Psychiatry and Clinical Neurosciences 2011; 65: 207–212
doi:10.1111/j.1440-1819.2011.02220.x
Editorial
Mental health care and East Japan Great Earthquake
HE JAPANESE SOCIETY of Psychiatry and Neurology (JSPN) and the editors of Psychiatry and
Clinical Neurosciences (PCN) would like to express our
sincere condolences to the people who have suffered
from the East Japan Great Earthquake (the Tohoku–
Pacific Ocean Earthquake) 3.11.
A massive 9.0-magnitude earthquake occurred in
the Pacific Ocean nearby Northeastern Japan, Friday
March 11, 2011 at 14:46 (JST), causing serious
damage to almost all of the Tohoku area and part
of the Kanto area. The Tohoku area is the northern
part of Japan including Fukushima, Miyagi, Iwate,
Aomori, Akita and Yamagata prefectures. Kanto is
the governmental and commercial center of Japan
including Tokyo and Yokohama, together with seven
prefectures. The cities damaged by the earthquake
are Iwaki, Minamisohma, Sohma, Iwanuma, Natori,
Sendai, Higashiatsushima, Ishinomaki, Kesennuma,
Rikuzentakada, Ofunato, Kamaishi, Miyako, Kuze,
and Hachinohe, all of which face the Pacific Ocean
coast of Tohoku. Even in Tokyo, some modern buildings have cracks in walls, and skyscrapers trembled
for several minutes, which was enough to terrify
people working and living in this area. However, it
was only a prelude to the merciless disaster by natural
threat following the quake.
People living in the Tohoku and Kanto areas
suffered from frequent aftershocks several times a
day in the following days. Though the magnitude of
each aftershock was smaller than the main quake,
they were high enough to cause survivors to feel
frightened and terrified in the blackouts and cold
winter weather in the affected areas.
The earthquake triggered in the 200 ¥ 500-km
area along the Pacific coast of Tohoku, and the
tsunami was the next disaster. Just after the earthquake, the tsunami was forecasted and the tsunami
warning was issued by the authorities, giving the
order to evacuate. The power of natural disaster
was, however, beyond our imagination. The massive
tides of 7–15 m in height wiped out houses,
bridges, buildings and everything else. The tsunami
water went 5 km inland destroying all infrastructure
for living.
T
pcn_2220
207..212
Japan has experienced frequent earthquakes
because it is located above the intersection of the four
earth plates. Japan should have been well prepared
with advanced technology for earthquake forecast
and prevention system and many know-hows
against earthquakes and tsunami; in fact, ‘tsunami’
has become the global term, originating from the
Japanese language, meaning high tides.
, Epicenters of Tohoku-Kanto Earthquake; , Inner circle:
evacuation area (within 20 km radius); outer circle: stay
indoors area (within 30 km radius).
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology
207
208
Editorial
Psychiatry and Clinical Neurosciences 2011; 65: 207–212
Table 1. Significant earthquakes with over 50,000 deaths since 1900
Rank Date
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
1976
2004
2010
1920
1923
1948
2008
2005
1908
1970
07
12
01
12
09
10
05
10
12
05
27
26
12
16
01
05
12
08
28
31
epicenter
death
magnitude
Tangshan, China (39.6N 118.0E)
Sumatra (3.30N 95.87E)
Haiti region (18.445 -72.571)
Haiyuan, Ningxia, China (36.5N 105.7E)
Kanto, Japan (35.3N 139.5E)
Ashgabat, Turkmenistan (37.95N 58.32E)
Eastern Sichuan, China (31.002 103.322)
Pakistan (34.53N 73.58E)
Messina, Italy (38.15N 15.68E)
Chimbote, Peru (9.36S 78.87W)
255,000
227,898
222,570
200,000
142,800
110,000
87,587
86,000
72,000
70,000
7.5
9.1
7.0
7.8
7.9
7.3
7.9
7.6
7.2
7.9
The East Japan Great Earthquake is the fourth
largest earthquake recorded in the world since 1900,
after the Temuco-Valdivia, the Chile earthquake (22
May 1960; M9.5, 1655 deaths); the Prince William
Sound, Alaska earthquake (28 March 1964; M9.2,
131 deaths); and the earthquake off the West Coast
of Northern Sumatra, Indonesia (26 December 2004;
M9.1, 227 898 deaths) (Table 1). The death toll is
now 12 259 and will inevitably climb higher as the
recovery of bodies in tsunami-hit coastal areas goes
into full swing. A total of 15 315 are still missing and
about 530 000 people are staying in more than 2600
temporary shelters.
