Psychosocial intervention is indispensable for psychiatry patients, but few patients are treated adequately. Training for psychosocial intervention also requires a significant amount of time and money. Technology-based intervention is more likely to reduce the cost. In this paper, meta-analyses showed mild to moderate efficacy in insomnia, schizophrenia, anxiety disorder and depression. However, there are some concerns about adherence and long-term effects. We discussed the necessity for further study of technology-based psychosocial intervention and how to implement said intervention in japan.

In several recent reviews, exercise and physical activity have been reported to be effective therapeutic strategies for the treatment of depression in adult men and women aged 18 and over. While aerobic exercise appears to be the most effective strategy for alleviating depression in adults, resistance training may represent a more effective strategy for the elderly. However, both the intensity and duration of exercise needed to treat depression effectively remain unclear. Advising patients to exercise for a short duration at a low intensity may represent the most practical strategy; it can also help to prevent fatigue. In the UK, guidelines for exercise therapy have been provided based on evidence obtained from intervention studies. However, few studies have investigated the effect of exercise on depression in Japan. In addition, the most effective method of using exercise as part of an overall psychiatric treatment plan has yet to be determined. In the near future, the effect of exercise on the treatment of depression in Japanese subjects needs to be validated so that evidence-based guidelines for exercise can be developed.

Psychiatrists in general hospitals usually manage mild or moderate cases of depression. Some guidelines such as those from the National Institute for Health and Clinical Excellence (NICE) and the Texas Medication Algorithm Project (TMAP) do not recommend antidepressants as a first choice for mild cases of depression. It is required to research other options for combating depression. Omega-3 fatty acids are one of the most studied interventions among life-style based approaches. In this paper, we review the evidence for the efficacy and mechanism of omega-3 fatty acids against depression. Moreover, we introduce our randomized controlled trial to aim to attenuate posttraumatic stress symptoms by omega-3 fatty acids.

Accumulating evidence suggests that Advanced Glycation End products (AGEs), generated as a consequence of facilitated carbonyl stress, are implicated in the development of a variety of diseases. These diseases include neurodegenerative illnesses, such as Alzheimer’s disease. Pyridoxamine is one of the three forms of vitamin B6 and it acts by combating carbonyl stress and inhibiting the formation of AGEs. Depletion of pyridoxamine due to enhanced carbonyl stress eventually leads to a decrease in the other forms of vitamin B6, namely pyridoxal and pyridoxine. We previously reported that higher levels of plasma pentosidine, a well known biomarker for AGEs, and decreased serum pyridoxal levels were found in a subpopulation of schizophrenic patients. In addition, we validated the replication of this metabolic abnormality in the new large cohort. Furthermore, we found that these patients shared many clinical features with treatment resistant schizophrenia, as defined by Kane et al. These features include a higher proportion of in-patients, low educational status, longer durations of hospitalization, and higher doses of anti-psychotic medication, compared with patients without carbonyl stress. Interestingly, psychopathological symptoms showed a tendency towards negative association with serum vitamin B6 levels. Our results support the idea that treatment regimes reducing carbonyl stress, such as supplementation of pyridoxamine, could provide novel therapeutic benefits for this subgroup of patients.

Non-pharmacological approaches have been drawn attention since CBT was covered by medical insurance here in Japan. In major treatment guidelines of depression including Japanese, pharmacotherapy was recommended in moderate to severe cases, however in mild cases, non-pharmacological approaches were mentioned instead. In most guidelines, it was common that treatment should finally be decided by patient's background, and preference. Clinicians should understand and utilize non-pharmacological approaches as well as pharmacotherapy. Upon decision, Shared Decision Making (SDM), which is a bilateral way of decision making is recommended. Through this process, patients might feel relieved, satisfied, and agreed, and this could promote resilience.

Oral hygiene of patients with mental disorders is an issue that needs to be addressed in the fields of mental health and preventive dental care for the disabled, as poor oral hygiene can adversely affect their health. In order to promote oral hygiene support for patients with schizophrenia, the aims of this study were two-fold: (1) to investigate research trends in the study of oral hygiene of patients with schizophrenia by reviewing the domestic and international literature, and (2) to highlight effective support systems and issues that need to be addressed in Japan regarding the oral hygiene of such patients in Japan. It was found that domestic research tends to focus on case reports and results of oral hygiene surveys, while international studies provide results of oral hygiene surveys and outlines of problems particular to schizophrenics. The results of the literature review suggest the need to enhance epidemiologic research about oral hygiene instructions to patients, improve organizational support systems to implement and manage oral hygiene instructions, and examine effective support systems based on Japanese mental health care and welfare systems.

Caring for demented patients markedly burdens their families, and this burden also affects the patients' QOL. In this study, we investigated behavioral psychological symptoms of dementia (BPSD) encountered in care, the severity of the burden, and factors that affect it. The subjects were 26 patents who visited the dementia clinic of the Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, and were diagnosed with Alzheimer's dementia. BPSD and the care burden were evaluated using a Japanese version of the Neuropsychiatric Inventory Questionnaire. Irritability (57.7%), depression (50.0%), and apathy/indifference (46.2%) were observed frequently, and irritability (15.4%), agitation/aggression (15.4%), depresssion/dysphoria (11.5%), and anxiety (11.5%) were mentioned frequently as symptoms that caused a moderate or severe burden. Concerning patients with each symptom, agitation/aggression (40.0%), irritability (26.7%), anxiety (33.3%), depression/dysphoria (23.1%), aberrant motor behavior (33.3%), delusion (28.6%), and disinhibition (25.0%) caused a moderate or severe care burden. While apathy/indifference was mentioned frequently, it did not cause a moderate or severe burden, and not all BPSD were perceived similarly as burdens by the care-givers. It is considered important to evaluate the burden felt by care-givers before taking hasty measures against BPSD. The care burden was correlated with only the clinical dementia rating (CDR) and revised Hasegawa Dementia Scale (HDS-R), and not with other neuropsychological tests or patients’ background factors. Further evaluation in a larger number of patients and from multiple viewpoints including factors on the care-givers’ side is considered necessary.

In this study, we assessed the relationship between the use of psychotropic drugs and fetal and neonatal complications encountered in patients with psychiatric disorders. From July 2007 to March 2012, 137 mothers with psychiatric disorders gave birth in our hospital. Ninety-nine mothers used psychotropic drugs within 12 weeks of pregnancy. There were 7 cases of miscarriage. However, they were not associated with the use of psychotropic drugs. There were 8 cases of malformation. All these mothers used psychotropic drugs within 12 this period. Among them, older mothers were more vulnerable to malformation risk (≥35 years: 6/30 cases; <35 years: 2/69 cases; p=0.0041). The number of psychotropic drugs used was associated with higher malformation risk (p=0.0021). Complications other than miscarriage and malformation were classified as complications that would be induced by the use of psychotropic drugs just before delivery and other complications. The incidence of each complication was 50% higher in the group that used psychotropic drugs after 12 weeks of pregnancy than in the group that did not. Thus, our findings indecate that the co-existence of psychotropic drug use, especially multidrug use, and older age may be associated with malformation in neonates of mothers with psychiatric disorders.