SSブログ

口内炎

軽い風邪を引いたおまけに口内炎

なにか食べるごとに痛い

その結果、精神は憂鬱 



共通テーマ:日記・雑感

無駄で悲惨で貧乏で孤独で人間不信の人生サンプル

いいことがひとつもない
惨めで貧乏で孤独で夢敗れる人生も
いや夢を見る事さえ一度もなかった人生も
人生のサンプルとしては悪くない


DNAも悪かったし環境も悪かった
そう考えれば当然の帰結でもある
劣悪DNAと劣悪環境から人間不信が生まれ
そのことが人生の不幸を決定的なものにする


私の人生は
無駄で悲惨な人生のサンプルとして
多少の役には立つだろう



共通テーマ:日記・雑感

決心する前に完全に見通しをつけようと決心する者は、 決心はできない。

決心する前に完全に見通しをつけようと決心する者は、
決心はできない。

アミエル

私は若い頃は強迫性傾向が強かったので
完全に見通しがつかない限りはどの方向にも進まなかった

年老いて頭がゆるくなってはじめて
あまり見通しも立たないままに決心するようになった

するとだいたい世間と歩調が合う程度になった

 



共通テーマ:日記・雑感

自分を常に切り開いていく姿勢を持つことが、この人生を最高に旅することになるのだ

自分を常に切り開いていく姿勢を持つことが、この人生を最高に旅することになるのだ

ニーチェ

残念ながら、彼の場合、切り開いたまま閉じなくなっています 



共通テーマ:日記・雑感

じっとこらえてゆくのが 男の修行である

苦しいこともあるだろう 言い度いこともあるだろう 
不満なこともあるだろう 腹の立つこともあるだろう 泣き度いこともあるだろう 
これらをじっとこらえてゆくのが 男の修行である

山本五十六



共通テーマ:日記・雑感

私は自分が幸せになるなんて想像もできません

私は自分が幸せになるなんて想像もできません

いままでの私の選択はすべて裏目に出て

不幸が続いています

こんなに確実な法則は他にないんです 

何とかして少しは人並みになりたいものだと思いますが

駄目なんですから仕方ありません

巡り合わせというか運命というか

むしろいっそのこと不幸せが常と思えば何の不満もないですね

徳川家康も言っています

-------------------------------------------------------------------- 

人の一生は重荷を負うて遠き道を行くが如し、急ぐべからず。

不自由を常と思へば不足なく心に望みおこらば

困窮したる時を思い出すべし。

 

堪忍は無事長久の基。怒は敵と思へ。

勝つ事ばかりを知って負くる事を知らざれば

害その身に至る。

おのれを責めて人を責むるな。

及ばざるは過ぎたるより優れり。 

---------------------------------------------------------------------

後輩によれば

人の一生は重き女を負うて遠き道を行くが如し、急ぐべからず。

とのことです。03C.gif



共通テーマ:日記・雑感

電気ひげそり 25年ぶりに買い換えた

電気ひげそり
25年ぶりに買い換えた
これまでは
替え刃を買って新しくしていた
今回替え刃の一覧を見たところ製造中止になっていた

替え刃を買い換えるより明らかに使い心地がよいので
驚いた

共通テーマ:日記・雑感

精神科診断解説の例


共通テーマ:日記・雑感

Change for the better life --Foreword by A.Ryle

Foreword
序文 
 
We are all born to particular parents at a particular time and in a particular
わたくしたちは皆、特定の両親もと、特定の時代、特定の場所に生まれてきて、

place and our early experiences combine with our inherited temperaments to
幼少時の経験と生まれながらの気質とが結合されて、他とは違う個々人つまり自己を形成する。

form us into recognisable individuals - ourselves. The journey through


infancy, childhood and adolescence to adulthood is a complicated one and,
幼児、小児、青年から成人への旅路は複雑なものであり、

while most of us acquire a more or less stable and satisfied sense of ourselves
多かれ少なかれ、私たちのうちのほとんどの者は安定した満足のできる自己感覚

and an adequate grasp of the world we live in, we all collect some habits or
と私たちが住んでいる世界について十分な理解を得る。しかしその一方で、くせ、性質、信念についてのいくらかは

dispositions or beliefs which serve us badly but which are so much part of our
私たちに悪い影響を与えるけれども、それはとても自分らしいので、それらに対して疑問を持ったり

sense of ourselves that we do not question them. Unless and until,that is, we
しないものである。
 
find ourselves suffering from unreasonable anxiety or frequent depression or
そして、自分が、理由のない不安、頻繁な抑うつ、 説明のつかない身体的な症状に苦しんでいると気がついたり、
 
unexplained physical symptoms or become aware of ways in which our life is
期待あるいは意図したとおりの人生でないことに気が付いて初めて、
 
not going as we hoped or intended. At this point we may stop and think
疑問を感じる。 この時点で私たちは立ち止まり、
 
about how our life has been and we may talk to family and friends and receive
自分の人生がどんな風であったのか考えて、家族や友人に話し、役に立つ支援やアドバイスが 
 
helpful support and advice. But for many more troubled people there is a
得られることもあるだろう。しかしもっと困っている人にとっては、援助やアドバイスがどんなに 
 
limit to how useful that may be, partly because those we choose to talk to will
いいものであっても限界がある。なぜなら、 ひとつには、私たちが相談しようとする人は、しばしば(無意識のうちに)
 
often be selected (not consciously) because they can be trusted to respond to
私たちの期待通りの反応をしてくれると信頼しているから選ぶのであって、 
 
us in the way we expect and not to challenge our problematic aspects and
 どうにもならない局面を打開しようとして挑戦するために選ぶのではないからである。
 
partly because,if they do challenge them, we may be unable to take on board
またひとつには、そのようにしてアドバイスの通りに結果の見えないことに挑戦したとしても、 
 
what they are saying. This is not because we are stupid,it is because,to a far
言われたとおりのことはできないことが多いだろう。これは私たちが愚かだからではなくて、
 
greater extent than we usually realise, we all live suspended in a web of relationships 
普段思っている以上に、 私たちは過去や現在の他者との関係の網の目の中に
 
 
with others, some from the past and some present, and it is this web
依存して生きているからであって、自分が自分であるという感覚を支えてくれているのは、 
 
 
of connections with others which sustains our sense of being ourselves. Or it
他者との連結の網の目に他ならない。 
 
 
may be that,in the face of early experiences that were emotionally unmanageable,
 
 
we have learned to conceal ourselves and to mistrust others to the
 
 
extent that there is nobody we can feel safe enough with to show our pains
 
 
and to expose what we may feel to be our weakness.
 
