Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[The Importance of Remaining a Psychiatric Medical Specialist].
Hirashima N
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620490
As a member of the Japanese Society of Psychiatry and Neurology's Committee to Improve the Medical Specialist System, I have used the Committee's discussions as my start- ing point for describing what action needs to be...
As a member of the Japanese Society of Psychiatry and Neurology's Committee to Improve the Medical Specialist System, I have used the Committee's discussions as my start- ing point for describing what action needs to be taken to update psychiatric medical specialist qualifications under the new medical specialist framework while retaining its key principles. The gist of the reform of the medical specialist system is that tasks such as clearing up confusion at clinical sites and restoring the public's trust in physicians should not be assigned to outside institutions. Instead, groups of physicians will themselves set up and run a self-reg- ulating organization that sets out their ideals as to quality, etc., and holds the profession to these ideals. To prevent any loss of professional pride and autonomy, they must establish, on their own initiative, a highly transparent system that the general public will accept, and which will support and develop high-quality medical professionals. In other words, building a system such as this cannot be considered separately from the process of educating specialized medical doctors. Medical specialists are expected to continue undergoing appropriate training and to maintain and enhance their competencies. Qualification as a medical specialist shows that the individual is continuing to undergo training to enhance his or her excellence as a medical spe- cialist and, at the same time, ensures his or her professional value. The key requirement for updating medical specialist qualifications is for the individual to be engaged in medical practice. Medical care provided at departments of psychiatry differs somewhat from that offered by other clinical departments and/or fields, since it covers a broad range of areas that can extend outside the clinical services offered at hospitals. Knowledge, skills and attitudes as a psychiatric medical specialist are evaluated based on a review of case reports. In addition to psychiatry-related content, training must cover themes related to pro- fessionalism such as medical ethics and legislation, as well as subjects necessary to obtain the latest medical knowledge such as clinical research and evidence-based medicine (EBM). Physi- cians intending to newly qualify as medical specialists need to be engaged in some sort of research, and to have the competency to compile and present the outcomes of their studies, as well as having a proven track record. Out of consideration to the actual circumstances, in the field of psychiatry, academic achievement is not a necessary condition for updating medical specialist qualifications. Japanese Medical Specialty Board supports this position. As defined in the upcoming reform of the medical specialist system, a medical specialist is a personal qualification. At the same time, it is individuals who play a role as a member of an autonomous group, responsible for maintaining the value of this qualification.
[Future Perspective on the Specialty Certification Examination for Psychiatry].
Nemoto T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620489
The system of the specialty certification of psychiatry of the Japanese Society of Psychiatry and Neurology (JSPN) was established in 2005, and certification examination has been conducted since 2009. The Japanese Medica...
The system of the specialty certification of psychiatry of the Japanese Society of Psychiatry and Neurology (JSPN) was established in 2005, and certification examination has been conducted since 2009. The Japanese Medical Specialty Board was established in 2014 in order to develop a new common specialty certification system encompassing 19 medical fields, and the training under the new system will be initiated in 2017. Under the new system, a core medical institution heads a group of medical institutions that consist of some hospitals and clin- ics for the specialty training program, and the core institution is responsible for the training and education of each resident. The committee of the certification examination of psychiatry in JSPN is responsible for administration of the examination. The aims of the examination, consisting of written and oral tests, are to assess knowledge, skills, and the attitude as a psychiatrist and decide whether or not an examinee meets the standards. Because the missions of the specialists are to treat severe and serious cases appropriately as well as to provide people with standard treatment, the role of the oral examination to assess clinical skills is important. However, there is not enough time or manpower to enrich the oral examination under the existing circumstances. Therefore, it is indispensable to assess the skills and attitudes of residents regu- larly and objectively in the training program. We need to discuss the specialty certification examination thoroughly in order to gain an image of the future of psychiatry in Japan.
[Curriculum of the New Certificate Psychiatrist System of the Japanese Board of Psychiatry-What Items are Applied Each Year for Three Years, and How Training Psychiatrists are Evaluated-].
Kojima T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620488
The new certificate psychiatrist system of the Japanese Board of Psychiatry is discussed from the viewpoint of the improvement of the current certificate psychiatrist system. In the new system, training items are applied...
The new certificate psychiatrist system of the Japanese Board of Psychiatry is discussed from the viewpoint of the improvement of the current certificate psychiatrist system. In the new system, training items are applied each year for three years. Actually general items and particular disease items of the current training book are rearranged in the new sys- tem. The results of training psychiatrists are evaluated multi-dimensionally and two-way com- municatively. The instructing doctor evaluates the performance of training psychiatrists at the time of completing the program at all training hospitals and gives some feedback to the psy- chiatrists. Staff with multiple occupations also evaluate the training psychiatrists. The training psychiatrists also evaluate the instructing doctors and training program. The program man- agement committee of each basic training hospital collaborates with the training committee of the cooperative training hospitals to examine and evaluate the training results, and improve the program.
[Minimum Requirement : The Advantage of Psychiatric Specialist Training].
Amayasu H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620487
The Japanese Society of Psychiatry and Neurology has been discussing what a Psychiatric Specialist should be for a long time. Although the so-called 'Yamauchi Report' eventually determined the professional accreditation...
The Japanese Society of Psychiatry and Neurology has been discussing what a Psychiatric Specialist should be for a long time. Although the so-called 'Yamauchi Report' eventually determined the professional accreditation system in 1994, it was not until 2006 that the first Psychiatric Specialist was accredited. Recently, the system that has been operated for 10 years is markedly changing. The Ministry of Health, Labour and Welfare (MHLW) launched an explanatory committee to discuss what a Psychiatric Specialist ought to be, and published a report in April 2013, which led to the inauguration of The General Incorporated Association of Japanese Medical Specialty Board as a trusted third party in May 2014. Thereafter, it set up a new training and accreditation system for Psychiatric Specialists, which is starting in 2017. With such situation in mind, in this paper, I explore the qualities a Psychiatric Specialist needs to acquire and the sort of professional training they shall undertake. I discuss reforming educational programs in medical schools, a clearer picture of a Specialist that the Psychiatric Specialist Investigative Commission at the MHLW and the Japanese Medical Specialty Board suggested, and the way a Psychiatric Specialist ought to be, which the Japanese Society of Psy- chiatry and Neurology has been considering. I emphasize that the methodology to achieve the goal is changing markedly along with the globalization of medical education; however, the phi- losophy, mission, and outcome of the Psychiatric Specialist system should not change.
[Renewal of Certification as a Japanese Board-Certified Psychiatrist].
Matsuda H
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620486
Medical specialists certified by the Japanese Medical Specialty Board are defined as medi- cal doctors who have been appropriately and extensively trained, provide standard medical care, and are trusted by patients, resp...
Medical specialists certified by the Japanese Medical Specialty Board are defined as medi- cal doctors who have been appropriately and extensively trained, provide standard medical care, and are trusted by patients, responding to citizens' needs to receive standard and safe treatment. In accordance with this definition, a committee of the Japanese Society of Psychiatry and Neurology has discussed the criteria for renewal since late 2014 so that the new criteria will not be markedly different from the previous ones. The major changes include the following: 1) adoption of the credit-based system in place of the point-based system, 2) making part of the courses mandatory, and 3) requiring five instead of two clinical reports as proof of clinical practice. The credits needed to renew certification as a Japanese Board-Certified Psychiatrist are calculated based on proof of clinical practice, across-specialty courses, psychiatry-specific courses, academic achievements, and activities other than clinical practice. In total, 50 credits in 5 years are required to renew the certification. In the case of exceptional circumstances where renewal in a timely manner is not possible (e.g., studying abroad for research, taking sick leave, taking maternity leave, caring for a fam- ily member, etc.), there are two options to choose from: one is to declare a state of suspension, whereby one's certification is temporarily unused, and the other is to use substitutional means, such as using self-learning in place of clinical practice. The committee intends to adopt measures as effectively as possible in order to avoid con- fusion regarding the new criteria among psychiatrists about to renew their certification, and also to minimize the discrepancy between the renewal process for the Board-Certified Psychi- atrists as stipulated by the Japanese Society of Psychiatry and Neurology and the require- ments for Medical Specialists.
[New Board Certification System in Psychiatry].
Takeda M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620485
The Japanese Society of Psychiatry and Neurology (JSPN) decided to establish the new board certification system in June 2015 under the guidelines proposed by the Japanese Medical Specialty Board (JMSB). After repeated co...
The Japanese Society of Psychiatry and Neurology (JSPN) decided to establish the new board certification system in June 2015 under the guidelines proposed by the Japanese Medical Specialty Board (JMSB). After repeated consultations with the JMSB, the JSPN released the new rules and bylaws of the New Board Certification System in November 2015. The new certification system will be implemented in April 2017, in which 4-500 trainees will start the new three-year training in psychiatry under the new program. The first accredi- tation of the qualified trainees will be approved by the JMSB in 2020. From then, all fellows approved by the JSPN are expected to renew their qualification under the guidelines proposed by the JMSB. I regard designing the board certification system as one of the most important endeavors of the JSPN, and the ad hoc committee has worked toward the goal of designing a new certifica- tion system acceptable to the JMSB, which will stimulate and promote the improved training and education of psychiatrists. In this paper, I report the present situation of the new certification system as of February 2016.
[Requirements of Training Facilities for New Medical Specialist System].
Morimura Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620484
The Japanese Medical Specialty Board is now reforming the medical specialist system. This article describes the requirements of training facilities, comprising one of the biggest modifications to the current medical spec...
The Japanese Medical Specialty Board is now reforming the medical specialist system. This article describes the requirements of training facilities, comprising one of the biggest modifications to the current medical specialty standard. The new medical specialty standard which the Japanese Medical Specialty Board is aiming to create has been designed based on psychiatric characteristics while considering other specialty fields. The major distinction from the old specialist system is that training is not completed at only one institution but at several, with the main training facility and some partner facilities making up a group. The new medical specialty standard is described in the text, which the Japanese Society of Neurology and Psy- chiatry (JSPN) medical specialty training facility committee drew up, and it has already been approved by the Japanese Medical Specialty Board. There are seven conditions a main training facility is expected to fulfill and three conditions for a partner training facility to meet the stan- dards. This paper introduces new requirements of training facilities and groups of training facilities for the new standards. Details on the new medical specialty standard are being posted on the JSPN website, and I strongly recommend that you view the site and gain a thorough understanding of the new medical specialty standard.
[Outcomes of Psychiatric Board System under the Japanese Society of Psychiatry and Neurology, and the New Board System under the Japanese Medical Specialty Board].
Yamauchi T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620483
The Psychiatric Board System under the Japanese Society of Psychiatry and Neurology was started in 2004. Over the last 10 years, psychiatrists who had worked in the field of psy- chiatry and were recognized as having the...
The Psychiatric Board System under the Japanese Society of Psychiatry and Neurology was started in 2004. Over the last 10 years, psychiatrists who had worked in the field of psy- chiatry and were recognized as having the necessary training took the board examination, and 10,498 psychiatrists acquired the Psychiatric Specialty Board certification. On the other hand, new psychiatrists who trained according to a special curriculum for more than 3 years took the board examination, and 762 psychiatrists obtained certification through the Psychiatric Specialty Board. According to principle of this system, the Psychiatric Board System should resolve several issues, such as the kind of training facility, issues with medical teaching staff and training pro- grams, the examination system, and the renewal system. An outline of the New Board System under the Japanese Medical Specialty Board is pro- vided, and this system is expected to improve the Psychiatric Board System and may promote the quality of psychiatrists.
[On the Japanese Translation of Binge-Eating Disorder Revision in DSM-5].
Nakai Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620482
Abstract loading — click title to view on PubMed.
[A Case of Recurrent Spontaneous Pneumomediastinum with Anorexia Nervosa].
Tokumitsu K, Hatoyama K, Kubota Y … +5 more , Asami K, Ohsato M, Okamoto M, Takeuchi J, Yachimori K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620481
In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29...
In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29 kg in approximately 5 months. In January 20XX, the subject was first examined as an outpatient at our psychiatric department at the recommendation of her eldest son. Upon diagnosis of anorexia nervosa, the subject underwent outpatient treatment ; however, there was no improvement in the disturbance in self-per- ceived weight or shape, and the subject voiced her desire to lose weight. In May 20XX, the subject complained of chest pain, pharyngeal pain, and respiratory distress after self-induced vomiting and was, thus, examined at the psychiatric outpatient services. Chest X-ray and chest CT revealed pneumomediastinum and subcutaneous emphysema. Spontaneous oesophageal rupture, a fatal condition, was suspected and, therefore, the subject was transferred to a more advanced medical institution capable of esophageal surgery. After admission, spontane- ous oesophageal rupture was ruled out based on the results of upper gastrointestinal endos- copy with esophagography, and spontaneous pneumomediastinum was diagnosed. The pneu- momediastinum disappeared with conservative treatment ; however, after approximately 8 months, spontaneous pneumomediastinum recurred, following self-induced vomiting. For patients with eating disorders and who are involved in self-induce vomiting, we believe that the vomiting can cause pneumomediastinum, and it is assumed that continuation or recommencement of vomiting can potentially increase the risk that pneumomediastinum will recur. We, therefore, report recurring pneumoediastinum as a physical complication caused by self- induced vomiting that should be noted in clinical practice of the psychiatric department.
[How Far is "Personalized Medicine" for Depression from Clinical Use?].
Kato M
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620480
Major depressive disorder is a debilitating disease that imposes significant social and eco- nomic burdens due to its 10% life-time prevalence and 15% association with suicide, and so urgent measures are needed. However,...
Major depressive disorder is a debilitating disease that imposes significant social and eco- nomic burdens due to its 10% life-time prevalence and 15% association with suicide, and so urgent measures are needed. However, not all individuals benefit from antidepressant treat- ment, and some patients poorly respond or develop side effects. It would be helpful to identify a biomarker that could indicate the best therapeutic tool that is likely to be effective and toler- able for each patient In this context, a marked effort has been directed toward the search for genetic predictors of drug efficacy in mood disorders over the last few years. However, the present evidence from pharmacogenomic studies does not match those expectations. So, how far is "personalized medicine" for depression from clinical use? It is important to translate the results of such pharmacogenomic studies to better treatment in clinical practice. Here, I pro- vide an overview of pharmacogenomic research results with both a genome-wide approach and candidate approach, and suggest possible ways to apply pharmacogenomic results in clini- cal settings.
[Studying the Efficacy of Long-acting Injectable Antipsychotics (LAI) While Considering Study Design Limitations : A Discussion in Favor of LAI].
Kishimoto T
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620479
This article was adapted from the presentation of a debate session at the 111th annual meeting of the Japanese Society of Psychiatry and Neurology. It addresses the pros and cons of long-acting injectable antipsychotics...
This article was adapted from the presentation of a debate session at the 111th annual meeting of the Japanese Society of Psychiatry and Neurology. It addresses the pros and cons of long-acting injectable antipsychotics (LAI), and the author of this article suppored the use of LAIs on the basis of their efficacy. Based on randomized controlled trials (RCTs), LAIs were similar to oral antipsychotics in terms of relapse prevention. However, in the RCTs, selection bias and alterations in treatment ecology have to be taken into consideration, in that patients in the RCTs are more likely to be adherent. For example, various treatment experiences in RCTs, such as reminders, assessments, and/or incentives, could have improved patients' adher- ence. In contrast, mirror image studies, which compare the equivalent duration before and after the initiation of a new treatment, may reflect the effectiveness of LAIs in real-world clini- cal settings. In mirror image studies, the hospitalization risk and rate significantly decreased after the introduction of LAIs. LAIs as a treatment option should be discussed with patients, especially those who have adherence problems and/or who prefer LAIs.
[Should Long-acting Antipsychotic Injection be Considered an Essential Treatment Option for Patients with Schizophrenia?].
Matsuo K
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620478
The objective of this article (and the corresponding symposium) was to assume an "oppo- sition" stance and argue against the presumed usefulness of long-acting injections (LAI) for the treatment of patients with schizoph...
The objective of this article (and the corresponding symposium) was to assume an "oppo- sition" stance and argue against the presumed usefulness of long-acting injections (LAI) for the treatment of patients with schizophrenia. Here, LAI demonstrated limited patient applica- bility and were found to be used infrequently in Japan, with insufficient evidence to their effi- cacy suggesting that LAI would be more appropriate playing a supplementary role in the pharmacotherapy guidelines for schizophrenia. Additionally, any potential benefits of LAI have yet to be fully realized in Japan due to the fact that 80% of patients treated with LAI for schizophrenia are also prescribed antipsychotics orally, and a hesitance towards LAI by psy- chiatrists is likely to be reflected in their limited usage nationwide, an attitude which may present an ethical problem in terms of just principles.
[Safety of Long-acting Injectable Antipsychotics Is Long-acting Injection a High-risk Treatment Option?].
Inagaki A
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620477
Early post-marketing phase vigilance (EPPV) of paliperidone palmitate (PAL-P) revealed a mortality of at least 32 (0.29%) out of approximately 11,000 patients with schizophrenia administered PAL-P between November 2013 a...
Early post-marketing phase vigilance (EPPV) of paliperidone palmitate (PAL-P) revealed a mortality of at least 32 (0.29%) out of approximately 11,000 patients with schizophrenia administered PAL-P between November 2013 and May 2014 (average administration period of four months). Since then, many psychiatrists may have become distrustful of PAL-P, as well as of other long-acting injectable antipsychotics (LAI). This study reviewed the mortality data observed in several premarketing clinical trials of antipsychotics, including PAL-P, post-mar- keting surveillances (PMS) of antipsychotics conducted in Japan, and several large-scale cohort studies performed in developed countries, and re-evaluated the mortality risk of PAL-P. The results of the literature review were as follows: 1) the mortality of the patients on LAI in clinical trials was 3.56-7.95/1,000 person-years. This number was not higher than that of those on oral antipsychotics (5.00-8.55/1,000 person-years) ; 2) the mortality of those on PAL-P in clinical trials (3.56/1,000 person-years) was not higher than that on the other LAIs (6.34-7.95/ 1,000 person-years); 3) the mortality of those on PAL-P observed in the EPPV (equivalent to 0.22% per three months) was similar to the three-month mortality observed in the PMSs of risperidone LAI, oral paliperidone, or oral blonanserin (0.19-0.31%); and 4) based on data of the cohort studies, the four-month mortality of those with schizophrenia was estimated at 0.35-0.68%. Therefore, the mortality observed in the EPPV of PAL-P did not seem to be of clinical significance, even allowing for the possibility of underestimating the mortality in the EPPV.
[The Safety of Using Long-acting Injections : From an Opposing Position-Is It Better to Administer Long-acting Injections?].
Suzuki Y
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620476
While long-acting injections (LAI) have arrived in Japan as a second-generation antipsy- chotic drug and LAI therapy for the symptom-stabilization phase is garnering attention, deaths associated with paliperidone (PAL) -...
While long-acting injections (LAI) have arrived in Japan as a second-generation antipsy- chotic drug and LAI therapy for the symptom-stabilization phase is garnering attention, deaths associated with paliperidone (PAL) -LAI were sensationally reported, attracting interest regarding the safety of LAIs. In writing this report, an opportunity to oppose LAI usage was provided, so we raise the following three issues concerning the usage of the second-generation antipsychotic LAI for the symptom-stabilization phase. 1) Particularly notable adverse reactions of LAI are those acutely developed and in some cases fatal, including malignant syndrome, diabetic ketoacidosis, torsade de pointes due to pro- longed electrocardiogram QT, and leukopenia. All antipsychotic drugs come with the risk of such adverse reactions, and since the occurrence of adverse reactions cannot be predicted prior to administration, once they have developed, the offending drugs should be immediately reduced or discontinued to remove the drug from the body ; however, since this process can- not be followed with LAIs, such fatal adverse reactions may be protracted. Moreover, in the US, adverse reactions from post injection delirium/sedation syndrome (PDSS) have been reported in relation with olanzapine (OLZ) -LAI. This is a disease state in which the drug rap- idly flows into the blood following LAI intramuscular administration along with an acute increase in blood level, leading to significant sedation (lethargy in some cases) and/or serious symptoms accompanied by delirium ; therefore, in order to minimize these risks, the US FDA has made it mandatory to use a monitoring system referred to as REMS (Risk Evaluation and Mitigation Strategy)for OLZ-LAI. Whether or not the phenomenon occurs only with OLZ-LAI remains to be seen, so careful attention must be paid. 2) In Japanese psychiatric clinical sites, the current situation is that monitoring of adverse reactions for antipsychotic drugs, particularly with outpatients, is not sufficiently carried out Under such circumstances, there remain doubts when it comes to advocating -looking to replace oral drugs with LAI in the symptom-stabilization phase. 3) Replacing oral drugs with LAI in the symptom-stabilization phase significantly increases treatment costs as well as increasing the number of hospital visits. This increase in treatment cost and number of visits may have a large impact on the adherence of the patients to the drugs.
[Hospital Acquired Pneumonia in General Hospital Psychiatric Ward A Retrospective Study].
Okada T, Shioda K, Kobayashi T … +3 more , Nishida M, Suda S, Kato S
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620475
(Introduction) Pneumonia is a well-known major physical complication that can occur in the course of treatment for severe psychiatric disorders and antipsychotic treatment. However, there are few reports indicating the d...
(Introduction) Pneumonia is a well-known major physical complication that can occur in the course of treatment for severe psychiatric disorders and antipsychotic treatment. However, there are few reports indicating the differences between pneumonia in the field of psychiatric medicine and the more commonly encountered type of pneumonia. In the present study, we examined the specific characteristics of in-hospital pneumonia in psychiatric wards and factors influencing the aggravation of this infection. (Methods) We retrospectively analyzed 22 patients in the psychiatric ward of Jichi Medi- cal University Hospital, which also has general wards, in whom pneumonia developed during hospitalization. We extracted occurrence, outcome, and sputum culture test results as charac- teristics. Severity of pneumonia was classified using the Pneumonia Severity Index (PSI) as follows : classes I -III, minor group (MG : 15 patients) and classes IV-V, moderate to severe group (MSG: seven patients). We examined the following factors related to the aggravation of pneumonia: body mass index (BMI), length of psychiatric treatment, number of hospital admis- sions, Global Assessment of Functioning (GAF) score, dose of antipsychotics, dose of benzodi- azepines (chlorpromazine and diazepam equivalent doses), and dose of antiparkinsonian agents (biperiden equivalent dose). (Results) Aspiration occurred prior to the onset of pneumonia in one patient, and one patient required ventilator management. There were no patient deaths. Streptococcus pneu- moniae and Staphylococcus aureus were detected in five and four patients, respectively. Nei- ther methicillin-resistant Staphylococcus aureus nor Pseudomonas aeruginosa was detected. In comparison with MG patients, MSG patients had significantly lower BMI (18.3 ?2.6 vs. 21.2? 3.5), significantly higher numbers of hospital admissions (3.4?i3.3 times vs. 1.1+?L1.4 times), and a significantly higher ratio of GAF scores of 30 or less (85.7% VS 33.3%). The doses of benzo- diazepines and antiparkinsonian agents were significantly higher for MSG patients in comparison with MG patients (benzodiazepines : 2.3?2.4 mg vs. 0.4?i1.1 mg; antiparkinsonian agents: 2.3?2.4 mg vs. 0.4? 1.1 mg). No significant differences were observed in the doses of antipsy- chotics. Sputum culture tests were performed in 18 patients. (Conclusion) Outcomes were comparatively favorable and the results of bacterial culture tests tended to show no antibiotic-resistant bacteria, differing in that regard from hospital- acquired pneumonia. In fact, the characteristics of cases of pneumonia in hospitalized psychiatric patients were similar to those of community-acquired pneumonia. Low BMI, multiple psychiatric ward admissions, and GAF scores of 30 or less all reflect poor mental control. The results of the present study suggest a relationship between the severity of pneumonia and both insufficient psychiatric treatment and the use of benzodiazepines and antiparkinsonian agents.
[Cognitive Behavior Therapy for Eating Disorders].
Nishizono-Maher A
Seishin Shinkeigaku Zasshi · 2016 · PMID 30620474
Cognitive dysfunction such as body-image disturbance and undue influence of body weight on self-worth is a conspicuous feature of eating disorders. The cognitive problems are known to be extremely difficult to treat. Why...
Cognitive dysfunction such as body-image disturbance and undue influence of body weight on self-worth is a conspicuous feature of eating disorders. The cognitive problems are known to be extremely difficult to treat. Why and how, therefore, is cognitive behavioral ther- apy (CBT) recommended, with high quality evidence, in clinical guidelines such as the NICE guidelines in the UK? In reverse direction to the history of eating disorders, namely anorexia nervosa first and then bulimia, CBT was developed for bulimics first and then after its establishment, the skills were applied to anorexia nervosa. Anorexia treatment whether behavioral or familial, has tended to place patients in a passive mode. The CBT technique, on the other hand, invites patients to participate fully in the treatment, via formulation-making and symptom self-moni- toring. This is particularly important because, unlike in the early days of adolescent anorexia 'epidemic', the number of adult patients has increased. Behavioral and family treatment is less applicable to adult patients who are expected to be more independent than early adolescent anorexics. CBT for bulimics consists of two parts. The first part, the normalization of eating pattern, is largely behavioral. In the enhanced CBT (CBT-E) by Fairburn, a standard CBT in the field of eating disorders research, patients are obliged to make two outpatient visits a week for the first four weeks in order to install a regular eating pattern. The cognitive work is added later on the basis that the patient has successfully achieved a regular meal schedule. This behav- ioral change through two sessions a week may be difficult in a Japanese clinical setting. Some modification such as a brief in-patient treatment may be considered. Also, the number of CBT therapists in Japan is lacking. Collaboration with clinical psychologists is necessary. The CBT for anorexia is a challenge. Fairburn has expanded the application of CBT to anorexia via his 'transdiagnostic' approach. Likewise, Pike et al started to use CBT-AN for relapse prevention for the patients who acquired sufficient weight through inpatient treatment. The research data is promising. In particular, Touyz et al show that CBT-AN had effects on severe and enduring AN (SE-AN), a category of AN which is often thought to be resistant to any type of treatment. It is of note that for both anorexics and bulimics, the effect of 'behavioral only' techniques expires early. By contrast, treatments which deal with psychological elements such as CBT and interpersonal psychotherapy (IPT) have a lasting effect. The time courses of CBT and IPT treatment effect seem sufficiently different that the matching of patient characteristics and the type of treatment should be investigated further. Another important aspect of cognitive dys- function among eating disorder patients is 'denial of illness'. More research should be per- formed with regard to how patients, on improvement from eating disorders, look back on aspects of denial and whether a better understanding of these phenomena is helpful in relapse prevention.
[What are the Specific Characteristics of Clinical Trials for Neuropsychiatric Disorders?].
Nakabayashi T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642735
To increase medical standards, not only the establishment of therapeutic strategies to accumulate evidence for existing therapies but also the development of new therapies are required. In recent years, as a number of ne...
To increase medical standards, not only the establishment of therapeutic strategies to accumulate evidence for existing therapies but also the development of new therapies are required. In recent years, as a number of new drugs have been approved, treatment options for neuropsychiatric disorders have expanded. It is significant for clinicians to interpret the evidence adequately in order to select the optimal therapeutic method. This paper aims to describe the important points in interpreting the results of clinical trials, which involve direct evidence for efficacy and safety. There are several specific characteristics of clinical trials for neuropsychiatric disorders. As typical features, the following can be mentioned: 1) a high and variable response in placebo groups, 2) impact on the effect size of the baseline severity of disorders, 3) high dropout rates, and 4) biases related to subjective measures of clinical symptoms. In this paper, the key points to be evaluated in the results of clinical trials for neuropsychiatric disorders are discussed based on these features.
[Higher Brain Dysfunction].
Kashima H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642734
The technical term "higher brain dysfunction" is used widely in Japan. However, it is not always clear what "higher" means. The author thinks that the term "higher" is understood as being associated with a meaning. In th...
The technical term "higher brain dysfunction" is used widely in Japan. However, it is not always clear what "higher" means. The author thinks that the term "higher" is understood as being associated with a meaning. In this article, the differences between higher brain dysfunctions and elementary brain dysfunctions are discussed from the point of view of lesion localization and the consistency of symptoms. The psychiatric approach is indispensable for the assessment of higher brain dysfunction. A simple test for mild Alzheimer-type dementia is also introduced.
[A Treatment for Drug Dependence not Requiring Specialists: A Treatment Program based on a Workbook, the "SMARPP"].
Matsumoto T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642733
In Japan, few psychiatric institutions provide rehabilitation for drug dependence, since dependence on illicit drugs including methamphetamine has generally been regarded as a crime and not an illness by Japanese psychia...
In Japan, few psychiatric institutions provide rehabilitation for drug dependence, since dependence on illicit drugs including methamphetamine has generally been regarded as a crime and not an illness by Japanese psychiatrists. However, partial revisions of the Penal Code (the Partial Stays of Execution System) are going to be enforced in 2016, and it has been predicted that many illicit drug-dependent convicts will be treated in the community. Accordingly, the expansion of support resources in the community, including psychiatric institutions, is an urgent requirement. The Serigaya Methamphetamine Relapse Prevention Program ("SMARPP"), which consists of once-a-week groups sessions including motivational interviewing attitudes, and cognitive behavioral therapy for relapse prevention following the Matrix model, is expected to be one of the community resources for drug-dependent convicts. This paper introduces the principle and contents of the "SMARPP".
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