Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[Long QT Syndrome Induced by Antidepressants].
Suzuki Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620510
A diagnosis of drug-induced long QT syndrome is made when the QT interval corrected for heart rate (QTc) is 500 msec or above or is prolonged 60 msec or more after initiating, substituting, or increasing the dose of the...
A diagnosis of drug-induced long QT syndrome is made when the QT interval corrected for heart rate (QTc) is 500 msec or above or is prolonged 60 msec or more after initiating, substituting, or increasing the dose of the drug, and it is considered that the risk of severe ventricular arrhythmia, referred to as torsade de pointes (TdP), increases under these condi- tions. Long QT syndrome is divided into the two broad categories of congenital or secondary, and among drug-induced long QT syndrome, which is classified as secondary, antipsychotic drugs are considered to be the most frequent cause of TdP, excluding anti-arrhythmic drugs. At the same time, escitalopram, which became commercially available in 2011, garnered attention in Japan due to administration contraindication in patients with prolonged QT. The guidelines of the International Conference on Harmonization of Technical Requirements for Regis- tration of Pharmaceuticals for Human Use (ICH) (E14) requires a detailed QT prolongation effect evaluation study (Thorough QT/QTc study) for new drugs, and in Japan, this has been adapted to drugs applied for on and after Nov 1, 2010. As a result of the study, escitalopram demonstrated a maximum of 11.8 msec prolongation from baseline when administered at 30 mg, which is the approved dosage overseas, and thus became contraindicated in patients with prolonged QT ; however, since the approved dosage of escitalopram in Japan is 20 mg/day, and since the study at our site indicated that other antipsychotic drugs may have a QT prolongation effect greater than escitalopram, our findings suggest the necessity to determine inter- drug differences and dose dependency of the antidepressant drugs and antipsychotic drugs that were commercially available before 2010 and are still used today, by conducting QT prolongation effect evaluation studies. Furthermore, the factors prolonging the QT intervals include a female sex, hypokalemia, hypomagnesaemia, bradyarrhythmia, various cardiac diseases, central nerve system diseases, drug interactions, and gene mutations; wherein, drug-induced long QT syndrome occurs due to the additive and synergistic effects of these factors, making it difficult to predict QT prolongation. Therefore, careful electrocardiogram monitoring is required in clinical settings.
[Prediction and Personalized Medicine of Antidepressant Treatment in Japanese MDD Patient].
Kato M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620509
Various classes of antidepressants have been used in the treatment of major depressive disorder (MDD) ; however, treatment efficacy is inadequate, as 30-40% of patients do not expe- rience response even after sufficientl...
Various classes of antidepressants have been used in the treatment of major depressive disorder (MDD) ; however, treatment efficacy is inadequate, as 30-40% of patients do not expe- rience response even after sufficiently long treatment period with adequate dose of antidepressant. For the treatment-resistant patient to the therapy based on the generalized evidence, is it possible to provide an appropriate and improved treatment based on personalized medicine, taking into account predictable candidates such as sub-symptoms of depression and genetic factors instead? There is only little evidence for this in Japanese MDD, and consequently we use the evidence of Caucasians as reference, however, could we use the evidence of the popu- lation whose genetical, social, and cultural background are very different from Japanese popu- lation? In this review, I will refer to our randomized controlled studies that have some predict- able candidates including genetic factors designed for personalized medicine in MDD patients, and present an overview of procedures for making predictions of current treatment and pro- ceeding towards personalized medicine.
[The Issue Regarding Polypharmacy of Antidepressants and Anxiolytics How Can We Manage Them?].
Watanabe K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620508
Newer antidepressants and anxiolytics can be used easily as these drugs have fewer side effects which could markedly influence the quality of life compared with other types of psycho- tropic drugs. When symptoms do not r...
Newer antidepressants and anxiolytics can be used easily as these drugs have fewer side effects which could markedly influence the quality of life compared with other types of psycho- tropic drugs. When symptoms do not remit with antidepressants, the following factors should be focused on : reconsideration of the diagnosis, assessment of side effects, comorbidity, psychoso- cial factors, therapeutic alliance and adherence, and reconsideration of dose settings from the viewpoint of pharmacodynamics. As shown in the major treatment guidelines, it is recom- mended to start with monotherapy and, if it does not work, a switch is recommended, but after this step, we have to depend on augmentation or combination with the burden of side effects. Once polypharmacy is initiated, putting closely categorized antidepressants into one and being careful to minimize withdrawal symptoms and risk factors are the ways to make the prescrip- tion simple. Regarding anxiolytics, clinicians should be aware of factors which could lead to depen- dence, such as short half-life and high-potency drugs used pro re nata, and these factors could result in poly- and high-dose pharmacy as well. Moreover, it will be difficult to reduce doses, as these drugs are associated with withdrawal symptoms. These factors could lead to long use and dependence. To prevent dependence and polypharmacy, administer the lowest effective dose and avoid using them aimlessly. Using booklets to help educate patients to reduce doses gradually, safe discontinuation will be achievable.
