Advances in Psychiatry of Japan

1
Advances in Psychiatry of Japan
1. Guideline for Treatment of Schizophrenia 2.
Re-naming the term Schizophrenia 3. A
Biological Research on Vulnerability
Mitsumoto Sato, M.D., Ph.D. Sendai,
Japan
March-13, Athens, 2005
2
Number of Patients

• 
  inpatients outpatients
• Mentally ill 490,000 334,000
  156,000
• Schizophrenia 260,000
  214,000 47,000
• Mood disorder 64,000
  26,000 39,000
• Dementia 63,000
  46,000 17,000
• Neurotic etc 46,000
  7,000 39,000
• Neurological disease (incl. Alzheimer disease,
  epilepsy)
• 184,000
  73,000 112,000
• 
  (number of patients treated / day, 1999)
  

3
The Yokohama Declaration

• Recommendation 1
• To do everything in their power to introduce
  adequate and comprehensive treatment of mental
  patients in their countries. This means that
  mental patients receive a balanced treatment
  combining pharmacotherapy with advanced
  psychosocial interventions for an optimal outcome.

4
The Practice Guideline for Treatment
of Schizophrenia 2004
5
Contents

• Chapter 1 Concept of schizophrenia
• (concept, epidemic, symptoms, course
  and outcome)
• Chapter 2 Formulation and implement of
  treatment plan
• (psychiatric management, acute phase,
  recovering phase,
• stable phase)
• Chapter 3 Review of available evidence
• (psychopharmacology algorithm,
  psychosocial
• interventions, treatment setting and
  housing, legislation)
• Chapter 4 Other important issues
• (suicide, physical complications,
  aging, judicial
• psychiatry)
• Chapter 5 Future direction of research

6
Formulation and Implement of Treatment Plan in 3
phases

• Diagnosis
• Evaluation of symptoms
• Psychopharmacology algorithm
• Psychosocial intervention
• Choice of treatment setting or housing

7
Principle for Treating Schizophrenia
Improve GAF considering risk-benefit of the
patients

• Community care with short administration
• Diagnosis using ICD-10 diagnostic criteria with
  multi-axial assessment
• 3. Comprehensive treatment plan (medication and
  psychosocial interventions) in acute, recovery
  and stable phase.
• 4. Psycho-educational approaches
• 5. Collaboration of medical staffs with patient,
  family, etc.

8
Concepts of Schizophrenia
Split-mind-disease Integration
disorder
(19372002)
(2002update)
Concept dementia praecox
a clinical entity Etiology
endogenous
vulnerability stress model Pathology unknown
imbalance of NTS Axis 1 2
inseparable separable Diagnosis
psychopathology operational
Prognosis poor (deterioration)
recoverable Psychoeducation difficult
easier
Treatment medication
comprehensive

(disease)
(syndrome)
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World Health Report 2001

• Schizophrenia follows a variable course, with
  complete symptomatic and social recovery in about
  one-third of cases.
• With modern advances in drug therapy and
  psychosocial care, almost half the individuals
  initially developing schizophrenia can expect a
  full and lasting recovery.

10
Course of Schizophrenia

• Prodromal phase 25 yrs
• Latency for referral
  12 yrs
• Recovery of psychotic phase 616 M
• Critical period 5
  yrs
• Long-term outcome
• Free of further episode 1015
• Exacerbation and remission 7080
• Chronically severely psychotic 1015

(APA,2004)
11
Vulnerability
Psychotic episode
Prodromal
Residual
Neurotoxicity?
Vulnerability Trait
Acquired Vulnerability
12
Number of Persons Arrested against the Stimulants
Control Law in Japan
55,664
55,664
1st Epidemic
2nd Epidemic
3rd Epidemic
WORLD WAR?
1950
1950
1960
1960
1970
24,372
19,937
1980
2000
1970
1980
1990
1990
1999
13
Paranoid Psychotic State with Hallucinationsinclu
ding the FRS
n

1st epidemic Hayashi (1955) 74
90 Tatetsu (1957) 131
92 Connell (1964)
42 100 2nd epidemic
Sato (1982) 82
90 Konuma (1987)
192
80
14
development
recur
prolong
flashback
symptom
psychotic episodes
abuse/dependence
methamphetamine
re-use
stress
Ujike et al, 2002
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Summary

• Dual Difficulties (re-name the term
  schizophrenia)
• Needs for realistic optimism in the practice of
  treatment (the guideline for treatment of
  schizophrenia)
• Disclose the vulnerability and relapse liability
  (biological research)