Language：Japanese   Publisher：(公財)明治安田こころの健康財団  

HPVワクチン接種の積極的勧奨が2022年4月から約9年ぶりに再開された。ワクチン接種に関わるストレスへの反応として観察される様々な症状は「予防接種ストレス関連反応」(ISRR)と定義され、接種への躊躇感や不安などの心理的要因も影響すると考えられている。著者らは、HPVワクチン接種に際しての躊躇感(予防接種レディネス)や、抑うつ、不安、接種の痛み、痛みの破局的思考などの心理学的要因について、各種尺度を用いて調査している。調査は現在も継続中であり、今後HPVワクチン接種が普及していく中で、ISRRの予防やワクチン躊躇感への対策を検討するための基礎資料としてデータを蓄積していきたいと考えている。

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Authorship：Lead author,　Last author,　Corresponding author   Language：Japanese   Publishing type：Research paper (conference, symposium, etc.)  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/pcn5.57

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/pcn5.57

Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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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：English   Publishing type：Research paper (scientific journal)  

ABSTRACT: Problematic Internet use (PIU) is common and likely to coexist with mental health problems among adolescents with school refusal behavior. To date, no study has revealed to what extent PIU relates to the daily burden compared with other mental health problems. This study has examined the association between daily difficulties and PIU among adolescents with school refusal behaviors.This cross-sectional study involved all first-visit patients, regardless of diagnosis, aged 10 to 18 years at 2 child/adolescent psychiatric outpatient clinics in Yokohama City, Japan, from April 2016 to March 2018. The Questionnaire-Children with Difficulties (QCD) were obtained from parents. Simultaneously, the severity of PIU was evaluated using the Internet Addiction Test and depressive and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 and General Anxiety Disorder-7 scale in the 2 weeks before the first-visit. From 684 first-visit patients, 227 with school refusal behaviors were enrolled in the study.PIU was observed in 40% of adolescents with school refusal behaviors. The QCD scores among patients with PIU were significantly lower than those in patients without PIU. Linear regression analysis revealed relationships between PIU and lower QCD scores throughout the day (except at night) and the total score of the day, after controlling for confounders such as depressive and anxiety symptoms.In conclusion, among adolescents with school refusal behaviors, PIU may affect their parent-assessed daily difficulties particularly experienced throughout the day.

File： Problematic_Internet_use_and_daily_difficulties.56 (1).pdf

DOI： 10.1097/MD.0000000000028916

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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)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本精神科救急学会  

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Suicide remains one of the leading causes of death among adolescents. Although recent studies have suggested a strong association between auditory hallucinations and suicidal behaviors, little is known regarding the association between suicidal behaviors and visual hallucinations, which are also common among adolescent psychiatric patients. METHOD: A cross-sectional study of all first-time patients aged 10-15 years was conducted at three child and adolescent psychiatric outpatient facilities in Kanagawa Prefecture, Japan, from April 2015 to March 2018. Self-reported questionnaires were administered to evaluate auditory and visual hallucinations, suicide planning, and suicide attempts within the two weeks prior to the first visit. Our logistic regression model included three covariates (sex, age, and presence of major depressive episode) for adjustments. Among the 1285 respondents, 37 who had moderate or severe intellectual disability were excluded, leaving 1248 for analysis. RESULTS: Among the 1069 patients who completed questionnaire items on hallucinations, 230 (21.5%) experienced auditory or visual hallucinations. After controlling for all confounders, visual hallucinations, but not auditory hallucinations, were significantly associated with increased odds of suicide planning (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.1). In contrast, auditory hallucinations, but not visual hallucinations, were significantly associated with increased odds of suicide attempts (OR 2.8, 95% CI 1.3-6.1). No interaction effects were observed between suicidal behaviors and auditory or visual hallucinations. CONCLUSIONS: Clinicians should consider the prevalence of both auditory and visual hallucinations among young adolescent patients, with emphasis on auditory hallucinations, given their association with suicide attempts.

