Seishin Shinkeigaku Zasshi [JOURNAL]
Sun
200 papers
[The Basic Act on Measures against Alcohol-related Health Harm and Role of General Psychiatrists--With focus on SBRIT and Deadly Triangle].
Ino A, Horii S, Tsujimoto S … +6 more , Aso Katsuro, Yuzuriha T, Kakibuchi Y, Yoshimoto H, Saito T, Higuchi S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642732
Japan has just enacted a national law for alcohol, that named "Basic Act on Measures Against Alcohol-related Health Harm". This article includes 5 topics; i) General psychiatrists have the roles and responsibilities in t...
Japan has just enacted a national law for alcohol, that named "Basic Act on Measures Against Alcohol-related Health Harm". This article includes 5 topics; i) General psychiatrists have the roles and responsibilities in this law, ii) All psychiatrists need to know about alcohol-related health harm and alcohol-related problem, iii) Alcohol dependence is attributed to change of neurotransmitter in the brain, iv) Mood disorder is more likely to be complicated by alcohol dependence and/or hazardous drinking. Some of the patients with the above-mentioned complicated disease have alcohol-induced mood disorder, v) If the patient has alcohol-induced mood disorder, it will place priority on alcoholism treatment and will be important to quickly resolve with abstinence. Finally, the proposals are made as follows; i) Making a guideline, ii) Physicians skilled at SBIRT (Screening, Brief Intervention, and Referral to Treatment) should be qualified as a certifying physician, and having the qualification should allow reimbursing medical institutions for the alcohol related service provided.
[Three Essential Shared Capabilities for Young Psychiatrists: Brain, Real-world, and Life-course Principles toward Values-based Psychiatry].
Kasai K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642731
The discipline of psychiatry promotes well-being and recovery based on a comprehensive understanding of the patient from the perspectives of the brain, real-world, and life-course. Pursuant to efforts toward addressing s...
The discipline of psychiatry promotes well-being and recovery based on a comprehensive understanding of the patient from the perspectives of the brain, real-world, and life-course. Pursuant to efforts toward addressing social issues at a regional and national level, it is assumed that the psychiatrist can assist individuals based on an understanding of these three perspectives. This tripartite relationship goes beyond the history of extreme reductionism in neuroscience and the aftermath resulting from the anti-psychiatry movement to provide a foundation for the development of psychiatry and a theoretical groundwork for such basic psychiatric issues as what role pharmacotherapy plays in psychiatric treatment, just why the lives of people living in the community are thought to be important to an individual's well-being, and just what constitutes recovery. Humans have come to possess highly developed brain and mental functions as a result of the adaptation to the social environment that takes place as part of the evolutionary process. While mental functions are thus dictated in large part by evolution of the brain, they also consist of important features that are not attributable to reductionist models of the brain. That is, human mental functioning forms a foundation for metacognition and sophisticated language functions, and through interactions with others and society, one's mental functioning allows for further brain transformation and development (self-regulation of mental functions). Humans develop their own brain and mental functions through mutual exchanges with others, and their dealings with other people and society form their individual modes of living in the real-world. The human brain and mental functions have evolved in such a way as to provide for a better mode of living. Accordingly, for the individual, the makeup of his or her mode of living in the real-world is the source of the well-being that serves to support that individual's values. The scientific background that the human recovery process for those suffering from mental disease involves the combined support of work, school, marriage, and childrearing stems from this fact. Humans develop their own mental capital over their life-courses and utilize it in an effort to realize their well-beings. Humans utilize mental function self-regulation based on the emotional and interpersonal functions developed during childhood in order to formulate an image of themselves (the ego) as well as the type of person they want to become (values/needs). This is indeed the true essence of adolescence. The values that drive an individual's behavior by their very nature exist in the outside world and are shared by others as well as society. These are internalized as individual characteristics through the self-regulation process of adolescence. Regardless of life stage or type of mental illness, individual reflection, verbalization, and reorganization of adolescent ego and values formation are essential to the recovery process. Humans are born with both bodies and brains, and throughout the courses of their lives, they formulate and develop values. Based on an understanding of the tripartite relationship between the brain, real-world, and life courses, it can be argued that the supporting of individual values is the scientific basis for the so-called "patient-centered care" and "needs-based support" that serve as a psychiatrist's essential capabilities. Along with the patient's recovery, which is based on this values-based psychiatry, professional growth is the privilege enjoyed by those in the psychiatric field. Beginning with a foundation based on assisted recovery at the individual level, the psychiatrist can produce mental health changes at the regional level. The psychiatrist consequently possesses the national-level vision necessary to implement a community design model that combines mental health and preventive medicine.
