Bio-psychosocial medicine in disasters—report from Kobe 10 years after the Great Hanshin-Awaji earthquake

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  • Today, family therapy has developed to one of the important clinical fields

    of psychotherapy and family support. The membership of JAFT is

    approximately 1100, and one third of them are medical doctors, which is

    one of the features of family therapy in Japan.

    The clinical feature of family therapy is to understand clinical symptoms in

    the context of interaction and/or the belief of family members.

    The basic epistemological background has been the systems theory for

    these several decades. Recently, new paradigm of clinical practice has

    appeared, which is known as postmodern approach in the Western world,

    whereas it is called as narrative therapy or narrative approach in Japan.

    The concepts and methods of family therapy has been gradually applied in

    clinical fields working with families, which, e.g., have child or adolescent

    problems, marital problems, problems of mental illness or chronic physical

    illness including terminal care, psychosomatic problems, and so on.

    The author would like to report about the development and the present

    situation of family therapy in Japan as the context of family therapy or

    family-based approach in the treatment of psychosomatic problems.

    30202The positioning of family therapy in Japanese

    psychosomatic medicine

    Kojima T

    It was in the mid-1980s that family therapy began to catch attention in

    Japanese psychosomatic medicine. It began with the introduction of family

    therapy for eating disorders by Minuchin, S., and also Palazzoli, M.S. It had

    a big impact on the psychosomatic field since it was just when they were

    groping for a more effective treatment in coping with the increasing number

    of patients with eating disorder. Also in Japan, credit goes to Shimosaka,

    K., for his original approach towards the families of such patients. In the

    1990s, a full-scale practice of family therapy started at the Department of

    Psychosomatic Medicine in Kyushu University Hospital by Hayakawa. H.,

    Higashi. Y., and Kojima. T, et. al. An effective outcome was seen not only

    in eating disorders, but also in various psychosomatic disorders. The most

    significant factor of the above practice is the development of a new medical

    family therapy model and the techniques based on it.

    30203Approach of family therapy for psychosomatic diseases in

    Japanpresentation of statistical data and concrete cases of family

    therapy for psychosomatic patients and the family

    Yoshikawa S

    In the United States, it is well known that approach of the family therapy for

    eating disorder is practiced by the research of Minuchin, S. et al. In Japan,

    the approach is practiced for psychosomatic patients too. The above-

    mentioned psychosomatic disease intends not only diseases, such as

    psychogenic physical irregularity, in a narrow sense. But psychosomatic

    medicine in Japan also includes psychosomatic diseases seen in the field of

    terminal care, for example. Primarily, as the basic approach for psychoso-

    matic disease, the medicine model and psychotherapy are used together.

    And the approach of family therapy is effective especially for the patients of

    diseases such as chronic pain and terminal care that are not improved by

    general psychosomatic treatments.

    The speaker practiced the approach of the family therapy for about

    140 patients and families of Somatoform Disorders. In this presentation, the

    speaker shows summary of some these cases and research after the illness

    and shows characteristics and effectiveness of the family therapy in the

    psychosomatic medicine.

    Bio-psychosocial medicine in disastersreport from Kobe 10 years

    after the Great Hanshin-Awaji earthquake

    30301What can medical assistance do for victims in catastrophes?

    Nakayama S, Kozawa S, Ukai T, Ishii N

    Introduction: Based on lessons from the Great Hanshin Earthquake, 15

    key hospitals for disasters were designated in Hyogo prefecture and have

    dispatched their medical teams to affected areas.

    Results: In domestic disasters, 13 teams were dispatched in flood in Hyogo

    and 10 in Niigata Chuetsu Earthquake in 2004 from key hospitals for

    disasters and Red Cross hospitals in Hyogo. In overseas disasters, Kobe

    University Medical Team was sent for 921 Chi-Chi Earthquake in Taiwan

    in 1999 and Gujarat Earthquake in India in 2001. Hyogo Emergency

    Medical Center sent doctors and nurses as members of GO (JMTDR) or

    NGO (HuMA) team to help victims of Tsunami disaster in Sri Lanka and

    Indonesia in 2004 and 2005. Activities of the teams were fact finding and

    advice and clinical activities. Most of serious trauma cases had been

    transported before their arrival, and assistance teams could take care of

    patients with minor injuries and sickness.

    Discussion: Prompt medical assistance must be provided in disasters,

    taking account of the fact that lack of information is one of the

    inevitabilities of catastrophe. Physical treatment was the first priority of

    disaster medical management. At the same time, mental supportive care,

    which could be given not only by specialists but also by any member of the

    teams, looked essential; even victims had difficulties to communicate

    with foreigners.

    Conclusion: Rapid dispatch of assistance teams is the most important as

    well as well timed withdrawal. Any team must be more conscious of its

    potential to reduce psychological and mental stress of the victims in

    affected areas.

    30302Participation for disaster relief as a psychiatrist

    Fujii S, Kato H

    When arguing about the relationship between psychiatry and disaster, we

    need to consider two of the same sort but different viewpoints: disaster

    psychiatry (medical treatment) and mental health care (psychological

    support). When the great Hanshin-Awaji earthquake hit the Kobe area in

    January 1995, psychiatric first aid stations and emergency services were

    provided for about 3 months against the rapidly increased treatment needs.

    Subsequently, 5 months after the strike, the Center for Mental Health Care

    was established because of its devastating damage and enormous sufferings.

    The center provided psychological support based on the existing local

    community health care system, especially for the residents in the temporary

    and the permanent housing, until March 2000. With growing general

    interests and needs in mental health care, the center reopened in April 2004

    as Hyogo Institute for Traumatic Stress, equipped with facilities for

    training, study, and a clinic, targeting not only for disaster survivors but also

    for victims from crimes and accidents.

    Thus, the experience of this huge earthquake urged us to think more about

    mental health and to start related programs in the very early stage after

    disaster strikes in Japan. Under such conditions, we experienced

    unexpected flood by typhoon in Hyogo prefecture, the Niigata Chuetsu

    Earthquake in Japan, and finally the Sumatra Earthquake and the Indian

    Ocean Tsunami Disaster internationally, all within this 1 year. In the

    symposium, we are going to report slightly different ways of participation

    as psychiatrists in each disaster, to exchange opinions in medical field and

    for the better future cooperation.

    30303The experience as a psychosomatic physician in the disaster

    area, Kobe

    Murakami N, Ozasa Y, Muramatsu S

    The Department of Psychosomatic Internal Medicine in Kobe Red Cross

    Hospital was founded in 1996 for the purpose of treating psychosomatic

    and psychological problems in patients from the Great Hanshin-Awaji

    (Kobe) earthquake on January 17, 1995.

    A disaster causes compound stressors. A disaster breeds physical, psycho-

    logical, and social distress because of disease, injury, death of family,

    homelessness, job loss, and loss of community. Such compound stressors

    have a bad effect on body and mind of victims for a long duration.

    For example, according to our research on 82 diabetes outpatients in 1996,

    those who had suffered from the Great Hanshin-Awaji Earthquake were

    Symposium abstracts / Journal of Psychosomatic Research 58 (2005) S7S29S8

  • more apt to have worse cases of diabetes. Diabetes represents one of the

    psychosomatic diseases. Multiple factors such as diet, exercise, compliance

    and coping for illnesses were related to this result.

    According to other researches on outpatients of psychosomatic internal

    medicine in 2000 and 2005, about 40% of the patients thought that there

    was still a correlation between the illnesses and the disaster 10 years after

    the earthquake. In fact, some patients came to consult us about their

    physical and psychological distress for the very first time.

    In our opinion, the victims should be provided physical, psychological, social

    and spiritual care over a long period after a disaster. We must provide a

    network among the various specialists in case of an event of a disaster.

    Brainbody interactions: real daily phenomena of

    psychosomatic medicine

    30401Theory of emotional awareness and brain

    processing of emotion

    Lane RD

    Negative affect that is not experienced or expressed may be the most

    pathogenic response to environmental stress. The purpose of this paper is to

    provide a way of understanding this phenomenon from a psychological and

    physiological perspective. A cognitive developmental model of emotional

    awareness will be presented that holds that the ability to become consciously

    aware of ones own feelings is a cognitive skill that goes through a

    developmental process similar to that which Piaget described for other

    cognitive functions. The developmental process consists of the transition

    from unconscious (implicit) to conscious (explicit) processing, with explicit

    emotional processing having a modulatory effect on implicit processes. A

    parallel hierarchical model of the neural substrates of emotional experience

    will be presented next supported by recent neuroimaging work. It will be

    argued that the neural substrates of implicit and explicit emotional processes

    are distinct. The neural substrates of implicit aspects of emotion and three

    distinguishable aspects of explicit emotional processing will be presented:

    background feelings, focal attention to feelings, and reflective awareness of

    feelings. The conscious processing of affective states requires the partic-

    ipation of structures that subserve attention andmental representation that are

    not unique to emotion. The domain general (i.e., not specific to emotion)

    function of these structures may help to explain the vast individual

    differences that are observed clinically in the ability that people have to

    monitor and report their own emotions. The implications of this psycho-

    biological model for behavioral medicine research will be presented.

