Psychiatry In Japan Research Articles

Mental health and psychiatry in Japan

Mental health services in Japan are fully integrated into the broader healthcare system, and patients have access to a wide range of services and specialists. In addition, psychiatry services are part of comprehensive mental healthcare that provides social support to address the whole person's needs. However, there are still challenges in the mental health system in Japan, including overuse of hospital beds and coercive practices such as involuntary admission, restraint and seclusion. This article will explore the current state of mental health services, the challenges the country still faces and the efforts being made to address these challenges.

Sports Psychiatry in Japan

Sports Psychiatry in Japan

Materiality of evidence-based policy making for child and adolescent psychiatry in Japan

Materiality of evidence-based policy making for child and adolescent psychiatry in Japan

A Personal Historical Perspective on Psychiatry in Japan During the Last 4 Decades

A Personal Historical Perspective on Psychiatry in Japan During the Last 4 Decades

A fact‐finding survey of medical care provided to neuromuscular disease patients at the National Center of Neurology and Psychiatry in Japan

AbstractSubjectThe aim of the present study was to conduct a fact‐finding survey of medical care practices that are provided to neuromuscular diseases (NMDs) patients and to identify the placement rate and timing of implementation for each of the diseases.MethodAll 3756 NMD patients who were admitted to the Neurology ward between April 2015 and March 2020 were included. This was a retrospective survey of specific medical care practices (percutaneous endoscopic gastrostomy (PEG) and tracheotomy) implemented.ResultsThe results showed that 325 patients (8.7%) had PEG placements, and 78 patients (2.1%) had tracheotomies. When the course of each disease from onset to medical care was examined, the diseases for which medical care was received soon after onset were MND, MSA, DLB, and progressive supranuclear palsy, whereas muscular dystrophy, myopathy, and Parkinson's disease (PD) were diseases with a relatively long time between disease onset and medical care. Discussion: In conducting the fact‐finding survey on medical care practices for NMD, the following were taken into consideration: (i) difficulty in conducting the investigation due to NMD being a rare disease; (ii) existence of a difference in age of onset and progression of the diseases; and (iii) differences in treatment environments due to disparities in treatment policies among medical institutions providing medical care and local support systems.ConclusionsThe course of medical care provision for NMD patients varied depending on the disease, and the difference in the time course of progression of symptoms greatly impacted patients' decision making.

Shūzō Kure’s essay on psychotherapy including music in twentieth-century Japan (1916)

This study offers a historical introduction to psychiatry and music therapy in Japan in the late nineteenth and early twentieth centuries, followed by English translations of related excerpts from Shūzō Kure's Psychotherapy (1916). Music was used as preventive healthcare during the Edo period (1603-1867). This continued into the Meiji period (1868-1912), when European music was also employed by psychiatrists alongside traditional Japanese songs. Kure (1865-1932) is known as the father of Japanese psychiatry and his work best illustrates the links between music and psychiatry in Japan at the turn of the century, showing the integration of European and Japanese theories and practices.

Psychiatric hospital, domestic strategies and gender issues in Tokyo, c. 1920-45.

This paper explores domestic dynamics in the complex making of institutional psychiatry in Japan in c. 1920-45. It mainly examines gender issues between the relatively long-lasting system of the family care of mentally ill members and the use of freshly introduced systems of psychiatric hospitals. I shall look at the record of Ohji Brain Hospital (1901-45) in Tokyo, which has several thousands of case histories mainly in Tokyo c. 1920-45. From the analysis of the cases of male and female patients, as well as the complex situations of their households and kin groups, I shall look at the gender issues in the making of the psychiatric hospital regime.

Pharmacological Profile of Viltolarsen for the Treatment of Duchenne Muscular Dystrophy: A Japanese Experience.

