Generalized Anxiety Disorder (GAD) originally started out as a residual category and was reconstructed as an independent category with “worry” as the central symptom. However, “worry” is not specific as a central symptom of the disorder, a symptom that is also common in other mental and physical disorders. In addition, GAD has an extremely high comorbidity rate with other psychiatric disorders, and its existence as a distinct entity is inevitably questionable. To begin with, the diagnostic criteria for GAD itself have changed significantly over the past 40 years, and differed greatly between the DSM and ICD. Some have suggested that GAD is merely a precursor, residual symptom, exacerbating factor, or severity indicator of depression. Especially in our country, GAD is not a diagnosis that is actively given. Even if a patient has GAD, it is assumed that he/she is being treated with a diagnosis of depression, other anxiety disorders, or somatoform disorders. Some cases may be treated with multiple medications. In order to overcome this situation, it is necessary to further raise awareness of GAD, develop antidepressants indicated for the treatment of GAD, and create guidelines for the treatment of GAD in Japan.

COVID-19 pandemic has had a non-negligible impact on our mental health, with an estimated 53.2 million (27.6%) more people worldwide suffering from depression and 76.2 million (25.6%) more suffering from anxiety than before the spread of COVID-19 infection. This paper presents findings from previous studies on depression, anxiety, and depressive anxiety symptoms during the pandemic, with a particular focus on general workers, health care workers, COVID-19 infected persons, and pregnant and postpartum women. As is the case with many disasters, COVID-19 may have increased health and mental health disparities that originally existed, and ongoing measures are required.

Self-focused attention (SFA) and other-focused attention (OFA) are central maintenance factors of social anxiety, but few studies have investigated both simultaneously in social situations. In this review, we introduced our studies of Tomita et al. (2020) and Tomita & Kumano (2021), in which we aimed to measure both that could be compared by visualizing SFA and OFA from eye tracking and brain activity. These studies suggested that greater activities in the rFPA and the lSTG are useful objective measures of SFA and OFA during speech tasks in high social anxiety individuals, respectively. By real-time monitoring of brain activities in these regions during social situations, we could assess how changes in SFA and OFA occur in people with high social anxiety without asking for subjective SFA and OFA. In addition, these studies suggested that SFA and OFA are independent attentional processes based on specific brain activities.

Cognitive behavioral therapy (CBT) has been the most established psychotherapy in effectiveness for mental disorders. Promising results have recently been observed not only in the face-to-face CBT, but also in remote conditions via the Internet. The Internet is an indispensable infrastructure, and CBT via the Internet will be continuing to develop and spread in the future. In this literature review, I would like to summarize the findings on Internet cognitive-behavioral therapy in Japan and overseas, introduce mainly the evidence in Japan, and suggest the direction of future research.

This paper outlines the epidemiology, clinical characteristics, and treatment of comorbid obsessive compulsive (OC) symptoms in patients with schizophrenia. Compared to that of the general population, the prevalence of OC symptoms in schizophrenic patients is high and has a negative prognosis, adversely affecting the patients’ emotional and psychosocial functioning. Only 15.8% schizophrenic patients with OC symptoms lack insight into their OC symptoms, similar to the proportion of patients with pure obsessive compulsive disorder. Treatment includes pharmacotherapy and cognitive behavioral therapy, incorporating exposure and response prevention. If OC symptoms are induced by the use of second generation antipsychotics, pharmacotherapy may include reduction of the dose of the causative antipsychotics, change to another antipsychotic, or addition of aripiprazole. Selective serotonin reuptake inhibitors may also be beneficial for comorbid OC symptoms in patients with schizophrenia, including those induced by antipsychotics.

This study aimed to develop the Japanese Version of the Selective Mutism Questionnaire (SMQ-J), a psychometric scale designed to assess speaking behavior in children with selective mutism (SM), and examine its reliability and validity. We conducted translated versions of SMQ and CBCL/4-18 with 139 parents and carers of children with SM ages 4 to 12. An exploratory factor analysis revealed a four-factor structure: “Social settings,” “Family-related settings,” “School settings (classmate),” and “School settings (teacher),” whereas a three-factor structure (wherein the two “School settings” factors were combined) was reported by the original authors. The reliabilities of the subscales were confirmed. Additionally, the criterion-related validity was confirmed via a comparison with 101 parents of children collected as a control group by Tomioka (2016). Furthermore, an examination of the relationship between SMQ-J and CBCL/4-18 revealed that the discriminant validity was well supported, however, the relationship between the severity of SM and anxiety was not clearly shown. These findings demonstrated the reliability and validity of the SMQ-J, suggesting that it can be applied as an effective tool in the assessment of speaking behavior in children with SM.