DAMAGE TO THE NUCLEAR
POWER PLANT
The East Japan Great Earthquake and the following
tsunami hit Fukushima No. 1 nuclear power station
with unbridled ferocity. When the earthquake
occurred, reactors 1, 2, and 3 were in operation, and
Nos. 4, 5, and 6 were at rest for regular maintenance.
Immediately after the huge tremor, the control rods
were automatically deployed and the reactors were
successfully stopped as scheduled. However, fuel rods
continued to give off extreme heat for a long time,
even after reactors have ceased operating, which
caused the coolant water inside the reactor to boil,
leading to the risk of the reactor boiling dry. The
emergency core cooling system (ECCS) is designed
and implemented to prevent this from occurring. The
system circulates water inside the reactor using electric power from sources other than the nuclear power
plant itself, and also features a doughnut-shaped
structure called a suppression pool, to cool highpressure steam into water. Spent fuel rods removed
from reactors need to be kept permanently cooled
with circulating water. However, in the Fukushima
No. 1 plant, power generators for operating the ECCS
broke down. Although the generators were designed
to keep operating even after very strong tremors,
the tsunami was of a scale beyond anticipation, and
might have thrown seawater on the generators.
The temperature began to rise rapidly inside the
reactor, which had lost its coolant functions. As a
result, the metal tubes containing the fuel rods began
melting down. In addition, the melted alloy caused a
chemical reaction with the water, leading to a discharge of hydrogen, which caused the explosions of
the No. 1 reactor building walls on Saturday, March
12, 15:36. A hydrogen explosion also occurred with
reactor No. 3 on Monday, March 14, 11:01. In the
damaged reactors, the temperature continued to rise
and a huge quantity of coolant water evaporated,
leading to the risk that the exposed parts of the fuel
rods above the water may melt. Although Tokyo Electric Power Co. workers poured seawater into the reactors using pump vehicles, the operation did not go
smoothly due to the fear of contamination from
radioactive material.
Then, on Tuesday morning, March 15, 6:00, there
was an accident at the No. 2 reactor in which the
pressure-control room appeared to have been
damaged. It is feared that exposure of the fuel rods to
the air sparked a fire that led to leakage of the radioactive material contained therein. Meanwhile, water
used to cool spent fuel rods in the No. 4 reactor could
no longer be circulated due to the loss of power, and
an explosion occurred at reactor No. 4 simultaneously.
To avoid exposure to radioactive material, the government issued an evacuation order to the people
within a radius of 20 km of the Fukushima Daiichi
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2011; 65: 207–212
Nuclear plant. The people living in a 20–30 km
radius of the nuclear plant, were ordered to stay
inside in order to avoid possible exposure to radioactive materials. The basic principle of a nuclear
power accident is to stop, to cool down and to close
in any leakage of radioactive materials. Even though
the first step was successfully done, the second and
even third tactics were not effective in the case of the
Fukushima No. 1 Nuclear power plant.
JSPN ACTIVITY IN MENTAL
HEALTH CARE
The news of the Great Earthquake spread across
Japan and to the world in a few hours. Considering
the magnitude of the quake and the wide area
affected by the tsunami, it was almost certain that
this would become one of the most serious natural
disasters in the history of Japan. All Japanese TV
channels broadcast news on the quake 24 hours for
several days. Many rescue teams were sent to the
affected areas trying to save and help as many
human lives as possible. It is well known that
72 hours after the quake the possibility of survival
would be drastically reduced and prompt rescue
activity was essential. Fire departments, police
departments together with the Japanese Self Defense
Forces, the US Navy and many volunteer rescue
teams from all over the world were called in to the
affected area. The Japanese Society of Psychiatry
and Neurology (JSPN), the academic association of
over 16 000 psychiatrists, responded to the disaster
promptly by trying to collect necessary information
and arrange any required actions to help people in
the affected area. JSPN uploaded a message to its
homepage for the victims in the Tohoku-Kanto area
on March 15 and started to offer volunteer work for
mental health care.
