Seishin Shinkeigaku Zasshi [JOURNAL]
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200 papers
[Side Effects of Rogerian Psychotherapy and Counseling].
Nomura T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524871
Rogerian psychotherapy relies on a patient's potential for self-healing and assumes that the patient will show desirable personality changes if the psychotherapist is satisfied with necessary and sufficient demands. Roge...
Rogerian psychotherapy relies on a patient's potential for self-healing and assumes that the patient will show desirable personality changes if the psychotherapist is satisfied with necessary and sufficient demands. Rogerian psychotherapy is usually not considered intrusive because of its supportive features. However, there is no treatment without side effects. Insufficient informed consent for psychotherapy, the risk of dependence, regression, traumatic stress caused by probing too deeply, and missing the chance to perform suitable medical treatment are discussed.
[Adverse Events and Precautions Regarding Cognitive Behavioral Therapy].
Okmaoto Y, Jinnin R, Yoshino A … +4 more , Kikuchi T, Nakano Y, Horikoshi M, Ono Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524870
Adverse events of cognitive behavioral therapy (CBT) can be used to identify two types depending on whether or not CBT is practiced appropriately. The results of a randomized control trial (RCT) when CBT is performed eff...
Adverse events of cognitive behavioral therapy (CBT) can be used to identify two types depending on whether or not CBT is practiced appropriately. The results of a randomized control trial (RCT) when CBT is performed effectively show that the rate of adverse events is as low as, or lower than, that on using a pill placebo. Many adverse events are associated with a low quality of CBT caused by inappropriate practice due to therapists' lack of knowledge, skills, and experience. In order to achieve effective CBT for RCT, it is considered important to frequently assess the status of patients before and during CBT sessions, utilize the Cognitive Therapy Rating Scale after the session, and conduct supervision based on audio recordings of the session.
[Psychoanalysis and Side Effect].
Shirahase J
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524869
A study of psychoanalysis from the perspective of side effects reveals that its history was a succession of measures to deal with its own side effects. This, however, does not merely suggest that, as a treatment method,...
A study of psychoanalysis from the perspective of side effects reveals that its history was a succession of measures to deal with its own side effects. This, however, does not merely suggest that, as a treatment method, psychoanalysis is incomplete and weak: rather, its history is a record of the growth and development of psychoanalysis that discovered therapeutic significance from phenomena that were initially regarded as side effects, made use of these discoveries, and elaborated them as a treatment method. The approach of research seen during the course of these developments is linked to the basic therapeutic approach of psychoanalysis. A therapist therefore does not draw conclusions about a patient's words and behaviors from a single aspect, but continues to make efforts to actively discover a variety of meanings and values from them, and to make the patient's life richer and more productive. This therapeutic approach is undoubtedly one of the unique aspects of psychoanalysis. I discuss the issue of psychoanalysis and side effects with the aim of clarifying this unique characteristic of psychoanalysis. The phenomenon called resistance inevitably emerges during the process of psychoanalytic treatment. Resistance can not only obstruct the progress of therapy; it also carries the risk of causing a variety of disadvantages to the patient. It can therefore be seen as an adverse effect. However, if we re-examine this phenomenon from the perspective of transference, we find that resistance is in fact a crucial tool in psychoanalysis, and included in its main effect, rather than a side effect. From the perspective of minimizing the character of resistance as a side effect and maximizing its character as a main effect, I have reviewed logical organization, dynamic evaluation, the structuring of treatment, the therapist's attitudes, and the training of therapists. I conclude by stating that psychoanalysis has aspects that do not match the perspective known as a side effect.
[It is Not an Antidepressant but Psychotherapy with Encouragement that Reassures Depressed People with Demoralization].
Tamada Y, Ohmae S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524868
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[Diagnosis and Treatment of Social Anxiety Disorder].
Asakura S
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524867
Many studies of social anxiety disorder (SAD) have been conducted because diagnostic criteria are defined as social phobia in DSM-III in the West. In Japan, several studies have examined pathological conditions similar t...
Many studies of social anxiety disorder (SAD) have been conducted because diagnostic criteria are defined as social phobia in DSM-III in the West. In Japan, several studies have examined pathological conditions similar to SAD, known as taijin-kyofu (TK). This highly remarkable disorder involves a convincing fear of giving another person discomfort from one's physical faults (e.g. feeling that neighboring people detect an unpleasant smell from one's body, "jikoshu-kyofu", or feeling that neighboring people feel unpleasant because of one's appearance,"shukei-kyofu") termed "convinced subtype of TK" (c-TK; also known as offensive subtype of TK). In DSM-5, the definitions of feeling rejection and offense of others are added to a fear of humiliating or embarrassing oneself. Moreover, TK is a sufficient criterion for SAD. However, it is confusing that body dysmorphic disorder is not in category of somatoform disorders but in that of obsessive-compulsive disorder and related disorders and that the Japanese terms of "jikoshu-kyofu" and "shubo-kyofu" are categorized as other specified obsessive-compulsive disorder and related disorders. The efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for the treatment of SAD has been reported in many controlled studies. Recently, SSRIs are regarded as first line pharmacotherapy for SAD. Cognitive behavioral therapy is also effective for SAD treatment. High rates of co-occurring SAD and other psychiatric disorders can be found in clinical samples and in the general population. Additional research must be conducted for these patients and for the management of treatment-refractory SAD patients.
[Clinical Handling of Patients with Dissociative Disorders].
Okano K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524866
This paper discusses the way informed psychiatrists are expected to handle dissociative patients in clinical situations, with a specific focus on dissociative identity disorders and dissociative fugue. On the initial int...
This paper discusses the way informed psychiatrists are expected to handle dissociative patients in clinical situations, with a specific focus on dissociative identity disorders and dissociative fugue. On the initial interview with dissociative patients, information on their history of trauma and any nascent dissociative symptoms in their childhood should be carefully obtained. Their level of stress in their current life should also be assessed in order to understand their symptomatology, as well as to predict their future clinical course. A psychoeducational approach is crucial; it might be helpful to give information on dissociative disorder to these patients as well as their family members in order to promote their adherence to treatment. Regarding the symptomatology of dissociative disorders, detailed symptoms and the general clinical course are presented. It was stressed that dissociative identity disorder and dissociative fugue, the most high-profile dissociative disorders, are essentially different in their etiology and clinical presentation. Dissociative disorders are often confused with and misdiagnosed as psychotic disorders, such as schizophrenia. Other conditions considered in terms of the differential diagnosis include borderline personality disorder as well as temporal lobe epilepsy. Lastly, the therapeutic approach to dissociative identity disorder is discussed. Each dissociative identity should be understood as potentially representing some traumatically stressful event in the past. The therapist should be careful not to excessively promote the creation or elaboration of any dissociative identities. Three stages are proposed in the individual psychotherapeutic process. In the initial stage, a secure environment and stabilization of symptoms should be sought. The second stage consists of aiding the "host" personality to make use of other more adaptive coping skills in their life. The third stage involves coaching as well as continuous awareness of their comorbid psychiatric conditions. Lastly, factors preventing the patients' smooth recovery process are mentioned. They include their contact with past and current aggressors, chronic and ongoing stress within the family, including abuse and violence, and comorbid conditions such as depression and chronic medical conditions.
[As a Child of a Parent with Schizophrenia, as a Patient, and as a Psychiatrist: A Message to All JSPN Members].
Natsukari I
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524850
I previously published an article, entitled About "Regarding a person Who recovers". It documents the actual situation and recovery of a family member with schizophrenia, and it does not describe my recovery as a patient...
I previously published an article, entitled About "Regarding a person Who recovers". It documents the actual situation and recovery of a family member with schizophrenia, and it does not describe my recovery as a patient as a psychiatrist. At the time of publication, the main purpose was to disclose the real name of the family member. Since the disclosure, I have met many patients and families, and learned their true thoughts and strengths that I would have never known simply through consultation, and this totally changed my perceptions of them. Meanwhile, I also received many comments from medical professionals who were also family members of patients at the same time. I learned that they were struggling with conflicting emotions of being a family member as well as a professional, and I realized the isolations of families, and persistent stigma attached to psychiatric disorders. The disclosure broadened my perspectives as a psychiatrist. Now, more than 30 years after becoming a doctor, I still question myself: 'what have I done?', 'Have I listened to the voices of patients and their families?' I still have persisted, as a psychiatrist, until today. Psychiatry is a field that can be neglected if you do not question its contradictions. I think this is also why 'patient-centered recovery' has been neglected, and, as a result, psychiatry has been left behind. I often hear people asking: 'how can we increase numbers of psychiatrists?' I did not become a psychiatrist because of my own experience. I believe that, by providing medical care that the patients and their families can appreciate, from those families, some younger members will desire to become psychiatrists ; that is the way psychiatry should be developed. For that purpose, I believe it is necessary more than anything to approach each case with great care, valuing the 'real voices' of patients and their families, and respecting their strengths.
[Vocational Training and Job Placement for People with Autism Spectrum Disorders in the Business Sector].
Suzuki K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524849
Kaien was founded in 2009 in order to help people with autism spectrum disorders work by leveraging their unique capabilities. Our four offices are all located in the Tokyo Metropolitan Area. Our services include job tra...
Kaien was founded in 2009 in order to help people with autism spectrum disorders work by leveraging their unique capabilities. Our four offices are all located in the Tokyo Metropolitan Area. Our services include job training and placement for adults, career awareness programs for college students, and career experience programs for teens with autism spectrum disorders. Currently, we help over 100 people on a daily basis. We believe that two factors play important roles when we provide job training programs for people. Firstly, they usually find it difficult to identify their occupational "fit" by themselves due to their weakness regarding imagination. It is not a good idea to convince them only through counseling. Rather, when we take their weaknesses into consideration, multiple trial sessions in the work environment are key because even people without imagination can understand their occupational "fit" once they try. The other aspect is to articulate communication as much as possible. In this case, it is also true that words are not enough to help people fully develop the communication skills necessary in an office. Thus, our trainers intervene very frequently in the job programs in order for trainees to get feedback at the right time on the spot. In other words, our five-year experience at Kaien has revealed that our "Here and Now" approach in the quasi-work environment is the most effective way. Most of our trainers do not have medical or social welfare backgrounds. This fact has revealed huge possibilities when it comes to helping people with autism spectrum disorders to get a job. That is, in many cases, autism experts may not be mandatory, and supervisors or colleagues, who work with people with autism every day, can become "job supporters" with a little knowledge and some training. Some estimates indicate that the prevalence rate of autism spectrum disorders is above one in one hundred, and might be as high as five or six percent. This number is daunting because only autism experts with marked experience cannot handle all issues. Therefore, we believe that empowering amateur supporters in the business arena is important, and we are thrilled to think that our findings and programs may be helpful to increase the proficiency of such amateur supporters.
[Support for Adult ASD in Medical Rework Program: Mutual Communication Program and Psychodrama].
Yokoyama M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524848
While carrying out the Medical Rework Program, we realized the necessity for a supplementary medical treatment program aimed at adult ASD. Consequently, we started the Mutual Communication Program, which consists of stan...
While carrying out the Medical Rework Program, we realized the necessity for a supplementary medical treatment program aimed at adult ASD. Consequently, we started the Mutual Communication Program, which consists of standard SST and the new element of psychodrama. As a result, 32 participants have returned to their workplace in the three-year period, and the rate of successfully continuing to work was 93.8% at the time of the investigation. Various psychological tests also indicated significant improvement. In this article, we present a case study, explain psychodrama techniques employed in the program, and discuss their usefulness. The results suggest that psychodrama is a very effective assistive technique when the characteristics of ASD are taken into consideration.
[The Outpatient Clinic and Rehabilitation Program Specialized in Adult Developmental Disorders].
Ebisawa T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524847
The rehabilitation program has been conducted at our psychiatric clinic for depressive patients who are absent from work, with the aim of assisting them to return to work. We have noticed that a substantial number of the...
The rehabilitation program has been conducted at our psychiatric clinic for depressive patients who are absent from work, with the aim of assisting them to return to work. We have noticed that a substantial number of the patients have traits of developmental disorders, which contribute to chronicity and/or recurrence of depression. Therefore, we have recently created a new rehabilitation program in addition to the specialty outpatient clinic and peer support group. All these programs specialize in treating adult patients with mild developmental disorders [mostly autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD)]. Since then, we have investigated a lot of depressive patients whose ASD symptoms have been identified for the first time in their life. Symptoms were first noted after they started work where they experienced impaired social functioning because the social demands were higher than those at schools. To assist patients with their goals of improving symptoms and stabilizing social functions, it is valid to evaluate whether the autistic traits cause mental stress and impairment during occupational functioning, even if the diagnosis of ASD is not definitive or the symptoms are below the diagnostic threshold for ASD. The profile of ASD symptoms is different for each patient, and therefore personalized support is essential.
[Challenges Related to Employees with Developmental Disabilities, from the Perspective of an Occupational Physician].
Morita T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524846
Changing in the work environment in recent years, an occupational physician needs to make a countermeasure to mental health disorders. When the occupational physician works with employees who have, or are suspected of ha...
Changing in the work environment in recent years, an occupational physician needs to make a countermeasure to mental health disorders. When the occupational physician works with employees who have, or are suspected of having, high-functioning developmental disorders, it is necessary to consider the following: Whether, in the course of addressing problems faced by employees, occupational health staff members are able to consider the possibility of developmental disorders. An additional issue is whether the occupational physician, when working with the treating psychiatrist, is able to appropriately provide precise information. Furthermore, when an employee is diagnosed with a developmental disorder, there are questions of whether a smooth internal company approach is possible in the context of appropriate workplace support, and whether it is possible to obtain the understanding of colleagues prior to implementing appropriate workplace assignments and accommodations. Additionally, it is necessary to consider the career paths of employees with high-functioning developmental disorders that are discovered subsequent to being hired. In this paper, introducing some cases, It was summarized the challenges of developmental disabilities in the workplace and discussed correspondence in the workplace.
[Perspectives on the Outpatient Clinic and Rehabilitation Program Exclusively Provided for Adults with Autism Spectrum Disorder].
Kato N, Igarashi Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524845
Developmental disorders came to be recognized by the Japanese general public only during the last decade. With the spread of recognition, consultations to medical institution and administrative agencies are growing rapid...
Developmental disorders came to be recognized by the Japanese general public only during the last decade. With the spread of recognition, consultations to medical institution and administrative agencies are growing rapidly. Since the opening of Developmental Disorders Clinic and Day Care at Karasuyama Hospital in 2008, the number of patients has exceeded 3,000. In this paper, the present state and perspectives are presented and discussed on the activity in Karasuyama Hospital, Showa University.
[Negative Symptoms Revisited--Toward the Recovery of Persons with Schizophrenia].
Ikebuchi E
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524844
The negative symptoms of schizophrenia are usually treatment-refractory, and considered to be a major cause of a poor outcome. Recently, it has become an important issue to elucidate the etiology of and develop treatment...
The negative symptoms of schizophrenia are usually treatment-refractory, and considered to be a major cause of a poor outcome. Recently, it has become an important issue to elucidate the etiology of and develop treatment for negative symptoms in order to improve the outcome of schizophrenia patients. Firstly, the history of negative symptoms was reviewed. Several lines of factor-analysis studies have suggested that negative symptoms are independent from other symptoms of schizophrenia, and consist of two factors, the poverty of expression and avolition, while the results depend upon the assessment scale employed in each analysis. Anhedonia, a part of avolition, may be considered as the impairment of pleasure-seeking behavior, the impairment of remembering non-current feelings, and a person's belief that he/she cannot experience pleasure, rather than the loss of pleasure itself. As neurological bases for avolition, decreases in reward expectancy, value representation, and the behavior to seek uncertain reward were observed, which resulted in poor social functioning due to the difficulties of initiating adaptive behaviors for the future. These impairments are the bases of decreased intrinsic motivation. The negative symptoms were considered to result in poor social functioning mediated by neuro-and social cognitive dysfunction and dysfunctional cognition, such as low self-efficacy and self-stigma. Pharmacotherapy for negative symptoms remains to be established due to a lack of evidence. Several psycho-social interventions in self-efficacy, self-stigma, intrinsic motivation, and environmental contexts are now being developed, while their effects are rather limited. The principles of psychiatric rehabilitation, i.e., respecting one's own value system and preference, self-determination, and motivation, are worth revisiting from the viewpoint of neuro-cognitive science. Furthermore, a hope-oriented approach, the presence of peers, and reconstructing social values as barrier-free may be considered to be of marked help not only for treating negative symptoms through re-establishing self-esteem, but also to aid the general population.
[Individually Safe and Realistic Correction of Antipsychotic Polypharmacy and High-dose Regimens in Japanese Patients with Chronic Schizophrenia: The SCAP method].
Yamanouchi Y, Sukegawa T, Inagaki A … +4 more , Inada T, Yoshio T, Yoshimura R, Iwata N
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524843
Compared with other countries, Japan exhibits prominent levels of antipsychotic polypharmacy and high-dose regimens. In view of these circumstances, the Safe Correction of Antipsychotic Polypharmacy and high-dose regimen...
Compared with other countries, Japan exhibits prominent levels of antipsychotic polypharmacy and high-dose regimens. In view of these circumstances, the Safe Correction of Antipsychotic Polypharmacy and high-dose regimens (SCAP) method was developed based on previous findings as a realistic way to reduce medication consumption in patients already experiencing polypharmacy and high-dose regimens. In the SCAP method, "clinicians can reduce medications one by one, gradually, with occasional breaks permitted." A clinical study conducted to evaluate this method found no change in clinical symptoms, side effects, or quality of life (QOL), and the number of withdrawals due to aggravation was also small. A leaflet describing these results, and which is designed to support efforts to reduce medications, has been released. Future research will involve the examination and analysis of data from this study, taking into account its limitations, with a view toward developing guidelines applicable to clinical settings. The pragmatic, gradual correction of polypharmacy and high-dose regimens that goes beyond the "multiple drugs or single agent" dichotomy can decrease the burden experienced by patients. This is a practical approach that can be applied when developing comprehensive plans for the future psychiatric care of aging patient populations.
[Acute Drug Poisoning: Focus on Psychotropic Drugs].
Kamijo Y
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524842
In acute psychotropic drug poisoning, it is important to diagnose and treat complications, including aspiration pneumonitis, abnormal body temperature, and atraumatic crush syndrome/compartment syndrome (3As). For the ga...
In acute psychotropic drug poisoning, it is important to diagnose and treat complications, including aspiration pneumonitis, abnormal body temperature, and atraumatic crush syndrome/compartment syndrome (3As). For the gastrointestinal decontamination (GID) of psychotropic drugs, excluding lithium, the administration of activated charcoal through a nasogastric tube should be considered first. For the GID of sustained-release or enteric-coated psychotropic drugs, total bowel irrigation is an option. To eliminate phenobarbital and carbamazepine, multiple doses of activated charcoal or direct hemoperfusion should be considered. To eliminate lithium, hemodialysis is an option. As an antidote to tricyclic antidepressants, the intravenous administration of sodium bicarbonate may be effective.
[Premenstrual Dysphoric Disorder (PMDD)].
Yamada K
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524841
Premenstrual dysphoric disorder (PMDD) is categorized as a subclass in depressive disorders of DSM-5. Speaking without fear of misunderstanding, my opinion is that patients with PMDD should be treated with medication, if...
Premenstrual dysphoric disorder (PMDD) is categorized as a subclass in depressive disorders of DSM-5. Speaking without fear of misunderstanding, my opinion is that patients with PMDD should be treated with medication, if there is no misdiagnosis as premenstrual syndrome (PMS). For the appropriate treatment of PMDD, it must be diagnosed accurately according to the DSM-5 criteria. The differential diagnosis and treatment of PMDD should be carried out by experienced psychiatrists.
[Social Anxiety Disorder].
Nagata T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524840
Social Anxiety Disorder (SAD) is not a rare psychiatric disorder, and the recent World Mental Health Japan Survey, Second (WMHJ2) reported the possibility that the twelve-month prevalence of SAD has increased from 0.7 to...
Social Anxiety Disorder (SAD) is not a rare psychiatric disorder, and the recent World Mental Health Japan Survey, Second (WMHJ2) reported the possibility that the twelve-month prevalence of SAD has increased from 0.7 to 2.3% over the last ten years. However, ten years have already passed since selective serotonin reuptake inhibitors (SSRI) were approved for the treatment of SAD in Japan, and not only laypersons but also mental health professionals still misunderstand SAD as public speech phobia. As a result, the boundary between normal shyness and SAD and threshold to start pharmacotherapy have been debated. Participants in most double-blind studies of SSRI were limited to those with a generalized subtype of SAD. While benzodiazepine led to a significantly more favorable response and symptom improvement and the effect size of benzodiazepine was larger than those of SSRI, it did not lead to a "cure" and is sometimes deleterious for atypical SAD patients. To sum up, a psychotherapeutic approach including cognitive behavioral therapy is suggested as first-line treatment for non-generalized SAD according to the NICE guidelines. On the other hand, patients with generalized SAD and secondary depression are still misunderstood (and under-recognized) as those with "treatment-resistant depression", and they suffer from severe impairment of the psycho-social function, including absences or withdrawal from working or schooling. They need more effective combination treatment of SSRI and cognitive behavioral therapy as generalized SAD patients.
[Clinical Problems before Initiating Pharmacotherapy for Insomnia].
Semba J
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524839
Insomnia is one of the most common complaints of psychiatric patients. Educational approaches for mental health always recommend early detection and intervention for insomnia. However, too much emphasis on insomnia may l...
Insomnia is one of the most common complaints of psychiatric patients. Educational approaches for mental health always recommend early detection and intervention for insomnia. However, too much emphasis on insomnia may lead to overdiagnosis and overtreatment. Psychiatrists are often accused of overprescribing hypnotics to patients with sleep disturbance. This drug is difficult to discontinue due to factors associated with both patients and prescribers. In order to prevent the unneccessary administration of hypnotics, clinicians should evaluate both the sleep quality and daytime activities of patients. A sleep diary may help this process. Clinicians should prescribe hypnotics only when a patient's sleep disturbance is neither a part of the symptoms of major psychiatric disorders nor sleep-wake schedule disorders, and is not a consequence of inadequate lifestyle behavior. The reasonable goal of hypnotic treatment should be set in advance, and then pharmacological and psychosocial interventions for insomnia should be initiated.
[Threshold of Application of Antidepressant Drugs for Treatment of Depressive Disorder].
Kuroki T, Tanaka T
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524838
In recent years, along with the expansion of medical care for depressive disorder, there has been much controversy regarding the application of antidepressant drugs for its treatment. The aim of this paper is to consider...
In recent years, along with the expansion of medical care for depressive disorder, there has been much controversy regarding the application of antidepressant drugs for its treatment. The aim of this paper is to consider critical issues concerning the threshold of application of antidepressant drugs for the treatment of depression. It was formerly important to diagnose the 'quality' of depression (melancholia or non-melancholia) in order to choose antidepressant treatment, whereas an assessment of the 'quantity' of depression (severity of symptoms) is crucial today to decide on the threshold. Recent guidelines for the treatment of major depressive disorder do not positively recommend the use of medication for the treatment of mild depression. The guidelines published by the Japanese Society of Mood Disorders also state that doctors have to give priority to treatments avoiding medication, although the effectiveness of antidepressant drugs for mild depression is controversial. Actually, in a clinical setting, doctors have to understand the conditions of individual cases and cope with many issues, such as a risk of suicide, comorbidity of other psychiatric disorders, target symptoms of pharmacotherapy, and choices of classes and doses of antidepressant drugs. The threshold of application of antidepressant drugs for the treatment of depression may vary according to the doctor-patient relationship and surrounding conditions. Doctors are required to provide treatment options other than pharmacotherapy.
[Cotard's Syndrome in Three Patients with Schizophrenia--Pathology of Involutional and Senile-onset Endogenous Psychosis].
Fuke T, Takahashi T, Yamada Y … +3 more , Miyashita M, Amano N, Matsushita M
Seishin Shinkeigaku Zasshi · 2015 · PMID 26524837
A large number of case studies on Cotard's syndrome have reported that this syndrome develops after repeated episodes of depression in the presenile stage of life. Therefore, it has been defined as a severe type of affec...
A large number of case studies on Cotard's syndrome have reported that this syndrome develops after repeated episodes of depression in the presenile stage of life. Therefore, it has been defined as a severe type of affective spectrum disorder. This report describes three patients who exhibited symptoms characteristic of Cotard's syndrome, such as negative thoughts and delusions of immortality, in the presenile and senile stages of their lives. They also had a history of long-term treatment for schizophrenia based on a diagnosis in early adulthood. Our review of reports on Cotard's syndrome revealed that the syndrome is more prevalent among presenile and senile female patients, who initially visit psychiatrists in their involutional and presenile stages of life with symptoms of an affective spectrum disorder, and later exhibit the symptoms of Cotard's syndrome. The results of the three case studies suggest that biological factors related to aging and sex differences may be associated with the development of Cotard's syndrome, regardless of the primary disorder. The pathology of "involutional and senile-onset endogenous psychosis," including Cotard's syndrome, is also discussed.
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