The palliative care system in Japan has been intensively consolidated since 2007, specifically for cancer treatment. During this period, the following core concepts of palliative care have been gradually integrated into cancer management: early identification, impeccable assessment, and treatment of pain and other problems, physical, psychosocial and spiritual in patients and their families facing problems associated with life-threatening illness. Consequently, the need for collaboration between psychiatrists has increased. Recently, palliative care for non-cancer diseases, e.g., heart failure, has been focused upon. How can we provide high-quality and cost-effective care service for multifaceted and individual needs? How can we develop effective interprofessional/interdisciplinary collaboration with regional cooperation? A closer collaboration between palliative and psychiatric care is warranted for cancer and non-cancer treatments.

The revision of medical fees in 2018 has contributed to the increase of palliative care efforts for heart failure. Heart failure is a disease whose prognosis is difficult to predict due to repeated acute exacerbations and recovery. Therefore, unlike malignant tumors, in which aggressive treatment is often not administered at the end of life, treatment for heart failure and its complications is continued until the end and offers symptomatic relief at the same time. Psychiatric medical care in the relief of heart failure involves treating anxiety, depression, and cognitive dysfunction, which are frequently associated with heart failure. The prognosis of heart failure can be affected when anxiety and depression are combined with this disease, and cognitive impairment complicates decision making. Psychiatrists are thus required to appropriately evaluate and treat anxiety, depression, and cognitive dysfunction. We believe that it is effective for psychiatry professionals to cooperate appropriately with cardiovascular staff and participate as a member of the collaborative care team.

The number of chronic kidney disease patients in Japan is said to be 13.3 million, and the number of patients receiving renal replacement therapy is increasing year by year. The use of renal replacement therapy can be expected to significantly prolong the prognosis of life. However, in recent years, the necessity of comprehensive renal replacement therapy has been re-recognized with the aging of chronic kidney disease patients and the increase of dementia patients. The treatment of total pain in patients with chronic kidney disease is performed first by relieving physical distress, such as by reviewing dialysis conditions. However, in cases where psychological distress such as anxiety, depression, or insomnia remains, psychiatrists are required. In the case of chronic kidney disease, attention must be paid to the use of psychotropic drugs, mainly for renal excretion type drugs. From the viewpoint of advanced care planning, it is expected that the number of cases in which psychiatrists are asked for opinions regarding the consent ability of patients in the field of decision support for renal replacement therapy will increase more and more in the future.

Many neurological intractable diseases are progressive and some are fatal. They cause disability in patients so they require care. Patients experience difficulty when they hear braking bad news, and they need to accept disability. Some diseases cause depression or a depressive state. The average prognosis of Creutzfeldt-Jakob disease is about 2 years, and that of Amyotrophic lateral sclerosis (ALS) is about 3-5. ALS patients will face serious problems such as choosing between a life on a ventilator or death. In multiple system atrophy, progress is slower, but patients become bedridden within about 10 years and then die from complications. For Parkinson disease, many medicines that control the symptoms are available, so patients will live almost as long as healthy old people but they often experience depression. Since there are many hereditary diseases among neurological intractable diseases, those patients who have them need hereditably counseling. In these situations, they often need phycological care. This paper will discuss common or special problems of neurological intractable diseases.

The Kanagawa Children’s Medical Center Palliative Care Support Team began its activities in 2008. The purpose of this team is to alleviate pain experienced by the children and families who use this center, regardless of the type and stage of disease in question. Requests for support mainly come from the Departments of Hematology/Oncology, Orthopedic Surgery, and General Internal Medicine and mainly pertain to cancer pain, postoperative pain, and chronic pain. Requests for medical examinations are made by non-psychiatry departments (i.e., departments providing care for physical disorders) to the Department of Child and Adolescent Psychiatry for patients with clear psychiatric problems, such as delirium, depression, anxiety, and agitation. The psychiatrists on the Palliative Care Support Team give advice on the use of psychotropic drugs to patients referred to the team and propose actions based on an assessment of the pathology. This paper presents actual activities of the team through case examples and describes what psychiatrists should keep in mind. The greatest role of psychiatrists providing pediatric palliative care should be to act as partners that any member of the staff can easily consult.

