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PCN Reports : Psychiatry and Clinical... Sep 2023Bin Kimura, the most internationally renowned Japanese psychopathologist, developed a unique life-theoretical position in his later years. The concept of "" or... (Review)
Review
Bin Kimura, the most internationally renowned Japanese psychopathologist, developed a unique life-theoretical position in his later years. The concept of "" or "betweenness," which was in the social dimension in his earlier thought, came to be called "horizontal betweenness," and the "vertical betweenness" in the vital dimension came to be emphasized. In relation to his time theory, the "intra festum," which signifies the tendency to immerse oneself in the present, has come to be highlighted as a direct contact with life. He used many coupled concepts, such as "/" and "reality/actuality," to contrast his life-theoretical position with the scientific-epistemological one. He was also heavily influenced by the ideas of Viktor von Weizsäcker, and superimposed his concept of "vertical betweenness" over Weizsäcker's concept of "ground relationship" by interpreting it as expressing the dependence of individual life () on life in general (). However, the strongest influences on his life theory were the ideas of Kitaro Nishida, the leading philosopher of the Kyoto School, with whom he had been familiar since his youth. In his last years, Kimura, under Nishida's influence, came to equate life in general with generalized death. Kimura's life philosophy might provide the foundation of psychotherapy by deepening subjective and empathetic understanding of psychiatric patients.
PubMed: 38867836
DOI: 10.1002/pcn5.145 -
PCN Reports : Psychiatry and Clinical... Sep 2023This paper will focus on the works of one of Japan's representative psychiatrists, Yomishi Kasahara, particularly on his works in the 1970s in which he proposed the... (Review)
Review
This paper will focus on the works of one of Japan's representative psychiatrists, Yomishi Kasahara, particularly on his works in the 1970s in which he proposed the concept of student apathy, and will discuss how this work was carried over into a contemporary topic, the study of "." Kasahara's well-known paper "Clinical Classification of Depression" (Kasahara and Kimura, 1975) described the present state of patients with Type III as "they do not have a complete set of symptoms as in Type I, but sometimes show dependency, strong exaggeration, complication of other neurotic symptoms, little tendency of self-reproaching, and tendency of accusing others"; the two subtypes as Type III-1 "those that remain at the neurotic level" and Type III-2 "those that transiently drop to the psychotic level." We have summarized and introduced below the case presented in the paper with this Type III-1. From today's perspective, where the concept of "" exists, this case could be considered as a typical case of "," that is, a person with a tendency to avoid social roles and responsibilities and to immerse oneself in areas with no responsibilities, such as hobbies. "" was discovered in the late 1980s, but to be precise, it was just that the concept emerged. The same clinical condition had already been brilliantly found by Kasahara in the 1970s under the concept of "apathy syndrome," which was distinguished from depression.
PubMed: 38867833
DOI: 10.1002/pcn5.120 -
PCN Reports : Psychiatry and Clinical... Sep 2023Pathography is a medical anthropological approach that examines the relationship between creation and psychiatric disorders through psychopathological and... (Review)
Review
Pathography is a medical anthropological approach that examines the relationship between creation and psychiatric disorders through psychopathological and psychoanalytical lenses using case studies. Since it was first defined in the mid-1960s, pathography in Japan has kept pace with current advances in psychopathological research. However, to date, the findings of pathographic research in Japan have not been published in English. Therefore, the purpose of this paper is to introduce the history, methodology, and development of pathography in Japan to the English-speaking world, accompanied by some classical examples. The paper first describes the history of pathography, from its origins in ancient Greece to important research in the field, including examples of publications and translations. Next, the paper presents the methodology of classical pathography as an approach that shares clinical psychopathology and psychiatric evaluation methods. This topic also introduces five main theses on the relationship between creativity and psychiatric disorders: opposition ("in spite of"), parallelism ("because of"), substitution ("instead of"), intrinsic ("belonging to"), and sublimation ("subsequent to"). Finally, the paper describes the development of pathographic research in Japan by summarizing the pathographies of several figures, including both creators and characters in literary works, and introducing the latest research on salutography, a newly developed field of study that explores the relationship between creativity and mental health. The paper concludes with a few words about the current limitations of pathography and suggestions for ethical considerations with respect to privacy legislation.
PubMed: 38867826
DOI: 10.1002/pcn5.130 -
Journal of Eating Disorders Jun 2024Schema therapy is promising for people with eating disorders, especially those unresponsive to cognitive behavioural therapy. Complex underlying psychological constructs...
BACKGROUND
Schema therapy is promising for people with eating disorders, especially those unresponsive to cognitive behavioural therapy. Complex underlying psychological constructs include dysfunctional schemas and maladaptive modes. This study aimed to explore people living with eating disorders' schema modes and their identification with and understanding of their high scoring modes.
METHODS
Sixteen women with enduring eating disorders without prior exposure to schema therapy completed the schema mode inventory for eating disorders short form (SMI-ED-SF), then participated in semi-structured interviews discussing their high scoring modes. Interviews were analysed by thematic analysis.
RESULTS
All participants scored above clinical concern on at least one maladaptive mode and many scored high on multiple modes, most commonly Demanding Mode, Vulnerable Child and Detached Self-Soother. Qualitatively, four themes emerged: 1) Adverse family environments related to (a) trauma and the vulnerable and angry child and (b) unrealistically high standards; 2) Mode effects on (a) everyday life and (b) disordered eating; 3) Modes are psychologically protective in (a) avoiding emotion by detachment and soothing, (b) people pleasing by compliance and surrender; 4) Help seeking including (a) barriers to recovery from an eating disorder, (b) dissatisfaction with interventions experienced to date, (c) schema therapy as a promising alternative.
DISCUSSION
Participants recognised and identified with their high scoring schema modes. After negative experiences with previous interventions, they considered schema therapy to be a promising alternative that could understand and work on their deeper psychological issues. This suggests that schema modes are a promising way of understanding and working with enduring eating disorders.
PubMed: 38867308
DOI: 10.1186/s40337-024-01031-x -
BMC Medicine Jun 2024Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient's family, school, and peers more... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient's family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking.
METHODS
We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing.
RESULTS
We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered.
CONCLUSIONS
This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment.
TRIAL REGISTRATION
Registered at PROSPERO (CRD42020177558), July 5, 2020.
Topics: Humans; Mental Disorders; Adolescent; Child; Home Care Services; Treatment Outcome; Female; Male
PubMed: 38867231
DOI: 10.1186/s12916-024-03448-2 -
Scientific Reports Jun 2024Anxiety disorders are the most prevalent worldwide mental health disorder, resulting in high societal costs. Emotion regulation and sleep quality are associated with the...
Anxiety disorders are the most prevalent worldwide mental health disorder, resulting in high societal costs. Emotion regulation and sleep quality are associated with the development of psychopathologies including anxiety. However, it is unknown whether habitual emotion regulation strategy use can mediate the influence of sleep quality on anxiety symptomology. An opportunity sample in a healthy population completed the Pittsburgh Sleep Quality Index to provide a measure of sleep quality, the Emotion Regulation Questionnaire to assess habitual use of emotion regulation strategies, and the Generalized Anxiety Disorder Scale to record anxiety symptomology. Data were analysed using correlation and regression-based mediation analyses. Improved sleep quality was predictive of reduced habitual use of expressive suppression and reduced anxiety symptomology. Additionally, increased use of expressive suppression was predictive of greater anxiety symptomology. Cognitive reappraisal was not associated with sleep quality or anxiety severity. Further, novel findings using mediation analyses show that expressive suppression partially mediated the relationship between sleep quality and anxiety. Whilst longitudinal and experimental research are needed to establish causality, these findings suggest that simultaneously targeting improvements in sleep quality and the use of specific emotion regulation strategies, including expressive suppression, may improve the efficacy of interventions focussed on reducing anxiety-related symptomology.
Topics: Humans; Male; Female; Sleep Quality; Adult; Anxiety; Surveys and Questionnaires; Middle Aged; Emotional Regulation; Anxiety Disorders; Young Adult; Adolescent; Emotions
PubMed: 38866858
DOI: 10.1038/s41598-024-63939-3 -
Eating Behaviors May 2024Dancers are at heightened risk for eating disorders (EDs) and have job and training demands that obscure ED assessment and likely impede treatment. Two behavioral...
