Language：Japanese   Publisher：(一社)日本認知症学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：Japanese   Publisher：(一社)日本認知症学会  

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Language：Japanese   Publisher：(一社)日本認知症学会  

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: The aim of this study was to conduct a 5-h training programme on anger-focused emotional management for nurses and verify its effectiveness. DESIGN: The study used a one-group pretest-posttest design. METHODS: Participants (N = 283) attended a programme comprising lectures and exercises. The Japanese version of the Buss-Perry Aggression Questionnaire was administered pre-, post- and 3-month posttraining. Regression analyses were used to assess the effects of the programme by gender. RESULTS: For the total aggression score, the difference between the pre- and posttraining scores was -2.827 points and remained at -1.602 points 3-month posttraining. Physical aggression scores decreased posttraining, but the scores increased after 3 months. There were statistically significant gender differences in hostility scores; pre-training scores were slightly higher for men than for women and lower for men after 3 months. Total and physical aggression scores were higher for men than for women. The training programme decreased aggression, and the effect persisted after 3 months.

DOI： 10.1002/nop2.1367

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Previous cross-sectional studies have reported that adolescent patients with anorexia nervosa (AN) showed global gray matter volume (GMV) reductions at the acute phase which were restored at the weight-recovered phase, compared with healthy controls (HC). However, few studies have investigated white matter volume (WMV) or cortical thickness in the context of AN, and results have been inconsistent. Voxel-based morphometry analyses for GM and WM, and cortical thickness analyses for GM were conducted in 31 adolescent patients with AN (vs. 18 HC) in the acute phase, and 16 patients with AN (vs. 13 HC) in the follow-up weight-recovered phase, over an approximately 1-year follow-up interval. At the acute phase, the AN patients showed significant reductions of GMVs and cortical thickness in widespread brain regions, compared with HC. Significant WMV reductions were identified in the bilateral superior longitudinal fascicle, superior thalamic radiation, corona radiata, and fornix, pons, and medulla in the patients. At the weight-recovered phase, the AN patients showed a significant GMV reduction in the left hippocampus, and a WMV reduction in the pons, compared with the HC. There was no difference in cortical thickness between two groups at the weight-recovered phase. In conclusion, the widespread volumetric reductions in GM and WM, and reduced cortical thickness observed in AN patients in the acute phase were not evident in the follow-up weight-recovered phase. The volume reductions observed in the hippocampus and pons in the weight-recovered phase could potentially reflect delayed neurogenesis or recovery from starvation in the AN patients.

DOI： 10.1007/s11682-021-00622-5

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Language：English   Publishing type：Research paper (scientific journal)  

The COVID-19 pandemic has been affecting the mental health of hospital workers. During the prolonged pandemic, hospital workers may experience much more severe psychological distress, leading to an increased risk of suicide. This study aimed to investigate changes in psychological effects on hospital workers over 12 months from the beginning of the pandemic and clarify factors associated with psychological distress and suicide-related ideation 1-year after the pandemic's beginning. These repeated, cross-sectional surveys collected demographic, mental health, and stress-related data from workers in 2 hospitals in Yokohama, Japan. The first survey, conducted in March-April 2020, contained the 12-item General Health Questionnaire (GHQ-12) assessing general distress and the Impact of Event Scale-Revised (IES-R) assessing event-related distress. In the second survey in March 2021, hospital workers at the same two hospitals were reassessed using the same questionnaire, and Item 9 of the Patient Health Questionnaire (PHQ-9) was added to assess their suicide-related ideation. The findings of the first and second surveys revealed that the average score of GHQ-12 (3.08 and 3.73, respectively), the IES-R total score (6.8 and 12.12, respectively), and the prevalence rates of severe general distress (35.0% and 44.0%, respectively) and severe event-related distress (7.0% and 17.1%, respectively) deteriorated. The second survey showed that 8.6% of the hospital workers were experiencing suicide-related ideation. Both the general and event-related distress were associated with suicide-related ideation. In these surveys, mental health outcomes among the hospital workers deteriorated over one year from the pandemic's beginning, and their severe psychological distress was the risk factor for the suicide-related ideation. Further studies are needed to compare the psychological effects on hospital workers during and after the prolonged pandemic and to explore appropriate measures to support hospital workers' mental health.

DOI： 10.1371/journal.pone.0277174

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Language：Japanese   Publisher：(一社)日本認知症学会  

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞IMR(illness management and recovery)は,科学的根拠に基づく実践の1つで,リカバリー概念を中心にした心理社会的介入プログラムである。自らの疾病を管理するための情報を得て,リカバリーを目指す。適応としては,主に統合失調症患者を対象に,デイケア,就労継続支援事業,地域活動支援センターなどで,数人のグループで行われており,疾病管理能力,精神症状,病識,生活の質の改善などの効果が報告されている。IMRが最大限の効果を発揮するためには,フィデリティ尺度を参考にしながら,参加人数,実施期間,スタッフのトレーニングなどを検討するとよい。施行する際には,実施施設の施設長がリカバリー志向について理解し,IMRを実施する環境の整備に協力的であることが望ましい。参加者としては,比較的高齢で,教育歴があり,精神症状が安定していることが継続的な参加に繋がり,効果を得やすい。また,プログラム実施全体を通して,「希望」を伝え続けることが重要である。

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(有)科学評論社  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English  

DOI： 10.1016/j.schres.2020.08.028

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.neulet.2020.135588

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Language：English   Publishing type：Research paper (scientific journal)  

The aim of the present study was to investigate the psychological effects of the COVID-19 outbreak and associated factors on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. This cross-sectional, survey-based study collected demographic data, mental health measurements, and stress-related questionnaires from workers in 2 hospitals in Yokohama, Japan, from March 23, 2020, to April 6, 2020. The prevalence rates of general psychological distress and event-related distress were assessed using the 12-item General Health Questionnaire (GHQ-12) and the 22-item Impact of Event Scale-Revised (IES-R), respectively. Exploratory factor analysis was conducted on the 26-item stress-related questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes for workers both at high- and low-risk for infection of COVID-19. A questionnaire was distributed to 4133 hospital workers, and 2697 (65.3%) valid questionnaires were used for analyses. Overall, 536 (20.0%) were high-risk workers, 944 (35.0%) of all hospital workers showed general distress, and 189 (7.0%) demonstrated event-related distress. Multivariable logistic regression analyses revealed that 'Feeling of being isolated and discriminated' was associated with both the general and event-related distress for both the high- and low-risk workers. In this survey, not only high-risk workers but also low-risk workers in the hospitals admitting COVID-19 patients reported experiencing psychological distress at the beginning of the outbreak.