The Message from the President of JSPN, Haruo
Kashima, conveyed his condolences to the victims
and expressed his willingness to help people in the
affected area:1
March 15, 2011
The Tohoku–Pacific Ocean Earthquake and Tsunami:
A message from the Japanese Society of Psychiatry
and Neurology
The Japanese Society of Psychiatry and Neurology
would like to take this opportunity to express its
Editorial
209
condolences for the unimaginable losses endured
by all those affected by the Tohoku–Pacific Ocean
Earthquake and Tsunami.
We are certain that people are struggling to deal
with all the thoughts and feelings resulting from this
disaster, at the same time as they work to cope with
its impact. For its part, the Japanese Society of Psychiatry and Neurology will do everything in its power
to support all persons affected by this tragedy.
Given the harsh conditions faced by survivors,
there are doubtless persons who will feel overwhelmed by their emotions, and that their hearts will
break under the strain. However, we have no doubt
that, with time, it is possible to persevere and pull
through this difficult period.
After a disaster, people often talk about ‘psychological care.’ As mental health professionals, we
define this word as 1) mental health service, in which
proper mental health services and psychiatric care are
provided as needed, and 2) psychosocial support, in
which wider caring effort should be provided by
offering practical help without relying on specific
counseling discipline. This refers to the act of organizing comprehensive support for both physical and
daily life needs, while keeping an eye on people’s
steps toward recovery. We value the strength of communal support and help by people from other areas.
We will strive to work with local authorities and other
organizations involved to provide easily accessible
mental health service and psychosocial care, and will
do this in a way that does not hinder survivors’
journey toward recovery.
In challenging times, it is common to increase
one’s intake of things like alcohol, tobacco, and caffeine (coffee, tea, green tea, etc.), but it is important
to be aware that these substances can also trigger
anxiety and insomnia. People may experience difficultly in recognizing how tired they are, or expressing
how they truly feel; they may also feel frustrated or
suddenly agitated. It has been established that these
symptoms naturally improve on their own, in most
cases. But if they persist for several days, or if they are
troubling, we urge people to consult a health care
professional. We also believe that special attention
must be paid to the needs of those persons who,
while enduring their own personal losses, are participating in relief and recovery efforts.
Finally, in circumstances such as these, we often see
the spread of gossip and unfounded rumors, which
can end up causing even greater anxiety for people
already struggling to deal with the impact of a disas-
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology
210
Editorial
ter. We call on all health care workers participating in
relief efforts to confirm the source and reliability of
information they may disseminate.
Haruo Kashima
President
The Japanese Society of Psychiatry and Neurology
MENTAL HEALTH CARE IN DISASTER
Recent disasters due to earthquakes include the Haiti
earthquake (12 January 2010, M7.0) in which more
than 222 570 were killed and 300 000 injured. The
Eastern Sichuan earthquake (12 May 2008, M7.9)
was another disaster in China with 69 195 killed
and 374 177 injured. At least 15 million people were
evacuated from their homes and more than 5 million
were left homeless. Reports of the Haiti2–4 and
Sichuan earthquakes5–8 from mental health view
points are all instructive in figuring out the tactics for
the East Japan Great Earthquake.
Earthquakes are relatively frequent in Japan and
some of them have been serious enough to cause
damage to human life for several months. The most
recent disaster caused by earthquake is the HanshinAwaji (Kobe) Earthquake (16 January 1995, M6.9),
which caused 5502 deaths, with 36 896 injured.
About 310 000 people were evacuated to temporary
shelters. Over 200 000 buildings were damaged or
destroyed. Numerous fires, gas and water main
breaks and power outages caused severe damage to
lifelines of city life. Owing to the long-lasting effects
to the mental health of the victims, may reports by
mental health professionals have been published.9–18
The JSPN organized a special symposium on mental
health of Hanshin-Awaji Earthquake on May 17,
1995, 4 months after the disaster.9
Other earthquake disasters in the central part of
Japan, the Niigata-Chuetsu Earthquake (23 October
2004, M6.8),19–21 the Noto Peninsula Earthquake,22
and the Hokkaido Earthquake23 were studied and
reported on their effects to mental health for many
years. Other disasters caused by floods,24 massive
traffic accidents,25,26 and the Ehimemaru accident, in
which a Japanese high school training ship was hit
and sunk by a collision with a US Navy submarine,27
were also studied and analyzed from psychiatric
view points.