Dancers are at heightened risk for eating disorders (EDs) and have job and training demands that obscure ED assessment and likely impede treatment. Two behavioral manifestations of ED psychopathology that may present uniquely in a dance environment are body checking and body avoidance. The current study sought to provide a foundational understanding of the phenomenology of body checking and avoidance among dancers by assessing the reliability (i.e., internal consistency) of existing body checking and avoidance measures and the relationships, or convergent validity, between measures of body checking and avoidance and measures of related constructs. Eighty professional and pre-professional (i.e., conservatory level) dancers (78.8 % female) from seven dance genres completed self-report measures of body checking and avoidance, ED pathology, clinical perfectionism, depression, and anxiety. Across the dancer sample, body checking and avoidance measures demonstrated adequate internal consistency. More frequent body checking and body avoidance was strongly related to higher levels of ED pathology. There were moderate to strong correlations between body checking and body avoidance and clinical perfectionism, depression, and anxiety such that higher body checking and body avoidance was related to higher clinical perfectionism, depression, and anxiety. Exploratory analyses found no significant differences between ballet dancers and dancers of other dance genres; professional dancers scored in the normative range on measures of body checking and body avoidance. Dancers' qualitative descriptions of body checking and avoidance revealed behaviors not included in existing questionnaires, such as unique mirror use behaviors, technology-assisted body checking, and the checking and avoidance of body parts relevant to the dance-specific body ideal. Results support the inclusion of body checking and avoidance interventions in ED treatments for dancers (particularly pre-professional dancers) and emphasize the need for dancer-specific ED assessment methods.
PubMed: 38865853
DOI: 10.1016/j.eatbeh.2024.101897 -
JAMA Network Open Jun 2024Racial discrimination is a psychosocial stressor associated with youths' risk for psychiatric symptoms. Scarce data exist on the moderating role of amygdalar activation...
IMPORTANCE
Racial discrimination is a psychosocial stressor associated with youths' risk for psychiatric symptoms. Scarce data exist on the moderating role of amygdalar activation patterns among Black youths in the US.
OBJECTIVE
To investigate the association between racial discrimination and risk for psychopathology moderated by neuroaffective processing.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used longitudinal self-report and functional magnetic resonance imaging (fMRI) data from Black youth participants in the US from the Adolescent Brain Cognitive Development (ABCD) study. Data were analyzed from January 2023 to May 2024.
EXPOSURES
At time 1 of the current study (12 months after baseline), youths self-reported on their experiences of interpersonal racial discrimination and their feelings of marginalization. Amygdalar response was measured during an emotionally valenced task that included blocks of faces expressing either neutral or negative emotion.
MAIN OUTCOMES AND MEASURES
At 24 and 36 months after baseline, youths reported their internalizing (anxiety and depressive symptoms) and externalizing symptoms (aggression and rule-breaking symptoms).
RESULTS
A total of 1596 youths were a mean (SD) age of 10.92 (0.63) years, and 803 were female (50.3%). Families in the study had a mean annual income range of $25 000 to $34 999. Two factors were derived from factor analysis: interpersonal racial discrimination and feelings of marginalization (FoM). Using structural equation modeling in a linear regression, standardized β coefficients were obtained. Neural response to faces expressing negative emotion within the right amygdala significantly moderated the association between FoM and changes in internalizing symptoms (β = -0.20; 95% CI, -0.32 to -0.07; P < .001). The response to negative facial emotion within the right amygdala significantly moderated the association between FoM and changes in externalizing symptoms (β = 0.24; 95% CI, 0.04 to 0.43; P = .02). Left amygdala response to negative emotion significantly moderated the association between FoM and changes in externalizing symptoms (β = -0.16; 95% CI, -0.32 to -0.01; P = .04).
CONCLUSIONS AND RELEVANCE
In this cohort study of Black adolescents in the US, findings suggest that amygdala function in response to emotional stimuli can both protect and intensify the affective outcomes of feeling marginalized on risk for psychopathology, informing preventive interventions aimed at reducing the adverse effects of racism on internalizing and externalizing symptoms among Black youths.
Topics: Humans; Female; Male; Racism; Black or African American; Child; Magnetic Resonance Imaging; Amygdala; Adolescent; Longitudinal Studies; United States; Depression; Anxiety; Cohort Studies; Self Report
PubMed: 38865126
DOI: 10.1001/jamanetworkopen.2024.16491 -
JAMA Psychiatry Jun 2024Accelerometry has been increasingly used as an objective index of sleep, physical activity, and circadian rhythms in people with mood disorders. However, most prior...
IMPORTANCE
Accelerometry has been increasingly used as an objective index of sleep, physical activity, and circadian rhythms in people with mood disorders. However, most prior research has focused on sleep or physical activity alone without consideration of the strong within- and cross-domain intercorrelations; and few studies have distinguished between trait and state profiles of accelerometry domains in major depressive disorder (MDD).
OBJECTIVES
To identify joint and individual components of the domains derived from accelerometry, including sleep, physical activity, and circadian rhythmicity using the Joint and Individual Variation Explained method (JIVE), a novel multimodal integrative dimension-reduction technique; and to examine associations between joint and individual components with current and remitted MDD.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study examined data from the second wave of a population cohort study from Lausanne, Switzerland. Participants included 2317 adults (1164 without MDD, 185 with current MDD, and 968 with remitted MDD) with accelerometry for at least 7 days. Statistical analysis was conducted from January 2021 to June 2023.
MAIN OUTCOMES AND MEASURES
Features derived from accelerometry for 14 days; current and remitted MDD. Logistic regression adjusted for age, sex, body mass index, and anxiety and substance use disorders.
RESULTS
Among 2317 adults included in the study, 1261 (54.42%) were female, and mean (SD) age was 61.79 (9.97) years. JIVE reduced 28 accelerometry features to 3 joint and 6 individual components (1 sleep, 2 physical activity, 3 circadian rhythms). Joint components explained 58.5%, 79.5%, 54.5% of the total variation in sleep, physical activity, and circadian rhythm domains, respectively. Both current and remitted depression were associated with the first 2 joint components that were distinguished by the salience of high-intensity physical activity and amplitude of circadian rhythm and timing of both sleep and physical activity, respectively. MDD had significantly weaker circadian rhythmicity.
CONCLUSIONS AND RELEVANCE
Application of a novel multimodal dimension-reduction technique demonstrates the importance of joint influences of physical activity, circadian rhythms, and timing of both sleep and physical activity with MDD; dampened circadian rhythmicity may constitute a trait marker for MDD. This work illustrates the value of accelerometry as a potential biomarker for subtypes of depression and highlights the importance of consideration of the full 24-hour sleep-wake cycle in future studies.
PubMed: 38865117
DOI: 10.1001/jamapsychiatry.2024.1321 -
Actas Espanolas de Psiquiatria Jun 2024Suicide in people without a mental health diagnosis pose a clinical challenge that is still poorly understood by psychiatrists, generating the debate between respecting...
INTRODUCTION
Suicide in people without a mental health diagnosis pose a clinical challenge that is still poorly understood by psychiatrists, generating the debate between respecting the patient's autonomy right or supporting involuntary admissions after a lethal gesture to rule out psychopathology.
AIMS AND METHODS
The authors take a case of an 81-year-old man without mental health history who, after his first suicide attempt by ingesting floor cleaners, presented acute kidney failure that required to initiate haemodialysis to preserve his life. Despite being aware of the fatal outcome in case of rejecting it, he denied the dialysis and verbalize the persistence of suicide ideation. This publication complies with the agreements of the Declaration of Helsinki and the informed consent was obtained from his wife.
RESULTS
It was finally considered that the patient maintained his capacity for judgment and no involuntary measures were taken, with family consent. Finally, he passed away ten days after carrying out the suicide attempt.
DISCUSSION
He was evaluated up to three times by mental health professionals and, after deciding that he had preserved judgment, his decision was respected. The patient passed away ten days later.
CONCLUSIONS
This approach could help psychiatrics better understand suicide behaviour in cases we don't make a mental health diagnosis.
Topics: Humans; Male; Aged, 80 and over; Suicide, Attempted; Fatal Outcome
PubMed: 38863040
DOI: 10.62641/aep.v52i3.1655