KONISHI TAKAKO

2012年6月〜2018年11月末の間にワンストップ支援センターからの紹介により精神科初心となった患者70名のカルテをもとに、対象者の属性、被害関連事項、診察および治療関連事項等の情報を収集し分析した。初診時平均年齢26.8±8.7、主診断がASDあるいはPTSD74.5％（52名）であった。CBT導入群34名と非導入群36名は、初心時年齢、種診断名、薬物療法のうむ、治療転帰において有意差があった。ASD、PTSD罹患率は前回報告と同様に高かった。ワンストップ支援センターから紹介される性暴力被害者の介入において、治療中断を防ぐことの重要性が示唆された。

国内29の「性犯罪・性暴力被害者のためのワンストップ支援センター」を対象に、被害者の精神科医療機関等への紹介を中心に連携の実態と、連携促進に資する取組について分析した。紹介件数年間10件以上の機関は9件以下の機関に比べ、スーパーヴァイズの依頼、紹介事例のカンファレンスの取り組みが有意に多かった。精神科医療機関等の利用促進にはセンターと医療機関等が事例を通した協力関係を構築することが重要である。

配偶者をがんで亡くした女性9名を対象に、半構造化面接を用いて、がん発病から現在までの心理について語りを得た。闘病期間1年未満と1年以上の2群に分けて分析を行った。1年未満群では死別への準備ができず、悲嘆のプロセスが阻害されていることが示唆された。早い段階から家族の死別への準備を支援する必要があると考えられる。

Background: Common mental disorders (CMD) during pregnancy can have a clearly harmful influence on both mothers and children. Some studies have reported related factors for mental disorders, such as region-specific background. This study examined the prevalence of CMD and its related factors in mid-pregnancy in Japan. Methods: Pregnant women between 12 and 24 weeks gestation and aged >= 20 years were consecutively recruited at a maternity hospital in Japan between May 2014 and September 2014. CMD were diagnosed using the Mini-International Neuropsychiatric Interview (MINI), self-rated depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale, and interpersonal traumatic experience was measured using the Life Events Checklist. Results: Among 297 eligible pregnant women, 177 participated in the study. Two participants (1.1 %) met the criteria for major depressive disorder. The most frequent diagnosis was agoraphobia (n = 7; 3.9 %). Eleven participants (6.2 %) met the criteria for one or more diagnoses, with 2 participants having two mental disorders and 3 having three mental disorders. Six participants developed CMD after gestation. Logistic regression analysis revealed history of psychiatric disorder, past interpersonal traumatic experience, and feeling pressure to have a child were associated with CMD. Conclusion: These findings indicate a lower prevalence of CMD in mid-pregnancy in Japan than reported in most other countries. Besides the related factors reported previously, feeling pressure to have a child might increase risk for CMD among pregnant women in Japan. Asian cultural background might be related to the lower CMD prevalence and risk factors identified in this study.

2010〜2013年の4年間における武蔵野大学心理臨床センター来談者のデータベース情報を元にカルテ調査研究を行い、来談者の傾向とその治療転帰を検討した。新規ケース総件数282件のうちトラウマ体験のある来談者は約56％、また、新規ケースの64％が医療機関・公共の専門機関等から紹介を受けて来談していた。トラウマ体験を持つ来談者は年々増えている。また、同一の医療機関や公共専門機関からの紹介は繰り返し行われることが多く、協力体制が整いつつあることを示していると考えられる。センターにおいて、今後はトラウマ体験に対して専門的技能を持った相談員の維持と育成が望まれる。<br /> （平成22〜24年度学院特別研究研究費助成「心理臨床センターにおける臨床記録のデータベース化およびデータベースを使用した被害者支援の研究」）

DV被害者女性5名にに対し半構造化面接を行い、逐語データを質的分析方法である修正版グラウンデッド・セオリー・アプローチによって分析した。その結果、調停や裁判の遂行あるいは心理的支援参加の動機付けを高める要因として、本人および他者からの「症状・困難さの理解」が示され、現実場面に即した「心理教育」の重要性が見いだされた。心理的支援の一環として調停や裁判関連の段階的な「情報のインプット」と、手続きや出来事に伴う「感情のアウトプット」を繰り返すことで「馴化」が起こり、「不安・恐怖感の現象」や「客観的視点の獲得」がもたらされ、「自己肯定感の回復」や「達成感」へとつながったことが示された。DV被害者が調停あるいは裁判手続きを行うにあたって、司法領域からの支援のみならずトラウマ反応に対する心理教育など心理的支援の必要性が示唆された。

Patients who have experienced traumatic events such as violence or traffic accidents are often involved with judiciary processes during their treatment. The worsening of symptoms, which can be triggered by the judicial process, is pointed out in cases of patients with PTSD or other mental disorders. Using psychological techniques, the authors provided mental health support to five victims of domestic violence who had not been able to participate in the judicial process. In this study, we investigated the difficulties the victims experienced during the judicial process and the effects of the mental health support. Most of the difficulties that the victims had experienced during the judicial process could be relevant to symptoms such as fear reaction or PTSD. It was suggested that the symptoms could be one of the factors disturbing the victims from adequately participating in judicial proceedings. It was also suggested that the mental support was effective to the patients who were not able to sufficiently exercise their rights due to the symptoms, making it possible for them to exercise their rights through reception of mental health support.

