The incidence of suicide has markedly increased in Japan since 1998. The government established a basic suicide prevention law in 2006, and the Cabinet Office published the outline of suicide prevention measures in 2007. Care for suicide attempters was included in this outline as previous suicide attempts have proven to a most potent risk factor of suicide later on. In recent Japan, two approaches toward suicide prevention for suicide attempters have been carried out. ACTION-J, a randomized, controlled, multicenter trial of post-suicide attempt case management for the prevention of further attempts, launched in 2006. The primary aim of ACTION-J is to examine the effectiveness of extensive intervention for suicide attempters in prevention of recurrent suicidal behavior, as compared with standard intervention. Another approach includes preparation of guidelines and training workshops for caring for suicide attempters. Action by entire nation is required for suicide prevention in Japan; especially, medical staff can play a great role for suicide prevention of suicide attempters. Additionally, measures for suicide attempters and good practices are expected to grow.

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More than thirty thousand people die by suicide every year in Japan. This paper introduces a synthetic activity of a surveillance committee of clinical care for suicide attempt patients of the Japanese Society of Emergency Medicine (JSEM). This committee publishes guidelines of clinical care for suicide attempt patients, which are utilized in the emergency department (ED) and for creation of a PEEC™ (Psychiatric Evaluation in Emergency Care) course for the staff treating suicide attempt patients in ED.

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Since 2001, psychiatrists started full-time work at the Emergency Critical Care Center (ECCC) in Kansai Medical University Takii Hospital (KMU Hospital). Psychiatrists also started somatic and mental treatment of suicidal patients in cooperation with emergency physicians. Since 2007, KMU Hospital has become one of the facilities of strategic research for preventing suicide, and psychiatric social workers have participated in assisting in the psychological and social support for suicidal patients together with emergency physicians and psychiatrists. KMU Hospital also received the assignment to investigate the reasons for attempted suicides in Osaka since 2010, and from then on psychiatric social workers began full-time work at the ECCC in KMU Hospital. As a result, collecting information, mental support to family, and social work intervention have become possible at an early phase after the patients have been admitted. We think that the important roles for the psychiatric social worker in the ECCC comprise the following 4 roles: First, sympathizing with suicidal patients; second, empowering coping skills when the patient is in a crisis situation; third, solving the patient’s psycho-social issues on the basis of suicide attempts by using social resources; and fourth, assuring long-range support by constructing a coordinated system with the patient’s family, close relations, and related organizations.

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Emergency medical care centers receive many suicide attempt patients. Nurses have not been able to appropriately assess patients since they do not know how they should treat patients with suicidal ideation, and thus they have not been able to accurately ask about suicidal ideation. However, we learned from past cases that it is important to accurately confirm their suicidal ideation for medical treatment. Therefore, we established the “Assessment sheet for suicide attempt patients” and tried to confirm safe conditions for them by confirming their suicidal ideations and their reattempt risk. However, the survey was usually conducted at the time of admission, and the safety confirmation was not continuously conducted during the admission. After the cases of suicide reattempt, we enhanced the security and removed dangerous items from patients. Thus, we positively responded to the cases, while limitations and inexperienced problems occasionally appeared. The critical thing is that all the staff in the hospital cooperated with each other in order to not repeat the same mistakes as was done with past cases.

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We investigated certain features, especially the methods of suicide attempts and self-harm for inpatients who participate in suicide attempts and self-harm in the emergency room of Nippon Medical School Main Hospital emergency room. Our results confirmed that many of them experienced psychotropic drug-overdose issues and alcohol problems which led to suicide. From the result, for the inpatients who attempted suicide and self-harm in the emergency room, we suggested the necessity of the early intervention of mental disorders do to use of psychotropic drugs and alcohol from the standpoint of re-suicide prevention. These diseases involve high suicide risk factors themselves. The fact that these are concomitant with mood disorders, schizophrenia and closely related disorders associated with higher suicide risk should be paid attention to.

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An open study was carried out on the usefulness of quetiapine (QTP) in 21 patients with cancer diagnosed as having delirium during management as inpatients at the Japanese Red Cross Kyoto Daiichi Hospital between July and December 2010 (6 months). The severity of delirium was rated with Delirium Rating Scale Revised 98 (DRS-R98). The QTP dose level was initially set at 50 mg and was increased every day until the DRS-R98 score was improved by 50% or more. The mean DRS-R98 score improved significantly from 20.6 to 6.7. The mean dose level was 147.3 mg, and it took 2.0 days on average until improvement in the DRS-R98 score. The burden/stress in caregivers and nurses in charge arising from care for the patients was evaluated on visual analogue scale (VAS). The mean VAS score improved significantly from 6.8 to 1.6. As adverse events, drowsiness and dizziness were noted in one case each, but they subsided after dose reduction. There was no case where medication was discontinued for reason of adverse events.

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The treatment of 57 patients with chronic schizophrenia and schizoaffective disorder managed at the Outpatient Neuropsychiatry Clinic of Kansai Medical University Takii Hospital was switched to risperidone long-acting injection (RLAI) in order to evaluate the efficacy, tolerability, changes in prescription trends, and treatment continuation rate during a 6-month study period. The continuation rate of RLAI treatment was 71.8%. A significant reduction was noted in the total brief psychiatric rating scale (BPRS) score (p=0.002), but not in the total drug-induced extrapyramidal symptoms scale (DIEPSS) score. Analysis of changes in the doses of drugs used concomitantly with RLAI, such as antipsychotics, benzodiazepines, and antiparkinsonian drugs, showed that there was no significant reduction in the doses of these drugs as compared to the doses before the start of RLAI treatment. The improvement in the continuation rate of RLAI treatment and BPRS score seems to be closely associated with a well-designed treatment approach, improvement in adherence and characteristics of RLAI as a drug. Thus, our findings indicate that RLAI may be one of the useful treatment options to ensure continued treatment of outpatients at the psychiatry department of general hospitals.

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Family members are important care-givers for patients with cancer. This study aims to clarify how family members of cancer patients recognize the psychological burden of cancer patients and psychological care/support for the patients. We administered a self-reported questionnaire via the Internet to five hundred family members. According to the survey results, the family members believed that disease notification (41.4%) was the instance when the patients’ distress was the most severe. The next stressful instance was recrudescence (metastasis) notification (14.0%) ; 26.4% of the family members confirmed that the patients received psychological care/support from the medical staff at this instance. In contrast, 26.9% of them confirmed that the patients did not receive any psychological care/support from the medical staff. The largest number of medical staff providing patients with psychological care/support were attending doctors (86.7%). The next largest number providing such care/support were nurses (38.1%). Moreover, 87.6% of the family members who confirmed that the patients received psychological care/support from the medical staff believed that it had a comforting effect on the patients. Furthermore, 53.5% of the family members confirmed that the patients had consulted someone about their condition. They thought that the person consulted by the patients was a family member (93.9%). They expected that psychological care/support was provided by the attending doctor or another doctor since the beginning (diagnosis) through measures such as empowerment, providing a sense of security, listening to the patient, understanding the patient’s views and anxieties that he/she is unable to express to the family members, and conveying apposite information. It was suggested that the family members of cancer patients recognize the psychological burden of cancer patients and psychological care/support for the patients differently from the cancer patients themselves.

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