Psychogenic non-epileptic seizures (PNES) are paroxysmal episodes resembling epileptic seizures. They have no abnormal electrical excitement and are thought to be triggered by psychological factors. Monitoring of EEG using a video recording has made diagnosis of PNES easier for clinicians. Guidelines to treat PNES have yet to be established. Particularly there are few interventional studies for treatment of PNES with intellectual disability (ID), and difficulties in treating it are common. In this study, we investigated the effectiveness of a group psychotherapy using an original textbook based on cognitive-behavioral therapy (CBT) in consideration of patients with ID. The study was performed at the National Center Hospital of Neurology and Psychiatry in Japan, and five patients with PNES and ID participated. We evaluated PNES symptoms before and after the twice a week intervention sessions for 3 weeks. PNES symptoms disappeared or were restrained in all cases after three-weeks. The study suggested a positive impact using group psychotherapy based on CBT for patients with PNES and ID. We also learned that intervention in consideration of personal issues of each patient with PNES and ID is necessary. Additional studies are needed for standardization of treatment of PNES with ID.

We conducted a questionnaire survey on the potential needs of clinical psychologists in a general hospital. Based on 553 answers from inpatients or their family members, nearly 70% of users have some awareness of clinical psychologists, and 83% of users insist that clinical psychologists are necessary in a general hospital. Additionally, over 50% answered ‘yes’ to the question of whether they actually want to see a psychologist to request mental support. Qualitative Analysis based on Relatedness Evaluation of the free description of the image of a clinical psychologist revealed two common axes, “The need for some explanation about clinical psychologists to relieve concern,” and “The importance of hard to confess anxieties or worries.” We concluded that general hospitals should make efforts to deliver more information about clinical psychologists to users and to provide general assuredness to hospital patients of easily accessible opportunities to ask for mental support in every situation.

The aim of the study was to understand the process of psychological change experienced by people with systemic lupus erythematosus (SLE) since the disease onset and identify the kinds of psychological support they need in various stages. For this purpose, semi-structured interviews were conducted with ten SLE patients recruited through snowball sampling and their narratives were analyzed using the Trajectory Equifinality Model (TEM) method. The analysis showed that while patients become increasingly distrustful of medicine as they receive treatment, they attempt to adapt to treatment through candid exchange of views with the doctor and by building close relationships with medical professionals. Patients are obliged to change their social status after contracting the disease, and it has been shown that they attempt to recover normality and accept reality with support from others who understand their circumstances and fellow patients. The study suggests that early psychological educational support and team-based medical care by a variety of professionals support the adaptation to the disease. It is also suggested that relationship-building among fellow patients should be encouraged so that they can accept changes in their social status.

There are few empirical intervention studies to promote resilience of the bereaved, and the number of systematic reviews is even more limited. The purpose of this study was to 1) evaluate the effectiveness of intervention studies to promote resilience in the recovery process from bereavement, and 2) identify methodological challenges. We searched electronic databases (Pubmed, EBSCO, Cochrane, Medical Finder, Ichushi-Web) using PRISMA guidelines. After screening 883 articles, 4 fulfilled inclusion criteria were extracted for review. Although the evidence was limited, it was suggested that interventions showed a moderate effect on improving psychological adaptation and mental health. In addition, the outcome of most articles dealt with depression, PTSD and pathological grief, and studies directly evaluating resilience were lacking. Well-designed randomized controlled trials and meta-analysis are needed to improve the quality of evidence.

We examined serum creatine phosphokinase (CK) levels in 72 psychiatric patients with neuroleptic malignant syndrome (NML; n = 17), rhabdomyolysis (n = 33), or water intoxication (n = 22). CK levels were lower in patients with NML than in the other 2 groups. In patients with NML or rhabdomyolysis, hemodialysis due to acute renal failure was needed in 14 patients when serum CK levels exceeded 46,000 IU/L. Hemodialysis was not necessary in any of the 8 patients with water intoxication who had serum CK levels greater than 46,000 IU/L, possibly because excessive water intake prevented acute renal failure. Serum CK levels in patients with water intoxication often increased after admission and this increase was related to rapid correction of serum Na levels. Massive extracellular electrolyte infusion prevented renal failure in patients with NML or rhabdomyolysis, and hyposaline infusion was considered to prevent rhabdomyolysis in patients with water intoxication.

The patient was a man in his 60s with a history of schizophrenia that was diagnosed during his 30s due to incoherent behavior. When the patient was in his 40s, he stopped taking his medication. At that time he was confined to his bed and diagnosed with substupor of schizophrenia, and he was prescribed neuroleptics and complied with his drug schedule. Later, during his 50s, the patient was diagnosed and treated for idiopathic thrombocytopenic purpura. His condition proved refractory, and when he was in his 60s, the patient underwent a splenectomy. Immediately following surgery, he demonstrated delirium and attempted suicide. A small cortical infarction was detected and he was diagnosed with anti-phospholipid syndrome and medicated with antiplatelet therapy. Approximately 2 years later, the patient demonstrated echolalia, minimal verbal response, visual hallucinations, and strange cries, and went outside without purpose; hence, he was diagnosed with catatonia, resulting in repeated hospitalizations. Despite adequate regulation of neuroleptic and anticoagulation therapies, he experienced recurrent catatonic episodes and committed suicide 4 years after being diagnosed with anti-phospholipid syndrome. Before his death, the patient did not have other cerebral infarctions, nor any apparent abnormalities in cerebrospinal fluid, nor any abnormalities detected on electroencephalography.

A man in his early thirties had been complaining of fever and fatigue similar to the common cold for four days before hospitalization. He developed psychomotor excitation, delusional mood and paranoid like schizophrenia on the day of admission. The patient was diagnosed with Mycoplasma pneumoniae upon examination, and treated with a course of antibiotics. Catatonic stupor, catalepsy, autonomic activation and myoclonic seizure were observed during hospitalization, and he was diagnosed with acute encephalopathy. Mycoplasma pneumoniae was not detected in the cerebrospinal fluid (CSF), whereas NMDA type GluR (ELISA) antibodies were detected in the blood and CSF. Thus, Anti N-methyl-D-aspartate (Anti-NMDA) receptor encephalitis was suspected because of characteristic clinical courses, limbic symptoms and examinations. Some of the encephalitis as central nervous system complications of Mycoplasma pneumoniae is considered a disorder caused by an autoimmune reaction. Anti-NMDA receptor encephalitis is caused by an autoimmune reaction in the same way. Thus, it is suspected that Anti-NMDA receptor encephalitis is associated with Mycoplasma pneumoniae.

Perinatal mental disorders are common. However, pharmacotherapy for these disorders is challenging and limited. Therefore, a non-pharmacotherapy approach is required. Shared decision making (SDM) has recently gathered attention with each patient’s and his/her family’s values needing to be supported. On the other hand, owing to psychiatric symptoms, SDM is not often possible. In this study, we evaluated two cases of pregnant women with severe mental disorders who needed urgent pharmacotherapy and required sufficient consideration about decision-making. In each case, limited medication was used and a personalized care plan including social environmental adjustment was developed. Subsequently, SDM could finally be reached, and the two women could continue pregnancy. It is important to carefully consider a personalized care plan with evidence-based pharmacotherapy and social environment adjustment, so that decision- making based on each value can be supported.

A 69 year-old male suffered from intermittent episodes of forgetfulness and attacks of impaired awareness. Interictal EEG showed epileptic waves in the F7 (“left anterior-temporal” in 10-20 system), but MRI showed no lesion in the corresponding area. The symptoms were completely resolved by 100mg of carbamazepine administered twice daily. Over 4 years later he complained of weakness in the right hand. MRI showed subarachnoid hemorrhage (SAH) mainly in the left frontal and temporal region and superficial siderosis (SS) on the surface of the left frontal gyri, suggesting recurrent SAH. MRI was repeated about 3 weeks later, and it demonstrated a subcortical hemorrhage in the left frontal lobe. A brain biopsy was performed around the hematoma. Small artery walls of the leptomeninges and the cerebral cortex were stained orange by direct fast scarlet (DFS), suggesting amyloid deposits. The site of the hemorrhage was well within the area covered by the F7 EEG electrode. Therefore, in this case, CAA lesions without hemorrhage seemed to have caused the epileptic seizures. In elderly onset epilepsies, a substantial proportion of patients has no identifiable lesions on brain MRI. In some elderly people with epilepsies, CAA lesions without hemorrhage may cause epileptic seizures.