DOI： 10.1371/journal.pone.0245294

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

【目的】終末期がん患者のセクシュアリティへの支援に対する看護師の現状を明らかにする.【方法】2018年12月に神奈川県内緩和ケア病棟18施設の看護師313名を対象に終末期がん患者の「パートナーとの愛を育む時間」に対する認識,感情,支援への行動意図と実践について質問紙調査を行った.【結果】165名中(回収率52.7%)「パートナーとの愛を育む時間」への支援経験があるのは82名(49.7%)であった.行ったことのある具体的な支援内容は「スキンシップを勧める」,「傾聴」,「ハグを勧める」,「入室の際に,ノックや声掛け後に返事を待つなど十分な時間をとる」が多かった.一方,病棟カンファレンスで「パートナーとの愛を育む時間」について話したことがあるのは11名(6.7%)であった.【結論】現状,「パートナーとの愛を育む時間」への支援は個人に任され,組織的には行われていないことが示唆された.(著者抄録)

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Language：English   Publisher：(一社)日本認知症学会  

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Language：English   Publisher：(一社)日本認知症学会  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The present study investigated the effects of plasma matrix metalloproteinases (MMPs) on longitudinal changes in Alzheimer's disease (AD)-related biomarkers in cerebrospinal fluid (CSF), brain atrophy, and cognitive function in patients with mild cognitive impairment due to AD (MCI-AD). METHODS: We used data from the Alzheimer's Disease Neuroimaging Initiative database. We included 95 ApoE4-positive patients with MCI-AD who were confirmed to have low Aβ42 and/or high phosphorylated-tau (p-tau) in CSF. We obtained baseline demographic data, plasma MMP levels, including MMP-1, -2, -7, -9, -10, and tissue inhibitor of MMP-1 (TIMP-1), longitudinal annual data on Aβ42, total tau, and p-tau in CSF, MRI-measured hippocampal volumes, and cognitive function evaluated by the Mini-Mental State Examination (MMSE) and AD Assessment Scale-11 (ADAS-11) over 4 years. We examined the effects of baseline MMP levels on longitudinal changes in CSF AD biomarkers, hippocampal volumes, and cognitive function using a linear mixed regression analysis. RESULTS: No significant differences were observed in baseline plasma MMP levels between MCI-AD patients and control subjects, except for MMP-10, which was significantly lower in MCI-AD than in controls. The baseline levels of MMPs did not correlate with longitudinal changes in CSF biomarkers. Declines in hippocampal volumes and cognitive function evaluated by MMSE and ADAS-11 were significantly faster in MCI-AD patients with high-MMP-9 levels at baseline than in those with middle and low MMP-9 levels at baseline. CONCLUSION: High plasma MMP-9 levels in MCI-AD patients might enhance neurodegeneration and cognitive decline.

DOI： 10.1016/j.jns.2020.116989

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Education regarding death diagnosis is not often included in the medical education. OBJECTIVE: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. DESIGN: Uncontrolled, open-label, multi-center trial. SUBJECTS: A total of 131 doctors undergoing their initial training were enrolled this study. MEASUREMENTS: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors' behaviors at the death diagnosis based on our guidebook at each hospital. RESULTS: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that "I do not know what to say to the family after a death diagnosis". Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for "Give words of comfort and encouragement to family" increased significantly after the lecture to 0.9. CONCLUSIONS: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients' families. After the lecture using our guidebook, residents' mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

DOI： 10.1177/0825859720951698

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.jns.2020.116829

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although the pathogenesis of panic attacks has been well studied in patients with panic disorder (PD), the neurobiological basis of the long-term fear memories and avoidance behavior that are often observed in PD have not been well investigated. Recent animal studies have suggested that nucleus accumbens (NAcc) plays an important role in neurobiological basis of long-term fear memories and avoidance behavior. METHODS: Thirty-eight patients with PD and 38 matched healthy control subjects (HC) participated in this study. Differences in relative volumes and shape deformations of NAcc were evaluated between groups. Correlation analyses were conducted to quantify the association between structural abnormalities in the NAcc and trait, state anxiety measured by the State-Trait Anxiety Inventory (STAI). RESULTS: Significant volume reductions were observed in the bilateral NAcc in the patients with PD, relative to the HC. In terms of shape differences, the PD patients demonstrated significant inward deformation of the NAcc bilaterally, compared to the HC. Degree of shape deformation in the right NAcc was associated with higher scores of the STAI-Trait, and STAI-State measures in the PD patients. LIMITATIONS: All the patients received medication such as Psychotropic drug. CONCLUSION: Patients with PD showed reduced volumes in the NAcc, especially in lateral regions, compared with HC. Furthermore, shape deformation in the right NAcc was associated with trait anxiety and state anxiety, which has been associated with avoidance behavior.

DOI： 10.1016/j.jad.2020.03.172

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Language：Japanese   Publisher：(一社)日本在宅医療連合学会  

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Language：Japanese   Publisher：(有)科学評論社  

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Publishing type：Research paper (scientific journal)  

© The Author(s) 2020. Background: Education regarding death diagnosis is not often included in the medical education. Objective: To investigate the change minds at the time of death diagnosis among residents after lectures based on our guidebook. Design: Uncontrolled, open-label, multi-center trial. Subjects: A total of 131 doctors undergoing their initial training were enrolled this study. Measurements: Questionnaires were administered to volunteers before and after the lecture by the clinical training instructor presented information regarding doctors’ behaviors at the death diagnosis based on our guidebook at each hospital. Results: The subjects had an average age of 27.1 years and comprised 76 men (58.0%) and 54 women (41.2%). A total of 83 subjects (63.4%) had learned how to diagnose death as medical students, and 52 subjects (39.7%) had experienced death diagnosis scenes as medical students. Among those who had difficulties related to death diagnoses, the highest number (88.4%) indicated that “I do not know what to say to the family after a death diagnosis”. Self-evaluation significantly increased after the lecture for many items concerning explanations to and considerations of the family: the effect size for “Give words of comfort and encouragement to family” increased significantly after the lecture to 0.9. Conclusions: Few of the residents felt that they had received education regarding death diagnoses; they reported difficulties with diagnosing death and responding to patients’ families. After the lecture using our guidebook, residents’ mind changed significantly for death diagnosis, suggesting that the guidebook at the time of death diagnosis may be useful.