 
  It is at such a time that this book can be of particular value. Liz McCormick
 
 
combines a wealth of experience as a psychotherapist with a gift for writing
 
 
and an attitude which is fully respecting of the reader. Those seeking simple
 
 
categorisations of distress or illness linked to prescriptions of how to get better 
 
 
will be disappointed,for there are no over simplifications of the problems
 
 
and no dispensing of ready-made solutions. Instead,readers are invited to
 
 
think clearly about their difficulties and to feel directly the meanings of their
 
 
past and present experiences. The common tendency to think about psycho-
 
 
logical symptoms as if they were analogous to physical illnesses and to treat
 
 
them with medication or simple symptom-oriented therapies is reinforced by
 
 
some psychiatrists and by the power of the pharmacological industry. It can
 
 
be difficult for many people to realise that their moods and symptoms are the
 
 
physical manifestations of difficulties in living and can signal the need for
 
 
change. That symptoms may be partly physical in origin and may sometimes
 
 
require medical treatment is of course acknowledged here, but the book aims
 
 
to emphasise the value of understanding the links between one's distress and
 
 
how one leads one's life. By indicating the possibility of understanding and
 
 
changing the thoughts,feelings and behaviours which underlie our depres-
 
 
sion, anxiety or headaches and our unhappiness or difficult relationships,it
 
 
allows passive suffering to be replaced by an active engagement in identifying
 
 
and changing damaging and restricting aspects of our own natures.
 
 
  To help in this task the book starts by offering clear descriptions of common
 
 
problematic patterns of thinking and acting. These usually repeat unhappy
 
 
patterns experienced early in our lives or represent our early attempts to solve
 
 
problems through means that have themselves become harmful or restricting.
 
 
We are usually only partly aware of our own patterns and here common ones
 
 
are usefully illustrated by examples and are linked to exercises that support
 
 
self-discovery and indicate possible alternative ways of coping. This is unfamiliar 
 
 
territory for most people and exploration needs the help of a guide.
 
 
A particular strength of the book is the way in which one has the experience
 
 
of being in dialogue with the author; one is not being given instructions and
 
 
a guide book so much as one is invited to participate in the construction of
 
 
one's own map and to conduct one's own exploration. This means that 
 
 
readers,to benefit, must accept their share of the work. This is not a book to read
 
 
while waiting for the bus;it demands concentration and the ideas need to be
 
 
thought about actively through the day. Change will not come about in a
 
 
flash of realisation,it will require sustained attention. The structure of the
 
 
book supports this and it will be most valuable to those who go through it
 
 
systematically and at their own pace. As well as helping one to think clearly
 
 
about negative aspects of oneself Liz McCormick draws on her knowledge
 
 
of Buddhist ideas to propose mindfulness techniques which can enlarge
 
 
self-awareness.
 
 
  The book can help many people through many problems and can contribute 
 
 
to enlarging what can be called emotional literacy but it does not
 
 
claim too much for itself. Enduring what cannot be changed is not a skill that
 
 
can be taught but learning to recognise what can be changed and knowing
 
 
how to begin to change will be greatly clarified by reading this book. Further
 
 
reading from a wide spectrum of viewpoints is listed and guidance on how to
 
 
find appropriate psychotherapy is provided. But whether or not further help
 
 
is needed,I warmly recommend it as an excellent place from which to start
 
 
the journey.
 
 
Anthony Ryle


共通テーマ:日記・雑感

南北・気質と病気

一般的に,南の地になるほど単純なうつ病ではなく,少し気分が高揚しやすい双極性の傾向のある患者さんが多くなるということは知られています。統合失調症においても非定型的な病像が多いといわれています。原因は光刺激であると推測されています。
とのこと。 



共通テーマ:日記・雑感

クローバー

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353.gif 



共通テーマ:日記・雑感

First/Second World Model, Time-delay Hypothesis

Ⅴ Pathological Hypothesis: First/Second World Model, Time-delay Hypothesis, Traits of Neurons
 
  In this section, the pathological hypothesis is introduced in the order of ①the process from ARMS to onset of schizophrenia, ②ego-disturbance which is characteristic to schizophrenia, ③depressive moods which are seen with schizophrenia.  
 
  First, pathological model of the process from ARMS to onset is explained.  Man’s proper interpersonal-distance is considered to reflect the sensitivity of dopamine receptors.  If he is sensitive, he may tend to take longer interpersonal-distance.  Some people are sensitive to dopamine from birth (for example, with excessive dopamine receptors), and they have sensitive traits.  Even if when they have the same experiences as others, they tend to emit excessive dopamine which makes them suffer.  As a result, they tend to select a life style that deals with fewer interpersonal relationships.  In a life tends to decline to isolation, they may become familiar with arts, nature, and animals.  In this way, they grow up with sensitiveness to dopamine and they somehow acquire the way to live without the onset of schizophrenia.  However, after the age of adolescence, living conditions change greatly.  “Rolls and assignments which require interpersonal relationships are given,” “they meet opposite sex,” “chances in which activeness and self-duty are required increase,” etc., life and interpersonal relationships get much more complicated.  The phase in which they can’t solve problems any more only by familiar withdrawal strategy emerges.  In midst of this, dopamine is emitted excessively under strongly stressed situations concerning “sexual affairs, money, honor, and health”, and combined with sensitiveness towards dopamine, they face crisis of the onset of schizophrenia.  In addition, it is easy to imagine these kinds of crises do exist prior to the obvious onset.  Psychotic like experiences (PLEs, later ARMS : at risk mental state), which are attracting attention recently, possibly correspond to these situations.
 
  Next is the pathological hypothesis of ego-disturbance, which is specific to schizophrenia.  The animal’s nervous system (except for human), in general, forms a loop as ①reception of stimulations at the sensory organ→②conditional reaction in the brain→③reaction through kinetic system, autonomic nervous system, etc.→④real outcomes→⑤reception of stimulations at the sensory organ.  Since there isn’t a part to guarantee the formation of self-consciousness in this loop, sense of active control of ego, which is obvious experience to human, can’t be explained.


共通テーマ:日記・雑感

家庭の内部で密かに進行するサンショウウオとカエルの関係

古い歌を聞く

We are all alone

Call me

家庭の内部で密かに進行するサンショウウオとカエルの関係

私は君にもっと別なことを伝えたかったような気がする

しかしそれ自体が錯覚かもしれない

伝えることは何もなかったのかもしれない

いやそうではない

伝えようと努力することの先にいい答えがありそうな気がする

あるいはいい質問がありそうな気がする

共通テーマ:日記・雑感

看護師や保健婦の実践するメンタルヘルス

NHK特集
1011.3.11の震災の後に生き残った人たちの中で
自殺する人がいる
その背景ということで番組が流れていた

そんな場合に精神的なケアをする中心は
看護師とか保健師とかそんな職種であるらしいことが
映像からも分かる
そしてその人達が精神医療について
どのような知識と技術を持っているのかが分かる

ーー
CATはCBTを看護師レベルの段階で
対応しようというもので
イギリスで言えば一般医と一緒に活動している看護師の役割と
考えられている

だから意義があると思われる 



共通テーマ:日記・雑感

小学校

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共通テーマ:日記・雑感

星 星雲

081206_rose_a.jpg

 

interstellarcloudsimagealbum1~12.jpg

 

imgc47b8836zik0zj.jpeg

 

nebulasimagealbum1~21.jpg 

 

 



共通テーマ:日記・雑感

Jung


共通テーマ:日記・雑感

Anthony Ryle +Elizabeth Wilde McCormick

CATの基本文献・単行本としては以下のもの

Denman, C (2001). Cognitive-analytic therapy. Advances in Psychiatric Treatment, issue 7, pp 243–252
 
Ryle, A (1990) Cognitive Analytic Therapy: Active Participation in Change. Chichester: John Wiley & Sons.
 
Ryle, A (1995). Cognitive Analytic Therapy: Developments in Theory and Practice. Chichester: John Wiley & Sons.
 
Ryle, A (1997). Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method. Chichester: John Wiley & Sons.
 
Ryle, A & Kerr, I (2002). Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: John Wiley & Sons. →2012/12月に改訂出版予定

Elizabeth Wilde McCormick (Author)(2008):Change for the Better: Self-Help through Practical Psychotherapy [Paperback]


 

それぞれ紹介すると以下の様子。
ーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー
 Denman, C (2001). Cognitive-analytic therapy. Advances in Psychiatric Treatment, issue 7, pp 243–252
 
ーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー
Cognitive-Analytic Therapy: Active Participation in Change: A New Integration in Brief Psychotherapy [Paperback]
Anthony Ryle (Author)

ISBN-10: 0471930695 | ISBN-13: 978-0471930693 | Publication Date: April 28, 1992
Cognitive-Analytic Therapy: Active Participation in Change A New Integration in Brief Psychotherapy Anthony Ryle, St Thomas’s Hospital, London With contributions from Amanda M Poynton, Guy’s Hospital, London and Bee J Brockman, West Midlands Regional Health Authority, Birmingham. This book presents a time-limited approach to psychotherapy. It describes a new framework for brief therapy—Cognitive - Analytic Therapy—the application of psychoanalytic understanding and of some psychoanalytic techniques within a framework, and with additional treatment methods derived from cognitive psychology and psychotherapy. This therapy involves a high degree of patient participation in the describing and in the learning to recognize and alter recurrent maladaptive procedures. The book is intended as a guide to clinical work—ideas and methods are illustrated with a large amount of case description, with writing from therapists and patients, and with some directly recorded material from sessions. Cognitive - Analytic Therapy is a precise and powerful method which uses active techniques, which recruits the patients’ capacities and which takes account of the complexity of psychotherapeutic change. The approach is brief, effective and researchable and is suitable as the first intervention in most patients. Anthony Ryle’s book will be essential reading to those already engaged in Cognitive - Analytic Therapy and will introduce many others to the possibility of an effective and theoretically coherent integration of psychodynamic, cognitive and behavioural therapies. This book appears in the Wily Series on Psychotherapy and Counselling, Series Editors Franz Epting, University of Florida, and Glenys Parry, University of Southampton.

From the Publisher
Presents the clinical applications of cognitive-analytic therapy (CAT) in treating patients in both primary care and outpatient settings and as an initial treatment for seriously disturbed patients. Delineates the reformulation process in which patients actively participate in defining their problems and modifying their behavior. Describes general treatment methods, more complex reformulations of patients' difficulties and treatment of the more severely disturbed patient. Also discusses the use of CAT procedures in long-term therapy, in couple therapy and in various work settings. Ideas and methods are illustrated with several case descriptions, studies from therapists and patients and directly recorded material from sessions.
About the Author
About the author Anthony Ryle qualified in medicine in 1949 and was until 1964 in general practice where his interest in neuroses and therapy began and where his first research was carried out. He was Director of the University Health Service at the University of Sussex until 1979. He is currently consultant psychotherapist at the United Medical and Dental Schools of Guy’s and St Thomas’s Hospital in London where he is active in both research and teaching and in the development of Cognitive - Analytic Therapy.

Paperback: 282 pages
Publisher: John Wiley & Sons (April 28, 1992)
Language: English
ISBN-10: 0471930695
ISBN-13: 978-0471930693
Product Dimensions: 9.1 x 6 x 0.8 inches
Shipping Weight: 1 pounds
Average Customer Review: Be the first to review this item
Amazon Best Sellers Rank: #3,080,077 in Books (See Top 100 in Books)

ーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー 
Cognitive Analytic Therapy: Developments in Theory and Practice [Paperback]
Anthony Ryle (Editor)

ISBN-10: 047194355X | ISBN-13: 978-0471943556 | Publication Date: July 18, 1995 | Edition: 1
Cognitive Analytic Therapy (CAT) is a fast-growing therapy remarkable not only for its integrative approach and power but also for its applicability in the context of brief therapy. Since Anthony Ryle developed the concepts of CAT in the early 1980s there has been an enormous demand for training in this method, from psychologists, psychiatrists, therapists and counsellors, as well as from other health professionals caring for disturbed patients in community settings. This book reviews the history and essential features of CAT, offers a state-of-the-art detailed description of practice, and continues the conceptual development of the field with discussion of the relationship of the CAT model to cognitive and analytical therapies, and to recent research in early child development. It includes authoritative accounts of the application of CAT to eating disorders, borderline personality disorder, self-harm problems, and to group work. Research into CAT is reviewed and, in the final chapter, Anthony Ryle looks forward to likely developments of research and practice in Cognitive Analytic Therapy. Trainees and practitioners will find this book a stimulating update on developments of the CAT model and a useful, practical guide to applying CAT in important problem areas. This book appears in The Wiley Series in Psychotherapy and Counselling Series Editors: Franz Epting, University of Florida, USA Bonnie Strickland, University of Massachusetts, USA and John Allen, City University, London, UK

Paperback: 210 pages
Publisher: Wiley; 1 edition (July 18, 1995)
Language: English
ISBN-10: 047194355X
ISBN-13: 978-0471943556
Product Dimensions: 8.8 x 6 x 0.7 inches
Shipping Weight: 12 ounces (View shipping rates and policies)
Average Customer Review: Be the first to review this item
Amazon Best Sellers Rank: #2,908,287 in Books (See Top 100 in Books)


ーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー
Cognitive Analytic Therapy and Borderline Personality Disorder: The Model and the Method [Paperback]
Anthony Ryle (Author)

ISBN-10: 0471976180 | ISBN-13: 978-0471976189 | Publication Date: September 1997 | Edition: 1
Borderline Personality Disorder patients are impulsive, unstable and destructive, hurting themselves and those around them, including those who seek to help them. This has resulted in a widespread reluctance to treat them and a pessimism about treatment. In the experience of the authors this pessimism is unjustified, because for many patients a relatively brief intervention can be effective in cost-benefit terms as well as human terms. The interventions illustrated here have been used to treat outpatients for 15 years. The results indicate that treatments can achieve clinically significant changes in the course of 16 24 sessions, in a substantial proportion of patients. While CAT shares some ideas and methods with other approaches, it introduces many new features and is uniquely integrated at both the theoretical and practical level. The early joint reformulation of patients problems serves to contain destructiveness and to create a working alliance. Also, the use of reformulation to teach self-reflection and avoid collusive responses from the therapist, throughout the therapy, represents a powerful new technique. The book offers a critical appraisal of current ideas and practices, contrasting with these the ways in which CAT mobilizes the patient s own resources. The authors argue that CAT should have a place in any service seeking to help these difficult patients. From a review of Cognitive Analytic Therapy: Developments in Theory and Practice (Anthony Ryle (Editor), 1995): "Ryle is surely the most original, productive and interesting writer in psychotherapy in Britain today, and CAT is a remarkable systematizing achievement which deserves to be better known on the other side of the Atlantic This book documenting CAT s recent theoretical and practical developments is a must for anyone interested in CAT itself and in integrative approaches, for those interested in brief, psychodynamically informed therapy, or indeed for those interested in developments in psychology generally." Robert Rentoul, British Journal of Medical Psychology
 

From the Publisher
Borderline personality disorder patients are impulsive, unstable and destructive, hurting themselves and those around them, including those who seek to help them. The use of cognitive analytic therapy (CAT) to treat patients with borderline personality disorder is a fairly recent (and successful) approach. This book presents the therapeutic approach and describes the developmental and structural models on which it is based.
From the Back Cover
Borderline Personality Disorder patients are impulsive, unstable and destructive, hurting themselves and those around them, including those who seek to help them. This has resulted in a widespread reluctance to treat them and a pessimism about treatment. In the experience of the authors this pessimism is unjustified, because for many patients a relatively brief intervention can be effective in cost-benefit terms as well as human terms. The interventions illustrated here have been used to treat outpatients for 15 years. The results indicate that treatments can achieve clinically significant changes in the course of 16?24 sessions, in a substantial proportion of patients. While CAT shares some ideas and methods with other approaches, it introduces many new features and is uniquely integrated at both the theoretical and practical level. The early joint reformulation of patients? problems serves to contain destructiveness and to create a working alliance. Also, the use of reformulation to teach self-reflection and avoid collusive responses from the therapist, throughout the therapy, represents a powerful new technique. The book offers a critical appraisal of current ideas and practices, contrasting with these the ways in which CAT mobilizes the patient?s own resources. The authors argue that CAT should have a place in any service seeking to help these difficult patients. From a review of Cognitive Analytic Therapy: Developments in Theory and Practice (Anthony Ryle (Editor), 1995): "Ryle is surely the most original, productive and interesting writer in psychotherapy in Britain today, and CAT is a remarkable systematizing achievement which deserves to be better known on the other side of the Atlantic ? This book documenting CAT?s recent theoretical and practical developments is a must for anyone interested in CAT itself and in integrative approaches, for those interested in brief, psychodynamically informed therapy, or indeed for those interested in developments in psychology generally." Robert Rentoul, British Journal of Medical Psychology

Paperback: 206 pages
Publisher: Wiley; 1 edition (September 1997)
Language: English
ISBN-10: 0471976180
ISBN-13: 978-0471976189
Product Dimensions: 8.8 x 6 x 0.8 inches
Shipping Weight: 12 ounces (View shipping rates and policies)
Average Customer Review: Be the first to review this item
Amazon Best Sellers Rank: #2,417,737 in Books (See Top 100 in Books)

ーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーーー

Introduction to Cognitive-Analytic Therapy: Principles and Practice [Paperback]
Anthony Ryle (Author), Ian B. Kerr (Author)

This is a comprehensive, up-to-date introduction to the origins, development, and practice of cognitive-analytic therapy (CAT). 

Written by the founder of the method and an experienced psychiatric practitioner and lecturer, it offers a guide to the potential application and experience of CAT with a wide range of difficult clients and disorders and in a variety of hospital, community care and private practice settings. 

Introducing Cognitive Analytic Therapy includes a wide range of features to aid scholars and trainees: 

? Illustrative case histories and numerous case vignettes 
? Chapters summaries, further reading and glossary of key terms 
? Resources for use in clinical settings 

Essential reading for practitioners and graduate trainees in psychotherapy, clinical psychology, psychiatry and nursing.

Paperback: 286 pages
Publisher: Wiley; 1 edition (December 15, 2001)→2012-Decに改版予定
Language: English
ISBN-10: 0471892734
ISBN-13: 978-0471892731
Product Dimensions: 9.4 x 6.5 x 0.7 inches
Shipping Weight: 1.1 pounds (View shipping rates and policies)
Average Customer Review: 5.0 out of 5 stars  See all reviews (1 customer review)
Amazon Best Sellers Rank: #724,207 in Books (See Top 100 in Books)

5.0 out of 5 stars Best of both worlds- deep understanding and short term treatment, August 30, 2008
By Robert M. Gordon, Ph.D. (allentown, pa USA) - See all my reviews
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This review is from: Introduction to Cognitive-Analytic Therapy: Principles and Practice (Paperback)
Otto Kernberg recently said, "I tried to bridge ego psychology and Klienian psychology. But when you try to build a bridge you get shot at by both sides!" Drs. Ryle and Kerr are still alive, but much of psychology is trying to pretend they do not exist outside of England. Here in America, CBT is trying to kill off anything psychodynamic or anything that suggests a whole person. Integration here is slow to come. Ryle took the deep understanding of personality from psychoanalysis and the pragmatism of short term cognitive psychology and developed a scientifically supported psychological treatment. 
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Change for the Better: Self-Help through Practical Psychotherapy [Paperback]
Elizabeth Wilde McCormick (Author)

ISBN-10: 1412948266 | ISBN-13: 978-1412948265 | Publication Date: February 1, 2008 | Edition: 3rd
This is the Third Edition of the best-selling self help psychotherapy program for lay people and students of psychotherapy since first publication in 1990. The new edition offers a therapeutic dialogic relationship between reader and author. It includes the most recent development in CAT practice and places greater emphasis upon the transformation of unhelpful learned reciprocal role procedures that underlie relationship to oneself and to others. Change in symptoms occur when new and beneficial reciprocal roles are created. 

