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The aim of this study was to determine the association of depressive symptoms with dietary habits among physicians working in hospitals in Japan. We mailed an anonymous questionnaire with the Quick Inventory of Depressive Symptomatology and items about dietary habits to 10,000 randomly selected physicians. Logistic regression analysis was used to explore the association of depressive symptoms with dietary habits. The participants comprised 3862 physicians (3025 men and 837 women). Among the respondents, 252 (8.3%) men and 88 (10.5%) women were determined to be in depressive symptoms. For men, “never eat a balanced diet” (Odds ratio; 95% confidence interval, 2.54; 1.70 - 3.80), and for women “eat quite small meals” (3.81; 1.14 - 13.1), “always eat until full” (4.40; 1.48 - 13.1), and “never eat a balanced diet” (3.05; 1.49 - 6.23) were associated with depressive symptoms. For men, “do not eat too much” (0.57; 0.39 - 0.83) was associated with prevention of depression. Physicians should recognize the important role of healthy dietary habits in good mental health. Hospitals should intervene to help physicians address depressive symptoms and dietary habits.

Physicians' mental health can be affected by unreasonable demands and complaints made by patients. The purpose of this study is to determine the association between depressive symptoms and suicidal ideation among physicians working in hospitals in Japan and unreasonable patient demands and complaints. We sent an anonymous questionnaire to 10,000 randomly selected physicians working at hospitals who were members of the Japan Medical Association. The anonymous self-report questionnaire sought to determine the number of unreasonable demands and complaints made by patients or their family members reported by physicians in the previous 6 months. Depressive symptoms and suicidal ideation were measured using the Japanese version of the Quick Inventory of Depressive Symptomatology (QIDS). Logistic regression analysis was used to explore the associations of depressive symptoms and suicidal ideation with reported unreasonable demands and complaints. Among the 3,864 respondents, men (46.3%) reported experiencing unreasonable patient demands and complaints more frequently than women (40.4%). Depressive symptoms were indicated in 8.3% of men and 10.5% of women, and 5.7% of men and 5.8% women were determined to exhibit suicidal ideation. The number of unreasonable demands and complaints in the previous 6 months was significantly associated with depressive symptoms and suicidal ideation for both men and women (P for trend

Background: Delirium is a common neuropsychiatric disorder in medical and surgical inpatients of all ages. It is associated with increased long-term mortality, longer length of hospital stay, poor functional recovery, and increased likelihood of nursing home placement. Objective: The aim of this study was to investigate the reliability and the validity of the Japanese translation of the Delirium Rating Scale, Revised–98 (DRS-R–98). Method: Psychiatric-consultation patients were assessed to compare groups of delirium, dementia, and non-delirium. Results: Mean Total and Severity scores significantly distinguished delirium from the other groups. The scale had high interrater reliability and high internal consistency. Mean Severity scores during delirium differed from the posttreatment scores. Stratum-specific likelihood ratios showed that the DRS-R98 –J is a reliable diagnostic tool. Conclusion: This study indicates that the Japanese version of the DRS-R-98 has high reliability and validity, and is a useful tool for assessing delirium among Japanese medically ill populations. (Psychosomatics 2010; 51:425– 431)

Objective: Although cancer patients frequently experience psychological distress, few cancer patients with psychological distress receive appropriate psychological care. The purpose of this study was to investigate the type and frequency of barriers to receive psychological care in patients with lung cancer. Methods: Randomly selected ambulatory patients with lung cancer participated in the study. A self-administered questionnaire developed for this study was used to assess patientperceived barriers toward psychological care provided in a medical context. Factor analysis indicated that this scale mapped four domains; emotional communication with their physicians, psychiatric consultation, psychotropic medication and counseling. The patients’ demographic factors and levels of past and current psychological distress were also assessed to reveal potential factors associated with patient-perceived barriers to psychological care. Results: Complete data were available from 100 patients. The mean (SD) age of the patients was 65.4 (9.8) years; more than 80% were male, and 77% suffered from advanced stage lung cancer. Lack of correct information and/or misunderstanding of treatments was found to be a major barrier for all four treatment options in common. Negative opinions toward the use of psychotropics were more frequent than those toward counseling. Patients with severe psychological distress were significantly more likely to report a reluctance to undergo psychiatric consultation than those without psychological distress. Conclusions: Lung cancer patients commonly experienced concerns to utilize psychological care. Encouragement from physicians to discuss emotional aspects and the provision of sufficient information regarding psychological care may be useful to alleviate such concerns. Medical staffs should also be aware that severe psychological distress may itself be related to a reluctance to undergo psychiatric consultation.

The authors investigated psychiatric consultation in two hospitals, one in the United States, the other in Japan. They examined similarities and differences, and drew inferences on possible cross-cultural values and/or temporary cultural conditions. As compared with the Japanese consultation patients, the Americans had more mood disorders, including anxiety and chemical-dependency problems, in respective diagnostic classifications. Patients in the United States also showed more acute as well as more serious chronic conditions. These differences may relate to disorder base-rates in the respective countries. In general, psychosocial problems emerged as ascendant in Japan, as compared with chemical-dependency difficulties among American patients. The results are discussed in terms of current conditions in Japan that affect the mental health professions, together with attempts by Japanese clinicians to protect collective mores by ascribing causation for disorders to the individual, rather than the societal conditions often invoked in the United States.

Purpose: To explore cancer patients' concerns about emotional disclosure (ED) to their physicians, and to investigate the factors associated with them. Subjects and Methods: Randomly selected ambulatory patients with lung cancer participated in this study. An 18-item questionnaire to assess patients' beliefs regarding ED to their physicians was developed for this study. Factor analysis was used to extract the underlying factors of this scale. Patients were asked to answer this questionnaire along with other self-administered questionnaires. Results: Complete data were available from 104 patients. Four factors were extracted by factor analysis: ‘Hesitation to disturb the physicians by ED’, ‘No perceived need for ED’, ‘Negative attitude towards ED’, and ‘Fear of a negative impact of ED’. All factors reached standards of internal consistency. The prevalence of the above concerns, in that order, among the patients was 68, 67, 46, and 20%. Patients with high distress levels were significantly more likely to endorse ‘Negative impact’ (p=0.02). Older patients were more likely to report ‘Negative attitude’ (p=0.06), whereas male patients were more likely than females to report ‘Hesitation’ (p=0.05). Conclusion: Knowledge of such patient-related barriers should better prepare physicians to build good communication channels with their cancer patients. Copyright © 2007 John Wiley & Sons, Ltd.

Studies on fatigue in disease-free breast cancer patients have consistently found a significant association between fatigue and depression; and some characteristics of this fatigue may be confused with and/or concealed by those of depression. To clarify the characteristics of fatigue in disease-free breast cancer patients, we examined the frequency of fatigue and associated factors in disease-free breast cancer patients without major depression.Seventy-nine ambulatory breast cancer patients without major depression who had been disease-free for more than 3 years since their surgery completed the Cancer Fatigue Scale (CFS), a multidimensional scale assessing cancer-related fatigue. Participants also completed the Short-form Eysenck Personality Questionnaire-Revised (EPQR) for assessing their personalities. Sociodemographic, physical, and treatment-related factors were also obtained by interview.We found that 36.7% of the patients exhibited fatigue and that fatigue was significantly associated with neuroticism.These results suggest that a considerable number of disease-free breast cancer patients without major depression experience fatigue and that careful attention to those exhibiting high neuroticism may be of benefit in ameliorating their fatigue.

We investigated the effects of psychiatric group intervention on the emotions, natural-killer (NK) cell activity and pregnancy rate in Japanese infertile women by a randomized study. Thirty-seven women completed a 5-session intervention program and were compared with 37 controls. Psychological discomfort and NK-cell activity (47.7% to 34.1%, P

We made detailed research for relationships among physical condition, self-efficacy and psychological adjustment of patients with advanced cancer in Japan. The sample consisted of 85 (42 males and 43 females) advanced cancer patients. Interviews were conducted with some measurement scales including the Self-efficacy scale for Advanced Cancer (SEAC), and the Hospital Anxiety and Depression Scale (HADS). Karnofsky Performance Status (KPS) and medication status were also recorded from the evaluation by physicians. We used structural equation modeling (SEM) for statistical analysis. The analysis revealed that the model, including three self-efficacy subscales, depression, anxiety, KPS, meal-, liquid-intake, prognosis and three latent variables: 'Self-efficacy', 'Emotional Distress', and 'Physical Condition,' fit the data (chi-square(24)=28.67, p=0.23; GFI=0.93; CFI=0.98; RMSEA=0.05). In this model, self-efficacy accounted for 71% of the variance in emotional distress and physical condition accounted for 8% of the variance in self-efficacy. Overall, our findings suggest clearly that close relationships existed among physical condition, self-efficacy and emotional distress. That is, patients in good physical condition had a high self-efficacy, and patients with high self-efficacy were less emotionally distressed. These results imply that psychological intervention which emphasizes self-efficacy would be effective for advanced cancer patients.

Telemedicine is the provision of professional medical services from sites removed from the patient. This study was conducted in order to assess the reliability of psychiatric evaluations via video-consultation. The inter-rater reliability was determined for each interviewing condition by employing the reliability-testing paradigm in which the brief psychiatric rating scale (BPRS) and the interclass correlation coefficient (ICC) are used. The inter-rater reliability scores between face-to-face interviews and interviews conducted by video at two different levels of image qualities were compared by the authors. Reliability was found to be in perfect agreement in each of the interviewing conditions. This study verifies that telepsychiatry is a reliable method of assessing patient conditions. It may be used to provide much needed mental health-care services to patients whose access to them is restricted.

This study was carried out to demonstrate the prevalence of depression among physically ill patients and to investigate its effects on the length of hospital stay. Out of 65 inpatients (44 male, 21 female; 51 with benign and 14 with malignant diseases), 14 (21.5%) met the criteria for major depression in the DSM-IV. The average length of hospital stay was compared according to the comorbidity with major depression. Among the patients with benign diseases, those with major depression stayed longer (P

Full disclosure of medical diagnosis to cancer patients in Japan remains controversial. Some physicians in Japan believe that full disclosure may affect the outcome of treatment, create stress and psychiatric problems, or lead to suicide. Although the trend toward full disclosure is increasing in Japan, approximately 70% of current cancer patients are still not fully informed of their condition. In this study, the authors examined the psychiatric status and effects of full disclosure among 100 otolaryngology patients at Tokai University Hospital (50 with benign diseases, 50 with malignancy) using major depression and adjustment disorders criteria of the DSM-III-R Structured Clinical Interview (SCID). This demonstrated that 15 of 50 (30%) patients with benign diseases and 23 of 50 (46%) patients with malignant diseases met the criteria for depression and adjustment disorder; 29 of the 50 patients (58%) with malignant cancer were not informed of their true condition, according to the wishes of their families (21 were fully informed). The prevalence rate of psychiatric disorders was 42.9% among the informed group and 48.3% among the uninformed group. These findings suggest that concealing the true diagnosis was not related to the presence of psychiatric disorders in Japanese cancer patients.

The authors conducted a study to demonstrate the prevalence of psychiatric symptoms among 100 otolaryngology inpatients (50 with non-malignant conditions; 50 with malignancies), and to investigate the efficacy of the Hospital Anxiety and Depression Scale (HADS) as a screening test for psychiatric disorders in otolaryngology. A structured interview was conducted according to the Adjustment Disorders and Major Depressive Episodes section of DSM-N, which demonstrated that 30% of the inpatients with benign diseases met the criteria for some psychiatric disorders (one patient for major depression and 14 for adjustment disorders) and that 46% of the inpatients with malignancies met the criteria (nine patients for major depression and 14 for adjustment disorders). There were highly significant differences between the HADS scores of the patients with psychiatric disorders and those without. Comparing the sensitivity and the specificity using the HADS as a screening test, the optimal cut-off point was 12, which produced 92% sensitivity, 90% specificity and 85% positive predictive value (PPV) among not only non-malignant and malignant cases taken together but also among malignant cases only.

Somatoform disorders are usually supposed to be seen in the clinical field of consultation-liaison (C-L) psychiatry. This study reviewed medical records of physically ill inpatients who were also treated by psychiatrists for concurrent psychiatric illnesses during a 5-year period. The prevalence of somatoform disorders was 40 out of 1581 cases (2.5%), which was unexpectedly low. From the perspective of C-L psychiatry, the authors propose three therapeutic models for somatoform disorders: 1. physician-oriented with psychiatric advice; 2. psychiatrist-oriented; and 3. cooperative physician/psychiatrist-oriented. The third model is particularly recommended because the patient can undergo physical examinations until the relationship between somatic complaints and psychosocial factors is recognized. Moreover, the psychiatrist can build an alliance with a patient, while the patient completes a 'testing phase' to determine whether the psychiatrist can be relied on or not. The third model is useful as such and can be used at least in the initial phase.

Background: Although several studies have indicated the association of mood states including depression with somatic complaints in HIV patients, there has been no report on Japanese HIV patients. The purpose was to examine the relationship between somatic complaints and mood states in HIV patients without AIDS. Methods: Subjects were 50 HIV patients without AIDS. As controls, we used 47 healthy persons without HIV, matched for age and gender of the subjects. After the Structured Clinical Interview for the DSM-III-R, several inventories including the Profile of Mood States (POMS) were administered. The presence or absence of somatic complaints were examined. Results: No patients fulfilled the criteria for the DSM-III-R Mood Disorders Including Major Depression. However, scores on depression as measured by the POMS were significantly higher for the HIV group than for the healthy group. Although depressive symptoms in the HIV group may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these HIV patients may be prone to a depressive state. The HIV patients indicated somatic complaints more frequently. Among these, the presence or absence of five complaints (i.e., abdominal distress, sleep disturbance, smothering sensations, chest pain or discomfort, and numbness or chills) was significantly discriminated based on scores on depression. Discussion: The results suggest that depressive symptoms accompany several somatic complaints in HIV patients without AIDS. Although a longitudinal follow-up study is required, the assessments of somatic symptoms may bring clinical benefits such as earlier diagnosis and/or intervention for a depressive state.

In 1961 in Japan, the son of a hospitalized man suffering from severe pain after a stroke mixed a cup of milk with insecticide and arranged for his unsuspecting mother to give this to the patient, who had requested that his son assist him in dying. The son could not endure his father's condition and killed him in order to show his love.

The first Medical Psychiatry Unit (MPU) in Japan was established in 1990. The clinical experience during the first 4 years of this unit is presented, and the characteristics of the Unit between its first 2 years and its latter 2 years are compared. The number of patients, the average length of stay, the primary psychiatric disorders, the combined physical diseases and their outcomes are presented. The data suggest that while the experience of the MPU is limited, it plays an important role in Japan as (i) an appropriate clinical setting for patients with combined medical and psychiatric illnesses, (ii) a strategic model for dealing with psychiatric patients in the general hospital, (iii) an educational setting for psychiatric residents to become more familiar with medicine and surgery, and (iv) an opportunity for non-psychiatric residents to become familiar with psychiatric illnesses and treatments.

Based on the work by Fawzy on a structured psychiatric intervention for malignant melanoma patients, the author developed a modified version for Japanese cancer patients. This program is a series of five one-hour sessions including psychoeducation, problem-solving, psychological support, relaxation training (progressive muscle relaxation and autogenic training) and guided imagery. In this preliminary study, 10 breast cancer patients received individual interventions and another 10 were divided into two groups for group therapies. Comparing the results of POMS and Dealing With Illness Inventory scores between pre- and post-interventions, both the individual and the group interventions were definitely effective in improving psychological distress but less effective for changing coping styles for Japanese patients with breast cancer. The subjects receiving individual intervention were also interested in the group sessions because they wanted to share their knowledge on breast cancer. On the other hand, the patients assigned to the group intervention were hesitant to talk each other in the earlier sessions. These impressions imply that this structured intervention should be modified to include both individual and group sessions.

The present article demonstrates the clinical application and the efficacy of relaxation techniques in general hospital psychiatry in Japan. During April to December 1993, 20 patients were treated with progressive muscle relaxation and "modified' autogenic training therapies. The targeted symptoms were anxiety attacks (or panic attacks), neurotic insomnia, hyperventilation syndrome, agoraphobia, chronic pain, and distress. Most patients (18/20) improved rapidly with the use of these techniques and their excellence encourages increased use in general hospital psychiatry for the following reasons. First, physically ill patients are likely to show unexpected reactions to psychotropic medications. Second, some patients prefer these treatment methods rather than medications because they feel that they are participating voluntarily in their own treatment and also because they are fearful of being addicted to tranquilizers. Third, these treatments have produced rapid improvement especially for patients with panic attacks and/or hyperventilation. This study strongly suggests that progressive muscle relaxation and "modified' autogenic training are simple and useful methods which can be easily employed in the clinical practice of general hospital psychiatry.

We conducted a study to demonstrate the frequency and types of psychiatric/psychological symptoms. A Structured Interview according to the DSM-III-R was conducted which demonstrated that 46 (41.4%) of 111 rehabilitation inpatients met the criteria for some forms of psychiatric disorders: 34 patients for major depression, 10 for adjustment disorder with anxious mood, and 2 for posttraumatic stress disorder. The remaining 65 patients (58.6%) showed normal reactions to their diseases. Average length of hospital stay for patients with major depression was significantly longer than those with no or the other types of psychiatric disease. They were also tested with Zung's Self-Rating Anxiety Scale (SAS), Zung's Self-Rating Depression Scale (SDS), and Profile of Mood States (POMS). Three psychological tests were useful in detecting depression or adjustment disorder among rehabilitation patients; however, these tests are not always specific to the type of psychiatric disorders. Patients with higher scores in those three tests should be referred to a psychiatric consultant for detailed examinations and proper treatments, if necessary.

Background Physicians' mental health may be adversely affected by the number of days of work and time spent on-call, and improved by sleep and days-off. The aim of this study was to determine the associations of depressive symptoms with taking days of off duty, hours of sleep, and the number of days of on-call and overnight work among physicians working in Japanese hospitals. Methods A cross-sectional study as a national survey was conducted by mail. The study population was 10,000 randomly selected physicians working in hospitals who were also members of the Japan Medical Association (response rate 40.5%). Self-reported anonymous questionnaire was sent to assess the number of days off-duty, overnight work, and on-calls, and the average number of sleep hours on days not working overnight in the previous one month. Depressive state was determined by the Japanese version of the Quick Inventory of Depressive Symptomatology. Logistic regression analysis was used to explore the associations between depressive symptoms and the studied variables. Results Among the respondents, 8.3% of men and 10.5% of women were determined to be depressed. For both men and women, depressive state was associated with having no off-duty days and averaging less than 5 hours of sleep on days not doing overnight work. Depressive state was positively associated with being on-call more than 5 days per month for men, and more than 8 days per month for women, and was negatively associated with being off-duty more than 8 days per month for men. Conclusion Some physicians need some support to maintain their mental health. Physicians who do not take enough days-off, who reduced sleep hours, and who have certain number of days on-calls may develop depressive symptoms.

Objective:To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians.Methods:Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician (“no perceived need to disclose emotions,” “fear of the negative impact of emotional disclosure,” “negative attitude toward emotional disclosure,” “hesitation to disturb the physician with emotional disclosure”). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0.Results:The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 ± 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer–related variables were associated with depression underrecognition by physicians.Significance of results:The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.

Objective This study evaluates patient characteristics that might predict a missed diagnosis of delirium prior to being seen by a psychiatric consultant. Method Study participants were assessed using quantitative standardized scales of cognitive function, delirium and physical impairment. Results Referring service personnel missed the diagnosis of delirium in 46% of psychiatric consultations. Two factors were associated with their failure to identify delirium accurately: use of a past psychiatric diagnosis to explain delirium symptoms and the presence of pain. Symptoms of delirium and quantitative scale scores did not distinguish between patients with whom diagnosis had been missed and those with accurate diagnoses. Conclusion The consulting physicians of patients with delirium often incorrectly turn to past psychiatric diagnoses and/or are distracted by the presence of pain and, thus, fail to accurately diagnose delirium.

Background: Insufficient knowledge about mental illness and its treatment has been shown to constitute a major barrier to its adequate care for mental illness in the lay public (LP). We therefore examined Japanese cancer patients' (CP) ability to recognize depression and their preferences of its treatments. Participants and Method: One hundred lung CP and 300 LP were selected at random to participate in the study. Structured interviews using a vignette of a person with both cancer and depression were conducted with CP, and those using a vignette of a person with depression were carried out with LP, respectively. Results: Only 11% of CP recognized the presence of depression in the vignette, while 25% of LP did (p

To clarify changes in mental disorder distribution in suicide attempters, a comparison was made between the period when an economic recession started (1992, 1993) and the period when the recession became serious (2000). The subjects were 212 suicide attempters admitted to the Emergency Medical Center of Tokai University Hospital during a 2-year period between 1992 and 1993 (group A) and 255 suicide attempters admitted during a 1-year period between January and December 2000 (group B). Mental disorders were classified according to the International Classification of Diseases (10th revision; ICD-10). Distribution was compared between groups A and B and significant differences were observed in mental disorder distribution (P < 0.001). The percentages of subjects with depression, those with neurotic disorders, and those with other disorders were higher in group B than in group A. Conversely, the percentage of subjects with schizophrenia was lower in group B than in group A. Mental disorder distribution in suicide attempters significantly changed. However, it was not certain that this change was related to the economic recession and increased unemployment in Japan.

We report that infertile women in Japan as well as in the Western world have high levels of emotional distress, anxiety, and depression. The reasons for anxiety and depression in infertile women are easy to presume but remain unclear. We conducted the present study to assess the relationship between the anxiety and depression of infertile Japanese women and their thought processes and emotional well-being with regard to their infertility. A cross-sectional questionnaire was administered to 101 infertile Japanese women who visited the infertility clinic at Tokai University. Inventories included the Hospital Anxiety and Depression Scale (HADS) and our original infertility questionnaire, which is composed of 22 questions to assess attitudes and emotional status in facing the stigma of infertility. After factor analysis, comparison between the HADS and the infertility questionnaire was made with simultaneous multiple regression analyses. Anxiety and depression in childless Japanese women were significantly associated with lack of husband's support and feeling stress. Our findings should prove useful in designing and implementing psychological support programs for infertile Japanese women. Psychological interventions to relieve or diminish these conditions might have significant therapeutic benefits for women attending infertility clinics in Japan.

The importance of board certification systems is increasing in parallel with changes in the social conditions surrounding general medical practice. The same is also the case for consultation-liaison psychiatry, a subspecialty of psychiatry. As a consequence, in April 2001 a board certification system for the Japanese Society of General Hospital Psychiatry was introduced. The clinical abilities required for liaison psychiatrists in this system can be summarized as follows: the ability to adequately treat patients with physical/psychiatric comorbidity or somatization, the ability to form an appropriate and adequate relationship with patients with physical diseases and to collaborate with medical and surgical professionals, and to have a good social and ethical awareness of general medical practice. The conditions required to obtain certification and the issues that remain to be addressed are also discussed.

Depression in physically ill patients is often encountered in consultation-liaison psychiatry. This investigation examined the relationship between length of stay (LOS) and depression comorbidity. Physically-ill patients with depression stayed significantly longer that those without. This study suggested that the early detection and antidepressant treatment is important for physically ill patients with depression that could lead to the shortening of LOS.

1. Board Certification System of Psychiatry There was a heated debate about "Postgraduate Psychiatric Education and Board Certification of Psychiatry" in the annual meeting for the Japanese Society of Psychiatry and Neurology held in Nagasaki in 1968 and in Kanazawa in 1969. The oppositions of young psychiatrists were as follows; 1) Issues of low cost of medical expense as government politics, social protect politics from psychiatric patients, and improper management of patients in mental hospitals should be dealt before making Board Certification System of Psychiatry. 2) Management of the Society of Psychiatry and Neurology dissatisfies many psychiatrists. Board Certification Systems started in many medical societies from 1969 to 1987. Main nine departments except psychiatry started the system. In 1987, the Japan Association of Chairmen of Department of Psychiatry of Medical Colleges (JACDPM) proposed a program for a postgraduate course. The Japanese Society of Psychiatry and Neurology (JSPN) formed the Committee on Psychiatric Education in 1987 and Working Group on Accreditation Program (WGAP) in 1991 under the Committee of Psychiatric Education. After intensive discussions on the Board certification, the WGAP reported a summary of their discussions in 1994. The essence of the WGAP recommended model for the Board of Association was as follows: Minimal Requirements Outline Training Period--three years psychiatric training after two years primary care experience by rotation through other departments. Field of Training--WGAP recommended that post-graduate training should be given at different kinds of institutes such as the department of psychiatry in medical schools, mental hospitals, out-patient mental clinics, community experiences in rehabilitation, day care, social clubs and health centers. Assessment--both oral examination and case reports are requested for evaluation and board certification. Re-evaluation every five years is required. However, there have been the following opinions and the Board Certification System has not been realized. 1) Making improvement in mental hospital is more important than starting Post-graduate Training and Organization for Board Certification of Psychiatry System (PTOBCP). 2) Starting PTOBCP makes professors in department of psychiatry in medical colleges give great power to suppress the right of personal management. 3) Financial support for postgraduate trainee and trainer is insufficient. Medical and psychiatric situations have changed from 2001 to 2002. 1) A neutral organization instead of academic societies will make Board Certification System in each department in the future. 2) Postgraduate educational rotation system (two years) will start in 2004. 3) Advertisement of being certificated by the Board has been possible. In recent situation, necessity for making of PTOBCP is increasing and many members of JSPN long to make it. In the 98th annual meeting, 2002 it was decided to make PTOBCP. 2. Post-graduate mandatory education system including psychiatry Recently, it was legally decided that post-graduate education for two years should be mandatory for every medical doctor who has passed a national board from 2004. Furthermore, psychiatric training should be mandatory for every rotating resident. The period of psychiatric training is one, two or three months, which depends upon each teaching hospital. It is epoch-making that every resident should receive psychiatric training, however, in other words, it means that psychiatric education in Japan will be re-evaluated through such a new training system.

Although recent papers have suggested that psychological factors are implicated in the experience of infertility, few studies have assessed this relationship in a sample of Japanese infertile women. This study was carried out in order to clarify whether Japanese infertile women experience emotional distress. A cross-sectional questionnaire study was performed to assess the psychological states of 101 infertile women compared to 81 healthy pregnant women. The hospital anxiety and depression scale (HADS) and the profile of mood states (POMS) were administered. These questionnaires produced scores for depression/dejection, anxiety, aggression/hostility, lack of vigour, fatigue, tension anxiety, and confusion. The HADS and the POMS scores of infertile women were significantly higher than those of pregnant women, except for fatigue score. Infertile women with positive HADS indicating emotional disorders (39/101, 38.6%) were significantly (P = 0.0008, chi(2) test) more than those of pregnant women (13/81, 16.0%) when the threshold was set at 12/13 of total HADS scores. The HADS scores were not affected by the women's age, duration of infertility, experience of conception, routine tests, and work states. In this Japanese population, infertile women reported higher levels of emotional distress than pregnant women, suggesting psychological support is needed for infertile women.

The aim of the present study was to investigate persistence of the clinical effectiveness of a 5-weekly structured group intervention program for Japanese breast cancer patients. Each program is a series of five 90-min sessions, which include psycho-education, problem-solving, psychological support, relaxation training, and guided imagery. Fifty-seven patients with breast cancer participated in the program and the 47 who completed were analyzed. The results of the Profile of Mood States (POMS) scores were compared before, just after, and 6 months after the intervention. According to the change in POMS scores, the clinical effectiveness of a structured group intervention program persisted for 6 months for the patients who had no psychiatric diagnoses at entry. By contrast, this 5-weekly intervention program did not show persistent effects for patients who had a psychiatric diagnosis at entry. Therefore, additional intervention would be needed for patients with psychiatric diagnosis at entry.

The purpose of this study was to investigate the efficacy of consultation–liaison (C-L) psychiatry from the perspective of medical economics, by comparing a part-time and full-time psychiatric department. One full-time (5 days per week) psychiatrist began work at a general hospital (GH-A), and one part-time (once per week) psychiatrist had been working at another general hospital (GH-B). Both general hospitals are teaching hospitals of the same size. The number of patients and the medical reimbursements were investigated each month and compared. This study demonstrated that the establishment of C-L psychiatry was economically profitable in contrast with what was the common belief among general hospital administrators. Also, the differences in the total number of patients (GH-A : GH-B = 500 : 35–50 patients/month) and the total reimbursement (GH-A : GH-B = 3 million : 2–300 000 yen/month) was not explained by the number of working days (GH-A : GH-B = 5 : 1 day/week). The full-time model of C-L psychiatry has also indirect effects (i.e. educational and relieving effects) on the hospital staff. Promoting the establishment of C-L psychiatry requires many evidence-based studies that demonstrate the necessity for C-L psychiatry and can directly persuade hospital directors.

Somatoform disorders commonly are supposed to be seen in the clinical field of consultation-liaison (C-L) psychiatry; however, a few patients are referred to psychiatry. From the perspective of C-L psychiatry, the authors propose three therapeutic models for somatoform disorders, i.e., (1) physician-oriented with psychiatric advice, (2) psychiatrist-oriented, and (3) cooperative physician/psychiatrist-oriented. The third model especially is recommended because the patient can undergo physical examinations until the relationship between somatic complaints and psychosocial factors is recognized through the third model. Moreover, the psychiatrist can build an alliance with a patient, while the patient completes a “testing phase” to determine whether the psychiatrist can be relied on or not. As such, the third model is useful and can be the aim at least at the initial phase. Each model has strengths and limitations as well. The most important thing in treating such patients in any model is to see the patient as a whole person who is suffering from distress.

This study examined correlations of social support with rated mood states, including depression, for 47 patients with cerebrovascular disease during the chronic poststroke period. After the Structured Clinical Interview for DSM-III–R, four psychological measures, the Zung Self-depression Scale, the Hamilton Depression Scale, Profile of Mood States, and Social Support Scale, were administered. The patients with cerebrovascular disease exhibited significantly more psychiatric disorders, including depression, and had poorer social support than healthy controls. The severity of depression was significantly related to poor social support and particularly to the presence of social support rather than just the perception of poor social support. Depressed patients may also rate their support as poor because they are depressed. For some patients with cerebrovascular disease during the chronic poststroke period, depression may be related to low social support.

The authors examined the influences of several psychosocial factors (i.e., coping behavior responses, social support, etc.) on mood states in 47 human immunodeficiency virus (HlV)-positive patients without the acquired immunodeficiency syndrome (AIDS). No patients fulfilled the DSM-III-R diagnostic criteria for mood disorders, in cluding major depression. However, the HIV group indicated significantly stronger depressive symptoms and lower social support than the healthy control group. The strength of depressive symptoms and poor social support were significantly correlated with one another. Although the HIV group indicated significantly stronger active coping behaviors than the healthy control group, depressive symptoms were significantly and positively correlated with avoidance coping behaviors. When existence of social support was controlled for, this significant correlation was not noted, indicating that avoidance coping behaviors are independently and significantly related to depressive symptoms. The results suggest that, although depressive symptoms are not strong enough to warrant a psychiatric diagnosis of mood disorders, including major depression, avoidance coping behaviors and poor existence of social support may be a high-risk combination for the manifestation of depressive symptoms in HIV-positive patients without AIDS in Japan.

We examined the relationship of somatic complaints to coping behaviors and mood states among 50 HIV-positive patients without AIDS. Although no patients fulfilled the DSM-III-R criteria for mood disorders including major depression, scores for depressive symptoms were significantly higher in the HIV-positive patients than in healthy persons. Although depressive symptoms in HIV patients may not be strong enough to warrant a psychiatric diagnosis of mood disorders, these patients may be prone to depressive symptoms. The HIV patients indicated a tendency toward somatic complaints more frequently than their healthy counterparts. The scores for depressive symptoms were significantly and positively correlated with scores for avoidance coping responses. The presence or absence of six complaints (i.e., general fatigue, abdominal distress, chest pain or discomfort, and numbness or chills) could be discriminated based on the score of avoidance coping responses. The results of this study suggest that avoidance coping responses associated with depressive symptoms accompany several somatic complaints in HIV patients without AIDS.

Background: The attitudes of the psychiatrists in Japan and the US were compared in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to do so or be assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes. Methods: Japanese and American general hospital psychiatrists’ attitudes towards the reasonability of suicide, physician-assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and 62 Japanese psychiatrists’ data were collected using the Suicidal Attitudes Inventory. Results: The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation or completed suicide in med-surg patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis. Conclusions: The results indicate that psychiatrists’ attitudes towards the relationship of psychopathology with suicidal ideation, the effect of depression, and other cultural factors on the desire to die in the medically ill are issues that need better clarification among both the medical profession as well as within society. Looking at how other societies handle these matters may help to understand one’s own approach to them.

The effects of psychosocial factors on peptic ulceration and/or erosions were examined in a sample of 189 volunteers. Analysis of variance found that the severity of gastrofiberscopic findings was related to two psychosocial factors-poor social support and degree of alexithymia- and that both psychosocial factors were significantly correlated with one another. Analysis of covariance indicated that gastrofiberscopic findings remained significantly related to poor social support when alexithymia was controlled for. These findings suggest that in both healthy persons, and in persons with alexithymia, peptic ulceration or erosions tend to manifest when social support is low. Poor social support and alexithymia may be an especially high-risk combination for the development of peptic ulceration and/or erosions.

This study was done to investigate the frequency of co-morbidity and to demonstrate the best method for assessing depression among cancer patients. The subjects were 50 (25 male and 25 female) cancer patients and 50 (25 male and 25 female) medically ill patients. All subjects were interviewed by psychiatrists and were administered psychological tests such as SAS (self-rating anxiety scale), SDS (self-rating depression scale), POMS (Profile of Mood States), HADS (Hospital Anxiety and Depression Scale) and DRP (Depression-related personality traits). The psychiatric interview revealed that 44% of cancer patients and 38% of the medical patients had mental disorders according to DSM-IV. The most frequently observed disorder was depression, which was seen in 28% of the cancer patients and 30% of the medical patients. The cancer patients with depression scored significantly higher on the DRP and the Anger mood state of POMS than did the medically ill patients with depression. In addition, most psychological tests employed had no discrimination between depressed and normal subjects among the cancer and the medical patients. However, it was found that the Depression scale in HADS (HADS-D) split depressed patients from normal subjects since the HADS-D was composed of items that were not concerned with physically ill conditions.

Recent studies have highlighted physiological effects of emotional stress presumably leading to gastrointestinal disease. This study examined the effects of stress (hostility) and coping (social support and negative responses to stress) on asymptomatic gastric diseases. We investigated whether gastrofiberscopic findings were related to stress and coping in 269 volunteers without gastrointestinal complaints. These subjects were taking part in primary health care assessments. Analysis of variance found that volunteers with abnormal gastrofiberscopic findings (i.e., erosions and/or ulceration) demonstrated significantly higher hostility and lower social support scores than those without abnormal findings. Analysis of covariance found that abnormal gastrofiberscopic findings remained significantly related to hostility scores after controlling for hostility's correlations with social support and negative responses to stress. The results suggest that hostility, along with poor social support or negative responses to stress, is associated with asymptomatic gastric disease.

The diagnostic criteria for alexithymia (DCA) was proposed by Fava et al. in 1995. The purpose of this study was to examine the criterion-related validity of the DCA in a general hospital psychiatric setting.The subjects included 126 outpatients with psychiatric disturbance. The severity of alexithymic characteristics was assessed using the DCA and Beth Israel Hospital Psychosomatic Questionnaire (BIQ). Two Japanese versions of the 26-item Toronto Alexithymia Scale (TAS-26) and Minnesota Multiphasic. Personality Inventory-2 (MMPI-2) were administered.The DCA had relatively high sensitivity and specificity, indicating adequate discriminant validity. The discriminant validity of the DCA was also supported by significant associations of the DCA with the TAS-26 and MMPI-2. These results indicate that when used for screening, the DCA has adequate criterion-related validity.The DCA may be clinically useful in a general hospital psychiatric setting.

We conducted a study to demonstrate the kinds and frequencies of psychiatric symptoms among 31 inpatients with malignant hematological diseases. The DSM-III-R (Diagnostic and Statistical Manual for Mental Disorders, third edition-revised, 1987) structured interview and three psychological tests, such as the Self-rating Anxiety Scale, Self-rating Depression Scale and Profile of Mood States, were administered. The structured interview demonstrated 29.0% of the patients to have met the criteria for some form of psychiatric disorder, i.e., two for major depression and seven for adjustment disorder (three with depressed mood, two with anxious mood and two with mixed emotional features). Of the remaining 22 patients (71.0%) none met the criteria for psychiatric disorders. Of the five patients who knew their true diagnoses, three were assessed as having adjustment disorder with depressed mood and one as having major depression. Also, among the five patients on chemotherapy, four met the criteria for psychiatric disorders. Adjustment disorders were fewer among Japanese patients with malignant hematological diseases than among patients from previous studies in western countries, which can be explained by the patients' defense mechanism such as 'denial' and/or the less frequent 'truth-telling' in Japan. In addition, since the diagnostic criteria or psychological scales contain physical symptoms, they should be arranged or revised if applied to patients with life-threatening diseases such as hematological malignancies.