Work of psychiatrists in general hospitals covers such diverse tasks as visiting patients in other departments. The situation and roles are different between psychiatrists in the same general hospital because demand for education and research, the role in psychiatric emergency systems, and involvement in management vary with each hospital category and its bed presence. Occupational stress is often described as "demand-control-support imbalance" and "effort reward imbalance," and psychiatrists in public general hospitals with beds seem to suffer more occupational stress. In consideration of the wide range of diversity of general hospital psychiatrists, individual support to psychiatrists should be considered from every aspect, such as self-help, mutual help, and public aid. For example, many general hospital psychiatrists find it worthwhile to treat many interesting cases such as symptomatic psychoses, therefore enhancement of such an advantage is related to self-help. To upgrade the support system of human resources from universities as needed (as mutual help), and to hire a medical secretary and to increase economic support (as public aid) are preferable.

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Physicians' health is essential not only for physicians themselves, but for the quality of medicine and sustainability of health care provisions in communities. However, physicians are not always healthy. In Japan, physicians work overtime and are exposed to significant stress. Support for maintaining and promoting physicians' health by hospitals and the medical associations would be indispensable. In some countries, medical associations are one of the key players in supporting physicians' health. Physicians' health programs operated by medical associations promote organizational approaches in hospitals, self-care, and these programs organize conferences related to physicians' health to continuously advocate better physician health. In Japan, occupational health physicians play a major role in promoting health in hospitals. Companies, including hospitals, with 50 or more employees are required to appoint occupational health physicians. In general hospitals, psychiatrists can cooperate with occupational health physicians for mental health promotion of physicians.

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This study was conducted by the Committee for Hospital Physicians' Health, the Japan Medical Association, which was established in June 2008. Ten thousands members of the Japan Medical Association working at hospitals were randomly selected. They were asked to complete and return a self-reported questionnaire which included the Japanese version of the Quick Inventory of Depressive Symptomatology (QIDS). As a result, the response rate was 40.6%. Half of the responders took holidays less than 4 days per month, and they encountered one and more unreasonable demands and/or complaints from their patients/families during last 6 months. Among the respondents, 8.4% of men and 10.6% of women were identified with depressive symptoms. Especially, 1.9% of them were found to be severely depressed. After this investigation, the committee provided three-month e-mail and one-day telephone consultation service. The committee received 10 e-mails during the three month period, but no responses were received by telephone. This result indicates that physicians are less likely to talk about their health problems, especially mental problems with other professionals. Some different support systems should be considered.

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This article gives an overview of the recently introduced concept of work engagement: a positive, fulfilling, affective-motivational state of work-related well-being. We first define engagement in terms of vigor, dedication, and absorption, and then explain how engagement differs from related concepts (e.g., burnout). Work engagement is a unique concept that is best predicted by job resources (e.g., autonomy, supervisory coaching, performance feedback) and personal resources (e.g., self-efficacy) and is predictive of psychological/physical health, proactive organizational behavior, and job performance. The most often used instrument to measure engagement is the Utrecht Work Engagement Scale, a self-report instrument that has been validated in many countries across the world, including Japan. The paper closes with the practical implications of work engagement especially for medical settings through individual- and organizational-focused intervention.

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Women diagnosed with breast cancer often experience menopausal symptoms. We have designed this study to assess the psychosocial impact on breast cancer patients who experience menopausal symptoms. Method: A total of 187 breast cancer patients 27-74 years of age were included in the study. Patients were asked to complete questionnaires to determine the following: Kupperman menopausal symptoms, Hospital Anxiety and Depression Scale, Functional Assessment Cancer Therapy General, and Functional Assessment Cancer Therapy Breast. Results: 60% of breast cancer patients experienced menopausal symptoms according to the Kupperman index. As a result of ANOVA, anxiety and depression scores were significantly higher in patients with menopausal symptoms, and a low quality of life score (F3,174 ≥ 12.13, p<.01). Conclusion: Psychosocial distress and quality of life were associated with menopausal symptoms in the breast cancer patients. Assessment and control of menopausal symptoms had a large impact on the maintenance of quality of life as well as the need for and importance of adequate psychological care.

