[in Japanese]

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The clinical features of 11 suicidal attempt cases (male: 2, female: 9) were analyzed. These subjects were admitted to the Iwaki Kyoritsu General Hospital, and were transferred from the Tertiary Emergency Center to the Department of Psychiatry during a 3-month period following the Great East Japan Earthquake on March 11, 2011. The number of female cases comprised 4.5 times that of male cases, and half of all cases (6 cases) were in their 20’s. The most preferable method(s) for neurotic young females were overdose of drugs and/or self-mutilation including wrist-cutting (4 cases). Females older than 40 years of age preferred hanging or self-poisoning and were often successful (3 cases). Back-grounded psychosocial factors of suicidal attempts varied according to cases, for example, excessive fatigue and manifestation of familial problems (4 cases), intersexual problems (3 cases), drinking (3 cases), anxiety over the future of agriculture, injury by nuclear crisis and radiation levels (3 cases), prolonged insomnia and depression (3 cases), or recurrence or incidence of post-traumatic stress syndrome or anxiety disorders (3 cases). Among all patients of suicidal attempts in the Emergency Center during the same 3-month period of last year as well as this year, the most frequent cases were females affected by acute poisoning of therapeutic agents. The number of completed suicide cases in the Emergency Center during the same period of both these 2-year periods included only 1 male, whereas among females, the number increased from 0 to 4.

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This is a summary of a unique experience I have learned from the earthquake that struck Northeast Japan on March 11th, 2011. Soon after the earthquake, I have served as an emergency room physician dealing super acute to acute phase patient as part of Disaster Medical Assistance Team (DMAT). This was followed by supporting patients as a psychiatrist dealing with sub acute to chronic phase patients. My expertise as both an emergency doctor and psychiatrist allowed me to follow a wide variety of patient populations throughout the disaster. Along with this experience, I have found establishing a good relationship between the medical doctor and psychiatrist was the key to supporting patients suffering from the disaster.

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In 1995, the central western urban area of Japan was hit by the Great Hanshin Earthquake, which resulted in over six thousand fatalities. In 2011, another earthquake, referred to as the Great Eastern Japan Earthquake, occurred in a northeastern rural area of Japan. This earthquake led to a mega-tsunami, which happened soon after and resulted in twenty thousand people killed or missing. The Fukushima Daiichi Nuclear Power Plant was also hit by the tsunami. We provided psychiatric assistance to the victims of both disasters one month and also around 6 months after the disasters. From those experiences, in the article we show similarities and differences in the psychological reactions between the people of both disasters during the "honeymoon phase." This phase is a short (two weeks to two months) post-disaster period, and is characterized by a euphoric affect, altruistic response, and group cohesion. We also discuss differences between the "honeymoon phase" and the following "disillusionment phase," lasting from several months to a year or more. Most sufferers developed comprehensive, transient, and mild reactions of anxiety/phobia or insomnia during the "honeymoon phase." They usually suppressed their negative emotions, which tended to easily disrupt the stability they had achieved. Some survivors even showed a hypomanic reaction, which was characterized by hyperactivity, an irritable mood and short sleep. In the "disillusionment phase," a considerable number of people suffered from anxiety and depression. Contrary to the general expectation, the people living in the disaster area did not express any additional concern about the radiation contamination.

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During the East Japan Great Earthquake Disaster, we psychiatrists who belong to Japanese Red Cross Hospitals offered support by liaison psychiatry to the Japanese Red Cross Ishinomaki Hospital, the base hospital in the stricken area with no psychiatrists. We offered support for 180 days and treated 162 new patients from April 2011 to November 2011. Diseases which were related to the earthquake disaster directly or indirectly constituted 44% of inpatients, 78% of emergency patients and 60% of the patients of the hospital staff. Although the percentage of the patients related to the disaster decreased gradually, we corresponded to these patients during a 9-month period after the disaster. Regarding psychiatric diagnosis, there were many patients of the F0 domain among inpatients and many patients of the F4 domain among emergency patients and the staff. As for symptoms, there were much delirium and dementia among inpatients, and many symptoms were related to anxiety among emergency patients. Suicide attempts were seen by about 20% of inpatients and by about 40% of emergency patients. We considered from our experiences that the need for psychiatrists in hospitals is key for disaster relief.

