The Effects of Bereavement Time on the Relationship Between Coping Strategies and Psychological Distress.

The purpose of this study was to investigate the relationship between bereaved individuals' coping patterns, mental health, and time post-loss. A questionnaire using the Coping with Bereavement Scale (CBS) and the Kessler Psychological Distress Scale (K6) was completed by 173 family members of individuals who died from cancer between August 2013 and March 2016. Confirmatory factor analysis revealed a three-factor solution for the CBS comprised of "life orientation," "avoidance," and "retaining ties" with the deceased. Scores on retaining ties were significantly but weakly correlated with K6 scores; however, the intensity of this relationship increased with more time post-bereavement, and individuals who retained strong ties with the deceased for two years or more demonstrated poorer mental health. Although retaining ties with the deceased might be an adaptive psychological process following bereavement, in this study, long-term persistence with that coping strategy was associated with greater overall psychological distress. Further research is needed to identify optimal coping methods to address evolving needs during the bereavement process.

Bereavement risk assessment of family caregivers of patients with cancer: Japanese version of the Bereavement Risk Assessment Tool.

OBJECTIVES: The Bereavement Risk Assessment Tool (BRAT) seems to be useful in identifying those who are likely to suffer from the more severe consequences of bereavement. To date, however, only a few studies have examined bereavement risk using the BRAT. This study investigated bereavement risk in family caregivers of patients with cancer using the Japanese version of the Bereavement Risk Assessment Tool (BRAT-J). We also investigated the relationship of bereavement risk with psychological distress and resilience among caregivers to determine the validity of the BRAT-J. METHODS: We conducted family psychoeducation in the palliative care unit of Tohoku University Hospital with participants who were recruited in this study. Among the participants, 50 family caregivers provided their written informed consent and were included in this study. Participants were assessed using the BRAT-J and completed the Japanese version of the Kessler Psychological Distress Scale (K6) and the Tachikawa Resilience Scale (TRS). RESULTS: According to the BRAT-J, five individuals (10%) were in the high category of bereavement risk (level 4 or 5). We also found that family caregivers of patients experienced many different pressures, such as facing the unknown; their own work; and insufficient financial, practical, or physical resources. These issues are associated with various mental problems. Additionally, the level of bereavement risk was significantly correlated with K6 scores (ρ = 0.30, p = 0.032), and the TRS score (ρ = -0.44, p = 0.001). These correlations confirmed previous findings and that the BRAT-J can be an efficient screening tool for the bereavement risk of family caregivers of patients with cancer. SIGNIFICANCE OF RESULTS: It appears that the BRAT-J is useful in predicting the likelihood of difficulties or complications in bereavement for family caregivers and could help to provide support with these issues when needed.

[Activity to prevent mental diseases after the Great East Japan Earthquake].

Following the Great East Japan Earthquake, we have been supporting psychiatric hospitals and mental health and welfare centers in Miyagi Prefecture. In October 2011, with a grant from Miyagi Prefecture, the Department of Preventive Psychiatry was established in Tohoku University Graduate School of Medicine. The institute aims to promote the prevention of and early intervention for mental diseases. As its members, we carry out our duties in collaboration with the Miyagi Disaster Mental Health Care Center. We refer to our activities as the Great East Japan Earthquake Mental Health Support and Research (GEMS) project. The GEMS project includes both practices and research in the affected areas in Miyagi Prefecture. The focus is on supporting those who provide services for survivors long-term, such as municipal employees, nurses, fire fighters, and staff of the social welfare council. We investigated how much the disaster impaired the functioning of psychiatric hospitals and clinics in Miyagi Prefecture. We also conduct mental health surveys in public organizations. Based on the results, we arrange workshops, consultation, or counseling. Moreover, we promote improvement of the mental health skills of mental health professionals, which are essential for mid and long-term support after the disaster. One of them is "Skills for Psychological Recovery". As members of the support organization in the region, we keep working toward the recovery and development of mental health systems in Miyagi Prefecture.

Emotional processing during speech communication and positive symptoms in schizophrenia.

AIMS: The recognition of emotion is often impaired in patients with schizophrenia. The relationship of this deficit with symptoms of psychosis remains unclear. In the current study, we investigated the relationship between emotional processing and positive psychotic symptoms in schizophrenia. METHODS: Twenty-eight patients with schizophrenia and 37 healthy participants were included in the study. They were instructed to listen to a set of sentences and judge whether the emotional valence expressed verbally and that expressed by affective prosody were congruous or incongruous. RESULTS: Overall, the patients with schizophrenia had more inaccurate responses than the healthy participants and the poor performance was prominent when the patients processed affectively negative scenarios. The percentage of accurate responses negatively correlated with the severity of positive symptoms when the scenarios and/or the affective prosody had a negative valence. CONCLUSION: Patients with schizophrenia appear to have impaired function in the processing of negative verbal information. Impaired processing of negative verbal and prosodic information seems to be associated with positive symptoms in schizophrenia.

[Application of cognitive behavioral therapy to early phase of psychosis].

Attempts to apply cognitive-behavioral therapy (CBT) to treat patients in the early stage of psychosis, including those with First-Episode Psychosis (FEP) and those with an At-Risk Mental State (ARMS), have recently attracted considerable attention. Such CBT for FEP focuses on promoting the recovery process and relapse prevention, although evidence on its efficacy is currently limited. Further, studies on CBT for ARMS have not consistently demonstrated its effectiveness. Some reports affirm the effectiveness of CBT in FEP prevention, while others claim that the treatment leads to no compelling difference in comparison to nonspecific treatment such as supportive therapy and treatment as usual. It is evident that psychosocial interventions play a fundamental role in the treatment of early stages of psychosis. Therapeutic approaches based on CBT have been applied to various cases: however, further research is necessary in order to produce more concrete results and obtain the evidence needed to approve this method.

Psychometric properties of the Japanese version of the Beck Cognitive Insight Scale: relation of cognitive insight to clinical insight.

AIM: Insight in schizophrenia is considered to have a multidimensional construct, and cognitive insight is thought to be an important dimension of insight: an ability to evaluate and correct one's own distorted beliefs and misinterpretations. The Beck Cognitive Insight Scale (BCIS) was developed to measure cognitive insight, and studies have shown that cognitive insight is associated with several clinical features in schizophrenia. The aim of the present study was to develop a Japanese version of the BCIS (BCIS-J) and assess the psychometric properties of this instrument. METHODS: The BCIS-J was completed by university students (n = 183) and patients with schizophrenia (n = 30). The Japanese version of the Schedule for the Assessment of Insight was used to measure clinical insight in patients with schizophrenia, and its association with the BCIS-J was investigated. RESULTS: Factor analysis in the university students indicated that the BCIS-J was composed of two factors, self-reflectiveness and self-certainty, as was seen in the original BCIS. The relation between the specific dimensions of clinical insight and each component of the BCIS-J in patients with schizophrenia indicated that overconfidence in their belief or judgment may be involved in their attitude to treatment and openness to feedback, and objectivity might be essential to attribute one's symptoms as part of mental illness. CONCLUSIONS: The BCIS-J is a reliable and valid instrument to measure cognitive aspects of insight and appears to complement clinical insight scales.

Relationship between cognitive insight and attenuated delusional symptoms in individuals with at-risk mental state.

Cognitive insight, defined as the ability to evaluate and correct one׳s own distorted beliefs and misinterpretations, is hypothesized to contribute to the development of psychotic symptoms. We investigated cognitive insight in individuals with at-risk mental state (ARMS), which is associated with a clinically high risk of psychosis. Sixty individuals with ARMS were compared with 200 healthy controls in terms of cognitive insight measured using the Beck Cognitive Insight Scale. We also investigated the relationship between cognitive insight and attenuated delusional symptoms. In addition, we examined differences in the cognitive insight of individuals with ARMS with or without near-threshold delusional symptoms and differences in the cognitive insight of individuals with ARMS with or without later transition to psychosis. The results showed that individuals with ARMS exhibited higher self-certainty than healthy controls, indicating impairments in cognitive insight in the former. More importantly, our results revealed that self-certainty was correlated with attenuated delusional symptoms and that individuals with ARMS who had near threshold delusional symptoms had higher self-certainty. These findings indicate that overconfidence in one׳s own beliefs or judgments might be related to the formation and maintenance of attenuated delusions in individuals with ARMS.