The symptoms of borderline (BPD) are often observed in young adults. They have difficulty in adaptation. Therefore, it is important to assess the extent of their BPD symptoms to ascertain intervention. However, there is no scale to assess BPD symptoms and their changes in young adults in Japan. Therefore, we developed a Japanese version of the Quick Evaluation of Severity over Time (QuEST-J) to assess these symptoms and investigated the reliability and validity of this scale in a sample of Japanese undergraduates (N＝733). QuEST-J comprises three sub-scales: “Thoughts and Feelings,” “Behaviors-Negative,” and “Behaviors-Positive.” A confirmatory factor analysis corroborates the factorial validity. Moreover, the results indicate enough internal consistency, test-retest reliability, and criterion-related validity. Therefore, QuEST-J is a reliable and valid scale to assess BPD symptoms in young adults.

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Patients with BPD are characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image. The efficacy of fluvoxamine and lamotrigine for affective instability in patients with BPD has been shown in controlled studies. However, no study has evaluated the effectiveness and safety of lamotrigine for treating irritability in adolescent patients with BPD in Japan. Here, we report the case of a patient with BPD whose condition improved after lamotrigine administration. Lamotrigine could be effective and safe for treating BPD-associated affective instability. However, large-scale controlled studies are needed to confirm our findings.

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We report here two cases of HIV infection with a borderline . Case 1 was a 25-year-old male patient who was diagnosed with HIV infection 4 years ago. Borderline was also diagnosed at that time. Although he was referred to our hospital in 1999, we had to refer him to another hospital for his regular outpatient hemodialysis. Case 2 was a 24-year-old male patient who had borderline since 1996. He was diagnosed with HIV infection in 1999 and referred to our hospital. Be ignored rules in visiting clinics such as prior reservations and frequently called doctors, case-workers and nurses. After several visit he intentionally took excessive sedative medicines and called a case-worker at our hospital. Be was admitted to our hospital for three days. After he was discharged, we set limitations for his behavior not to harm himself and to obey the rules in visiting clinics. In other countries investigators report that borderline is more common in HIV-infected persons. It may be because persons with borderline are more likely to engage in high-risk sexual behavior, which is also applicable to these two cases. As HIV infection is rapidly prevailing in Japan, it is possible that the chance are that this disoder will be seen more frequently in HIV infected cases.

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症例は, 41歳女性, 37歳で血液透析 (HD) に導入, 精神的動揺よりアルコール依存を生じ肝障害, 膵炎, Mallory-Weiss症候群などを併発した. 禁酒後は著しい水分管理不良が出現した. 導入3年目頃より精神的に安定し自己管理が改善され安定したHDが可能となったが, 腎性貧血治療目的でrecombinant human erythropoietin (rHuEPO) を投与したことを契機にアルコール依存, 水分管理不良が再燃, 腎性貧血改善に基づく血圧上昇と相侯って重症高血圧を発現し, 3回の高血圧性脳症発作を発症した後に死亡した. 本例はHD導入前後より種々の問題行動があり精神医学的には境界性人格障害と思われ, これが自己管理不良の原因に関係したと考えた. rHuEPO投与後に自己管理不良が再燃したことから, 貧血改善に伴う身体症状改善の影響およびrHuEPO自体の中枢神経系への直接作用が関与した可能性が考えられた. 問題行動のある例, 自己管理不良が著しい例でのrHuEPO投与に際してはより慎重にすべきであると思われる.

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In this paper, the author discusses dissociation as a psychological phenomenon. First, from Jung's description of the case of Miss. E with hysterical delirium, the essence of dissociative disorders is extracted as the patient's futile attempts to compensate for her inner emptiness with something external. Second, the relationship between modern consciousness and dissociation is examined mainly from a review of Jung's discourses, and the author attempts to psychologically define the concept of dissociation. Third, variations on dissociative phenomena-from hysteria to multiple -are reviewed by regarding psychoanalysis as a "vaccine therapy," with the history of the self-development of dissociation as a psychological "virus" mutating over time to produce new-generation viruses. Finally, the author critically reviews Putnam's research and discusses the psychotherapy of dissociative disorders from a Jungian viewpoint with some practical notes.

