{"id":651,"date":"2024-11-23T11:25:01","date_gmt":"2024-11-23T02:25:01","guid":{"rendered":"https:\/\/wako-psy-clinic.com\/kimoto\/?p=651"},"modified":"2024-11-23T11:25:01","modified_gmt":"2024-11-23T02:25:01","slug":"tms%e6%b2%bb%e7%99%82%e3%80%81%e5%b7%a6%e5%89%8d%e9%a0%ad%e5%89%8d%e9%87%8e%e3%81%ab%e5%af%be%e3%81%99%e3%82%8b%e9%80%a3%e7%b6%9a%e5%88%ba%e6%bf%80%e3%81%a7%e3%80%81%e5%bc%b7%e8%bf%ab%e6%80%a7","status":"publish","type":"post","link":"https:\/\/wako-psy-clinic.com\/kimoto\/blog\/651.html","title":{"rendered":"TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u306b\u5bfe\u3059\u308b\u9023\u7d9a\u523a\u6fc0\u3067\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u306f\u767a\u63ee\u3059\u308b\u304b\uff1f\u305d\u306e\u6839\u62e0\u306f\uff1f"},"content":{"rendered":"\n
TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u306b\u5bfe\u3059\u308b\u9023\u7d9a\u523a\u6fc0\u3067\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u306f\u767a\u63ee\u3059\u308b\u304b\uff1f\u305d\u306e\u6839\u62e0\u306f\uff1f

\u4eca\u56de\u306f\u3001TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u306b\u5bfe\u3059\u308b\u9023\u7d9a\u523a\u6fc0\u3067\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u306f\u767a\u63ee\u3059\u308b\u304b\uff1f\u305d\u306e\u6839\u62e0\u306f\uff1f\u306b\u3064\u3044\u3066\u89e3\u8aac\u3057\u307e\u3059\u3002

TMS\u6cbb\u7642\u306b\u304a\u3051\u308b\u5de6\u524d\u982d\u524d\u91ce\uff08DLPFC: Dorsolateral Prefrontal Cortex\uff09\u3078\u306e\u9023\u7d9a\u523a\u6fc0\u306f\u3001\u5f37\u8feb\u6027\u969c\u5bb3\uff08OCD: Obsessive-Compulsive Disorder\uff09\u306e\u6cbb\u7642\u306b\u3082\u4e00\u5b9a\u306e\u6709\u52b9\u6027\u3092\u793a\u3057\u307e\u3059\u3002\u4ee5\u4e0b\u306b\u305d\u306e\u6839\u62e0\u3068\u30e1\u30ab\u30cb\u30ba\u30e0\u3092\u8a73\u7d30\u306b\u8aac\u660e\u3057\u307e\u3059\u3002

1. \u5f37\u8feb\u6027\u969c\u5bb3\uff08OCD\uff09\u3068\u5de6\u524d\u982d\u524d\u91ce\u306e\u95a2\u4fc2
OCD\u306b\u304a\u3051\u308b\u8133\u306e\u7570\u5e38
OCD\u306f\u3001\u524d\u982d\u76ae\u8cea-\u57fa\u5e95\u6838-\u8996\u5e8a\u56de\u8def\uff08Cortico-Striato-Thalamo-Cortical circuit, CSTC\uff09\u306e\u904e\u5270\u306a\u6d3b\u6027\u5316\u304c\u4e3b\u306a\u539f\u56e0\u3068\u3055\u308c\u3066\u3044\u307e\u3059\u3002
\u7279\u306b\u3001\u524d\u982d\u524d\u91ce\u3068\u6241\u6843\u4f53\u3001\u57fa\u5e95\u6838\uff08\u5c3e\u72b6\u6838\u3001\u88ab\u6bbb\uff09\u3068\u306e\u9023\u643a\u7570\u5e38\u304c\u3001\u5f37\u8feb\u89b3\u5ff5\u3084\u5f37\u8feb\u884c\u70ba\u3092\u5f15\u304d\u8d77\u3053\u3059\u3068\u8003\u3048\u3089\u308c\u307e\u3059\u3002
\u5de6DLPFC\u306f\u611f\u60c5\u5236\u5fa1\u3084\u610f\u601d\u6c7a\u5b9a\u306b\u95a2\u4e0e\u3057\u3001\u904e\u5270\u306a\u4e0d\u5b89\u3084\u5f37\u8feb\u7684\u306a\u601d\u8003\u3092\u6291\u5236\u3059\u308b\u5f79\u5272\u3092\u62c5\u3044\u307e\u3059\u3002

