中島 聡美

Background: The mental health community in Japan had started reviewing the country's disaster mental health guidelines before the Great East Japan Earthquake, aiming to revise them based on evidence and experience accumulated in the last decade. Given the wealth of experience and knowledge acquired in the field by many Japanese mental health professionals, we decided to develop the guidelines through systematic consensus building and selected the Delphi method. Methods: After a thorough literature review and focus group interviews, 96 items regarding disaster mental health were included in Delphi Round 1. Of 100 mental health professionals experienced in disaster response who were invited to participate, 97 agreed. The appropriateness of each statement was assessed by the participants using a Likert scale (1: extremely inappropriate, 9: very appropriate) and providing free comments in three rounds. Consensus by experts was defined as an average score of >= 7 for which >= 70% of participants assigned this score, and items reaching consensus were included in the final guidelines. Results: Overall, of the 96 items (89 initially asked and 7 added items), 77 items were agreed on (46 items in Round 1, and 19 positive and 12 negative agreed on items in Round 2). In Round 2, three statements with which participants agreed most strongly were: 1) A protocol for emergency work structure and information flow should be prepared in normal times; 2) The mental health team should attend regular meetings on health and medicine to exchange information; and 3) Generally, it is recommended not to ask disaster survivors about psychological problems at the initial response but ask about their present worries and physical condition. Three statements with which the participants disagreed most strongly in this round were: 1) Individuals should be encouraged to provide detailed accounts of their experiences; 2) Individuals should be provided with education if they are interested in receiving it; and 3) Bad news should be withheld from distressed individuals for fear of causing more upset. Conclusions: Most items which achieved agreement in Round 1 were statements described in previous guidelines or publications, or statements regarding the basic attitude of human service providers. The revised guidelines were thus developed based on the collective wisdom drawn from Japanese practitioners' experience while also considering the similarities and differences from the international standards.

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.

Background: Complicated grief, which is often under-recognized and under-treated, can lead to substantial impairment in functioning. The Brief Grief Questionnaire (BGQ) is a 5-item self-report or interview instrument for screening complicated grief. Although investigations with help-seeking samples suggest that the BGQ is valid and reliable, it has not been validated in a broader population. Methodology/Principal Findings: A questionnaire was mailed to a randomly selected sample (n = 5000) residing in one of 4 areas of Japan. The BCQ was examined for responders who were bereaved more than 6 months and less than 10 years (n = 915). Non-specific psychological distress was assessed with the K6 screening scale. Multiple group confirmatory factor analysis supported a uni-dimensional factor structure and the invariance of parameters across gender and age. Cronbach's alpha was sufficiently high (alpha = .75) to confirm internal consistency. Average Variance Extracted (0.39) was higher than the shared covariance (0.14) between BGQ and K6, suggesting discriminant validity. Conclusions: The results of this study support the reliability and validity of the BGQ in the Japanese population. Future studies should examine predictive validity by using structured interviews or more detailed scales for complicated grief.

Background: The present research investigated whether the relationship between alexithymia and complicated grief was different from the relationship between alexithymia and general depressive symptom according to the seriousness of complicated grief in the Japanese general population. Methods: In the Japanese general population sample, 948 participants between 40 and 79 years old (effective response rate, 48.0%) completed a cross-sectional anonymous questionnaire about alexithymia, depression, and complicated grief. To compare the high risk (n = 243) and low risk (n = 705) of complicated grief groups, simultaneous analysis of two groups with standard maximum likelihood estimation was performed and six hypothesized models were verified. Results: The model (RMSEA = 0.047, AIC = 71.520) that showed that the path coefficients of the latent variable of alexithymia to the observed variables were equal and that the path coefficient of alexithymia to psychological distress was equal was adopted. The contribution ratios from alexithymia to complicated grief were apparently smaller (2-4%) than those to depression (37-38%). Conclusions: Our findings showed that alexithymia scarcely contributed to complicated grief compared to depression and that the contribution ratio in the high risk group was lower than that in the low risk group. The contribution of the latent variable of psychological distress to complicated grief and depression was lower in the high risk group than in the low risk group. The lack of a correlation between alexithymia and complicated grief might indicate that there are different mechanisms underlying the symptoms of alexithymia and complicated grief. (C) 2011 Elsevier B.V. All rights reserved.

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.

Cognitive therapy/cognitive behavior therapy was introduced into the field of psychiatry in the late 1980s in Japan, and the Japanese Association for Cognitive Therapy (JACT), founded in 2004, now has more than 1500 members. Along with such progress, awareness of the effectiveness of cognitive therapy/cognitive behavioral therapy has spread, not only among professionals and academics but also to the public. The Study Group of the Procedures and Effectiveness of Psychotherapy, funded by the Ministry of Health, Labor and Welfare, has conducted a series of studies on the effectiveness of cognitive therapy/cognitive behavior therapy since 2006 and shown that it is feasible for Japanese patients. As a result, in April 2010 cognitive therapy/cognitive behavior therapy for mood disorders was added to the national health insurance scheme in Japan. This marked a milestone in Japan's psychiatric care, where pharmacotherapy has historically been more common. In this article the authors review research on cognitive therapy/cognitive behavior therapy in Japan.