[An Adolescent Case of ASD Presenting with Persistent Catatonia and Epileptic EEG Discharge].
Izuno T, Takagi S, Nakamurai M … +3 more , Narushima K, Uchiyama T, Nishikawa T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620507
A 26-year-old man developed a catatonic state after his grandmother's death and the Great East Japan Earthquake. He was admitted to hospital because of the prolonged severe stupor. Electroencephalography (EEG) revealed f...
A 26-year-old man developed a catatonic state after his grandmother's death and the Great East Japan Earthquake. He was admitted to hospital because of the prolonged severe stupor. Electroencephalography (EEG) revealed focal (F3 electrode) and generalized epileptic abnormalities. He was administered antiepileptic agents and benzodiazepines, but his stupor did not improve in spite of a reduced frequency of epileptic EEG abnormalities. His clinical his- tory did not suggest any psychotic disorders. Thereafter, extensive physical examinations were performed, but an organic cause of the stupor was not determined. For about two years, he was unable to intake food without tubal feeding, have a conversation, or move spontaneously. One day, a generalized tonic-clonic seizure (GTC) occurred spontaneously for the first time in his life, and then his stupor markedly improved. Thereafter, he could eat food spontaneously, have a fluent conversation, and move actively. After his condition had improved, we asked his parents about his developmental history, clinical history, and present state. According to clini- cal interviews including the use of PARS (Pervasive Developmental Disorders Autism Society Japan Rating Scale), DISCO (Diagnostic Interview for Social and Communication Disorders), and WAIS-III (Wechsler Adult Intelligence Scale-third edition), he was diagnosed with autistic spectrum disorder (ASD) and mild intellectual disability. It was considered that his stupor had occurred secondary to ASD. Wing et al. reported that catatonia occurred in about 17% of ASD adolescents and young adults as a later complication. It is possible that this case, without any psychotic disorders and with ASD that has been undiagnosed until young adult, progress to such a severe and prolonged catatonic state. We report this case to show that severe catatonia is possible in adolescents and young adults during the carry-over period in ASD patients.
[Your Partnership for Psychiatry and Neuroscience in the World -An Integrated Perspective on Mental Illness-].
Kishimoto T, Kimoto S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620506
Human disease structure has constantly changed in close association with the times and society. Nowadays, there are so many"brain and mind problems"against a background of social issues. In developed countries including...
Human disease structure has constantly changed in close association with the times and society. Nowadays, there are so many"brain and mind problems"against a background of social issues. In developed countries including Japan, mental illnesses have seriously affected the lives and health of patients and their families. It is historically clear that stigma towards mental ill- nesses and a fragile mental health service have led to the existing situation. Therefore, to achieve the development of psychiatry in the future, we need to ruminate over the possibility of prevention, early intervention, and treatment and recovery to reduce stigma towards mental illnesses while regarding them as brain diseases. Based on the point of view that cognitive impairment could largely influence social functioning, and by introducing schizophrenia as a representative cognitive illness, we would like to discuss the remaining problems and future directions of psychiatry.
[The Use of Symptomatic Drugs for Dementia].
Kudo T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620505
The treatment of Alzheimer's disease (AD) can be roughly divided into Disease-modifying Drugs (DMD) and Symptomatic Drugs (SD). Major strategies of DMD are the amyloid vaccine therapy and β/γ-secretase inhibitors, which...
