At general hospital, very few psychiatrists can focus on the treatment of child psychiatry, and psychiatrists who are performing the treatment of adults must examine children, too. It is necessary that “not” child psychiatrists in general hospital should understand the characteristics of the child’s mental health care and make efforts accordingly, in order to provide mental health care for the children. There is a feature that children who require psychiatric treatment are receiving outpatient pediatric first. Cooperation should be taken well with the pediatrician. This paper addresses several problematic issues that occur when psychiatrists who usually examine adults examine children, and introduces ways to overcome said problems; 1) Child psychiatric practice in outpatient pediatrics, 2) Cooperation with clinical psychologists, 3) How to collect and put the materials to practical use, 4) Use of outside institutions.

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Children that visit the child and adolescent psychiatric unit often suffer psychiatric disorders including developmental disorders, physical complaints and behavioral problems. General hospitals are able to differentiate somatic disorders and provide treatment, and since there is little resistance to consultation, the services in child and adolescent psychiatric units are in high demand. However, at present, few psychiatric units in general hospitals provide child and adolescent psychiatric care. At the Yokohama City University Medical Center, an outpatient child and adolescent psychiatric unit has been established as a specialty outpatient clinic that provides acute inpatient psychiatric care to children in the same closed ward as adults. The main diagnoses of outpatients according to the ICD-10 are often neurotic, stress-related and somatoform disorders (F4), and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F9). On the other hand, the main diagnoses of inpatients other than F4 are often eating disorders (F5) and psychotic disorders (F2). Inpatients are often older than outpatients, with predominant symptoms including behavioral problems, nutritional disorders and psychopathological symptoms, which have little difference to the neurological manifestations that mandate hospitalization for adults. Even general hospitals that do not have a child and adolescent psychiatric ward can often accommodate child and adolescent psychiatric patients. We believe that the psychiatry ward in general hospitals can be expanded to include child and adolescent psychiatric services through staff gaining experience with child and adolescent psychiatric treatment and multidisciplinary collaboration.

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The necessity for the child and adolescent psychiatry services network in communities is continuing to gain recognition in Japan. General hospital psychiatry is expected to play an important role in connection with regional child and adolescent psychiatry centers and community services. However, the current situation involving child and adolescent psychiatry in general hospitals is not well known in Japan. Therefore, we conducted a questionnaire survey in child and adolescent psychiatry among 140 members of the Japanese Society of General Hospital Psychiatry (JSGHP). More than 80% of the participant’s institute provided child and adolescent psychiatry services. Among those, more than 80% provided outpatient care of child and adolescent patients in the psychiatry unit, where adult patients mainly visit. More than 40% of them could not provide child and adolescent psychiatry inpatient care, and, more than 40% of them had to hospitalize child and adolescent patients in the adult psychiatry ward. Less than 60% of the participants joined the child and adolescent psychiatry training workshop. To further develop child and adolescent psychiatry in general hospitals, a more sufficient training system is required, one that expands the manpower base of experts in the field and smooths the network in communities.

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Objective: Suicide attempts by jumping from a height and suicide attempts by severe self-cutting are both high-risk means of suicide. We investigated the clinical features and differences of suicide attempts by jumping and severe self-cutting. Materials and Methods: A retrospective study was performed with medical records. The survey period was five years, from June 2006 until July 2011. We compared the group of patients with suicide attempts by jumping from a height (jumping group) (n=23) and the group of patients with suicide attempts by severe self-cutting (severe self-cutting group) (n=21). The survey items are age, gender, diagnosis ICD-10, history of psychiatric visits, history of psychiatric hospitalization and history of suicide attempts. Results: The jumping group had a higher proportion of women (8 males and 15 females). On the other hand, the severe self-cutting group had a higher proportion of men (14 males and 7 females). In the ICD-10 diagnosis, the proportion of F2+F3 was higher in both groups. There was no significant difference between the two groups in regards to history of psychiatric visits, history of psychiatric hospitalization and history of suicide attempts. Focusing on the ICD-10 diagnostic category F2, about half of jumping group was associated with psychosocial factors. On the other hand, all of severe self-cutting F2 group was associated with delusional state. Conclusion: In our study, the severe self-cutting group had a higher proportion of men than the jumping group. The proportion of F2+F3 was higher in both groups. Severe self-cutting might be more strongly associated with a delusional state than jumping.

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Members of the Japanese Self-Defense Forces, their families, and outside patients all attend the Self-Defense Forces Yokosuka Hospital for general hospital treatment. We counted the numbers and analyzed the characteristics of the patients who received counseling and psychiatric services at our hospital for one year from October 2010. The number of new patients for counseling was 92 in total, and the number who returned for review was 729. The most frequent chief complaint at the first consultation was “poor mental condition” in 48.9%, followed by “trouble with work” in the second place at 37.0%. The total number of new psychiatric patients was 204, and the number of patients who returned to the clinic for review was 2489. The most frequent diagnosis of new psychiatric patients was neurotic, stress-related and somatoform disorders (F4) at 59.3%, while the second most frequent diagnosis was mood disorders (F3) at 23.5%. Half of the psychiatric patients were suffering from adjustment disorder, and this is considered to be a feature of general hospital psychiatry. In the future, we hope to better treat maladjustment to work, strengthen rehabilitation support, and improve the suitability of medical treatment for individual patients.

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Postpartum psychosis is a rare psychiatric syndrome that develops mood and psychotic symptoms, with an acute onset during the first 1-2 weeks after childbirth. One of the possible etiologies of postpartum psychosis is estrogen’s effect on the dopamine receptor function. Postpartum withdrawal of prepartum-increased endogenous estrogen may induce dopamine receptor supersensitivity. Treatment guidelines including pharmacotherapy have not yet been recommended; however, several case reports reported effectiveness of electroconvulsive therapy (ECT). We report a case of postpartum psychosis with grandiose delusions, auditory hallucinations, thought disorganization, mood instability, catatonia and consciousness disturbance; the patient was initially treated with atypical antipsychotics such as olanzapine and aripiprazole. She was intolerant to these medications and suffered severe extrapyramidal symptoms. ECT quickly relieved her psychotic and mood symptoms and she was discharged to outpatient follow-up.

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