[Knowledge of Man Returns: Some Considerations on Spirituality and Resilience].
Kumakura N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642730
Over the last decade,"spirituality" and "resilience" have jointly become a topic in psychiatry. The aim of this paper is to discuss the future of psychiatry suggested by this topic. It may be related to what Jaspers, K....
Over the last decade,"spirituality" and "resilience" have jointly become a topic in psychiatry. The aim of this paper is to discuss the future of psychiatry suggested by this topic. It may be related to what Jaspers, K. called "Knowledge of Man (die Erkenntnis des Menschen)". Knowledge of man in psychiatry can be learned only through clinical experince: e. g., clinical observations and case studies. Modern academic psychiatry seems to be suffering a loss of knowledge of man, which returns periodically in clinical practice. Hence, I will call the re-discovery of the topic in psychiatry as "Return of Man". Since WW II, there have been three eras in which psychiatrists showed deep concern regarding knowledge of man. Firstly, psychopathology and psychotherapy widely developed, when the destructive impulses of mankind were revealed in the nuclear weapons of WW II. Secondly, in the 1970's, the reforms of psychiatric services and legal systems took place somewhat successfully, when social reforms were concerns of the younger generations. Lastly, over the last decade, the topic again returned as spirituality and resilience, when scientists seemed to be powerless in the aftermath of the West Japan Earthquake. Regarding the definition of health made by the WHO in 1946, I further discuss that "Return of Man" in psychiatry is the necessary dynamism between negative and positive health, or between disease control and health promotion. There is an underlying dynamism between "Knowledge of Man" and natural sciences, which is constantly changing. So long as any theory can exist only as a part of dynamism, the Return of Man may re-surface whenever clinical theories do not fit with clinical realities.
[Resilience and Spirituality Considered from Viewpoint of Existential Philosophy of Karl Jaspers].
Kato S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642729
After publishing "General Psychopathology" in 1913, Jaspers turned his attention to serious philosophical contemplation. Using the term grenzsituation (limit situation) as a key concept, he first presented a framework to...
After publishing "General Psychopathology" in 1913, Jaspers turned his attention to serious philosophical contemplation. Using the term grenzsituation (limit situation) as a key concept, he first presented a framework to shed light on the pathology of both individuals and groups, and this led on to include the perspective of resilience. He then used three more key concepts, transzendenz (transcendence), chiffer (cipher), and unverstädliche (unintelligible) to offer a framework to focus on the possibilities of human existence. In the field of medicine, this is useful to support a spiritual approach which is discussed in palliative treatment. The philosophy developed by Jaspers can be considered as indicating a practical form of guidance for people to find self-support from a limit situation where they have lost their own support, and finally, come to a degree of mutual acceptance. Mutual acceptance is made possible at the level of ciphers, in which specific meaning remains undefined, by directing both the self and the other toward a state of "transcendence". Nowadays there is a trend for those chaplains involved in spiritual care from a specialist point of view to be trained to effectively transcend any difference in religious belief. As a basic premise, the author considers there is a need to once again return to a state before the start of individual religions, and stand on a cross-sectional ground level, an area which could be regarded as common to all religions. When conducting such a task, in the author's view, the restrained spirituality that Jaspers expounded is thought-provoking.
