A pilot trial of an online guided self-help cognitive behavioral therapy program for bulimia nervosa and binge eating disorder in Japanese patients

BackgroundThe purpose of this study was to develop an internet-based Guided Self-Help CBT (iGSH-CBT) for Bulimia Nervosa (BN) / Binge Eating Disorder (BED) for Japanese patients and to test its feasibility.MethodsA single-arm feasibility study. After baseline assessment, patients underwent a 16-week iGSH-CBT program, our Japanese adaption of the European-based Salut BN program. During the treatment period, weekly email support from trained counselors was provided. Evaluations were performed at baseline, after 8 weeks, at the end of the 16-week intervention, and at 2 months after treatment had ended. The primary outcome measure was the change in the weekly frequency of objective binging. Secondary outcomes were the change in the weekly frequency of objective purge episodes, responses on self-report questionnaires of the frequencies of binging and purging, psychopathological characteristics of eating disorders found on BITE, EDE-Q, EDI-2, HADS and EQ-5D, measurements of motivation, and completion of intervention (vs. dropout).ResultsParticipants were 9 female outpatients with BN (n = 5) or BED (n = 4), of whom 8 (88.9%) attended the assessment at the end of the 16-week intervention. Mean age was 28 years (SD = 7.9). Percent change of the weekly frequency of objective binging was -4.40%, and at the end of the 16-week intervention 25% of the participants had achieved symptom abstinence.ConclusionsNo adverse events were observed during the treatment period and follow-up, and the implementation and operation of the program could be performed without any major problems, confirming the feasibility of iGSH-CBT for BN and BED for Japanese patients. Although no significant change was observed in the weekly frequency of objective binging, the abstinence rate from bulimic behaviors of those who completed the assessments was 25.0% at the end of treatment, and the drop-out rate was 11.1%. iGSH-CBT may be an acceptable and possibly even a preferred method of CBT delivery for Japanese patients with BN or BED, and our Japanese adaptation of Salut BN seems feasible.Trial registrationUMIN, UMIN000031962. Registered 1 April 2018 - Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R00003633

精神科看護の魅力

本研究の目的は，長期入院の精神障害者の退院支援のための精神科看護の魅力について文献検討により明らかにすることである．日本においては長期入院の精神障害者に対する積極的な退院支援が行われている．しかし，退院後の継続的な支援環境が整わないために，退院できない状況もあり，看護師は仕事への無力感を感じる場合も多い．それでもなお，精神障害者の退院支援に魅力を抱いている看護師がいる．したがって看護師らが退院支援に対して抱く魅力は何かを明らかにすることが長期入院の解決に対して重要である．文献検討の結果，長期入院の精神障害者の退院支援の魅力として（１）患者との相互作用のなかでの自己洞察と自らの人間的成長，（２）患者と看護師の関係発展過程から得られる患者の本質的な理解，（３）看護師が主体性を持って患者と関わることができるという特徴が示唆された．The purpose of this literature study is to clarify the fascination of positive programmed discharge support （PPDS）and psychiatric nursing for long-term inpatient with mental disorders. Long-term psychiatric hospitalization remains as a major problem in Japan. PPDS is performed to such inpatient with social hospitalization. Despite nurses’ efforts with the best intentions, some nurse feel powerless to work because patient cannot discharge from a hospital by reason that living environment after patient leaves hospital was not ready. Therefore, it is important to clarify nurses’ fascination for PPDS and their achievement motive to work to solve prolonged hospitalization. The result of literature review, it was suggested that fascination of psychiatric nursing have the following features : （１）nurse’s self-insight and personal growth in the interaction between patient and nurse, （２）intrinsically understanding of patient obtain from developmental process in the interaction between patient and nurse, and （３）psychiatric nurse is able to intervene to the patient independently

アルコール依存症と感情障害への支援

アルコール依存症と感情障害の関係性は以前から指摘されている．アルコール依存症とうつ病は，自殺企図者の精神障害の内訳の半数を占め，それらが合併した場合には自殺の危険性を一層高める．また，アルコール依存症治療において，患者がうつ症状を呈している場合，再飲酒のリスクが高くなり治療の継続を妨げる原因となりうる．そのため，うつ病の治療にも注意を払うことが求められる．さらに，家族からの支援はアルコール依存症患者の断酒を継続するなどの治療において重要な役割を果たしている．しかし，患者の断酒の継続に注意を払いすぎるあまり，それがストレスとなり患者の問題飲酒を助長することになったり，家族自身がさまざまな悩みを抱え苦しんだりすることが考えられ，家族への支援もとても重要となる．加えて，親がアルコール依存症である場合，子どもも将来アルコール依存症となる危険性が高くなるなど，子どもに与える影響も大きい．そこで医師，看護師，ソーシャルワーカーが支援に関わることや自助グループを活用することが重要となる．本総説ではアルコール依存症と感情障害の関係と治療方法，アルコール依存症と感情障害を抱える患者とその家族への支援に焦点を当て，包括的な支援のありかたを検討した．The relationship between alcohol dependency and affective disorder has been noted. Alcohol dependence and depression account for approximately half of psychiatric disorders which suicidal persons have, and in case of the combination of them, the risk for suicide would be much higher. Also, in case of patient suffering from alcohol dependence and depression as a complicated disease, it becomes an obstructive factor to provide appropriate alcoholism treatment. Therefore, it is desired to pay attentions to care of depression. In addition, the support from self-help group and patient’s family plays a great role in the alcoholism and depression treatment. However, too much attention of patient’s family to continuation of abstinence becomes a cause of stress for patient. That stress fosters problem drinking. Furthermore, it is conceivable that family has many worries and is plagued with anxiety, so family support is also very important. In this review, we focus on comprehensive support for people with both alcohol dependency and affective disorder, and their families

Traditional Japanese Formula Kigikenchuto Accelerates Healing of Pressure-Loading Skin Ulcer in Rats

We evaluated the effect of kigikenchuto (KKT), a traditional Japanese formula, in a modified rat pressure-loading skin ulcer model. Rats were divided into three groups, KKT extract orally administered (250 or 500 mg/kg/day for 35 days) and control. KKT shortened the duration until healing. Immunohistochemically, KKT increased CD-31-positive vessels in early phase and increased α-smooth muscle actin-(α-SMA-) positive fibroblastic cells in early phase and decreased them in late phase of wound healing. By Western blotting, KKT showed the potential to decrease inflammatory cytokines (MCP-1, IL-1β, and TNF-α) in early phase, decrease vascular endothelial growth factor in early phase and increase it in late phase, and modulate the expression of extracellular protein matrix (α-SMA, TGF-β1, bFGF, collagen III, and collagen I). These results suggested the possibility that KKT accelerates pressure ulcer healing through decreases of inflammatory cytokines, increase of angiogenesis, and induction of extracellular matrix remodeling

Reverse pharmacological effect of loop diuretics and altered rBSC1 expression in rats with lithium nephropathy

Reverse pharmacological effect of loop diuretics and altered rBSC1 expression in rats with lithium nephropathy.BackgroundRenal urinary concentration is associated with enhanced expression of rBSC1, a rat sodium cotransporter, in the thick ascending limb of Henle. Increased expression of rBSC1 was reported recently in nephrogenic diabetes insipidus induced by lithium chloride (Li nephropathy). However, the pathophysiological implication of altered rBSC1 expression has not yet been investigated.MethodsLi nephropathy was induced in rats by an oral administration of 40 mmol lithium/kg dry food. In rats with reduced urinary osmolality to less than 300 mOsm/kg H2O, we examined the expression of rBSC1 mRNA and protein, plasma arginine vasopressin (AVP) and RNA expression of kidney-specific water channel, aquaporin-2 (AQP2), of collecting ducts. Rats with Li nephropathy were treated with furosemide (3 mg/kg body weight), which blocks the activity of rBSC1, and changes in urine concentration, plasma AVP, medullary accumulation of Li ions, and apical AQP2 expression were determined.ResultsRats with Li nephropathy showed increased rBSC1 RNA and protein expression and reduced AQP2 RNA. In these rats, furosemide, which induces dilution of urine and polyuria in normal rats, resulted in a progressive and significant rise in urine osmolality from 167 ± 11 (mean ± SD) at baseline to 450 ± 45 mOsm/kg H2O at three hours after administration, and significant oliguria. In the same rats, plasma AVP decreased significantly from 5.7 to 3.0 pg/mL. In addition, recovery of apical AQP2 expression was noted in a proportion of epithelial cells of the collecting ducts. Although Li+ in the renal medulla was slightly lower in rats with Li nephropathy treated with furosemide, statistical significance was not achieved.ConclusionsOur results suggest that dehydration or high plasma AVP results in an enhanced rBSC1 expression in Li nephropathy, and that rBSC1 expression is closely associated with the adverse effects of Li ions on collecting duct function

A novel histone exchange factor, protein phosphatase 2Cγ, mediates the exchange and dephosphorylation of H2A–H2B

In eukaryotic nuclei, DNA is wrapped around a protein octamer composed of the core histones H2A, H2B, H3, and H4, forming nucleosomes as the fundamental units of chromatin. The modification and deposition of specific histone variants play key roles in chromatin function. In this study, we established an in vitro system based on permeabilized cells that allows the assembly and exchange of histones in situ. H2A and H2B, each tagged with green fluorescent protein (GFP), are incorporated into euchromatin by exchange independently of DNA replication, and H3.1-GFP is assembled into replicated chromatin, as found in living cells. By purifying the cellular factors that assist in the incorporation of H2A–H2B, we identified protein phosphatase (PP) 2C γ subtype (PP2Cγ/PPM1G) as a histone chaperone that binds to and dephosphorylates H2A–H2B. The disruption of PP2Cγ in chicken DT40 cells increased the sensitivity to caffeine, a reagent that disturbs DNA replication and damage checkpoints, suggesting the involvement of PP2Cγ-mediated histone dephosphorylation and exchange in damage response or checkpoint recovery in higher eukaryotes