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Tokyo Wom Me吋d U凶 8 6 (artxE 1り)E38~E47 )61ρ0(2Views
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Kaoru SAKAMOTO D e p a r t m e n t Pfoyrtaihcys lo， ohcS Mfoenicide ， Tkyoo en'sWom lacideM ytisrevinU ( A c c e p t e d gustAu 31)5， 102 T h is ydtus demia aotniatrecs eht sweiv fo J esenaap stsirtaihcysp tno eh meaning making fo sesongaid and o
n
tehlacinilc esu ofolanoitarep .sesongaid A qeriannoitseu gniksa utoab sedutitta dswarot making sesongaid was tnes 2ot 38 members tfo eh
J
esenapa yteicoS rofcirtaihcysP .sisongaiD The esnopser etar was .4%5 The ma-j o r i t y psftsoirtaihcys tlef taht gnisongaid a ptneita did tonylirassecen etubirtnoc tot eh neitap 'ts tnemtaer ，t even when ehttsirtaihcysp was aware taht eno tfo eh sseporup fognisnogaid siot dia ni eht noitalumrof afo n a-ed q u a t e tnmeatret .nalp netenveeS ntecerp rfostnendospe deined ehtecnacifingis making fo laitnea dreffi -ongaid s i s fo"neewteb-ni“-sesac ainrehpozihcs and mood redrosid ylf， eihc eusecab yeht htughot taht sihtlaitnereffid id“ a g n o s i s did tonyltnacifingis tceffa ehtlaitini management tfosih upgro pfo.stneita owt-ytfiF tncerep rfo-nopse d e n t s sedu lanoitarepo citsongaid airetirc roflacinilc sesoprup etipsed rieht deviecerp kcal dfo hpte ， elihw eht -sid a d v a n t a g e cfolanoitnevno sesongaid sideredisnoc bot e teh kcal efoticilpx .airetirc The stluser gnirdaegr eht -id a g n o s e s pfostneita thiw eht ecnerrucco-oc mfo rjoa nosiserped and cinap redrosid detacidni taht more onpesr 司 d e n t s were lacitirc tfo ehlanoitces-ssorc ytidirboomc ochaprpa )%45( naht yeth were tfo ehemitefil ytdiibormoc a p p r o a c h .)%93( eerh-tytneveS tncerpe htgouth taht citsongaid stpcenoc euqinu ot J eseanap yrtaihcysp dlouhs be a c t i v e l y .dyelompe The sgnidnif tfo eh tnesrep yduts tesgugs taht ehtlacinilc esu ofolanoitarep citsongaid -etirc r ia insmare laisrevortnoc among
J
esnepaa stsirtaihcysp ， most whom fo make yratnemelpmoc esu cfolanoitnevno and lanoitarepo citsongaid methods hitw an asseneraw tforieh ssenlufesu and .snoitatimilKey W o:sdr J esneapa stsirtaihcysp lanoit， nevnoc sisongaid lanoi， tarepo sisongaid I n t r o d u c t i o n The noitucdortni folanoitarepo citsongaid -etirc r i
a such tsa he ctiosgnaiD and lacitsitatS Manual fo Mental ersordDis ， 3rd noitdiE (DSM-III) )1 has
g r e a t l y detatilicaf lcairipme seiduts and del a sot b-u s t a n t i a l searecni ni chsearer on pcirtaihcys o-ngiad s e s . N essleetherv e， rutaretil si gnikcal rdingrega t h
e views pfostsirtaihcys on teh meaning and fo -op t e n t i a
l problems detaicsosa with making a p-tiahcys r
i
c ssionagid and ， more yllacificeps ， on how they s h o u l d seu usioarv setpcnoc systems ro rof o-getac r i z i n g mental srdersoid ， gnidulcni lanotienvnoc and o p e r a t i o n a l citsnogaid tsncepco ， nilacinilc .sgnittes However stsir， taihcysp yllareneg agree taht -arpeo t i o n a l citosngaid airetirc doulhs be used ni rchseare s e t t i n g s
. The aims tfo eh tneserp survey were :ot )a( o
b t a i
n het views fo
J
apanese stsirtaihcysp on what they rdesionc ot be teh purposes and problems fo making a pciratihcys sisongaid ， and )b( niatrecsa t h e i r views on the lacinilc eus cfo lanointevno and o p e r a t i o n a l citsongaid s.tpecnoc MethodsA erianniostequ was detucstronc ， which was -id v i d e d otni eehrt :strap 'stenndopser demographic 図 uoraK SAKAMOTO tnemrtapeD foyrtaihcysP ， loohcS foenicideM ， Tokyo 'smenoW lacideM ytisrevinU ， 8-1 K a w a d a -c h o uk-uku， jnihS ， oykoT 666， 8-261 J anpa E -m a i l : [email protected]
-E38-6 1 e d b ~ー一一一一， a 5 4 今 、 u ω
・
回
。
ω ω ロ m w ω 田 園 2。
A B C D E F F i g . 1 Mean gniknar serocs rof hcae rotcaf -disnoc e r e d ot rebtnavele oteht smia fognkiam -a pihcys a t r i c sisongaid %95( )IC T h esrotcaf eerw :ssawollof )A(gnitalumrof ana-ed q u a t e tnemtaert nalp ， gn)iB(ziretcarahc eht-ohcysp p a t h o l o g i c a l etats ， )C(gnitciderp ehtlacinilc esruoc a n d emoctuo g， nit)D(atilicaf noitacinummoc among p s y c h i a t r i s t s ， )(Egnidnatsrednu fsiosenegohtap ， )F( p r o v i d i n g noitamrofni otehttneitap dna.ylimaf :a N S ;:f-b OOOp<O. .l d a t a and eht laerneg and laiceps seussi delvovin ni making ca pirtaihcys .sisongaid A dtfar noisrev was p i l o t e d hwit p06stsirtaihcys and snoitacifidom were made ni eht thgil tforieh comments erofeb gdinens ou t teh lanif .noisrev A l l 382 members tfo ehJ
eesnapa yteicoS rof -ysP c h i a t r ic ssionagiD ， who were dreeidsonc eht most
l i k e l y ot be detseretni nicirtaihcysp essnogiad among
J
esepana stsirtaihcysp ， were tens eht lanif v e r s i o n tfo eh eriannoitseuq gni， tsisnoc fo 0 q2 -seu t i o n s ， a cgnriveo rettel gninialpxe eht imsa fo eht s u r v e y ， and a pidaepr nruetr peloveen niJ
une .2102The eriannoitseuq was nirder-okanr and -elpitlum c h o i c e atormf ithw ecpas roflanoitidda comments. The gniwollof xislapicnirp saera were :derolpxe )1( t h e msai and problems making fo cia prtaihcys -gaid n o s i s ni ehtlacinilc ;gnittes )II( eht meaning mak-fo i n g laia dtnereffi sisongaid fo e“tadiemertni -ysp c h o t i c "aera 2))1; (II ehtnoitubirtsid fo sentndposer u t i l i z i n g lanoitnevnoc usrsev lanoitarepo citsongaid c o n c e p t s ; )V1( eht gesantavda and segatandvasid fo c o n v e n t i o n a l usrsve lanoitarepo ;sesongaid )V( eht a t t i t u d e s fo stnednopser sdrawot eht ytidirbomoc d i a g n o s t i c roachapp ， deredisnoc ot be one fo eht h i g h l i g h t e d themes folanoitarepo ;sisongaid and ( V 1 ) eht sedutitta rfostndenopse rsdawot eht eus fo c o n v e n t i o n a l citsongaid stepcnoc euiqnu ot