[Resilience and the Role of Spiritual Care].
Shimazono S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642728
One of the main goals of spiritual care is to elicit the patient's own power. Previously, religious professionals encouraged people to believe in God, Buddha, or spiritual beings and helped those who were suffering. The...
One of the main goals of spiritual care is to elicit the patient's own power. Previously, religious professionals encouraged people to believe in God, Buddha, or spiritual beings and helped those who were suffering. The power to recover was believed to come from outside human beings. For example, the foremost role of hospital chaplains in the past was to pray to a transcendental being (s) with those who were suffering. When resilience was expected, the first thing to do was to rely on the transcendental being (s). In contrast, the priority in contemporary spiritual care is to trust the resilience of those with difficulties, even when the concerned believe in a transcendental power. The emphasis is on human beings and things which can be seen, rather than transcendental beings. Through this kind of expectation, resilience is to be expected and becomes a source of hope. However, there may be cases in which resilience does not grow. On caring for the dying or those with marked grief, just facing spiritual pain may be the prevalent situation. Care workers need to accept the reality that overcoming spiritual pain is not easy. Then, the paradox is that facing weakness itself can become a source of power. This may be experienced in spiritual care, and it helps elucidate an aspect of resilience. The author's position is that there are many cases in which power is elicited from weakness. Examples are found through the activities to provide aid following the Great East Japan Earthquake, in the spiritual care of dying persons at home, as well as in the care of psychiatric patients who are liberated from the obsession that they must be cured.
[Spirituality and Resilience in Psychiatric Medicine].
Yamada K, Yamada K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642727
At the end of the twentieth century, the WHO tried to change the definition of health. Until then, the health of a person comprised biological, psychological, and social aspects. At the conclusion of the twentieth centur...
At the end of the twentieth century, the WHO tried to change the definition of health. Until then, the health of a person comprised biological, psychological, and social aspects. At the conclusion of the twentieth century, we understood that happiness required more than just these 3 aspects of health. So, the WHO discussed the addition of a spiritual aspect for the new definition of health. It is difficult to translate spirituality into Japanese. However, spirituality is very important in psychiatric care. For example, people who have spiritual pain or grief of loss experience a need for spiritual care. In the recovery process, the importance of resilience has been reported numerous times. Doctor Mieko Kamiya was an excellent psychiatrist and poet. After she contracted tuberculosis and recuperated alone, she fell into a deep depressive state and spent days of distress. In extreme situations, she had the mysterious experience of having her whole body bathed in light. She felt the presence of a great, natural power. Her spirituality and resilience awakened. So, she recovered to strong health through resilience and spirituality. Strong resilience was induced by spirituality. Spiritual care is important in disasters.
[A Clinical Case of Grief Hallucination through the Mourning Work Normal Grief and Spiritual Care].
Kurotori I, Kato S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642726
Auditory or visual hallucinations of a deceased person are well known in the normal course of the bereavement process. According to DSM-5, this symptom is included in the associated features supporting diagnosis of persi...
Auditory or visual hallucinations of a deceased person are well known in the normal course of the bereavement process. According to DSM-5, this symptom is included in the associated features supporting diagnosis of persistent complex bereavement disorder. In Japan, however, little is known about these hallucinatory experiences during grieving, and few reports on their prevalence are available. Here, we have reported a clinical case of such experiences following the loss of a spouse. A 66-year-old patient presented to the outpatient department with insomnia after her husband's death. She was preoccupied with a sense of loss and absolute loneliness. One day, she confessed to regularly encountering her husband's ghost at night; the ghost was distinguishable from a dream and provided the bereaved wife with some degree of comfort. The appearances lasted for 15 months and occurred several times a week without disturbing her social functioning. She gradually became aware that her husband was returning from the spirit world to give her solace. Her treatment was focused on resolving her conflicting feelings concerning her grief at his death and her relief at his no longer suffering from disease. While accepting her experiences, she started to review the days they spent together and appreciated his attachment. Therefore she completed the work of mourning and the ghost no longer appeared. One year after the departure of the ghost, she still attends the hospital regularly and there has been no recurrence. A reconstruction of her internal world leads us to conclude that the support of normal grief with such hallucinations prevents the intense experience of loss from generating pathological grief. Furthermore, we suggest reconsidering the importance of the mourning work and the inclusion of both the bereaved and deceased person in the medical context.