The treatment of Alzheimer's disease (AD) can be roughly divided into Disease-modifying Drugs (DMD) and Symptomatic Drugs (SD). Major strategies of DMD are the amyloid vaccine therapy and β/γ-secretase inhibitors, which have been developed with high expectations as fundamental treatments for AD. As SD, donepezil, galantamine, rivastigmine, and memantine are now usable. While memantine is an NMDA receptor inhibitor, the remaining three agents are cholinesterase inhibitors. The inhibitory mechanisms of the four agents exhibit some differ- ences. Although they may offer tips for proper use, the SD guidelines have so far stated that there are no significant differences among SD. The guidelines also state that no SD can stop the progression of AD and that their use for MCI should not be encouraged. There are some criticisms about the use of SD because they are not root treatments. In contrast, there are some reports that SD delay AD progression, preserve ADL, reduce the care burden and have an effect on BPSD. Therefore, in proper combination with non-drug treat- ments, the use of SD is considered to be valuable.
[The Adaptation of Anti-dementia Drugs for BPSD].
Hashimoto M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620504
In this article, I discuss the adaptation of antidementia drugs for Behavioral and Psycho- logical Symptoms of Dementia (BPSD). During the last few years, a large body of evidence has been accumulated to support the use...
In this article, I discuss the adaptation of antidementia drugs for Behavioral and Psycho- logical Symptoms of Dementia (BPSD). During the last few years, a large body of evidence has been accumulated to support the use of antidementia medication for BPSD in both Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) patients. On the selection of antidemen- tia drugs for BPSD, the following 3 factors should be considered : 1) the type of dementia the patients have (AD or DLB), 2) the type of drugs to be selected (cholinesterase inhibitors or memantine), and 3) the type of BPSD to be treated (such as delusions, hallucinations, agitation, and apathy). Cholinesterase inhibitors should be used for the treatment of people with DLB, especially BPSD. On the other hand, in AD patients with severe BPSD such as agitation and hallucinations, memantine should be initially considered. Pharmacological treatment of wander- ing and disinhibition in patients with dementia remains a challenge. As BPSD can cause marked distress for both the patient and caregiver, clinicians are required to treat the symptoms effectively. The consensus statement focuses on the fact that pharmacotherapy and psychological interventions can be effective both for cognitive dysfunc- tion and BPSD. Total care for BPSD involves the combination of pharmacotherapy with a non- pharmacological approach.
[Evaluation of Efficacy and Adverse Effects of Symptomatic Drugs for Alzheimer Disease].
Oishi S, Miyaoka H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620503
The symptomatic drugs used for the treatment of Alzheimer disease (AD) are considered to exert their effect by suppressing the progression of dementia symptoms. Although clinical trials conducted on the drugs in Japan ha...
The symptomatic drugs used for the treatment of Alzheimer disease (AD) are considered to exert their effect by suppressing the progression of dementia symptoms. Although clinical trials conducted on the drugs in Japan have revealed statistically significant differences in assessments of change in cognitive function, three of the four drugs have not shown any statis- tically significant differences in the clinician's global impression. There are many overseas reports indicating the efficacy of these drugs, whereas many other reports also indicate that the assessment procedures themselves are difficult and have many limitations. In order to determine the efficacy of the drugs in clinical practice, physicians need to determine whether the progression of dementia symptoms is inhibited. However, AD symptoms vary and are affected by the patient's living environment, personal relationships, and other factors. Although there are certain trends in the time of symptom onset according to disease stages, the symptoms progress by the year and greatly vary among patients. Comparison of progression rates to the average rate is a primary requirement for measurement of the drugs' inhibitory effects on progression. However, because progression rates greatly vary among patients, it is difficult to determine the average rate. In principle, drug therapy should be discontinued if it is not effective. However, because it is difficult to determine whether the drugs are effective, they are likely to be unnecessarily prescribed even when there is a lack of efficacy. The typical adverse effects of cholinesterase inhibitors (ChEIs) include gastrointestinal, neuropsychiatric, extrapyramidal, and cardiovascular symptoms. Transdermal patch formulations of ChEIs may cause pruritus. N-methyl-D-aspartic acid receptor antagonists may also cause various adverse effects. Patients with AD often have impaired ability to recognize psychosomatic changes and to inform people around them of the changes. Thus, detection of adverse effects is likely to be delayed. If the somatic symptoms caused by adverse effects appear as a lack of animation or irritation, the changes due to adverse effects will be likely misunderstood as symptoms caused by progression of AD, behavioral and psychological symptoms. Since the four symptomatic drugs became available, there have been more opportunities to discuss how the use of the drugs can be differentiated. However, the need for using these drugs should be reevaluated before differentiation of their use.
[More Attention Should be Paid to Alzheimer's Disease Patients' Daily Living Than to Their Cognitive Function: Interventions Offering a Social Role, Including Psychotherapy].