DOI： 10.1177/0825859720951698

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Language：English  

AIMS: In this study, we implemented the Illness Management and Recovery (IMR) program for middle-aged and older patients with schizophrenia hospitalized for long periods and assessed the effect of the IMR program on psychiatric symptoms and psychosocial function. The effects of the IMR program on brain structure were also evaluated. METHODS: The IMR program was implemented for 19 patients with schizophrenia; 17 patients with schizophrenia receiving treatment as usual (TAU) were also recruited as controls. In all patients, mean age was 61.4 years (range, 50-77 years) and mean hospitalization duration was 13.1 years (range, 1-31 years) at enrollment. Structural magnetic resonance images and Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores as clinical variables were obtained at the beginning and end of the IMR program. Longitudinal analyses were performed to compare the effects of the IMR program on clinical symptoms and cortical thickness in the superior temporal gyrus (STG) between the IMR and TAU groups. RESULTS: Significant improvements in GAF scores and the total, Insight and Judgment, and Positive components of the PANSS were found in the IMR group compared with the TAU group. Cortical thickness in the left STG was preserved in the IMR group compared with the TAU group. CONCLUSIONS: This is the first report demonstrating the effectiveness of the IMR program for improving psychotic symptoms and psychosocial function and protecting brain structure in middle-aged and older inpatients with schizophrenia hospitalized for long periods.

DOI： 10.1111/pcn.12919

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Language：English   Publisher：(一社)日本認知症学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

高カルシウム(Ca)血症は癌患者の約20〜30%に随伴するとされ、癌診療において比較的多く遭遇する合併症である。高Ca血症は意識障害などの原因となり、さらに重症例では腎不全を来し致死的となる。今回われわれは、悪性エナメル上皮腫にコントロール不能な高Ca血症を合併し、致死的転機をたどった症例を経験した。本症例では高Ca血症が在宅期間を短縮しており、医療者側が高Ca血症の早期発見やコントロール改善につながる知識を習得することで在宅期間の延長をもたらすと考えられた。また、悪性腫瘍の治療のみでなく合併症である高Ca血症に対する集学的治療をいつまで行うか検討することで、看取り場所の選択肢が広がる可能性があると考えられた。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Chemical coping also has an idea that it is an early stage of abuse and dependence of opioids, it is important to grasp the frequency, complaints, and risk factors of chemical coping. In this study, observational research was performed backwardly with 549 people using opioids who were newly requested to the palliative care team. Results revealed that 13 of 549 patients (2.4%)were diagnosed with chemical coping. In terms of a breakdown of the complaint, and it was following rate and reasons, 6 people(46%)felt easy, 2 people(15%)were anxious, 2 people(15%)could sleep, 2 people(15%)had unknown reasons, and 1(8%)was calm. Characteristics of each patient diagnosed with chemical coping included frequent psychiatric symptoms such as life expectancy of 3 months, opioid oral administration period of 1 year or more, disease incidence period of 1 year or more, anxiety, delirium, and depression. One benign disease also confirmed the transition to opioid dependence.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The goal of palliative care is to support the ideal life of cancer patients and their partners, but the medical staff does not listen to all the needs of cancer patients and their partners. Cancer patients choose opponents and situations and express their suffering. Additionally, the typical problem of hidden suffering is not the issues of sexuality ? The suffering from sexuality of cancer patients is not expected to be expressed unless there is a suitable opponent. Are we the medical staff ready to respond to the suffering from sexuality of terminal cancer patients ? In this study, we thought that it was necessary to investigate the preparation of medical staff for the suffering from sexuality of terminal cancer patients, through a relationship with the hospitalized inpatient who reported suffering from sexuality.

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Language：Japanese   Publisher：(株)癌と化学療法社  

緩和ケアの目標はがん患者・家族の理想の生活を支えることであるが、医療者は目の前のがん患者のニーズをすべて聞き取れているとは限らない。入院患者の様々な苦痛は相手や場面を選んで表出される。そして隠された苦悩の代表的なものはセクシュアリティの問題ではないだろうか。がん患者のセクシュアリティの苦悩はふさわしい相手がいなければ表出されることはないと予想される。医療者は患者・家族のセクシュアリティの問題に対して準備をしているだろうか?今回われわれ緩和ケアチームは、入院中に性についての発言があった終末期がん患者とのかかわりから現況調査が必要と考えた。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

ケミカルコーピングは乱用や依存の初期段階との考え方もあり、ケミカルコーピングの頻度や訴え、危険因子を把握することが重要である。本検討では緩和ケアチームに新規依頼となったオピオイドを使用している549名を対象とし、後方視的に観察研究を行った。その結果、549名中13名(2.4%)の患者でケミカルコーピングを認めた。訴えの内訳として、6名(46%)で気分が楽になるから、2名(15%)で不安だから、2名(15%)で眠れるから、2名(15%)で何となく、1名(8%)で落ち着くからというような割合であった。ケミカルコーピングと診断された各々の患者の特徴としては、余命3ヵ月以内、1年以上のオピオイド内服期間、1年以上の疾病罹患期間、不安や譫妄、抑うつなどの精神症状を高頻度に有していた。また良性疾患の1名は、オピオイド依存への移行を認めた。(著者抄録)

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Language：English  

BACKGROUND: Panic disorder (PD), an anxiety disorder characterized by the recurrence of panic attacks, has been reported to be associated with volumetric changes in several brain regions. There are, however, very few studies investigating abnormalities in cortical thickness, and little is known about the relationship between cortical thickness and social dysfunction in PD. METHODS: Thirty-eight patients with PD and 38 healthy control participants (HC) were recruited for this study. A whole-brain analysis was performed to evaluate groupwise differences in cortical thickness using the FreeSurfer software. Symptom severity and social functioning were evaluated with the Panic Disorder Severity Scale (PDSS) and the Global Assessment of Functioning (GAF) scale. RESULTS: The patients with PD demonstrated a significant reduction in cortical thickness in the left rostral middle frontal cortex (MFC), compared with the HC. Correlational analyses revealed that cortical thickness in the left rostral MFC showed a significant negative relationship with PDSS score and a significant positive relationship with GAF scores in the PD patients. LIMITATIONS: All the patients received medication. CONCLUSION: PD patients showed reduced cortical thickness in the left rostral MFC compared with HC. Furthermore, cortical thickness in this region was associated with patients' symptom severity and degree of social dysfunction.