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We aim to identify the characteristics and problems of antenatal patients with psychiatric disorders and attempt to identify psychiatric support needed in departments of psychiatry and obstetrics and gynecologist (OBGY). Thirty two antenatal patients with psychiatric disorders out of 1688 women gave birth in the hospital. Information including, maternal age, the time of initial contact with the OBGY, psychiatric diagnosis, presence of breast feeding, the presence of one’s child during hospitalization and pediatric diagnosis and the child rearing environment were obtained from the participants. As a result, 32 (1.9%) antenatal patients possessed symptoms of psychiatric disorders. The average maternal age was 30.1±5.5 years old. The initial contact with the OBGY was 23.3±9.2 weeks into their pregnancy. The breakdown of the psychiatric disorder was F1 (1 woman), F2 (6), F3 (10), F4 (1) and F6 (4) according to the ICD-10. Fifteen children required hospitalization. Nine children were bottlefed mostly in order to keep mothers medication. After discharge, 2 children were placed into child living support facilities, and 8 children and mothers went to maternal and child living support facilities. Many mothers of children placed in facilities were young, unmarried, and delayed contact with the OBGY. Our conclusion is that 1.9% of the antenatal patients who possessed psychiatric disorders in our hospital were possibly under diagnosed compared to those of previous reports. The children placed in these facilities were likely to have limited support.

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Purpose: In this study, we performed qualitative analysis to investigate the perception medical care providers have of psychological consultation-liaison (C-L) service in general hospitals. Methods: Two hundred forty nine medical care providers of a core general hospital in a local area completed a questionnaire consisting of three open-ended questions: the first question asked them to describe their image of the word ‘counseling,’ the second asked about their needs for C-L psychologists, and the third asked for their opinion on which clinical cases need referral to psychologists. The qualitative methods KJ technique and CQR (Consensual Qualitative Research) were used to analyze the data. Results: The image medical care providers have about counseling was categorized into the following: “Neutral,” “Giving Emotional Significance,” “Assessment,” “Personal Advice,” “Psychiatric Treatment,” “Psychotherapy (narrow sense),” “Assistance for Medical Activities,” and “Mind-reading.” The needs for C-L psychologists were categorized into “Needs for C-L System,” “Preventive Educational Approach for Health Care Providers,” “Psychological Support Approach for Patients,” “Psychological Support Approach for Patients’ Family,” and “Needs for Psychologists’ Talent for C-L Service.” Clinical cases subjects considered requiring referral to psychologists included seven disease categories, with cancer and chronic disease being the most frequently citied disease categories. There were three categories of problems for cancer patients: “Emotional Distress Problem,” “Patient-Medical Care Provider’s Relationship” and “Distress with Cancer Care Process.” When we compared cancer and chronic disease, both included not only psychological problems, but also pure therapeutic problems. In contrast, cancer patients had two unique characteristics: one was “Emotional Problems regarding Informed Consent,” and the other was “Complicated Patient-Medical Care Provider’s Relationship Problems.” Conclusion: Health care providers have various needs for C-L psychologists, but their image of counseling as psychologists’ main work is not always correct and it is partial. They expect not only counseling/psychotherapy (personal psychotherapeutic intervention), but also preventive and an educational approach for themselves for the patients’ family (consultative intervention). Some of their needs are based on excessive expectations or misunderstanding. Based on our findings, we suggest that C-L psychologists be required to provide intervention for medical care providers’ anxiety and conflict about the care they receive, and for the patient-medical care providers’ relationship in terms of cancer care early.

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On April 1, 2008, the Department of Psychiatry was established as a policy approach within Shizuoka City Hospital located in the middle region of Shizuoka prefecture. One of the main purposes of establishing this department is to respond to physical complications in patients hospitalized at psychiatric hospitals in the city area. In December 2009, four beds for psychiatric patients with physical complications were placed within the general ward, and they have since been used for patient car. Although it has not been long since this policy was launched and the number of bed users is still small, challenges and limitations have been identified and faced through the operation of these beds. The details are as follows: 1. Challenges and limitations of bed placement sites and bed fixation; 2. Challenges in the process of hospitalization; and 3. Limitations due to the absence of designated beds for psychiatric patients. A study of these items showed that responses to physical complications are ideal when providing care in general hospital bed-equipped psychiatric departments. However, it is often difficult to establish a new psychiatric ward. Therefore, if beds for psychiatric patients with physical complications are placed within a general ward, it is important to place these beds in wards responding as extensively as possible to physical diseases and to assure involvement in responding to physical complications with both responsibility and authority either equaling or surpassing that of attending doctors managing physical diseases.

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