The concept of resilience has gained much attention, but its understanding and application to clinical practice are not necessarily easy. In this paper, three points are listed as the reason resilience has attracted increasing attention include: 1. It comprises the process of recovery, 2. It could be defined as modifiable, and 3. It has potential to be developed into therapeutic and recovering theory. Moreover, application of resilience to clinical practice in general hospital psychiatry was discussed, referring to treatment of chronic depression and dysthymic type of depression, and shared decision making. The concept of resilience could contribute to development of general hospital psychiatry through linking findings of research and insight from clinical work.

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In this review, cognitive behavioral therapy is illustrated from the perspective of enhancing patients’ resilience. A case of a cancer patient is illustrated in which techniques of cognitive case formulation (case conceptualization) are applied.

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In the field of psychiatry and psychology, the term “resilience” refers to an individual’s capacity to withstand stressors and not to manifest mental illness. To understand the biological basis of resilience, studies using various approaches have been conducted.
1. Gene-environment interactions
Recent large scale genetic analyses such as genome-wide association studies have identified several genetic variations that are robustly associated with psychiatric diseases. However, each variant identified so far only increases the disease risks 1.1-1.5 times. To delineate genetic architecture more precisely, complex analysis of genetic variations and environmental factors, gene-environment interaction analysis, has been conducted. These studies have identified several promising candidate genes, such as SLC6A4 encoding serotonin transporter for major depression and ADCYAP1R1 encoding PAC1 receptor and FKBP5 encoding a protein that plays an important role in stress response for PTSD, have been identified.
2. Resilience as a consequence of active processes
Most of the genetic variations are binary, only having two types of alleles. Therefore, carriers of one allele must be resilient and carriers of the other allele must be vulnerable at the level of genomic sequences. On the other hand, there are some lines of evidence from molecular, cellar and biological experiments suggesting that there should be active processes leading to the manifestation of psychological resilience. For example, enhancement of adult neurogenesis in hippocampus or reactive up-regulation of ion channels in ventral tegmental area might be involved in resilience against stressful conditions. This issue reviews the current status of research aiming for identification of active biological processes that prevent pathological conditions.

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In this review, we discuss our current understanding of the association between resilience and fish oil. We defined resilience as the ability to rebound from adversity when one’s ability to function has been to some degree impaired. Omega-3 fatty acids such as eicosapentaenoic acid and docosahexaenoic, which humans mostly attain from dietary fish, are crucial for maintaining membrane integrity and consequently neuronal excitability and synaptic function. Previous studies suggested that omega-3 fatty acids deficiency was associated with a pathogenesis of depression. Psychiatrists in general hospital are usually confronted with the management of physically ill patients, injured patients and pregnant women. We reviewed some previous relevant studies and proposed the possibility of omega-3 fatty acids as one of the potential interventions to promote their own resilience, because of their safety, feasibility and applicability.

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In order to propose clinical intervention for suicide prevention, we examined the suicide attempters taken to the emergency room of Wakayama Medical University Hospital from July 2010 to March 2011. The total number of suicide attempters was 76, and 71% of them had overdosed. The number of repeating suicide attempters (5 or more times) was 18, and 83% of them had overdosed. Five attempters were pronounced dead by the time they arrived at the emergency room, and 4 of them had a history of overdose medication. Three of them were confirmed to have overdosed one time or more in the past year. In line with the preceding reports, overdose medication was most frequently employed among the suicide methods, and it seems to have been easily repeated. In addition, overdose medication may have a potential for leading to completed suicide, while its fatality rate is rather low. We have proposed an intervention to restrict prescription days and shorten the consultation interval for patients who have overdosed in the past year, and a system to share their information with emergency services, emergency medical institutions and family doctors.

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BACKGROUND: The causative role of encephalitis in major psychotic features, dyskinesias (particularly orofacial), seizures, and autonomic and respiratory changes has been recently emphasized. These symptoms often occur in young females with ovarian teratomas and are frequently associated with serum and CSF autoantibodies to the NMDA receptor (NMDAR). METHODS: The study included a total of 61 patients from age 15 to 61 and was carried out between January 1, 2005 and December 31, 2010. The patients were divided into the following three clinical groups for comparison. Group A; Patients with typical clinical characteristics of anti-NMDAR encephalitis. Group B; Patients with narcolepsy with severe psychosis. Group C; Patients with schizophrenia or schizo-affective disorders. RESULTS: Ten out of 61 cases were anti-NMDAR antibody positive among typical encephalitis cases (group A: 3 of 5 cases), and cases among a broader range of psychiatric disorders included narcolepsy (group B: 3 of 5 cases) and schizophrenia (group C: 4 of 51 cases). CONCLUSION: In addition to 3 typical cases, we found 7 cases with anti-NMDAR antibody associated with various psychotic and sleep symptoms, which lacked any noticeable clinical signs of encephalitis (seizures and autonomic symptoms) throughout the course of the disease episodes. These results suggest that further discussion on the nosology and pathophysiology of autoimmune-mediated atypical psychosis and sleep disorders is required.

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[Background] Most cases of pulmonary embolism (PE) are caused by deep venous thrombosis (DVT). PE followed by electroconvulsive therapy (ECT) was reported by several researchers irrespective of the modality of ECT. We report a case of DVT where additional PE was prevented by implanting a retrievable inferior vena cava (IVC) filter combined with anticoagulant therapy during modified ECT (mECT), and we discuss the potential risks of DVT and PE. [Case] Over a period of 2 years, seven cases suffering from both DVT and PE were diagnosed at admission among severely depressed patients transferred from other hospitals. In four of these cases, to avoid additional PE and contamination, e.g., from aspiration pneumonia or ileus, we rapidly applied mECT and concomitantly implanted a retrievable IVC filter combined with anticoagulant therapy. A 73-year-old woman was admitted to the hospital in a depressive substupor state accompanied by dehydration and starvation, resulting from poor response to pharmacotherapy in a previous hospital. Immediately after diagnosing both DVT and PE, a retrievable IVC filter was implanted, and anticoagulants were concomitantly administered during six ECT sessions. [Conclusion] In order to perform ECT safely, prior checking for both PE and DVT is important, and implantation of a retrievable IVC filter is useful in such cases involving rapid induction of mECT.

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The summary of the obtained findings were as follows: GHP provides valuable contributions to psychiatric care in many fields including emergency medicine, palliative care, and psychiatric training courses for residents. The above services are provided mainly in facilities that have psychiatric inpatient beds. The basic inpatient charge for facilities with a patient-nurse ratio of 13:1 has been introduced, and about a third of the hospitals that had been qualified for the basic inpatient charge for a ward with a patient-nurse ratio of 15:1 shifted to a new one. Many hospitals kept almost the same number of psychiatric inpatient beds, but there were more hospitals with increased psychiatric beds than those with decreased ones. Hospitals with inpatient wards employed more co-medical staff than those without ones, but the number of staff was one or two for each profession in each institute. Hospitals with psychiatric inpatient wards have important functions, including modified ECT, psychiatric emergency, and liaison-consultation psychiatry. High reimbursement for inpatient charges for psychiatric emergency admission was not available in most facilities. Financial vulnerabilities observed in many general hospital psychiatry were improved in a portion of the facilities to some extent by the revision of the medical service fee of 2010. However, a host of institutions have not obtained any merit from these reforms due to the too high standard for acquiring the high reimbursement. It is necessary to further investigate what influences the revision has made on GHP in more detail.

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