Violent death, such as homicide, accident, and suicide, is sudden, unexpected, and caused by intentional power. The prevalence of complicated grief among those bereaved by violent death is 12.5% to 78.0%. The factors affecting this prevalence rate are considered to be comorbid mental disorders, lack of readiness for the death, difficulty in making sense of the death, high level of negative appraisal about the self and others, and various social stressors. Post-traumatic stress disorder is, in particular, considered to contribute to the development of complicated grief by suppressing function of the medial prefrontal cortex and the anterior cingulate cortex, which works at facilitating the normal mourning process. An understanding of the mechanism and biological basis of complicated grief by violent death will be helpful in developing effective preventive intervention and treatment. © 2012, LLS SAS.

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. Depression and Anxiety 28:103-117, 2011. (C) 2011 Wiley-Liss, Inc.

The present study was a 52-week, non-comparative, open-label study of flexible dose paroxetine (20-40 mg) in 52 Japanese post-traumatic stress disorder (PTSD) patients in order to obtain clinical experience regarding efficacy and safety in regular clinical practice. Efficacy was measured using the Clinician-Administered PTSD Scale One Week Symptom Status Version (CAPS-SX). The mean change from baseline in CAPS-SX total score was -19.1, -22.8 and -32.3 at weeks 4, 12 and 52, respectively, and that in the Clinical Global Impression (CGI) Severity of Illness score was -1.1 at week 12 and -1.7 at week 52. A total of 46.9% were CGI responders at week 12, while 67.3% were improved on the CGI at week 52. Of 52 subjects who entered into the drug treatment, 25 completed the study. Only one patient withdrew from the study due to lack of efficacy. In patients who were rated as &apos;moderately ill&apos; or less at baseline, the proportion of CGI responders at end-point was higher at a dose of 20 mg/day than at higher doses, whereas in patients rated as &apos;markedly ill&apos; or more, it was higher at 30 and 40 mg/day, suggesting that severely ill patients could benefit from higher doses. Paroxetine appeared generally tolerated in short- and long-term use, and the safety profile in this study was consistent with international trials and other Japanese populations (i.e. patients suffering from depression, panic disorder or obsessive-compulsive disorder). Although the study was not conducted in double-blind fashion, the current findings suggest that paroxetine may contribute to clinically meaningful improvement that is maintained during long-term use and is generally well tolerated.

Background: Past traumatic experiences have been reported to lower stress tolerance, thereby increasing job strain. However, the relationship between past traumatic experiences and employee sickness absence is poorly understood. Aims: This study explores the relationship between sickness absence and past traumatic experience with regard to the amount of time lapsed after the experience, job strain and other mental health states such as depression and anxiety. Methods: A total of 3238 workers were assessed for levels of traumatic stress, depressive status, anxiety and job stress. Results: Odds ratios of the presence of traumatic experiences to sickness absence, adjusted for sex, age and depressive and anxiety states, were presented according to the length of time that had passed since the traumatic events. The odds ratio in the 0-1 Years Group was 1.75 (p &lt; 0.05), and the odds ratio for the 19+ Years Group was 1.46 (p &lt; 0.1). Conclusions: Past traumatic events are related to sickness absence. Sickness absence resulting from a past traumatic experience is important with respect to industrial health.

無作為抽出された日本全国の消防職員1,914名を対象に職務上の体験がもたらす急性ストレス反応を検討し、PTSDの発症を予測しうる急性ストレス反応の測定尺度「PTSD予防チェックリスト」の作成を試みた。

看護職の中でも直接的・間接的に外傷性ストレスを被るおそれのある救急領域の看護師を対象に、外傷性ストレスならびに精神健康状態の実態把握を行い、その関連要因について検討した。予備調査として、三次救急医療に従事する看護師11例に面接調査を、45例に質問紙調査を行った。その後、三次救急医療に従事する看護師195例を対象に本調査を実施した。96.1%が職務上で衝撃的な出来事に遭遇し、中でも子どもの死が最も衝撃的な出来事として認識されていた。16.9%がIES-RによるPTSDハイリスク群に該当し、62.3%がGHQ12で精神健康度の低い状態にあった。職場での評価的サポートは外傷性ストレスの低減、精神健康悪化の防止に有用であることが示唆された。

平成12年7月に精神科医を対象に行った夏季セミナー講演録。犯罪被害者と医療的な関わりを持つ際に重要となる解離やPTSDなどの概念、診断、治療について解説した。

Objectives: There is disagreement over the roles of biological and psyche-social factors in the prolongation of whiplash symptoms. The issue of whether differences in recovery time result from differences in the severity of physical injury or from non-physiological social variables, such as insurance compensation, remains unresolved. We examined, for one year, the circumstances of Japanese receiving treatment who had been in rear-end collisions during a specified time period, and were presumed to have whiplash injuries. Methods: Subjects were 6,167 adults over 20 years of age who had been examined at an emergency center or a general hospital for symptoms such as neck pain presumed to be the result of cervical hyperextension caused by rear-end collision. No abnormalities were detected by neurological examinations, nor by X-rays. Data collected included the following items: gender, age, area of residence, date of accident, date of initial examination, occupation, seat belt use, whether they were driver or passenger, awareness of impending collision, behavior after accident, method of transportation to initial examination, whether there was loss of consciousness, and duration of medical treatment. We calculated the odds-ratios [OR] of those who continued to receive treatment and those who did not at 1.5 months, 3 months, and 6 months post-trauma. Results: Factors such as: female gender, use of emergency vehicle transportation, and early complaint of symptoms were significantly correlated with persistence of symptoms at six months posttrauma, while employment status had no significant association with continued treatment. Conclusions: Our results suggest that although both biological and social factors increased the probability of short- and medium-term prolongation [1.5 months and 3 months], the biological variables were mainly found to influence long-term prolongation of whiplash symptoms [6 months].