Kochi: Recent topics in psychiatry and mental health in Japan

Effects of a one-hour educational program on medical students' attitudes to mental illness

A new 1-h educational program was developed to change attitudes towards mental illness, and was conducted on 95 first-year medical students in order to investigate its effects on their attitudes towards mental illness, using a pre- and postquestionnaire study design. A similar study without the program was conducted on 94 first-year medical students as controls. After the program, more students replied that they would accept former patients on relatively close social distance items. Favorable attitudinal changes were observed in terms of 'psychiatric services', 'human rights of the mentally ill', 'patients' independence in social life', and 'cause and characteristics of mental illness'. In contrast, no significant change was observed in the control group. These results suggest that attitudes towards mental illness could be changed favorably by this program.

Critical comments made to schizophrenic patients by their families in Japan

Critical comments (CCs) are one of the components of expressed emotion (EE), an excess of which is related to relapse. Therefore, CCs could be a target of family psychoeducation. We examined the nature of CCs for clues to family therapy. We classified CCs expressed in the Camberwell Family Interview (CFI) into nine categories: (1) positive symptoms, (2) negative symptoms, (3) compliance with medical care, (4) life problems, (5) socially inappropriate behavior, (6) aggression, (7) rejection, (8) premorbid personality, and (9) other. Positive symptoms were the most frequently commented on (34%). Negative symptoms were not so frequently commented on (11%), as expected. In comparing high-EE and low-EE relatives or relapsers and nonrelapsers, there were no significant differences in the distribution of the nine CC categories. We conclude that positive symptoms should be a main topic of family psychoeducation in such cases.

Expressed emotion and the course of schizophrenia in Japan

BACKGROUND

We examined whether expressed emotion (EE) influenced the course of schizophrenia in Japan.

METHOD

We conducted a cohort study. Of 73 subjects with schizophrenia meeting the diagnostic criteria of ICD-9 or DSM-III-R, 52 participated in the study. The Camberwell Family Interview was conducted to evaluate EE. The subjects had been followed up for nine months and psychiatrists who were blind to the EE status evaluated their symptoms with the Brief Psychiatric Rating Scale.

RESULTS

The relapse rate in the high-EE group was 58% and that in the low-EE group 21% (P < 0.01). Nine-month relapse risk ratio was 2.72 (95% CI 1.24 to 5.97). CONCLUSION. In Japan, as elsewhere, EE is a good predictor of schizophrenic relapse.

Training in evaluation of expressed emotion using the Japanese version of the Camberwell Family Interview

To evaluate the effect of training in rating expressed emotion (EE) using the Japanese version of the Camberwell Family Interview (CFI), interrater reliability between a certified rater and a trainee was examined. The material was 65 CFI interviews with the families of 46 schizophrenic patients. The two raters independently rated EE status, critical comments (CC), hostility (H), emotional overinvolvement (EOI), warmth (W) and positive remarks (PR). The interrater reliability was satisfactory with regard to EE status, CC, H, EOI and PR. In the category of W, however, the results were unsatisfactory, as there was no positive development of agreement over time. In fathers, the interrater reliability of W was lower than in other relationships. Use of interview transcripts could contribute to a more satisfactory interrater agreement in EOI, and this is recommended as a useful training tool in EE evaluation.