稲川 優多

BACKGROUND: Mindfulness interventions are considered an effective strategy for preventing mental health problems among health care workers (HCWs). While prior reviews have often included facilitator-guided or multicomponent interventions, it is unclear whether self-guided digital mindfulness interventions can also be effective without professional or in-person support. OBJECTIVE: This systematic review aimed to investigate the effects of self-guided digital mindfulness interventions on the mental health and well-being of HCWs. METHODS: This work was conducted as part of the DeLiGHT project. We searched electronic databases, including PubMed (MEDLINE), Embase, Cochrane CENTRAL, PsycINFO, PsycARTICLES, and the Japan Medical Abstract Society database, from inception in 2010 to July 25, 2023. To ensure timeliness, we performed an updated search on December 27, 2025. Database searching yielded 37,851 abstracts and 145 studies that examined the effectiveness of digital health interventions for workers in the initial 2023 screen. In the present study, we limited the included studies to those that met the following criteria: randomized controlled trials (RCTs) using self-guided digital mindfulness interventions (eg, smartphone apps or web-based programs) delivered without face-to-face or professional support compared to waiting list controls or usual care among HCWs. The updated search in 2025 yielded 6328 additional records, of which 11 studies were examined. Study quality was assessed using the Cochrane Risk of Bias tool, with meta-analyses conducted using a random-effects model. RESULTS: A total of 9 RCTs with 3088 participants were included in the final analysis. The study populations were diverse, covering North America, Europe, Oceania, and Asia. Interventions were delivered via various digital platforms, including commercial mindfulness apps (n=3), social networking service tools (n=3), and web-based programs (n=3), with an average duration of 6.17 weeks (range: 1.5-18 wk). Five studies assessed outcomes only postintervention, and 4 included short-term follow-up (4-12 wk); no long-term effects were evaluated. The meta-analysis showed a significant beneficial effect on depression (standardized mean difference [SMD]=-0.44, 95% CI -0.88 to -0.00; P=.049), anxiety (SMD=-0.29, 95% CI -0.51 to -0.06; P=.011), perceived stress (SMD=-0.42, 95% CI -0.77 to -0.06; P=.02), and well-being (SMD=0.20, 95% CI 0.09 to 0.30; P<.001) immediately postintervention. The adherence rates reported across studies were highly variable, ranging from 19% to 56%. According to the Cochrane Risk of Bias tool, most studies were rated as having some concerns or a high risk of bias. The certainty of evidence included in the analysis ranged from "Low" to "Very Low." CONCLUSIONS: Overall, low to very low certainty evidence suggests that self-guided digital mindfulness interventions may have short-term beneficial effects on depression, anxiety, perceived stress, and well-being among HCWs. Future high-quality studies are needed to examine the long-term effects and cross-cultural generalizability of these interventions.

Abstract Background Self-induced vomiting (SIV) in patients with eating disorders exposes the oral cavity to repeated chemical and mechanical insults, leading to various oral complications. Necrotizing sialometaplasia (NS) is one such complication; however, most cases resolve spontaneously and follow a benign course without requiring surgical intervention. Case presentation A woman in her twenties with a long history of an eating disorder characterized by habitual SIV developed NS of the hard palate. Unlike the usual benign course, the lesion failed to heal spontaneously and progressed to a palatonasal fistula. Her clinical course was notable for several behavioral and clinical factors that may have contributed to sustained local irritation of the palatal tissues, such as persistent vomiting, smoking, and dental procedures requiring local anesthesia. Multidisciplinary psychiatric and dental management was provided throughout the clinical course. Since spontaneous closure of the fistula could not be expected, surgical repair was ultimately performed. Conclusions Although NS associated with SIV in patients with eating disorders is usually benign and self-limiting, it can rarely progress to severe and irreversible oral complications such as a palatonasal fistula. Despite the fact that NS is not life-threatening, its severe progression can significantly impair quality of life. Accumulating clinical experience with such hidden complications may improve the quality of psychoeducation and advance the treatment of eating disorders.

Objective: Catatonia is a motor dysregulation syndrome that is often accompanied by deep vein thrombosis (DVT) and pulmonary embolism (PE). Although electroconvulsive therapy (ECT) is effective for catatonia, it is unknown whether ECT contributes to the onset of a PE from a residual DVT. We conducted this study to examine and propose safety methods for ECT in catatonia patients with a DVT.<br /> Methods: Among inpatients diagnosed with catatonia based on DSM-IV-TR or DSM-5 in our psychiatric ward from April 2010 to March 2017, five patients underwent ECT after developing a DVT. We obtained the patients&#039; clinical information by chart review.<br /> Results: All five patients received anticoagulation therapy after the onset of DVT and underwent subsequent ECT. Patients #1 to #3 had distal DVT (thromboses located below the knee in the calf veins) before ECT, not resulting in an onset of PE in the course of ECT. Patient #4 had a proximal DVT (thromboses in the popliteal vein and above), and the ECT session was completed without the occurrence of PE. In Patient #5, on the other hand, a proximal DVT developed into a PE after an ECT session.

1980年にDSM-IIIが刊行されて以降、統合失調症は妄想型、緊張型、解体型、残遺型、鑑別不能型の５つの亜型に分類されてきた。しかし、これらの亜型には診断の妥当性や継時的な安定性が乏しいため、DSM-5では亜型分類が廃止された。この歴史的変更は、亜型分類が疾患単位の概念として不適当であることを示している。一方Kraepelinは、亜型分類はあくまで「経過の諸型」を示すにすぎず、「諸型の間にはっきりと境を引くことは今日では不可能」と既に指摘している。したがって、疾患単位の確立を目的とする操作的診断基準から亜型分類を廃止したことは、当然の成り行きとも言える。本稿では、DSM-5で亜型分類が廃止された背景と、統合失調症の概念史を辿り、統合失調症の亜型分類の位置付けを再確認する。そのうえで具体的な症例を提示し、実地臨床における亜型分類の有用性について考察する。

近年，緊張病(カタトニア)は，統合失調症のみならず，気分障害や器質性精神障害など様々な精神疾 患を背景に生ずるものと考えられているが，神経症圏との関連を論じた報告はほとんどない.今回，神経症圏の患者が緊張病を呈し，benzodiazepine系薬剤のみで速やかな寛解を得た症例を経験した. 緊張病において早期治療が予後を改善する可能性が示唆されており，背景が神経症圏の病態であったとしても，一時的に緊張病へ移行する可能性があることを念頭に置くことは，臨床上意義のあることと思われるため，若干の考察とともに報告する.なお，症例の特定を防ぐため主旨に影響を与えない範囲で改変を施した.