    30402Neurovisceral integration, emotions, and health

    Thayer JF

    A comprehensive model of emotions and health must attempt to account for

    the complex mix of cognitive, affective, behavioral, and physiological

    concomitants of normal and pathological affective states and dispositions,

    and how these might impact upon health. We present the outlines of a

    model that integrates some of these components into a functional and

    structural network that may help to guide us in our understanding of

    emotion and health. Functionally, this network involves autonomic

    regulation, affective regulation, and cognitive regulation. Structurally, this

    network includes reciprocal, inhibitory circuits between prefrontal cortex

    and subcortical evolutionarily primitive motivational structures that can be

    indexed by rhythmic activity of the cardiovascular system. We will briefly

    review some of the work that we have done to uncover the functional

    aspects of this reciprocal, inhibitory circuit with respect to autonomic,

    affective, and cognitive regulation. We will emphasize the relationships

    among autonomic, affective, and cognitive regulation in organism health

    and propose a group of underlying physiological systems that serve to

    integrate these functions in the service of self regulation and adaptability of

    the organism. We will attempt to place this network in the context of

    dynamical system models that involve feedback and feedforward circuits,

    with special attention to negative feedback mechanisms and inhibitory

    processes. Importantly, we will show that the negative behavioral states and

    dispositions associated with a relative autonomic imbalance toward

    sympathetic dominance represent a disinhibition of positive feedback

    circuits that are normally under tonic inhibitory control.

    30403Braingut interactions and emotion

    Fukudo S

    Clarifying functional module of the brain in response to visceral stimulation

    is one of keys to understand the mechanism of emotion because the brain is

    thought to form primitive emotion by integration of interoceptional signal.

    Antonio Damasio has suggested that when we think about the potential

    consequences of a behavior, the memory of our emotional state (visceral

    experiences) in similar circumstances may provide useful information for

    evaluating the behavior. Therefore, research on gut feeling is important not

    only for clarifying pathegenesis of irritable bowel syndrome (IBS) but also

    for understanding the mechanism of emotion. In studies of positron emission

    tomography (PET) with injection of H2[15O], colonic distention pressure

    dependently induced visceral perception, and anxiety, which significantly

    correlated with activation of specific regions of the brain including the

    prefrontal, anterior cingulate, parietal cortices, insula, pons, and the

    cerebellum. Specific triphasic cerebral evoked potential of N1, P1, and N2

    was obtained with the rectal electrical stimulation. Colonic distention

    induced a significant decrease in the alpha power and a significant increase in

    the beta power of electroencephalogram (EEG). Some molecules which

    modifies braingut interactions were identified. They were at least cortico-

    tropin releasing hpormone, histamine, and serotonin. These data suggest that

    the functional module of the brain in response to the visceral perception is

    present. Besides, the abnormal consequence of stimulation evoked arousal

    and emotion may relate to pathophysiology of IBS. Further research on

    braingut interactions will provide clinically useful information and basic

    knowledge of psychosomatic medicine.

    30404Brainbody interactions as the psychosomatic pathway to

    essential hypertension?

    Deter HC, Richter S, Buchholz K, Rudat M, Weber C

    Introduction: Salt-sensitive normotensive men (SS) are an interesting model

    for studying the development of essential hypertension (EH). These

    participants exhibit also an enhanced pressor (BP) and heart rate (HR) response

    to mental stress. The high stress-induced HR and BP acceleration is also a EH

    risk factor and may result from sympathetic activation or vagal withdrawal.

    This seems interesting to study brain cardiovascular interactions.

    Methods: To understand the importance of autonomic dysbalance for the

    increased stress responsiveness, we studied cardiovascular reactivity to mental

    challenge in 17 SS healthy Caucasian male and 56 SR control participants.

    Salt sensitivity was determined by a 2-week dietary protocol (20 vs...

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