Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[From Electrical Activity of a Neuron to Psychiatric Disorder].
Yoshino H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620836
In clinical practice, electroencephalography (EEG) can remind us that the human execu- tive function is based on neural activity and its oscillation. It is generally considered that each neuron receives electrical inputs...
In clinical practice, electroencephalography (EEG) can remind us that the human execu- tive function is based on neural activity and its oscillation. It is generally considered that each neuron receives electrical inputs from other neurons and produces an action potential to trans- mit signals to the next neuron, leading to the generation of a neural network underlying mental activity. However, these mechanisms remain poorly understood. Thus, it is necessary to accumulate new knowledge about neuronal activity to overcome mental disease in the future. In the cerebral cortex or hippocampus, the core regions of the executive function, neurons are mainly classified into two types, pyramidal cells and interneurons, which are excitatory gluta- matergic neurons and inhibitory GABAergic neurons. Whole-cell patch clamp recording is widely known as a laboratory technique in electrophysiology. This technique enables us to record one neuron's electrical activity, such as action potentials, excitatory synaptic inputs, and inhibitory synaptic inputs. In this review, I would like to introduce several studies conducted using this technique to further our understanding of the pathophysiology of psychiatric illness.
[A Pilot Program of Training in Psychotherapeutic Approach for Psychiatric Residents].
Fujiyama N
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620835
One of the main problems in the training of psychiatrists in Japan is psychotherapy. What is meant by "psychotherapy" in this context is not some special form of therapy, but the skills regarding constructing and sustain...
One of the main problems in the training of psychiatrists in Japan is psychotherapy. What is meant by "psychotherapy" in this context is not some special form of therapy, but the skills regarding constructing and sustaining therapeutic relationships in order to carry out daily medical practice smoothly. Those with skills in medical practice, in the case of psychiatric practice, will meet difficulties when facing patients' pathologies and personalities, and thus require professional training. In other countries, as a condition for acquiring the qualification of a psychiatrist, experi- ences on individual supervison are included. Supervision is productive in the sense of receiving evaluations on therapeutic relationships from the eyes of a detached observer and obtaining advice accordingly, and also in the sense of contributing to establishing identities as psychia- trists through one-to-one affective relationships with senior psychiatrists. In Japan, however, it is difficult to provide trained supervisors who can meet the needs of initial psychiatric training. The absolute number of supervisors is limited and they are not evenly distributed. Against this situation in Japan, for example, in the psychiatric departments of university hospitals and psychiatric offices of hospitals, they have made attempts to provide group consul- tations by inviting external consultants a few times a year. Although those attempts have a certain significance, they have demerits such as each resident can give a case presentation only once a year at the most, there are no chances to continually receive advice, and relation- ships with the consultants are not intense. In the Neuropsychiatry Department, University of Tokyo Hospital, a new training pro- gram, TPAR (Training in Psychotherapeutic Approaches for Residents), is in operation in order to overcome this situation. Residents form groups of 2 to 3 and visit a number of exter- nal consultants to receive continuous advice once a month. After 6 months, they rotate to other consultants. The advantages of this program are discussed from the perspectives of continuity, individuality, and subjectivity of the residents.
[Psychiatric Residency Training in the United States].
Okano K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620834
Psychiatric residency training programs in the United States are based on regulation by the ACGME (Accreditation Council for Graduate Medical Education). They basically consist of a four-year course (six years if the chi...
Psychiatric residency training programs in the United States are based on regulation by the ACGME (Accreditation Council for Graduate Medical Education). They basically consist of a four-year course (six years if the child program is included), with a variety of didactic courses as well as clinical assignments in different clinical settings affiliated with the local resi- dency program. Each resident is closely supervised by his/her supervisor during his/her clini- cal assignment. Clinical training opportunities are supplemented by on-call duties which require each resident to apply the entire repertoire of skills of a fully-fledged psychiatrist, with intake assessment for hospitalization as well as acute psychiatric coverage in emergency rooms. The author participated in one of these programs at the Menninger Clinic in Kansas in the early 1990s. He discussed one of his own anecdotes, which depicts a potential pitfall for inexperienced psychiatric clinicians.
[Supervision in Psychiatric Training].
