Japanese Journal of General Hospital Psychiatry
Online ISSN : 2186-4810
Print ISSN : 0915-5872
ISSN-L : 0915-5872
Volume 27, Issue 2
Displaying 1-7 of 7 articles from this issue
Special topics: A contribution of general hospital psychiatry supports for the elderly with dementia
Clinical report
Original article
  • Ko Furuta
    2015 Volume 27 Issue 2 Pages 100-106
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    In Japan, the super-aged society, it is very important issue to treat physical complications of dementia patients. For the purpose of estimating the prevalence of dementia among aged inpatients in general hospital, the Dementia Committee of Japan General Hospital Psychiatric Association did a multi-institution joint research. In this paper, we report the results of the research. 972 inpatients admitted to treat physical complications in 6 general hospitals, and aged 65 or older were examined. We examined cognitive function section of comprehensive geriatric assessment (CGA) (in this research, that means immediate recall & delayed recall of 3 wods), history of medical diagnosis of dementia, prescription of anti-dementia drugs, and presence of dementia diagnosis in terms of medical insurance. We estimate the prevalence of dementia in general hospital elderly inpatients is 17.5 to 52.3%.

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Original article
  • Kousuke Hino, Toshinari Odawara, Yoshio Hirayasu
    2015 Volume 27 Issue 2 Pages 107-114
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    Abstract:Because of the mutual influence between somatic diseases and psychological symptoms, it is sometimes necessary to deal with both conditions at the same time in elderly patients with dementia. Mental healthcare workers often assist these patients in consultation-liaison psychiatry. In May 2013, our hospital began offering consultation-liaison psychiatry services targeted primarily towards elderly patients with delirium and dementia. This system provides intervention and effective multidisciplinary team healthcare to a large number of these patients. Furthermore, the intervention for suicidal individuals is the most important activity for consultation-liaison psychiatry at emergency departments. When dealing with suicidal elderly patients, it is essential to assess the risk of a repeated suicide attempt, perform a psychiatric evaluation, cooperate with somatic medicine specialists, and undertake evaluation and intervention from as many different viewpoints as possible.

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Overview
  • Asao Ogawa
    2015 Volume 27 Issue 2 Pages 115-122
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    Because the elderly population is increasing rapidly in Japan, the development of support system for patients with dementia is an urgent task. In recent years, a palliative care approach, which has conventionally evolved to the patients with cancer, has also been attempted with dementia. The greatest feature of the palliative care approach is to perceive the illness trajectory in terms of recognizing when pain and distress can or will occur, and what the patient-family may experience, in order to pre-measure the distress of the patient and family and to be proactive about future crises. The support for dementia includes not only psychological symptoms, but also the management of comorbidity, psychological support for the physical symptoms, and the socio-economic problems. In the acute hospitals, the consultation-liaison psychiatrists play an important role in evaluating physical and mental problems and building a comprehensive support system for people with dementia.

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Overview
  • Tadashi Wada
    2015 Volume 27 Issue 2 Pages 123-130
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    According to the Law for Preventing the Abuse of Older People and Providing Assistance to Caregivers, the definition of ‘elder abuse’ includes physical abuse, psychological abuse, sexual abuse, neglect, and financial exploitation. In addition, we should focus on ‘self-neglect’ which is associated with increased risk of mortality. Local governmental facilities for receiving reports, for the most part, accept reports only during daytime hours, not at night and on holidays. Each small area in a city has each phone number for reports of elder abuse. That means there are many different phone numbers depending on the areas where the abuses take place. Therefore, it is extraordinarily difficult for ordinary people to report an elder abuse appropriately, especially in an emergency situation. In Japan, it is often assumed that family members share their properties. This is not only a custom, but a regal reality. For example, in cases of public health insurance and long-term care insurance, if a member of a family cannot pay the premiums, other members in the same household have an obligation to pay them, instead of him or her. Due to this cultural and legal background, one can easily carry out financial exploitation, especially on dementiated ones. Furthermore, law enforcement authorities are extremely reluctant to prosecute a family member who is exploiting. In coping with elder abuse cases, it is very important to give assistance to family members, especially to the perpetrator.

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Contribution
Original article
  • Junko Tsutsui, Sayaka Kobayashi, Noriko Yamauchi, Shin-ichi Suzuki, Ka ...
    2015 Volume 27 Issue 2 Pages 131-138
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    There are various levels of psychological interventions required in the Consultation Liaison (CL) service. The CL service also has to take in account that the main treatment is taking place at the somatic department and that there are various mental health care professionals involved, serving as one team. The stepped-care model (SCM) may enable the CL service to clarify the role of each member. We reported 4 cases in which psychological intervention was delivered. Cases were selected so as to correspond to each level of the SCM. Psychological interventions were conducted by a clinical psychologist in every case. However, it was obvious that cases which needed only level 1 or 2 techniques could have been managed by primary care staff or expert nurses. To perform this task, an education system that provides psychological knowledge and skills according to the Stepped-care model is necessary.

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Clinical report
  • Akihiro Yamashita, Masato Usuki, Hiroko Noguchi, Miki Ono, Yoshinori Y ...
    2015 Volume 27 Issue 2 Pages 139-144
    Published: April 15, 2015
    Released on J-STAGE: April 27, 2018
    JOURNAL FREE ACCESS

    A cohort study is an observational study used to investigate risk factors for disease, and a prospective cohort study is a longitudinal follow-up survey where participants are recruited at the start of the study. A high-quality study requires the preparation of several resources to prevent attrition. Currently, we are conducting the “Prospective Cohort Study on Nutritional Risk Factors for Posttraumatic Stress Disorder after Acute Coronary Syndrome” in cooperation with various psychiatry and cardiology departments. In this paper, we describe some liaison activities between psychiatry and somatic medicine for preventing attrition in our cohort study. We found that preventing attrition requires focusing on older participants, who comprise the majority, by acting quickly according to length of hospital stay and maintaining regular contact. Strategies for reducing participants’ burden included taking research-related blood samples and conducting interviews during cardiology examinations in their regular treatment course.

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