This article provides an overview of traumatic stress experienced in general hospital psychiatry. Individuals can experience traumatic stress directly in relation to accidents and physical diseases, or they may have experienced adverse childhood events that affect various current mental and physical problems. Healthcare professionals also can experience traumatic stress both in usual medical care and while providing disaster assistance. Traumatic stress among health care professionals is common in general hospitals, and even in cases where PTSD specific treatment cannot be implemented, incorporating appropriate psychoeducation and trauma-informed care into usual medical care can help people cope with traumatic stress. To engage in these efforts, it is important to be aware of traumatic stress for health care professionals in daily clinical practice.

Healthcare professionals are exposed to various feelings expressed by patients and their families, and they are required to adequately respond to them. As a result, healthcare professionals have the potential to suffer from a variety of negative psychological responses, which have been described in such terms as burnout, compassion fatigue, and secondary traumatic stress. To avoid such adverse effects, in the past, a professional attitude known as “detached concern,” which means maintaining an emotional distance from the patient while retaining cognitive empathy for them, was recommended. On the other hand, recent studies have reported that healthcare professionals’ emotional empathy leads to better treatment outcomes in addition to the enhancement of patient-healthcare provider relationships and their sense of satisfaction. While these findings promote educational interventions that could be used to cultivate healthcare providers’ empathy, it should not be forgetten to include countermeasures against negative psychological responses from which the providers could suffer. This report provides some ideas about current problems and future issues on clinical empathy after reviewing previous findings related to this subject.

Because of the declining mortality rate for patients with critical illness, the long-term sequelae of intensive care unit survivors, including psychological, cognitive, and physical burdens, are becoming more apparent. Post-intensive care syndrome (PICS) has been the term that refers to the broad range of such symptoms, and some major critical care societies have already promoted the spread of its knowledge and the importance of managing PICS. However, the level of awareness of PICS in non-critical care practitioners remains low. Without the knowledge of psychiatry, the management of PICS, especially when struggling with psychological impairment, including post-traumatic stress disorder, anxiety, and depression, and/or cognitive decline, may fail. Better communication and collaboration with psychiatrists and critical care physicians are required to achieve the best possible outcomes for patients with critical illness in the near future.

While posttraumatic stress disorder (PTSD) is diagnosed based on traditional psychobehavioral symptoms such as re-experiencing (or intrusion), accumulated evidence indicates a link between this disorder and alterations in the immune/inflammatory system. Epidemiological studies have shown that individuals with PTSD have significantly increased rates of physical comorbidities where immune dysregulation is involved, such as metabolic syndrome, atherosclerotic cardiovascular disease, and autoimmune diseases. In line with this, a number of blood biomarker studies have demonstrated that compared to healthy controls, individuals with PTSD show significantly elevated levels of proinflammatory markers such as interleukin-1β, interleukin-6, tumor necrosis factor-α, and C-reactive protein. Moreover, various lines of animal and human research have suggested that inflammation is not only associated with PTSD but can play an important role in its pathogenesis and pathophysiology. In this review, I first summarize evidence suggestive of increased inflammation in PTSD. Findings that suggest possible mechanisms of inflammation in this disorder are then examined in terms of two different (yet interrelated) perspectives: putative causes of increased proinflammatory activities and potential consequences that inflammation generates. Given that there is currently a dearth of treatment options for PTSD, possibilities of novel therapeutic strategies targeting inflammation are also discussed. Despite the growing attention given to the inflammatory pathology of PTSD, there remains much to be clarified, including more detailed mechanisms of inflammation, potential usefulness of inflammatory biomarkers as diagnostic and prognostic markers, and efficacy of new treatment approaches targeting inflammation.

Approximately 12% of patients after acute coronary syndrome suffer “ACS induced PTSD” which is considered as a risk for major adverse cardiovascular events. We psychiatrists are required to handle “ACS induced PTSD” adequately. To help clinical practice, we introduce our case and examine previous studies of “ACS induced PTSD.”

