Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
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Seishin Shinkeigaku Zasshi · Jan 2003
[Clinical factors related to gains in body mass index (BMI) among patients under long-term antipsychotic treatment].
Weight gain and obesity are often seen among patients taking antipsychotic drugs, the incidence being higher in this group than among the general adult population. They constitute risk factors for other diseases, such as hyperlipidemia, type 2 diabetes mellitus and hypertension, and may also adversely affect a patient's compliance. Thus the control of weight gain and obesity is significantly related to the quality of life for those who are under long-term antipsychotic treatment. We therefore conducted a retrospective investigation on the process of BMI increase in patients treated with antipsychotic agents over an extended period. The BMI of these patients was compared with measurements in the general adult population and the clinically relevant factors contributing to weight gain were identified. ⋯ 1) Gender, age, and clinical outcome were the independent factors that contributed to the increase in BMI for those patients under long-term antipsychotic treatment. 2) The gain in BMI was greater in female patients than in male patients. 3) Age was inversely related to the gain in BMI, therefore special care must be taken after administering antipsychotic drugs because younger patients may gain excessive weight and develop weight-related complications at an earlier stage. 4) The increase in BMI was minimal for patients in complete remission, suggesting that these patients were better adapted socially and aware of maintaining an optimum BMI. In planning antipsychotic treatment for each patient, not only its efficacy on psychiatric symptoms but also the risks--such as an increase in BMI--should be taken into consideration.
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Seishin Shinkeigaku Zasshi · Jan 2003
[Structuralistic and meta-psychological approaches to ambivalence in schizophrenia].
The word "ambivalence" generally signifies a psychic state in which a subject holds a contradictory or conflicted attitude towards an object. The literal meaning of the word is that two valences occur simultaneously, and this connotes the epistemological and ethical problem of where and how the valences arise. The concept of ambivalence implies that the relationship between the subject and the world is ambivalent, that the subject has free will in the alternative evaluation, and that the meanings of the two valences derive from the meta-level outside the world. ⋯ That the subject simultaneously announces and is announced in the language system also reflects this paradoxical relationship. Thus, ambivalence of dichotomy between "good and bad" is the very basic phenomenon of consciousness, and the inversion of "good and bad" is a reflection of the structure of the relationship of the subject and the world. If the schizophrenic specificity exists, it may involve the exposure of this intrinsic ambivalence and this paradoxical structure in confrontations with the tellgate into the world under the dominance of the negative side.
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Seishin Shinkeigaku Zasshi · Jan 2003
[Some resolutions in difficulties of postgraduate psychiatric education in Japan].
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. ⋯ 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.