\u5de6DLPFC\u306e\u4f4e\u6d3b\u52d5
OCD\u60a3\u8005\u3067\u306f\u3001\u5de6DLPFC\u306e\u6d3b\u52d5\u4f4e\u4e0b\u304c\u5831\u544a\u3055\u308c\u3066\u304a\u308a\u3001\u3053\u306e\u9818\u57df\u306e\u6d3b\u6027\u5316\u3092\u4fc3\u9032\u3059\u308b\u3053\u3068\u3067\u75c7\u72b6\u6539\u5584\u304c\u671f\u5f85\u3055\u308c\u307e\u3059\u3002

2. TMS\u6cbb\u7642\u306e\u30e1\u30ab\u30cb\u30ba\u30e0\uff08\u5de6DLPFC\u3078\u306e\u523a\u6fc0\uff09
(1) \u9ad8\u983b\u5ea6TMS\uff0810\uff5e20Hz\uff09\u306b\u3088\u308b\u795e\u7d4c\u53ef\u5851\u6027\u306e\u4fc3\u9032
\u9ad8\u983b\u5ea6\u523a\u6fc0\u306f\u3001\u5de6DLPFC\u306e\u6d3b\u52d5\u3092\u5897\u52a0\u3055\u305b\u3001\u6a5f\u80fd\u4f4e\u4e0b\u3092\u88dc\u6b63\u3057\u307e\u3059\u3002
\u30b7\u30ca\u30d7\u30b9\u53ef\u5851\u6027\uff08\u9577\u671f\u5897\u5f37\u3001LTP\uff09\u3092\u8a98\u767a\u3057\u3001\u8133\u5185\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u5168\u4f53\u306e\u8abf\u548c\u3092\u6539\u5584\u3057\u307e\u3059\u3002

(2) \u795e\u7d4c\u4f1d\u9054\u7269\u8cea\u306e\u5206\u6ccc\u4fc3\u9032
\u9ad8\u983b\u5ea6\u523a\u6fc0\u306b\u3088\u308a\u3001\u30bb\u30ed\u30c8\u30cb\u30f3\u3001\u30c9\u30fc\u30d1\u30df\u30f3\u3001\u30ce\u30eb\u30a2\u30c9\u30ec\u30ca\u30ea\u30f3\u306a\u3069\u306e\u795e\u7d4c\u4f1d\u9054\u7269\u8cea\u306e\u5206\u6ccc\u304c\u5897\u52a0\u3002
\u3053\u308c\u306b\u3088\u308a\u3001\u4e0d\u5b89\u611f\u306e\u8efd\u6e1b\u3084\u3001\u5f37\u8feb\u7684\u306a\u601d\u8003\u30fb\u884c\u52d5\u306e\u5236\u5fa1\u304c\u4fc3\u3055\u308c\u307e\u3059\u3002

(3) CSTC\u56de\u8def\u306e\u30d0\u30e9\u30f3\u30b9\u8abf\u6574
\u5de6DLPFC\u3078\u306e\u523a\u6fc0\u306f\u3001\u524d\u982d\u524d\u91ce\u3068\u57fa\u5e95\u6838\u306e\u904e\u5270\u306a\u76f8\u4e92\u4f5c\u7528\u3092\u6291\u5236\u3002
\u6241\u6843\u4f53\u3084\u57fa\u5e95\u6838\u304b\u3089\u306e\u904e\u5270\u306a\u4fe1\u53f7\u304c\u7de9\u548c\u3055\u308c\u3001\u5f37\u8feb\u75c7\u72b6\u306e\u6e1b\u5c11\u306b\u5bc4\u4e0e\u3057\u307e\u3059\u3002

