.8%). The prescription prevalences of anxiolytic/hypnotic and antipsychotics increased with age. Patients aged 6 years or older had around 2-fold higher prescription duration of antipsychotics (median duration of over 300 days per year) than those aged 3 to 5 years. The likelihood of polypharmacy and excessive dosage (defined as chlorpromazine equivalents of >300 mg/day) of antipsychotics increased with age. CONCLUSION: We observed a higher prescription prevalences of anxiolytics/hypnotics and antipsychotics and a longer prescription duration of antipsychotics in the present study than those in previous studies. Our results suggest a need for developing clinical practice guidelines for the management of problem behaviours among children and adolescents with intellectual disability.
[Palliative Care for Dementia].
Ogawa A
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620837
The population of the elderly is increasing rapidly in Japan; therefore, the development of a support system for patients with dementia is an urgent task. In recent years, the palliative care approach, which has conventi...
The population of the elderly is increasing rapidly in Japan; therefore, the development of a support system for patients with dementia is an urgent task. In recent years, the palliative care approach, which has conventionally evolved according to the needs of patients with can- cer, has been applied for people with dementia. The palliative care approach aims to prevent and relieve suffering by means of early identification and impeccable assessment and treatment of pain and other problems, respects the dignity of the patient, and ensures open commu- nication with honesty. Care for persons with dementia involves a number of key palliative interventions, includ- ing symptom management, especially pain control, which is under-recognized and under- treated, psychological support, decision making since diagnosis, and caregiver support. Since palliative care is applicable in conjunction with other treatments, the palliative care approach is suitable for dementia care with comorbidity. Therefore, the importance of palliative care is rec- ognized in acute care and home care settings.
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