Ueda S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620502
Both biological and psychological interventions are important in the treatment of Alzheimer's disease(AD). Although there is no curative therapy for AD, current interventions that focus mainly on their cognitive function...
Both biological and psychological interventions are important in the treatment of Alzheimer's disease(AD). Although there is no curative therapy for AD, current interventions that focus mainly on their cognitive functions are neither sufficient nor effective. More atten- tion should be paid to their self-efficacy in daily life. When people develop AD, they will lose their self-respect and social role or relationships. The aim of the treatment for AD is simply to regain these, which will not be successful unless their daily lives become the target of sharp focus. Behavioral and psychological symptoms of dementia (BPSD) are also strongly associated with patients'daily life rather than with their cognitive function. Upon medical examinations, psychiatrists should not only listen to patients' caregivers, but also provide psychotherapy for the AD patients themselves, despite their being cognitively more or less impaired. Psychiatrists have to inform caregivers about the loneliness AD patients feel and the importance of respecting their feelings. Regarding pharmacotherapy, discussion concerning the best for each patient's condition among the four kinds of current anti-dementia drugs would not be useful, as each patient's condition, inclusive of BPSD, does not only depend on their neurological impairment. General function of the brain is largely normal in AD patients at early stage, therefore rarely causing BPSD. What may well cause BPSD are the patients' circumstances including social interaction between caregivers and themselves in their daily life. Thus, psychi- atrists need to keep in mind both biological and psychological factors in the treatment of AD.
[Psycho-social Treatment for Developmental Disorders -Parent and Social Skills Training-].
Iwasaka H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620501
As one of the treatments for developmental disorders, psychosocial treatment has attracted attention. Because of the advances in support for children and adults with develop- mental disorders in terms of health, educatio...
As one of the treatments for developmental disorders, psychosocial treatment has attracted attention. Because of the advances in support for children and adults with develop- mental disorders in terms of health, education, and welfare, comprehensive and long-term treatment may have become demanded along with medical treatment, called the spread of medication therapy for ADHD. I introduced our investigation with the child psychiatric practice organization after having spoken about the trend in support for developmental disorders in Japan in this report. Next, parent training (PT) and social skills training (SST), recommended by both domestic and foreign diagnosis treatment guidelines, gave an outline and particularly emphasized the need for a basic platform of PT. Furthermore, I suggested the aim of psychosocial treatment after having given examples of environmental adjustment at home, at school, and in the workplace.
[The Diagnosis and Treatment of Sleep and Neurodevelopmental Disorders].
Horiuchi F, Oka Y, Kawabe K … +1 more , Ueno SI
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620500
Neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are commonly associated with sleep disturbances. The etiology of sleep disorders is multifactori...
Neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), are commonly associated with sleep disturbances. The etiology of sleep disorders is multifactorial, such as congenital vulnerability of the quality and quantity of sleep, congenital abnormality of the sleep-wake pattern, comorbid sleep problems with developmental disorders, and sleep disturbances associated with pharmacological treat- ment. Obstructive sleep apnea disorder (OSAS) and restless legs syndrome (RLS) are closely associated with ADHD. OSAS in children not only presents with symptoms of sleep distur- bances, but also with associated symptoms such as growth failure, neurocognitive and behav- ioral symptoms, ADHD-like symptoms, and enuresis. The first-line treatment is adenotonsillec- tomy. ADHD and RLS show high rates of comorbidity with common etiologies like iron defi- ciency and the alternation of dopamine transporter expression. Hypnotics are not effective for RLS, and a precise diagnosis is vital to treat RLS associated with ADHD. ASD is also associated with a high frequency of sleep disorders, especially insomnia, para- somnia, and sleep-wake disorders. The first strategy against sleep disturbances is behavioral intervention ; however, pharmacological treatment is sometimes needed. In clinical practice, excessive daytime sleepiness was reported in children with ADHD or ASD, which might lead to a deficit in alertness. Alertness deficits associated with neurodevel- opmental disorders remain uncertain, and so they should be assessed. The effect of stimulants on sleep in patients with ADHD differed among individuals, which might be the cause of insomnia and also treatment for ADHD and sleep hygiene. Non-stimu- lants are often effective for insomnia. Neurodevelopmental and sleep disorders are complex and bidirectional. Sleep disturbances should be taken into consideration in daily clinical practice.