J
-apa n e s e .yrtaihcysp S t a t i s t i c a l onsrispamoc roflacirogetac selbairav were performed ginsu eht derauqs-ihc tset ro het t w o -t a i l e d s'rehsiF ctaex tset where .etairporppa M u l t i p le snisomparoc were made gnius one-way a n a l y s e s foecnariav (ANOVAs) dewollof by ptso h o c stset by uro ngis eht Friedman tset dewollof by t h e ooxncliW kanr-edngis tset hwit eht niorrefnoB c o r r e c t i o n when .yrassecen The level sfeocnacifingi was tes ta p
<
.50.0 llAlacitsitats surecedpro were p e r f o r m e d thwi SPSS ， noisrev 02 (SPSS .cn1 ， -ihC c a g o ， 1L ， .USA) R e s u l t s RespondentsThe enspoesr etar was 4 .5 % (l 351 /.)382 The mean noitarud efocenieerpx pniyratihcys tfo eh -er s p o n d e n t s was 8.22 sarye :egnar( ;7-52 95% -ifnoc d e n c e lavretni C[:].)I67.42-8.02 The snoitubirtsid -er g a r d i n g eht 'stendnopser secalp work fo were fsa-lo l o w s : 50% worked ni a uytisrevin department fo p s y c h i a t r y ， 25% a mni lenta atipsoh ，l 8% in a petavir o u t p a t i e n t cinilc ， 7% in a pcirtaihcys tinu fo a g-ne e r a l atipsoh ，l and 10% worked ta rehto .snoitacol The snoitubirtsid fo eht 'stndenopser cirtaihcysp s u b s p e c i a l t i e s were sa:swollof 42% dezilaiceps ni b i o l o g i c a l rytahicysp ， 16% nilacinilc yrtiahcsyp and p s y c h o p a t h o l o g y ， 12% dezilaiceps ni hotb tfo eh -rof mer two seitlaicepsbus ， and 30% dezilaiceps ni o t h e r saera .g.e( l， aicos yrtaihcysp ， yphareothcysp ， f o r e n s i c rytiahcsyp cirta， ireg .)yrtaihcysp
Aims and raleneg problems making of -ogniad s e s cnilacinil sgnittes R e s p o n d e n t s were asked ot rank ， ni gdincenesd o r d e r folacinilc enacortipm ， xis srotcaf dreeidsonc by teh rothua be rot tnavele tot eh saim making fo a p s y c h i a t r i c .sisongaid sreocS dnegsisa ranged from 1 (sael t )tnatorpmi 6 (ot stom .)tnatropmi tnacifingiS d i f f e r e n c e s ni gkinanr redro were ndfou among eht s i x srotcaf p(
<
000.0 ，1 Friedman .)tset As F.gi 1 shows ， eht mean serocs rof eht two tshegih rankeds c h i z o p h r e n i c symptomatology ， ngidulcni S c h n e i d e r ' s knar-tsrif symptoms 3)， rof one month. Respondents were asked iotetacidn what ot ntteex t h e y would reidsonc tilufginnaem make ot -a dreffi e n t i a l sisongaid among ainehropzihcs ， mood -rosid d e r ， lacipyta isshocysp ， and evitceffa-ozihcs -rosid d e r reofeb gnitrats eht nteatmert tfosih esac ， which c o r r e s p o n d s ot e“taiedmertni ciothycsp area ro “etbn-is-easc w e e n " 2). The noitubirtsid fo -nosper D i a g n o s i s of “eiatredmetni icotychsp area" I n eht reianonitseuq ， a cesa ettengiv was -erp s e n t e
d a 3fo dlo-raey-2 male who had ysluoviepr -xe p e r i e n c e
d two manic and one evisserped )s(edosipe and who has ylnterrucnoc dsetfeainm manic
d e n t s gdinegarr eht esonpser ot eht epyt-trekiL q u e s t i o n was fsa:swollo r23 sdentspone answered very ngfuleanim 12(，)% 9 s6 dia lufningema )%5(4 ， 25 s a i
d somewhat guflinnaem )%16( ， and 6 answered 2
n o t fluningaem .)%71( The r26 ntsondeesp who -noc s i d e r e
d taht ereth was no need ot make -a dnereffi t
i a
l sisongaid ni het “etaidemretni citohcysp "eara were asked otetacidni eht .nosaer The most -erf quent nsespoer )%67( totsih noisteuq was taht mak-i n g laita dnereffi sisognaid soed ton rappea ot -noc t r i b u t e tot eh management and tnemtaert fo -“sesac i n -b e t w e e n . " No stnacifingi snoitaicossa emerged between eht a t t i t u d e s fo stondenspre towards laitnereffid -gaid n o s e s fo "enewt“e-bn-isesac and rieht cirtaihcysp s u b s p e c i a l t i e s trorieh ytiniffa rof lanoitnevnoc -rev s u s lanoitarepo citsongaid a.athemsc There were a l s o no stnacifingi secnereffid between eht n-opsre d e n t s ithw and touhtiw evitisop sedutitta towards t h e meaning folaitnereffid seosngaid fo-lil-s“esac between" ni terms tfo he noitarud forieht -irepxe e n c e pni.yrtaihcys C o n v e n t i o n a l susver lanoitarepo ssinoagdi Respondents were asked ot etacidni t h e y make a dsisongai gndicorca notlanoitarepon-o c o n v e n t i o n a l citsongaid stceponc ， S c h n e i d e r ' s 3) and eht htnni noitide fo eht -anretnI t i o n a l noitacifissalC Dfosesaesi )9-DCI( 4)， aro-drocc i n g otlanoitarepo citsongaid airetirc ， such sa eht DSM-IV 5
) and ICD-1061• As idetacidn Fni.gi 3， among
whether a s such c o n t r i b u t e tot reatmen .t and -E4一-G i t e m s .e.i( ， gniatulmrof an aaetudqe nttreatme nalp [ A ] and ngiziretcaarhc eht lacioglhoatphocysp etats [ B ] ) were ralimis and nacifingis ylt rheigh < 0p( 000. ，1 Wilcoxon kna-redngis )tset nhat het serocs rof het r e m a i n i n g semit .e.i( ， gnitciderp ehtlacinilc seurco
and outcome C[g，nitaJtilicaf communication among p s y c h i a t r i s t s ]D[ ， agnidnstrednu pfosseineogtha ]E[ ， and ginidovpr notiamrfoni tot eh tneitap and ylmiaf [ F ] ) .
Respondents were osla asked rot an，k descendni 幽
i n g derro focitamleobrp evel ，levif srotcaf -disnoc e r e d ot be picmatlebor when making a pcirtaihcys d i a g n o s i s . srecoS dengissa ranged from 1 (tsael p r o b l e m a t i c ) 5 (ot tmos .)citamelborp tnacifingiS -fid f e r e n c e s ni ngranki redro were found among eht f i v e srotcaf (p< 000.0 ，1 Friedman .)tset As shown ni F i g
. 2， eht tsheghi mean erocs was rof mtei (A) ， which detats taht gnsinoagid esdo ton ylirassecen F i g . 2 Mean gniknar serocs rof hcae rotcaf -disnoc e r e d ot pebcitamelbor niginkam cirtaia phcys -gaid n o s i s (95% )1C The srotcaf eerw s:sawollof )A(gnisongaid seod ton n e c e s s a r i l y etubirtnoc ottnemtaert ， y)tB(luciffid ni m a k i n g laitnesse sisongaid eud oyttniatrecnu foeht e t i o l o g y . )C(gnisongaid seod tonylirassecen -birtnoc u t e otgnitciderp eht esruoc dna .emoctuo )(D roop i n t e r r a t e r .ytilibailer )(Egnisongaid siylerem -lebal i n g fciortaihcysp .snoitidnoc :a p ;9= 100.0 :d-b p< 0 . 0 0 0 .1 d E D b F一一a一.一.一... C B A 3 . 5 2 . 5 1 . 5 . 5 4 3 2
。
ω 1圃 。
ω 市 町 田 園 w ω 田 岡ONLYCONV. 10% 2 0 怖 ONLYOPE. CONV.&OP .E 64% F i g . noi3 tubirtsiD fostnednopser gnidrocca otrieht esu flanooitnevnoc susrev -arepo t i o n a l citsongaid airetirc CONV: lanoitnevnoc citsongaid airetirc ， OPE: lanoitarepo citsongaid .airetirc t h e tsdenonespr ， 010 )%46( dteorper taht heyt esu b o t h lanotinevnco citsongaid stpecnoc and -arepo t i o n a l citsongaid airetirc ， (30 %)20 detats taht eyth p r e d o m i n a n t l y seu alnoitenvnoc citsongaid -noc c e p t s ， 51 10%)( detacidni taht eyth lyantminoedrp u s e lanoitarepo citsongaid airetirc ， and 8 (5%) -er p o r t e d taht eyth ylno seu laonitnevnoc citsongaid c o n c e p t s n( = )4 rolanoitarepo citsongaid airetirc ( n = .)4 A one-way ANOVA dealever tnacifingis -fid f e r e n c e s among eht setnodnpser who lyno ro -erp d o m i n a n t l y seu lanointevnoc ongiad cits tsepncoc ( n = 34 d， errefer aot ts eh lanointevnoc )pourg ， esoht who ylno pro yltanindmoer esu lanoitarepo -songaid t i c airetirc n( = 91 ， derrefer ot sa eht lanoitarepo g r o u p
) ， and eshot who eus thob citsongaid schemata ( n = )001 htiw srdgare tot eh mean noitarud tforieh e x p e r i e n c e ni ytraichyps (F 2川 = 50.3 ， p = .)50.0 B o n n f e r o n i / n'sDun elpitlum rnosipamoc tset showed taht eht lanoitnvenoc puorg had -ifingis c a n t l y more sarye focirtaihcysp ecneriepxe anth d i d eht lanoitarepo group n:mae( 3.62 sarye ， :1C 2 2 . 2 -3 0 4..sv mean: 0.81 rsaye ， C:1;24-21 p = .)510.0 R e s p o n d e n t s thwi a sytlaicepsbu folacigoloib -ysp c h i a t r y were more ylekil ot eus lanoitarepo -songaid t i c airetirc nhat were stndeonpser hwit a s-pesbu c i a l t y cfloacinil yratihycsp ro ygohloopatychps 6.74( v s . 9.1，% p = 330.0 s'r， ehsiF tcxae .)tset One hundred evif-ytrof stdneonpser ， ngdiuclxe t h o s e who ylno esu lanotinevnoc citsongaid -noc c e p t s n( = )4 orolanoitarep citsongaid airetirc n( = )4， were osla asked otetacidni how yeht yllautca esu t h e two tnereffid citsongaid .ataemhcs As shown ni F i g . 4， ehtnoitubirtsid rfosseonspe otsiht noitsueq was sa:swollof 42% rfostnednopse seu lanointevnoc d i a g n o s t i c tspceonc nilacinilc sgnittes and -arepo t i o n a l citsongaid airetirc ni hcareser sgnittes ， 42% make n eatroff ot seu thob citsongaid schemata ni c l i n i c a l sgnittes ， and 8% seu lanoitarepo citsongaid c r i t e r i a nilacinilc sgnittes ylno rofcificeps -songaid t i c seirogetac hcus psaytilanosre .redrosid R e s p o n d e n t s were kedas ot kran ， ni gdincenesd o r d e r pfocitaemlbor evel ，lxis srotcaf deredinsoc ot b e ictmalebrop ni eht lanoitarepo citsongaid -pa p r o a c h . sreoSc dnegissa ranged from 1 l(tsae -borp l e m a t i c ) ot 6 (tmos .)citamelborp tnacifingiS -reffid e n c e s ni ngnkira rerdo were deviecrep among eht f i v e srotcaf (p< 000.0 ，1 Friedman .)tset As idetacidn i n .giF 5， eht mean serocs rof eht mseit fo “kcal fo d e p t h and "sseisvenrheneocmp and “ngingcha fo c r i t e r i a rof ya rlevitale trohs "doirep were -ifingis c a n t l y erghih (p< 000.0 ，1 noxocliW knar-dengis )tset t h a n eht serocs rof eht rehot .srotcaf R e s p o n d e n t s were osla daske rot kan ， ni-dencesd i n g rdero focitmaeblorp level ， evif srotcaf -disnoc e r e d be ot ictmaeblopr ni eht lanoitenvnoc -songaid t i c .chaorppa sreocS degnissa gednar from 1 l(tsae p r o b l e m a t i c ) 5 (ot tosm .)citamelborp The Friedman t e s t dleaeevr tnacifingis secnereffid < 0p( )1000. ni A 官
OPE. FOR SPECIAL CATEGORIES IN CLINICAL SETTINGS
80/(
。
OPE. & CONV. IN CLINICAL SETTINGS 42% OTHER 8% OP E. IN RESEARCH SETTINGS CONV. IN CLINICAL SETTINGS 4 2 怖 F i g . 4 Dnoitubirtsi fostndeonsper gndircoca otrieht seu folanoitnevnoc susrev -arepo t i o n a l citsongaid methods roflacinilc rrohcraese esosurpp CONV: lanoitnevnoc citsongaid .airetirc OPE: lanoitarepo citsongaid .airetirc ，d 4 . 5 、 ， c -b 3 . 5 3 = ω ω UE 5.2
出
品
ム
I
e ロ q E喧J 2 1 . 5 . 5。
A B C D E F F i g . 5 Mean ngkianr serocs rof hace rotcaf -disnoc e r e d ot e pbcitamlebor ni ehtlanoitarepo citsongaid a p p r o a c h 5%(9 )ICThe srotcaf were sa:swollof )A( kcal fo thdep and c o m p r e h e n s i v e n e s s . )B( ngngicha foairetirc rof a r e l a t i v e l y trohs .doirep )C( tcelgen efoylra .sisongaid ( D ) kcal folaciteroeht .sisab )E( gnitcurtsbo -taert m e n t . )F(lanoitnevnoc citsongaid stepcnoc aer esu -f u l enough rof.gnisongaid :ap ;= 9210.0 :e-b pく000.0 .1
the ranking order among the rfou .srotcaf As F.gi 6
shows ， the highest mean score was orf item (A) ，
“ckla f eoticilpx aiertirc ." Comorbidity diagnosis
Two case vignettes were presented ttah dellifluf
3 . 5 τ「ー一一一a'- -3 2 . 5 ω 』 8 Q m 2 国 e ωE q E5 . 5
。
A B C D F i g . 6 Mean ngkianr serocs rof chea rotcaf -disnoc e r e d ot be pcitamlebor ni eht lanoitnvenoc -songaid t i c hoacppra %(95 )IC The srotcaf were sa:swollof )A( kcal foticilpxe -irc t e r i a . )B( ropo retarretni ytilibailer . )C(lnaoitnevonc c l a s s i f i c a t i o n emsysts reffid among .sloohcs )D( -noc v e n t i o n a l sisongaid siylekil ot be idecneulfn by i-utn i t i o n and niotaupccoerp . :a p ;= 5100.0 .b:c p< 0000. .1the DSM-IV airetirc both fo major depression and panic disorder together ni one episode ifossenll or i
n
dnteerfif .sedosipe and asked respondents iot-idn c
a t
e ireht diagnoses and sdeuittta towards the c r o s s -s e c t i o n a
l and emtiefil comorbidity appro-aches7l
• .ylevictpeser Of the respondents ， (83 54%)
-E42-o f f e r e d noitisoppo ot ehtlanoitces-ssorc d-bioromc i t y proachpa nterruncoc( ecneserp more fo ntha one d i s o r d e r ) and 0 r6 snetndspoe )%93( argued tsniaga t h e emitefil yitidrbomoc ahcporpa laitneuqes( -serp e n c e dfosredrosi rove eht whole .)napsefil pon-Res d e n t s who edoravf laonitnenvoc sisongaid -nenvoc( t i o n a l )uporg were yltnacifingis more ylekil be oot -p p o s e d ot ehtlanoitces-ssorc ytidirbomoc sisongaid ( 7 5 . 0 .sv 35% ，χ2
=
73.7 ， fd=
1， p=
)6600.0 and eht-efil t i m e tydibioromc sisongaid 6(.15 v.s 32，%1. p=
0 . 0 4 0 7 s'， rehsiF tcxae )tset ntha were esoht who -af v o r e d lanoitarepo citsongaid airetirc lanoitarepo( g r o u p ) . These tsenondspre were edaks ot evig -aer s o n s rof rieht noitcejbo ot eht ytidibromoc -pa p r o a c h . The most ntequefr esnopser %)87( otsiht q u e s t i o n was taht lanoitidda seosngaid such sa p a n i c redrosid dluohs be idetaorprcon otni eht most e s s e n t i a l sisongaid ， such major sa onisesrpde ， which c o r r e s p o n d s ot eht neitap 'ts comprehensive main d i m e n s i o n pfoy.gloohtaopchys Furthermore ， stnndeposer were edntesepr thwi a c a s e ettengiv fo a 22dloぅ-raeT ealemf who demon-s t r a t e d ylon two DSM-IV airetirc rof enilredrob erp 目 s o n a l i t y redrosid hucs a psa nretta ufoelbatsn -retni p e r s o n a l spihsnoitaler and ytitnedi encaburtsdi s i n ce eht gea 1fo 7 ， tub who rof eht tsal two months h a s ytlnrercunco dellifluf lla thgie DSM-IV airetirc f o r enilredrob ytilanosrep redrosid and eht airetirc f o r a major evissepred edsoipe hwit ciolhncalme f e a t u r e s .reificeps nI esnopser ot eht onitseuq “1九tahT si your sisongaid rof siht "?esac ， a vyteira fo r e s p o n s e s were dorderec ， htiw eht most ntequefr b e i n
g Axis :1major evisserped edospie and Axis :II b o r d e r l i n e ytilanosrep redrosid ginrdocca ot DSM-IV cairetir ;)%6.33( Axis :1major evsisepred edoispe and xisA :IIenilredrob ytilanosrep serutaef 71(;)%1. o n l y einlredrob ytilanosrep redrosid gndiorcac ot c o n v e n t i o n a l citsongaid sptecnoc 1(.1;)%8 Axis :1 ma-j o r evisserepd deosiep and sxiA :IIenilredrob -rep s o n a l i t y erdrosid gnidrocca ot DSM-IV airetirc and o n l y neilredrob ytilanosrep redrosid gndiorcac ot c o n v e n t i o n a l citsongaid stepcnoc ;)%5.01( and ylno d e p r e s s i v e ssenlli gndiorcca otlnaoitnevnoc -gaid n o s t i c tsepncco .)%3.5( D i a g n o s t i c ptsnceco euiqnu ot Japanese -ysp c h i a t r y There era lareves citsongaid stpecnoc queuni ot J sepanea yrtiahcysp ， which etaler ot otn lyno c u l t u r e -b o u n d syndromes ， but osla ot a tyogolyp fo premorbid ytilanosrep foevisserped ssenlli ， eht -id a g n o s t i c noitacifissalc system dfoeivsserpe etats ， a n o s o l o g i c a l ytitne lacipyta( sishocysp Mitsudfo ぷ)) ， and seirogetacbus dfoevsiserpe ssenlli and -ozihcs p h r e n i a . R e s p o n d e n t s were kedas otetacidni whether t h e y ghtthou chsu citsongaid stpecnoc ldouhs be a-c t i v e l y employed nilacinilc sgnittes ， hguhotla heyt have ton tye deviecer lanoitanretni .ecnatpecca Of t h e tsdenonespr ， 901 (73%) deorvfa siht aedi ， whereas (44 %)72 were oppodes ot eht seu sfo uch c o n c e p t s . Respondents who ylno pro lynantdmioer u s e lanotinevnoc citsongaid tspceonc were more l i k e l y be iot fn rova tfo eh eus J fo neseapa -songaid t i c tsepncoc anth were esoht who ylno pro i-omedr n a n t l y eus lanoitarepo sisongaid 3.37( .sv 7%5.2 ，χ 6 . 3 4 ， fd = ，1 p .)= 210.0 D i s c u s s i o n Although usoviepr seiduts have edsu -noitseuq n a i r e sveyurs otetagitsevni 'stsirtaihcysp -nvenco t i o n a l citsongaid stibah 9)1 0) and rieht sedutitta -ot wards ralucitrap citsongaid seirogetac such sa b o r d e r l i n e ytilanosrep redrosid
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evitaicossid -rosid der，l21 and noitazitamos redrosid 31)， siht si eht tsrif s u r v e y ot ssessa eht views fostsirtaihcysp on teh meaning and fo lsmeborp detaicossa ithw making a p s y c h i a t r i c sisongaid ， wsa lle sa ehtlacinilc eus fo c o n v e n t i o n a l and lanoitarepo citsongaid .stpecnoc M e t h o d o l o g i c a l snioatrdeinsco I t may be dtluciffi gotezilarene eht sgnidnif from t h i s eysvru tfo eh members tfo eh aneseJap yteicoS f o r cirtaihcysP essagnoDi J ot epanesa stsirtaihcysp i n aLnereg However ， eth stneondpser deduclni a l a r g e number pfo entnromi srosseforp ， roines -noc s u l t a n t stsirtaihcysp ， and srotcerid s fefiotilica who a r e dreeidsnoc be tot eh gnidael stsirtaihcysp J ni -a p a n . gnierdsinoC rieht taerg ecneulfni on J seaneap p s y c h i a t r y ， eht sgnidnif tfo eh tnserep ysurve may r e p r e s e n t eht mainstream tnoiwpeiv fo enesapaJ p s y c h i a t r i s t s .At1hough ehttseter-tset ytilibailer dluhos be e-x amined cotmrinfo eht sgnidnif some fo tfo eh -seuq t i o n s ylral， ucitrap esoht where sntdenpoesr were a s k e d ot nkra setubirtta ni rerdo forieht -ropmi t a n c e ， such laormpet seitilibailer were ton exam-i n e d . However ， eht user t1s o tf eh nteserp yudst -er v e a l e d ylhgih tnacifingis nkar 国redor secnereffid rof t h e s e snoitseuq ， which dluoc etagitim uchs -thme o d o l o g i c a l .ssesnekeaw Aims of making a pcirtaihcys sisongadi The sensopser ot eht snoitseuq gindargre eht a i m s and emsoblpr making fo cia prtaihcys -ongaid s i
s may laever a dilemma common most ot -aihcysp t r i s t s . N amely ， eseht sesnopser tesggus taht most p s y c h i a t r i s t s leef taht making a dsisongai seod ton n e c e s s a r i l y etubirtnoc tot eh tnmeatret ， even when t h e y redisnoc gnitalumrof n aa etaqued tentmaret p l a n bot e teh most tnatropmi serpopu making fo a d i a g n o s i s . The stluser on tehsedutitta rfostenndpose tot eh meaning making fo laitnera deffi sisongaid "fo-sesac i n -b e t w e e n
" ainerhpozihcs and mood redrosid may p r o v i d e rehtruf thgisni otni siht a.memlid Seven 目 t e e n tncerep rfostnednpose denied ehtecnacifingis o f making laia dtnereffi sisongaid fo-lll-s“esac between ，y"lfeihc seaucbe yeht tghouth taht -reffid e n t i a l sesongaid made no stnacifingi ecnereffid ot t h elaitini management fosiht proug fo.stneitap T h e i r iewv may be bedas on trieh ydayever -carp t i c e ， ni which "neewteb-“ni-sesac used otlla be t r e a t e d gnsiu scitpeloruen evitcepserri forieht -fid f e r e n t i a l .sisongaid ireTh weiv may be frehtru -ilicaf t a t e d by teh marked seicnapercsid nilanoitnevnoc d i a g n o s t i c stepcnoc eviftcoeffa-ozihcs redrosid -da v o c a t e d by slareve .srohtua riehT euqitirc tfoeh -fid f e r e n t i a l sisongaid fo"neewteb-ni“-sesac tmigh -er f l e c t neo tfo eh snosaer why eht lanoitnevnoc -gaid n o s i s ev siftceoffa-ozihc redrosid siylerar duse by J esnepaa stsirtaihcysp .)9 Thus ， J seneapa -aihcysp t r i s t s edendt ot evig a clanoitnevno sisongaid fo s c h i z o p h r e n i a arolacipyt sisohcysp ， hsa as been -da v o c a t e d by Maitsud 8 ) and yldewi detpoda ni panJa ， t ostneitap thwi DSM-IV a-ozihcs 百e'evitc redrosid o r ralopib redrosid htiw mood tneurgnocni -ysp c h o t i c serutaef 9 )円
However ， when gniredisnoc taht making -ra deffi e n t i a l sisongaid among ainerhpozihcs ， -ozihcs a f f e c t i v e redrosid ， and mood redrosid sah dnouofpr i m p l i c a t i o n s rof eht esu mood fo srezilibats hucs sa l i t h i u m .etanobrac which ash neeb demirfnoc cot-no t r i b u t e tot eh esruoc and outcome pfostneita -gaid n o s e d hsa ngiva DSM evitceffa-ozihcs redrosid 41 ) ro DSM ralopib redrosid gnidulcni mood tnuerngocin p s y c h o t i c serutaef
ペ
eht ecnatropmi lfaiotnereffid d i a g n o s i s ""nefeowteb-ni-sesac nca be brette -erppa c i a t e d . I n csartno ，tereht may osla pbestneita rof whom making laitnea dreffi sisongaid esod tonylirassecen c o n t r i b u t e ot enatmert .t For ecnatsni ， many -ysp c h i a t r i s t s lno regno eveileb taht eht endogenous/ n o n -e n d o g e n o u s .g.e( ， citoruen ro)evitcaer -tohcid omy foevisserped ssenlli sah tentmaret -acilpmi t i o n s 附ω~ ，hgouhtla sihtnoitazirogetacbus sha nbee r e g a r d e d sa tnartpomi nilanoitnevnoc cirtaihcysp t r e a t m e n t sgnittes J ni apan 9 ) . C o n v e n t i o n a l ssurev laoniatrepo citsongaid -pa p r o a c h e s The tneserp ydust detacidni taht most tfo eh -er s p o n d e n t s edus thob lanoitnevnoc citsongaid -noc c e p t s and lanoitarepo citsongaid airetirc ， elihw ylno a few tsndeonpser )%5( ylevisulcxe sedu rehtie -sys t e m . houghAlt most stnednopser seemed otezilitu c o n v e n t i o n a l citsongaid stpecnoc ni yadeyrve -carp t i c e t， iwas osla deotn taht more stnendposre 25()%4. t h a n dteecxpe edus lanoitarepo citsongaid airetirc s u c h tsa eh DSM-IV ton ylno rof hcreaser ， tbu osla f o rlacinilc .sesoprup The stndeonpesr ddearegr eht l a c k efoticilpx airetirc and eht rweol retarretni -iler a b i l i t y folanoitnevnoc citsongaid methods sa eht most citamleborp serutaef fo eseht ataschem ， and t h e se srotcaf may nialpxe why stsirtaihcysp employ o p e r a t i o n a l citsongaid airetirc nilacinilc .sgnittes However ， tidlouhs osla e nb deto taht desaercni -iler a b i l i t y seod tonylirassecen eetnaruag desaercni -id a g n o s t i c .ytidilav I n anoitidd tot eh stluser tfo eh tenserp yduts ， er 同 c e n t seatbed dleh ata n alaunn eetingm tfoeh J -apa n e s e yteicoS foyrtiahcysP and N eygoloru 20)2 )1-er v e a l e d taht ehtlacinilc seu ofolanoitarep citsongaid c r i t e r i a llits sniamer laisrevortnoc among J eesanpa
-E44-p s y c h i a t r i s t s . A sgnort argument tsniaga eht-inilc c a
l esu tfoeh DSM-IV was taht tistcelgen ylrae and p r o b a b l e sisongaid ， gnitseggus taht eht DSM-IV d o e s ton tneserper lacinilc citsongaid airetirc ， utb r a t h e r laa ncigoloso noitacifissalc mestys 21.) On teh o t h e r hand ， ninoitidda otdesaercni retarretni -iler a b i l i t y ， eht tcaf taht most DSM dsesongai have -ossa c i a t e d laciripme atad stes taht edulcni noitamrofni o n teh ygoloimedipe laci， nilc esruoc ， tnematetr -er s p o n s e ， outcome ， and lailimaf nrettap sideredisonc t o dnel trpopus ot ehtlacinilc ytilitu fo eht DSM-IV 02 ) . The stluser stgegsu taht stsirtaihcysp htwi a s h o r t e r noitarud foecneirepxe niyrtaihcysp and t h o s e thwi a more etamitni ytiniffa roflacigoloib p s y c h i a t r
y were more ylekil ot employ lanoitarepo d i a g n o s t i c .airetirc tI dulohs be ederusn taht siht t e n d e n c y among geryoun stsirtaihcysp utothiw s u b s t a n t i a l lacinilc gniniart and ecneirpexe esod ton i n c r e a s e eht ksir forieht gniyfilpmisrevo plexcom p s y c h o p a t h o l o g i c a l serutcip and ginndtarsdenuism p s y c h o p a t h o l o g i c a l slaitnesse ;)22 eseht sksir may a r i s e esauecb tfo eh kcal fo hptde and hen-compre s i v e n e s s folanoitarepo citsongaid airetirc ， which t h e sntendopsre ni eht tnerruc dytus deredsinoc sa t h e most ciatmelbopr serutaef folanoitarepo -gaid n o s t i c .sodhetm Thus ， eht esu folanoitarepo -gaid n o s t i c airetirc hucs sa eht DSM-IV nilacinilc and e d u c a t i o n a l sgnittes dluohs be dermfoni by na a w a r e n e s s ifost sksir and .snoitatimil S i n c e ehtnoitacilbup tfo eh R-IIM-IDS 却，eht -noc c e p t cfoytidibromo sha deniag desaercni noitnetta i n teh dleif pfotaihcys ry .)7 sN eselehtrev ， eht stluser showing tnacifingis id旺e'sencer ni eht setar fo -ca c e p t a n c e tfo eh ytdiibromoc hcaroppa between -er s p o n d e n t s who rovaf lanoitarepo sisongaid and t h o s e who rovaf lanoitnevnoc sisongaid stseggus t h a t eht ytiidbrmooc tpencoc si a stcejbu cfo-disno e r a b l e yrsevrotnoc among
J
esenapa .stsirtaihcysp The stluser ngirdager eht sesonagid fostneitap w i t h ocecner回rucco fo rojam noisserped and cinap d i s o r d e r detacidni taht more sntdenpoesr were c r i t i c a l tfo ehlanoitces-ssorc ytidirbomoc achproap ( 5 4 % ) nath yhet were tfoehemitefil ytidibromoc -pa p r o a c h .)%93( shiT gnidnif stsgegus taht a legra number foJ
eesanap stsirtaihcysp llits ubtdo eht -av l i d i t y efognitanimil eht III-MSD lacihcrareih -ulcxe s i o n a r y elur taht sevig rojam noisserped -ecerp d e n c e rveo eht yteixna .sredrosid nInoitidda ot f a m i l y citeneg seiduts 42 )お) and evitcepsorter lacinilc s t u d i e s )62 ， rehtruf itcepsorp evlacinilc seiduts era n e e d e d dotlepsi eseht .stbuod Such seiduts need ot d e t e r m i n e whether stneitap thiw ecnerrucco-oc fo m a j o r noisserped and yteixna tedrosid ni eht same e p i s o d e ifossenll o og n to poleved rehtruf sedosipe o f mjora noisserped enola roa/dn yteixna redrosid a l o n e nirieht lanidutignol .sesruoc fI major -serped s i o n and yteixna snoitidnoc sywaal rucco-oc ni-ruf t h e r sedosipe ， eht ytidilav fo ehtlanoitces-ssorc c o m o r b i d i t y citsongaid hcaroppa dluohs be r-noce s i d e r e d . N e a r l y flah tfo eh stnedonpser veag a dlau -gaid n o s i s mfo rajo noisserped and enilredrob -lanosrep i t y redrosid ， gndirocca ot eht DSM-IV ， ot a ptneita w i t h enilredrob ytilanosrep serutaef who -ianm f e s t e d eht nwolb-lluf syndrome foenilredrob -rep s o n a l i t y redrosid ylelos gnirud a major evisserped e p i s o d e . shiT gnidnif stseggus taht a lkca rfo-goce n i t i o n fo eht tneisnart noitacifidom foytilanosrep f e a t u r e s by Asxi 1 dsredrosi hcus msa oraj -serped s i o n dluoc dael ot oansisongaidrev foytilanosrep d i s o r d e .r More stendonsper )%37( nhat dteecxpe were ni f a v o r fo eht esu focitsongaid stpecnoc ueiqun otJ
eesanpa yrtaihcysp elihw ylsuoenatlumis gnieb aware tfo ehytluciffid nignicudortni uchs -songaid t i c stpencoc gnisu a、
ommon "geauganl rof-anretni t i o n a l .niotcaniummoc ishT ytluciffid was -disnoc e r e d by rsntdenpose who dreovaf lanoitarepo -gaid n o s t i c airetirc bot e teh rajom noitcejbo ot eht-inilc c a l seu sfo hcu .stpecnoc These stluser tesggus taht a legra number foJ
seneapa stsirtaihcysp may em-p l o y uchs stepcnoc nilacinilc sgnittes asedb on an a w a r e n e s s tforieh "latcel“aid ssenlufesu and -atimil t i o n s . C o n c l u s i o n The stluser tfo eh tenserp dytus steggus taht a l a r g e number foJ
eesnapa stsirtaihcysp leef taht making cira ptaihcys sisongaid seod tonylirassecen c o n t r i b u t e ot menattre ，t neve hought eyht era4 6
aware hatt a main reason rof gnihslibatse a do-iagn s
i
s si formulate ot an adequate treatment .nalp The r e s u l t s showing that tlnoianvnoce ciotsngaid -con c e p t s ， gludininc esoht unique ot
J
apanese chia-psy t r y ， are being employed nilacinilc sngtiets by the majority fo respondents suggest that mostJ
-apa nese stsirtaihcysp ieatecrppa the lacinilc ytilitu fo these concepts iteespd rieth suoriav .snoitatimilMore than flha tfo eh respondents argued instaga the lacinilc use cfolaonicte-sssor comorbidity -agid noses ， suggesting ttha they do not dreoisnc such p-o e r a t i o n a l concepts be uot lfuse everyday ni e.citcrap I n contras ，t the lacinilc nsseufesul ofo nlaoatirep -id a g n o s t i
c airetirc such sa the DSM-IV was sug -gested ， rof ceinstan ， by the view ttha the i 旺ed en-r
t i a l osisiagnd fo “"eneewtn-b-isesac according oot p -e r a t i o n a l airetirc hertra than ilanoetnvnoc concepts c oul
d make a cnoitiburtno treatmenot .t Neverthe-l e s s ， ti must osla be emphasized that lanioratoep -id a g n o s t i c airetirc should be employed by pia-sych t r i s t
s who have reaitprppao lacinilc experience )5
and who are railmiaf with such icstgnodia systems.
Lack f such o ytiraliimaf may dela ot ， rof neciatsn ，
t h
e gsisnoaidorev fo ytilanosrep redorsid ， as ug-s gested by the current .sgnidnif
In summary ， the stulser the fo current study g-su g
e s
t ttha
J
apanese stsirtaihcysp do not make -lucex s i v e use f eo rheti tlaoinnevnoc or olanotiarep -gaid n o s t ic methods cnilacinil sngtiets ， but rather make complementary use both fo with an awareness fo the ssefulnesu and snoittaimil eachfo ， thereby ena -b
l i n
g them achieve ot the aims dfo g.osingnai
Acknowledgments 1 am glufetar otlla my cfo seuagello who completed t h e .eriannoitseuq The orutha setacidni no cstcilfno ifoseretn .t R e f e r e n c e s 1 ) American citraihcysP :notiaicossA citsongaiD a n dlacitsitatS Manual Mfolatne serdrosiD ， dr3 -ide t i o n . .)III-MSD( American cirtaihcysP sserP ， Wash-i n g t o n ， DC ()0891 2 ) Marneros A ， Tsuang MT: aozihcS 旺evitce -rosid d e r s : tneesrp level and.sevitcepsrep nIaozihcS 宜-ce t i v e ssehocsyP sosrenraM( ，A Tsuang MT e)sd ， -E46-pp 390 - 381 ， rengirpS glareV grebled， ieH-nilreB ( 1 9 8 6 ) 3 ) eridnechS K: Kehcsinil eigloohtapohcysP ， orgGe Thieme wNe-rt， atgttuS York )7691( 4 ) W odlr Hea 1t h O:noitaizangr latneM :sredrosiD G l o s s a r y nda deuiG totriehnoitacifissalC ni-roccA d a n c e htwi eht hntiN noisiveR tfo ehlanoitanretnI C l a s s i f i c a t i o n fosesaesiD .)， 9-DCI( WHO ， Geneva ( 1 9 7 8 ) 5 ) American ciratihcysP :noitaciossA citsongaiD a n dlacitsitatS Manual Mfolatne sredrosiD ， ht4 -ide t i o n . .V)I-MSD( American cirtaihcysP sserP ， Wash -i n g t o n ， DC ()4991 6
) World Hea 1t h O:niotaiznagr The ICD 幽-0 C1ifissal
c a t i o n Mfo alent and laroivaheB .sredrosiD lacinilC d e s c r i p t i o n s dna citsongaid senilediug ， WHO ， -eG n e v a )2991( 7 ) enhttcWi HU: lacitirC seussi ni ehtnoitaulave fo c o m o r b i d i t y pfocirtaihcys .sredrosid Br J Piahcsy 司 t r y :03p1puS 619- ，6991 8 ) udaitsM H: The tpecnoc folacipyta :sesohcysp f r o m eht tcepsa clfoacinil .sciteneg ailoF rtaihcysP N e u r o l pnJ :61 22-412 ，12691 9 ) Kitamura T， Shima S， oakiS E e at:lcirtaihcysP d i a g n o s i s ni J .napa .l A sydtu dnocitsongai slebal u s e d .srby penoititcar ygolohtpaohcysP :22 924-923 ， 1 9 8 9 1 0 ) Kitamura T ， Shima S， akioS E e at:lcirtaihcysP d i a g n o s i s ni J .napa y.til2ibaileR cfolanoitnevno -id a g n o s i s danseicnapercsid thiw charseeR -songaiD t i c airetirC .sisongaid ygoolthpaochysP :22 95-2502 ， 1 9 8 9 1 1 ) Tarnopolsky A ， tziowelreB M: enilre‘droB -rep s o n a l i t y ' : citsongaid sedutitta taeht lyedsMua -soH p i t a .lBr J Pyrtaichys :441 96-3436 ，4891 1 2 ) Pope HG Jr ， aviOl PS ， Hudson eIJ at:l sedutittA t o w a r d DSM-IV evitaicossid sredrosid sesongaid among deifitrec-draob American .stsirtaihcysp Am J Prytaihcsy :651 2331-23 ，9991 1 3 ) nertS J， Murphy M ， Bass :CsedutittA fohsitirB p s y c h i a t r i s t s toteh sisongaid sfonoitasitamo -rosid d e r . A qeriannoitseu .yevrus Br J Pyrtaihcys :261 4 6 3 -4 6 6 ，3991 1 4
) Keck PE Jr ， McElroy SL ， wiksaokrtS SM: New d e v e l o p m e n t s niehtlacigolocamrahp tnmetaret fo s c h i z o a f f e c t i v e .redrosid J Cnil yrtaihcysP (75lppuS 9 ) : 8-414 ， 6991 1 5 ) American ciratihcysP :noitiaocssA ecitcarP g u i d e l i n e rof eht ntetmaret pfostneita htiw ralopib d i s o r d e r . Am J Pyrtaihcys 151:)21lppuS( 63-1 ， 4991 1 6 ) Garvey MJ ， erffhaSc CB ， Tuason VB: mpariCo 同 s o n folacigolocamrahp tnetmaret esnosper -eb t w e e n lanoitautis danlanoitautis-non .snoisserped Br J Pyrtaihcys :541 6533-63 ，4891 1 7 ) aykelP ES ， tseirP RG: noitingoceR and nage-ma ment fonoisserped ni ge
( S u p p l l ) : 3-291 ， 9391 1 9 ) American citrahicysP :ntoiiaocssA ecitcarP g u i d e l i n e rof jorma evissreped redrosid ni.stluda Am J Pyratihycs 051 lppuS( :)4 ト26 ，3991 2 0 ) Kitamura P:T emslbor pfocirtaihcys sisongaid and n e c e s s i t y folanoitarepo .sisongaid acirtaihcysP te N e u r o l o g i c a cainpoaJ :99 647-247 ， 9791 i(n J-apa n e s e ) 21) Nakayasu An i:N aed cfloacinil tahw-ssiongaid era needed rof lanoitarepo citsongaid .airetirc Psy 同 c h i a t r i c a Nteacioglorue acinopaJ :99 6476-37 ， 7991 ( i n J )esenapa 2 2 ) Maj M: Ceuqitir fo eht DSM-IV lanoitarepo -gaid n o s t i c airetirc rof.ainerhpozihcs Br J Pytrahicys 1 7 2 : 4 5 8 -4 6 0 ，8991 2 3 ) American icratihcysP :noitiacossA citsognaiD and lacitsitatS Manual Mfo latne srerdosiD ， rd3 -ide t i o n ， dseviRe .， )R-III-MSD( American cirtaihcysP P r e s s ， nothingsaW ， DC ()7891 2 4 ) Leckman JF ， Merikangas KR ， slauP DL e at:l A n x i e t y sredrosid and :noisserped snoitcidartnoc between ylimaf dytus aatd and III-MSD n-envoc t i o n s . Am J Pyrtiahycs :041 2880-88 ， 3891 2 5
) Leckman JF ， Weissman M M ， Merikangas KR et a l : cinaP redrosid and ormja .noisserped dsearecIn r i s k dfonoissrepe msil， ohocla ， cinap ， and ciobhp -sid o r d e r s fniseilima dfodesserpe asndborp hitw cinap d i s o r d e r . Arch Gen yratihycsP :04 6010-5510 ， 3981 2 6
) ierBre A， Charney DS ， Heninger GR e at:l Major d e p r e s s i o n nistneitap hitw aibhoaporga and cinap d i s o r d e r . Arch Gen yrtiahycsP 41: 5311-2911 ， 4819 診断に関する日本の精神科医の見解ー伝統的診断と操作的診断基準の臨床使用 東京女子医科大学医学部精神医学講座 サカモト カオル 坂元 薫 本研究では，診断の意義や操作的診断の臨床使用に関する日本の精神科医の見解を検討することを目的とした 日本精神科診断学会の会員 283 名に精神科診断の意義に関する調査用紙を送付した. 回収率は， 54% であった 診断決定は，十分な治療計画策定のためになされることがその目的のひとつであることを意識しながらも，多く の精神科医は診断決定が必ずしも治療に貢献していないと感じていた.回答者の 17% は，統合失調症と気分障害 の中間領域の症例の鑑別診断をしても，そうした症例の初期の治療には有意な影響を与えないという理由で，そ の鑑別診断の意義を否定していた回答者の 52% は操作的診断基準は表層的な診断方法であると意識しながら も臨床に使用していた.一方伝統的診断の問題点としては明確な診断基準項目が挙げられていないことが指摘さ れた大うつ病とパニック障害の操作的診断基準を同一エピソード中にあるいは異なるエピソードで満たす症例 の診断については，横断面的な併存 ()ityidrbomoc 診断に反対する精神科医 (54%) は，縦断的な併存診断に反 対する精神科医 (37%) よりも多かった回答者の 73% は，日本特有の伝統的診断概念を積極的に使用すべきだ と回答していた.本研究の結果から，操作的診断基準の臨床的使用は， 日本の精神科医にとってまだ議論のある ところであり，多くの精神科医は伝統的診断概念と操作的診断基準の両者の有用性と限界を意識しながら両者を 相補的に使用していることが示唆された.