Background: Few epidemiological studies have examined complicated grief in the general population, especially in Asian countries. Therefore, this study aimed to explore the prevalence and predictors of complicated grief among community dwelling individuals in Japan. Methods: A questionnaire survey regarding grief and related issues was conducted on community dwelling individuals aged 40-79 who were randomly sampled from census tracts. Complicated grief was assessed using the Brief Grief Questionnaire. Stepwise logistic regression analysis was conducted in order to identify predictors of complicated grief. Results: Data from 969 responses (response rate, 39.9%) were subjected to analysis. The analysis revealed 22 (2.4%) respondents with complicated grief and 272 (22.7%) with subthreshold complicated grief. Respondents who were found to be at a higher risk for developing complicated grief had lost their spouse, lost a loved one unexpectedly, lost a loved one due to stroke or cardiac disease, lost a loved one at a hospice, care facility or at home, or spent time with the deceased everyday in the last week of life. Limitations: limitations of this study include the small sample size, the use of self-administered questionnaire, and the fact that the diagnoses of complicated grief were not based on robust diagnostic criteria. Conclusions: The point prevalence of complicated grief within 10 years of bereavement was 2.4%. Complicated grief was maintained without significant decrease up to 10 years after bereavement. When subthreshold complicated grief is included, the prevalence of complicated grief boosts up to a quarter of the sample, therefore, routine screening for complicated grief among the bereaved is desired. Clinicians should pay particular attention to the bereaved families with abovementioned risk factors in order to identify people at risk for future development of complicated grief. (C) 2010 Elsevier B.V. All rights reserved.

Background The Tachikawa cohort of motor vehicle accident (TCOM) Study has been carried out in Tokyo since 2004. This study examined the association of medical and psychosocial variables evaluated shortly after admission to the acute critical care center with long-term psychiatric morbidity risk in patients with accidental injuries. Methods Between May 2004 and January 2008, patients with accidental injury consecutively admitted were recruited to the TCOM Study. Psychiatric morbidity as a primary endpoint was measured using a structured clinical interview at 1, 6, 18 and 36 months after involvement in a motor vehicle accident (MVA). The baseline investigation consisted of self-administered questionnaires concerning acute psychological responses and personality. Medical information was obtained from patients' medical charts. Various socio-demographic data, health-related habits and psychosocial factors were assessed by interview. To examine potential biomarkers of psychological distress, blood samples were collected. Results Out of 344 patients who were asked to participate in this study, 300 (87%) patients with MVA-related injury were enrolled. Corresponding rates for the questionnaires on psychological responses and blood sampling were 98-99 and 79%, respectively. The cohort sample was composed of 78% men; the median age was 34 years; and 45% of the participants were motorcycle drivers. Conclusions The TCOM Study should prove useful for researchers examining the association between bio-psychosocial variables and psychological distress and may contribute to the formation of a framework for providing care for patients with MVA-related injury.

It has been reported that mycelia of the Cordyceps sinensis (CS) can function as an immunostimulant. However, the active constituents of the mycelia are not well known. In this study, we investigated which components of the mycelia of CS induce monocyte activation and then structurally analyzed the active components. Assay of the effect of crude-(CS-P), soluble-(CS-Ps) and insoluble-(CS-Pp), polysaccharides extracted from the mycelia of CS, on macrophage production of TNF-alpha, indicated that CS-Pp enhanced TNF-alpha production to the highest extent. Furthermore, Structural analyses demonstrated that CS-Pp is a 1,3-beta-D-glucan contained some 1,6-branched chains and the mean particle diameter is 1.5 mu m. (C) 2009 Elsevier B.V. All rights reserved.

The aim of the present study was to investigate the development of, prediction of, protection against, and the course of psychological distress and well-being in a sample of patients with motor vehicle accident-related injuries, in a cohort study. In a secondary analysis, the question of whether psychiatric morbidity was associated with quality of life in 95 injured patients after motor vehicle accident at 1-month follow up, was investigated. Results indicated that psychiatric morbidity has an adverse effect on quality of life.

In longitudinal studies of traumatic stress, it is particularly important to examine the data for any differences between those who drop out and those who continue to participate, because reluctance to participate might reflect symptoms of avoidance frequently seen in posttraumatic stress disorder (PTSD). However, whether those who drop out are at high risk of PTSD remains unclear. Over a 25-month period, 188 consecutive patients with motor vehicle accident (MVA)-related injuries admitted emergently were enrolled and followed for 4 to 6 weeks. Baseline characteristics were compared between subjects who did and did not participate in the follow-up study. At 4 to 6 weeks, 66 (35.1%) of the participants had dropped out. Bivariate analyses revealed that those who dropped out were likely to be men, alcohol drinkers, smokers, and unconscious just after MVA and to have fewer years of education, less severe injuries, less posttraumatic symptoms, and lower cooperativeness as assessed by the Temperament and Character Inventory. Logistic regression analysis revealed that male sex, unconsciousness during MVA, low cooperativeness, and less severe injuries were significant predictors of dropout. The literature says that male sex and unconsciousness just after MVA might be protective factors against MVA-related PTSD, whereas low cooperativeness is a risk factor for general mental problems. To summarize, it is expected that those who drop from the follow-up are unlikely to have MVA-related PTSD, but might have mental problems independent of injury. (C) 2008 Elsevier Inc. All rights reserved.