File： camh.12504.pdf

DOI： 10.1111/camh.12504

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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：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：English  

DOI： 10.1111/pcn.13143

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

BACKGROUND: Guideline for Pharmacological Therapy for Schizophrenia was published by the Japanese Society of Neuropsychopharmacology in 2015. "Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)" project aimed to standardize medical practice using quality indicators (QIs) as indices to evaluate the quality of medical practice. In this study, we have reported the quality indicator values of prescription before the beginning of the guideline lectures in the EGUIDE project to ascertain the baseline status of treating patients with schizophrenia. METHODS: A cross-sectional, retrospective case record survey was conducted, involving 1164 patients with schizophrenia at the time of discharge. We checked all types and dosage of psychotropic drugs. RESULTS: Forty-three percent of patients had antipsychotic polypharmacy, and substantial concomitant medication was observed (antidepressants; 8%, mood stabilizers: 37%, anxiolytics or hypnotics: 68%). CONCLUSIONS: In the results obtained in this study, we plant to report changes in the effectiveness of education in the EGUIDE project near the future.

DOI： 10.1002/npr2.12122

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

OBJECTIVE: This study aimed to compare the effect of continuing and discontinuing medications on quality of life of patients with attention-deficit/hyperactivity disorder (ADHD). DATA SOURCES: PubMed, Cochrane Library, and Embase databases were searched using generic terms for ADHD, discontinuing, continuing, pharmacotherapy, and randomized controlled trials without date or language restrictions. STUDY SELECTION: Of the 3,672 screened studies, 9 met the predefined inclusion criteria on patients with ADHD; 5 of these 9 studies reporting on 1,463 patients (children and adolescents, n = 894; adults, n = 569) measured quality of life and were included in this meta-analysis. Only randomized, double-blind, placebo-controlled withdrawal trials of ADHD medications were included. DATA EXTRACTION: Data were independently extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. Analyses were based on random-effects models. RESULTS: Compared with continuing medications, discontinuing them significantly worsened quality of life score in patients with ADHD (standardized mean difference [SMD] = 0.19; 95% CI, 0.08 to 0.30]). Moreover, discontinuing medications worsened this score in children and adolescents with ADHD (SMD = 0.21; 95% CI, 0.06 to 0.36) but not in adults with ADHD (SMD = 0.02; 95% CI, -0.46 to 0.50). CONCLUSIONS: Discontinuing medications was associated with a small but statistically significant decrease in quality of life among children and adolescents with ADHD but not in adults with ADHD. Quality of life can be applied in pharmacologic interventions regarding continuing and discontinuing medication because this concept is related to individuals' appraisal of their situation. Quality of life is an important factor for planning individualized ADHD medication treatment.

DOI： 10.4088/JCP.19r13015

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (other academic)  

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Authorship：Lead author   Language：Japanese   Publishing type：Research paper (scientific journal)  

File： 児童青年精神医学とその近接領域61（1）55-65，2020.pdf

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

File： PCN-73-642.pdf

DOI： 10.1111/pcn.12911

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/pcn.12911

Language：Japanese  

File： 03.pdf

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

File： 60_147.pdf

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

File： 抗精神病薬の新規使用者における血糖・プロラクチン検査.pdf

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File： prevalence_incidence_and_persistence_of_adhd_drug_use_in_japan.pdf

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

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

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Language：Japanese   Publishing type：Research paper (conference, symposium, etc.)  

File： 58_64.pdf

DOI： 10.20615/jscap.58.1_64

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Other Link： http://search.jamas.or.jp/link/ui/2017234788

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

File： Disp.pdf

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Other Link： http://search.jamas.or.jp/link/ui/2017053941

Language：Japanese  

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Other Link： http://search.jamas.or.jp/link/ui/2016213891

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCIENCE BV  

Objective: It is important to prevent patients with suicidal ideation from actually attempting suicide. A school based cohort study suggested that auditory verbal hallucinations (AVHs) might play an important role in driving young people with mental health problems to attempt suicide. However, no clinical study to date has specifically investigated the association between AVHs and suicide attempts among young patients with suicidal ideation.
Method: We conducted a cross-sectional study of first-visit psychiatric referrals aged 10-15 years at two general child and adolescent mental health hospitals in Japan. We administered self-reported questionnaires to measure suicidal ideation and suicide attempts, AVHs, and depression in the two weeks prior to the date of first-visit.
Results: Among 188 patients with suicidal ideation, the presence of AVHs was associated with increased odds of suicide attempts (OR 3.4, 95% CI 1.7-6.9; p < 0.05); however, depression was not associated with a significant change of odds (OR 0.7, 95% CI 0.4-1.3; p = 0.29).
Conclusions: AVHs may increase the risk of suicide attempts made by adolescents with suicidal ideation. Clinicians should consider AVHs when adolescent patients present with suicidal ideation. (C) 2015 Elsevier B.V. All rights reserved.

File： Fujita20150716.pdf

DOI： 10.1016/j.schres.2015.07.028

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CAMBRIDGE UNIV PRESS  

Background: We aimed to examine trends in the use of psychotropic medications among elderly outpatients with dementia in Japan between 2002 and 2010.
Methods: We used data from the 2002-2010 Survey of Medical Care Activities in Public Health Insurance (SMCA-PHI), a nationally representative cross-sectional survey of claims data for the month of June in every year. We included ambulatory care visits by patients aged 65 years or older who were prescribed cholinesterase inhibitors (n = 15,591), and identified use of any psychotropic medications during the survey month.
Results: In 2008-2010, the most prevalently prescribed psychotropic medications to patients with dementia were sedatives-hypnotics (37.5%), antipsychotics (24.9%), antidepressants (13.0%), and mood-stabilizers (2.9%). Between 2002-2004 and 2008-2010, use of second-generation antipsychotics (SGAs) increased from 5.0% to 12.0%, while use of first-generation antipsychotics (FGAs) decreased from 20.6% to 12.9%. These numbers resulted in a 1.1-fold increase in the adjusted prevalence of the overall use of antipsychotics. Quetiapine and risperidone use showed a 4.8- and 1.8-fold increase, respectively, while haloperidol use showed a 2.3-fold decrease.
Conclusions: Despite safety warnings against the use of antipsychotics for patients with dementia in several countries, our study revealed a slight increase in the extensive use of off-label antipsychotics over time in Japan. This finding indicates an urgent need for evaluation of the efficacy of antipsychotics for the approved treatment of severe agitation, aggression, and psychosis associated with dementia. Moreover, psychosocial interventions and antipsychotic withdrawal strategies are needed in order to reduce the overall prevalence of antipsychotic use.

DOI： 10.1017/S1041610214001975

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Language：Japanese   Publisher：(株)星和書店  

本研究は、生活保護受給者における向精神薬の多剤処方の地域差を検討することを目的とした。2011〜2012年の医療扶助実態調査における調剤レセプト2,285,106件をデータ源とした。向精神薬の多剤処方割合が全国平均よりも29〜55%高い地域は、北海道、山形県、岐阜県、大阪府、奈良県と和歌山県の6地域であった。多剤処方割合の最も高い地域と低い地域の間には11倍の差がみられた。人口あたりの生活保護人員数が多い地域と精神病床を有する病院が少ない地域は、向精神薬の多剤処方割合が高いことが示された。2011年と比較した2012年の多剤処方のオッズが20%よりも減少した地域は、川越市、千葉市、兵庫県の3地域であった。向精神薬の多剤処方の状況を定期的にモニタリングするための体制を構築し、地域の実情に応じた対策を進めることが望まれる。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本児童青年精神医学会  

目的:われわれは精神病性障害の前駆状態とされるARMS(At risk mental state for psychosis:ARMS)の15歳以下への適応の可能性を検討するために児童精神科受診者の中で、ARMS基準に該当する患者を抽出し、その臨床像および経過の検討を行った。対象と方法:平成22年4月から平成23年3月までに神奈川県立こども医療センター児童思春期精神科を初診した10歳〜15歳の患者310名のうち、後方視的調査でARMS基準を満たした20名に関して、初診時および初診1年後の状態の診療録調査を行った。結果:初診時の状態がARMSと判断されたのは20例(男子8例、女子12例、平均年齢は12.3±1.4歳)だった。初診時の主訴および精神科診断は多岐にわたっていた。初診1年後の時点で継続通院していた13例の中で精神病性障害に移行していた症例はなかった。13例の治療状況は以下の4群に分ける事ができた。I群:統合失調症への移行や診断変更を念頭に入れた治療(4例)II群:発達障害特性を考慮した治療(4例)III群:対人機能上の問題への治療(4例)IV群:気分障害への治療(1例)結論:若年のARMS症例に関しては、精神病性障害に限定しない精神障害への視点や対応が必要であると考えられた。(著者抄録)

File： Arai2014.pdf

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Other Link： http://search.jamas.or.jp/link/ui/2015128181

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

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Publisher：11  

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J-GLOBAL

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

【背景】未成年における精神疾患の受診者数は増加しているものの,子どもにおける向精神薬の多くは適応外である.これまでの研究では,どの程度の子どもへ向精神薬が処方されているか,明らかにされてこなかった.【目的】日本全国の子どもに対する向精神薬処方の経年変化を把握することを目的とした.【研究法】2002〜2010年の社会医療診療行為別調査における18歳以下の外来患者の診療報酬明細書と調剤報酬明細書をデータ源とした.【評価項目】向精神薬の処方件数と向精神薬の多剤併用処方の件数を評価項目とした.【結果】レセプトの件数は9年間で233,399件であった.2002〜2004年と2008〜2010年を比較すると,6〜12歳における向精神薬の処方オッズは,ADHD治療薬が84%増(95%CI 1.33,2.56),抗精神病薬が58%増(95%CI 1.06,2.34),抗不安・睡眠薬が33%減(95%CI 0.46,0.99)であった.13〜18歳における向精神薬の処方オッズは,ADHD治療薬が2.5倍増(95%CI 1.34,4.62),抗精神病薬が43%増(95%CI 1.20,1.70),抗うつ薬が37%増(95%CI 1.09,1.72)であった.クラス間多剤併用処方は,気分安定薬では93%,抗うつ薬では77%,抗不安・睡眠薬では62%,抗精神病薬では61%,ADHD治療薬では17%にみられた.【結論】向精神薬の適応外使用が増えているため,治験の推進と長期的な有効性と安全性をモニタリングするための臨床データベースの構築が喫緊の課題である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

背景:児童青年期の統合失調症を中心とする精神病性障害の診断や治療は成人を診療対象とする精神科医と児童精神科医が協働した臨床や研究が深まっておらず、標準的診断・治療に関して十分な合意が得られていない。一方で世界的には精神病性障害を統合失調症を含めて一つの症候群として広く捉え、早期に支援・治療を開始して継続して患者の長期的予後を改善するという概念は一つの潮流である。この概念は医学的診断の妥当性などの議論は一旦棚上げにしつつ、患者や家族に良質な支援を早期に提供することに重点を置いている。日常臨床を意識して児童青年期の精神病性障害の診断・治療の標準化を行う場合、この概念は実践的であり一つの指針となりうる。目的:国際早期精神病協会が作成した早期精神病ガイドラインを参考に、日本の児童青年期の統合失調症を中心とする精神病性障害の診断・治療の標準的指針作成の準備段階として4つの骨子を作成した。10代から20代の青年期に好発する精神病性障害の初期治療もしくは集中治療にあたる機会が多いと思われる精神科医にアンケート調査を実施して適切性を検討した。対象と方法:2011年5月に日本児童青年精神医学会員医師1483名、日本精神科救急学会員医師572名、両学会に同時に所属する医師78名、合計2133名に調査を依頼した。アンケート結果の返信をもって調査の協力同意を得た899名中、有効回答の得られた887名(有効回答率41.6%)を調査対象とした。4つの骨子に関する質問項目は、1)対象を統合失調症に限定せず「精神病症状を呈する疾患群」と広く捉えること、2)ハイリスク群(将来精神病を発症する可能性が高い一群)の同定とこの群への早期支援を行うこと、3)精神病症状が顕在化した時点で早期かつ集中的に精神医学的治療を行うこと、4)精神病症状が顕在化した後、数年間は治療中断がないような支援・治療およびリハビリテーションを行うことについて"適切"〜"不適切"の5段階で評価した。結果:1)〜4)の骨子について80%以上の医師が"適切"〜"やや適切"と回答し、児童学会と救急学会、もしくは両学会所属医師の間に有意な差は認めなかった。結論:4つの骨子に沿って本邦における児童青年期の統合失調症を中心とする精神病性障害の診断・治療の標準的指針を作成していくことは概ね適切であると考えられる。(著者抄録)

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014110851

Language：Japanese   Publisher：神奈川県立こども医療センター  

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Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)   Publisher：(国研)国立精神・神経医療研究センター精神保健研究所  

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

AIMS: It has been recommended that for patients with schizophrenia, antipsychotics should be prescribed simply, using an optimal dose. However, pro re nata (p.r.n., meaning to use on an as-needed basis) antipsychotics may increase the risk of excessive dosing (defined as mean chlorpromazine-equivalent doses above 1000 mg) and polypharmacy (combination use of different antipsychotics). This study aimed to investigate the increased risk caused by p.r.n. antipsychotics. METHOD: The subjects included 413 patients with schizophrenia from 17 acute psychiatric wards in nine hospitals. Over a 24-h period on a survey day, data on regular medication and the use of p.r.n. were collected. The analysis focused on p.r.n. antipsychotics in agitated patients. We used McNemar's test to evaluate differences in the proportions of patients prescribed antipsychotics with excessive dosing or polypharmacy before (i.e., regular medication only) and after prescribed p.r.n. antipsychotics were added to regular medication (i.e., regular medication plus p.r.n. antipsychotics). RESULTS: Of 413 patients, 312 (75.5%) were prescribed p.r.n. for agitated status. Of those, 281 (90.1%) were prescribed p.r.n. antipsychotics. The total doses were significantly higher and more compounded in case patients prescribed p.r.n. antipsychotics than in those who were not. Seventeen patients (4.1%) were actually administered p.r.n. antipsychotics. Their total medication, including p.r.n. on the current day, represented excessive dosing or polypharmacy of antipsychotics. CONCLUSION: The use of p.r.n. antipsychotics may cause hidden excessive dosing and polypharmacy. Our results indicate the importance of careful monitoring of p.r.n. antipsychotics to agitated patients with schizophrenia.

File： 10.1111-pcn.12056.pdf

DOI： 10.1111/pcn.12056

PubMed

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Language：English   Publishing type：Doctoral thesis  

AIMS: It has been recommended that for patients with schizophrenia, antipsychotics should be prescribed simply, using an optimal dose. However, pro re nata (p.r.n., meaning to use on an as-needed basis) antipsychotics may increase the risk of excessive dosing (defined as mean chlorpromazine-equivalent doses above 1000 mg) and polypharmacy (combination use of different antipsychotics). This study aimed to investigate the increased risk caused by p.r.n. antipsychotics. METHOD: The subjects included 413 patients with schizophrenia from 17 acute psychiatric wards in nine hospitals. Over a 24-h period on a survey day, data on regular medication and the use of p.r.n. were collected. The analysis focused on p.r.n. antipsychotics in agitated patients. We used McNemar's test to evaluate differences in the proportions of patients prescribed antipsychotics with excessive dosing or polypharmacy before (i.e., regular medication only) and after prescribed p.r.n. antipsychotics were added to regular medication (i.e., regular medication plus p.r.n. antipsychotics). RESULTS: Of 413 patients, 312 (75.5%) were prescribed p.r.n. for agitated status. Of those, 281 (90.1%) were prescribed p.r.n. antipsychotics. The total doses were significantly higher and more compounded in case patients prescribed p.r.n. antipsychotics than in those who were not. Seventeen patients (4.1%) were actually administered p.r.n. antipsychotics. Their total medication, including p.r.n. on the current day, represented excessive dosing or polypharmacy of antipsychotics. CONCLUSION: The use of p.r.n. antipsychotics may cause hidden excessive dosing and polypharmacy. Our results indicate the importance of careful monitoring of p.r.n. antipsychotics to agitated patients with schizophrenia.

File： （乙７）F2501009.pdf

DOI： 10.1111/pcn.12056

PubMed

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Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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

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Language：Japanese  

DOI： 10.11477/mf.1405101974

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2012002606

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

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Language：Japanese  

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

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Other Link： http://search.jamas.or.jp/link/ui/2010117935

Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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

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Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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Language：Japanese  

DOI： 10.11477/mf.1405101439

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Other Link： http://search.jamas.or.jp/link/ui/2009270046

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

本研究は，精神科救急入院料病棟における精神運動興奮状態にある急性期統合失調症の治療技法の現状およびばらつきを把握することを目的に行った。精神科救急入院料病棟を有する医療機関の医師に対して，精神運動興奮状態を呈する統合失調症のモデル事例を提示し，その症例に対する入院直後の治療技法についての郵送式アンケート調査を行った。抗精神病薬の主剤はrisperidoneの１０名（５３％）と，haloperidol注射液の９名（４７％）の２群に分かれた。両群の平均総chlorpromazine換算量（標準偏差）はrisperidone群６３９．０（２７６．４）mg／day，haloperidol注射液群１９５１．４（６６６．０）mg／dayであった。本結果は，精神科救急入院料病棟における統合失調症の精神運動興奮に対する急性期治療技法は，中等量のrisperidoneと高用量のhaloperidol注射液を主剤とする２群に分かれていることを示唆している。今後，このような治療技法の差が生じる原因を探り，急性期治療の標準化を目指していく必要がある。

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

DOI： 10.11477/mf.1405101135

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Other Link： http://search.jamas.or.jp/link/ui/2008135770

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

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

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

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

DOI： 10.11477/mf.1405100998

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2007330363

Language：Japanese   Publishing type：Research paper (bulletin of university, research institution)  

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Language：Japanese  

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

Few analyses have been carried out in Japan concerning factors contributing to physical restraint of patients. We compared demographic data for 241 inpatients who were restrained during a 4-year period with data for 1093 inpatients who were not restrained in a general hospital psychiatric unit in Japan. Increased likelihood of restraint use was associated with older age, male gender, off-hours admission, involuntary hospitalization, transfer from other departments of the hospital, frequent hospitalization, absence of previous treatment, physical complications, history of suicide attempts, organic mental disorders, mental and behavioral disorders from psychoactive substance use, schizophrenia, schizotypal and delusional disorders. Importantly, physical complications not only were more prevalent among restrained than unrestrained patients, but additionally in restrained patients physical complications were associated with more prolonged hospitalization and periods under restraint than were associated with assaultive behavior or periods of unconsciousness. In conclusion, general hospital psychiatric units in Japan often treat patients with psychiatric disorders or symptoms that were associated with physical problems. Particular caution is needed in deciding whether such patients should be restrained since hospitalization may be prolonged or functional status compromised.

