[Show abstract][Hide abstract] ABSTRACT: When clinicians are concerned about an increased risk of suicidality induced by antidepressants in young patients, mirtazapine is considered a suitable option because of its low risk of provoking suicidality and its sedative effect. However, mirtazapine often needs to be discontinued or the dose reduced because of drowsiness, especially in young persons. This study retrospectively compared the clinical effects of mirtazapine in 16 young university students to those in 16 elderly patients with depression. Drowsiness was the most frequent side effect, and was observed more often in the students. Greater numbers of students also had their doses reduced or stopped using mirtazapine specifically because of oversedation. Furthermore, the final dose of mirtazapine was much lower in the student group even though the therapeutic effects were similar to those in the elderly group, suggesting that lower doses of mirtazapine should be administered to young depressed patients as starting or maintenance doses to avoid sedation and achieve a minimal level of therapeutic efficacy.
[Show abstract][Hide abstract] ABSTRACT: Following the Great East Japan Earthquake, although there are a growing number of reports on the care of the mental health of victims and supporters, the influence of this disaster on individuals with mental disorders has not yet been sufficiently clarified. Here, we present a case of "oneiroid Erlebnisform" (Mayer-Gross, W.), which was influenced by the disaster and relapsed one year after the earthquake. We discussed the meaning of this experience and the factors leading to recurrence in this case. A male international student in his thirties had repeatedly suffered from acute episodic alteration of consciousness. Although he had experienced anxiety just after the disaster, he showed improvement during his temporary evacuation to Western Japan. Nearly one year after the disaster, however, he relapsed, with symptoms characteristic of an oneiroid state. The patient stated that he was a fuel rod in the Fukushima nuclear power plant, and he then immersed himself in a bathtub full of water in order to avoid meltdown. According to ICD-10, the patient was diagnosed with acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0). In addition to the alteration of consciousness as the main symptom, since there was no decrease in the level of personolity function, it was also considered that the diagnosis of this case was atypical psychosis, as proposed by Mitsuda and Hatotani. In the oneiroid experience, a variety of visual hallucinations, illusions, and images had appeared one after another. We can find catastrophe and salvation as the main themes in this state, related to the disaster and nuclear accident. Unloading situation after thesis defense, insufficient sleep, poor medication adherence, and the increased frequency of earthquakes were important factors in the recurrence of the present case. To continue research in Japan after the earthquake, the decision was accompanied by anxiety for the patient. One year after the earthquake, the patient was trying to enter a doctoral program with continued anxiety over the nuclear accident. When the frequency of earthquakes increased again, the patient was taking an entrance examination. There is a possibility that the anxiety in this situation led to the recurrence. People are vulnerable to being exposed to the fear of a disaster even after experiencing relief. This situation may increase the risk of recurrence.
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica 07/2013; 115(5):477-84.
[Show abstract][Hide abstract] ABSTRACT: With the expected increase in the number of international students coming to Japan as part of the Ministry of Education, Culture, Sports, Science & Technology's "300,000 Foreign Student (Global 30) Plan", the demands on university mental health facilities will also increase. However, the rate of mental disorders of recent international students has not been fully evaluated. As part of an initiative to establish effective treatment measures for the mental health of international students, we investigated the present status and recent trends of these students who visited the Mental Health Service (MHS) in the Tsukuba University Health Center. The demographic characteristics, pathway, stress, and diagnosis of international students who visited the MHS from 2005 to 2010 were investigated retrospectively based on medical records. The subjects were 59 international students (15 male, 44 female; mean age: 28.4). The consultation rate of international students was significantly lower than that of Japanese students each year. Although the rate is almost stable in Japanese students (2.1-2.5%), it has increased significantly in international students, from 0.5% in 2005 to 1.4% in 2010. A larger percentage of the subjects were from Asia (66%), compared to the former Soviet Union (10%) and Europe (7%). A greater proportion of the subjects were graduate students (67%). The diagnoses were as follows: depression (34%), adjustment disorder (32%), insomnia (15%), and schizophrenia (9%). The percentage requiring emergency consultation was 24%, including the most severe cases that had to return to their home country. Sixty-nine percent of the subjects stayed in Japan for more than 1 year. Half of the subjects decided to visit the MHS themselves. The results of the present study show that the consultation rate of international students was lower than that of Japanese students in spite of the "culture shock" experienced by international students. This result is in agreement with previous reports. Among international students, however, there is a trend indicating an increase of visits to the MHS in recent years, approaching the rate for Japanese students. Preparations for emergency consultation are still important.
Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica 01/2012; 114(1):3-12.