The number of suicides in Japan has tended to gradually decrease in recent years, however, the proportion of suicides among people who are 60 years and older is about 40% of the total number of suicides, and it is predicted that aging trends will continue in Japan. The current study explored characteristics of suicide in elderly people. We divided patients who attempted suicides and were hospitalized in ER into two groups: those who were elderly patients aged 65 years and over (83 people); and another group of non-elderly patients under the age of 64 (586 people). Characteristics were compared between each group. Because elderly group tended not to receive psychiatric treatment, it might be important for primary care physicians to conduct suicide prevention with elderly patients. Regarding the psychiatric diagnosis, the proportion of dementia in the elderly group was more frequent than in those in the non-elderly group. Elderly suicide attempters tended to be more severely physically harmed and need to be hospitalized for a long time; therefore, elderly patients will have lower Activities of Daily Living (ADL) levels. We reconfirm the importance of suicide prevention for the elderley.

The purpose of this study was to investigate the relationships between how mothers with cancer inform their children about their disease and the mothers’ mental health. The participants comprised 31 cancer patients who had children under the age of 18 at the time of their diagnosis. We asked the patients to complete a series of questionnaires. The results revealed that mothers who told their children more about their cancer scored higher on posttraumatic growth (PTG); however, no correlations with anxiety, depression, and posttraumatic stress symptoms (PTSS) were found. Additionally, mothers who told children the treatment methods scored higher on PTG than those who did not. Furthermore, mothers who communicated the side effects of treatment with their children scored lower on depression indicators than those who did not. Owing to the limitations of this study, including the study design and sample size, the results can neither be generalized nor do they suggest that communicating with their children about their disease influences the mothers’ mental health. However, by recruiting larger samples, future studies will be able to investigate its influence considering children’s developmental stage and mothers’ mental health conditions.

Behavioral Activation Therapy (BAT) has been reported to be effective in cancer patients with depression. However, it is unknown whether it is beneficial in cancer patients who do not agree with treatment using antidepressants. BAT could be an important psychological treatment in this population since it encourages patients to value themselves. For this reason, we report a case in which BAT was effective in a breast cancer patient with depression. A BAT program consisting of eight sessions was initiated for a breast cancer patient with depression. At the beginning of the program, her depression was considered to be moderately severe based on the Hamilton Rating Scale for Depression (HRSD). However, she achieved remission by the end of the program without antidepressants and began to live independently. This case suggests that BAT can be adapted particularly well to this population, and it will lead to patients living more independent and active lives after their cancer diagnosis.

[Introduction] Development of alternative medicines other than antipsychotics to treat delirium in Parkinson’s disease (PD) is imperative. Some reports suggest that gabapentin might be able to suppress delirium. Here, we report cases of PD with delirium that were effectively and we safely improved with gabapentin without exacerbation of extrapyramidal symptoms, and we discuss the potential of gabapentin as an alternative to antipsychotics. [Case 1] An 82-year-old PD patient with pneumonia presented with delirium accompanied by impairment of sleep-wake cycle, attention and short-term memory. Gabapentin 100 mg nocte improved sleep-wake cycle disturbance initially, and most symptoms were alleviated faster than the pneumonia. Parkinsonism did not deteriorate. [Case 2] A 66-year-old PD patient with cerebellar infarction developed delirium. Perceptual disturbance, delusion, labile affect, and impairment of attention, short-term memory, and visuospatial ability were observed. Gabapentin 100 mg nocte improved cognitive function and affect initially. Hallucination and delusion diminished after gabapentin was increased to 200 mg/day. Parkinsonism was not aggravated. [Discussion] Our study highlights two important findings. Firstly, gabapentin assuaged delirium without exacerbation of symptoms of PD, suggesting that gabapentin is a likely alternative to antipsychotics for treatment of delirium in PD patients. Secondly, gabapentin, which affects the γ-aminobutyric acid (GABA)/glutamate system, seems to improve delirium by a different mechanism in comparison to the administration of antipsychotics. The pharmacological function of gabapentin is also distinct from that of benzodiazepines. [Conclusion] Gabapentin is a likely alternative to antipsychotics for treating delirium in PD patients. Further study will be necessary.