Search

Introduction: We evaluated the mental health status of children residing in Kawauchi village (Kawauchi), Fukushima Prefecture, after the 2011 accident at the Fukushima Daiichi Nuclear Power Station, based on the children’s experience of the nuclear disaster. Methods: We conducted this cross-sectional study within the framework of the Fukushima Health Management Survey (FHMS);FHMS data on age, sex, exercise habits, sleeping times, experience of the nuclear disaster, and the “Strengths and Difficulties Questionnaire (SDQ)” scores for 156 children from Kawauchi in 2012 were collected. Groups with and without experience of the nuclear disaster — “nuclear disaster (+)” and “nuclear disaster (−)” — were also compared. Results: Our effective response was 93 (59.6%);the mean SDQ score was 11.4±6.8 among elementary school-aged participants and 12.4±6.8 among junior high school-aged ones. We statistically compared the Total Difficulties Scores (TDS) and sub-item scores of the SDQ between “elementary school” and “junior high school” or “nuclear disaster” (+) and (−). There was no significant difference between these items. Conclusions: We found indications of poor mental health among elementary and junior high school-aged children in the disaster area immediately following the accident, but no differences based on their experience of the nuclear disaster. These results indicate the possibility of triggering stress, separate to that from experiences related to the nuclear disaster, in children who lived in affected rural areas and were evacuated just after the nuclear disaster., Fukushima journal of medical science, 67(1), pp. 8-16; 2021

Mental health literacy (MHL) refers to one's knowledge and beliefs about mental disorders. MHL is necessary for the prevention and early detection of eating disorders, but little research exists on the MHL of Japanese people. This paper aims to reveal the degree of MHL about eating disorders in the Japanese individuals most susceptible to them (namely, female university students). Female Japanese university students were surveyed with a self-report questionnaire, using the Japanese versions of anorexia nervosa and bulimia nervosa vignettes. Most participants responded that the main problem described in each vignette were "eating disorders" and tended to suggest medical care for the treatment. However, many still believed these issues to be simple problems of eating behavior. Overall, the participants demonstrated inadequate MHL about eating disorders. Initiatives to improve this population's knowledge and understanding of eating disorders are necessary.

Background Although the prevalence of drug addiction in Japan is lower than that of in European and/or American countries, the number of methamphetamine-related arrests in this decade has exceeded 10,000 every year, with 66.2% of the arrests made in 2017 being of re-offenders. This study was performed to assess the mental health status among prison inmates whose sentences were related to methamphetamine use. Methods Face-to-face individual interviews using a questionnaire including self-rated health questions (answered on a 4-point Likert scale) and the Kessler 6-item psychological distress scale (K6, range: 0-24) was established by the authors and conducted with 30 methamphetamine-dependent inmates (15 male and 15 female inmates) in Japan. Results The age of inmates ranged from the 20s to the 70s. The median time served in adulthood was 5 (range: 2 - 12) among male inmates, and 4.5 (range: 2 - 12) among female inmates (Mann-Whitney U test, P = 0.202). The median K6 scores were 4 (0-8) for the male inmates and 6 (1-17) for the female inmates (Mann-Whitney U test, P = 0.074). The cut-off point for K6 exhibited variation, and the authors considered a participant psychologically distressed if K6 was 10 or higher. Six (40.0%) female inmates were found to be psychologically distressed, which was a higher proportion than among the male inmates (0.0%) (Fisher's exact test, P = 0.017). Regarding self-rated health, 13 (86.7%) of both male and female inmates reported being in “very good/good health” (Cochran-Armitage Test, P ¬= 1.000). There was no statistical correlation between the K6 scores and the self-rated health scores among the male inmates (ρ = 0.148, P = 0.599) or the female inmates (ρ = -0.499, P = 0.058). Conclusions Although the interviewees were not representative samples, the male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders. Key messages The male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders. Gender differences in mental health status among inmates, should be considered when a drug addiction recovery program is implemented to ensure the successful prevention of relapse.

Objective/Background The purpose of this pilot study was to examine the effectiveness of standard earmuffs and noise-cancelling (NC) headphones in controlling behavioural problems related to hyper-reactivity to auditory stimuli in children with autism spectrum disorder (ASD). Methods Twenty-one children with ASD aged 4–16 years (16 boys and 5 girls), after a 2-week nonwearing baseline period, were asked to use standard earmuffs and NC headphones for 2 weeks, in a random order. Parents or teachers rated participants’ behaviours that were related to their reaction to auditory stimuli. Results Four participants refused to wear either the earmuffs or the NC headphones. It was found that the T-score on the Goal Attainment Scaling was significantly higher during the earmuff period than that in the baseline period (Z = 2.726, p = .006). The behaviours of 5 children with ASD improved during the NC headphone period as compared with those in the baseline period; there were no differences in the T-scores on the Goal Attainment Scaling between the NC headphone period and the baseline period (Z = 1.689, p = .091) and between the earmuff and NC headphone periods (Z = −0.451, p = .678). Conclusion This study demonstrated the effectiveness of standard earmuffs and NC headphones in helping children with ASD to cope with problem behaviours related to hyperreactivity to auditory stimuli, therefore, children with ASD could use earmuffs to help to deal with unpleasant sensory auditory stimuli.

