[The Importance of Remaining a Psychiatric Medical Specialist].

As a member of the Japanese Society of Psychiatry and Neurology's Committee to Improve the Medical Specialist System, I have used the Committee's discussions as my start- ing point for describing what action needs to be taken to update psychiatric medical specialist qualifications under the new medical specialist framework while retaining its key principles. The gist of the reform of the medical specialist system is that tasks such as clearing up confusion at clinical sites and restoring the public's trust in physicians should not be assigned to outside institutions. Instead, groups of physicians will themselves set up and run a self-reg- ulating organization that sets out their ideals as to quality, etc., and holds the profession to these ideals. To prevent any loss of professional pride and autonomy, they must establish, on their own initiative, a highly transparent system that the general public will accept, and which will support and develop high-quality medical professionals. In other words, building a system such as this cannot be considered separately from the process of educating specialized medical doctors. Medical specialists are expected to continue undergoing appropriate training and to maintain and enhance their competencies. Qualification as a medical specialist shows that the individual is continuing to undergo training to enhance his or her excellence as a medical spe- cialist and, at the same time, ensures his or her professional value. The key requirement for updating medical specialist qualifications is for the individual to be engaged in medical practice. Medical care provided at departments of psychiatry differs somewhat from that offered by other clinical departments and/or fields, since it covers a broad range of areas that can extend outside the clinical services offered at hospitals. Knowledge, skills and attitudes as a psychiatric medical specialist are evaluated based on a review of case reports. In addition to psychiatry-related content, training must cover themes related to pro- fessionalism such as medical ethics and legislation, as well as subjects necessary to obtain the latest medical knowledge such as clinical research and evidence-based medicine (EBM). Physi- cians intending to newly qualify as medical specialists need to be engaged in some sort of research, and to have the competency to compile and present the outcomes of their studies, as well as having a proven track record. Out of consideration to the actual circumstances, in the field of psychiatry, academic achievement is not a necessary condition for updating medical specialist qualifications. Japanese Medical Specialty Board supports this position. As defined in the upcoming reform of the medical specialist system, a medical specialist is a personal qualification. At the same time, it is individuals who play a role as a member of an autonomous group, responsible for maintaining the value of this qualification.

Left frontotemporal hyperperfusion in a patient with post-stroke mania.

A 78-year-old housewife with major depression developed a right-sided infarction in the territory of the middle cerebral arteries, followed by acute post-stroke mania. Comparison between pre- and post-stroke SPECT scans demonstrated a unique pattern of left orbitofrontal hyperperfusion with extensive right frontal hypoperfusion. A functional imbalance between right and left orbitofrontal cortices may be important in mania.

Induction of micronuclei in germinating onion seed root tip cells irradiated with high energy heavy ions.

Effects of high LET charged particles on a perfect in-vivo system are an essential theme for the study of the biological effects of radiation. Germinating onion seeds are independent complete organisms and the radiation induced micronuclei in the root chip cells can be examined quantitatively and theoretically. We irradiated with three types of high energy accelerated heavy ions germinating onion seeds using a synchrotron and observed micronuclei in the root tip cells. Micronuclei induction showed characteristic dose responses of an upward convex bell shape and a steep rise near zero doses for all types of the ions. The bell curve dose responses, however, could be explained by a simple mathematical model. A parameter in the model which indicates micronuclei induction frequency and another parameter which indicates induction frequency of lethal damages (or damages delaying cell divisions) per heavy ion track were both proportional to square of the LET. Because we suspected by-stander effect concerning the dose responses rising steeply near zero doses and tapering off for higher doses, we tested acute irradiation to remove time of information transmittance between cells using a single spill (about 0.3 s) of the synchrotron beam. No difference was detected between normal multiple spill irradiations and single spill.