Paperback: 280 pages
Publisher: Sage Publications Ltd; 3rd edition (February 1, 2008)
Language: English
ISBN-10: 1412948266
ISBN-13: 978-1412948265
Product Dimensions: 9.1 x 6.1 x 0.7 inches
Shipping Weight: 14.9 ounces (View shipping rates and policies)
Average Customer Review: Be the first to review this item
Amazon Best Sellers Rank: #2,344,197 in Books (See Top 100 in Books)

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共通テーマ:日記・雑感

Key References for CAT

Key References

Bennett, D and Parry, G. (1998) The accuracy of reformulation in cognitive analytic therapy: a validation study. Psychotherapy Research, 8, 84-103.

Bennett, D and Parry, G. (2004) A measure of psychotherapeutic competence derived from Cognitive Analytic Therapy. Psychotherapy Research, 14, 176-192.

Bennett, D, Pollock, P and Ryle, A. (2005) 'The States Description Procedure: The Use of Guided Self-Reflection in the Case Formulation of Patients with Borderline Personality Disorder'. Clinical Psychology and Psychotherapy, 12, 50-57.

Bennett, D, Parry, G. and Ryle, A. (2006) Resolving threats to the therapeutic alliance in cognitive analytic therapy of borderline personality disorder: a task analysis. Psychology and Psychotherapy: Theory, Research and Practice. 79, 395-418

Brockman, B., Poynton, A., Ryle, A. & Watson, J. P. (1987) Effectiveness of Time-limited Therapy carried out by trainees. British Journal of Psychiatry, 151, 602 - 610. 

Chanen, A.M., Jackson, H. J., McCutcheon, L. K., Jovev, M., Dudgeon, P., Yuen, H. P., Germano, D., Nistico, H., McDougall, E., Weinstein, C., Clarkson, V., and McGorry P. D. (2008) Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial. The British Journal of Psychiatry, 193, 477-484.

Chanen A.M., McCutcheon L., Germano D., Nistico H., Jackson H. J., & McGorry P.D. (2009a) The HYPE Clinic: An Early Intervention Service for Borderline Personality Disorder. Journal of Psychiatric Practice, 15, 163-172. 

Chanen A.M., Jackson H.J., McCutcheon, l.K et al. (2009b) Early intervention for adolescents with borderline personality disorder: quasi-experimental comparison with treatment as usual. Australian and New Zealand Journal of Psychiatry, 43, 397-408.

Daly, A-M. , Llewellyn, S. and McDougall, E. (2010). Rupture resolution in the cognitive analytic therapy for adolescents with borderline personality disorder. Psychology and Psychotherapy: Theory, Research and Practice. In print.

Duignan, I. and Mitzman, S. (1994) Change in patients receiving time limited cognitive analytic group therapy. International Journal of Short-Term Psychotherapy, 9, 2/3, 151-160. 

Golynkina, K and Ryle, A. (1999) The identification and characteristics of the partially dissociated states of patients with borderline personality disorder. British Journal of Medical Psychology, 72, 429-445.

Hepple, J. & Sutton, L. (eds) (2004) Cognitive Analytic Therapy and Later Life: A New Perspective on Old Age. Brünner-routledge, Hove and New York

Hepple, J. (2010) Cognitive Analytic Therapy in a Group. A dialogic approach. British Journal of Psychotherapy (submitted for publication).

Kellett, S. (2005) The Treatment of Dissociative Identity Disorder with Cognitive Analytic Therapy: Experimental Evidence of Sudden Gains. Journal of Trauma & Dissociation 6, 55-81.

Kellett, S. (2007) A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice, 80, 389-405.

Kerr, I, Dent-Brown, K, & Parry, G (2007) Psychotherapy and mental health teams. International Review of Psychiatry, 19, 63–80.

Maple, N. and Simpson, I. (1995) CAT in groups. In: A. Ryle (ed.) Cognitive Analytic Therapy: Developments in theory and practice. Chichester: Wiley.

Pollock, P. (2001) Cognitive Analytic Therapy for Adult Survivors of Childhood Abuse: Approaches to Treatment and Case Management. Chichester: Wiley.

Pollock, P.H., Broadbent, M., Clarke, S., Dorrian, A.J. and Ryle, A. (2001) The Personality Structure Questionnaire (PSQ): A measure of the multiple self states model of identity disturbance in cognitive analytic therapy. Clinical Psychology and Psychotherapy, 8, 59-72.

Pollock, P., Stowell-Smith, M. and Göpfert, M. (2006) Cognitive Analytic Therapy for Offenders: A New Approach to Forensic Psychotherapy, Routledge.

Ryle, A. (1967) 'A Repertory Grid Study of the Meaning and Consequences of a Suicidal Act', British Journal of Psychiatry, 113, 1393-1403.

Ryle, A. (1975) 'Self-to-Self, Self-to-Other: The World’s Shortest Account of Object Relations Theory', New Psychiatry, 12-13.

Ryle, A. (1980) 'Some Measures of Goal Attainment in Focused Integrated Active Psychotherapy: A Study of Fifteen Cases', British Journal of Psychiatry, 137, 475-486.

Ryle, A. (1982) Psychotherapy: A Cognitive Integration of Theory and Practice. London: Academic Press.

Ryle, A. (1990) 'Cognitive Analytic Therapy', in Handbook of Integrative Therapies 1 pp 84 - 193. OUP

Ryle, A. (1996) Ogden’s autistic-contiguous position and the role of interpretation in psychoanalytic theory building. British Journal of Medical Psychology, 69, 129-138.

Ryle, A. (1997a) Cognitive Analytic Therapy and Borderline Personality Disorder. The Model and the Method. Chichester: Wiley.

Ryle, A. (1997b) The structure and development of borderline personality disorder; a proposed model. British Journal of Psychiatry, 170, 82-87.

Ryle, A. (2001). Constructivism and Cognitive Analytic Therapy (CAT). Constructivism in the Human Sciences, 6, 51-58.

Ryle, A. (2003). Something more than ‘something more than interpretation’ is needed: a comment on the paper by the process of change group. International Journal of Psychoanalysis; 84:109-118.

Ryle, A. (2007) Investigating the phenomenology of borderline personality disorder with the States Description Procedure: clinical implications. Clinical Psychology and Psychotherapy; 14, 329-341.

Ryle, A. (2010) ‘The view from CAT’ Ch. 3 in Loewenthal, D. & House, R. (Eds) 'Critically Engaging CBT'. Maidenhead: Open University Press.

Ryle, A. & Golynkina, K. (2000) Effectiveness of time-limited cognitive analytic therapy of borderline personality disorder: Factors associated with outcome. British Journal of Medical Psychology, 73, 197-210.

Ryle, A. & Kerr, I. (2002) Introducing Cognitive Analytic Therapy: Principles and Practice. Chichester: Wiley.

Thompson, A.R., Donnison, J., Warnock-Parkes, E., Turpin, G., Turner, J., and Kerr , I.B. (2008) Multidisciplinary community mental health team staff's experience of a 'skills level' training course in cognitive analytic therapy. International Journal of Mental Health Nursing, 17, 131-137.



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BOOK REVIEWS Introducing Cognitive Analytic Therapy

  • BOOK REVIEWS

Introducing Cognitive Analytic Therapy. Principles and Practice

By Anthony Ryle & Ian B. Kerr

  1. Isaac Marks, Emeritus Professor

+Author Affiliations

  1. Institute of Psychiatry, King's College London, and Senior Research Investigator and Honorary Consultant Psychiatrist, Department of Psychiatry, Faculty of Medicine, Imperial College School of Science, Technology & Medicine, 303 North End Road, London W14 9 NS, UK
  • EDITED BY SIDNEY CROWN and ALAN LEE

  • Chichester: John Wiley & Sons. 2002. 265 pp. £19.99 (pb). ISBN 0 471 892734


Reading this book brought to mind a sobering experience from my youth. In 1966, I visited a psychotherapy institute in Leningrad (now St Petersburg). Its doctors said they used ‘Pavlovian’ psychotherapy. How did they do this? They admitted patients, took a detailed history of their upbringing and showed them how current maladaptive behaviours grew out of earlier forms of interaction with family and others which needed revision to become more appropriate to current circumstances. Western psychotherapists using a similar approach might have been surprised to hear that Pavlov was its progenitor. Now Ryle & Kerr see it as part of cognitive analytic therapy (CAT), which takes about 16 sessions. Together with the patient, the therapist writes a reformulation letter that sets out aims in therapy. The patient self-monitors, with the help of a diary, to spot problems as they arise and try to revise them, and rates target problems. The patient and therapist exchange goodbye letters at the penultimate or last session to review what has been achieved or remains to be done, and follow-up is arranged.

Case examples show how CAT assessment is done and reformulation letters and diagrams are constructed. Its use of a goal-oriented approach, diary-keeping, self-ratings and collaboration with the patient overlaps with the practice of behavioural and cognitive therapists. However, a case history of CAT in a patient with obsessive—compulsive rituals (pp. 138-144) highlights how CAT differs from behaviour therapy by exposure and ritual prevention: the ‘ target problem’ procedures did not mention the rituals, the post-treatment rating of improvement did not say whether or not rituals reduced, and a mean of 16 sessions of ‘brief’ CAT exceeds the 9 sessions usual with face-to-face behavioural therapy, let alone the single hour of clinician contact needed with computer-aided behavioural therapy. The authors acknowledge the paucity of controlled trials of CAT. The aim of CAT in early dementia seemed unclear (p. 156).

The authors say that CAT derives its ideas from evolutionary psychology, genetics, developmental neurobiology and psychology, and uses a ‘ Vygotskian perspective’ regarding ‘sign mediation’, ‘ Bakhtinian concepts of the dialogic self’ and ‘Kellyian personal construct therapy, cognitive therapy and psychoanalytic object relations theory’. These supposed roots remind one of the historian's warning of ‘idols of origin’.

A would-be practitioner might learn more from the book's case illustrations than its turgid theoretical digressions, replete with redundant argot. We need not have heard of Vygotsky to know about meaning, intention and signs, or of Bakhtin to know that we are social beings.

The case histories give an idea of what CAT is about, but the book testifies to the long journey ahead before psychotherapy can reach the authors' laudable goal of a lucid language, method and evidence-base shared by all practitioners.

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こんなことを書くものだから 

あとでおもいっきり反論されている。 



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Tony Ryle, the founder of Cognitive Analytic Therapy

Tony Ryle, the founder of Cognitive Analytic Therapy

Tony Ryle in 1995Tony Ryle’s first work was in General Practice. Together with colleagues who shared his socialist and egalitarian views and his support for the newly established NHS he was a founder of the Caversham Centre, a group practice which offered an appointment system, a carpet in the waiting room, a receptionist and a nurse and good clinical care. It was described by the local bookie’s runner as ‘the poor man’s ‘arley Street’.

Within a few years he found himself increasingly concerned with his patients’ problematic lives as well as with their diseases. He began to spend more time listening and talking to patients and took up some clinical assistant sessions at the Royal Free with the aim of extending his skills. At the same time he undertook some epidemiological research within his own practice population, investigating the inception and prevalence rates by age, gender and social class of the common psychological disorders. Further research within the practice, with the help of Madge Hamilton, an experienced social worker, studied the transmission of psychological problems within the family. Of this experience Tony wrote “I learned to value Madge Hamilton’s unpretentious use of psychodynamic ideas and her way of thinking about families. And from the many parents who commented on how moving and useful it was to sit down with her through the long research interviews, I learned to appreciate the power of the listening professional to catalyse self-reflection.”

I learned to appreciate the power of the listening professional to catalyse self-reflection

In treating patients with mental health problems in general practice Tony never felt the need to choose between pharmacological treatment and psychotherapy – he felt that patients who needed both should receive both. Of his psychotherapeutic work with patients he wrote, “I have had a lifelong ambivalence towards psychoanalysis but my attitude was not simply negative and I was glad of its guidance when my listening to patients began to evoke powerful transference attachments and rejections, and I welcomed the attempt it made to understand personality in terms of developmental processes.”

In 1964 Tony joined the University of Sussex as the Director of the University Health Service. The common problems of students were psychological and the University setting offered support and time for training and research. A close working group of doctors and nurses evolved and provided much brief counselling as well as formal individual and group psychotherapy. The main focus of Tony's research shifted closer to his clinical work and he made considerable use of Kelly's repertory grid techniques over the succeeding 15 years. He received supervision from a psychoanalyst and his psychotherapy practice reflected a basically object relations and group analytic theoretical orientation. But his reservations about psychoanalysis had not gone away and as he read more widely and struggled to make sense of psychoanalytic writers, and as he tried to link psychoanalytic ideas to his clinical work and the repertory grid data, he became increasingly interested in integrating the ideas and methods of the different psychotherapies.

Research into the process and outcome of psychotherapy needs measures related to individual aims; in the case of dynamic therapy these go beyond symptomatic and behavioural changes to the revision of underlying structures and processes. He had already used repertory grid methods to demonstrate that such changes were achieved. To look at the process of change, Tony studied the notes of a series of completed psychotherapies. He found that the work was centred on identifying and confronting the ways in which the patients were failing to revise manifest but unrecognised harmful ways of thinking and acting. Non-revision could be accounted for in terms of three patterns which were labelled traps, dilemmas and snags. These descriptions emerged in forms which owed something to the sequential descriptions of behaviour therapy (traps), something to the way repertory grids display the limited options open to individuals (dilemmas), and something to psychoanalytic understandings of the operation of (conscious or unconscious) guilt and to the understanding of the link between individual disturbance and family and group processes provided by family and systems approaches (snags).

The next step was to use these ideas in the first sessions of therapy with new patients to determine what their particular patterns might be, so that it could be seen whether therapy changed them. At this point, what had started as a research procedure proved to have a profound and positive impact on the course of therapy. In identifying and describing their problem procedures (as they came to be called), patients began to recognise their operation and to revise them. This observation initiated the most satisfying phase of Tony’s career, the development of Cognitive Analytic Therapy, an approach which maintains as its core features the early description of problem procedures through the joint work of the patient and therapist, the use of these descriptions by the patient to recognise and control damaging ways of acting and their use by the therapist to avoid reciprocating and reinforcing such damaging patterns.

what had started as a research procedure proved to have a profound and positive impact on the course of therapy
 

At this time Tony began to visit Guy’s Hospital to supervise brief therapy, and heard about, applied for and was appointed to the new Psychotherapy Consultant post at St. Thomas’s, so commencing his third career. As the only psychotherapist serving a population of about 180,000, he clearly had to decide where to put his energy. Tony focussed on training and service provision, and while a proportion of junior psychiatrists trained and did good therapeutic work, it became clear that the only way to provide a service was to attract non-medical trainees. As soon as Tony was in post, large numbers of social workers, occupational therapists, nurses and others started requesting supervision. They proved an excellent resource but the rapid growth in referrals would not have been coped with but for the parallel accelerating demand for CAT training which yielded an inexhaustible supply of trainees from outside the hospital, prepared to see patients in return for supervision.

In order to try to meet the needs of the population of the catchment area, not just the demands of those who found their way to the head of the queue, a policy of offering only the minimum sufficient intervention was established. Very few patients received long-term treatment, the great majority, including those with personality disorders, being given 12-16 sessions of CAT. During his 10 years at St. Thomas’s, Tony personally assessed around 1% of the adult population of the catchment area. Most of those, unless psychotic or seriously substance misusing, were treated in the unit by trainees.

From the early trainees there emerged a group of experienced practitioners who became involved in teaching and supervision and who went on to form and develop ACAT. Aided by Mikael Leiman, Tony developed the distinct theoretical basis of CAT and continued research, in particular into Borderline Personality Disorder. After retirement from the NHS in 1992, and while spending the summer months walking and gardening in Italy, Tony continued to be involved in teaching, supervision, research and theoretical development. As he slowly reduced his involvement others came forward concerned with theory and research and with the battle to develop effective services in the beleaguered NHS. Despite being taught in many separate centres in the UK and abroad CAT has retained its core values and continues to evolve new applications and methods. On finally stopping work in 2010 Tony was content to know that the model was in safe hands.
 



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Cognitive analytic therapy (CAT)

Definitions

Behavioural therapy

This is a treatment approach based on clinically applying theories of behaviour that have been extensively researched over many years. It is thought that certain behaviours are a learned response to particular circumstances and these responses can be modified. Behavioural therapy aims to change harmful and unhelpful behaviours that an individual may have.

Cognitive therapy

This was developed later and focuses on clinically applying research into the role of cognitions in the development of emotional disorders. It looks at how people think about, and create meaning about, situations, symptoms and events in their lives and develop beliefs about themselves, others and the world.2 These ways of thinking (harmful, unhelpful or 'false' ideas and thoughts) are seen as triggers for mental and physical health problems. By challenging ways of thinking, cognitive therapy can help to produce more helpful and realistic thought patterns.

Cognitive therapy was developed in the 1960s by Aaron Beck, an American psychiatrist. He felt that his patients were not improving enough through simple analysis and believed that it was their negative thoughts that were holding them back. At around the same time, another therapist, Albert Ellis, was also realising that people's negative thoughts and irrational thinking could be underpinning mental health problems. He developed a form of cognitive therapy that has come to be known as rational emotive behavioural therapy (REBT).

Subtypes of cognitive therapy

  • Rational emotive behavioural therapy (REBT): this is based on the belief that we all have sets of very rigid, and perhaps illogical, beliefs that can make us mentally unhealthy. It teaches the patient to recognise and spot the beliefs that could be causing them harm and to replace them with more logical and flexible ones.
  • Cognitive analytic therapy (CAT): this is another form of cognitive therapy that combines some of the ideas of cognitive therapy with the more analytical approach of psychodynamic psychotherapy. The client and the therapist work together to look at what has hindered changes in the past, in order to understand better how to move forward in the present.3 It was founded by Dr Anthony Ryle in the 1970s. The therapy sessions explore the patient's past and childhood and determine why any problems have happened. They will then look at the effectiveness of any current coping mechanisms that the patient may have and will help the patient find ways to improve these. The work is very active. Diagrams and written outlines may be created to help recognise and challenge old patterns and coping mechanisms that do not work well, and provide revised mechanisms.3 There is a professional organisation known as the Association for Cognitive Analytic Therapy (ACAT) with a wealth of explanation about the therapy on the website (see link in Internet and further reading section below).

CBT

The term 'cognitive behavioural therapy' (CBT) has come to be used to refer to behavioural therapy, cognitive therapy and therapy that combines both of these approaches. The emphasis on the type of therapy used by a therapist can vary depending on the problem being treated. For example, behavioural therapy may be the main emphasis in phobia treatment or obsessive compulsive disorder(OCD) because avoidance behaviour or compulsive actions are the main problems. In depression, the emphasis may be on cognitive therapy.