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Developments in the assessment of general and maladaptive personality traits in children and adolescents have been reviewed in the present paper, with an emphasis on instruments based on the Five-Factor Model (FFM), such as the Hierarchical Personality Inventory for Children (HiPIC; Mervielde & De Fruyt, 1999), which describes general traits, and the Dimensional Personality Symptom Item Pool (DIPSI; De Clercq, De Fruyt, Van Leeuwen, & Mervielde, 2006), which accounts for maladaptive traits. We have additionally discussed measures available in Japanese, to assess traits in children, adolescents, and adults, and pertaining issues in cross-cultural personality research, especially with respect to Western and Asian differences. Finally, a number of key implementation areas for personality assessment have been identified, together with some challenges for this promising field of research.

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It has been known that psychological factors are one cause of dizziness. We report a patient with dizziness with specific psychological causes. The patient was a 26-year-old woman who had previously been examined at several hospitals for a complaint of dizziness. A detailed examination at our hospital revealed no organic or functional abnormalities. She participated in group psychotherapy on the supposition that her dizziness had strong psychological causes, but communication with the doctor and other patients was difficult and psychotherapy had no effect. We then introduced a clinical psychotherapist, who said the patient had a borderline . The patient become hostile to treatment when administration of drugs either by drip infusion or orally was also ineffective, making further treatment virtually impossible. Mistakes in the care of patients with borderline personality disorders can aggravate the symptoms or even lead to self-mutilation or suicidal behavior. Moreover, commonly used simple psychological tests do not always detect this disorder. Consequently, accurate diagnosis and treatment of borderline is difficult for the otorhinolaryngologist. If this disorder is suspected, the best course for the otorhinolar-yngologist is to introduce a specialist in psychiatric diagnosis at an early stage.

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The validity of the Five-Factor Model (FFM) of personality for diagnosing

(PD) was examined in two equivalent PD groups, one with dimensional criteria (N = 246) and the other with categorical criteria (N = 165), selected from 1,088 university students. Both equivalent PD groups did not exhibit specific profiles for each PD on FFM scales of the NEO Personality Inventory-Revised (NEO-PI-R), and multiple regression analyses showed that FFM scores only partly predicted PD, although it was improved by the prototype-matching method. The comorbidity was not different in dimensional and categorical measures of PD. The results suggest that the FFM of personality is useful for providing information about the personality in each individual, but is not very helpful for diagnosing PDs, because each PD does not necessarily exhibit a specific homogeneous trait constellation on FFM based on the NEO-PI-R. Personality trait description and diagnosis of PD are not the same issues. It is necessary to integrate dimensional and categorical approaches to PDs for a more precise classification and diagnosis.

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Background: Anxious-depressive attack (ADA) is a proposed novel symptom complex associated with anxiety and mood disorders. Its main features are (1) sudden intense distressing emotions with no direct psychological cause, (2) intrusive memories of various negative events, (3) worry and agitation about the details of the rumination and (4) various coping behaviors, including acting out. The author has reported five previous cases of ADA. The present study investigates the clinical significance of ADA.

Method: First, to compare clinical characteristics between subjects with and without ADA, 331 consecutive new outpatients were examined (Study I). Second, because of the similarities between ADA and panic attack, the characteristics of ADA were examined in 65 panic disorder (PD) patients (Study II).

Results: The overall incidence of ADA was 43.2%. In PD and social anxiety disorder patients, those exhibiting ADA were significantly younger and had significantly more severe depression and social anxiety than those without ADA (Study I). In PD patients with ADA, ADA preceded panic attacks, and ADA frequency was correlated with the severity of depression and social anxiety but not with panic symptoms (Study II). ADA was often managed with acting out behavior (Study II).

Conclusion: ADA appears to be relatively common among people with anxiety and mood disorders. We found that ADA was correlated with the severity of social anxiety, but not PD. PD patients exhibited a “seesaw” phenomenon between ADA and panic attacks. ADA may be a core symptom complex of a severe form of anxious depression.

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反社会性人格障害（ASPD）は，違法行為の反復，人をだます傾向，衝動性，無責任性，良心の呵責の欠如によって特徴づけられる。本研究は，2つの行動選択課題を用いて，ASPD傾向者が高い衝動性を示すかを検討した。遅延価値割引課題では，参加者は，即時小報酬と遅延大報酬の間で選択を行う。衝動性は即時小報酬への選好と定義される。他方，確率価値割引課題では確実な小報酬と不確実な大報酬との間で選択を行う。衝動性は不確実な大報酬への選好と定義される。16名のASPD傾向者と19名の健常者が両課題を行った結果，まず，遅延価値割引課題ではASPD傾向者は健常者より急激に遅延報酬の価値を割り引くことが示された。確率価値割引課題では両群の差はなかった。遅延価値割引は，「反社会的行為の反復」ならびに「性的関係における無責任性・搾取性」と有意に関連していた。本結果から，長期的な結果の価値を切り下げることがいくつかのASPD症状の根底にあることが示唆された。

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There exists in human psychology the narcissism that is self-love, self-esteem and selfrespect. The narcissism would be divided into normal and pathological ones, both of which are hard to be differentiated from each other in the actual issues. Even those who possess a narcissistic personality usually appear to function socially quite well, and they are never to consult a psychiatrist. However, few need to see the psychiatrist and may present seriously disturbed behavior.
In the present com munication, the authors have reported a 26-year-old female patient with the narcissistic personality in pathological sense. After having graduated from a university school, she became to work for a company and increasingly attained good social adjustment as an office lady. Somewhat abruptly, one of her male colleagues made a proposal to her. She was rapt up with this fact of the proposal itself and engaged to him without thought Then, she realized that she came to scorn him badly. After all, she broke off the engagement just before the wedding, and became to show frequently self-destructive behaviors. Urged by her mother, she first visited our hospital against her will.
The authors have described the psychotherapeutic procedures c arried out for her in the actual treatment and reviewed Kernburg's research on the pathological narcissism.

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昭和54年から60年までの7年間に, 順天堂医院に入院したDSM-IIIの境界性人格障害の診断基準を満たす32例について臨床脳波学的に検討を行ない, 以下の結果を得た. 1) 境界性人格障害には脳波異常が27例 (84.4%) と高率に示された. 2) 脳波異常の内訳では, 基礎波の徐波化, 6Hz spike and wave (通称phantom spike and waveとも呼ばれる) が精神分裂性障害群に比較して有意に多かった. 3) 突発性異常を示す群では, 自殺企図が高率にみられ, またDSM-IIIの診断基準の「身体的に自己を傷つける行為」の項目が有意に多くみとめられた. 4) 脳波異常 (特に突発性異常) を伴う症例の示す情動障害, 衝動性の治療に抗てんかん剤が有効な場合があり, 治療後の脳波は改善を示す傾向がみとめられた. 5) 境界例の示す脳波異常は, さまざまの情動障害, 自殺企図を含む衝動行為などの臨床症状と密接な関係をもち, 境界例の病態の理解や治療にとって脳波異常と関連するような脳生理学的基盤の存在が重要であると考えられた.

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In this paper, the position that mindfulness has in dialectical behavior therapy (DBT) and its effects are discussed in relation to the historical background of the birth of DBT, the main theory, and treatment strategies, on which the personal history of M. M. Linehan, the founder of DBT, has a bearing. Mindfulness, called “core mindfulness skills” in DBT, is the core of all DBT skills. In the second edition of the skills manual published in 2015, new explanations and instructions on core mindfulness skills were added. Explanations from a spiritual perspective were also enhanced. This change suggests that mindfulness in DBT is in the process of dialectical evolution. Finally, the future prospects of mindfulness in DBT are discussed in terms of the expansion of its application, including in trauma care.

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【要旨】　抑肝散は古くから小児の癇癪、夜泣きや不眠症に対する効果が認められてきた生薬である。近年、認知症に伴う精神・行動障害に対する有効性に関する報告が増えている。我々は、境界性人格障害および遅発性ジスキネジアの症状改善にも有効であることや、治療抵抗性の統合失調症の増強療法にも有用であることを報告した。本稿ではこれらの臨床試験を総説するとともに様々な精神疾患への応用についての考察を加えたい。

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