[The Possible Role of Oxytocin in Autism Spectrum Disorder].
Munesue T, Minabe Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620499
The core symptoms of autism spectrum disorder (ASD) comprise impairments of social communication and social interactions as well as restricted and repetitive patterns of interests and activities. No definitive treatments...
The core symptoms of autism spectrum disorder (ASD) comprise impairments of social communication and social interactions as well as restricted and repetitive patterns of interests and activities. No definitive treatments for these core symptoms currently exist. Oxytocin, a highly conserved peptide, has been suggested to moderate inter-individual relationships based on the results of many vertebrate studies. Recently, oxytocin has received a great deal of attention as a promising candidate for the treatment of ASD. Here, we review studies on the role of oxytocin in ASD. Numerous randomized controlled trials (RCTs) have shown single- dose oxytocin administration to have significantly favorable effects compared with placebo for both neuro-typical individuals and individuals with ASD. Furthermore, extended administra- tion of oxytocin was associated with effects that significantly exceeded those of a placebo in three of five published RCTs for ASD. Moreover, approximately 20 RCTs investigating whether oxytocin is favorable for ASD participants are in progress, according to clinical trial registries certified by the World Health Organization. The results of these RCTs may elucidate the issues regarding favorable and adverse effects, appropriate doses and treatment durations, participant selection, and specifically how to assess the changes in impairments of social com- munication and social interactions. In addition, it is necessary to consider which version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used for the diagnosis of ASD in each RCT because the range of individuals diagnosed with ASD has become gradually nar- rower with each DSM revision, i. e., the Fourth Edition, the Fourth Edition Text Revision, and the Fifth Edition.
[The Pharmacotherapy of Autism Spectrum Disorder with ADHD Symptoms].
Yamamuro K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620498
Diagnostic and treatment guidelines for childhood attention deficit/hyperactivity disorder (ADHD) were first released in Japan in 2003. Since then, there has been numerous changes in how ADHD is treated, such as the appr...
Diagnostic and treatment guidelines for childhood attention deficit/hyperactivity disorder (ADHD) were first released in Japan in 2003. Since then, there has been numerous changes in how ADHD is treated, such as the approval of slow-release methylphenidate and atomoxetine for use from childhood to adulthood. Demand regarding adult ADHD has also risen, as the symptoms of ADHD can persist into adulthood, and due to problems with high prevalence rates and comorbidities. Moreover, the DSM-5 recognized the coexistence of ADHD and autis- tic spectrum disorder (ASD), which further raised the level of concern. Yet at present, treat- ment guidelines have not been established for ASD with ADHD symptoms, so it is hoped such guidelines will be created quickly. This article provides a brief summary of recent findings on pharmacological therapy for ASD with ADHD symptoms.
[Basic Principles of Psychotherapy and Integrative Psychotherapy].
Murase K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620497
There are psychotherapies in a narrow sense that are systematized as a theoretical model and there are also psychotherapies in a wider sense that provide foundations to the former. This paper first discusses that the lat...
There are psychotherapies in a narrow sense that are systematized as a theoretical model and there are also psychotherapies in a wider sense that provide foundations to the former. This paper first discusses that the latter underlies the former and delineates the features of one of such psychotherapies. Recently, the nature of psychological problems has become so complex and diverse with multiple layers of contributing factors interacting with one another that it is necessary to employ an integrative framework that allows idiographic yet multiphasic observation and multi-axial judgment. The paper contrasts this type of integrative psycho- therapy with other more common approaches and then argues that psychotherapy integration needs to go beyond the integration of theoretical models and the eclectic adoption of different techniques and aim for the personal integration of psychotherapists, which will contribute the most to the betterment of psychotherapy.
[Clinical Significance of Bidirectional Interactions between Obsessive-compulsive Disorder and Depressive Disorders].
Matsunaga H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620496
Major depressive disorder (MDD) has consistently been regarded as the most frequently diagnosed comorbid disorder in patients with obsessive-compulsive disorder (OCD). More than half of OCD patients have the lifetime com...