All reports pointed out the common findings that
weaker people, like the elderly, children, and the
mentally handicapped, tend to become the first
Psychiatry and Clinical Neurosciences 2011; 65: 207–212
victims of the disaster. Under the critical situations,
mentally handicapped people have less chance of
being helped, and sometimes they are the first to be
neglected under circumstances. The East Japan Great
Earthquake might be no exception.
Japan’s relatively large elderly population presents
a particular challenge for rescue and relief in what
is already a disaster of epic proportions. About 23
percent of Japan’s 127 million people are age 65 or
over28 and the psychiatry emergency system for the
elderly has been under discussion for many years.29
Japan’s rural areas have been in decline for years, and
many of the small coastal towns hit hardest by the
tsunami had seen an exodus of young people moving
to cities for work. At least 11 men and women perished
inside a retirement home in Kesennuma, where
they faced freezing temperatures for 6 days. Elderly
dementia patients in a temporary shelter readlily
show behavioral and psychological symptoms due to
insufficient care and a stressful living situation.30–33
Fourteen senior citizens died after being moved to a
temporary shelter in a school gym because their hospital was in the evacuation zone near the damaged
Fukushima nuclear power plant.
Some psychiatric hospitals and nursing homes for
the elderly are located in the suburbs of the city or
in small towns that are relatively isolated by public
transportation. Some psychiatric hospitals affected by
the tsunami were severely damaged and in-patients
had to be transferred to other psychiatric hospitals.
Many schizophrenic and depressive patients who are
under medication lost their drugs due to the disaster
and they could easily relapse due to the abrupt discontinuation of the medication. They are vulnerable to
various stresses in temporary shelters.
Children in shelters are apparently cheerful, but it
can be easily speculated that the unusual living
situation may cause burden to them. Many survivors
experienced observing the disaster of the tsunami
wiping out everything, and those extraordinary experiences will surely cause trauma in many children
who survived this disaster. Those affected children
should be monitored closely for the possible occurrence of post-traumatic stress disorder,34–36 according to their gender,37 temperaments,38 resilience,39 or
physiological parameters.40
The effect of the East Japan Earthquake will not
terminate within months. Psychiatric services will be
absolutely essential for longer term than the medical
services for physical diseases. The JSPN, Japanese
Association of Psychiatric Hospitals, and depart-
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2011; 65: 207–212
ments of psychiatry in medical schools are sending
psychiatric service teams to the affected areas in coordination with psychiatry departments of Tohoku
University, Fukushima Medical College, and Iwate
Medical College, which are located in the middle of
the affected area. A long-term program to support
those weak people in the affected area should be
implemented and kept functioning over the coming
years to secure the mental health of the people in the
affected area.
REFERENCES
1. http://www.jspn.or.jp/info/2011_03_11info/da_news.
html
2. Bailey RK, Bailey T, Akpudo H. On the ground in Haiti: a
psychiatrist’s evaluation of post earthquake Haiti. J. Health
Care Poor Underserved. 2010; 21: 417–421.
3. Fullerton CS, Reissman DB, Gray C et al. Earthquake
response and psychosocial health outcomes: applying
lessons from integrating systems of care and recovery to
Haiti. Disaster. Med. Public Health Prep. 2010; 4: 15–17.
4. Ben-Ezra M, Shrira A, Palgi Y. The hidden face of Haiti’s
tragedy. Science. 2010; 327(5971): 1325.
5. Liu M, Wang L, Shi Z et al. Mental Health Problems among
Children One-Year after Sichuan Earthquake in China: A
Follow-up Study. PLoS One. 2011; 6(2): e14706.
6. Liu Z, Zeng Z, Xiang Y et al. A Cross-Sectional Study on
Post-Traumatic Impact Among Qiang Women in Maoxian
County 1 Year After the Wenchuan Earthquake, China. Asia
Pac. J. Public Health. 2011 Jan 19. [Epub ahead of print]
7. Kun P, Wang Z, Chen X et al. Public health status and
influence factors after 2008 Wenchuan earthquake among
survivors in Sichuan province, China: cross-sectional trial.