Ono Y, Fujisawa D, Nakagawa A … +4 more , Sado M, Kikuchi T, Tajima M, Horikoshi M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620833
Psychotherapy is an essential component of psychiatric treatment. Although appropriate training including supervision is essential to become able to conduct psychotherapy skillfully, supervision has not been performed in...
Psychotherapy is an essential component of psychiatric treatment. Although appropriate training including supervision is essential to become able to conduct psychotherapy skillfully, supervision has not been performed in the training of Japanese psychiatrists. In this article, we explain how to utilize supervision in psychiatric training.
[Difficulties in Therapeutic Relationships and How to Deal with Them].
Fuse-Nagase Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620832
It is essential to develop a good therapeutic relationship with a patient. However, it is not always easy. There are various factors that make the therapeutic relationship difficult. Being unaware of a change in the ther...
It is essential to develop a good therapeutic relationship with a patient. However, it is not always easy. There are various factors that make the therapeutic relationship difficult. Being unaware of a change in the therapeutic structure and also being unaware of countertransfer- ence are some of those factors. It is difficult for trainees to realize them by themselves. Suffi- cient opportunities for supervision and case conferences should be made available.
[How Should We Understand the Concept of "Recovery" and Draft Recovery Guidelines?].
Murai T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620831
In mental health services, the importance of the concept of recovery has been increasingly recognized. However, the concept and definition of "recovery" have not reached a consensus among mental health service users and...
In mental health services, the importance of the concept of recovery has been increasingly recognized. However, the concept and definition of "recovery" have not reached a consensus among mental health service users and professionals. Clarifying the concept of recovery is one of the important issues in the process of drafting recovery guidelines.
[Recovery-oriented Practice Using a Question Prompt Sheet].
Kumakura Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620830
Shared decision making (SDM) is being considered increasingly important in today's medical practice. This approach should also be promoted in the field of mental health. We developed a question prompt sheet (QPS) for per...
Shared decision making (SDM) is being considered increasingly important in today's medical practice. This approach should also be promoted in the field of mental health. We developed a question prompt sheet (QPS) for persons with schizophrenia as a decision aid to empower them with autonomy. We published it on the website as a free download available to the general public. The therapeutic relationships respecting otherness between mental health service users and professionals can be the basis of recovery-oriented support. This article aims to introduce the background and process of making a QPS and to rethink recovery and growth from the viewpoint of dialogism.
[Consideration of Recovery, as a Family Member, as a Patient, and as a Psychiatrist].
Natsukari I
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620829
I have previously published a paper in this journal that described my mother's schizo- phrenia, how I became a patient and the process by which I subsequently became a psychia- trist. After that paper, I began to think t...
I have previously published a paper in this journal that described my mother's schizo- phrenia, how I became a patient and the process by which I subsequently became a psychia- trist. After that paper, I began to think that my mother made a strong recovery. I no longer see my mother as an 'unfortunate person'. This change in perspective has also altered my values and internal strength, and I have begun to see the course of my own recovery. It is directed toward my 'recovery as a psychia- trist' ; it involves my contribution to psychiatric care and the social activities that I can par- ticipate in as a patient's family member and as a patient myself. For one of these activities, I administered a questionnaire survey directed toward patients and their family members throughout the country on 'psychiatrists' communication abilities' in June 2015. This survey is based on my frustrating experience of being unable to speak hon- estly with my attending physician when my mother and I were receiving psychiatric care. From my own experiences, I realised that recovery represents subjective improvement. Being subjective, it changes throughout life ; therefore, it is not something that can be defi- nitely ended, as in 'recovered'. I feel that recovery is similar to constantly 'climbing up a hill'. Sometimes, encounters and events in life may make us feel that we have fallen down. Dur- ing such times, we need people who can support us to climb 'the hill of recovery'. I believe that a psychiatric specialist is an important person who supports 'recovery according to the patient' by the side of the hill, firmly grounded in medical knowledge but also based on a sub- jective viewpoint of the patient and his/her family. In my description of these changes, I hope that this article can depict how I am climbing the hill to'recovery as a psychiatrist' and serve as a reference for the readers' clinical practice.
[The Conceptual Framework and Science of Personal Recovery].
Kasai K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620828
While objectively measurable outcomes have been emphasized in modern psychiatry, sub- jective or patient-reported outcome measures have attracted renewed interest recently. This trend coincides with the advent of the con...
While objectively measurable outcomes have been emphasized in modern psychiatry, sub- jective or patient-reported outcome measures have attracted renewed interest recently. This trend coincides with the advent of the concept of "personal recovery". We psychiatrists may have become too accustomed to institutionalized care and academic frameworks of psychopa- thology and biological psychiatry and, thus, be so incapable of maintaining an insight into the patient's life in the real-world that we might share a medically biased misunderstanding of the concept. Our task here is to scientifically clarify the construct of the concept of personal recovery in order to optimize clinical services and professional education so that they are recovery- oriented.
[A Case of Dilated Cardiomyopathy after 17 Years of Clozapine Treatment].
Okubo R, Hashimoto N, Kusachi M … +2 more , Narita H, Kusumi I
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620827
Clozapine-induced cardiomyopathy is a rare but fatal complication with a reported incidence of 0.4% in Japan. Clozapine-induced cardiomyopathy develops at an average of 14.4 months after initiating clozapine, and to our...
Clozapine-induced cardiomyopathy is a rare but fatal complication with a reported incidence of 0.4% in Japan. Clozapine-induced cardiomyopathy develops at an average of 14.4 months after initiating clozapine, and to our knowledge, has a duration no longer than seven years. We present a patient who developed dilated cardiomyopathy after 17 years of clozapine treatment and made a full recovery of cardiac function at 40 weeks after clozapine treatment cessation. A 43-year-old male with a 24-year history of schizophrenia was treated with clozapine (600 mg/day) for 17 years. No abnormal findings were revealed at follow up until he pre- sented with dyspnea with no accompanying symptoms while walking. He was suspected of worsening asthma due to his past history and lack of abnormalities of ECG and CXR. However, as he experienced gradually worsening dyspnea accompanied by listlessness and lightheaded- ness, he was referred to a cardiologist. The echocardiogram revealed left ventricular dilatation and systolic dysfunction (left ventricular ejection fraction, LVEF=40%), which made a diagno- sis of dilated cardiomyopathy. We excluded cardiac ischemia and other possible causes of dilated cardiomyopathy with cardiac catheterization and endomyocardial biopsy. Clozapine treatment was stopped and switched to olanzapine along with standard heart failure medica- tions. The symptoms and left ventricular function improved following clozapine discontinua- tion. The symptoms resolved and echocardiogram showed a LVEF of 50% within 11 weeks after treatment with clozapine was ended. LVEF was reported at 59% 40weeks after cessation of clozapine. At the present time, 32 months since ceasing clozapine treatment, no worsening of symptoms has been presented. After ceasing clozapine and inducing standard heart failure medications, the patient presented the excellent recovery and the normalization of his echocar- diogram. Despite this outcome, there is currently insufficient evidence to conclusively establish a causal relationship between clozapine and cardiomyopathy in this case. In addition, this case demonstrates that we cannot exclude cardiomyopathy due to lack of abnormal findings of ECG and CXR. Therefore, we recommend that echocardiograms should be performed annually. The mortality associated with clozapine-induced cardiomyopathy is high, so if patients undergoing therapy with clozapine develop new symptoms or signs suggestive of cardiac dysfunction such as dyspnea, a focused cardiovascular examination should be considered.
[Reconsidering Morita Therapy for Depression].
Nakamura K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620826
The author outlined Morita therapy-based living-guidance (yojo) and inpatient treatment for depressed patients. He further discussed commonalities and differences between Morita therapy and "the third generation" of cogn...