DOI： 10.1111/j.1440-1819.2005.01422.x

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Language：Japanese  

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Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Authorship：Lead author   Language：Japanese   Publishing type：Rapid communication, short report, research note, etc. (bulletin of university, research institution)  

File： 神精診誌Vol222023Fujita.pdf

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Authorship：Corresponding author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Authorship：Last author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Authorship：Lead author   Language：Japanese   Publishing type：Meeting report  

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Language：Japanese   Publisher：(一社)日本女性心身医学会  

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Language：Japanese   Publisher：(株)星和書店  

自閉スペクトラム症(autism spectrum disorder:ASD)と注意欠如多動症(attention deficit hyperactivity disorder:ADHD)は、有病率に男女差を顕著に認める神経発達症であり、いずれも男児において高い。また診断時期も男児の方が早い。最近の研究からASD、ADHDともに臨床像は男女で異なることが指摘されている。ASD女児では易刺激性による興奮やかんしゃくなどの外在化症状より、抑うつや不安といった内在化症状が前景化する。ADHD女児では多動や衝動性よりも不注意症状が目立つ。ASDの女児は男児よりも両親から社会性の問題を重視され、学校などの集団生活の場への過剰適応の後、対人様式のありかたが複雑になり自立が必要になって初めて適応が破綻し、内在化症状が顕在化して受診するパターンが多い。女児の学童期後期頃からの、諸因の不明確な精神的不調の背景に発達障害特性が存在する可能性を考慮して診療に当たることも、適切な診断や支援方針の決定に際しては有用であろう。(著者抄録)

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Language：Japanese   Publisher：(一社)日本睡眠学会  

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (bulletin of university, research institution)  

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Language：Japanese   Publisher：(株)星和書店  

近年は子どもの精神疾患に対応できる新薬が次々と承認され、過去20年間で子どもに対して処方される向精神薬は増加している。しかしながら、児童青年期の薬物治療の選択肢は未だ十分とは言えず、実臨床では成人期の薬物治療を援用した適応外処方が行われている。児童青年期の患者に薬物治療を行う際は、子どもと家族に十分説明を行い、益と害のバランス、および子どもや家族の価値観や現状の困難感など患者側のニーズとともに処方を検討することが重要である。実臨床で児童青年期に処方される向精神薬は多岐にわたるが、本稿では児童青年期患者に投与される機会が比較的多い、抗うつ薬、抗精神病薬、抗多動薬、気分安定薬、抗不安薬・睡眠薬に関する有害事象を紹介し、児童青年期患者に薬物治療を実施する際の留意点を述べた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01647&link_issn=&doc_id=20210412110021&doc_link_id=%2Fet9child%2F2020%2F006105%2F028%2F0547-0551%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fet9child%2F2020%2F006105%2F028%2F0547-0551%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

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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)星和書店  

不登校は本人側の要因としては、精神的要因が過半数を占めており、さらに学校や家庭などの環境要因が影響していることが多いため、医療機関だけで対応するのではなく、教育機関や福祉機関などと連携して対応することが必要である。学校においては、精神科受診が必要と思われる子どもは少なくないが、子どもや保護者は精神科医療への受診に抵抗感を示すことが多く、受診につながり、それを継続するためには対応の工夫が必要である。精神科医療機関の役割は、不登校の子どもの精神医学的評価と治療であり、保護者や学校との情報共有や、環境調整を含めた対応の助言が必要である。障害を持つ場合や養育環境に課題のある場合には、福祉機関との連携が重要である。円滑な連携には日頃から多職種が「顔の見える関係」を構築していることが望ましい。(著者抄録)

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Language：Japanese   Publishing type：Lecture material (seminar, tutorial, course, lecture, etc.)  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (other)  

File： 思春期精神疾患のプライマリケアにおける診療（藤田Dr).pdf

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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J-GLOBAL

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Language：English   Publisher：CAMBRIDGE UNIV PRESS  

DOI： 10.1017/S1041610214002294

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：(一社)日本児童青年精神医学会  

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Language：Japanese   Publisher：医学書院  

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Other Link： http://search.jamas.or.jp/link/ui/2005005012

Language：English   Presentation type：Poster presentation  

File： ICCAPAP2016poster Final Fujita.pdf

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Language：English   Presentation type：Poster presentation  

File： FujitaWPA20140830.pdf

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Language：English   Presentation type：Symposium, workshop panel (public)  

File： Depression and comorbidities in child and adolescents.pptx

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