Major depressive disorder (MDD) has consistently been regarded as the most frequently diagnosed comorbid disorder in patients with obsessive-compulsive disorder (OCD). More than half of OCD patients have the lifetime comorbidity of MDD, which is more likely to develop after the onset of OCD. MDD may occur in response to the chronic distress and functional impairments associated with OCD, resulting in either a negative impact on the quality of life of these patients or poor responses to treatments and unfavorable prognoses. However, obses- sions, particularly aggressive obsessions, and excessive anxiety have been identified as contrib- uting factors to the occurrence of comorbid MDD, which may support the possible role of an altered relationship between the orbitofrontal cortex and amygdala/parahippocampal region in the development of lifetime MDD in OCD patients. Thus, based on the heterogeneity of OCD, the cognitive (typical) type of OCD, which is characterized by the presence of obsessions or cognitive processes resulting in provoked anxiety and compulsions, is more likely to develop comorbid MDD than the motoric type of OCD that accompanies compulsions to alleviate tension related to sensory phenomena such as feelings of incompleteness and urges to reach a specific sensation of feeling "just right". Even though comorbid MDD does not markedly impact on the phenomenological or psychopathological features of OCD, bidirectional interactions between these disorders need to be considered in order to establish adequate treatment strategies for such OCD patients. Pre- ceding pharmacotherapies such as SSRI are indispensable in these treatments because of the possible refractoriness associated with such a concurrently depressive condition to CBT. Fur- thermore, SSRI augmentations with antidepressants that enhance noradrenergic function may sometimes be effective in the treatment of OCD with comorbid MDD. The influences of environmental factors and/or personality pathology need to be evaluated in order to assess the addition of further treatment options such as environmental manipulations, family-focused interventions, cognitive therapies, or interpersonal psychotherapy, especially for OCD patients with treatment-refractory MDD.
[Traumatic Grief and PTSD].
Kim Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620495
The concept of traumatic grief was once maintained by Prigerson in the late 1990s to be soon replaced by various concepts such as persistent grief or complicated grief, to cause a con- fusion of diagnostic criteria, the...
The concept of traumatic grief was once maintained by Prigerson in the late 1990s to be soon replaced by various concepts such as persistent grief or complicated grief, to cause a con- fusion of diagnostic criteria, the common element across those concepts being the psychological disturbance caused by the loss of a beloved one. Most contemporary psychotherapy for compli- cated grief put an emphasis upon the cognitive restructure of the meaning of the loss reflect- ing the prevailing understanding that the basis of the pathogenesis of the disorder is the loss of attachment and that the intrusion symptom is actually the yearning for the deceased. In those cases, however, where the loss of attachment is complicated by the comorbid symptoms of PTSD, caused by the death due to accident or murder, contradictory psychological processes are generated by the desire to forget the traumatic nature of the event but to maintain the vivid image of the deceased. The trauma-focused treatment is often necessary for those cases and the concept of traumatic grief, grief caused by trauma, would be clinically beneficial and should be further verified through clinical practice and research.
[The Relationship between Generalized Anxiety Disorder and Depression, and Its Countermeasures].
Otsubo T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620494
Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification systems until the publication of the diagnostic an...
Generalized, persistent, and free-floating anxiety was first described by Freud in 1894. The diagnostic term generalized anxiety disorder (GAD) was not in classification systems until the publication of the diagnostic and statistical manual for mental disorders, third edition (DSM-III) in 1980. Initially considered a residual category to be used when no other diagnosis could be made. The term GAD is not accepted as a distinct diagnostic category yet. Since 1980, revisions to the diagnostic criteria for GAD in the DSM-III-R, DSM-IV and DSM-5 classifica- tions have slightly redefined this disorder. The classification is fluid. This article reviews the development of diagnostic criteria for defining GAD from Freud to DSM-5. Excessive worry- ing impairs the individual's capacity to do things quickly and efficiently, whether at home or at work. The worrying takes time and energy; associated symptoms of feeling keyed up or edge, tiredness, difficulty concentrating, and depression. Individuals whose presentation meets crite- ria for GAD are likely to have met, or currently meet, criteria for unipolar depressive disor- ders. Comorbid depression are common in GAD and negatively impact treatment outcome.
[Social Anxiety Disorder and Depression].
Asakura S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620493
Social anxiety disorder (SAD ; also known as social phobia) is a prevalent disorder with an onset mostly in childhood or adolescence. Furthermore, SAD was found to be a predictor of the subsequent development of depressi...
Social anxiety disorder (SAD ; also known as social phobia) is a prevalent disorder with an onset mostly in childhood or adolescence. Furthermore, SAD was found to be a predictor of the subsequent development of depressive disorder. There is a possibility that early interven- tion for SAD may prevent the subsequent development of depressive disorder. SSRI treatment may benefit patients with primary SAD and comorbid depressive disorder. Moreover, it is important to pay attention to depressive symptoms showing atypical features or bipolarity. Clearly, much more work is needed to establish the treatment of patients with SAD who fail to respond to SSRI.
["Anger" Seen in Obsessive-compulsive Disorder : A Study of 40 Subjects Who Underwent Inpatient Morita Therapy].
Kawakami M, Nakayama K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620492
We conducted a study on "anger" seen in obsessive-compulsive disorder (OCD). Subjects were 40 men and women (age range: 20-58 years) admitted to the Jikei University Center for Morita Therapy who had been diagnosed with...
We conducted a study on "anger" seen in obsessive-compulsive disorder (OCD). Subjects were 40 men and women (age range: 20-58 years) admitted to the Jikei University Center for Morita Therapy who had been diagnosed with OCD (DSM-IV-TR) and undergone inpatient Morita therapy. The Japanese version of the Structured Clinical Interview for DSM-IV (SCID) (DSM-IV Axis I and Axis II diagnoses), the Yale-Brown Obsessive Compulsive Scale (Y- BOCS) (changes in OCD severity), the State-Trait Anger Expression Inventory (STAXI-2) using "anger" as the indicator, and the State-Trait Anxiety Inventory (STAI) using "anxiety" as the indicator were used, and the data were subjected to statistical analysis. Improvements were seen in the Y-BOCS for all of the following : total score, obsessional idea, compulsive act, insight, and avoidance. These results indicate that inpatient Morita ther- apy improves OCD. In the STAI, improvements were seen for both state anxiety and trait anxiety. Improvement of trait anxiety may be considered an indicator of the cultivation of a hypochondriacal temperament. In the STAXI-2, improvements were seen for anger reaction and anger expression-in, which are both aspects of the obsessive-compulsive style (Salzman, L.). Improvements in these items therefore indicate that inpatient Morita therapy improves aspects of the obsessive-compulsive style. A correlation with the degree of OCD improvement was observed for the insight level. Poor insight was a factor associated with poor outcomes of inpatient Morita therapy. Furthermore, two cases were presented, and the actual condition of treatment for OCD and "anger" in inpatient Morita therapy was elucidated.
[How to Learn and Practice Psychotherapies -A Proposal from the Japan Psychotherapy Week-].
Inoue K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620491
In the JSPN postgraduate training guideline for certified psychiatrists, cognitive-behav- ioral therapy (CBT) is to be referred to, understood, and explained in psychotherapeutic treatments of certain mental disorders. T...
In the JSPN postgraduate training guideline for certified psychiatrists, cognitive-behav- ioral therapy (CBT) is to be referred to, understood, and explained in psychotherapeutic treatments of certain mental disorders. The Japanese Association for Cognitive Therapy has annually sponsored the Cognitive Therapy Workshop for mental health professionals since 2000. The Japan Psychotherapy Week (JPW) has been a dream project of the present author to provide opportunities to learn such psychotherapies as psychoanalysis, Morita therapy, and CBT at the same place during the same periods of time, simultaneously or sequentially. The idea of the JPW has two sources: Differential therapeutics in psychiatry on one hand, and the Japan Digestive Disease Week on the other hand. The JPW2015 "East Meets West" was held at a traditional hotel in Kobe in the evenings of February 21 and 28, 2015. As described in Plato's Symposium, the audience was served food and drinks while listening to the speaker talk about psychoanalysis, Morita therapy, and CBT. The first evening began with making a toast, followed by opening remarks about the author's intentions regarding the JPW, based on excerpts from Zeami's Fushihaden (the Flowering Spirit). Two well-known psychiatrists majoring in CBT and Morita therapy gave an address, entitled: "What is a desirable encounter of East with West?" and "On psychotherapy having roots", respectively. In the second evening, a prominent psychiatrist in the field of psychoanal- ysis gave a lecture on"The power of words in psychotherapy". After drinking a toast, excerpts from Plato's Symposium were presented to identify Eros as a "great daimon" mediating between immortal gods and mortal human beings. The cognitive therapist showed how cognitive therapy has the power of incorporating ele- ments of interpersonal, behavioral, and psychodynamic approaches. The JPW has nothing to do with psychotherapy integration. Instead, cognitive therapy, as an intermediary, will vanish in the process of the JPW. When established, the JPW will further develop the psychotherapeutic competence of psychiatrists.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe