ワークショップ「オキシトシンと自閉症」

Ethical Issues in Psychiatry Workshop

10:00-10:50　 Ryoji Sato, Koji Ota and Kohji Ishihara (The University of Tokyo)

                     Ethical issues in Neurofeedback
10:50-11:40　 Kohji Ishihara (The University of Tokyo)

                     Oxytocin and Autism: Ethical Issues
13:00-13:50　 Eric Racine (Institut de recherches cliniques de Montreal (IRCM))

                     Ethics in pediatric deep brain stimulation: Are there lessons to learn?
13:50-14:40　 Kevin Chien-Chang Wu (National Taiwan University)

                     Responsibilities and responsibilization in alcohol-related crimes

15:10-16:00 　Toshihide Kuroki (National Organization Hospital Hizen Psychiatric Center)

                     A dramatic increase in the use of psychotropic drugs in children and

                      adolescents: Current status in the United States and Japan

16:00-16:50 　Masafumi Mizuno (Toho University)

                     Ethics of early intervention for early psychosis
16:50-17:20 　Closing

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lecture 

Mind over Matter: Placebo for Psychogenic Movement Disorders（心因性運動障害に対するプラシーボ治療）

Abstract

Psychogenic movement disorders (PMD) mimic known movement disorders, yet cannot be attributed to an underlying neurological substrate. PMD has been reported to affect up to 15-25% of patients who visit specialized movement disorder clinics. The lack of mechanistic understanding of this disorder contributes to the hesitation of physicians to give a diagnosis of PMD, and patients often experience inordinate healthcare costs and multiple referrals between psychiatrists and neurologists who have differing views on the diagnosis and terminology of PMD. Given that the prognosis for PMD is poor, that the success of standard treatment for PMD is highly dependent on the patient’s belief in the diagnosis and treatment regimen, and that case studies suggest the efficacy of placebo for PMD, placebo therapy has recently been advocated for PMD. Recent surveys report a high percentage of physicians administering placebo therapy. Therefore, perhaps, the ethical question in PMD should be, “Are we harming patients by withholding placebo treatment?”

PMD and placebo share, and perhaps suffer from, the same dualistic mind-body conceptualization wherein a psychological origin or nature (e.g. the mind) is not physiologically based and is somehow separate from the body (e.g. the brain). However, neuroscience research has begun to establish physiological evidence of placebo activity, which challenges notions that placebos are truly inert, and thereby challenges the bioethical claims against placebo therapy. While placebo therapy may not be ideal for all diseases, placebo therapy becomes more defensible for diseases that lack successful standard measures of care. PMD patients are thus, promising candidates for placebo therapy. Effects of placebo can be physiologically potent; however, substantial empirical evidence demonstrates that placebo effects are highly contextually dependent on clinical environment and physician attitudes.  In this neuroethics discussion, we will explore the neurobiology of psychogenic movement disorders and placebo as well as the ethical issues around current contexts of care for PMD patients. 

Sponsored by JSPS Grant-in-Aid for Scientific Research (24118502) P.I. Kohji Ishihara