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Background: Although the need for psychological care/support among cancer patients and their family members seems important, the current status of cancer patients' consultation is not clear. Object: The purpose of this study is to clarify whether cancer patients need individuals who can support them psychologically and in other ways and provide them with psychological care, and the current status of cancer patients' consultation. Subjects: Subjects are cancer patients and cancer survivors. Method: Method is a self-reported questionnaires via the Internet. Results: It was observed that 64.6% of the subjects needed individuals who could support them psychologically and in other ways and provide them with psychological care, and that almost all the persons who provided psychological care/ support were their family members. Further, 46.8% of the subjects discussed their condition with other patients who had the same disease, and they counseled each other in the same way. Moreover, 84.2% of them thought that such an experience was psychologically helpful. On the other hand, only 10.8% of the patients consulted a psychiatrist or a psychosomatic medicine doctor. Furthermore, 22.0% of the subjects tried to get a second opinion from another doctor. In addition, 35.4% of the patients experienced spiritual pain, and 33.9% of them discussed it with another person. Finally, 42.4% of the subjects reported that their family members were depressed during their treatment, and 62.7% of family members lent an ear to the subjects. Discussion: It was suggested that the construction of a system which could encourage cancer patients to consult with someone in the hospital is necessary.

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To clarify the demographics and clinical diagnoses of patients treated in our Japanese child and adolescent clinic, we studied data from outpatients who visited the clinic between 1991 and 2005. Subjects included 1339 patients (508 boys, 831 girls) ranging from 3 to 18 years of age. Analysis revealed an annual increase in new patients; most were over 13 years old (79.0%). The highest percentage were diagnosed with neurotic, stress-related and somatoform disorders (F4) (49.2%), followed by behavioral and emotional disorders of childhood (F9) (13.1%), schizophrenia and delusional disorders (F2) (11.4%) and behavioral syndromes associated with physical factors (F5) (9.0%). All diagnoses were based on ICD-10 classifications. In recent years, there has been an increase in the prevalence of developmental and hyperkinetic disorders. Of the 1339 patients, 429 (32.0%) showed non-attendance at school which was the most commonly observed chief complaint among child and adolescent patients. These results indicate that treatment of adolescents with neurotic disorders and developmental disorders comprises a significant proportion of our clinical practice. Therefore appropriate training for specialists in child and adolescent psychiatry is urgently needed.

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Herein, we present a 66-year-old man with a pacemaker who was successfully treated for psychotic depression using modified electroconvulsive therapy (mECT). The patient received a pacemaker at the age of 55 due to severe arrhythmia. He had struggled with depression since the age of 58 and had experienced recurrent depression. Four months prior to admission to our psychiatric department, he began to show psychotic symptoms as well as severe depressive symptoms. On the day of admission, he was evaluated for mECT because he showed no response to drug treatment. Five courses of mECT were conducted, during which cardiac and pacemaker functions were closely monitored. An immediate improvement in psychiatric symptoms was observed, and no arrhythmia or pacemaker malfunction was detected following the mECT sessions. In addition, it was not necessary to convert the pacemaker to a fixed rate pacing or deactivate the pacemaker before mECT. Consequently, the presence of a pacemaker should not be considered a contraindication for mECT.

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In order to grasp the actual situation of general hospital psychiatry in October, 2008, we conducted a questionnaire at 718 general hospitals. There was a response from 452 institutions (63.0%), and 53 institutions, which did not perform psychiatry medical examination and treatment, were excluded. As a result, the data of 399 institutions were analyzed. General hospitals with psychiatric departments were expected to play a central role, especially in emergency medicine, physical complication treatment and palliative care and so on. However, responses from psychiatrists and support staff were insufficient. There were a large number of psychiatrists at institutions with psychiatric beds. The number of psychiatric social workers, psychiatric occupational therapists or clinical psychologists was small, except for those at general hospitals with psychiatric beds. There were few institutions which had special medical treatment wards. It was difficult to secure responses from doctors and support staff, and the medical service fee system does not properly reflect the staff assignment standard. Some general hospitals have reduced or abolished psychiatric beds and decreased psychiatric staff including psychiatrists. A medical service fee system that properly reflects staff enhancement and close collaboration with general medical service is needed in order to guarantee an adequate number of psychiatric staff.

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