DOI： 10.1016/j.jad.2018.07.064

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

われわれは、入院中に睡眠障害を有したがん患者に合併したせん妄に対するsuvorexantの有用性について検討した。方法は2016年4月〜2017年3月の1年間、当院緩和ケアチームに依頼となった悪性腫瘍に罹患し、不眠症状を有するせん妄患者に対してsuvorexantを用いた9例を対象とし後方視的に観察研究を行った。せん妄の重症度評価としては、DRS-R98の日本語版を用い、その結果suvorexant投与前後におけるDRS-R98の重症度スコアは投与前に比較し、投与後では有意に総スコアの低下を認めた(投与前:10±3.20 vs 6.66±1.73、p=0.0031)。また、安全性の面においてもsuvorexantの有害事象は認められなかった。睡眠障害を有するがん患者に合併したせん妄症状に対するsuvorexantの有用性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は52歳、女性。乳がん胸椎転移に伴う難治性疼痛に対してアセトアミノフェン、NSAIDs、オキシコドンを内服していたが疼痛コントロール不良であった。鎮痛補助薬としてプレガバリンやガバペンチンを使用したが副作用のため継続できなかった。タペンタドールのノルアドレナリン再取り込み阻害作用に注目し、タペンタドールとオキシコドンによる併用療法を導入したところ、患者の満足のいく疼痛コントロールを得ることができた。オピオイド併用による副作用の出現はなかった。神経障害性疼痛を合併した難治性疼痛に対して、モルヒネ、オキシコドン、フェンタニルなどのμオピオイド受容体作動薬とノルアドレナリン再取り込み阻害作用をもつタペンタドールを併用することが、疼痛緩和に有効である可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

アカシジアとは「足がむずむずしてじっとしていられない」を代表的な訴えとする静座不能症状であり、主に抗ドパミン作用によると考えられている。重度の場合、自殺企図の原因となることが知られている。今回、内服困難症例の薬剤性アカシジアに対してフェンタニルクエン酸塩舌下錠が症状緩和に有効と考えられた1例を経験したので報告する。症例は50歳代、女性。胃癌、腹膜播種による癌性疼痛、嘔気のコントロール目的で緩和ケアチームに依頼となった。嘔気に対してメトクロプラミド、ハロペリドールを用いていたが、足のむずむず感、落ち着きのなさを訴え薬剤性アカシジアと診断した。疼痛コントロールのレスキューでフェンタニルクエン酸舌下錠を内服したところ、一時的なアカシジア症状の改善を認めた。(著者抄録)

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Language：Japanese   Publisher：神奈川県精神医学会  

当院のコンサルテーション・リエゾン活動について総括した。2015年1月から2016年12月までの2年間で、身体科から当科へ診察依頼があった入院患者681名を対象とした。681例(男性390例、女性291例)の平均年齢は65.5±17.2歳、依頼診療科別では消化器外科、整形外科、耳鼻咽喉科が上位を占め、全体の59%が外科系診療科であった。精神科診断別ではせん妄が43%(295例)、適応障害10%、不眠症8%と続いた。せん妄の診断がついた295例(男性203例、女性92例)の平均年齢は74.1±15.5歳とリエゾン症例全体の平均年齢を大きく上回った。適応障害の診断がついた70例のうち、男女比は半々で平均年齢は61.2±16.5歳となった。当科で診察したせん妄症例は男性、高齢が多く、一般にせん妄の準備因子とされる項目に一致した。今後は当科の介入による予後や入院期間の差などについても調査していきたい。(著者抄録)

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 52-year-old woman had been prescribed oral medication of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and oxycodone for intractable pain associated with thoracic metastasis of breast cancer. However, the pain control was poor. Although pregabalin and gabapentin were used as supplementary analgesics, they could not be continued because of their side effects. Based on the noradrenalin reincorporation-inhibiting action of tapentadol, a combination therapy of tapentadol and oxycodone was introduced and satisfactory pain control was achieved. No side effects from the combined opioids were observed. This finding indicates the potential of administrating a combination therapy of m-opioid receptor agonists(such as morphine, oxycodone, and fentanyl)with tapentadol, which has a noradrenaline reincorporation-inhibiting action, as an effective remedy for alleviating intractable pain complicated with neuropathic pain.

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Language：Japanese   Publisher：(株)癌と化学療法社  

口腔癌における超選択的偽注化学放射線療法は、治療により粘膜炎の合併症を引き起こす。その症状緩和にオピオイドを用いた疼痛コントロールを行っているが、臨床現場で患者側からの質問として、(1)超選択的動注化学放射線療法終了後からオピオイド中止までの平均日数、(2)オピオイド中止が可能となった患者側の因子の問い合わせが多い。本検討ではこれらを解明することを目的とする。方法として2016年4月〜2017年3月の間、当院口腔外科で超選択的動注化学放射線療法を施行した患者を対象とし、後方視的に観察研究を行い、オピオイド中止が可能な患者群、不可能であった患者群を2群に分類し臨床的背景や臨床データとの比較検討を行った。その結果、オピオイド中止が可能な群では、治療終了後からオピオイド中止までの期間の平均は51(±34.4)日であった。非糖尿病患者と治療中のせん妄ない群がオピオイド中止に寄与する因子として抽出された。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

局所進行口腔癌に対する超選択的動注化学放射線療法は、粘膜炎などの合併症を引き起こし、経口摂取や内服が不可能となる。そのため当院では治療期間中にほぼ全例に胃瘻造設を施行し、栄養および薬剤投与ルートの確保を行っている。本検討では超選択的動注化学放射線療法終了後から胃瘻抜去までの平均日数の算出と、胃瘻抜去が可能な因子を抽出することを目的とした。方法は2016年4月〜2017年3月までの間、当院口腔外科で超選択的動注化学放射線療法を施行した患者を対象とし、後方視的に観察研究を行った。胃瘻抜去が可能であった患者群、不可能であった患者群の2群に分類し、臨床的背景や臨床データの比較検討を行った。その結果、胃瘻抜去可能群において、治療終了後から胃瘻抜去までの平均期間は132(±51.6)日であった。胃瘻抜去が可能な患者因子として、アルコール摂取量が多い、治療前の接触時痛がない、開口3横指確保可能といった因子が抽出された。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Superselective intra-arterial chemoradiation therapy for oral cancer induces the complication of mucositis. Although the associated pain is controlled using opioids, major questions from patients in clinical practice are as follows:(1)the mean number of days from the completion of superselective intra-arterial chemoradiation therapy to the discontinuation of opioid administration, and(2)patient factors enabling the discontinuation of opioids. The purpose of this study was to clarify these points. A retrospective follow-up study was conducted from April 2016 to March 2017 on patients who underwent superselective intra-arterial chemoradiation therapy at our department of oral surgery. The patients were divided into 2 groups:one who discontinued opioids, and the other who did not. Clinical backgrounds and data were compared between the 2 groups. The mean number of days from the completion of superselective intra-arterial chemoradiation therapy to the discontinuation of opioid administration was 51±34.4 days. The absence of diabetes and deliria during treatment were determined as factors contributing to the discontinuation of opioids.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Superselective intra-arterial chemoradiation therapy for locally advanced oral cancer induces complications such as mucositis, which impedes oral intake. Thus, at our hospital, a gastrostomy is performed in almost all patients during the treatment period to ensure the presence of an alternative administration route for nutrition and drugs. The purpose of this study was to calculate the mean number of days from completion of superselective intra-arterial chemoradiation therapy to the decannulation of gastrostomy, and extract patient factors for the decannulation. A retrospective follow-up study was conducted from April 2016 to March 2017 on patients who underwent superselective intra-arterial chemoradiation therapy at our department of oral surgery. The patients were divided into 2 groups:one who was decannulated and the other who did not. Clinical backgrounds and data were compared between the 2 groups. In the group with the decannulation, the mean period from treatment completion to the decannulation was 132±51.6 days. Heavy alcohol consumption, absence of haphalgesia before treatment, and possible securement of the opening with the breadth of 3 fingers, were determined as factors contributing to the decannulation of gastrostomy tube.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Akathisia is a condition wherein sitting calmly and quietly is impossible, with a representative complaint of restless legs. It is generally assumed to be caused by anti-dopamine activity. In severe cases, it has been known to result in suicide attempt. We reported a case of drug-induced akathisia with difficulty in oral intake, in which fentanyl citrate sublingual tablets were found to be effective in relieving symptoms. The patient was a female aged 50's who had a gastric cancer with peritoneal dissemination causing pain and vomiting. Palliative care was requested for management of symptoms. Metoclopramide and haloperidol were administered for vomiting. However, because of the complaints of restless legs, the case was diagnosed as drug-induced akathisia. Fentanyl citrate sublingual tablets were then administered for pain management, resulting in temporary improvement of akathisia symptoms.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We investigated the usefulness of suvorexant for complicated delirium in patients with cancer who experience sleep disturbance during hospitalization. Nine patients with malignant tumors complicated with symptoms of delirium and insomnia were included in this study; their palliative care was managed by the palliative care team of our hospital for a period of one year from April 2016 to March 2017. A retrospective follow-up study was then conducted. The Japanese version of DRS-R98 was used to evaluate the severity of the patient's delirium. The total severity score of DRS-R98 significantly decreased after the administration of suvorexant when compared to the score before its administration(6.66±1.73 vs 10±3.20, p=0.0031). In addition, suvorexant did not exhibit any harmful effects. Our results indicate that suvorexant was useful in alleviating delirium symptoms in cancer patients who experience sleep disturbance.

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Language：English  

The amygdala plays an important functional role in fear and anxiety. Abnormalities in the amygdala are believed to be involved in the neurobiological basis of panic disorder (PD). Previous structural neuroimaging studies have found global volumetric and morphological abnormalities in the amygdala in patients with PD. Very few studies, however, have explored for structural abnormalities in various amygdala sub-regions, which consist of various sub-nuclei, each with different functions. This study aimed to evaluate for volumetric abnormalities in the amygdala sub-nuclei, in order to provide a better understanding neurobiological basis of PD. Thirty-eight patients with PD and 38 matched healthy control (HC) participants underwent structural MRI scanning. The volume of the whole amygdala, as well as its consistent sub-nuclei, were calculated using FreeSurfer software. Relative volumes of these amygdala sub-regions were compared between the two groups. Results showed significantly smaller volumes in the right lateral and basal nuclei in the patients with PD compared with the HC. Lateral and basal nuclei are thought to play crucial role for processing sensory information related with anxiety and fear. Our results suggest that these particular amygdala sub-regions play a role in the development of PD symptoms.

DOI： 10.1371/journal.pone.0207163

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Language：Japanese   Publishing type：Research paper (scientific journal)  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本サイコオンコロジー学会・日本臨床死生学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publisher：(NPO)日本緩和医療学会  

死亡診断時の医師の立ち居振る舞いは,その後の遺族の悲嘆に大きく影響を及ぼすと考えられているが,現在の医学教育プログラムのなかには,死亡診断時についての教育内容はほとんど含まれていない.われわれは遺族アンケートを基に「地域の多職種でつくった死亡診断時の医師の立ち振る舞いについてのガイドブック」(以下ガイドブック)を作成した.本ガイドブックを用い,横浜市立大学医学部4年次生に対し授業を行い,授業前後で死亡診断時の困難感,自己実践の可能性を評価するアンケート調査を行い解析した.有効回答を得た39名において死亡確認についての困難感についての項目は,「死亡確認の具体的な方法」が最も高く,89.5%であった.しかし,授業前後では,死亡診断時における自己実践を評価する項目で有意な改善がみられた.死亡診断時の医師の立ち居振る舞いについての卒前教育にわれわれが作成したガイドブックは有効な可能性が示唆された.(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J05370&link_issn=&doc_id=20170908220014&doc_link_id=10.2512%2Fjspm.12.906&url=https%3A%2F%2Fdoi.org%2F10.2512%2Fjspm.12.906&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(NPO)日本緩和医療学会  

死亡診断時の医師の立ち居振る舞いは,その後の遺族の悲嘆に大きく影響を及ぼすと考えられているが,現在の医学教育プログラムのなかには,死亡診断時についての教育内容はほとんど含まれていない.われわれは遺族アンケートを基に「地域の多職種でつくった死亡診断時の医師の立ち振る舞いについてのガイドブック」(以下ガイドブック)を作成した.本ガイドブックを用い,横浜市立大学医学部4年次生に対し授業を行い,授業前後で死亡診断時の困難感,自己実践の可能性を評価するアンケート調査を行い解析した.有効回答を得た39名において死亡確認についての困難感についての項目は,「死亡確認の具体的な方法」が最も高く,89.5%であった.しかし,授業前後では,死亡診断時における自己実践を評価する項目で有意な改善がみられた.死亡診断時の医師の立ち居振る舞いについての卒前教育にわれわれが作成したガイドブックは有効な可能性が示唆された.(著者抄録)

DOI： 10.2512/jspm.12.906

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

AimNumerous reports have described differences in the distribution of orbitofrontal cortex (OFC) sulcogyral patterns between patients with schizophrenia (SZ patients) and healthy controls (HC). Alterations in OFC morphology are also observed in those at high risk for developing SZ and in first-episode SZ, suggesting that genetic associations may be extant in determining OFC sulcogyral patterns. We investigated the association between single nucleotide polymorphisms (SNP) in NRG1 and OFC sulcogyral patterns.
MethodsA total of 59 Japanese patients diagnosed with SZ and 60 HC were scanned on a 1.5-T magnet. Patients were also assessed clinically. OFC sulcogyral patterns were evaluated for each participant, and genotyping was performed for four SNP in NRG1(SNP8NRG243177, SNP8NRG221533, SNP8NRG241930, and rs1081062).
ResultsThere were significant differences in the distribution of OFC sulcogyral patterns between SZ patients and HC ((2) = 6.52, P = 0.038). SZ patients showed an increase in the frequency of Type III expression, which was associated with an earlier age of disease onset ( = -0.302, F = 4.948, P = 0.030). Although no difference was found in genotype frequencies between SZ patients and HC, an NRG1SNP, SNP8NRG243177, was associated with Type II expression in SZ patients ( = 0.237, F = 4.120, P = 0.047).
ConclusionOur results suggest that OFC sulcogyral pattern formation in schizophrenia may be associated with NRG1 allele frequency, which is closely related to neurodevelopment.

DOI： 10.1111/pcn.12384

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publisher：日本認知症学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本認知症学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(株)ワールドプランニング  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Numerous brain regions are believed to be involved in the neuropathology of panic disorder (PD) including fronto-limbic regions, thalamus, brain stem, and cerebellum. However, while several previous studies have demonstrated volumetric gray matter reductions in these brain regions, there have been no studies evaluating volumetric white matter changes in the fiber bundles connecting these regions. In addition, although patients with PD typically exhibit social, interpersonal and occupational dysfunction, the neuropathologies underlying these dysfunctions remain unclear. A voxel-based morphometry study was conducted to evaluate differences in regional white matter volume between 40 patients with PD and 40 healthy control subjects (HC). Correlation analyses were performed between the regional white matter volumes and patients' scores on the Panic Disorder Severity Scale (PDSS) and the Global Assessment of Functioning (GAF). Patients with PD demonstrated significant volumetric reductions in widespread white matter regions including fronto-limbic, thalamo-cortical and cerebellar pathways (p<0.05, FDR corrected). Furthermore, there was a significant negative relationship between right orbitofrontal gyrus (OFG) white matter volume and the severity of patients' clinical symptoms, as assessed with the PDSS. A significant positive relationship was also observed between patients' right OFG volumes and their scores on the GAF. Our results suggest that volumetric reductions in widespread white matter regions may play an important role in the pathology of PD. In particular, our results suggest that structural white matter abnormalities in the right OFG may contribute to the social, personal and occupational dysfunction typically experienced by patients with PD.

DOI： 10.1371/journal.pone.0092862

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：AMER PSYCHIATRIC PUBLISHING, INC  

Objective: This study investigated the feasibility and outcomes of the illness management and recovery program in Japan. Methods: Thirty-five patients with schizophrenia were recruited. Participants were assigned (not randomly) to the intervention and wait-list comparison groups. Symptom severity, functioning, activation level in self-management, quality of life, satisfaction, self-efficacy in community living, and satisfaction with services were measured before and after the intervention. Results: Over two years 25 patients completed the intervention (some after being wait-listed). In the pre-post comparison, they showed significant improvement in symptoms and functioning, self-reported activation in self-management, quality of life, satisfaction, and self-efficacy in community living. Compared with the ten participants in a wait-list comparison group, the eight participants in the first intervention group showed an increased quality of life in social functioning, satisfaction in living, and self-efficacy for social relationships in community living. Conclusions: Findings suggest that the program is effective for participants with severe mental illness in Japan. (Psychiatric Services 61:1157-1161, 2010)

DOI： 10.1176/appi.ps.61.11.1157

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Tardive dyskinesia (TD) is a neurological disorder caused by the prolonged administration of dopamine antagonists, usually antipsychotics and especially first-generation antipsychotics. Herein, we report on an elderly patient suffering from TD with depression induced by amoxapine, an antidepressant that antagonizes dopamine receptors. This case report demonstrates the therapeutic effect of donepezil even for TD due to amoxapine, corroborating the view that donepezil is beneficial for the treatment of TD induced by dopamine antagonists. A randomized placebo-controlled double-blind trial is required to confirm the usefulness of donepezil in the treatment of dopamine antagonist-induced TD.

DOI： 10.1111/j.1479-8301.2008.00245.x

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Language：English   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Adherence to antipsychotic treatment is particularly important in the long-term management of schizophrenia and other related psychotic disorders since poor adherence to medication is associated with poor health outcomes. Although the patients' subjective satisfaction with the medication is crucial for adherence to medication, few studies have examined the relationship between subjective satisfaction with antipsychotics and adherence. In this study, we investigated subjective satisfaction with antipsychotics in patients with schizophrenia by using the Treatment Satisfaction Questionnaire for Medication (TSQM), a self-reporting instrument to assess the major dimensions of patients' satisfaction with their medication. The subjects included 121 clinically stabilized outpatients who met the following criteria: 1) patients between 20 and 65 years of age, diagnosed with schizophrenia or other psychotic disorders as defined by DSM-IV, 2) patients undergoing oral antipsychotic monotherapy or taking only an antiparkinsonian agent as an adjuvant remedy, and 3) patients who had received a stable dose of an antipsychotic for more than four weeks. Patients were asked to answer the TSQM questions, and their clinical symptoms were also evaluated by the Brief Psychiatric Rating Scale (BPRS). Satisfaction with regard to side-effects (p=0.015) and global satisfaction (p=0.035) were significantly higher in patients taking second-generation antipsychotics (SGAs, n = 111) than those taking first-generation antipsychotics (FGAs, n = 10), whereas no significant difference was found between the two groups in clinical symptoms according to BPRS (p=0.637) or the Drug-induced Extrapyramidal Symptoms Scale (DIEPSS, p = 0.209). In addition, correlations were not significant between the subjective satisfactions and clinician-rated objective measures of the symptoms. These findings suggest that SGAs have more favorable subjective satisfaction profiles than FGAs in the treatment of schizophrenia. Since it is often difficult to detect the difference by a traditional objective assessment of the patients, it is desirable that physicians pay attention to the patients' subjective satisfaction in conjunction with their own objective clinical assessment. (C) 2007 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.pnpbp.2007.12.002

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Language：Japanese   Publisher：(株)医学書院  

第2世代抗精神病薬であるオランザピンの剤型による服薬満足度の違いを、標準経口錠(SOT)と口腔内崩壊錠(ODT)の2種類について、治療満足度の評価スケールであるTSQM日本語版を作成して比較した。対象は「統合失調症およびその他の精神病性障害」と診断された通院中の患者46名とした。その結果、SOT群とODT群の間で、TSQMの「効果」、「副作用」および「全般満足度」の得点に関して有意差は認められなかったが、「利便性」に関してはODT群がSOT群より有意に高かった。SOT、ODT両群の間で、BPRSおよびDIEPSSのいずれについても総得点で有意な差は認められなかった。

DOI： 10.11477/mf.1405100998

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Language：English   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Huntington's disease (HD) is a hereditary disorder clinically characterized by involuntary movements, cognitive decline and psychiatric symptoms. We report on a patient with HD, whose involuntary movements and psychiatric symptoms were clinically improved with perospirone, a second-generation antipsychotic agent with antagonistic effects on serotonin 5-HT2A and dopamine D-2 (D2) receptors, as well as a unique agonistic effect on serotonin 5-HT1A (5-HT1A) receptors. The fact that perospirone antagonizes D-2 receptors could explain its effects on the hyperkinetic syndrome, while its agonistic effects on 5-HT1A receptors may explain the amelioration of psychiatric symptoms (fear and anxiety) in this patient. Future studies would be valuable to elucidate the utility of perospirone for the treatment of involuntary movements and psychiatric symptoms in HD. (c) 2006 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.pnpbp.2006.06.021

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publisher：(一社)日本社会精神医学会  

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Language：Japanese   Publisher：神奈川県精神医学会  

せん妄を疑い薬物療法を行った結果、経過中にCO2ナルコーシスを呈した1例を経験した。症例は70代男性の頸部食道癌患者。睡眠薬投与後に生じたせん妄に対し抗精神病薬を投与したが、せん妄の改善が得られず、さらに抗精神病薬を投与した結果、呼吸状態が悪化し、最終的に気管切開による呼吸管理により精神症状も含めて著明な改善に至った。振り返って本症例では抗精神病薬の投与の結果、CO2ナルコーシスを引き起こしていたと考えられた。周術期には全身状態が短時間で変化する可能性があり、呼吸不全の可能性を常に念頭に置き、動脈血血液ガス分析も含めた検査を施行し、CO2ナルコーシスの可能性に十分配慮する必要がある。せん妄の治療は、身体所見、検査所見、投薬内容の検討などを行い、治療可能な原因を同定すること、そして随時身体状況の変化に注意を払い治療方針を見直していくことが重要と考えられた。(著者抄録)

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県精神医学会  

日本における高齢長期入院統合失調症患者の地域移行支援はなかなか進んでいない。Illness Management and Recovery(IMR)は、リカバリーの概念を基本とした心理社会的介入プログラムである。実施によって本人が主体性を取り戻し疾病の自己管理能力が向上することが期待されるプログラムである。今回、高齢の長期入院患者にIMRを施行し、退院に結びついた症例を経験したので報告する。症例は60代男性の統合失調症患者。通行人への暴力行為にて入院し、入院後も他患者やスタッフへの暴力のため入院が長期化していた。ここ数年は退院の希望は話すものの自発的な行動は見られなかった。IMRに参加後、積極的な行動が多く認められ自分の症状が妄想であると自覚するようになった。暴力行為の背景には被害妄想があることが理解されそれに対応した援助が行われるようになり、退院となった。長期入院患者にも積極的にIMRを実施していくことにより、退院が促進される可能性があると考えられた。(著者抄録)

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Language：Japanese   Publisher：日本評論社  

CiNii Books

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Language：Japanese   Publisher：科学評論社  

CiNii Books

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Language：Japanese   Publisher：日本認知症学会  

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Language：Japanese   Publisher：(株)星和書店  

わが国では長期入院患者の退院促進が重要な課題である。退院促進が進まない原因の1つとして患者が主体性や希望を喪失していることが考えられる。心理社会的介入プログラムであるIllness Management and Recovery(疾病管理とリカバリー、以下IMR)はリカバリーの概念を中核としており、患者自身の主体性や希望を回復し、病気の自己管理が進む中で退院が促進される効果が期待される。今回、当院の長期入院患者においてIMRを導入した。導入過程においては、病院内においてリカバリー概念の理解が進んでおり、スタッフの確保に大きな問題は生じなかったが、スタッフがプログラムに継続して関われるよう人員の配置などの面で配慮が必要であった。IMR導入の結果、長期入院患者の主体性の回復や、病識が獲得されるなどの変化が見られた。実際に退院につながった者もおり、IMRの退院促進への可能性が感じられる結果となった。他施設においてもぜひ積極的に取り入れていくことを勧めたい。(著者抄録)

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Language：Japanese   Publisher：(株)ライフ・サイエンス  

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Language：Japanese   Publisher：(一社)日本精神科看護協会  

【研究目的】IMR(Illness Management and Recovery:以下、IMR)は精神疾患を抱える人々が、病気を理解し自己管理していくためのプログラムであり、その効果は諸外国で評価されている。一方日本においては、全国の施設で導入され、介入研究が多くされているが、論文として掲載されているものは5本と少ない。当院では、昨年10月よりプログラムが導入され多職種協働で運営されており、参加される対象へのサポート体制が重要であることから、患者支援にかかわる専門職者のプログラム参加意識や、接遇に関連した意識調査を行い今後のプログラム運営に役立てるとともに、日々の支援活動に役立てることを目的とした。今回、IMRプログラム導入にあたり、かかわる多職種への周知、プログラム運営の学習過程を振り返るとともに、アンケート調査の結果明らかとなったことから今後の課題について述べる。【研究方法】全部署を対象とした調査研究を行った。調査内容は、IMR導入過程を振り返り、評価・分析する。調査対象者は職員140名であり、質問項目ごとに分類し、度数分布表を作成し結果を表示する。得られた調査結果から、職員のプログラムの理解度、今後の運営方法の検討、患者への支援の方向性の示唆を得る。【倫理的配慮】本研究は横浜市立大学精神医学教室との連携にて行われるもので、横浜市立大学付属病院の倫理委員会の承認を得ている。また、横浜舞岡病院にプログラムを導入するにあたり、横浜舞岡病院倫理委員会での承認を受けた。対象患者への承諾は、IMR導入に拠る効果、倫理的配慮について書面と口頭にて患者・家族に説明をし同意が得られた者を対象とした。【結果・考察】回答が得られたのは134名であった。解答結果では、「IMRを知ってはいるが、介入したことはない」が最も多く、プログラムに参加したいかでは「参加はしたいが業務が忙しく参加が難しい現状がある」が多かった。プログラムは導入の過程にあり、様々な課題があるが、専門職者の患者へのかかわりの質の向上、心理教育の拡充などの必要性を理解している職員が多いことから、今後の支援の課題としていきたい。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014032944

Language：Japanese   Publisher：医学生物学速報会  

IMR(Illness Management and Recovery)(以下IMR)は、アメリカ連邦政府のEBP実施・普及ツールキット、連邦保健省薬物依存精神保健サービス部(SAMHSA)が科学的根拠にもとづく実践(EBP;Evidence Practices)の実施・普及のために作成された各種支援ツールをまとめたものの一部であり、現在世界中でその介入研究報告がなされ、5年前に日本にも導入され一定の効果を挙げている。EBPツール活用に際しては、包括的に全体を捉え支援体制を組む事が求められる。IMR疾病管理とリカバリープログラム内容は、心理教育、再発防止、服薬管理行動的な調整、精神症状に対処するためのプログラムとなっている。世界的なIMR研究の検索をCINAL、MEDLINEを用いて検索を行った結果、諸外国における研究報告は20本弱と少ないが、それぞれの国で助成研究がなされ導入の過程にあり、今後ますます多く研究報告がなされると予測される。日本では、EBPプログラムの導入は、EBPプログラム作成者であるRAPP教授から日本精神障害者リハビリテーション学会へ紹介されたのが導入のきっかけであった。本研究では、EBPプログラムのなかのIMRプログラムに焦点を当て、現在の日本での導入の状況とその効果の検証がどの程度なされているのかを述べ、長期入院する統合失調症患者への導入の意義について論じる。(著者抄録)