Background This study determined factors related to the burnout of long-term care facility employees, including employees' expressed emotion (EE) toward patients. Methods A survey of 411 long-term care facility employees was conducted. Employee burnout was evaluated using the Maslach Burnout Inventory (MBI). EE levels were evaluated using the Nurse Attitude Scale (NAS). Results The percentage of high scorers on the MBI's three subscales of emotional exhaustion, depersonalization, and low personal accomplishment were as follows: emotional exhaustion, 197 people (51.6%); depersonalization, 122 people (31.4%); and low personal accomplishment, 301 people (83.8%). Results of multiple logistic regression analysis using presence of a high score on the MBI subscales as dependent variables confirmed significant relevant factors. For emotional exhaustion, this was criticism [odds ratio (OR): 1.74, p = 0.046], for depersonalization, male (OR: 1.99, p = 0.021), younger than 40 years (OR: 1.84, p = 0.038), and hostility (OR: 2.99, p < 0.001). Conclusion Results indicate that employees' EE of criticism and hostility toward patients is related to burnout., International Journal of Gerontology, 9(3), pp.161-165; 2015

Problem Although pharmacotherapy is an effective treatment for many psychiatric disorders in children and adolescents, medication adherence rates among children are low. This study clarifies factors affecting children's medication adherence and the role of parental involvement. Method Patients aged 7–17 years with a history of psychotropic medication treatment and their mothers were included in this study. Each mother and child completed self-administered questionnaires. Thirty mother–child pairs who fully completed the questionnaires were included in the analysis. Results Medication adherence was greater in children and mothers when mothers felt that “children's symptoms improved with treatment and medication.” Medication adherence in children and mothers significantly correlated with the child's reported trust in their parent. Conclusions The results suggest the need for psychosocial support that considers the influence of mothers on medication adherence in children treated in child psychiatry departments.

Background There has long existed a need for early detection and early intervention for children with autism spectrum disorder. Accordingly, the aim of this study was to demonstrate, in a prospective manner, the relationship between behavioral features during the neonatal period and social behavior and sensory issues at 18 months. Methods Participants were 105 full-term infants considered "healthy" by an obstetrician. The behavioral features of the infants were evaluated using the Neonatal Behavioral Assessment Scale (NBAS) between 2 and 7 days after birth. Follow-up assessments were conducted 18 months later using a Japanese version of the Modified Checklist for Autism in Toddlers (M-CHAT-JV) and the Infant / Toddler Sensory Profile (ITSP). Results Sixteen (15.2%) of the 105 infants were M-CHAT-JV-positive. There were significant differences between the M-CHAT-JV-positive and M-CHAT-JV-negative groups in two of the NBAS clusters: orientation and motor. We observed a significant negative correlation between the NBAS orientation cluster and the ITSP "low registration" and "auditory processing" sections, as well as between the NBAS motor cluster and the ITSP "sensation avoiding" and "tactile processing" sections. Logistic regression analysis showed that the NBAS orientation cluster and ITSP low registration were significantly associated with the M-CHAT-JV at 18 months. Conclusions The results suggest a relationship between the NBAS orientation cluster in full-term neonates and their social behavior and sensory features at 18 months.

Monozygotic (MZ) twins have been thought to be genetically identical. However, recent studies have shown discordant variants between them. We performed whole-exome sequencing (WES) in five MZ twin pairs with discordant neurodevelopmental disorders and one healthy control MZ twin to detect discordant variants. We identified three discordant variants confirmed by deep sequencing after analysis by personalized next-generation sequencing (NGS). Three mutations in FBXO38 (chr5:147774428;T>G), SMOC2 (chr6:169051385;A>G) and TDRP (chr8:442616;A>G), were detected with low allele frequency of mutant alleles on deep sequencing, suggesting that these loci are mosaic due to somatic mutations in a developmental stage. Our results suggest that deep sequencing analysis would be an adequate method to detect discordant mutations in candidate genes responsible for heritable diseases. “Identical„ twins in which only one twin has a psychiatric illness may not be so genetically identical after all. A genomic sequencing analysis from Koh-ichiro Yoshiura and colleagues from Nagasaki University Graduate School of Biomedical Sciences, Japan, has identified a 30-year-old male with gender dysmorphia (also known as gender identity disorder) who harbors three non-inherited mutations in a subset of his cells that his healthy twin does not have. The researchers made this finding by sequencing all the protein-coding DNA from five identical twin pairs in which one twin only had a neurodevelopmental disorder (schizophrenia, autism or gender dysphoria ) as well as from a healthy control twin pair. They conclude that mutations that arise in some body cells in later stages of development could help explain psychiatric differences between identical twins.

