Patients who overdose on psychotropic drugs can be difficult to transport to emergency facilities in Japan. Reasons for this may include difficulties with receiving liaison psychiatric services at emergency facilities despite such patients having psychiatric disorders, negative attitudes toward patients who ingest drugs acting on GABAA receptor complexes (e.g., such as benzodiazepine receptor agonists or barbiturates) and become excited, aggressive, and violent owing to paradoxical reactions, and negative attitudes toward psychiatrists as they may prescribe dangerous drugs (e.g., tricyclic antidepressants or short-acting barbiturates) to those at risk of overdose and often cannot be contacted at night and during holidays. Patients who visit clinics are at a higher risk of polypharmacy overdose, and this may be attributed in part to the lack of transparency in medical care and prescription practice at such facilities. To resolve difficulties associated with transporting patients who overdose on psychotropic drugs to emergency facilities, efforts should be made to improve liaison psychiatric services.

It is ideal for psychiatrists and emergency physicians to cooperatively treat acute physical complications in patients with a psychiatric disorder. In actual clinical settings, however, it often happens that that psychiatrists treat physical complications and emergency physicians encounter psychiatric patients, requiring them to learn each other’s field. Therefore, at our hospital, psychiatric and emergency care departments cooperatively respond to psychiatric cases with physical complications. In addition, the two departments exchange personnel and offer joint training. Psychiatrists in the training program experience emergency care at our emergency center while treating the psychiatric symptoms of patients transported to the center. Emergency physicians take a course on Psychiatric Evaluation in Emergency Care. Together with psychiatrists, they act as first responders to actually treat patients with a psychiatric disorder. After continuing this program for some time, we began to see different outcomes in suicide attempt survivors brought to our emergency center. The mission of our hospital is to cultivate personnel who will contribute to clinical coordination between psychiatrists and emergency physicians in the community.

As psychiatrists working for Kitasato University Hospital Emergency Center (hereafter, the Center), we examined the cases of patients who were transferred to the Center and were suspected of having a psychiatric disorder. We have been involved in the treatment of suicidal patients, such as acute drug intoxicated patients and people who have attempted suicide by hanging, those injured by leaping, and those with stab wounds, as well as patients who were hospitalized with severe non-mental diseases and developed psychiatric disorders. The following tendencies were observed in patients treated at the Center: 1) The percentage of suicidal patients is high among those treated by psychiatrists at the Center. 2) The percentage of patients with mood disorders (F3) is high among suicidal patients treated by psychiatrists at the Center, and many of them are transferred to psychiatric medical institutions after discharge. 3) The duration of hospitalization tends to be related to the method of attempted suicide (the duration is short for overdose patients, whereas it is long for patients injured by leaping). We have the following impressions from working at the Center: 1) As reported previously, the percentage of suicidal patients is high (≥10%) among patients transferred to the Center. 2) The main role of psychiatrists is the treatment of suicidal patients. 3) A high turnover of beds in the Center is required for early treatment and casework for each patient is necessary. 4) Further studies are required to realize efficient cooperation with other psychiatric medical institutions.

We have established a system in which an emergency doctor from the critical care center at Kansai Medical University hospital paid weekly visits to four psychiatric hospitals within the same medical service area for medical examination starting in November 2013. We investigated the extent to which this system influenced the establishment of cooperative links between the critical care center and psychiatric hospitals. We compared the three and a half year period (April 2010-October 2013) preceding the introduction of this system with the two year period following it (November 2013-October 2015). Furthermore, we retrospectively analyzed the following items of two periods. : the ratio for the psychiatric patients with the whole patient, outcomes in patients following suicide attempts, and the transfer requests for patients with coexisting physical and mental illness. The number of hospitalization of patients with coexisting physical and psychiatric illness as well as those transferred to a psychiatric hospital following a suicide attempt was considerably increased within the latter period. We considered that the establishment of a cooperative system between a critical care center and psychiatric hospitals might be strengthened by the introduction of the visit system.

In the patient survey, there were a high number of emergency patients to merge mental illness to general medical care. However, it can been seen that, in order to overcome difficulties and delays, the Fire and Disaster Management Agency and the Ministry of Health, Labour and Welfare have taken measures. The commission of the Ministry of Health, Labour and Welfare has been shown the parallel model and column model. In Aichi Prefecture, we are producing a medical cooperation model, which was based on the column model from 2013. An emergency hospital and a nearby psychiatric hospital make a unique pair, using the unique clinical path. One hundred ten emergency patients who merged mental illness can access psychiatric care in two years. We think meaningful cooperation is necessary for the following reasons: ① motivation, ② understanding medical content ③ officials and tools. In particular, in general hospital psychiatry with a full-time psychiatrist, the role of mediator that connects the two medical institutions is expected.

Abstract：Direct comparisons of anxiety between recipients and donors in living-donor kidney transplantation are few. Among fifty pairs of patients whom we attempted to assess from March 2012 to July 2014, using the State-Trait Anxiety Inventory-Form JYZ (STAI-JYZ), 46 pairs consented to the study. The value of STAI-JYZ was utilized as a dependent variable to compare between the groups, while that between pre- and post-operative time was used as independent variables in a three-way analysis of variance for comparisons of state and trait anxiety. Our results showed that donor anxiety was significantly lower as compared to that of the recipient, while postoperative anxiety was significantly lower than that before surgery. Furthermore, the primary interaction between the groups and anxiety scale resulted in a lower test score, whereas the anxiety trait was not different between the groups. However, the anxiety state in the donor was lower than that in the recipient and also lower than the trait anxiety. Thus, regardless of the situation, donor anxiety increased with surgery, though it might be excessively suppressed as compared to the recipient.

In Japan, the total number of elderly patients and the number of elderly patients with dementia are increasing nationwide. As a result, the treatment and management of delirium and the behavioral and psychological symptoms of dementia are placing a considerable burden on hospitals without psychiatrists. According to a report by the Ministry of Health, Labor and Welfare, only 22% of general hospitals have a psychiatric department, and less than half of ambulatory hospitals in Japan have psychiatrists. Given the need to provide the most effective service possible within the limited amount of time available, the Shimane prefectural government sent a psychiatrist to several ambulatory hospitals to provide psychiatric consultation-liaison services. During his monthly half-day visits to each hospital, the psychiatrist provided educational programs, such as case conferences, which soon produced favorable outcomes, including an immediate improvement in the pharmacological interventions administered for delirium. This study demonstrated that the establishment of an effective support mechanism involving infrequent visits by part-time psychiatrists (i.e.,“ part-time liaison consultation”) allows psychiatric care to be provided over a broad region.

Our research aimed to identify the relationship between the mental and social background with impulsivity of suicide-attempt patients, and to aid psychiatric intervention at emergency centers. Method: We studied 37 patients who were admitted to the emergency center as a result of a suicide attempt. The patients were divided into two groups, impulsive and non-impulsive suicide attempt groups and were retrospectively studied. Patient data were analyzed by both univariate and multivariate analyses. Result: In the non-impulsive suicide attempt group, the number of patients who attempted suicide by lethal means and in whom the suicidal ideations appeared following suicide attempts was significantly more than in the impulsive group by univariate analysis. On the other hand, the number of patients who had interpersonal problems in the non-impulsive group was significantly more than in the non-impulsive group by univariate analysis. The lethal mean and appearance of a suicidal feeling were significantly different by multivariate analysis. Conclusion: We thought that it was necessary to consider individual characteristics when providing intervention to prevent recurring suicide attempts.