[Cancer-related Cognitive Impairment: Current Knowledge and Future Challenges].
Tanimukai H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26642725
Cancer patients often suffer from various distresses, including cognitive impairment. Cognitive impairment during and after cancer diagnosis and treatment are collectively called "Cancer-related cognitive impairment (CRC...
Cancer patients often suffer from various distresses, including cognitive impairment. Cognitive impairment during and after cancer diagnosis and treatment are collectively called "Cancer-related cognitive impairment (CRCI)". The number of publications about cognitive impairment due to cancer therapy, especially chemotherapy, hormonal therapy, and radiotherapy, has been growing. Patients often worry not only about their disease condition and therapies, but also experience concerns regarding their memory, attention, and ability to concentrate. Even subtle CRCI can have a significant impact on social relationships, the ability to work, undergo treatment, accomplish meaningful goals, and the quality of life. Longitudinal studies of cancer patients indicated that up to 75% experience CRCI during treatment. Furthermore, CRCI may persist for many years following treatment. However, it is not well understood by most physicians and medical staff. CRCI can be mediated through increased inflammatory cytokines and hormonal changes. In addition, the biology of the cancer, stress, and attentional fatigue can also contribute to CRCI. Genetic factors and co-occurring symptoms may explain some of the inter-individual variability in CRCI. Researchers and patients are actively trying to identify effective interventional methods and useful coping strategies. Many patients are willing to discuss their disease condition and future treatment with medical staff and/or their families. Some patients also hope to discuss their end-of-life care. However, it is difficult to express their will after developing cognitive impairment. Advance care planning (ACP) can help in such situations. This process involves discussion between a patient, their family, and clinicians to clarify and reflect on values, treatment preferences, and goals to develop a shared understanding of how end-of-life care should proceed. The number of cancer patients with cognitive impairment has been increasing owing to the super-aging of society. Psychiatrists need to develop appropriate care for them and understand the value of ACP. In this review, an outline of CRCI is given, especially related to cancer therapy such as chemotherapy, hormonal therapy, and radiation therapy. In addition, the importance of ACP to facilitate a living will for patients likely to develop impaired cognitive functions in the future is described.
[Optimal Antipsychotic Dose and Dosing Interval in the Treatment of Schizophrenia].
Takeuchi H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552322
While antipsychotic treatment is essential for acute and maintenance phases of schizophrenia, antipsychotics can induce various undesirable side effects. Thus, antipsychotic dose and dosing interval should be optimized f...
While antipsychotic treatment is essential for acute and maintenance phases of schizophrenia, antipsychotics can induce various undesirable side effects. Thus, antipsychotic dose and dosing interval should be optimized for each patient. Some of the side effects of antipsychotics, including cognitive impairment, are related to antipsychotic dose. To date, there have been only a few studies examining the effect of atypical antipsychotic dose reduction on clinical outcomes, and there has been no study employing neurocognitive assessments. Based on this background, we conducted a randomized controlled trial and found that atypical antipsychotic reduction significantly improved cognitive function without an increased risk of relapse. In addition, we analyzed the Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) data, revealing that there were no significant differences in clinical outcomes between once- vs. twice-daily perphenazine dosing regimens; however, the mean dose of perphenazine was significantly lower with once-daily dosing than that with twice-daily dosing. These findings suggest the possibility of effective antipsychotic treatment with lower doses and longer dosing intervals.
[Key Policy Challenges in Japanese Mental Health Relevant to the Next Generation of Japanese Psychiatrists: A Medical Officer's View].
Ezoe S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552321
The Japanese mental health community is going through a series of major reforms initiated by the Ministry of Health, Labour and Welfare (MHLW) of Japan. As of 2013, mental disorder was included as the fifth priority nati...
The Japanese mental health community is going through a series of major reforms initiated by the Ministry of Health, Labour and Welfare (MHLW) of Japan. As of 2013, mental disorder was included as the fifth priority national disease in the Regional Healthcare Strategic Plan. In the same year, the Act on Mental Health and Welfare of People with Mental Disorders was revised for the first time since 1999, and enacted on 1 April, 2014, aiming to promote community-based mental health, among others. With this as a background, this article aims to inform the next generation of psychiatrists regarding: 1) the process in which mental health reform takes place at the government level, 2) the role of medical officers instrumental in promoting such reform processes, and 3) an overview of the recent mental reform, with a focus on ministerial guidelines envisioning future directions.
[What Psychiatrists Should Know about the Medical Documentation They Issue: Admission for Medical Care and Protection, Medical Treatment for Persons with Disabilities, Mental Health Disability Certification, etc].
Yamasaki M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552320
Psychiatrists issue a wide variety of documentation, among which are torms such as Registration of Admission for Medical Care and Protection, Periodic Report of Condition, Certification of Medical Treatment for Persons w...
Psychiatrists issue a wide variety of documentation, among which are torms such as Registration of Admission for Medical Care and Protection, Periodic Report of Condition, Certification of Medical Treatment for Persons with Disabilities, and Mental Health Disability Certification, which are required under laws such as the Act on Mental Health and Welfare for the Mentally Disabled. These documents are important in that they are related to protecting the human rights of people with mental disorders, as well as securing appropriate medical and welfare services for them. However, in the course of reviewing and evaluating documentation at our Mental Health and Welfare Center, we encounter forms which are incomplete, or which contain inappropriate content. In order to protect the human rights of people with mental disorders, and to ensure the provision of appropriate medical and welfare services for them, I call on psychiatrists to issue carefully written and appropriate documentation. In this talk I will focus primarily on what psychiatrists should know when filling in forms in the course of their day-to-day clinical work.
[Practice of Community Psychiatry for the Treatment of Depression].
Miyaoka H
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552319
The practice in the psychiatric division of Kitasato University East Hospital and Kitasato University Hospital has been emphasizing community psychiatry. The problems and proposed solutions are discussed. 1. Both hospita...
The practice in the psychiatric division of Kitasato University East Hospital and Kitasato University Hospital has been emphasizing community psychiatry. The problems and proposed solutions are discussed. 1. Both hospitals are core hospitals located in Sagamihara City (Kanagawa Prefecture), which has no municipal hospital. 2. Kitasato University East Hospital has 94 beds in two closed wards and is one of the hospitals designated for psychiatric emergencies in Kanagawa Prefecture. 3. Over the last 10 years aroud Sagamihara City, cooperation between psychiatric hospitals and outpatient clinics, the treatment of patients with mental and physical diseases, improvement of the quality of psychiatric practice, emergency psychiatry, and imbalances in the incomes and workloads of psychiatrists have been problematic. 4. Problems that need to be solved in practice to treat depression involve inappropriate pharmacotherapy, disease mongering (the practice of widening the diagnostic boundaries of illnesses in order to expand the markets for drug treatment), clinical skills of psychiatrists, profitability, and medical institutions which cannot cope with regular patients in an emergency. 5. Up to now, we have established a consulting service ("Second opinion" clinic) at Sagamihara Mental Health and Welfare Center (Municipal institution), recommended patients' consultation with family pharmacists, and increased the frequency of conferences for doctors without the support of pharmaceutical companies. 6. In order to develop community psychiatric services for patients with depression, the author is preparing a community-based critical path for depression as well as community-based treatment network in the Sagamihara area. 7. The author believes that the urgent issue necessitates transparency and the increased visibility of psychiatric services.
[The Asahi Model-Regional Mental Health Services at Department of Psychiatry and Child Psychiatry, Asahi General Hospital].
Aoki T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552318
The Asahi model, Psychiatric Services of Department of Psychiatry and Child Psychiatry, Asahi General Hospital, is characterized by multiple dimensions of mental health services, such as multidisciplinary team approach,...
The Asahi model, Psychiatric Services of Department of Psychiatry and Child Psychiatry, Asahi General Hospital, is characterized by multiple dimensions of mental health services, such as multidisciplinary team approach, medical cooperation, specialized psychiatric treatment of acute care, clozapine and modified ECT, outreach services of home nursing and assertive community treatment, and the close and mutual coordination with housing services and social welfare services. The Asahi Model makes it possible to be deinstitutionalized, to improve patients satisfaction, to shorten hospitalization, to decrease psychiatric emergency visits and to be of service in a natural disaster. It also might prevent the relapse of schizophrenics within twelve months after discharge and improve the quality of mental health staffs trainings to support patients better. In the future, we will need to work on providing sectorized care, early psychosis intervention programs, to construct networking systems of clozapine and modified ECT, to strengthen growth of home nursing, and to take place mental health anti-stigma campaigns.
[Approach of Private Hospitals to Support Individuality-respected Community Living].
Nagao K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552317
The government has taken a variety of measures to actualize the basic philosophy of the policy for"shifting medical treatment under hospitalization to regional medical treatment". The problems associated with mental diso...
The government has taken a variety of measures to actualize the basic philosophy of the policy for"shifting medical treatment under hospitalization to regional medical treatment". The problems associated with mental disorders requiring long-term psychiatric treatment and reducing psychiatric beds have been discussed from various viewpoints. Although the transfer of psychiatric medical treatment to regional medical treatment is taking place, it is true that some large barriers exist. According to research on the actual situation in 1954, 1,300,000 psychiatric disorders were estimated, including 350,000 disabilities requiring hospitalization, and mental beds available increased up to a maximum of 350,000 with government subsidies. In 1987, mental bed availability was controlled according to the local healthcare program. As a result, periods of psychiatric hospitalization became prolonged due to factors including social prejudice and the inadequacy of rehabilitation centers; it was called "social hospitalization". Nevertheless, it is true that private psychiatric hospitals have successfully provided various psychiatric medical services in order for people with disabilities to be able to live in the community. The Program for Dissolution of Social Hospitalization of Psychiatric Disabilities in 2000 started in Osaka. The Ministry of Health, Labour and Welfare started the Program for Hospital Discharge Promotion of Psychiatric Disabilities as a model program in 2003. This program was included in the Regional Life Support Program in Prefectural and City Governments, and expanded throughout Japan in 2006. The Regional Shift Support Special Action Program of Psychiatric Disabilities was started in 2008. The report of the "Symposium for Ideal Future Psychiatric Medical Welfare" as compiled in September 2009, and the target value was indicated there. Various measures were implemented in order to promote the basic philosophy for "shifting medical treatment under hospitalization to living in the community". In 2012, the Japan Psychiatric Hospitals Association, joined by the private psychiatric hospitals responsible for medical treatment under hospitalization, set forth their basic polity for "shifting medical treatment under hospitalization to regional medical treatment and medical care" as part of "Future Vision of Psychiatric Medical Treatment".
[Kinshicho Model for Community Care by Multifunctional Vertical Integration of Psychiatric Care].
Kubota A
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552316
The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have conc...
The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have concluded a long-period of hospitalized or repeated involuntary commitment, and for people who suffer from social withdraws over a long period of time. There are over 3,000 private psychiatric outpatient clinics in Japan. Over 400 of them are multifunctional psychiatric outpatient clinics that provide daycare services and outreach activities. In the future, if systematized those clinics entrusted by an administrative organ with performing as a "community mental health center". Multifunctional vertical integration of psychiatric care is possible in Japan to create a catchment area with 24 hours phone service and continued free access.
[Evidence-based Prospects for the Future of Mental Health Policies in Japan].
Fukuda Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552315
The "Visions in Reform of Mental Health and Medical Welfare" is a report by the Headquarters for Mental Health and Welfare of the Ministry of Health, Labour and Welfare, with the Minister serving as the Director-General....
The "Visions in Reform of Mental Health and Medical Welfare" is a report by the Headquarters for Mental Health and Welfare of the Ministry of Health, Labour and Welfare, with the Minister serving as the Director-General. The report generally presents the goals that must be realized over the next 10 years in order to reform the focus of Japan's mental health and medical welfare from "hospitalized medical treatment to living in the community". Reviewing the recent developments after the "Visions in Reform of Mental Health and Medical Welfare", evidence-based prospects for the future of mental health policies in Japan are as follows: patient-centered, continuity of care, care management (CM), and vertical integration of multifunction of care are key functions of the new business model of mental health facilities under the regional medical vision.
[Changing Forensic Mental Health in France: A Review].
Nakatani Y, Hasuzawa S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26552314
This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of...
This article describes the background and recent changes in French forensic mental health. The literature suggests that three law reforms have been crucial to changes in the mental health system. First, the Penal Code of 1992 redefined the provisions of criminal responsibility and introduced the category of diminished responsibility. Second, a controversial law for preventive detention (rétention de sûretê) was enacted in 2008, according to which criminals with severe personality disorders are subject to incarceration even after the completion of their prison sentences if they are still considered to pose a danger to the public. Third, the revision of mental health laws in 2011 altered the forms of involuntary psychiatric treatments, stipulating a judge's authority to decide treatment. In parallel with these legal reforms, the psychiatric treatment system for offenders with mental disorders has been reconstructed. The number of difficult patient units (unités pour malades difficiles) has increased from four to ten across the nation in order to meet the needs of patients transferred from general psychiatric institutions for the reason of being unmanageable. In the penitentiary system, new facilities have been established to cope with the growing number of inmates with mental disorders. As background to these changes, it is pointed out that the current psychiatric system has undergone deinstitutionalization and become less tolerant of aggressive behavior in patients. In the broader context, public sensitivity towards severe crime, as shown by the sensation triggered by serious crimes conducted by pedophiles, seems to urge tough policies. In the 2000 s, several homicides committed by psychiatric patients had a great impact on the public, which led President Sarkozy to issue a statement calling for stronger security in psychiatric institutions. The harsh attitude of courts towards psychiatric practices is illustrated by a 2012 ruling; after a patient escaped from the hospital and hacked an elderly man to death, his psychiatrist was sentenced to a one-year suspended prison sentence for failing to recognize the danger that the patient posed to the public. Another lawsuit was raised against a psychiatrist following this case. Apparently, a sense of crisis is growing among psychiatric professionals. Their concerns are based on several points. Introduction of diminished responsibility may narrow the possibility of acquittal by reason of insanity, and lead to the criminalization of those with mental disorders. Dangerousness (dangerosité), pivotal in the procedure of preventive detention, is not a medical concept, but is instead based on the erroneous identification of criminality and mental disorders. Therefore, it is unreasonable to entrust the evaluation of dangerousness to psychiatric expertise. Court intervention in the process of deciding appropriate treatment may intensify judicialization (judiciarisation) of psychiatry. Establishment of facilities for prisoners within the mental health system would create a new segregating function of psychiatry. Thus, French experience seems to be figuring out all the challenges that contemporary metal health is facing. Above all, effective measures should be taken to prevent patients from entering the criminal justice system. Following this recommendation would be helpful in Japan, where a new forensic mental health system has just started.
[The Present Status of, and Issues Related to, Mental Health Activities in the Ishinomaki Region, with a Focus on Outreach Activities].
Hara K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524874
The Great East Japan Earthquake was a colossal event, registering a magnitude of 9.0 and causing huge tsunami that in some places were more than 40 meters in height. As of March 31, 2014, the number of dead nationwide st...
The Great East Japan Earthquake was a colossal event, registering a magnitude of 9.0 and causing huge tsunami that in some places were more than 40 meters in height. As of March 31, 2014, the number of dead nationwide stood at 15,882, while 2,668 persons were listed as missing; 3,089 other deaths have also been classified as being disaster-related. There were 5,500 victims in the Ishinomaki area alone. The disaster, comprising the earthquake itself, the subsequent tsunami, fires, and the nuclear power plant accident, was a combined natural and man-made catastrophe of epic proportions, affecting a broad, underpopulated region. Those hit by the disaster were affected not only by the loss of life, but also the loss of homes and livelihoods. These people experience psychological stress, fear, and anxiety as a result of lifestyle and environmental changes associated with moving from evacuation areas to prefab temporary housing, or the homes of parents, siblings, relatives, friends, or acquaintances, followed by attempts to rebuild their own homes. Other changes, such as the loss of employment, the transition to new workplaces, or having to change schools, also take a psychological and emotional toll. Delays in the construction of new housing and the resulting prolongation of life as evacuees only serve to increase anxiety and the sense of stagnation. With the above as a backdrop, the author will report on activities being conducted by his organization, particularly outreach efforts.
[Uses of Language in Psychotherapy--at the Place Where the Evaluation Becomes Divided].
Kitayama O
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524873
The psychiatrist sometimes has to read a patients' tragic script. There has been a point of view since long ago that one has a repetitive script of life, reversing roles, and Freudian psychoanalysis tries to make such a...
The psychiatrist sometimes has to read a patients' tragic script. There has been a point of view since long ago that one has a repetitive script of life, reversing roles, and Freudian psychoanalysis tries to make such a script conscious, reading it word by word. There is a script of life which was implanted together with one's special others during infancy, which is called object relations. If such a repetitive object relation is to be repeated always in a tragic manner, it is better to read it. The purpose of reading the script is to rethink and rewrite it. However, any historical events that actually took place cannot be changed. In addition, psychoanalysis has a history of being initiated from "dramatic" hysterics and we can say that it has a dramatic point of view of thinking about the patients' life in terms of dramatic metaphors from the beginning. Moreover, there is a point of view of reading the psychological movement as a drama of actors/actresses and therapy might also become a drama. The word 'transference' frequently used in the psychoanalysis also indicates the repetition in a clinical relationship such as script of mind or object relations. Then, the analytic therapist understands the events, while participating in the clinical setting, attends the drama as an object in the script and sometimes plays such given role. In the therapeutic relations in play therapy for children, the script of drama is repeated, which can be called a dramatization of transference. The English word 'play' can also signify 'drama' and therefore it becomes a goal of therapists of children to read and understand the story, while participating in the drama. Thus, the interpretation of transference in psychoanalysis is the words made to trace and to re-weave the script of one's life story.
[Prolonged Exposure Therapy for Post-traumatic Stress Disorder].
Asukai N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524872
Prolonged exposure therapy (PE), a well-known trauma-focused cognitive behavioral treatment (TFCBT), is the most scientifically established treatment for post-traumatic stress disorder (PTSD) among a variety of pharmacot...
Prolonged exposure therapy (PE), a well-known trauma-focused cognitive behavioral treatment (TFCBT), is the most scientifically established treatment for post-traumatic stress disorder (PTSD) among a variety of pharmacotherapies and psychotherapies. It is comprised of two types of exposure technique: imaginal exposure and in vivo exposure. This paper overviews a recent review of psychotherapies for adult chronic PTSD, the emotional processing theory and structure of PE, and the effectiveness and dissemination of PE in Japan.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe