Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients.

OBJECTIVE: There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. METHODS: We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age=38.57 years, SD=8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. RESULTS: Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. CONCLUSIONS: Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.

Intervention for several behavioural disorders in Alzheimer's-type dementia.

In Alzheimer's-type dementia, significant nerve cell degeneration is seen in the medial temporal lobe, including the hippocampal region, and in the temporoparietal association area. As symptoms progress, impairments in various behaviours begin to occur in daily life. In particular, higher brain dysfunction, including parietal association area dysfunction, are major impediments to providing care or rehabilitation. Herein, we explain behavioural disorders stemming from higher brain dysfunction and discuss the methodology in providing specific care and appropriate rehabilitation. To provide appropriate rehabilitation, it is important to properly assess the causes of behavioural disorder by organizing the characteristics of symptoms, the person and the environment.

Effects of Yokukansan on behavioral and psychological symptoms of dementia in regular treatment for Alzheimer's disease.

Yokukansan (YKS) is used frequently against behavioral and psychological symptoms of dementia (BPSD) together with donepezil in patients with Alzheimer's disease (AD). Here, we investigated the efficacy and safety of YKS in patients with AD in a non-blinded, randomized, parallel-group comparison study. Patients who had at least one symptom score of four or more on the Neuropsychiatric Inventory (NPI) subscales were enrolled in the study. The subjects were randomly assigned to the YKS-treated group (YKS/donepezil combination therapy group) and the non-YKS-treated group (donepezil monotherapy group). TSUMURA Yokukansan (TJ-54, 7.5g, t.i.d.) was administered in a four-week study treatment period. The subjects were evaluated twice at the start (Week 0) and completion (Week 4) of the study treatment in terms of NPI, Mini-Mental Status Examination (MMSE), Disability Assessment for Dementia (DAD), Zarit Burden Interview, and Self-rating Depression Scale (SDS). The efficacy analysis was performed in 29 patients (YKS-treated group) and 32 patients (non-YKS-treated group). The NPI total score improved significantly more in the YKS-treated group than in the non-YKS-treated group. In the NPI subscales of agitation/aggression and irritability/lability, the YKS-treated group showed significantly greater improvement than the non-YKS-treated group, but no statistically significant improvement was seen with YKS in the other subscales. There were no significant differences between the YKS-treated group and the non-YKS-treated group in MMSE, DAD, Zarit Burden Interview and SDS. No adverse reactions were noted in either group. The results of this study showed that YKS is safe and effective in the treatment of BPSD in AD patients.

Characteristics of psychiatric hospitals associated with length of stay in Japan.

OBJECTIVE: Average length of inpatient stay at psychiatric hospitals in Japan has been consistently longer than that in any other developed country, and was 330 days in 1996. Although some reforms have been implemented with the intention of decreasing length of stay (LOS), appreciable reductions have not been achieved. The present study examined hospital characteristics associated with length of stay in regional psychiatric hospitals in Japan, in order to identify variables that might help to reduce LOS. METHOD: This cross-sectional study analysed the complete database of one district in Japan. Analyses were conducted using aggregate data from 24 hospitals. Multiple regression analysis was performed to determine hospital characteristics influencing LOS in psychiatric hospitals. RESULTS: Significant positive associations were identified between LOS and two hospital characteristics: inpatient capacity; proportion of involuntary admissions. Negative associations were observed for three variables: number of outpatients; human resources in terms of healthcare professionals available in each hospital; community activity. Multiple linear regression analysis for the 24 hospitals revealed that number of outpatients and proportion of patients receiving public aid were independently associated with shorter LOS, while proportion of involuntary admissions was independently associated with longer LOS. A negative association between human resources in terms of number of healthcare professionals and LOS was suggested. CONCLUSION: Several hospital characteristics are associated with LOS in psychiatric hospitals. Factors identified in this study offer insights into directions for effective psychiatric health policy to reduce LOS.