Although it is important to deal with alcohol-related problems, countermeasures against heavy drinkers are rarely conducted in general hospitals. Therefore, a survey was conducted on outpatients who visited the general hospital in Saga city. As a result, the drinking volume of outpatients was larger than that of general adults for both males and females, and few people had been instructed to reduce alcohol consumption at medical institutions, but in fact, many of them wanted to reduce alcohol consumption. However, they seemed to lack confidence in their ability to reduce alcohol consumption, and it seemed impossible for them to imagine what kind of merit could be specifically achieved by reducing their alcohol consumption. Based on the above, for medical personnel at general hospitals, it seemed necessary to disseminate knowledge on alcohol-related problems and intervention methods for heavy drinkers. We also thought that a consultation desk was necessary for heavy drinkers at general hospitals.

In this modern age where the decreasing birth rate has resulted in an aging population, society has high expectations for nursing students. However, nursing students often find it difficult to study while maintaining good physical and mental health. The present study sought to determine the effect of coping and social skills on mood in order to better understand the psychological characteristics of nursing students. An observational study was conducted using a self-administered questionnaire to survey nursing students in A Prefecture and 105 valid responses were obtained. The results demonstrated that mood was associated with coping and social skills. In accordance with previous studies, we also identified some demographic factors that were associated with mood and included them as independent variables in a multiple regression analysis. The analysis further revealed that emotion-oriented coping was a factor that influences mood. The present findings suggest that it is important for nursing students not to rely solely on emotions but to acquire coping strategies based on constructive problem solving skills in order to ensure their mental and physical well-being.

Background: After cardiac surgery, patients very often develop delirium. In particular, delirium occurs at a higher rate and tends to be prolonged in duration after surgery for thoracic aneurysm. There have been few studies of the clinical factors of this prolongation in adult patients. Objective: We aim to elucidate these factors in this study. Methods: The subjects were 49 patients who underwent surgery for thoracic aneurysm. The diagnosis of delirium was determined using the Japanese version of the Intensive Care Delirium Screening Checklist (ICDSC). Patients were divided into two groups, the prolongation group and non-prolongation group, based upon a duration of more or less than 7 days, respectively, and relevant clinical factors were compared. Results: There were significant differences between two groups in a prolonged duration of selective cerebral perfusion during surgery and the dose of benzodiazepine hypnotics before and after surgery. Conclusions: A prolonged duration of selective cerebral perfusion and the dose of benzodiazepine hypnotics may be associated with prolongation of delirium after surgery for thoracic aneurysm.

This report describes a man in his 40s who presented at a psychiatric clinic with depressive symptoms and sensitivity. About one year later, he was admitted to our psychiatric department because he developed cognitive disorder, doppelganger-like symptoms, delirium, incontinence and gait disturbance. After admission to our department, he was found to be infected with HIV. A subsequent magnetic resonance imaging (MRI) revealed age-inappropriate brain atrophy and diffuse lesions with high intensity in the cerebral white matter. These MRI findings triggered suspicion of a diagnosis of HIV-associated neurocognitive disorder (HAND). HIV wasting syndrome was considered to be the cause of delirium in the patient, because his delirium resolved after hospitalization and improvement in his physical condition. However, cognitive disorder persisted after the delirium resolved. No other central nervous system infections or organic brain disorders were found in the patient. Therefore, he was diagnosed with HAND. Antipsychotic medication and antiretroviral therapy improved his psychiatric symptoms and cognitive disorder, but the size of the lesion in the white matter increased. These findings suggest that psychiatrists should consider the possibility of HAND when patients present with psychiatric symptoms in the absence of a diagnosis of HIV infection. When diagnosing HAND, age-inappropriate brain atrophy and cerebral white matter lesions on brain MRI are considered to important findings.

In recent years, the need for pain control for patients has been emphasized also in Japan and opioid preparations have been introduced. Given that the opioid drug ‘tramadol’ is currently prescribed for chronic non-cancer pain and is not designated as a narcotic drug in Japan, its utilization in the clinical field has markedly increased. As a result, such a drug was extended to patients with mental illnesses. However, considering that tramadol is known to cause serious side effects, including convulsive seizures, psychiatrists should be cautious. In the current report, a case of convulsive seizures caused by the combination of an antipsychotic drug and tramadol is presented. Given that antipsychotic drugs are established to evoke convulsions, attention should be given to their combination with tramadol. In addition, antidepressants and lithium preparations are commonly used in the psychiatric field and have also been associated with convulsions. Therefore, psychiatrists should also be cautious when combining such drugs with tramadol.