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Patients with schizophrenia face several difficulties in their daily social life owing to the impairment of social cognitive ability. However, the neural basis of this impairment has not been fully clarified. We attempted to identify the neuronal basis of social dysfunction of schizophrenia by focusing on the thalamus, which is a subcortical structure. We have shown that right thalamic volume, as well as white matter integrity between the right thalamus and right frontal lobe, is associated with the social function of patients with schizophrenia, by using T1-weighted magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) data. These findings suggested that neural network abnormalities between the thalamus and the frontal lobe can be related to social dysfunction in patients with schizophrenia. Thus, these findings may contribute to the development of new treatments for schizophrenia.

22q11.2 deletion syndrome (22q11.2 DS) is characterized by cardiac defects, abnormal facial features, thymic hypoplasia, cleft palate, and hypocalcemia, including DiGeorge syndrome (DGS), velocardiofacial syndrome (VCFS), and conotruncal anomaly face (CTAF) syndrome. Psychiatric symptoms were recently shown to be very common in patients with 22q11.2 DS, prompting greater interest in this syndrome. Early diagnosis during childhood based on a con- stellation of physical features is optimal ; however, as some patients remain undiagnosed until the presentation of other symptoms in adult life, psychiatrists are well advised to familiarize themselves with basic information concerning 22q11.2 DS. A 25-year-old woman presenting with auditory hallucinations was referred to A hospital for examination and treatment. Her family history revealed both paternal and maternal rela- tives with schizophrenia. At birth, she presented a cleft palate and ventricular septum defect. She first became ambulatory at age 4 and became verbal a year later. Her intelligence quotient was estimated at around 40 and mental retardation (DSM-IV) with autistic features was diag- nosed at age 7. After graduating from a special high school, she obtained fulltime employment in a workshop. However, auditory hallucinations began disrupting her life from 22 years of age. Although olanzapine temporarily alleviated her symptoms, the resultant extrapyramidal symp- toms worsened and she was referred to A hospital again at age 25. The patient presented with micrognathia and a flat nasal root and spoke a maximum of 3 words per sentence in a very high and indistinct tone. A cardiac defect (ventricular septal defect), scoliosis, and low platelets were also observed. The diagnosis of 22qll.2 DS was confirmed using fluorescence in situ hybridization (FISH). The patient and her family were subsequently introduced to a 22q11.2 DS patients' support group. Careful genetic counseling is paramount, but the diagnosis of 22q11.2 DS can make updated information, official aid, and access to support groups available to patients and their family. Emergency complications such as seizures due to hypocalcemia can also be anticipated. The comparatively late diagnosis of 22q11.2 DS in our patient, which went undetected until the presentation of auditory hallucinations, in the context of mental retardation with autis- tic features (DSM-IV) underscores the importance of detailed clinical observation. "One rare variant" possibly points out the essence of psychiatric pathophysiology. Moreover, 22q11.2 DS has been listed as an intractable disease in Japan since 2015. When patients present with neurodevelopmental disorders and schizophrenic symptoms, we should carefully observe their physical features for clues to the possible diagnosis of 22q11.2 DS.

While objectively measurable outcomes have been emphasized in modern psychiatry, sub- jective or patient-reported outcome measures have attracted renewed interest recently. This trend coincides with the advent of the concept of "personal recovery". We psychiatrists may have become too accustomed to institutionalized care and academic frameworks of psychopa- thology and biological psychiatry and, thus, be so incapable of maintaining an insight into the patient's life in the real-world that we might share a medically biased misunderstanding of the concept. Our task here is to scientifically clarify the construct of the concept of personal recovery in order to optimize clinical services and professional education so that they are recovery- oriented.

The roles of university hospital psychiatric departments are: 1) the development and pro- vision of advanced psychiatric treatments unique to university hospitals, 2) the provision of psychiatric intervention models for patients with physical diseases, and 3)the provision of real- world environments for young psychiatrists to learn the principles and experience the practice of such innovative care. As for 1), our facility offers a hospitalization for examination program, which uses near-infrared spectroscopy as a biomarker useful for the auxiliary diagnosis of psy- chiatric disease and selection of the treatment method. University psychiatric departments also play a major role in neuropsychiatry, such as through the use of Epilepsy Monitoring Units (EMU) to differentiate between epilepsy and psychogenic non-epileptic seizures (PNES). Additionally, hospitalizations for examination programs are being implemented for psychosocial and employment support for psychiatric patients, and the diagnosis and evaluation of develop- mental disorders. With regard to 2), our facility has a psychiatric liaison-consultation team. In addition to providing consultation for all departments on delirium, anxiety, and depression, they are actively committed to various transplant treatments. There is also a strong cooperative relationship between the critical care center and psychiatric department. Of the patients hospi- talized for physical conditions and emergencies, over ten percent require psychiatric support, and without the psychiatric department, many patients with severe physical diseases cannot be treated. As such, the medical fees for psychiatric departments in universities and general hospitals should be evaluated appropriately. We would like to propose an "Advanced Psychiat- ric Treatment Development Management Center" (tentative name) to manage the following cycle : a) every university psychiatric department will develop and offer model projects utiliz- ing their respective expertise and specialties ; b) after collecting information on best practices, they will establish evidence through multicenter research, Diagnosis Procedure Combination (DPC) data, and others ; c) they will progress to advanced medical treatments and insurance coverage ; and d) they will continue to improve quality. Finally, I emphasize the role of univer- sity psychiatric departments as the center of education where young psychiatrists learn the principles and experience the practice of such an advanced care model, which will innovate and reform future mental health care.

The discipline of psychiatry promotes well-being and recovery based on a comprehensive understanding of the patient from the perspectives of the brain, real-world, and life-course. Pursuant to efforts toward addressing social issues at a regional and national level, it is assumed that the psychiatrist can assist individuals based on an understanding of these three perspectives. This tripartite relationship goes beyond the history of extreme reductionism in neuroscience and the aftermath resulting from the anti-psychiatry movement to provide a foundation for the development of psychiatry and a theoretical groundwork for such basic psychiatric issues as what role pharmacotherapy plays in psychiatric treatment, just why the lives of people living in the community are thought to be important to an individual's well-being, and just what constitutes recovery. Humans have come to possess highly developed brain and mental functions as a result of the adaptation to the social environment that takes place as part of the evolutionary process. While mental functions are thus dictated in large part by evolution of the brain, they also consist of important features that are not attributable to reductionist models of the brain. That is, human mental functioning forms a foundation for metacognition and sophisticated language functions, and through interactions with others and society, one's mental functioning allows for further brain transformation and development (self-regulation of mental functions). Humans develop their own brain and mental functions through mutual exchanges with others, and their dealings with other people and society form their individual modes of living in the real-world. The human brain and mental functions have evolved in such a way as to provide for a better mode of living. Accordingly, for the individual, the makeup of his or her mode of living in the real-world is the source of the well-being that serves to support that individual's values. The scientific background that the human recovery process for those suffering from mental disease involves the combined support of work, school, marriage, and childrearing stems from this fact. Humans develop their own mental capital over their life-courses and utilize it in an effort to realize their well-beings. Humans utilize mental function self-regulation based on the emotional and interpersonal functions developed during childhood in order to formulate an image of themselves (the ego) as well as the type of person they want to become (values/needs). This is indeed the true essence of adolescence. The values that drive an individual's behavior by their very nature exist in the outside world and are shared by others as well as society. These are internalized as individual characteristics through the self-regulation process of adolescence. Regardless of life stage or type of mental illness, individual reflection, verbalization, and reorganization of adolescent ego and values formation are essential to the recovery process. Humans are born with both bodies and brains, and throughout the courses of their lives, they formulate and develop values. Based on an understanding of the tripartite relationship between the brain, real-world, and life courses, it can be argued that the supporting of individual values is the scientific basis for the so-called "patient-centered care" and "needs-based support" that serve as a psychiatrist's essential capabilities. Along with the patient's recovery, which is based on this values-based psychiatry, professional growth is the privilege enjoyed by those in the psychiatric field. Beginning with a foundation based on assisted recovery at the individual level, the psychiatrist can produce mental health changes at the regional level. The psychiatrist consequently possesses the national-level vision necessary to implement a community design model that combines mental health and preventive medicine.

The Department of Neuropsychiatry of Tokyo University continues to support mental health care in Higashi-Matsushima City, Miyagi, Japan. We participate in mental care from the acute to the chronic phase. We also provide mental care for children. In this paper, we summarize our activities during the two years since the disaster. We also state our views on management in disaster care.

The patients with schizophrenia suffer from a lot of severe symptoms; positive symptoms, negative symptoms and cognitive impairment. However, the pathophysiology remains almost unknown, and no curative therapy is available for the patients. Thus, the elucidation of the pathophysiology and development of curative therapy are imperative. Epigenetics is a promising approach in that it can explain the environmental effects as well as gene-environmental interaction. Here, we review the recent progress of epigenetic studies in relation to schizophrenia and discuss the limitation of previous studies. Epigenetic studies applying the recent progress of genomics and neuroscience will contribute to better understanding of schizophrenia pathophysiology and the development of therapeutic strategy.

Not only physical but also mental health is the wish of every individual, and this is a fundamental human right as a citizen. Rather than the pursuit of economic wealth, the future goal of society should consist of improving each individual's mental "capital" in the different stages of life, which will ultimately lead to an increase in the level of mental wealth in society as a whole. The disability-adjusted life years (DALYs) of psychiatric disorders have outweighed diseases such as cancers and cardiovascular disorders, and the early detection and prevention of psychiatric disorders has become a top-priority issue. We, psychiatrists, are thus professionals markedly responsible for public wealth. Psychiatric disorders and a person with a disorder should be understood from pluralistic perspectives; universality as a brain disorder and, on the other hand, individuality as a person who lives a personal life in pursuit of personal values. Here, I redefine psychiatry as medical science of the brain, mind, and social life, where a balanced model between medical treatment in academia and social support in the community may constitute a new way of working (NWW) for psychiatrists. It is time to launch NWW for young psychiatrists to make a true difference for individuals with psychiatric disorders. To do so, they need to achieve a deeper understanding of developmental processes of establishing self and values, and the significance of living in the community and employment for human beings.

Schizophrenia is associated with enormous morbidity, mortality, personal disability, and social cost. Although considerable research on schizophrenia has been performed, the etiology of this disease has not been fully elucidated. In recent years, imaging and genetic technologies have been developed dramatically. Disturbances in glutamate and GABAergic neurotransmission may underlie the pathophysiology of schizophrenia. We attempted an integrative review, of studies pertaining to recent advances of schizophrenia research with a focus on neuroimaging and genetic studies. Additionally, we present the preliminary findings of the clinical research in our outpatient unit, specialized for early intervention, at the University of Tokyo Hospital.

The editorial of the new-year issue of Nature 2010 features "A decade for psychiatric disorders". The DALY estimation clearly shows that psychiatric disorders are the top source for burden of diseases to the individual life and society. Schizophrenia is a most devastating psychiatric disorder in which the onset is usually at youth and the cognitive dysfunction persists for life-long in some patients. Schizophrenia is associated with neurodevelopmental abnormalities. It has been unknown whether post-onset progressive pathology is also present in schizophrenia until the recent sophistication of in vivo neuroimaging techniques. Longitudinal neuroimaging studies on first-episode schizophrenia have shown a progressive deterioration of structure and function of neocortical regions in the early stage of the disorder. Insult to dendritic spines through glutamatergic dysfunction may underlie this process, which may in turn be a promising molecular target for intervention to improve the functional outcome of schizophrenia. More recently, the question of whether early intervention can be targeted at prodromal stage of schizophrenia has called special attention in psychiatry. In University of Tokyo, the integrative neuroimaging studies for schizophrenia targeting early intervention and prevention (IN-STEP) is ongoing. Through these efforts, we would like to contribute to the establishment of "youth mental health", where every youth in the community can know, prevent, and have easy access to needs- and value-based services, and pursue mental well-being and recovery.

The editorial of the new-year issue of Nature 2010 features "A decade for psychiatric disorders". The DALY estimation clearly shows that psychiatric disorders are the top source for burden of diseases to the individual life and society. Schizophrenia is a most devastating psychiatric disorder in which the onset is usually at youth and the cognitive dysfunction persists for life-long in some patients. Schizophrenia is associated with neurodevelopmental abnormalities. It has been unknown whether post-onset progressive pathology is also present in schizophrenia until the recent sophistication of in vivo neuroimaging techniques. Longitudinal neuroimaging studies on first-episode schizophrenia have shown a progressive deterioration of structure and function of neocortical regions in the early stage of the disorder. Insult to dendritic spines through glutamatergic dysfunction may underlie this process, which may in turn be a promising molecular target for intervention to improve the functional outcome of schizophrenia. More recently, the question of whether early intervention can be targeted at prodromal stage of schizophrenia has called special attention in psychiatry. In University of Tokyo, the integrative neuroimaging studies for schizophrenia targeting early intervention and prevention (IN-STEP) is ongoing. Through these efforts, we would like to contribute to the establishment of "youth mental health", where every youth in the community can know, prevent, and have easy access to needs- and value-based services, and pursue mental well-being and recovery.

Accumulated evidence from a number of previous structural MRI studies have revealed 1) the existence of abnormalities even at the brain structural level in subjects at an early stage of endogeneous psychotic illness, including schizophrenia and bipolar disorder, and 2) the existence of similar brain structural abnormalities to the patients even in individuals at high-risk of endogeneous psychotic illness. Recently, an increasing number of studies have investigated the associations between the functional polymorphism of candidate genes for susceptibility to schizophrenia and regional brain volume, a highly heritable trait marker, to uncover the linkage between the candidate genes and endophenotype of schizophrenia. Firstly, this review article overviewed recent literature examining the relationship between the candidate genes for susceptibility to schizophrenia and indices obtained from neuroimaging modalities. In contrast, a relatively limited number of previous studies examined associations between candidate genes for susceptibility to bipolar disorder and regional brain volume, although the high heritability of bipolar disorder has been reported as comparable to that of schizophrenia. Then, we discussed the possibility of endophenotyping of bipolar disorder and introduced our preliminary study. Finally, methodological considerations and future directions of endophenotyping of endogeneous psychosis were suggested.

Advances in neuroimaging and neurophysiological techniques have enabled detailed investigations of the brain pathophysiology of schizophrenia. In this article, we first overviewed neuroanatomical and neurophysiological studies of the superior temporal gyrus and anterior cingulate cortex in patients with schizophrenia, using structural magnetic resonance imaging (s-MRI), MR spectroscopy (MRS), event-related potentials (ERPs) and magnetoencephalography (MEG). Next, we discussed several key points for future research in psychiatric neuroimaging, such as disease specificity, heterogeneity, utility as endophenotype markers, relationship to psychosocial outcome, and application to clinical purposes. Finally, we described important issues, in terms of the infrastructure and system, which need to be improved in clinical psychiatry research in Japan.