In psychiatric disorders there is a sex difference in prevalence, clinical course and drug response. Especially, in women, biological and psychosocial factors influence the clinical features of the disease in synchronization with their life cycle. Low fertility and risk of developing breast cancer or osteoporosis due to hyperprolactinemia are major concerns in the pharmacotherapy of schizophrenia. Premenstrual dysphoric disorder and perinatal or perimenopausal depression are mood disorders specific to women. In the pharmacotherapy of perinatal psychiatric disorders, drug effects on the fetus and birth and drug transfer to infants remain an important clinical problem. Interruption of pharmacotherapy during pregnancy increases the risk of relapse in bipolar disorder, while some mood stabilizers are contraindicated due to their teratogenicity. Regarding pharmacotherapy for women, the effects on female-specific physical conditions and pregnancy and childbirth must be evaluated while considering the risk of recurrence and relapse over their life cycle.

The prevalence of late-life depression is more common in women. As a psychological factor of onset, elderly women often experience ‘loss experiences’ unique to elderly women. For the treatment of women patients with late-life depression, psycho-social intervention taking these psychological backgrounds into account is most important. And the psychological approach is also important for pharmacological treatments.

In clinical practice of psychiatry, it has been suggested that blood concentrations of psychotropic drugs are different between women and men. Women secrete less gastric acid and have a slower rate of gastric emptying rate than men, which could potentially lead to increased absorptivity. Women have a larger volume of distribution than men, which could potentially lead to prolonged excretion. Women have a smaller liver and a lower liver blood flow than men. Additionally, most cytochrome p450 enzymes have a sex-dependent difference in activity. Women have a lower activity of many uridine diphosphate glucoronyl enzymes. Despite the many pharmacokinetic sex differences indicated, there are few investigations on sex differences in blood concentrations of psychotropic drugs. More reserch is needed to guide drug treatment for women with appropriate doses.

Women’s health, including reproductive health and maternal outcomes, has been strongly influenced by social determinants of health. Recently, in Japan, while the total number of pregnancies among teenager has decreased, the number of pregnancies among teenagers under sixteen, thought to be a result of abuse or sexual exploitation, has not changed so much. In this group, girls who have been brought up in a condition of poverty, neglect, or abuse are thought to adapt to high-risk sexual behavior as a mean to self-harm or adaptation. After running away from home to escape from their adverse environment, they are vulnerable to victimization of sexual exploitation in ‘JK-business’, a form of sex work which exploit young people, because of their low self-esteem. After birth giving birth and then without childcare support, these teenagers have difficulty graduating from high school. These girls are vulnerable to be caught up by sex work. And in some cases, they tend to be victims of intimate partner violence from men who get closer for the purpose of sexual abuse, so this undesirable environment is passed from generation to generation. Recognizing the chain of violence, poverty, and unintended pregnancy as an important problem in public health, special support and comprehensive care should be offered.

The author reported 2 female cases with mental disorders, and showed the change of the number of suicide attempt cases of both sexes, following the Great East Japan Earthquake on March 11, 2011, to focus on women’s mental health after the earthquake disaster. An increased number of crimes and abuses affected women’s mental health. For three years since 2012, the highest number of female suicide cases has been recorded during the period of July to September of each year. During these 3 months, there is Obon festival and holiday period, which tends to reveal intersexual as well as familial problems, and which may trigger mental disorders. Some factors which affect women’s mental health following an earthquake disaster were discussed.

Debate on euthanasia in Europe has been conducted actively since the 1990s, not only by medical experts but also by experts in areas of philosophy, ethics, theology, and others, in an attempt to form a consensus on ethical principles. In the early 2000s, euthanasia and physician-assisted suicide has been successfully legalized in the Benelux countries. Additionally, physician-assisted suicide has been legalized in other countries and regions, and globally ongoing discussions take into consideration a broader perspective on the approach toward terminal care at the end-of-life stage. In this article, we reviewed the perspectives of palliative care at the end of life and discuss their relationship to psychiatry, along with its required role. We explain the global trend toward accepting euthanasia and physician-assisted suicide, and describ current, legalized euthanasia systems and their associated problems. On that basis, while admitting that there is an idea that euthanasia and physician-assisted suicide are part of "the rights of the patient," we considered the role of medicine in the end of life. Palliative care has expanded its subjects; therefore, we fear there are even more challenges in psychiatry.

Background and purpose: Many unconscious patients are transferred to emergency centers, and an electroencephalogram (EEG) is frequently used to identify the cause of unconsciousness. Our study aimed to evaluate the usefulness of an EEG in an emergency center. Objective and methods: Among patients admitted to a critical care center, between January and December 2016, we studied 68 patients (80 EEGs) who underwent EEGs. We investigated both the EEG purposes and examination findings. Result: The EEGs were performed to investigate long-lasting disturbance of consciousness in 24 patients, and to investigate the transient disturbance of consciousness in 13 patients. Follow-up EEGs were undertaken on 29 post-seizure patients, on nine patients with suspected stupor and on five patients for reasons unspecified. Examination results revealed 37 normal EEG findings and 43 EEGs indicated abnormal findings. Among the EEG patients, we found the cause of consciousness disorders in two patients (one patient with non-convulsive status epilepticus and one patient with Creutzfeldt-Jakob disease). Post-convulsion follow-up EEGs identified nine patients with a seizure-related paroxysmal discharge. Their antiepileptic medication was adjusted accordingly. The EEGs of nine patients with suspected stupor were normal, except in one patient. Conclusion: EEG is useful for evaluating diseases regarding disturbance of consciousness and adjusting antiepileptic drugs in emergency center.

Evidence focusing on medically serious suicide attempts is lacking despite recommendations of mental health services to provide psychological assessments to all patients who have attempted suicide. Tokyo Metropolitan Tama Medical Center, a core general hospital in the Tama area, Tokyo, has a consultation-liaison service that is available around-the-clock. We retrospectively examined all patients with suspected psychiatric illness who were transported to our hospital by the municipal tertiary emergency service and received a consultation with the liaison team between April 2014 and March 2016 to identify their clinical features and to determine the current state of cooperation between the departments of emergency medicine and neuropsychiatry. The median age of the 272 patients was 41.5 years (quartile: 28.0-51.3 years) and males comprised 41.5% of the population, closely reflecting previous reports from university hospitals. The present study suggested a tendency that serious suicide attempters transported by the tertiary emergency service were relatively elderly and mostly male compared to previous reports which examined all emergency cases. By the following day, 76.1% received consultation, and within two days, 68.8% were discharged, which showed a faster tendency than in previous reports. Psychiatric hospitalization was indicated in 22.4% of the patients. Further inter-departmental and inter-facility cooperation to establish effective intervention guidelines is desired.