The need for child and adolescent psychiatry services is gaining recognition in Japan; however, inpatient treatment services of child and adolescent psychiatry are still not sufficient. This paper introduces the clinical practice of the Child and Adolescent Psychiatry Department at Tokyo Metropolitan Children's Medical Centre, which has the largest child and adolescent inpatient treatment services in Japan. Among the 692 inpatient children in 2011, the most common disorders were pervasive developmental disorders (45%: including autism, Asperger's syndrome, and pervasive developmental disorders not otherwise specified), followed by schizophrenia and adjustment disorder. Average period of hospitalization was greatly reduced to around 90 days in 2011 compared to that of the former child psychiatry metropolitan center before 2009. It is becoming easier for patients to receive early hospitalization and early hospital discharge; on the other hand, it is getting more difficult to treat children who need long-term hospitalization. Clinical training system of the medical center is also reported.

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Background: Emergency care in child psychiatry has been provided at the Child and Adolescent Psychiatry Department of Tokyo Metropolitan Children's Medical Center since its opening. Object and Purpose: We added up the statistics of a patient who was urgently hospitalized and needed physical complication treatment from 3/2010 to 3/2011. We used ICD-10 for a diagnosis. Outcome: The urgent inpatient whom there was the most was schizophrenia and the second most was patients of developmental disorder. And there were five patients who were urgently hospitalized for physical complications treatment. Consideration: It is necessary for the hospital care of the developmental disorder to understand and correspond to a characteristic. Since a medical institution with an infant psychiatry first aid function is limited, we examined the cooperation with other clinical departments and other organizations.

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Attachment theory has led to great strides in understanding the development of social behavior and psychopathology in infancy and early childhood, but the theory is just beginning to be applied to adolescence. Attachment theory may potentially shed valuable light on adolescent social development and deviant behavior. The aim of this article is to examine methods for assessing and treating attachment disorders in adolescence. This article outlines existing theory and strategies for assessment with particular emphasis on the need for the development of clinical protocol. The applications and implications for treatment are then discussed, with a case vignette of pregnancy in adolescence where preoccupied teens may be threatened by growing autonomy and sexuality. Finally, attachment based interventions according to the level of family functioning was demonstrated with emphasis of a function of support system as a transitional attachment figure.

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Recent surveys demonstrated that the total number of school refusal in elementary, junior high and high school in 2010 reached about 170,000. In this context, school refusal means a protracted absence from school, typically more than 30 days per year, caused by psychological factors such as fear, anxiety and a sense of refusal. The prominent finding is the steep increase of the number of school refusals from the sixth grade of elementary school to the first grade of junior high school, which is almost three times higher than that in elementary school. Hikikomori is a phenomenon in which persons become recluses in their own homes, avoiding various social situations for at least six months. The latest nationwide surveys revealed that the number of ongoing hikikomori could be estimated at 230,000. These two phenomena, school refusal and hikikomori, have many commonalities, including underlying psychological factors, and could be closely related to each other. In this article, I report the current condition of both phenomena, explain the adolescent mentality commonly observed in school refusal and hikikomori, introduce a multi-axis approach to understand and support them, investigate the background psychiatric disorders and developmental disorders, and refer to the treatment of school refusal and hikikomori at general hospitals. The guidebook for school refusal and the hikikomori guidelines are useful to assess both conditions correctly and initiate treatment as early as possible.

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This pilot study demonstrates the efficacy of a liaison psychiatric ward in a general hospital, managed by psychiatrists and staffed with internists, for treatment of patients with comorbid medical and psychiatric illnesses. Although there were just two attending psychiatrists and five beds available within the unit, 687 patients were admitted during a period of five years. Out of the entire patients, 74 percent of them were involuntarily admitted, while 80 percent of them were through emergency room. This unit proved to be able to shorten an overall length of stay by 13.0 days. With more acute medical care and shorter admissions, a liaison psychiatric ward should be able to treat any psychiatric patients with higher medical acuity with integrated cooperation from the emergency unit, medical services and community psychiatric facilities.

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Patients who have experienced traumatic events such as violence or traffic accidents are often involved with judiciary processes during their treatment. The worsening of symptoms, which can be triggered by the judicial process, is pointed out in cases of patients with PTSD or other mental disorders. Using psychological techniques, the authors provided mental health support to five victims of domestic violence who had not been able to participate in the judicial process. In this study, we investigated the difficulties the victims experienced during the judicial process and the effects of the mental health support. Most of the difficulties that the victims had experienced during the judicial process could be relevant to symptoms such as fear reaction or PTSD. It was suggested that the symptoms could be one of the factors disturbing the victims from adequately participating in judicial proceedings. It was also suggested that the mental support was effective to the patients who were not able to sufficiently exercise their rights due to the symptoms, making it possible for them to exercise their rights through reception of mental health support.

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In Japan, the departments of psychiatry in general hospitals have been facing financial difficulties under the present medical fee system. Many general hospitals reduced or removed the number of psychiatric beds, and, furthermore, some hospitals discontinued psychiatric services. Of these, the outpatient clinic for dementia in general hospitals has been put in the most difficult situation in terms of profitability. Its roles in general hospitals include the early detection and differential diagnosis of dementia using diagnostic devices, as well as the diagnosis and treatment of physical complications, often in cooperation with other medical departments. These processes involve a large number of examinations, such as hematological, neuropsychological, and diagnostic imaging, compared to those conducted in general psychiatric outpatient clinics; however, the profit associated with these examinations does not meet the requirements for maintaining the outpatient clinic for dementia in general hospitals. I examined and confirmed the profitability of our outpatient clinic for dementia using actual data, and pointed out several problems of conventional referral systems.

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