Duchenne muscular dystrophy (DMD) is a fatal, X-linked recessive disorder characterized by progressive muscle loss and cardiorespiratory complications. Mutations in the DMD gene that eliminate the production of dystrophin protein are the underlying causes of DMD. Viltolarsen is a drug of phosphorodiamidate morpholino oligomer (PMO) chemistry, designed to skip exon 53 of the DMD gene. It aims to produce truncated but partially functional dystrophin in DMD patients and restore muscle function. Based on a preclinical study showing the ability of antisense PMOs targeting the DMD gene to improve muscle function in a large animal model, viltolarsen was developed by Nippon Shinyaku and the National Center of Neurology and Psychiatry in Japan. Following clinical trials conducted in Japan, Canada, and the United States showing significant improvements in muscle function, viltolarsen was approved for medical use in Japan in March 2020 and the United States in August 2020, respectively. Viltolarsen is a mutation-specific drug and will work for 8% of the persons with DMD who carry mutations amenable to exon 53 skipping. This review summarizes the pharmacological profile of viltolarsen, important clinical trials, and challenges, focusing on the contribution of Japanese patients and researchers in its development.

19.1 The Present State of Child and Adolescent Psychiatry in Japan

Asian Americans are known to be less likely to utilize mental health care. Although stigma is noted to be a barrier toward access to resources in Asian populations, we should pay more attention to how the country of heritage provides mental health care. This study focuses on Japan, investigating the current child and adolescent psychiatrists per youth population capita and its future projections. The Japanese board of child and adolescent psychiatry certifies by administering examinations to physicians credentialed through 4 academic societies. We calculated the number of board-eligible child and adolescent psychiatrists as the sum of credentialed physicians per society. We contacted the Japanese Society of Psychiatry and Neurology for statistical data on psychiatrists. We obtained other data from publicly available sources. We estimated the future psychiatry workforce and child and adolescent psychiatrists per capita of Japan’s youth population by Holt-Winters forecasting. We compared the number of child and adolescent psychiatrists and those per capita between Japan and the United States. The Japanese child and adolescent psychiatry board created in 2014 endorses 554 actively board-certified and 829 board-eligible physicians. Only 7.2% (829 of 11,539) of Japanese board-certified psychiatrists are board-eligible for child and adolescent psychiatry, compared to 24.2% (9956 of 41,133) of practicing US psychiatrists. The Japanese general psychiatry workforce in 2018 has increased by 167% since 1998. If child and adolescent psychiatry follows this trend, we predict a 4% to 6% annual growth of child and adolescent psychiatrists per youth population capita. Wait times were 3 to 6 months in nearly 50% of child and adolescent psychiatry institutions, according to a 2017 Japanese government study. Median wait times were 50 days in a 2015 US study. There is a lack of availability of child and adolescent psychiatrists. We assess the lack of child and adolescent psychiatrists overall and how increased median wait times contribute to stigma and low awareness in Japanese immigrants. More child and adolescent psychiatrists are needed worldwide to increase the utilization of child mental health care in those of Asian heritage.

Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study

BackgroundConsultation-liaison psychiatry (CLP)—professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders—was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region.MethodsWe retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates.ResultsData from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75–84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = − 0.220, p < 0.034), Chugoku (β = − 0.160, p < 0.026), and Shikoku (β = − 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274).ConclusionsOur study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.

Drug Treatment for Patients with Postoperative Delirium and Consultation-Liaison Psychiatry in Japan: A Retrospective Observational Study of a Nationwide Hospital Claims Database.

Delirium is the most commonly experienced disorder in consultation liaisons. There are currently research and guidelines in Japan for delirium treatment. Still, there is no retrospective observational study of consultation-liaison psychiatry (CLP) and antipsychotic-centered drugs. This study aims to examine CLP's effectiveness and drug treatment. Using a Japanese national inpatient database of 2016 and 2017, we investigated the presence or absence of CLP for the treatment of delirium in postoperative delirium patients, the status of drug selection, delirium days, and the average days from surgery to discharge. We examined factors affecting days from surgery to discharge using multiple linear regression analysis. This study was classified into a CLP group (n = 1,142) and a non-CLP group (n = 11,355). The days from surgery to discharge in the CLP and non-CLP groups was 16.7 and 17.1, respectively (p = 0.3613). There was a significant difference in the delirium days between the CLP and non-CLP groups (8.9 vs. 7.4; p < 0.00001). Haloperidol infusion was frequently used between the days from surgery to first day of delirium. It was prescribed less often than other oral drugs. Multiple regression analysis identified an association between age, men, CCI1-2, CCI ≥3, number of drugs used, days from surgery to first day of delirium, and early CLP (0-2days) with days from surgery to discharge. We investigated the effectiveness of CLP and the actual conditions of pharmacotherapy for postoperative delirium. Our findings suggest that early CLP may be associated with shorter days from surgery to discharge.

Application of Deep Brain Stimulation for Treatment-resistant Obsessive Compulsive Disorder: Current Status and Future Perspectives in Japan.

As in many Western countries, deep brain stimulation (DBS) is already being used daily in Japan to clinically treat neurological diseases such as Parkinson’s disease, essential tremor, and dystonia. Additionally, in both Europe and the United States, numerous case reports as well as multicenter randomized controlled trials have examined its use for treatment-refractory mental illnesses such as obsessive compulsive disorder (OCD) and major depressive disorder. Based on a number of the reports, the European Union (EU) and the USA Food and Drug Administration (FDA) granted limited approval of DBS for treatment-resistant OCD in 2009. Furthermore, a systematic review and meta-analysis in 2015 showed that DBS therapy for patients with treatment-resistant OCD had efficacy and was safe. Unlike the EU and the USA, DBS is not used to treat OCD or other psychiatric disorders in Japan, even though people with treatment-resistant OCD and their physicians and families urgently need additional treatments. This situation results from the “Resolution of total denial for psychosurgery,” which the Japanese Society of Psychiatry and Neurology adopted in 1975. We believe that the appropriateness of using DBS for treating psychiatric disorders including OCD should be considered after thorough discussion and consideration based on accurate and objective understanding. Currently, the field of psychiatry in Japan seems to lack scientific consideration as well as scientific understanding in this area. Under these circumstances, we hope that this review article will help psychiatrists and other relevant parties in Japan to gain an accurate and scientific understanding of DBS.

A Review of Eye Eye Nose Mouth and Reflections on the History of Art and Psychiatry in Japan

Creative Arts Educ Ther (2019) 5(1):25–32 DOI: 10.15212/CAET/2019/5/4 A Review of Eye Eye Nose Mouth and Reflections on the History of Art and Psychiatry in Japan “眼鼻嘴”评述及对日本艺术精神病学史的反思

Study protocol for a randomised controlled trial of cognitive processing therapy for post-traumatic stress disorder among Japanese patients: the Safety, Power, Intimacy, Esteem, Trust (SPINET) study

IntroductionCognitive processing therapy (CPT) is widely regarded as a safe and effective first-line treatment for individuals with post-traumatic stress disorder (PTSD); however, no comparative studies have been conducted to examine...

Disaster Psychiatric Assistance Team (DPAT): The Present Situation and Future Measures to Address Disaster Psychiatry in Japan

Disaster Psychiatric Assistance Team (DPAT): The Present Situation and Future Measures to Address Disaster Psychiatry in Japan

Current Challenges and Future Opportunities for Child and Adolescent Psychiatry in Japan.

Japan has been facing a serious shortfall of child and adolescent psychiatric workforce relative to increasing service needs. Likely because of a combination of limited workforce supply and limited trust or perception of effectiveness, mental health services are under-utilized by the educational and child welfare systems. Child and adolescent psychiatry (CAP) has not been a formally established specialty in Japan. The lack of basic structure in the specialty most likely contributes to a lack of training facilities, limited exposure to and interest in the specialty, and hence an inadequate workforce. To date, there exists no standardized training program for CAP in Japan and each training hospital determines its own teaching curriculum and training content. Clinical experience in CAP varies greatly among hospitals. To solve current problems in child and adolescent psychiatry in Japan, we advocate for the development and establishment of a more standardized child and adolescent psychiatry training system that is akin to what exists in the US and that teaches and evaluates according to specific competencies. Through standardizing care and education and ultimately improving workforce, the quality of mental health services can be raised. The tragic and costly consequences of unidentified and untreated mental illness in youth can be avoided by taking timely evidence based actions in partnership with others.

Some aspects of contributions of the information technology to psychiatry including social psychiatry in Japan

Some aspects of contributions of the information technology to psychiatry including social psychiatry in Japan

For Body, Mind and the Nation: An Archaeology of Modern Japanese Psychiatry

Abstract This paper reassesses the history of psychiatry in Japan through application of the theory of disciplinary power by Michel Foucault. The society of the early Meiji era (1868-1912) is defined as a disciplinary society within the scope of discourses on punishment and general social reforms. By focussing on a close reading of both canonical and marginalised fragments of psychiatric texts, this analysis reveals their constitutive character for the establishment of psychiatric discourses. These texts, rooted in biological psychiatry, are shown to stress the hazard that mental illness presented to the nation. Recourse to juridical problems, which derive from enacting a European model of law, provides an explanation for the necessity of psychiatry as a social institution. The key point is to identify a discursive break between two major legal acts dealing with the confinement of the mentally ill: the Mental Patients Custody Act of 1900 and the Mental Hospital Act of 1919. The first deals mainly with administrative issues, while the latter was formed under the influence of an emerging psychiatric power. The Mental Hospital Act refines the disciplinary network operating in the social space, while blurring the discursive fissure between traditional care and psychiatric techniques.

Genome‐wide association study of atypical psychosis

Atypical psychosis with a periodic course of exacerbation and features of major psychiatric disorders [schizophrenia (SZ) and bipolar disorder (BD)] has a long history in clinical psychiatry in Japan. Based upon the new criteria of atypical psychosis, a Genome-Wide Association Study (GWAS) was conducted to identify the risk gene or variants. The relationships between atypical psychosis, SZ and BD were then assessed using independent GWAS data. Forty-seven patients with solid criteria of atypical psychosis and 882 normal controls (NCs) were scanned using an Affymetrics 6.0 chip. GWAS SZ data (560 SZ cases and 548 NCs) and GWAS BD (107 cases with BD type 1 and 107 NCs) were compared using gene-based analysis. The most significant SNPs were detected around the CHN2/CPVL genes (rs245914, P = 1.6 × 10(-7)) , COL21A1 gene (rs12196860, P = 2.45 × 10(-7) ), and PYGL/TRIM9 genes (rs1959536, P = 7.73 × 10(-7) ), although none of the single-nucleotide polymorphisms exhibited genome-wide significance (P = 5 × 10(-8) ). One of the highest peaks was detected on the major histocompatibility complex region, where large SZ GWASs have previously disclosed an association. The gene-based analysis suggested significant enrichment between SZ and atypical psychosis (P = 0.01), but not BD. This study provides clues about the types of patient whose diagnosis lies between SZ and BD. Studies with larger samples are required to determine the causal variant.

Avoidant personality disorder

ABSTRACTIn this paper, we discuss avoidant personality disorder and its complexities by presenting a case in which the differential diagnosis was extremely difficult. The presented case concerns a patient, who initially received the diagnosis of ‘Taijin kyofusho’, a diagnosis commonly made in the traditional psychiatry in Japan, and later, his diagnosis was changed to avoidant personality disorder as the DSM‐III gained popularity. His chief complaint was his concern over his odour from his genitourinary organs, which led him to avoid interpersonal relationships. During the course of illness, his concern over his body odour and appearance grew to the extent that he sought surgical treatment, but he managed to succeed in his business. Currently, he is being treated with the medium dose of selective serotonin reuptake inhibitors in addition to psychotherapy, but his symptoms concerning interpersonal relationships still remain. Many symptoms other than typical ones of avoidant personality disorder were observed, and other psychiatric diagnoses, including delusional disorder, somatization disorder, and body dysmorphic disorder, were considered for differential diagnosis. Although they were ruled out in light of the criteria in the current diagnostic classification, this case illustrates the complex nature of the diagnosis of avoidant personality disorder, and furthermore, of psychiatric diagnoses. Copyright © 2012 John Wiley &amp; Sons, Ltd.