The number of clinical psychologists (CPs) working in general hospitals is expected to increase after start of the national governmental license system for clinical psychologist, along with the promotion of team medicine. This paper summarizes what are requested in curriculum for student CPs for their work in general hospitals at undergraduate/graduate levels. CPs in general hospitals may be required to conduct various works including psychological intervention in liaison consultation and mental-care of medical staff, in addition to conventional works in outpatient/inpatient psychiatric clinics such as psychological test, psychotherapy and psychological education. The curriculum should include studies of psychiatric disorders due to brain lesion or medical conditions, in addition to typical psychiatric illnesses for them. In addition, works in team medication, for example as a member of psychiatric liaison team, are more requested recently, which requires student CPs learn skills of collaboration with team members and systems in general hospitals.

The characteristics of educational curriculums for clinical psychologists in Japan were identified and analyzed in comparison with the current status of those for psychiatrists. While medical doctors are educated under a natural science-based curriculum, clinical psychologists study the humanities and social sciences and select medical course subjects during graduate school to obtain practical psychiatric experience in areas such as attendance in clinical examinations, group therapy, and psychological assessments. According to existing data, approximately 80% of psychiatrists are men, more than 90% of whom work in medical facilities. By contrast, about 80% of certified clinical psychologists are women, only a little less than 30% of whom work in the medical and healthcare fields as their primary place of employment. In other words, a large number of certified clinical psychologists work outside of the medical field. Following the enactment of the Certified Public Psychologists Act in September 2015, medical and psychiatric subjects were to become compulsory requirements. Furthermore, this law requires certified public psychologists to cooperate with other professionals in relevant disciplines. We hope that clinical psychologists can deepen cooperation and collaboration with psychiatrists and contribute as members of multidisciplinary teams in general hospitals in the future.

The work of clinical psychologists in the physical field has been increasing at general hospitals and a similar tendency has been seen at our hospital over the past 10 years. However, education and training programs for such psychologists in regard to physiology have yet to become well developed. In response to this situation, we have applied training methods used in the psychiatric field to the physiology field, which we consider to have helped to consolidate such education and training. Furthermore, we show the complexity of psychological support by presenting some case studies from the physiology field. For all types of psychological support, a method of dynamic assessment is useful. Thus, for training in the physiology field, we emphasize the importance of learning methods for dynamic assessment through one-to-one interviews in the psychiatric field. For providing effective consultation, it is important to obtain necessary knowledge, technique, and attitudes as specialists, which we consider can only be acquired through observation of senior psychologists.

While education and training for those working in the psychology department at general hospitals and the field of physical care are improving, development of those in the psychology profession is an urgent issue. At our hospital, we are continuing with the psychological internship system which emphasizes consultation liaison practice (CL), and we have examined how a practical program in this field should be based on the changes of this system. In conducting the program, the CL core competencies are (1) multifaceted understanding, (2) dynamic understanding and ability to cooperate and (3) the ability to communicate with patients who have difficulty communicating. At least 480 hours are required to acquire these abilities, and while it was possible to obtain multifaceted understanding and communication ability through the practical program, further time and experience were needed for cooperative ability. In conducting the practical program, it is necessary to note the complexity of the structure unique to CL and its risk management. In the future, while assuring the quality of instructors will become an issue, it is hoped that the practical program will lead to the development of staff who become an immediate asset to the workplace.

It is expected that the number of psychologists involved in consultation liaison (CL) will increase, but in the training of psychologists, opportunities to learn CL are limited. This study aims to discuss the development of CL practicum program at this institution and to identify the practices of the program and its challenges. The program development considered the ideas of outcome-based education, set goals, and created a practicum career ladder, practicum content, and schedule while establishing an evaluation for practicum students. The practices focused on understanding the physical, mental, and psychosocial problems of medically ill patients by attending to them with clinical psychologists and psychiatrists. As a practicum effect, practicum students understood the psychotherapy structure peculiar to CL and learned the assessment of medically ill patients. In addition, they were able to understand the roles of psychologists at CL and the multi-disciplinary team. Challenges include constructing practical programs, training practicum instructors, collaborating with graduate schools, and on-site burdens. For psychologists involved in CL to meet the needs of patients, patients’ families, and medical staff and become useful for overall medical treatment, it is crucial to continue proceeding to prepare a consistent education and training system from training education to postgraduate education.

In this review, we summarized present knowledge on an appropriate care for suicide attempters admitted to emergency department (ED) in Japan. Our systematic review and meta-analysis previously revealed that the pooled prevalence proportion of suicide attempters in ED was approximately 5.0%. As expected, most of the suicide attempters in ED had psychiatric disorders, such as mood disorders. On the other hand, a large-scale randomized controlled multicenter trial, ACTION-J study, recently demonstrated that assertive case management was effective for reducing the incidence of repetition of suicide attempts among suicide attempters with psychiatric disorders admitted to ED. In order to conduct this assertive case management effectively, the collaboration between ED and the department of psychiatry is required. However, the number of such hospitals is limited in Japan. To promote the evidence based care for suicide attempters admitted to ED, it is necessary to strengthen the collaboration and develop a system to provide appropriate care services.

Metabolic syndromes constitute an important risk factor for mental disorders, and vice versa. We report a case of a woman in her fifties with schizophrenia and type 2 diabetes mellitus, who required involuntary admission to a local hospital after physically assaulting her brother. On admission, her HbA1c was 11.7%, and her blood glucose was 323 mg/dL. After initial treatment with oral risperidone, we offered the patient the option of treatment with risperidone long-acting injection (LAI). Since she was already accustomed to insulin injections, she willingly accepted our recommendation. We set up a post-discharge treatment plan involving biweekly visits to the hospital by the patient in the company of a community supporter. The medication consisted of treatment with trelagliptin, a dipeptidyl peptidase (DPP)-4 inhibitor designed for once-weekly administration (changed later to dulaglutide, a glucagon-like peptide (GLP)-1 analogue also designed for once-weekly injection), supervised by a home visit nurse. As a result of this treatment, she stabilized physically and mentally, and started enjoying daily activities such as drawing and cooking. Adherence with medication is critical for the stabilization of psychological symptoms and blood glucose levels. Long-acting hypoglycemic drugs as well as antipsychotic LAIs have recently been developed for this purpose. Further, general hospital psychiatrists can play an important role in collaborating with physicians and in mobilizing social resources to promote patients’ recovery while reducing the risk of exacerbation or complication of an existing condition.