Language：Japanese   Publisher：Japanese Society of Psychosomatic Medicine  

<p>The author has accumulated six years of clinical experience at a university hospital and an additional two years in the psychosomatic medicine department of a community general hospital, placing him in an intermediate position between junior and senior practitioners. Comparing the clinical practices at these two institutions, the presenter frequently encountered cases in a community hospital, struggling to determine the appropriate approach or lacking confidence in treatment plans. In psychosomatic medicine, the optimal approach often depends not only on the specific characteristics of the disease but also on the psychosocial background of each patient. Such knowledge cannot be fully acquired from textbooks alone ; experiential learning is essential. Each time the presenter encountered challenging cases, senior colleagues in the medical department provided support, gradually providing advice to younger physicians.</p><p>In this paper emphasizes the importance of sharing knowledge and experience in psychosomatic medicine to establish an “All-Japan” framework from a clinical perspective. Initiating a discussion forum through case conferences and bringing together psychosomatic medicine specialists across generations helps in achieving this. A case involving a teenage female patient initially brought to the emergency department due to a hyperventilation attack and subsequently treated for anorexia nervosa is presented as an example from the presenter’s clinical experience.</p>

DOI： 10.15064/jjpm.65.2_126

CiNii Research

Language：English   Publisher：PLoS ONE  

Recent evidence suggests a crucial role of the gut microbiota in the pathogenesis of anorexia nervosa (AN). In this study, we carried out a series of multiple analyses of the gut microbiota of hospitalized individuals with AN over three months using 16S or 23S rRNA-targeted reverse transcription-quantitative polymerase chain reaction (PCR) technology (YIF-SCAN®), which is highly sensitive and enables the precise quantification of viable microorganisms. Despite the weight gain and improvements in psychological features observed during treatment, individuals with AN exhibited persistent gut microbial dysbiosis over the three-month duration. Principal component analysis further underscored the distinct microbial profile of individuals with AN, compared with that of age-matched healthy women at all time points. Regarding the kinetics of bacterial detection, the detection rate of Lactiplantibacillus spp. significantly increased after inpatient treatment. Additionally, the elevation in the Bifidobacterium counts during inpatient treatment was significantly correlated with the subsequent body weight gain after one year. Collectively, these findings suggest that gut dysbiosis in individuals with AN may not be easily restored solely through weight gain, highlighting the potential of therapeutic interventions targeting microbiota via dietary modifications or live biotherapeutics. Copyright:

DOI： 10.1371/journal.pone.0296037

Web of Science

Scopus

PubMed

Language：English   Publisher：Physiological Reports  

1-Kestose (KES), a dietary fiber and prebiotic carbohydrate, benefits various physiological functions. This study aimed to examine whether diets supplemented with KES over three consecutive generations could significantly affect some host physiological aspects, including behavioral phenotypes and gut microbial ecology. Mice that received KES-supplemented diets for three generations demonstrated increased activity compared with those fed diets lacking KES. Furthermore, the KES group showed increased striatal dopamine (DA) and serotonin (5-HT) levels. The observed increase in DA levels within the striatum was positively correlated with locomotor activity in the KES group but not in the control (CON) group. The α-diversities were significantly lower in the KES group compared to the CON group. The three-dimensional principal coordinate analysis revealed a substantial distinction between the KES and CON groups across each generation. At the genus level, most gut microbiota genera exhibited lower abundances in the KES group than in the CON group, except for Bifidobacteria and Akkermansia. Spearman's rank-order analysis indicated significant negative correlations between the striatal DA levels and α-diversity values. These findings suggest that prolonged supplementation with KES may stimulate increased locomotor activity along with elevated striatal DA levels, which are potentially associated with KES-induced alterations in the gut microbiota.

DOI： 10.14814/phy2.15882

Web of Science

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PubMed

Web of Science

Language：English   Publisher：Physiology and Behavior  

Important precursors of monoaminergic neurotransmitters, dietary tryptophan (TRP), tyrosine, and phenylalanine (all referred to as TTP), play crucial roles in a wide range of behavioral and emotional functions. In the current study, we investigated whether diets devoid of TTP or diets deficient in TRP alone can affect body weight, behavioral characteristics, and gut microbiota, by comparing mice fed on these amino acids-depleted diets to mice fed on diets containing regular levels of amino acids. Both dietary TTP- and TRP-deprived animals showed a reduction in food intake and body weight. In behavioral analyses, the mice fed TTP-deprived diets were more active than mice fed diets containing regular levels of amino acids. The TRP-deprived group exhibited a reduction in serum TRP levels, concomitant with a decrease in serotonin and 5-hydroxyindoleacetic acid levels in some regions of the brain. The TTP-deprived group showed a reduction in TTP levels in the serum, concomitant with decreases in both phenylalanine and tyrosine levels in the hippocampus, as well as serotonin, norepinephrine, and dopamine concentrations in some regions of the brain. Regarding the effects of TRP or TTP deprivation on gut microbial ecology, the relative abundance of genus Roseburia was significantly reduced in the TTP-deprived group than in the dietary restriction control group. Interestingly, TTP was found even in the feces of mice fed TTP- and TRP-deficient diets, suggesting that TTP is produced by microbial or enzymatic digestion of the host-derived proteins. However, microbe generated TTP did not compensate for the systemic TTP deficiency induced by the lack of dietary TTP intake. Collectively, these results indicate that chronic dietary TTP deprivation induces decreased monoamines and their metabolites in a brain region-specific manner. The altered activities of the monoaminergic systems may contribute to increased locomotor activity.

DOI： 10.1016/j.physbeh.2021.113653

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Scopus

PubMed

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese  

Language：Japanese   Publisher：(一社)日本心身医学会  

筆者は,大学病院で計6年間,市中総合病院で2年間,心療内科医として臨床を経験し,ちょうど若手とベテランの中間の位置に当たるのではないかと考えている.それぞれの病院での臨床を比較すると,市中総合病院で単独で勤めていた際に,どのように対応していけばよいかわからない症例,治療方針に自信がもてないまま苦心する場面を何度も経験した.心身医学的治療においては,疾患ごとの特徴だけではなく,一人ひとりの患者の心理社会的背景によっても,適切なアプローチが異なることは少なくない.それに対応するためには教科書だけでは学ぶことのできない,経験に基づく知識が必要不可欠であろう.私は苦慮する症例に出会うたびに,当医局の先輩方からの教えに助けられてきたが,また一方で自身が若手の医師に少しずつアドバイスできるようになりつつもある.今回テーマに沿って,オールジャパン体制の構築を臨床の観点から考えたとき,心身医学の臨床における知識と経験の共有の重要性を強調したいと考え,症例検討会を通して,世代を超えた心療内科医の諸先生方とのディスカッションの場を作ることを試みた.筆者が経験した,過換気発作を契機に救急搬送され,その後神経性やせ症として治療を継続した10代女性の1症例を提示した.(著者抄録)