Japanese Journal of General Hospital Psychiatry Vol. 26(2014) No. 3

Cognitive behavioral therapy (CBT) is an effective treatment for depression, anxiety disorders, and other psychiatric disorders. Although it is preferable that CBT be offered to all psychiatric patients who need CBT, it difficult for general hospital psychiatrists to routinely administer CBT to depressive patients because hospital psychiatrists are usually too busy attending to an ever-increasing number of patients. However, CBT training is important because CBT helps psychiatrists and comedical staff to develop therapeutic skills, facilitate team treatment, and improve psychiatric educational programs. CBT could be administered more easily in general hospital psychiatry by using low intensity CBT, such as self-help CBT guides, and computer- or internet-based self-help programs.

Cognitive behavioral therapy (CBT) is a form of psychotherapy which improves dysfunctional cognition and enhances the ability to manage problems in daily life. In late 1980s, CBT came to receive much attention and is now covered by the national health insurance in Japan. In this paper, the author explained the basic concepts of CBT, and described how to use the several CBT techniques, such as behavior activation, cognitive restructuring, problem solving, in a daily clinical settings and how to treat patients effectively by combining CBT and pharmachotherapy. For cognitive restructuring, for example, patients rethink his/her automatic thoughts and develop functional thoughts. This process helps the patient to separate their problems from themselves, deal with them in an objective manner, and replace dysfunctional thoughts with realistic and adaptive thoughts. It is also suggested that it would be useful to use Web-based CBT program which helps patient to examine automatic thoughts and generate functional thoughts.

Objective: The aim of this article is to review computer/internet psychotherapy for any mental disorders. Methods: We searched PubMed and selected the systematic review that meets the following criteria: participants with any mental disorders; computer/internet therapy as the intervention; and any mental disorder severity scale or quality of life scale as the outcome. Results: We identified five systematic reviews: 1) computerized cognitive behavioral therapy (cCBT) for depression; 2) Media-delivered CBT for anxiety disorder; 3) cCBT for insomnia; 4) cognitive remediation schizophrenia; and 5) virtual exposure for anxiety disorder. Although the methodological quality of each review varied widely, computer/internet therapies were statistically more effective than waiting list or no treatment. Only 2) review showed results from the comparison between face-to-face psychotherapy and media-delivered CBT. Symptoms of anxiety was statistically lower in face-to-face psychotherapy than media-delivered CBT. 1) and 2) reviews compared the difference in dropout rate between cCBT and waiting list or no treatment. The reviews reported that cCBT statistically resulted in more dropout than waiting list or no treatment. Conclusions: Computer/internet therapies for depression, anxiety disorder, insomnia and schizophrenia were statistically more effective than waiting list or no treatment. However, computer/internet therapies may increase dropouts.

Cognitive-behavior therapy (CBT) has been shown to be as effective as pharmacotherapy for depression. However, we do not have enough skilled clinicians to provide CBT to many patients with depression; even when the clinician has the required skills, he/she will not have sufficient time to administer the therapy to his/her many of his/her patients with depression. We have therefore decided to develop a smartphone CBT application which would help the clinicians in making CBT accessible to as many patients as possible. We plan to conduct a randomized controlled trial to test the application this year.

To the best of our knowledge, no study has compared the effectiveness of diazepam suppositories among various mental disorders. The purpose of this retrospective study was to determine the effectiveness of diazepam suppositories as the initial treatment of catatonic syndrome. The study subjects included 22 patients with catatonic syndrome; the primary condition was bipolar disorder in eight patients, schizophrenia in seven patients, major depressive disorder in four patients, acute and transient psychotic disorder in one patient, obsessive-compulsive disorder in one patient, and Lewy body disease in one patient. We used the Bush-Francis Catatonia Rating Scale (BFCRS) to assess the severity of catatonic syndrome. The BFCRS score significantly improved from 18.5 ± 9.39 to 4.80 ± 4.69 after diazepam suppository treatment. Our results show significant effectiveness of diazepam suppositories treatment for catatonic syndrome; however, further investigations of differences in the clinical use of diazepam suppositories for schizophrenia, major depression disorder and bipolar disorder presenting with catatonic syndrome is required.

During the perinatal period, women with psychiatric disorders are often at great risk of recurrence or deterioration of their disorders due to the discontinuation of psychotropic medication, increasing psychosocial and physiological stress, and other factors. However, some systematic strategies have been developed for preventing relapse in these patients during this period. The development of a comprehensive intervention program for women with psychiatric disorders is needed to appropriately manage their perinatal problems and improve their reproductive mental health. Therefore, in this study, we sought to prospectively evaluate the effectiveness of our comprehensive intervention program for women with psychiatric disorders during the perinatal period. The program consisted of five domains: 1) psychoeducation, 2) perinatal care planning using shared decision making, 3) management of social support, 4) familial education, and 5) parenting-skills training. According to the results, pregnant women who had completed the program were more likely to show clinical improvements in psychiatric conditions and global functioning at post-intervention and one-month follow-up after delivery. However, as this open-label study lacked a control group, no definitive conclusions could be reached on the effectiveness of the comprehensive intervention program. Larger randomized multicenter trials are needed to elucidate optimal strategies for the population.

Background: Alexithymia has been reported to hinder psychotherapeutic outcome. However, whether alexithymia influences the pharmacotherapeutic outcome of patients with major depression is unknown. The purpose of this study was to explore whether alexithymia predicts the prognosis of major depression patients treated with pharmacotherapy.

Methods: A prospective study was undertaken in 26 inpatients with major depression. Patients were treated with pharmacotherapy in a naturalistic setting. At baseline, the patients' scores on the 20-item Toronto Alexithymia Scale (TAS-20) and the Zung Self-rating Depression Scale (SDS) and other sociodemographic and medical data were obtained. Six months after discharge, outcome data (presence or absence of being at work and presence or absence of readmission after discharge) were obtained.

Results: A logistic regression analysis revealed that low TAS-20 scores and being unmarried were associated with being at work at 6 months after discharge in the participants. No factor was significantly associated with the presence of readmission in this sample.

Conclusions: Our findings suggested that alexithymia might be associated with the six-month prognosis in patients with major depression treated with pharmacotherapy. Individual traits such as alexithymia should be taken into account when we formulate the strategy to improve the prognosis of patients with major depression.