Public Health. 2010; 124: 573–580.
8. Jia Z, Tian W, He X et al. Mental health and quality of life
survey among child survivors of the 2008 Sichuan earthquake. Qual. Life Res. 2010; 19: 1381–1391.
9. Asai M, Sakai T. Learning from the Hanshin-Awajishima
earthquake: report of the reality and future psychiatry in
Japan. Seishin Shinkeigaku Zasshi. 1995; 97: 1101–34; discussion 1034–1039 (in Japanese. No abstract available).
10. Kako M, Ikeda S. Volunteer experiences in community
housing during the Great Hanshin-Awaji Earthquake,
Japan. Nurs. Health Sci. 2009; 11: 357–359.
11. Nishio A, Akazawa K, Shibuya F et al. Influence on the
suicide rate two years after a devastating disaster: a report
from the 1995 Great Hanshin-Awaji Earthquake. Psychiatry Clin. Neurosci. 2009; 63: 247–250.
12. Mita T, Nakai T, Sekiguchi N et al. Psychiatric effects of the
great Hanshin earthquake (1995): from the psychiatric
outpatient department of a general hospital close to the
disaster-stricken area. Seishin Shinkeigaku Zasshi. 1997; 99:
215–233 (in Japanese. No abstract available).
Editorial
211
13. Kato H, Asukai N, Miyake Y et al. Post-traumatic
symptoms among younger and elderly evacuees in the
early stages following the 1995 Hanshin-Awaji earthquake in Japan. Acta Psychiatr. Scand. 1996; 93: 477–
481.
14. Sakai T, Yoneda H, Okamura T et al. Organization of
disaster-related psychiatric care and psychiatric medicine
in Japan–relief activities, mental health care, training in
disaster medicine, and relationship between the committee of 7 psychiatric representatives and legislation. Seishin
Shinkeigaku Zasshi. 1996; 98: 771–774; discussion 777–
781 (in Japanese. No abstract available).
15. Aso Y, Ota M, Nagao T et al. Survey on patients admitted
to psychiatric departments at the areas affected by
Hanshin-Awaji Earthquake. Seishin Shinkeigaku Zasshi.
1996; 98: 751–757; discussion 777–781 (in Japanese. No
abstract available).
16. Tsuo Y, Tanabe K, Akimoto K et al. Initial activities of the
psychiatric care center at the Ashiya Public Health Clinic
after Hasnshin-Awaji Earthquake. Seishin Shinkeigaku
Zasshi. 1996; 98: 744–751; discussion 777–781 (in
Japanese. No abstract available).
17. Matsuyama M, Kiriike N, Nagata T et al. Psychiatric problems of patients rescued during Hanshin earthquake–with
special reference to those cared at ICU. Seishin Shinkeigaku
Zasshi. 1996; 98: 739–744; discussion 777–781 (in
Japanese. No abstract available).
18. Nagao K, Okuyama M, Miyamoto S et al. Treating early
mental health and post-traumatic symptoms of children
in the Hanshin-Awaji earthquake. Acta Paediatr. Jpn. 1995;
37: 745–754.
19. Kuwabara H, Shioiri T, Toyabe S et al. Factors impacting
on psychological distress and recovery after the 2004
Niigata-Chuetsu earthquake, Japan: community-based
study. Psychiatry Clin. Neurosci. 2008; 62: 503–507.
20. Shioiri T. Psychological care during disasters: through the
experience during the 2004 Niigata-Chuetsu Earthquake.
Seishin Shinkeigaku Zasshi. 2010; 112: 521–529 (in
Japanese. No abstract available).
21. Suzuki Y, Tsutsumi A, Fukasawa M et al. Prevalence
of mental disorders and suicidal thoughts among
community-dwelling elderly adults 3 years after the
Niigata-Chuetsu earthquake. J. Epidemiol. 2011; 21: 144–
150. Epub 2011 Feb 12.
22. Hibino Y, Takaki J, Kambayashi Y et al. Health impact of
disaster-related stress on pregnant women living in the
affected area of the Noto Peninsula earthquake in Japan.
