RESUMO
Although adult patients with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often have sleep problems, few studies have verified the effect of a psychological approach specific to sleep-wake rhythms on these sleep disturbances. Therefore, the aim of this pilot study was to develop a trans-diagnostic approach with sleep scheduling and regularity of sleep duration as core modules, and to examine the effect of the intervention in adult ADHD and/or ASD subjects with sleep disturbances. This was a within-group pilot study. Ten patients with adult ADHD and/or ASD with sleep disturbances (10 males, age: 27.4 ± 5.6 years) took part in a 90-min weekly group intervention for 5 weeks. All participants were assessed on scales for sleep complaints, anxiety, depression, and symptoms of ADHD and ASD before and after the intervention, and at 3-month follow-up. The results showed that the intervention significantly improved sleep disturbances at post-intervention (p = 0.003, d = 1.30, 95% CI 0.31-2.28) and at the 3-month follow-up (p = 0.035, d = 0.41, 95% CI - 0.48 to 1.30). In addition, attention switching for ASD symptoms was significantly reduced post-intervention (p = 0.031, d = 1.16, 95% CI 0.19-2.13). This is the first pilot study of a trans-diagnostic group approach for adult ADHD and/or ASD with sleep disturbances. The intervention primarily led to an improvement of sleep disturbances, followed by improvement of disease-specific symptoms in adult subjects with ADHD and ASD.
RESUMO
The 2010 announcement by the Education Commission for Foreign Medical Graduates, related to accreditation by the World Federation for Medical Education, accelerated medical education reform in Japan. This article reviews reports on reforms undertaken in undergraduate medical education in psychiatry in Japan after 2010, and discusses resulting implications. While Japanese medical education has made significant progress, achieving global standards in less than a decade, there remain issues related to utilisation of active learning - inclusion of self-directed learning, problem-based learning, team-based and small group learning, and clinical training - as well as the provision of opportunities for students to be involved in certain medical procedures, and the integration of behavioural and social sciences, including communication skills, decision making, medical ethics, medical psychology, and general health promotion perspectives. These issues imply considerable paradigm shifts for psychiatry in Japan. It remains to be seen whether these progressive perspectives in undergraduate education can be effectively incorporated into postgraduate training, as well. There is also an issue of balance with specific important areas. The question of how undergraduate education in psychiatry in Japan can assimilate issues relevant to the practice of psychiatry in Japan, while ensuring conformity with high-level global standards, remains a serious challenge.
