精神障害と治療

Abstract Introduction: Anger is a defensive mechanism for highly stressful and threatening situations and is considered as the most “negative” emotion, difficult to control and often combined to aggressive behavior. However, anger is just a secondary emotion and useful for the organism as a whole. The present study investigates, in presence of a humanistic experiential learning programme, anger as a personality trait that can be reduced, and its hidden power can be unleashed in order to proceed to active experimentation. This study is based on the hypothesis that anger is considered as an alarm signal indicating unmet needs. Results: Using the STPI instrument for measurements, a significant reduction of the mean personality trait scores for anger (p=0.029, N=35) after eight sessions of the programme has been observed. The mean scores reduction was higher (p=0.01, N=32) in participants who showed a higher mean score of anger (≥ 2) at the pre intervention measurements. Conclusion: This is a preliminary study showing that a short-term (eight sessions) humanistic experiential learning programme for anger may have a significant effect on the reduction of anger as a personality trait. Anger reduction is a result of lower subcortical activity, and opens the gate for the elaboration of beliefs into cortical areas of the brain. Cortical areas can offer a higher degree of freedom of choice and responsibility for more functional behaviours

Background: Posttraumatic stress disorder (PTSD) affects the quality of life of employees exposed to a workplace trauma. Cognitive behavioral therapy (CBT) is an effective treatment for PTSD. Less is known, however, about the effect of CBT for work-related PTSD on symptom reduction and QoL enhancement, and how those variables evolve throughout the therapy. Aim: This study aims to thoroughly monitor the evolution of symptoms and quality of life during and after CBT for work-related PTSD. METHODS: Forty-four participants completed structured interviews and questionnaires four times over the course of treatment (at pre-treatment, after the third session, after the ninth session, and posttreatment) and at follow-up (six months). The assessment of quality of life includes the level of current functioning, general quality of life, and work-related quality of life. CBT included 20 weekly individual sessions. Results: Our study showed that all outcomes improved significantly at post-treatment and improvements remained stable over the following six months. 69% of the participants no longer met the criteria for PTSD diagnosis, and half of the sample was able to return to work following psychotherapy. PTSD and QoL significantly improved following each CBT strategy until the end of therapy, and the variables appeared to change synchronously throughout the therapeutic process (i.e., no lagged effect). Conclusions: The findings suggest that work-related trauma victims can benefit from CBT for PTSD. The addition of specific strategies targeting quality of life in CBT for PTSD seems to be not essential for quality of life improvements, but clinicians should consider adding interventions focused on returning to work

Veterans suffering from psychological disorders that stem from combat is a problem that has not been appropriately or effectively addressed in the mental health professions. Posttraumatic Stress Disorder and Depression have consistently plagued returning combat veterans, and though mental health counseling is offered, current treatment modalities limit the scope of the therapeutic process. Mental Health Professionals have focused on Cognitive Behavioral Therapy and medication as sufficient treatment. This article suggests that while this may be a useful treatment modality for addressing symptoms it does not adequately help veterans to resolve the full trauma of combat.

This review aims to identify and correct several prevalent misunderstandings about mental health and mental disorders which are potentially damaging to society. Organized into themes around four myths about mental disorders, this discussion provides readers with helpful information and references to other useful readings to support their skepticism and critical thinking about psychopathology. The four myths identified here are that mental disorders are unimportant, are solely biomedical entities, are only treatable with medication or CBT, and are real. In each case, the author makes a reasoned argument to the contrary, culminating in a discussion about how mental disorders are actually not real, but are nevertheless very important considerations. Throughout the discussion several logical fallacies are introduced (e.g., confusing correlation with causation, the nominal fallacy, the reification fallacy), as well as brief historical notes on the field of psychology (e.g., varying treatment modalities, schools of thought around treatment impactfulness, and problems with language progression in research).

Stressed mice perseverate. Stressed humans perseverate. Freud described in what I had feel was his only true “science fiction thriller” – Beyond the Pleasure Principle – how traumatized patients perseverated, that is they persisted in repeating “un pleasure”. It is I think rather unlikely that the “Death Instinct” is at the etiologic root of these behaviors for either mice or for men. Rather it may be stress and neural circuits that favor the locus ceruleus, the amygdala, and the dorsal striatum. And in order to impact these pathways, it may be necessary to intervene at the moment of anxiety. This paper describes just such active interventions at moments of anxiety – interventions informed by psychotherapy but very much expanding the boundaries of where and how psychotherapy should be done. The work is described with two patients both of whom persisted in repeating “unpleasure”.

