1. “Advances in Psychiatry of Japan”
1. Guideline for Treatment of Schizophrenia
2. Re-naming the term “Schizophrenia”
3. A Biological Research on Vulnerability
Mitsumoto Sato, M.D., Ph.D.
Sendai, Japan
March-13, Athens, 2005

2. Number of Patients inpatients outpatients
Mentally ill , , ,000
Schizophrenia , , ,000
Mood disorder , , ,000
Dementia , , ,000
Neurotic etc , , ,000
Neurological disease (incl. Alzheimer disease, epilepsy)
184, , ,000
(number of patients treated / day, 1999)

3. The Yokohama Declaration
Recommendation 1
To do everything in their power to introduce adequate and comprehensive treatment of mental patients in their countries. This means that mental patients receive a balanced treatment combining pharmacotherapy with advanced psychosocial interventions for an optimal outcome.

4. The Practice Guideline for Treatment
of Schizophrenia 2004

5. Contents Chapter 1 Concept of schizophrenia
(concept, epidemic, symptoms, course and outcome)
Chapter 2 　 Formulation and implement of treatment plan
(psychiatric management, acute phase, recovering phase,
stable phase)
Chapter 3　 Review of available evidence
(psychopharmacology algorithm, psychosocial
interventions, treatment setting and housing, legislation)
Chapter 4 　 Other important issues
(suicide, physical complications, aging, judicial
psychiatry)　
Chapter 5 　 Future direction of research

6. Formulation and Implement of Treatment Plan in 3 phases
Diagnosis
Evaluation of symptoms
Psychopharmacology algorithm
Psychosocial intervention
Choice of treatment setting or housing

7. Principle for Treating Schizophrenia
Improve GAF considering risk-benefit of the patients
Community care with short administration
Diagnosis using ICD-10 diagnostic criteria with multi-axial assessment
3. Comprehensive treatment plan (medication and psychosocial interventions) in acute, recovery and stable phase.
4. Psycho-educational approaches
5. Collaboration of medical staffs with patient, family, etc.

8. Concepts of Schizophrenia
“Split-mind-disease” “Integration disorder” 　　　　
(1937～2002) (2002～update)
Concept 　　 dementia praecox a clinical entity
Etiology endogenous vulnerability stress model
Pathology　　　unknown　　 　 　 imbalance of NTS　　　
Axis 1 & inseparable 　　　 　　 separable
Diagnosis psychopathology operational
Prognosis poor (deterioration) recoverable
Psychoeducation difficult easier
Treatment medication comprehensive
(disease) (syndrome)

9. World Health Report 2001
Schizophrenia follows a variable course, with complete symptomatic and social recovery in about one-third of cases.
With modern advances in drug therapy and psychosocial care, almost half the individuals initially developing schizophrenia can expect a full and lasting recovery.

10. Course of Schizophrenia
Prodromal phase　　　　　　 　 2～5 yrs
Latency for referral ～2 yrs
Recovery of psychotic phase ～16 M
Critical period 　　 yrs
Long-term outcome
Free of further episode　　 ～15 %
Exacerbation and remission 70～80 %
Chronically severely psychotic ～15 %
（APA，２００４）

11. Vulnerability Psychotic episode Vulnerability Trait Prodromal Residual
Neurotoxicity?
Vulnerability Trait
Acquired Vulnerability

12. Number of Persons Arrested against the Stimulants Control Law in Japan
55,664
55,664
1st Epidemic
2nd Epidemic
3rd Epidemic
WORLD WARⅡ
1950
1950
1960
1960
1970
24,372
19,937
1980
2000
1970
1980
1990
1990
1999

13. Paranoid Psychotic State with Hallucinations including the FRS%
1st epidemic
Hayashi (1955) 　　　　　　　　　　74　　　　　　　　　　90
Tatetsu (1957)　　　　　　　　 　　131 　　 　　　　　
Connell (1964)
2nd epidemic
Sato (1982)
Konuma (1987)

14. symptom methamphetamine development prolong recur flashback
DA-D2R↓
DRD2 Taq IA A1/A1 genotype
DA-D2R↑
DRD2 -141C Del
DAT↓
hDAT1 VNTR ≤ 9R
COMT ↓
COMT 158Met
MAO-A ↑
MAO-A 4 repeats
DRD1 -48G
Mu-opioid IVS+691G
development
symptom
prolong
recur
flashback
psychotic episodes
methamphetamine
abuse/dependence
re-use
stress
Dynorphin↑
Prodynorphin 3-4 repeats
Ujike et al, 2002

15. Summary Dual Difficulties (re-name the term “schizophrenia”)
Needs for realistic optimism in the practice of treatment (the guideline for treatment of schizophrenia)
Disclose the vulnerability and relapse liability (biological research)