3. \u81e8\u5e8a\u7814\u7a76\u306b\u3088\u308b\u6839\u62e0
(1) \u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6TMS\u306e\u6709\u52b9\u6027
\u30e9\u30f3\u30c0\u30e0\u5316\u6bd4\u8f03\u8a66\u9a13\uff08RCT\uff09\u3067\u306f\u3001\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u304cOCD\u60a3\u8005\u306e\u75c7\u72b6\u3092\u6709\u610f\u306b\u6539\u5584\u3059\u308b\u7d50\u679c\u304c\u5831\u544a\u3055\u308c\u3066\u3044\u307e\u3059\u3002
\u53cd\u5fdc\u7387\uff08\u75c7\u72b6\u306e50%\u4ee5\u4e0a\u6539\u5584\uff09\uff1a20\uff5e30%\u3002
\u5bdb\u89e3\u7387\uff08\u75c7\u72b6\u304c\u307b\u307c\u6d88\u5931\uff09\uff1a10\uff5e20%\u3002

(2) \u7e70\u308a\u8fd4\u3057\u6cbb\u7642\u306e\u52b9\u679c
1\u56de\u306e\u6cbb\u7642\u30bb\u30c3\u30b7\u30e7\u30f3\u3067\u306f\u306a\u304f\u30011\uff5e2\u304b\u6708\u306e\u7d99\u7d9a\u7684\u306a\u6cbb\u7642\u304c\u3001\u9577\u671f\u7684\u306a\u75c7\u72b6\u6539\u5584\u306b\u5bc4\u4e0e\u3059\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u3066\u3044\u307e\u3059\u3002

(3) \u4ed6\u90e8\u4f4d\u523a\u6fc0\u3068\u306e\u6bd4\u8f03
\u88dc\u8db3\u904b\u52d5\u91ce\uff08SMA\uff09\u3078\u306e\u4f4e\u983b\u5ea6\u523a\u6fc0\u304cOCD\u6cbb\u7642\u306b\u6709\u52b9\u3067\u3042\u308b\u3053\u3068\u3082\u77e5\u3089\u308c\u3066\u3044\u307e\u3059\u3002
\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u306f\u3001\u4e0d\u5b89\u75c7\u72b6\u3084\u6291\u3046\u3064\u75c7\u72b6\u306e\u4f75\u767a\u4f8b\u306b\u7279\u306b\u52b9\u679c\u7684\u3002

4. TMS\u6cbb\u7642\u306e\u52b9\u679c\u3092\u9ad8\u3081\u308b\u8981\u56e0
(1) \u75c7\u72b6\u306e\u30bf\u30a4\u30d7\u306b\u5fdc\u3058\u305f\u30a2\u30d7\u30ed\u30fc\u30c1
\u5f37\u8feb\u89b3\u5ff5\u304c\u4e3b\u75c7\u72b6\uff1a\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u304c\u52b9\u679c\u7684\u3002
\u5f37\u8feb\u884c\u70ba\u304c\u4e3b\u75c7\u72b6\uff1a\u88dc\u8db3\u904b\u52d5\u91ce\uff08SMA\uff09\u3078\u306e\u4f4e\u983b\u5ea6\u523a\u6fc0\u3068\u306e\u4f75\u7528\u304c\u6709\u52b9\u3002

(2) \u4ed6\u306e\u6cbb\u7642\u3068\u306e\u4f75\u7528
\u85ac\u7269\u7642\u6cd5\uff08SSRI\u3001\u30af\u30ed\u30df\u30d7\u30e9\u30df\u30f3\uff09\u3068\u7d44\u307f\u5408\u308f\u305b\u308b\u3053\u3068\u3067\u3001\u76f8\u4e57\u52b9\u679c\u304c\u671f\u5f85\u3055\u308c\u307e\u3059\u3002
\u8a8d\u77e5\u884c\u52d5\u7642\u6cd5\uff08CBT\uff09\u3068TMS\u3092\u4f75\u7528\u3059\u308b\u3068\u3001\u6cbb\u7642\u52b9\u679c\u306e\u6301\u7d9a\u6027\u304c\u5411\u4e0a\u3002

(3) \u523a\u6fc0\u30d1\u30e9\u30e1\u30fc\u30bf\u306e\u8abf\u6574
\u523a\u6fc0\u983b\u5ea6\uff1a10Hz\uff5e20Hz\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u3002
\u30bb\u30c3\u30b7\u30e7\u30f3\u6642\u9593\uff1a20\uff5e40\u5206\u3002
\u671f\u9593\uff1a\u90315\u56de\u30921\uff5e2\u304b\u6708\u7d99\u7d9a\u3002

5. TMS\u6cbb\u7642\u306e\u5229\u70b9\u3068\u9650\u754c
\u5229\u70b9
\u975e\u4fb5\u8972\u7684\u3067\u526f\u4f5c\u7528\u304c\u5c11\u306a\u304f\u3001\u85ac\u7269\u6cbb\u7642\u304c\u96e3\u3057\u3044\u60a3\u8005\u306b\u9069\u5fdc\u53ef\u80fd\u3002
\u4ed6\u306e\u8133\u90e8\u4f4d\uff08SMA\u3001ACC\uff09\u3078\u306e\u523a\u6fc0\u3068\u4f75\u7528\u3059\u308b\u3053\u3068\u3067\u3001\u591a\u89d2\u7684\u306a\u30a2\u30d7\u30ed\u30fc\u30c1\u304c\u53ef\u80fd\u3002

\u9650\u754c
\u53cd\u5fdc\u7387\u3084\u5bdb\u89e3\u7387\u306f\u500b\u4eba\u5dee\u304c\u3042\u308a\u3001\u5168\u3066\u306e\u60a3\u8005\u306b\u5287\u7684\u306a\u6539\u5584\u3092\u3082\u305f\u3089\u3059\u308f\u3051\u3067\u306f\u306a\u3044\u3002
\u75c7\u72b6\u306e\u91cd\u75c7\u5ea6\u3084\u9577\u671f\u7684\u306a\u6cbb\u7642\u7d99\u7d9a\u304c\u5fc5\u8981\u3002

6. \u65bd\u8853\u30b9\u30b1\u30b8\u30e5\u30fc\u30eb\u306e\u4f8b
\u521d\u671f\u6cbb\u7642\uff081\uff5e4\u9031\u76ee\uff09\uff1a
\u5de6DLPFC\u306b10Hz\u306e\u9ad8\u983b\u5ea6\u523a\u6fc0\u30011\u65e53000\u30d1\u30eb\u30b9\u3001\u90315\u56de\u5b9f\u65bd\u3002
\u75c7\u72b6\u306e\u5909\u5316\u3092\u8a55\u4fa1\u3057\u3001\u5fc5\u8981\u306b\u5fdc\u3058\u3066\u8abf\u6574\u3002

\u7dad\u6301\u6cbb\u7642\uff085\uff5e8\u9031\u76ee\u4ee5\u964d\uff09\uff1a
\u90312\uff5e3\u56de\u306e\u523a\u6fc0\u306b\u6e1b\u3089\u3057\u3001\u52b9\u679c\u3092\u6301\u7d9a\u3002

\u4ed6\u90e8\u4f4d\u3068\u306e\u4f75\u7528\uff1a
SMA\u3078\u306e\u4f4e\u983b\u5ea6\u523a\u6fc0\u3092\u8ffd\u52a0\u3057\u3001\u5f37\u8feb\u884c\u70ba\u306e\u6291\u5236\u3092\u56f3\u308b\u3002

\u307e\u3068\u3081
\u5de6DLPFC\u3078\u306e\u9ad8\u983b\u5ea6TMS\u306f\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u304a\u3051\u308b\u5f37\u8feb\u89b3\u5ff5\u3084\u4e0d\u5b89\u306e\u8efd\u6e1b\u306b\u6709\u52b9\u3067\u3042\u308b\u3053\u3068\u304c\u793a\u3055\u308c\u3066\u3044\u307e\u3059\u3002\u305d\u306e\u6839\u62e0\u306f\u3001DLPFC\u306e\u6a5f\u80fd\u6d3b\u6027\u5316\u304c\u8133\u5185\u30cd\u30c3\u30c8\u30ef\u30fc\u30af\u306e\u30d0\u30e9\u30f3\u30b9\u3092\u6539\u5584\u3057\u3001OCD\u306e\u6839\u672c\u7684\u306a\u75c5\u614b\uff08CSTC\u56de\u8def\u306e\u7570\u5e38\uff09\u306b\u30a2\u30d7\u30ed\u30fc\u30c1\u3059\u308b\u70b9\u306b\u3042\u308a\u307e\u3059\u3002\u7279\u306b\u3001\u4e0d\u5b89\u75c7\u72b6\u3084\u6291\u3046\u3064\u75c7\u72b6\u3092\u4f34\u3046OCD\u60a3\u8005\u306b\u306f\u3001\u5de6DLPFC\u3078\u306e\u523a\u6fc0\u304c\u52b9\u679c\u7684\u3067\u3059\u3002

\u305f\u3060\u3057\u3001\u75c7\u72b6\u306e\u30bf\u30a4\u30d7\u306b\u5fdc\u3058\u3066\u88dc\u8db3\u904b\u52d5\u91ce\uff08SMA\uff09\u306a\u3069\u4ed6\u90e8\u4f4d\u3068\u306e\u4f75\u7528\u304c\u5fc5\u8981\u306a\u5834\u5408\u3082\u3042\u308a\u3001\u5c02\u9580\u533b\u306e\u8a3a\u65ad\u3068\u6cbb\u7642\u8a08\u753b\u304c\u91cd\u8981\u3067\u3059\u3002



Today, I will discuss whether repetitive transcranial magnetic stimulation (rTMS) targeting the left dorsolateral prefrontal cortex (DLPFC) is effective for obsessive-compulsive disorder (OCD) and explain the evidence behind this approach.

OCD and the Role of the Left DLPFC
Neurological Basis of OCD
OCD is characterized by hyperactivity in the Cortico-Striato-Thalamo-Cortical (CSTC) circuit, which involves the prefrontal cortex, basal ganglia (caudate nucleus, putamen), and thalamus.
Dysregulation in this circuit leads to intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
Importance of the Left DLPFC
The left DLPFC is crucial for emotional regulation, decision-making, and impulse control.
In OCD, the left DLPFC shows reduced activity, contributing to impaired control over intrusive thoughts and compulsive behaviors.
Mechanisms of TMS on the Left DLPFC
1. High-Frequency Stimulation for Enhanced Neuroplasticity
High-frequency rTMS (10\u201320 Hz) increases activity in the left DLPFC.
It induces long-term potentiation (LTP), promoting synaptic plasticity and enhancing the DLPFC\u2019s ability to regulate the CSTC circuit.
2. Modulation of Neurotransmitter Systems
rTMS promotes the release of serotonin, dopamine, and norepinephrine, which are often imbalanced in OCD.
These neurotransmitters play a critical role in mood stabilization and the suppression of intrusive thoughts.
3. Restoring CSTC Circuit Balance
Stimulation of the left DLPFC helps reduce excessive communication between the prefrontal cortex and the basal ganglia.
This mitigates the hyperactivity in the CSTC loop, which is a core feature of OCD.
Clinical Evidence Supporting Left DLPFC Stimulation
1. Randomized Controlled Trials (RCTs)
Studies have demonstrated that high-frequency rTMS targeting the left DLPFC significantly reduces OCD symptoms.
Response Rates (\u226550% symptom improvement): ~20\u201330%.
Remission Rates (symptoms nearly eliminated): ~10\u201320%.
2. Sustained Benefits with Repeated Sessions
Continuous treatment for 1\u20132 months has been shown to provide long-lasting symptom relief.
3. Comparison with Other Target Sites
Supplementary Motor Area (SMA): Effective for reducing compulsive behaviors.
Left DLPFC: Particularly beneficial for reducing obsessive thoughts and comorbid anxiety or depression.
Factors Enhancing TMS Effectiveness for OCD
1. Tailored Stimulation Based on Symptom Profiles
Obsessive thoughts dominant: High-frequency stimulation of the left DLPFC is effective.
Compulsive behaviors dominant: Combining left DLPFC stimulation with low-frequency stimulation of the SMA enhances outcomes.
2. Combination with Other Treatments
Medications: Selective serotonin reuptake inhibitors (SSRIs) or clomipramine combined with TMS show additive effects.
Cognitive Behavioral Therapy (CBT): Particularly exposure and response prevention (ERP), synergizes with TMS to improve and sustain results.
3. Optimal TMS Parameters
Frequency: 10\u201320 Hz.
Duration: 20\u201340 minutes per session.
Schedule: Five sessions per week for 4\u20138 weeks.
Advantages and Limitations of TMS for OCD
Advantages
Non-invasive: No need for anesthesia or surgical intervention.
Minimal side effects: Compared to medication, TMS has a low side effect profile.
Customizable: Different brain regions can be targeted based on the patient\u2019s symptoms.
Limitations
Varied Response: Not all patients achieve significant symptom relief.
Time-Intensive: Requires multiple sessions over weeks to months.
Cost: TMS can be expensive and may not always be covered by insurance.
Example TMS Treatment Protocol for OCD
Initial Phase (Weeks 1\u20134)
Target: Left DLPFC.
Frequency: 10 Hz.
Intensity: 3,000 pulses\/session.
Schedule: 5 sessions per week.
Maintenance Phase (Weeks 5\u20138 and beyond)
Schedule: 2\u20133 sessions per week.
Evaluation: Regular monitoring of symptom changes using standardized scales like the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).
Combination with Other Targets
SMA stimulation: For patients with prominent compulsive behaviors, add low-frequency (1 Hz) stimulation to the SMA.
Summary
Repetitive TMS targeting the left DLPFC has shown promise as an effective treatment for obsessive-compulsive disorder, particularly for reducing intrusive thoughts and anxiety symptoms. Its efficacy stems from enhancing prefrontal activity, modulating neurotransmitters, and restoring balance in the CSTC circuit.

Best suited for: OCD patients with dominant obsessive thoughts and those resistant to conventional treatments like SSRIs or CBT.
Combination therapy: Enhanced when paired with SMA stimulation, medications, or CBT for comprehensive symptom management.
While TMS offers a promising non-invasive option, individualized treatment planning and regular evaluation by a specialist are essential to maximize its benefits.
<\/pre>\n","protected":false},"excerpt":{"rendered":"
TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u306b\u5bfe\u3059\u308b\u9023\u7d9a\u523a\u6fc0\u3067\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u306f\u767a\u63ee\u3059\u308b\u304b\uff1f\u305d\u306e\u6839\u62e0\u306f\uff1f\u4eca\u56de\u306f\u3001TMS\u6cbb\u7642\u3001\u5de6\u524d\u982d\u524d\u91ce\u306b\u5bfe\u3059\u308b\u9023\u7d9a\u523a\u6fc0\u3067\u3001\u5f37\u8feb\u6027\u969c\u5bb3\u306b\u5bfe\u3057\u3066\u6709\u52b9\u6027\u306f\u767a\u63ee\u3059\u308b\u304b\uff1f\u305d\u306e\u6839\u62e0\u306f\uff1f\u306b\u3064\u3044\u3066\u89e3\u8aac\u3057\u307e\u3059\u3002TMS\u6cbb […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-651","post","type-post","status-publish","format-standard","hentry","category-blog"],"_links":{"self":[{"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/posts\/651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/comments?post=651"}],"version-history":[{"count":1,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/posts\/651\/revisions"}],"predecessor-version":[{"id":652,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/posts\/651\/revisions\/652"}],"wp:attachment":[{"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/media?parent=651"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/categories?post=651"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wako-psy-clinic.com\/kimoto\/wp-json\/wp\/v2\/tags?post=651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}