The author outlined Morita therapy-based living-guidance (yojo) and inpatient treatment for depressed patients. He further discussed commonalities and differences between Morita therapy and "the third generation" of cognitive-behavioral therapies, such as behavioral activa- tion (BA) and mindfulness-based cognitive therapy (MBCT). Both Morita therapy and BA share at least a common view that it is effective to activate patients' constructive behavior at a certain point in depression treatment. In a corresponding manner, as MBCT emphasizes the "being" mode and Morita therapy, "arugamama, or being as is," they both state that the turn- ing point to break the vicious cycle (or "doing" mode) is accepting thoughts and emotions as they are. However, Morita therapists, compared with BA therapists, seem to pay more attention to the necessity of resting and appropriate timing for introducing behavioral activation. MBCT has patients concentrate their attention on their own aspirations and bodily sensations (medita- tion), while in Morita therapy, their attentions are naturally diverted through the practice of daily life. Besides the differences of cultural backgrounds, there seem to be differences in depression models between Morita therapy and "the third generation" of CBT. In the BA model, the cause of depression lies in a lack of positive reinforcement, and negative reinforcement resulting from the avoidance of the experience of discomfort. The cognitive theory of depression places the model of the vicious cycle among the elements of cognition, emotion, and behavior. In this regard, MBCT shares a common assumption regarding the pathogenesis of depression with conventional cognitive therapy. As BA and MBCT are based on psychological models of depression, both treatments have been primarily practiced by clinical psychologists. On the other hand, medical doctors mainly offer a psychotherapeutic approach with medication treat- ments for depressive patients in Japan. In this context, the practice of treating depression is based primarily on medical models of endogenous depression. This is also true of Morita ther- apy, but in a broad sense. While those who follow medical models in a narrow sense try to identify the cause of illness and then to remove it, Morita therapists pay more attention to the recovery process rather than the pathogeneses of depression and attempt to promote patients' natural healing-power. Therefore, it may be more appropriate to refer to the model used in Morita therapy as "a resilience model".
[Cognitive Behavioral Therapy for Depression].
Ono Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620825
Cognitive behavioral therapy (CBT) is a form of psychotherapy that improves dysfunc- tional cognition, and enhances the ability to manage problems in daily life. Not only CBT tech- niques, such as behavior activation, co...
Cognitive behavioral therapy (CBT) is a form of psychotherapy that improves dysfunc- tional cognition, and enhances the ability to manage problems in daily life. Not only CBT tech- niques, such as behavior activation, cognitive restructuring, and problem solving, but also case formulation and therapeutic relationships are important in CBT, which are useful for psychia- trists who work at a general hospital.
[How Jungian Psychology Has Been Developed in Japan].
Yamanaka Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620824
Jungian Psychology was introduced to Japan in 1931 by Kokyo Nakamura for the first time in Sekai Daishiso Zenshu ("The Complete Works of Thoughts in the World") vol. 33. (Shunjusha Publishing Company). Yoshitaka Takahash...
Jungian Psychology was introduced to Japan in 1931 by Kokyo Nakamura for the first time in Sekai Daishiso Zenshu ("The Complete Works of Thoughts in the World") vol. 33. (Shunjusha Publishing Company). Yoshitaka Takahashi and others made Jungian Psychology more accessible to the Japanese public in the mid-1950s although they did not succeed in full repre- sentation of the fundamental ideas of C. G. Jung. It was Hayao Kawai who truly understood those ideas and initiated the Jungian movements in Japan in 1967. In my opinion, however, there are hardly any Jungian Analysts who develop Jung's ideas further enough to reach a new awareness of the human psyche except a very few people such as Neumann, E., and Gug- genbtihl-Craig, A., Kalff, D. M., Spiegelman, M., Meier, C. A. and Hillman, J., Giegerich, W, in the West and H. Kawai and me in Japan. Kawai develops and deepens Jungian thoughts to a cer- tain extent in his book, The Buddhist Priest Myoe : A Life of Dreams (Shohakusha Publishing Company), while his understanding of Buddhism does not exceed what D. T. Suzuki describes in his work, An Introduction to Zen Buddhism. That is to say the ideas of both Zen and Shin Buddhism are abstracted and assimilated in general Buddhism in his work, resulting in losing their unique features which could have been pursued further. Moreover, although Kawai translates Jung's idea of SynchronizitAt to "kyoji-sei" (synchronicity), I claim that "engi-ritsu" (the pratitya-samutpada principle) would be a more appropriate term to reflect the original concept as it would imply the opposite principle to"inga-ritsu" (the causal principle). It should be noted that the pratitya-samutpada principle is different from the Buddhist concept of pratitya- samutpada which includes causality. In addition I transcribed the Avatamsaka sutra, which originated in India and was developed in China. I also attended to the 2"d international confer- ence featuring the Avatamsaka sutra at Belesbat on the outskirts of Paris. Eventually I have reached an idea that when combined with the concept of the pratitya-samutpada principle, the Avatamsaka sutra could be considered as a-product of Eastern wisdom which would provide an insight beyond Jung. What was originally comprehended by Gautama Buddha was crystallised in abstract images of Amitabha and Vairocana in China during the second and fourth centuries. Amitabha is a celestial buddha that Shinran, the founder of Shin Buddhism, established his own understanding of in his school whereas Vairocana is a celestial buddha that appears in the Avatamsaka sutra. Vairocana could be taken as an image of the"rising sun", the creator of all things, while Amitabha as the "sinking sun", the saviour of all creatures. This picture of psychological cosmology gives a new perspective on the human psyche that would succeed Jungian Psychology. I believe this unique conception is equivalent to the findings in modern physical cosmology, such as Einstein's theories and the Alpha-Beta-Gamow paper, which provided a new understanding of the universe.
[Zen and Mindfulness: Their Form and Spirit].
Kumano H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620823
Mindfulness is equivalent to the spirit of Zen. The 'spirit' means the function of the exer- cise of Zen that is comparable with its effects or influences. The relation is understandable from a term handed down in Japane...
Mindfulness is equivalent to the spirit of Zen. The 'spirit' means the function of the exer- cise of Zen that is comparable with its effects or influences. The relation is understandable from a term handed down in Japanese culture,"Going into the Form, and out of the Spirit". The way of exercising mindfulness emphasizes the combination of two kinds of meditations: samatha meditation bringing about attention concentration, and vipassana meditation preventing the birth of thinking and grasping realities and the self. The strategies of mindfulness have a commonality that the meditators create the three frontiers of awareness, being aware what is occurring in their body and mind, restraining their habitual responses, and free- ing themselves from autopilot behavior patterns. As a result, they can give the meditators the chance to overcome their maladaptive learning habits, clarifying their 'values' based on life- sized realities and selecting desired behaviors. Usually, although it is impossible to achieve the effects we want without certain forms of exercise, there is a term in Japanese culture,"Going into the Form, and out of the Form". This means that when the exercise becomes the way of one's living, one no longer needs its form. It is the lasting change of a psychological trait, such as the way of living everyday life rather than the transient psychological state of awareness that mindfulness seeks.
[Studies on Naikan Therapy Focusing on Its Ideological Background -A Comparison between Japanese and Western Patterns of Thought and Reconsidering Max Weber's Theory].
Nagayama K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620822
A deliberately crafted setting of intensive Naikan therapy has its base in traditional Japa- nese culture that attaches importance to practical and procedural knowledge. Whereas a ratio- nal explanation by using descript...
A deliberately crafted setting of intensive Naikan therapy has its base in traditional Japa- nese culture that attaches importance to practical and procedural knowledge. Whereas a ratio- nal explanation by using descriptive knowledge is valued in western society, Japanese society tends to value procedural knowledge. The contrast between these two values can be explained by a difference in understanding transcendent existences. In Western society, it has been understood in relation to logos related to logical orderliness. On the other hand, it has been understood in relation to WAZA, which has to do with a magical or hands-on knowledge. Both types of knowledge involve two phases in a process of development; construction and deconstruction. The deconstructive phase in which reformation and renovation of knowledge is induced consists of intuitive and holistic experience, which in Western Christian society is related to hypostasis-persona of the Trinity, while it is related to "sumu" from Shintoism in Japan. Both are symbols of the Creation, coming from the precipitative phenomenon, symbolized in liquid. Insight in psychotherapy is one with a person's experience of deconstructing procedural knowledge. Max Weber has discussed over these two kinds of knowledge and its construction/deconstruction moments. Reconsidering Weber's theory from a psychotherapeutic viewpoint will therefore give us a new key to understand the core of legitimacy of domination and a Tenno system of Japan.
[Morita Therapy Related to Eastern Views of Nature].
Kitanishi K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620821
Psychotherapies have developed closely associated with cultures. The 21st century was the era during which Western intellect, or scientific thought, was by far the predominant influence in the world. Under the influence...
Psychotherapies have developed closely associated with cultures. The 21st century was the era during which Western intellect, or scientific thought, was by far the predominant influence in the world. Under the influence of such scientific thought, psychoanalysis, behavior therapy, and cognitive therapy were developed, from which various psychotherapies have been derived. These can be regarded as control models with which ego enhancement is aimed at by control- ling symptoms or conflicts. Morita therapy is a psychotherapy which lies at the other end of the spectrum. The thera- peutic mechanism of this psychotherapy is based on the oriental understanding of human beings, which include naturalism or one embodiment theory for mind, body, and nature, consid- eration of human ego and language as definite, and relational theory (a Buddhist idea that every phenomenon arises in mutual relationships). In this paper, I would like to : 1) clarify the characteristics of Morita therapy related to eastern views of nature, and 2) discuss the characteristics of self and acceptance/behavior change. As for self, contrary to mind-body dualism, nature lies at the bottom of all of us, on which the body exists, on which the mind exists. These are mutually related and inseparable, while being open to one another. In Morita therapy, the mind (consciousness) is understood only to a limited extent in relation to nature and the body (unconsciousness). It therefore strongly questions the omnipotent interpretation of thought mediated by lan- guage, which the other psychotherapies sometimes present. Morita therapy aims to be in touch with body and nature in different approaches. The above is what "following nature" means. It is the understanding that fears (inner nature) have to be accepted as nothing but fears, and desires (also inner nature) cannot be given up. By awakening to the fact that there are things that are out of our control, one realizes the presence of desire for life that self-pos- sesses, and its exertion becomes a possibility. This is what we call the state of "Arugamama (being as-is) ", being comprised of the tension between the two poles of desire and fear, which is highly dynamic. Arugamama is the same as the concept of mindfulness to accept fear/anguish as it is. Aru- gamama remains from the concept of desire for life, to assume a dynamic recovery. This is a very useful concept to resolve the narcissism in modern times.
[Considering Mental Health from the Viewpoint of Diet: The Role and Possibilities of Nutritional Psychiatry].
Matsuoka Y, Hamazaki K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620820
Disease burden from psychiatric disorders is an important public health issue worldwide, and should be addressed proactively. Because the development of psychiatric disorders involves both genetic and environmental facto...
Disease burden from psychiatric disorders is an important public health issue worldwide, and should be addressed proactively. Because the development of psychiatric disorders involves both genetic and environmental factors, as well as their interactions, lifestyle interven- tion is a feasible treatment and prevention strategy. The human brain uses a substantial por- tion of the body's total energy and nutrient intake. Nutrients strongly influence both brain structure and function, and nutrition also affects neurodevelopment and neurotrophic function. It has been recognized in recent years that diet and nutrition may be an important factor con- tributing to psychiatric morbidity, and that prevention or treatment of psychiatric disorders could be conducted by addressing diet and nutrition. Against this background, in 2013 we founded the International Society for Nutritional Psychiatry Research (ISNPR). The aim of the present paper is to provide a set of practical recommendations for the prevention and treat- ment of depression based on the ISNPR statement and the review by Opie et al. Here, we introduce Opie's five key dietary recommendations and state our hypotheses for improving mental health: (1) follow traditional dietary patterns, such as the Mediterranean, Norwegian, or Japanese diet (2) increase consumption of fruits, vegetables, legumes, whole-grain cereals, nuts, and seeds; (3) consume higher amounts of foods rich in omega-3 fatty acids; (4) replace unhealthy foods with wholesome nutritious foods ; (5)limit intake of processed foods, fast foods, commercial baked goods, and sweets ; and (6) be mindful of probiotic gut bacteria. The pos- sible biological mechanisms by which nutrition might affect mental state are not known in depth, and full associations between nutrition and mental disorders have not been examined in randomized controlled trials. However, the existing evidence suggests that a combination of healthy dietary practices may reduce the risk of developing depression. As dietary practices and lifestyle can be changed by individuals at any time, new integrated approaches to mental health from the viewpoint of diet and nutrition-that is, nutritional psychiatry-could be appli- cable to a wide population. Gathering the findings of high-quality studies and implementing nutritional psychiatry within clinical practice are important tasks for the future.
[Diagnosis of Feeding and Eating Disorders Using DSM-5 -Checkpoints on Making a Diagnosis-].
Nakai Y, Nin K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620819
We reviewed the diagnostic checkpoints associated with the diagnosis of feeding and eat- ing disorders (FED) using the Diagnostic and Statistical Manual of Mental Disorders (DSM) - 5, focusing on two new categories : avo...
We reviewed the diagnostic checkpoints associated with the diagnosis of feeding and eat- ing disorders (FED) using the Diagnostic and Statistical Manual of Mental Disorders (DSM) - 5, focusing on two new categories : avoidant/restrictive food intake disorder (ARFID) and binge-eating disorder (BED). There are some differences between the diagnostic checkpoints for FED employed in Japan and Western countries. In Japan, some patients with anorexia ner- vosa (AN) -like conditions do not exhibit any evidence of fat phobia or a distorted view of their body weight and shape. Accordingly, we need to differentiate these patients from those with AN or ARFID. Since Japanese BED patients do not have high body mass indices compared with those in Western countries, it is not easy to differentiate BED from non-purging bulimia nervosa in Japan. We observed a 30% reduction in the diagnostic frequency of other specified FED/unspecified FED after the implementation of DSM-5 compared with the diagnostic fre- quency of eating disorder not otherwise specified based on DSM-IV. These findings suggest that DSM-5 is useful for diagnosing FED, but there are various checkpoints that we need to consider when diagnosing FED using DSM-5.
[Psychotropic Medication and Operating Automobiles and Machinery].
Matsuo K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620512
Beginning in March 2013 and following again in May of the same year, warnings on the potential for medication-related impairment during the operation of motor vehicles were issued by the Ministry of Internal Affairs and...
Beginning in March 2013 and following again in May of the same year, warnings on the potential for medication-related impairment during the operation of motor vehicles were issued by the Ministry of Internal Affairs and Communication as well as the Ministry of Health, Labour, and Welfare. These notices have proven to be confusing for staff at psychiatric departments and pharmacies alike, as many widely prescribed psychotropic medications were included on the list. In response.to this issue, here I reviewed the aforementioned proscriptions as well as equivalent pronouncements from other countries and provided a brief overview on the subject from the point of view of pharmaceutical companies and regulatory agencies. The results showed that drug safety regulations in Japan were significantly more restrictive than the other countries surveyed for driving automobiles and operating machinery, and that the tone of the language used differed greatly from country to country. Additionally, observation of the current situation in the EU specifically reveals that, compared to Japan, the issue is being confronted much more proactively. Moving forward, it is recommended that Japan also, through the combined effort of regulatory agencies, academia, medical facilities, pharmaceutical companies and patients and their families, make greater efforts to adopt standards that assure traffic safety for the general public at large while concurrently respecting patients' right to freedom of movement and autonomy, even when receiving medical treatment.
[The Drug Interaction that Psychiatrists Should be Careful about].
Yasui-Furukori N
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620511
Drug combination therapy is sometimes used in clinical situations. CYP has been intensely studied numerous times ; thus, its pharmacokinetic interactions have been predicted to some extent. Basically, a drug interaction...
Drug combination therapy is sometimes used in clinical situations. CYP has been intensely studied numerous times ; thus, its pharmacokinetic interactions have been predicted to some extent. Basically, a drug interaction is defined as competitive inhibition of an enzyme by two drugs. We are concerned that fluvoxamine may have a drug interaction with paroxetine. Flu-voxamine inhibits CYPlA2 and CYP2C9 activity, and paroxetine inhibits CYP2D6 activity. However, recently, new drug targets have been identified, such as P-glycoprotein, a drug transporter. Fluvoxamine and paroxetine inhibit not only CYP but also P-glycoprotein. Additionally, there is an increased risk of upper gastrointestinal tract bleeding with the combination of a SSRI and NSAIDs. There are also individual differences in the pharmacokinetics of drugs due to genetic factors and individual differences in drug receptors, which have not yet been investigated for fluvoxamine or paroxetine. Obtaining clinical diagnoses of drug interactions is necessary in all patients.
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