Little evaluation has been done on the psychomotor development of babies in cases of maternal psychiatric pathology in the first year. The Mother and Baby Unit (MBU) is a psychiatric hospital healthcare system available to infants and their mothers during the postpartum period.

Objectives: To determine emotional and behavioral problems among adolescents and to define risk factors for these emotional and behavioral problems. Methods: A cross-sectional study was conducted among selected and qualified middle and high school children, their parents and teachers. The “Strength and Difficulties Questionnaire“(SDQ) was employed with the intention to measure psychosocial problems and strengths [prosocial behavior] in children between the ages of 4-10 and adolescents ages 11-17, through a multi-informant methodology. The questionnaire consists of 25 items equally divided across five scales measuring: 1) emotional symptoms; 2) conduct problems; 3) hyperactivity-inattention; 4) peer problems; and 5) prosocial behavior. Except for the prosocial scale, the combined scale (Total Score) reflects total difficulties, indicating the severity and content of the psychosocial problems. The prosocial scale indicates the amount of prosocial characteristics a child displays. Results: In the SDQ questionnaires answered by parents, we obtained the following scores: 27.4% for emotional symptoms, 28.2% for conduct disorders, 20.4% for hyperactivity, 81.4% for interpersonal relationships, and 43.3% as the Total Score. In the SDQ questionnaires answered by teachers, we obtained high scorings such as 8.9% for emotional symptoms, 20.2% for conduct disorders, 13.4% for hyperactivity, 47.6% for interpersonal relationships, and a Total Score of 33.4%. In the SDQ questionnaires answered by the adolescents themselves, we obtained scorings such as: 10.0% for emotional symptoms, 10.2% for conduct disorders, 18.8% for hyperactivity, 14.6% for interpersonal relationships, and 16.3% as the Total Score. Conclusion: Mongolian adolescents have emotional and behavioral problems as confirmed by the Total Scores of parents 43.3%, by teachers 33.4% and self-reports 16.3%. The SDQ confirmed that an adolescent’s age, gender, family environment and living areas will influence their emotional and behavioral well-being.

We present a case of a 59-year-old woman with bipolar affective disorder and idiopathic calcium accumulation in the basal ganglia (lenticular nuclei). Her physical and neurological examinations were without clinically significant abnormalities. Neuropsychological assessment shows mild cognitive deficit. Clinical and laboratory data meet the diagnostic criteria for Fahr’s disease. Discussions were held about the relationship between calcification of basal ganglia and the occurrence of the bipolar disorder.

The prevalence of Autism Spectrum disorder has been increased rapidly worldwide in last few years. However most of the estimation comes from developed regions of western countries. There are no reliable and consistent data from non-western or non-affluent countries.
Aim: The primary aim of this systematic review was to synthesise the results of wide range of epidemiological studies to estimate prevalence of ASD with respect to gender and socio-economic status (SES). Secondarily, available studies were analyzed with identified themes for assessing the trend of these studies.
Methods: Based on pre-defined inclusion and exclusion criteria epidemiological reports were identified by internet search and recent relevant papers were included (2005-2015).
Results: 27 eligible studies were identified for review of which 22 estimated Autism spectrum Disorder (ASD) or Pervasive developmental disorder (PDD) and 4 concentrated on typical Autism. Most of the studies used special educational and mainstream school records (N=11) for data extraction. Overall mean age of study samples ranged between ages 2-17 years. International classification of disabilities (ICD)-9 and 10 criteria as well as Diagnostic Statistical Manual (DSM)-III and IV criteria were retained for diagnostic assessment. The average prevalence of these twenty seven studies was 91.92 per 10,000 populations. The reported prevalence of ASD varied substantially by country and continent, use of methodology, assessment tools, gender, geographic region and Socioeconomic status (SES).
Conclusion: Recent studies provided higher estimation and prevalence rate in developed or much affluent countries as well as urban areas. Also Parental high SES was found positively associated with prevalence of ASD. Analyses suggest more strong instruments and awareness is needed. Also more population based investigations is needed in rural as well as developing countries for revealing clear picture of this disability.