From the standpoint of direct pure experience in our actual world, Buddha realized that everything is impermanent and is the subject to change. Therefore, nothing exists eternally in this world. Due to our misinterpretation about this mirage through our attachments we experience every sort of suffering.

The teaching on what such phenomenal existence should be is the Theory of Dependent Origination. Here we define this theory as showing that every phenomenal existence exists as the state of arising from and depending on different elements and conditions of each other.

Then we shall consider the about existence of I (man). Naturally the theory of Dependent Origination should be adopted when dealing with this issue.

As our existence is only a kind of form of phenomenon, it exists in a form of dependent origination. Buddhism taught that I-ness, so man is only a collection of five different constituents or aggregates. The five aggregates or constituent elements are 1) matter or form, which have material form of existence as our body. 2) perception 3) conception 4) volition ; and 5) consciousness.

The form of existence which originates depending on these five aggregates is called “I”. Buddhism attaches importance to the consciousness. It is considered as a synonym with discrimination, recognition, mind and intention. Thus, we can understand that our mind includes them as its function.

Moreover, in addition to this, Buddhism has one more important catch. It is the idea of Karma. Karma indicates our deeds and their effects. Our deeds will be eradicated in a moment, but some effects shall remain. These effects tend to surface sooner or later, and they become the very conditions under which our future form of existence will originate. In accordance with that Our life shall be moulded in the following sequence.

Mind→words→considerations→ideas→deeds→personality→life

Biomarkers for diagnosis and severity assessment of psychiatric disorders are currently unavailable for many psychiatric conditions, which results in discrepancies in diagnoses, inaccurate evaluation of treatment efficacy, and failure of clinical trials. Development of careful and close symptom monitoring, symptom quantification techniques, and treatment modalities that utilize digital technology are gaining momentum worldwide as potentially useful approaches to address the aforementioned concerns. Additionally, the COVID-19 pandemic has significantly affected psychiatry worldwide, and digital health solutions, including telemedicine and artificial intelligence have emerged as major models of care during the pandemic. Application of digital technologies is reshaping psychiatry and opens new possibilities. In this article, we discuss trends in psychiatric care using digital technology and its prospects in Japan, focused on our research activities.

The so-called “placebo response” is associated structurally with the true placebo effect (P) on the natural healing ability (N), which can be expressed N＋P. Therapeutic effects of drugs can then be expressed as D＋N＋P, because the true effect of the drug (D) is added to that of N＋P. When we increase N＋P, we can expect an increase in drug effects, drug reduction, or loss of the need for drugs. The concept of a “soft 1.5 person” is a desirable attitude in which we can come and go between the first person (I) and the second person (you) softly and freely. Because the concept facilitates our empathy with patients, a relationship of mutual trust is built and N＋P increases, and an improvement of the curative effect can be then be hoped for with or without drug use, and communication becomes smooth in general personal relationships and stress can be decreased.

This paper introduces the management of stuttering by general physicians.

The author himself stutters and has struggled with speech anxiety since puberty. When he was a student, he tried every method that he could think of, such as autonomic training methods, private stuttering correction centers, associative therapy, and hospitalization Morita therapy, but nothing could correct his stuttering. Over the years, he was no longer bothered by stuttering. In 2016, while working as an internal medicine doctor, he opened a stuttering consultation outpatient clinic. After meeting many people who stuttered, he became convinced of the importance of the attitude of “loving yourself as you are and accepting what you cannot do.” Stuttering has waves and reversals that cannot be helped. Since it is extremely difficult to improve stuttering after becoming an adult, the author began to focus on how to prevent stuttering from getting worse in elementary and junior high school students. Regardless of the severity of the symptoms, a person who feels socially stigmatized, can receive reasonable accommodation, and get a disability certificate and pension. One can live with stuttering without being it being obvious, even if it cannot be cured. The author recommends it. If the patient does not focus too hard on trying to cure the stuttering, the symptoms will often improve spontaneously.

The author hopes that through the article, the number of doctors who are interested in treating stuttering will increase, and that the day will come when patients who stutter can visit an outpatient clinic anytime, anywhere.

Stuttering is a speech disorder characterized by disfluency, but it also includes social and anticipatory anxiety as well as language symptoms. People who stutter often experience fear and anxiety due to the co-presentation of stuttering with negative experiences and respondent conditioning. This can lead to avoidance of speech situations and reinforcement of anxiety through operant conditioning. In the cognitive model of social anxiety in stuttering, premonition, anxiety, avoidance, and self-attention form a complex, vicious cycle that further complicates the problem.

Low-intensity cognitive-behavioral therapy uses techniques such as exposure and attention training to reduce social and anticipatory anxiety, respectively. Exposure challenges speech situations that are often avoided, while attention training removes attention from the anticipation of stuttering. This method is expected to show an improvement of approximately one out of five on the Overall Assessment of the Speaker’s Experience of Stuttering for adults, as measured by a comprehensive questionnaire for stuttering.

People who stutter often experience anxiety and fear when speaking in public. These feelings can be magnified during important events such as entrance examinations and job interviews, which can have a significant impact on an individual’s life. Communication is a two-way street between the speaker and the listener. In 2016, the “Law for the Elimination of Discrimination Against Persons with Disabilities” was enacted, requiring universities and other institutions to provide reasonable accommodation. This paper presents examples of such accommodations for interviews, practical tests in entrance examinations, and other examinations. In contrast to the job-based employment system in the United States, the employment system in Japan is membership-based, and many students have difficulty finding a job. Even after employment, individuals with shuttering disorders may face challenges with telephone-based work, which was not a concern during their school years. The stuttering disorder is classified as F98.5 in the International Classification of Diseases, 10^th edition, and individuals can obtain a mental disability health welfare certificate. Such a certificate can be an effective means of employment support and can only be provided by a physician.

Objectives : In patients with eating disorders, the high rate of interrupted or unattended medical care is problematic. The underlying reasons and the kinds of treatment and support patients seek have not yet been clarified. This study aimed to identify the underlying factors that may encourage patients with eating disorders who do not seek medical care to seek support.

Methods : We conducted a web-based survey of patients with suspected eating disorder and their families. The survey items included basic attributes, hospital visit status, reasons for interruption or non-attendance, help-seeking scales, patients’ support needs for consulting a doctor at the time of the survey and when their symptoms had been most severe. Two hundred and sixty-four patients (mean age, 30.6±9.6 yo) and 115 family members (mean age, 49.5±10.8 yo) participated. This study was conducted with the approval of the Ethics Committees of the National Center of Neurology and Psychiatry, and Atomi University.

Results : The disease subtypes among the participants included 155 with anorexia nervosa, 98 with bulimia nervosa, 45 with binge eating disorder, 74 in recovery, and 7 were unknown. Moreover, 169 patients were currently visiting the hospital, 64 were not receiving treatment, 143 were interrupted, and 3 responded with “others”. The most common reason for not visiting the hospital was “I feel uncomfortable going to a psychiatrist or psychosomatic physician”, while the most common reason for discontinuation was “symptoms did not improve”. There was no significant difference in the help-seeking scores according to patients’ hospitalization status or disease subtypes. In terms of support needs, only “information about a nearby psychiatrist or psychosomatic physician who does not specialize in eating disorders” was more needed at the time of the survey, than “interruption of consultation” or “hospital visit”. In contrast, “provision of information to family members to help them support the patient”, “information about medical institutions with eating disorder specialists”, and “medical institutions that check the patient’s physical condition” were more needed by the participants when the illness was most severe. During severe illness, the need for “information for family members to support the patient”, “information on medical institutions with eating disorder specialists”, and “information on medical institutions that check the patient’s physical condition” were lower for participants who had not received medical care than for those who had interrupted medical care or were visiting hospitals at the time of the survey.

Conclusion : The results indicate that the patient’s help-seeking trait is not an important factor in receiving medical treatment. In contrast, the results suggest the importance of providing information regarding clinics close to the patients, educating patients to reduce stigma, and building a medical system to reduce patients’ disappointment in the medical care they receive.

Objective : Somatogenic pseudoneurosis is a concept advocated by Frankl V. E. There is a latent physical disease, but it is misidentified as a mental disease. Whether to treat the original physical disease or to use a lot of psychotropic drugs because of the psychological reaction, the doctor’s identity is questioned, and the prognosis of the patient changes drastically. This report aims to demonstrate the efforts of the team.

Case : A female in her thirties. The patient had been diagnosed with depression, but she had essential hypotension, reactive hypoglycemia, and Hashimoto’s disease. She took complementary agents, and she was counseled and nutritional guidance. The patient had an obsessive-compulsive personality disorder, but it was symptomatic of spontaneous hypoglycemia. As a result of comprehensive team treatment, her obsessive-compulsive behavior was alleviated and she is now able to look for a job.

Discussion : Team efforts contributed to the treatment process from patient dependence to independence in many ways. Many team members with a consistent view of medical care found it most useful to be “being”.