Psychiatry Clin. Neurosci. 2009; 63: 107–115.
23. Shichida H. [Status and problems associated with disasterrelated psychiatric care in Hokkaido: experiences during
the earthquake off the southwest coast of Hokkaido].
Seishin Shinkeigaku Zasshi. 1996;98: 793–798 (in Japanese.
No abstract available).
24. Araki K, Takahashi R, Nakane Y et al. Natural disaster and
mental disorders: psychiatric study on Nagasaki floods,
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology
212
25.
26.
27.
28.
29.
30.
31.
32.
33.
Editorial
1982. Seishin Shinkeigaku Zasshi. 1985;87: 285–302 (in
Japanese. No abstract available).
Nishi D, Matsuoka Y, Yonemoto N et al. Peritraumatic
Distress Inventory as a predictor of post-traumatic stress
disorder after a severe motor vehicle accident. Psychiatry
Clin. Neurosci. 2010; 64: 149–156.
Matsuoka Y, Nishib D, Nakajima S et al. Impact of psychiatric morbidity on quality of life after motor vehicle accident at 1-month follow up. Psychiatry Clin. Neurosci. 2009;
63: 235–237.
Maeda M, Kato H, Maruoka T. Adolescent vulnerability
to PTSD and effects of community-based intervention:
Longitudinal study among adolescent survivors of the
Ehime Maru sea accident. Psychiatry Clin. Neurosci. 2009;
63: 747–753.
Tanaka T, Kazui H, Sadik G et al. Prevention of psychiatric
illness in the elderly, I: Path to prevention of dementia.
Psychogeraitrics. 2009; 9: 111–115.
Sawayama E, Takahashi M, Arai H et al. Characteristics of
elderly people using the psychiatric emergency system.
Psychiatry Clin. Neurosci. 2009; 63: 577–579.
Konishi K, Hori K, Oda T et al. Effects of aging on behavioral symptoms in Alzheimer’s disease. Psychogeraitrics.
2009; 9: 11–16.
Wakae N. Psychogeriatric services for outpatients
undergoing long-term care at Mental Silver Clinic.
Psychogeraitrics. 2009; 9: 17–22.
Kinoshita T, Hanabusa H. Issues facing home-based
medical support services. Psychogeraitrics. 2010; 10: 90–94.
Amano N, Inuzuka S, Ogihara T. Behavioral and psychological symptoms of dementia and medical treatment.
Psychogeraitrics. 2009; 9: 45–49.
Psychiatry and Clinical Neurosciences 2011; 65: 207–212
34. Wang L, Shi Z, Zhang Y et al. Psychometric properties of
the 10-item Connor–Davidson Resilience Scale in Chinese
earthquake victims. Psychiatry Clin. Neurosci. 2010; 64:
499–504.
35. Hayano F, Nakamura M, Asami T et al. Smaller amygdala
is associated with anxiety in patients with panic disorder.
Psychiatry Clin. Neurosci. 2009; 63: 266–276.
36. Jackowski AP, De Araújo CM, Tavares De Lacerda AL et al.
Neurostructural imaging findings in children with posttraumatic stress disorder: Brief review. Psychiatry Clin.
Neurosci. 2009; 63: 1–8.
37. Matsumoto Y, Sato T, Ohnishi M et al. Stress-coping strategies of patients with gender identity disorder. Psychiatry
Clin. Neurosci. 2009; 63: 715–720.
38. Su CY, Tsai KY, Chou FHC et al. A three-year follow-up
study of the psychosocial predictors of delayed and unresolved post-traumatic stress disorder in Taiwan Chi-Chi
earthquake survivors. Psychiatry Clin. Neurosci. 2010; 64:
239–248.
39. Evren C, Dalbudak E, Cetin R et al. Relationship of
alexithymia and temperament and character dimensions
with lifetime post-traumatic stress disorder in male
alcohol-dependent inpatients. Psychiatry Clin. Neurosci.
2010; 64: 111–119.
40. Yetkin S, Aydin H, Özgen F. Polysomnography in patients
with post-traumatic stress disorder. Psychiatry Clin. Neurosci. 2010; 64: 309–317.
Masatoshi Takeda, MD, PhD
Editor-in-Chief
© 2011 The Author
Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology