In the fourth year since the launch of our psychiatric liaison team services, we compared days of hospitalization due to delirium and conducted a questionnaire survey of nurses in order to analyze the achievement of team services. According to the results of the questionnaire survey of 36 floor nurses, more than 80 ％ gave positive evaluations regarding the improvement of psychiatric symptoms such as delirium and anxiety and the improvement of care and communication derived from the involvement of the team. Examples of the improvements included nurses being able to directly consult the team about medications, and regular rounds conducted by the team. These activities can help nurses solve problems, which we consider to be a major achievement. We compared orthopedic patients suffering from postoperative delirium who were conventionally seen by psychiatrists and those whose treatment the liaison team was involved in. We found that the patients seen by the liaison team had fewer days of hospitalization and shorter disease duration, though the differences were not statistically significant. This might mean that the intervention by the liaison team after the onset of delirium may have been too late to make a difference compared to the conventional visit by psychiatrists. In the future, we need to address the issue of preventive intervention for delirium to achieve tangible results.

Toyonaka Municipal Hospital is a general hospital without a psychiatric ward, where specialized psychiatric liaison and consultation are practiced for inpatients. Since delirium has been the most frequent complication following hospitalization, we established "the prevention of delirium care program system" led by nurses. This movement enabled early intervention of the liaison team and development of delirium care by nurses. As a result, the incidence of delirium has decreased.

Background: Delirium is a common, severe and costly problem that worsens patients’ prognosis and increases length of stay (LOS). However, many delirious patients are undetected, and few studies have demonstrated how to decrease LOS. The primary aim of this study is to clarify whether ward rounds decrease LOS of delirious patients. Methods: An Interdisciplinary team made weekly ward rounds for early detection and intervention of delirious patients in general medical wards between April 2014 and September 2015. In advance of the rounds, the team screened patients suspected of delirium by referring to pharmacists for information about the prescription of high-risk drugs for delirium on admission and the use of pro re nata antipsychotics in general medical wards. On the rounds, the team received reports from ward nursing staff about the screen-detected and other suspected patients and advised them on the spot to deliver pharmacological and nonpharmacological intervention or to refer to psychiatrists as needed. The delirious patients who were referred to psychiatrists from April 2013 to September 2015 were eligible for enrollment in this analysis. The endpoints were the number and LOS of the referred delirious patients. We compared the endpoints in post-implementation with pre-implementation of the rounds. Findings: The delirious patients of the 2nd year implementation were referred significantly more than those in pre-implementation (ratio to all inpatients: 1.60 % vs. 0.64%; p<0.001). The former had significantly shorter LOS (median 28.5 days vs. 42.0 days; p<0.01) than the latter. Interpretation: The rounds may be effective and feasible in detecting more delirious patients and decreasing LOS.

The ‘era of 5 diseases and 5 projects’ began in 2012 April, and it became obvious that the collaboration between general medicine and psychiatric medicine is important. Under this situation, additional payment to the psychiatric liaison team was introduced and was attractive to most of those engaged in the psychiatric medicine. At first, however, the increase of the number of facilities where it was applied was rather slow, due to its smallness of the actual payment amount and the strict standard which was required for its application.

In 2016 April, in the revision of the medical fee system, it was decided that the involvement of the psychiatric liaison team should be a significant requirement for the additional payment to the distribution of the psychiatric acute stage doctors. In addition, the team became one of the requirements for the additional payment to the general hospitalization system 2 & 3 and they caused the number of the facilities where the additional payment to the liaison team was applied to grow rapidly and succeeded in showing its importance.

When the psychiatric liaison team is regarded as a functional unit, which accelerates the collaboration between general medicine and psychiatric medicine, it can be seen that this additional payment to the liaison team contributes to the appraisal of General hospital Psychiatry both directly and indirectly. This implies new position and the possibility of the general hospital psychiatry, from the view point of the medical fee system.

Introduction: The demand for licensed clinical psychologists in cancer care is increasing in Japan, but it is difficult to ensure good quality of psychological care. This study aims to elucidate psychologists’ activities and identify the relationship between the attributes of psychologists and the activities undertaken by them in cancer care. Methods: A semi-structured interview was conducted with 15 psychologists, and 37 concepts and 15 categories were extracted from the data obtained to create questionnaires. A total of 143 psychologists from regional cancer centers and hospitals in Japan participated in this study, and the results were analyzed. Results: Almost all participants had psychiatric affiliation in the middle of their careers, worked full-time and concurrently in cancer care. They reported to prefer activities that focused on cooperation. Psychologists with higher knowledge and experience gave significantly better consultation and psycho-education compared to those with lower knowledge and experience. Conclusions: Interprofessional collaboration and the therapeutic relationship support is required for psychologists involved in cancer care for it to become a consultation-liaison activity. This study shows that the difference in providing psychological care emerged from the knowledge and experience of psychologists. Therefore, an enhancing model or a training system is required for providing good quality psychological care for in cancer patients.

This report describes a 48-year-old woman who was implanted with a permanent inferior vena cava (IVC) filter and treated for schizoaffective disorder using modified electroconvulsive therapy (mECT). The patient had struggled with recurrent mania since the age of 34. Psychotic symptoms started and severity of the mania increased from the age of 35. She required repeated admission to the hospital for psychoneurotic exacerbation, which was refractory to drug therapy. She then underwent repeated mECT while in the hospital. She was implanted with an IVC filter to treat deep vein thrombosis of the left leg at the age of 45. Three years later, more severe psychiatric symptoms recurred. Additional mECT immediately improved these symptoms and the IVC filter remained intact. Therefore, an IVC filter should not be considered a contraindication for mECT when medical therapy for psychoneurosis is ineffective.