According to domestic and foreign surveys, it was found that maternal suicide frequency was high. Especially according to the survey of 23 wards of Tokyo, the suicide rate of perinatal women was much higher internationally. On the other hand, from the UK large cohort studies, some significant relationships between the depression and anxiety of pregnant women and behavioural/emotional problems of children were revealed. In response to these evidence, the following new movements for perinatal mental health were noted in Japan. 1) The latest guideline of obstetrics and gynecology related academic society clearly stated the methods of early detection of mental illness during pregnancy checkup. 2) The Ministry of Health, Labor and Welfare presented a screening system for postpartum depression at the regular medical checkups after childbirth (two weeks & 1 month). For municipal government, they mentioned the task of early detection of postpartum mental illness and strengthening of cooperation with the regional liaison system for appropriate care. 3) In 2017, the new strategy for postnatal depression described in “the comprehensive measures to prevent suicide”.

In Western countries, the number of late maternal deaths occurring between 42 days and less than 1 year postpartum is considered to be important as representing the number of maternal deaths. In particular, suicide attributable to psychiatric disorders has become a serious issue. However, in Japan, the actual number is unknown since neither death certificates nor postmortem certificates include information on pregnancy and delivery. Although the total number of deaths by suicide is known, it is not clear whether such deaths are associated with perinatal mental healthcare, and thus no measures can be taken. Untreated perinatal depression and psychiatric disorders not only cause problems such as suicide but also result in pediatric developmental disorders, mental disorders, neglect, and/or child abuse due to impaired nursing abilities, which can result in major social problems. The suicide rate of pregnant and parturient women in Osaka, Tokyo, and Mie is much higher than those in the UK and Sweden. The establishment of a regional cooperation support system is urgently needed, with cooperation among the gynecological field that monitors and supports mothers and babies, the psychiatric field, and local administrations.

The widespread and growing use of psychotropic drugs by pregnant women requires deeper comprehension of mental disorders by health care professionals regarding pregnancy treatment. Health literacy, or the ability to access, understand, appraise and apply health information is important to improve individuals’ perinatal mental health. A previous study demonstrated that Japanese health literacy is lower than that of Europeans which suggests that there are difficulties in health decision-making in Japan. This complication may be associated with less reliable and comprehensive website access comparable to that in Europe and the U.S. Effective risk communication sharing potential benefit and risk is essential to improve the prevention and control of benefits and high risks of pregnant women with severe mental disorders. Since the quality of web-based perinatal mental health resources in Japan is poor to moderate, specialist physicians should warn pregnant women about these facts and recommend they access appropriate resources of perinatal health by the Internet or by telephone counseling. Specialist perinatal mental health services can provide assessment of mental disorder including risk of relapse during pregnancy, treatment by combination of pharmacotherapy and psychotherapy, communication with specialist consultation, and advice regarding services for managing pregnant women. It is important to emphasize structured perinatal mental health services and managed networks in Japan.

The perinatal mental health consensus guide (CG) was published on the website of the Japanese Society of Perinatal Mental Health on March 31, 2017. This CG has been developed to provide advice to clinical management and serve as provision for mental health problems during pregnancy and the postnatal period. This paper focuses on how to use antipsychotics, antidepressants and mood stabilizers from pregnancy to childbirth according to the contents of the CG.

A general hospital is a valuable place where a broad range of healthcare professionals can gather together and evaluate the conditions of pregnant women from various perspectives. What is the expected role of general hospital psychiatrists? To be specific, the following are indicated: understanding of drug therapy related to pregnancy and lactation; psychiatrists’ understanding of the child-rearing assistance system; educational efforts aimed at staff members of obstetrical departments; education on perinatal mental health for psychiatrists; collaboration with multi-occupation such as with obstetricians, neonatologists, midwives, public health nurses, and social workers.

Even hemodialysis (HD) patients who are able to perform basic activities of daily living (ADL) and instrumental ADL tasks show high rates of ADL difficulty, i.e., difficulty carrying out routine self-care activities. ADL difficulty is reportedly associated with poor physical function in HD patients. However, the relationship between ADL difficulty and psychological function remains unclear. This study aimed to examine depressive symptoms in HD patients who have perceived difficulty in performing ADL related to mobility. Subjects included 186 Japanese outpatients (mean age, 66.5 years) undergoing maintenance HD three times a week. Clinical characteristics, ADL difficulty related to lower-limb function such as mobility issues, physical function (walking speed), and depressive symptoms (four dimensions of the 10-item CES-D: Depressed Affect, Positive Affect, Somatic and Retarded Activity, and Interpersonal) were measured and compared across three difficulty groups (higher, middle, and lower) as classified according to tertiles of ADL difficulty score. Differences in four dimensions of the CES-D10 were assessed using an analysis of covariance model adjusted for age, albumin, comorbidity index, and walking speed. A significant difference in “Depressed Affect” was observed between higher and middle vs. lower difficulty groups. Moreover, a significant difference in “Somatic and Retarded Activity” was observed between higher vs. middle and lower difficulty groups. No significant differences were observed in the other dimensions between the three groups. These findings suggest that an effective intervention for not only physical function but also the psychological dimension may be needed in order to prevent deterioration of ADL in patients undergoing maintenance HD.

For the super-aging society in Japan, there are difficulties in treating psychiatric patients with medical problems at psychiatric emergency hospitals. Psychiatrists from a psychiatric hospital provided outreach consultation –liaison services at three general hospitals in the absence or shortage of psychiatrists. These outreach services functioned as general hospital psychiatry for a community, which might be model of good practice for the super-aging society with adequate educational experience.

A male patient with dementia with Lewy bodies (DLB) presented with a gustatory disorder, which was difficult to distinguish from gustatory hallucination because his complaints were severe and bizarre. Zinc therapy was effective against his symptoms, which started to improve within about 6 weeks. From this, it was possible to conclude that zinc deficiency had caused his gustatory disorder. The important points of this case are as follows: 1) As there are many treatments for gustatory disorders, multidisciplinary cooperation and collaboration are very important for treating such disorders in patients with DLB. 2) Some important features for differentiating between zinc deficiency-induced gustatory disorders and gustatory hallucination are described in this report, but a greater number of similar cases are required to establish the optimal method for differentiating between these conditions. 3) The possibility of so-called ‘central neuropathic dysesthesia’ caused by Lewy pathology and the treatment of this condition will be considered further in the near future. 4) The effectiveness of cholinesterase inhibitors, including donepezil, against gustatory hallucination needs to be established.

Realimentation is a pressing issue and is associated with increased risk of refeeding syndrome in the treatment of anorexia nervosa, especially with patients grossly underweight. In this paper, we describe 2 patients with anorexia nervosa who were admitted to the psychiatric ward of our hospital with low body weight (BMI < 12). Both patients showed marked liver enzyme elevation and impaired general condition after realimentation was instituted. The psychiatrists and the consulting physicians were in dispute as to whether the conditions resulted from starvation or refeeding syndrome. The psychiatrists prescribed increased alimentation, and this decision enabled the patients to pass through the critical points in their recovery. These critical points can typically be overcome through higher calorie refeeding more than had been initially recommended under close medical monitoring and correction of electrolyte imbalance.