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誤訳

誤訳のことは何かの際に話題になり
訳書でも映画の字幕でも
いろいろなことが言われる

翻訳の場合には
テキストがあるので
あとで検証することが可能である

文脈(コンテキスト)も検証可能である

ーーーーー
ところが一般のコミニュケーションの場合には
検証が難しい 

翻訳の際にこれだけ多くの誤訳が起こっているのだから
翻訳でない場合にも
誤解が沢山起こっているはずだと思う

ーーーーー
それを単純な誤解と考えるか
あるいは意図的な曲解と考えるかは
やはり大きな問題だと思う

 



共通テーマ:日記・雑感

西郷隆盛 人を咎めず、我が誠の足らざるを尋ぬべし

西郷隆盛

人を咎めず、我が誠の足らざるを尋ぬべし

 

勝海舟先生

 「要するに、処世の秘訣は誠の一字。」 



共通テーマ:日記・雑感

あなたの魅力について語らず自分の涙について語る習慣

たとえば、あなたに恋焦がれていて、夜も眠れず、
食事も喉を通らず、毎日泣いて暮らしておりますという場合、
「あなた」についての性質は何も分からない。
この、泣いている人の性質はある程度分かる感じがする。
和歌の世界は圧倒的にこんな感じだ。

和歌の世界の人は
人をそのように泣かせるなんてどんなに素晴らしい人なのか
エピソードを詳細に語るという習慣がない

そこはやはりフィクションだし
本当に好きなら行動すればいいわけだし
フィクションで言い合うぶんには
対象についての詳細な情報など
あまり必要ないのだろうと思う
最大限魅力的な異性を想定せよというだけなのだろう。

あるいは「あなた」が誰であるのか、そしてどのように魅力的であるのか、については、
宮廷社会のスターがいたのでそれで充分だったのかもしれない。 



共通テーマ:日記・雑感

SADとうつの解説


共通テーマ:日記・雑感

愛を尽くせないもどかしさ

後輩が語る

ーーーーー
痛いとか熱いとか落ちちゃうとか
いろいろに言っていた

朝になると見違えるようにしっかりして
黒いスーツなどを着て
職業人になっている

身繕いの間も後ろから愛していると
口紅を二種類塗っている
重ねて塗って色合いに深みを出すのだという

解語の花
愛を尽くせないもどかしさばかりを感じる



共通テーマ:日記・雑感

受診される患者様の特徴を教えてください。

受診される患者様の特徴を教えてください。

 開業して25年になるため,開業当時から通院されている患者さんには高齢の方がいますが,若い方を積極的に診察しており,患者さんの平均年齢は若いと思います。女性の患者さんでは男性医師に抵抗がある方が多いためか,3対1で女性の割合が多いですね。
 若い方のうつ病は現代型うつ病とよばれる新しいタイプのものです。基本となる人格や育ってきた時代背景が異なると,当然ものに対する考え方や反応が異なるため,年代によってうつ病のタイプが異なるのは当然だと思います。若い世代のうつ病は,自分を今の時代により適応させようとして失敗して落ち込むなど,成長過程での悩みが原因となっているケースが多くみられます。
うつ病の薬物治療において,重要と思われる点は何でしょうか。

 比較的軽症例の現代型うつ病患者さんには,抗うつ薬は,服用して劇的に効果が表れるというよりもゆっくり効果が表れてその効果が持続する,しかも副作用が少ないということが重要だと思います。うつ病では長期の服用が必要となりますが,従来の抗うつ薬では長期になるほど副作用が表れ,それに対する治療薬が必要となることもあります。高齢者では副作用として認知障害がみられることもあります。従来の抗うつ薬でないと効果がみられない患者さんもいますが,SSRI,SNRIの発売後は,初診の患者さんでの第一選択はSSRI,SNRIとしています。
 また,若い患者さんでは自分が納得しないと服用してくれないため,薬剤について十分説明することが重要です。服用開始時も増量時も,きちんと服用しないと効果がみられないため,自己判断で中断しないように伝えています。

先生がお考えになるフルボキサミンの特徴は何でしょうか。

 私は,患者さんの訴えやうつ病に併存する症状,例えば強迫症状や不眠,過眠,食欲不振,過食などにより薬剤を選択しています。フルボキサミンは強迫症状が併存していたり,不眠や,過食などの摂食障害を伴っているタイプに選択しています。
 また,フルボキサミンは効果が大変穏やかに発現しそれが安定して持続するという特徴があります。このことからフルボキサミンは現代型うつ病に対して第一選択となると思います。さらに,フルボキサミンは重篤な副作用が少ないと思います。投与初期に吐き気や頭痛がみられることがありますが,服用を開始する前に「そういった症状がみられますが数日間で自然に消えることが多いため,3日待ってみてください」とお伝えしておきます。これでクリアできれば,あとは問題となることはほとんどありません。さらにフルボキサミンは離脱症状が表れにくいため,妊娠などにより中断する際も便利だと思います。太りにくいということもあり,若い女性に適していると思います。

フルボキサミンに新たに追加された75mg錠を使用していかがでしょうか。

 患者さんたちが学校や勤務先に薬剤を持参することを考えると,1回に服用する錠数はなるべく少ないほうが便利です。75mg錠の発売により錠数を減らすことができ,変更した患者さんからは非常に評判がよいですね。75mg錠がなかったころは,1日150mg投与の場合,1回につき25mg錠と50mg錠を1錠ずつ組み合わせて服用していただいていましたが,組み合わせが煩雑で服用時に落としてしまうこともあったようです。今では服用も簡便になり,コンプライアンスも高まったと思います。
 さらに,うつ病治療は長期にわたるため,患者さんにとって経済性は重要です。今までも同じ系統の薬剤であれば,できるだけ薬価の安いものを選択することがありました。75mg錠が発売されて,フルボキサミンはさらに経済的になったと思います。


共通テーマ:日記・雑感

100年後にカルテが読まれるとき

カルテをどう書くかと考えて
100年後に精神医学が大幅に進歩したとして
そのときに
ああなるほどと話がつながるようなカルテであって欲しいと思う

いまの我々には深い因果関係は分からないが
100年後には何か分かっているかもしれない
その目で見て、大切な要素がくっきりと表現されていたらとてもいいと思う

私達が現在の学説に興味を持ち
その目で症例を見れば
当然だが見方は偏り目は曇る
それでいいはずがない

100年後の学者が読んでも役に立つような書き方をすべきである

そのようなことをまとめて
現象学的記述という

例えば現在ならば
インタビューや活動の記録を全部ビデオに収録する方法がある
そのようなものがデータというものである

様々な解釈の可能性を許容しているが
たった一つの何かに決めつけることはしない
決め付ける前に必要な基本情報

客観的記録に限りなく近い何か





共通テーマ:日記・雑感

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