In the field of consultation-liaison psychiatry, the psychiatric liaison team is desirable. Such a team facilitates the visualization of mental health and the practice of standardization in general hospitals. In the April 2012 revision of medical fees, the addition of a psychiatric liaison team was established. The psychiatric liaison team acts as a communicator to patients with mental disorders, delirium and, depression in the general hospital wards. They conduct evaluation of psychiatric symptoms, regular conferences, psychotherapy, drug therapy, social work, and psychology education. They coordinate with the patient and caregiver to allow the continuation of psychiatric treatment after discharge. In this regard, we need to resolve the problems associated with clinical practice guidelines, team organization, the role of psychiatric doctors and nurses, training content, medical fees, and bias of medical institutions.

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Consultation-liaison services are used to tackle a diverse range of pathologies in bio-psycho-social models of medicine. The demand for these services is expanding to the clinical, educational, and research fields. Our hospital is a general hospital with approximately 500 beds. Because of the unavailability of beds for psychiatry patients, in the past, we responded to requests for medical treatment through individual liaison performed by a limited number of staff; however, in July 2012, a liaison team was formed for which medical fees apply. As we receive approximately 350 requests for treatment each year, the issue of the lack of manpower persists. However, the system is being refined by the rounds and conferences that are performed each morning. It appears that the team's routine ward rounds lead to more efficient treatment and improved the communication between the other departments and our liaison team. We found that suicide-attempt consultations account for most emergency examinations, which involve issues such as the difficulty of building a treatment relationship within the short hospitalization period and the increasing number of elderly people who attempt suicide. This report summarizes the initiatives mentioned above and examines and discusses issues that became apparent during liaison treatment.

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To clarify the effect of the consultation liaison psychiatry team (CLPT), we conducted a focus group interview with five members of the CLPT including one psychiatrist, two registered psychiatric nurses, clinical psychologist, and psychiatric social worker. The interview was audio taped, transcribed, and the results summarized. Three categories were created for the themes that emerged: <Effectiveness for the CLPT>, <Effectiveness for general hospital ward staff>, and <Improvement in quality of medical care>. Subthemes emerged from each of three themes, as described below. 1. <Effectiveness for the CLPT> → <Alleviating emotional strain>, <Improved communication with hospital ward staff> 2. <Alleviating emotional strain> → <Sense of Belonging>, <Improved motivation>, <Greater objectivity> 3. <Improved communication with hospital ward staff> → <Alleviated anxiety in addressing ward staff>, <Smoother negotiation with ward staff>, <Ward staff had better understanding of role of psychiatry> 4. <Effectiveness for general hospital ward staff> → <Sense of relief>, <Improvement in ability to manage clinical problems> 5. <Improvement in quality of medical care> → <Faster response to consultation request>, <Able to perform multiple assessments>, <Greater guarantee of quality> <Effectiveness for the CLPT> seemed to promote increased liaison consultation activity that resulted in other positive effects. In this way, each subsequent effect did not work alone, but synergistically.

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After reviewing 731 cases in which the CLT at Tokyo Women's Medical University Hospital had intervened, we identified differences among those cases with intervention by single function care providers and a team deploying multiple functions. From the 731 cases, we further reviewed the details and structures of 63 cases that involved the psychiatric liaison nurses and clinical psychotherapists. Patients with sleep disorders were treated by physicians; patients with adjustment disorders were treated by the psychiatric liaison nurses; more patients with impaired psychic functions (e.g., deliria) before transplant or with Axis IV were treated by the multiple functions teams than those treated by single function care providers. By emphasizing the educational and emotional support to other medical care providers, the psychiatric liaison nurses and clinical psychotherapists have been promoting cooperation both within and outside the team. Characteristically, the liaison nurses mediated conflicts within the nursing team, assessed self-care and provided assurance and sympathy through active listening; the latter assessed the psychological state of the patients by utilizing objective tools and providing the patients demonstrating severe psychopathological disorders with systematic psychotherapy. It is possible for care providers to offer treatment intervention from an interdisciplinary point of view, by indexing the psychological problems according to medical and psychosocial complexity and the difficulties in performing the jobs of the medical care personnel.

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Most professional liaison psychologists have not been trained in primary care settings. There are two difficulties for those psychologists who work as members of ‘psychiatric liaison team’. One is the difficulty of collaboration within their own team, and the other difficulty is with a primary team. This paper demonstrates difficulties and proposes resolutions in collaboration among other health care professionals. A functional analysis of consultation reveals that the difficulty in collaboration within their team derives from the fact that the team consists of similar professionals, whose roles often overlap, and where psychological interventions are not defined clearly. To resolve this problem, expertise of psychologists and mutual respect among the team members are necessary. The difficulty of collaboration with a primary team derives from their function as a consultant. Psychologists who do not have sufficient knowledge of medicine and general medical services sometimes cannot fully understand the problem. There are two proposed resolutions. The first is to develop their abilities in comprehending the case from multiple points of view. The second is to enhance their communication skills in order to share crucial information among the medical staffs and in order to solve the problem.

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We determined the D-dimer cutoff level and established a new system for diagnosing pulmonary thromboembolism in the early stages. We then evaluated the usefulness of this new system in patients with physical restraints who were admitted to our psychiatric unit. We performed receiver operating characteristic (ROC) analysis for 186 patients with D-dimer levels of ≥0.5μg/ml who underwent echo and/or contrast-enhanced computed tomography (CT) for assessing the presence of venous thromboembolism. We determined that the D-dimer cutoff level was 3.0μg/ml (sensitivity, 91.7%; specificity, 78.2%; false-positive rate, 78.2%) in these patients. Under the new system, when D-dimer levels are above normal and below the cutoff, patients should undergo frequent examination of oxygen saturation by pulse oximetry (SpO₂), not echo or contrast-enhanced CT, as part of routine testing. When patients exhibit a decrease of ≥3% in SpO₂, we recommend contrast-enhanced CT of the chest and lower limbs because these patients have a strong chance of developing pulmonary embolism. On application of the aforementioned criteria recommended by the new system, we found that among 38 patients with physical restraints who exhibited D-dimer levels that were below the cutoff level for 19 months (from September 2010 to March 2012), none developed venous thromboembolism or related complications. Therefore, determination of the D-dimer cutoff level may enable us to diagnose venous thromboembolism more effectively in psychiatric patients.

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Patients often develop delirium after cardiovascular surgery. To determine the association of the preoperative use of statins with a reduced incidence of post-operative delirium, we retrospectively collected data from 324 patients who underwent cardiac and aortic surgery at our hospital from July 2011 through June 2012. The incidence of postoperative delirium significantly decreased in patients who were administered statins preoperatively. Based on the data collected, emergency surgeries, advanced age, and longer operation time were further indicated predictors of postoperative delirium. These results indicate that preoperative administration of statins decreases the risk of delirium after cardiac and aortic surgery, by possibly protecting the central nervous system.

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The Japanese Adult Reading Test (JART) is a standardized cognitive function test to estimate the premorbid intelligence quotients (IQ) of examinees with cognitive impairments. However, use of JART in clinical practice gives an impression that IQ, as estimated by JART, decreases as cognitive impairment progresses. In this study, we examined the association between cognitive impairment severity and scores for the JART-25 (the abridged version). Moreover, JART-25 and the subscales of cognitive function tests were also examined to determine which cognitive functions are associated with JART-25. This study included 828 patients who visited our outpatient memory loss clinic, and we also examined whether the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale-Revised (HDS-R) were associated with JART-25. The results revealed low MMSE and HDS-R scores to be associated with low JART-25 scores. Next, we examined whether the MMSE and HDS-R subscales were associated with JART-25. We found JART-25 to be weakly associated with cognitive functions of orientation, memory, comprehension, and executive function but strongly associated with those of attention, language function, and number concept. Thus, our results suggest that JART-25 scores should be interpreted with a degree of caution.

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