[Purpose] Auditory hypersensitivity has been widely reported in patients with autism spectrum disorders. However, the neurological background of auditory hypersensitivity is currently not clear. The present study examined the relationship between sympathetic nervous system responses and auditory hypersensitivity induced by different types of auditory stimuli. [Methods] We exposed 20 healthy young adults to six different types of auditory stimuli. The amounts of palmar sweating resulting from the auditory stimuli were compared between groups with (hypersensitive) and without (non-hypersensitive) auditory hypersensitivity. [Results] Although no group × type of stimulus × first stimulus interaction was observed for the extent of reaction, significant type of stimulus × first stimulus interaction was noted for the extent of reaction. For an 80 dB-6,000 Hz stimulus, the trends for palmar sweating differed between the groups. For the first stimulus, the variance became larger in the hypersensitive group than in the non-hypersensitive group. [Conclusion] Subjects who regularly felt excessive reactions to auditory stimuli tended to have excessive sympathetic responses to repeated loud noises compared with subjects who did not feel excessive reactions. People with auditory hypersensitivity may be classified into several subtypes depending on their reaction patterns to auditory stimuli., Journal of Physical Therapy Science, 26(7), pp.1087-1091; 2014

This study's objective was to investigate the efficacy of sensory integration therapy (SIT) for children with high-functioning autism spectrum disorder (HFASD). The subjects were 20 HFASD children with IQs above 70 selected from previously collected data. Eight participated in individual SIT sessions, and 12 participated in group therapy (GT) including social skill training, communication training, kinetic activities, and child-parent play for 8-10 months. Changes in Total score and five Index scores on the Japanese version of the Miller Assessment for Preschoolers before and after therapy between children in the SIT and GT groups were compared. The results showed that Total score and all Index scores except for Verbal Index increased significantly in the SIT group, while only Total score increased in the GT group. Furthermore, the SIT group showed more improvement compared with the GT group in Total score and on Coordination, Non-verbal, and Complex Index scores. SIT might have a more positive effect on motor coordination abilities, non-verbal cognitive abilities, and combined abilities of sensory motor and cognition in children with HFASD when compared with GT. This study has limitations such as being an analysis of previously collected data. Further study should be conducted with a randomized control trial.

Aims The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for identifying abnormalities in prefrontal brain activity in children with autism spectrum disorders (ASD) as they inferred the mental states of others. Methods The subjects were 16 children with ASD aged between 8 and 14 years and 16 age-matched healthy control children. Oxygenated hemoglobin concentration was measured in the subject's prefrontal brain region on NIRS during tasks expressing a person's mental state (MS task) and expressing an object's characteristics (OC task). Results There was a significant main effect of group (ASD vs control), with the control group having more activity than the ASD group. But there was no significant main effect of task (MS task vs OC task) or hemisphere (right vs left). Significant interactions of task and group were found, with the control group showing more activity than the ASD group during the MS task relative to the OC task. Conclusions NIRS showed that there was lower activity in the prefrontal brain area when children with ASD performed MS tasks. Therefore, clinicians might be able to use NIRS and these tasks for conveniently detecting brain dysfunction in children with ASD related to inferring mental states, in the clinical setting.

Aim: ‘Internalized stigma’ is a construct that reflects the degree to which a person accepts beliefs endorsed by society about mental illness. Among people with schizophrenia spectrum disorders, internalized stigma has been found to moderate the associations between insight and social function, hope, and self-esteem. Among families of patients with schizophrenia, internalized stigma may not only hinder help-seeking but also result in the families attempting to provide care themselves, without assistance from mental health services. Little is known about internalized stigma among service providers, especially psychiatric nurses in Japan. Therefore, we investigated the correlation between internalized stigma and ‘beliefs about the most appropriate form of hospitalization’ among psychiatric nurses. Methods: The subjects were 215 psychiatric nurses employed in psychiatric hospitals who completed the personal stigma scale, perceived stigma scales, and Difficulty of Community Living Scale (DCLS) with respect to a chronic schizophrenia case vignette. Results: Internalized stigma was positively correlated with greater ‘beliefs about the most appropriate form of hospitalization’ among psychiatric nurses. We also showed that stronger ‘beliefs about the social disadvantages of schizophrenia patients in the community’ was positively correlated with stronger ‘beliefs about the most appropriate form of hospitalization’. Conclusion: The present findings suggest that the psychiatric nurses employed at Japanese psychiatric hospitals have a pessimistic view of the community living of people with schizophrenia and their families. And these psychiatric nurses' beliefs were related to their understanding of the deeply dependent relationship between patients and families, and was related to the Confucian ideal.

Sex differences in opportunities to use alcohol or drugs, and transition to use, were investigated in 15 surveys, in 2001-2004 (Europe 6; Americas 3; Africa 2, Asia 3; Oceania 1). The paper focuses on 18-29 year olds (N = 9,873). The World Mental Health Survey Initiative oversaw the surveys; each country obtained its own funding. A complex picture emerged with different results for alcohol and for drugs and for opportunity to use and the transition to use. Sex differences in opportunity to use alcohol were small except in Lebanon and Nigeria, whereas for drugs, the largest differences were in Mexico and Colombia.

Objective: Down syndrome (DS) patients share certain neuropathological features with Alzheimer disease patients. A randomized, double-blind, placebo-controlled study was performed to investigate the efficacy and safety of donepezil, an Alzheimer disease drug, for DS patients. Method: Twenty-one DS patients with severe cognitive impairment were assigned to take donepezil (3 mg daily) or a placebo for 24 weeks, and evaluated for activities in daily lives by concisely modified International Classification of Functioning, Disability and Health (ICF) scaling system. Results: ICF scores significantly increased without any adverse effects in the donepezil group in comparison to those in the placebo control. Among the individual functions tested, there was a dramatic improvement in the global mental functions and in specific mental functions. Conclusions: Donepezil may effectively and safely improve overall functioning of DS patients with severe cognitive impairment.

The DSM-IV and ICD-10 are both operational diagnostic systems that classify known psychological disorders according to the number of criteria symptoms. Certain discrepancies between the criteria exist and may lead to some inconsistencies in psychiatric research. The purpose of this study was to investigate these differences in the assessment of depression with item response theory (IRT) analyses. The World Mental Health-Japan (WMHJ) Survey is an epidemiological survey of the general population in Japan. We analyzed data from the WMHJ completed by 353 respondents who had either depressive mood or diminished interest. A two-parameter logistic model was used to evaluate the characteristics of the symptoms of the DSM-IV and ICD-10. IRT analyses revealed that the symptoms about psychomotor activity, worthlessness and self-reproach were more informative and suggestive of greater severity, while the symptoms about dietary habits were less informative. IRT analyses also revealed that the ICD-10 seems more sensitive to the mild range of the depression spectrum compared to the DSM-IV. Although there were some variations in severity among respondents, most of the respondents diagnosed with a severe or moderate depressive episode according to the ICD-10 were also diagnosed with a major depressive episode according to the DSM-IV.

Introduction: It has been extensively documented that caregivers of persons who have serious and persistent mental disorders must successfully cope with many challenging problems in order to provide good care. However, little is known about the relationship between family stigma and strategies for coping with patients with schizophrenia. Therefore, the present study compared the personal stigma and coping strategies of families of patients with schizophrenia by examining the socio-cultural factors that affect the care experience of families in Northeast Asian countries. Methods: Two self-rating scales were used to compare personal stigma and coping strategies regarding family members of patients with schizophrenia in 47 Japanese and 92 Korean families. Respondents reported their personal attitudes (personal stigma) with respect to a case vignette that described a person with chronic schizophrenia. Results: Analysis revealed the following: 1) although no differences in coping strategies were observed between the countries, the personal stigma of families was significantly higher in Korea than in Japan; 2) coping strategies, such as positive communication, coercion, and avoidance, were significantly associated with personal stigma in Korean families; however, in Japanese families, resignation was significantly associated with personal stigma. Discussion: The present findings suggest that personal family stigma was higher in Korea than Japan, and the features associated with coping strategies differ between countries. It is important to determine the features of personal stigma that are associated with schizophrenia. Furthermore, education and support programs for families with schizophrenia based on trans-cultural considerations must be emphasized in both countries.

Introduction: In the present study, we compared the care burden and stigma experienced by families of patients with schizophrenia in Japan (Niigata) and Korea (Seoul and Daegu) to elucidate similarities and differences in the sociocultural factors that affect the care experience of families in East Asia. Methods: Factors such as care burden (evaluated using the eight-item short version of the Zarit Caregiver Burden Interview [ZBI-8]), stigma, and social distance were evaluated in members of support groups for families of mentally ill individuals in Japan (n=47) and Korea (n=92) using an interview questionnaire. Interviewees reported their personal attitudes (personal stigma and social distance) and perceptions of the attitudes of others in the community (perceived stigma) with respect to a case vignette. These vignettes described a person with chronic schizophrenia. Results: The data analysis revealed the following: (i) feelings of care burden (according to ZBI-8), perceived stigma, and social distance were significantly stronger in Japan compared to Korea, and (ii) feelings of personal stigma were significantly stronger in Korea than in Japan. Discussion: The care burden and stigma experienced by families of patients with schizophrenia differed between Japan and Korea. The present findings suggest that to provide effective support for reducing family stigma and care burden, the necessity of such support must be emphasized in both countries.

To describe the prevalence of illicit and non-medical use of drugs, the age of first use, and their correlates in the general population of Japan, based on data collected between 2002 and 2004 as part of the World Mental Health (WMH) surveys. Participants included were a subsample (n = 887) of the total 2,436 Japanese-speaking respondents aged ≥20 years, randomly sampled from residents in seven cities/municipalities in Japan. Face-to-face household surveys were conducted using the Japanese version of the fully structured WHO WMH Survey Initiative version of the Composite International Diagnostic Interview. Lifetime prevalence of marijuana and cocaine use, non-medical use of prescribed drugs such as tranquilizers, stimulants and analgesics, and use of other substances was 1.5, 0.3, 6.4 and 2.4%, respectively. Lifetime use of marijuana was significantly greater among men. Prescription drug abuse/misuse was significantly more common among the middle-aged (35–49 years) group and those who were married/cohabitating. The 12-month prevalence of marijuana and non-medical use was 0.3 and 1.9%, respectively. Age of first use was likely to be early adulthood. Non-medical use was significantly related to mood disorder, anxiety disorder, intermittent explosive disorder and alcohol abuse/dependence. The present study confirmed lower prevalence of drug use in Japan than in other countries, such as the United States. However, the non-medical use of psychotropic drugs seems more common in Japan.

Two new screening scales for psychological distress, the K6 and K10, have been developed using the item response theory and shown to outperform existing screeners in English. We developed their Japanese versions using the standard backtranslaton method and included them in the World Mental Health Survey Japan (WMH‐J), which is a psychiatric epidemiologic study conducted in seven communities across Japan with 2436 participants. The WMH‐J used the WMH Survey Initiative version of the Composite International Diagnostic Interview (CIDI) to assess the 30‐day Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM‐IV). Performance of the two screening scales in detecting DSM‐IV mood and anxiety disorders, as assessed by the areas under receiver operating characteristic curves (AUCs), was excellent, with values as high as 0.94 (95% confidence interval = 0.88 to 0.99) for K6 and 0.94 (0.88 to 0.995) for K10. Stratum‐specific likelihood ratios (SSLRs), which express screening test characteristics and can be used to produce individual‐level predicted probabilities of being a case from screening scale scores and pretest probabilities in other samples, were strikingly similar between the Japanese and the original versions. The Japanese versions of the K6 and K10 thus demonstrated screening performances essentially equivalent to those of the original English versions. Copyright © 2008 John Wiley & Sons, Ltd.

Aim: Suicide is a major public health concern in Japan but little is known about the prevalence of and risk factors for suicidal ideation, plans, and attempts. The aim of the present study was to clarify the prevalence of and risk factors for important suicide-related outcomes. Methods: Important suicide-related outcomes and risk factors were assessed in face-to-face interviews with 2436 adult respondents in seven areas as part of the World Health Organization (WHO) World Mental Health Survey Initiative. Mental disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Results: The lifetime prevalence estimates of suicidal ideation, plans, and attempts were 10.9%, 2.1%, and 1.9%, respectively. Risk of suicide plans and attempts was highest when suicidal ideation occurred at an early age and within the first year of ideation. In middle-aged individuals, the period after first employment and the presence of mental disorders were risk factors. Conclusions: Risk of suicide plans and attempts is highest when suicidal ideation occurred at an earlier age and within the first year of ideation. Mental disorders are as predictive of the suicide-related outcomes examined here, and comorbidity is an important predictor.

Problem Although pharmacotherapy is an effective treatment for many psychiatric disorders in children and adolescents, medication adherence rates among children are low. This study clarifies factors affecting children's medication adherence and the role of parental involvement. Method Patients aged 7–17 years with a history of psychotropic medication treatment and their mothers were included in this study. Each mother and child completed self‐administered questionnaires. Thirty mother–child pairs who fully completed the questionnaires were included in the analysis. Results Medication adherence was greater in children and mothers when mothers felt that “children's symptoms improved with treatment and medication.” Medication adherence in children and mothers significantly correlated with the child's reported trust in their parent. Conclusions The results suggest the need for psychosocial support that considers the influence of mothers on medication adherence in children treated in child psychiatry departments.

BACKGROUND: Few studies have examined social inequalities in self-rated health in Japan, and the issue of gender differences related to social inequalities in self-rated health remains inconclusive.METHODS: The data derived from interviews with 2987 randomly selected Japanese adults in four prefectures in Japan who completed the cross-national World Mental Health survey from 2002 through 2005. We calculated odds ratios (ORs) of having poor self-rated physical and mental health by two social class indicators independently with multivariate logistic regression models, adjusted for age, gender, marital status, and area. Stratified analyses by gender and age group were also conducted.RESULTS: The adjusted ORs of the lowest educational attainment category having poor self-rated physical and mental health were 1.42 (95% confidence interval [CI]: 1.15-1.76) and 1.37 (95% CI: 1.10-1.70), respectively. Among females, educational attainment had significant linear associations with selfrated physical and mental health. Adjusted household income was also significantly associated with self-rated physical health among female respondents. No associations were found among males. While educational attainment was associated with self-rated health among the young age group, adjusted household income was associated with self-rated physical health in the middle and old age group.CONCLUSION: These results indicated social inequalities in self-rated health and prominent social inequalities in self-rated health among females in Japan. Social inequalities in self-rated health seemed to exist across age groups. However, the mechanism of social inequalities in self-rated health could be different depending on the age group.J Epidemiol 2006; 16: 223-232.

緩和ケアチームの立ち上げを依頼され, コンサルテーション型のチーム活動を行っている. 紹介理由の87%が痛みの緩和であったが, 呼吸困難, 消化管閉塞, 適応障害などでの紹介もみられた. 活動開始2ヵ月後に行った職種別アンケート調査の結果から, 活動開始にあたっては, 一般病院での緩和ケアの必要性や意義について啓発していくこと, 病棟や主治医とのコミュニケーション方法を確立するさまざまな試みが必要と考えられた. 麻酔科医として緩和ケアチームに参加したが, もともとケアを中心とした医療に携わってきた麻酔科医は, 緩和ケアにおいて重要な役割を果たすことができると考えられた. また緩和ケアの習熟は麻酔の質向上にもフィードバックできると考えられた.

This paper introduces a psychiatric patient robot that can be used for medical interview training in psychiatric education. The patient robot is developed based on an android robot technology. Medical interview training in psychiatric field is generally conducted by employing human simulated or standardized patient (SP) who is trained to reproduce a set of symptoms of intended mental disorder by veteran psychiatrists. But in the use of a healthy person as a SP there are some problems such as mental burden, time-consuming, the lack of human resources, and so forth. In contrast, the merit of the use of a patient robot is to offer standardized and reproducible interview training to psychiatric trainees. Furthermore, it is expected that psychiatric trainees are able to experience realistic medical interview as if they face to a real human SP by taking advantage of characteristics of android robots. As the first step, the patient robot was particularly designed to simulate a set of symptoms of unipolar depression, because it is a common mental disorder worldwide. The interview scenario, that is question and answer process between an interviewer and the patient robot, was prepared based on the “Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D)” which is widely used for interview training and clinical studies. The medical interview training with patient robot was introduced in actual psychiatric education, and eight students participated and evaluated its educational effect.

A research survey was conducted to find out which diagnostic classification systems were commonly used in university hospitals in Japan. By using a questionnaire, we collected data to determine which diagnostic classification systems and diagnostic criteria were being used to identify schizophrenia, affective (mood) disorders, and neurosis. The results indicated that most university hospitals used either the International Classification of Diseases (ICD) of the WHO or the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. For research of academic presentations, more than 60% of the surveyed institutions used DSM. In clinical settings, however, ICD and DSM were used with similar frequencies (42–43%). It was also noted that 15% of institutions still use a traditional psychiatric diagnosis for schizophrenia and mood disorders. This paper addresses historical aspects of the diagnosis and classification of mental illness in Japan.

Revision of ICD-11 will be submitted for approval at the general assembly in 2015. The influence of the ICD revision will be marked in the field of psychiatry. The trend in developing ICD-11-PHC is promoting cooperation with primary carers. The goals of the revision of ICD-11-PHC are as follows: 1) To produce a classification system that corresponds more closely to common mental disorders encountered in general medical practice; 2) The "co-morbidity" we want practitioners to recognize is that between physical and psychological disorders; 3) To allow dimensions of severity of some common disorders to be recognized, rather than case/non-case distinctions. The ICD-11-PHC draft consists of 28 categories and detailed clinical descriptions. The number of categories has increased in the ICD-11-PHC draft in comparison with ICD-10-PHC. Anxiety disorders such as neurasthenia, and phobic disorders and panic disorder have been deleted. On the other hand, new diagnostic categories such as autistic spectrum disorder, PTSD, and personality disorder have been introduced. Furthermore, name changes such as anxious depression, bodily stress syndrome, health anxiety, and persistent psychotic disorders have been suggested. We should be aware of such new diagnostic concepts. In addition, it is thought that it is necessary for us to deepen our understanding of ICD-11, which will be important in the future.

This paper proposes a depression patient robot using the android robot. The purpose of this patient robot is to offer standardized and reproducible diagnosis training and education to psychiatrist trainees by using robot technologies instead of human standardized patients. Furthermore, it can be expected that psychiatrist trainees are able to experience realistic diagnosis as if they have an interview with a real human standardized patient by taking advantage of android robot technologies. In the proposed system, as the first step, the patient robot mimics unipolar depression, because it is a typical psychiatric disease. The robot expresses symptoms of unipolar depression by exploiting its communicative functions such as facial expressions, eye and head movements, and speech. Robot's speech and communicative behavior are controlled remotely by an operator according to a diagnosis scenario. The diagnosis scenario, question and answer process between an interviewer and the patient robot, is prepared based on the "Structured Interview Guide for the Hamilton Depression Rating Scale" (SIGH-D) which are widely used for diagnosis of depressed symptoms. Finally, some psychiatrists evaluate the proposed system through a diagnosis experiment.

In rats with a unilateral 6-hydroxydopamine (6-OHDA)-induced lesion in the nigrostriatal fibers, methamphetamine (3 mg/kg, i.p.) induced Fos-like immunoreactivity (FLI), which was inhibited by pretreatment with N-methyl-D-aspartate antagonist MK-801 (1 mg/kg, i.p.), not only in the medial striatum contralateral to the lesion but also in the substantia nigra pars reticulata (SNr) ipsilateral to the lesion. Thus, hemispheric asymmetries in FLI were induced by methamphetamine in the medial striatum and the SNr in the 6-OHDA model of turning which may be related to the altered function of glutamatergic transmission.

The WHO recognizes the importance of a psychiatric diagnostic system in primary care. Regarding the revision of ICD-11 primary health care (ICD-11-PHC), a working group is organized and acts positively. The WG makes the draft of ICD-11-PHC. Some new and interesting disease names, such as ANXIOUS DEPRESSION and BODILY STRESS SYNDROME (BSS), are incorporated in ICD-11-PHC. Revision to ICD-11 continues, and an international Field Trial of ICD-11-PHC by the WHO is planned. Participation in the Field Trial of Japanese researchers is expected. We psychiatrists should closely follow trends in interesting new knowledge in ICD-11-PHC.

Schizophrenia exhibits wide variation in epidemiological characteristics. Through the past few decades, we have learned much about schizophrenia epidemiology, providing important findings for etiological research, clinical care and public health. In this article, we provide overview of current research on incidence, prevalence, risk factors, mortality and outcome of schizophrenia. Contrary to traditional understanding, the incidence and prevalence of schizophrenia show prominent variation between locations. Risk factors for schizophrenia include urbanicity, migration, sex, season of birth and pregnancy and birth complications. Schizophrenia patients have an increased mortality risk compared with the general population. Recent studies about outcome show not so tragic, especially in regard to social functioning. Over the recent decades, circumstances have been changing around schizophrenia. As to treatment, for example, 'the second generation antipsychotics' have replaced conventional ones and 'early intervention' is developing. However, we have only limited evidences of current schizophrenia. Further epidemiological development is needed.

This study's objective was to investigate the efficacy of sensory integration therapy (SIT) for children with high-functioning autism spectrum disorder (HFASD). The subjects were 20 HFASD children with IQs above 70 selected from previously collected data. Eight participated in individual SIT sessions, and 12 participated in group therapy (GT) including social skill training, communication training, kinetic activities, and child-parent play for 8-10 months. Changes in Total score and five Index scores on the Japanese version of the Miller Assessment for Preschoolers before and after therapy between children in the SIT and GT groups were compared. The results showed that Total score and all Index scores except for Verbal Index increased significantly in the SIT group, while only Total score increased in the GT group. Furthermore, the SIT group showed more improvement compared with the GT group in Total score and on Coordination, Non-verbal, and Complex Index scores. SIT might have a more positive effect on motor coordination abilities, non-verbal cognitive abilities, and combined abilities of sensory motor and cognition in children with HFASD when compared with GT. This study has limitations such as being an analysis of previously collected data. Further study should be conducted with a randomized control trial.

Japanese suicide rate is one of the highest among industrialized nations, especially following the economic crisis of the 1990s, with more than 30000 suicides every year since 1998. Previous studies have pointed out to relationships between overwork and/or job stress, and death and other health risks, and suggested several possible avenues for releasing stress and emotional burden, including suicidal ideation, through talking with intimate friends, family, and specialists, such as counselors and physicians. The present study was performed to explore the potential role of owners and managers of bars and izakaya-pub establishments in mitigating stress of middle-aged and elderly Japanese men by having informal conversations with them. A self-administered questionnaire was posted to all bars and izakaya-pubs registered in Ohmura-city, Nagasaki prefecture, in December 2009. Among 260 bars and izakaya-pubs, a total of 103 owners and managers completed the questionnaire. More than half of the respondents experienced engaging in conversations with their customers regarding customers’ various personal and private issues. The most frequently talked about problem was that regarding work (56.3%). Regardless of sex and age of the respondents, those with longer working experience in bar and izakaya-pub establishments were more likely to have had customers confiding in them financial problems including debts/loans (adjusted odds ratio: 5.48, p = 0.033). Owners and managers of bars and izakaya-pubs may be in a position to act as “listeners”, to whom middle-aged and elderly men can talk about their personal problems casually and without having to worry about conflict of interests, and direct those in need to professional counseling.

'Internalized stigma' is a construct that reflects the degree to which a person accepts beliefs endorsed by society about mental illness. Among people with schizophrenia spectrum disorders, internalized stigma has been found to moderate the associations between insight and social function, hope, and self-esteem. Among families of patients with schizophrenia, internalized stigma may not only hinder help-seeking but also result in the families attempting to provide care themselves, without assistance from mental health services. Little is known about internalized stigma among service providers, especially psychiatric nurses in Japan. Therefore, we investigated the correlation between internalized stigma and 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses.The subjects were 215 psychiatric nurses employed in psychiatric hospitals who completed the personal stigma scale, perceived stigma scales, and Difficulty of Community Living Scale (DCLS) with respect to a chronic schizophrenia case vignette.Internalized stigma was positively correlated with greater 'beliefs about the most appropriate form of hospitalization' among psychiatric nurses. We also showed that stronger 'beliefs about the social disadvantages of schizophrenia patients in the community' was positively correlated with stronger 'beliefs about the most appropriate form of hospitalization'.The present findings suggest that the psychiatric nurses employed at Japanese psychiatric hospitals have a pessimistic view of the community living of people with schizophrenia and their families. And these psychiatric nurses' beliefs were related to their understanding of the deeply dependent relationship between patients and families, and was related to the Confucian ideal.

Background A combination of factors such as substance abuse problems, medication noncompliance, and insufficient insight are generally known to increase the risk of violent behavior. However, little is known regarding the psychological impact on caregivers who are traumatized by the violent behavior of a family member with schizophrenia. Therefore, we carried out an investigation to measure this impact. Method A questionnaire was given to 116 caregivers of individuals with schizophrenia in family support groups in Seoul and Daegu, Korea. Their responses were then evaluated using the 22-item version of the Impact of Event Scale-Revised (IES-R), the 8-item short version of the Zarit Caregiver Burden Interview (ZBI-8), and the 15-item version of the Mental Illness and Disorder Understanding Scale (MIDUS). Results The mean (SD) IES-R score was 26.69 (17.83) (range, 1–84). Multiple regression analysis showed that the psychological impact of traumatic experiences was significantly associated with the following factors: medical non-adherence ( P P P Conclusion Our results from the present study suggest that even when family caregivers live apart from the patient, they still experience the harmful psychological impact of trauma from the patient's violent behavior. The psychological impact continued as a result of the huge caregiver burden and the medication non-adherence of the family member with schizophrenia in spite of receiving long-term treatment and multiple hospitalizations. The present findings suggest the need for improved community-based service for preventive long-term care, including medication adherence, for outpatients with schizophrenia instead of multiple hospitalizations.

Noradrenaline release in rat medial prefrontal cortex (PFC) was measured using a brain microdialysis technique. Immobilization stress increased noradrenaline release to a maximum level of 248.7 +/- 12.8% of the basal release, which was significantly attenuated by preinjection of alpha-helical CRF9-41 (50 micrograms/rat) into the lateral cerebroventricle. Intracerebroventricular injection of CRF also increased noradrenaline release in the medial PFC. These results suggest that immobilization-stress facilitates noradrenaline release in the medial PFC through activation of the CRF system in the brain.

Major depression is expected to become the leading contributor to disease burden worldwide by 2020. Previous studies have shown that the societal cost of depression is not less than that of other major illnesses, such as cardiovascular diseases or AIDS. Nevertheless, the cost of depression in Japan has never been examined. The goal of the present study was to estimate the total cost of depression in Japan and to clarify the characteristics of this burden.A prevalence-based approach was adopted to measure the total cost of depression. The total cost of depression was regarded as being comprised of the direct cost, morbidity cost and mortality cost. Diagnoses included in this study were depressive episodes and recurrent depressive disorder according to the ICD-10 or major depressive disorder according to the DSM-IV. Data were collected from publicly available statistics and the World Mental Health Japan Survey database.The total cost of depression among adults in Japan in 2005 was estimated to be ¥2.0 trillion. The direct cost was ¥0.18 trillion. The morbidity cost was ¥0.92 trillion, while the mortality cost was ¥0.88 trillion.The societal costs caused by depression in Japan are enormous, as in other developed countries. Low morbidity costs and extremely high mortality costs are characteristic in Japan. Effective interventions for preventing suicide could reduce the societal costs of depression.

The purpose of this study was to examine the usefulness of near-infrared spectroscopy (NIRS) for identifying abnormalities in prefrontal brain activity in children with autism spectrum disorders (ASD) as they inferred the mental states of others.The subjects were 16 children with ASD aged between 8 and 14 years and 16 age-matched healthy control children. Oxygenated hemoglobin concentration was measured in the subject's prefrontal brain region on NIRS during tasks expressing a person's mental state (MS task) and expressing an object's characteristics (OC task).There was a significant main effect of group (ASD vs control), with the control group having more activity than the ASD group. But there was no significant main effect of task (MS task vs OC task) or hemisphere (right vs left). Significant interactions of task and group were found, with the control group showing more activity than the ASD group during the MS task relative to the OC task.NIRS showed that there was lower activity in the prefrontal brain area when children with ASD performed MS tasks. Therefore, clinicians might be able to use NIRS and these tasks for conveniently detecting brain dysfunction in children with ASD related to inferring mental states, in the clinical setting.