CiNii Books

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Language：Japanese   Publisher：(学)青淵学園東都医療大学ヒューマンケア学部  

IMR(Illness Management and Recovery)(以下IMR)は、アメリカ連邦政府のEBP実施・普及ツールキット、連邦保健省薬物依存精神保健サービス部(SAMHSA)が科学的根拠にもとづく実践(EBP;Evidence Practices)の実施・普及のために作成された各種支援ツールをまとめたものの一部である(大島2009)。EBPツールキットの開発経緯の背景には、家族心理教育など科学的根拠にもとづく実践(EBP)と呼ばれる心理社会的介入プログラムが、優れた効果を発揮するにも関わらず、臨床の場では用いられてはいない世界共通の現状があった。EBPツール活用に際しては、病院組織や地域ケア体制などのシステムを変更する必要があり、包括的に全体を捉え支援体制を組む事が求められる。IMR疾病管理とリカバリーの中心となるプログラムの内容は、心理教育、再発防止、服薬管理行動的な調整、精神症状に対処するための認知行動的な方法となっている。これらのランダム化比較臨床研究が、アメリカ、イギリス、ドイツ、カナダなど広範囲の人種や民族に対して実施されてきた。IMRの対象者は、性別を問わず、研究の対象地域は、都市部、地方都市を問わず、入院治療を受ける患者、外来治療を受けているものの全体を包括した。研究対象者の年齢は18歳から67歳までを含み、平均年齢は40歳前後であった。IMR研究では、人種、性別、地理的条件、年齢、入院・外来の区別はIMRの構成要素に異なる効果をもたらすことを示す科学的根拠は存在しない。この研究成果に関しては、CINAHL、MEDLAINを用いて検索を行った結果、諸外国における研究報告は20本弱と少ないが、それぞれの国で助成研究がなされ導入の過程にあり、今後ますます多く研究報告がなされると考えることができる。これに対して、日本では、平成16年にとりまとめられた精神医療福祉の改革ビジョンに基づき、入院医療中心から地域生活中心へと退院促進が政策として取り組まれてきた。精神障害者は個別的な退院支援を受けるが、それは画一的であり、個別性に乏しい傾向があった。日本における地域リハビリテーション技術は変換期にあり、精神障害者が、自分自身の生きる意味や夢、将来の目標を持てるよう働きかけられる専門職者の養成が急務である。日本へのEBPプログラムの導入は、EBPプログラム作成者であるRAPP教授から日本精神障害者リハビリテーション学会へ紹介されたのが導入のきっかけであった。本研究では、EBPプログラムのなかのIMRプログラムに焦点を当て、現在の日本での導入の状況とその効果の検証がどの程度なされているのかを述べ、日本への導入の意義について論じる。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：神奈川県医師会  

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Language：English   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Tardive dyskinesia (TD) is a neurological disorder caused by the prolonged administration of dopamine antagonists, usually antipsychotics and especially first-generation antipsychotics. Herein, we report on an elderly patient suffering from TD with depression induced by amoxapine, an antidepressant that antagonizes dopamine receptors. This case report demonstrates the therapeutic effect of donepezil even for TD due to amoxapine, corroborating the view that donepezil is beneficial for the treatment of TD induced by dopamine antagonists. A randomized placebo-controlled double-blind trial is required to confirm the usefulness of donepezil in the treatment of dopamine antagonist-induced TD.

DOI： 10.1111/j.1479-8301.2008.00245.x

Web of Science

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Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1405101244

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2008261851

Language：Japanese   Publisher：(一社)日本社会精神医学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：Japanese   Publisher：(公社)日本精神神経学会  

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Language：English   Publishing type：Book review, literature introduction, etc.   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Obsessive-compulsive disorder (OCD) is often complicated by depression. We report on a patient with treatment-refractory OCD and treatment-refractory major depression who demonstrated a robust response to augmentation of paroxetine with perospirone. Perospirone is a second-generation antipsychotic agent with antagonist effects on both serotonin 5-HT2A and dopamine D-2 receptors, as well as a unique agonist effects on serotonin 5-HT1A receptors. Future studies would be valuable to elucidate the utility of augmentation therapy of selective serotonin reuptake inhibitors with perospirone in the treatment of refractory OCD with depression. (c) 2006 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.pnpbp.2006.10.014

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Scopus

PubMed

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Language：Japanese   Publisher：(株)医学書院  

DOI： 10.11477/mf.1405100951

CiNii Books

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Language：Japanese   Publisher：(株)医学書院  

12歳時の交通外傷による前頭葉眼窩面損傷後、経時的に様々な精神症状を呈した1例(40歳男性)を経験したので、前頭葉損傷と精神症状の関連について考察を加えて報告した。本例においてみられた発動性減退、易刺激性、易怒性などの症状は、いずれも前頭葉眼窩面損傷後にみられる症状として記載されてきたものである。本例ではさらに強迫傾向や他飲水がみられたが、これらは眼窩脳損傷群の情動障害でみられる「脱抑制的多動」と解することができた。WCSTやStroopテストの成績低下がみられたが、これは画像上明らかであった眼窩部の脳損傷の影響が前頭葉外側穹窿部にも及んで入る可能性が考えられた。強迫傾向と多飲水を前頭葉外側穹窿部の障害との関連で考えると、これらの症状が行動の中止困難、保続、固着の症状の表れととらえることができるかもしれない。

DOI： 10.11477/mf.1405100392

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：(株)医学書院  

ネットトレードによる株取引を繰り返し、病的賭博との診断に至った1例(32歳男性)を報告した。ネットトレードによる病的賭博には、他の病的賭博とは異なるいくつかの特徴が見いだされた。第1に他の賭博と比べてハイリスク・ハイリターンであること、第2に参加が容易であり、自宅で参加できる点があげられる。第3の特徴としては、罪悪感が希薄なままに依存が形成される可能性があげられる。他の病的賭博では、うつ症状や気分変調症との合併がみられるが、本例ではみられたうつ症状は、内因性うつ病の悲哀感や精神運動抑制とは性質を異にし、焦躁感、空虚感が支配的であった。

DOI： 10.11477/mf.1405100372

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Language：Japanese   Publisher：神奈川県精神医学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：神奈川県医師会  

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