Coronavirus disease 2019 (COVID-19) continues to have a profound impact on society and has changed the outlook and values of many people. Behaviors and lifestyles have changed drastically due to infection control procedures, and many social and economic losses have occurred, from which people are trying hard to readjust to. Mental health support is an important issue from the perspective of future reconstruction. Socially vulnerable group, or people who require support during disasters, are a high-risk group for mental health problems and need stronger support. In the current situation in which anxiety, fear, depression, discrimination, slander, and suicide are on the rise, leading to the fragmentation of individuals and society, it is necessary to provide appropriate and continuous social support including public assistance, mutual aid, and self-help for those who have difficulty adjusting. Although it is difficult to see the future, it is important for medical professionals to protect themselves from experiencing burnout to ensure that they can respond to situations in a calm and solemn manner, as the end of the pandemic is sure to come.

I looked back on what I could do and what I could have done as a psychologist in a general hospital when the COVID-19 infections were spreading. I spelled out what I could or could not do and described my feelings in such a challenging period. As a psychologist, I desperately attempted to help those who directly supported patients testing positive during the Coronavirus pandemic. In the end, all I could do was consult with the chief. This gap between the desire as a psychologist and the needs of the clinical site appeared to come from my frustration as I grew impatient over the fact that I was of little else, wondering there should be more to do with my professional capacity. I needed the interdisciplinary support of the medical team to remain calm and face what to do in the given situation. I recognized the normal-time relationships in encouraging and caring for each other would be essential in times of emergency.

The COVID-19 pandemic has influenced many aspects of our society and medical situation. The managers of our hospital in Kyoto, Japan suddenly converted our psychiatric ward to a COVID-19 ward in March of 2020. We transferred or discharged all inpatients against their and our will. We renovated our wards within just a week, for example, setting and separating booths in terms of whether we should wear PPEs or not, removing facilities (sofas, trash cans etc.). All psychiatric nurses had to work in the same ward and to practice wearing on/off PPEs. After a few months, our ward has restarted as a psychiatric ward, and some beds are available now for COVID-19 patients. We treated some patients with COVID-19 and severe mental illness (schizophrenia or dementia) who were not able to stay in their room because of their cognitive functions and comprehensions. This report is a narrative record of our experiences with COVID-19 in our department dealing with our emotions and feelings of stigma for mental health and ourselves, to share our experiences. We would like all readers to take a glance at psychiatry, which is often put on the back burner during the COVID-19 pandemic.

Since the declaration of the new coronavirus (COVID-19) pandemic, more than a year has passed, and concerns have been raised that the ongoing burden on healthcare workers will worsen their mental health. According to reports primarily from overseas regarding the first wave of the pandemic, the impact on healthcare workers has been cumulative. Healthcare workers battling the pandemic are experiencing high rates of various psychiatric symptoms, such as depression, anxiety, insomnia, post-traumatic stress, and burnout. Lack of personal protective equipment, training, experience, and support from the workplace and society, and working in a high-risk environment while facing isolation and stigma, have been shown to be risk factors. Although there are situations unique to infectious diseases, it has become clear that dealing with them has many commonalities with facing natural or intentional disasters. In this unprecedented crisis, psychiatric staff of general hospitals must play a major role in mental health measures in the hospital and community, such as dealing with people showing acute psychiatric symptoms, improving working conditions, and disseminating information and educating others about critical incident stress.

Poor adherence is common in children with Type 1 diabetes mellitus. A literature review was conducted to examine psychosocial factors affecting adherence in children with Type 1 diabetes and clarify the differences in these factors during different developmental stages. The eligibility criteria for inclusion in the review were met by 27 articles. As a result of comparison by age group, in childhood and elementary school, the parent's psychosocial factors are the main factors. In junior and senior high school students, the child's cognitive and emotional factors become more important, and the parent-child interaction and the parent's involvement in the treatment behavior also affects adherence. Supports that take into account these differences are needed.

This study aimed to clarify the factors related to the mental health status of nurses engaged in tertiary emergency care. Anonymous self-administered questionnaires were posted to 2,122 nurses employed in one of 73 emergency care centers. The scales used in this study were General Health Questionnaire (GHQ), a 12-item version, Multidimensional Empathy Scale (MES), and The Practice Environment Scale of the Nursing Work Index (PES-NWI), all of which were confirmed to be reliable and valid. A total of 829 surveys were returned (response rate: 39.1%), 419 of which were valid and analyzed. As a result of multiple logistic regression analysis with mental health (good status / bad status) as dependent variables and other variables as independent variables, the following was clarified. “Emotional susceptibility” was a factor that deteriorated mental health status (odds ratio 1.97: 95% confidence interval 1.42-2.73), and “nurse manager ability, leadership, and support of nurses” were factors that improved mental health status (0.57: 0.41-0.78). The present findings suggest that nursing management is important for improving the mental health of nurses.

Aim: Clinicians in emergency rooms (ERs) play critical roles in the care of patients at high risk for suicide. This study explored the practice of suicide risk assessment by front-line physicians in an ER and its associated factors. Methods: We conducted a single-center, retrospective chart-review study focusing on patients who were admitted to an emergency room following an episode of self-harm. We examined whether known risk factors for suicide were evaluated by front-line physicians in the ER. We also investigated the factors that were associated with the assessment for suicidal ideation from the following three perspectives: patient characteristics, medical-professional characteristics, and their working conditions. Results: A total of 499 episodes of self-harm were subjected to the analyses. The rate of suicide risk assessment varied widely among each risk factor. Patients’ suicidal ideation was less likely to be assessed when a patient was treated by non-psychiatrists, or when a patient presented with problematic behaviors (p<0.001, respectively). Emergency-medicine physicians are more likely to assess patients’ suicidal ideation than other non-psychiatrist physicians (p<0.05). Patients who were directly discharged from the emergency room were less likely to be assessed for their suicidal ideation (p<0.001). The working conditions of physicians, including ambulance caseload and midnight shift were not associated with the practice of suicide-risk assessment. Conclusion: Suicide risk assessment by front-line physicians in an emergency room was not sufficient, warranting further educational research on this issue. Knowledge and skills of front-line physicians are more influential in terms of their risk-assessment practice in comparison to their working conditions.

Patients undergoing hemodialysis tend to experience psychological burdens, but few medical facilities make available mental health care provided by health professionals. We retrospectively examined the needs and roles of psychologists working for a year in a hospital which specialized in providing hemodialysis services. We found that psychologists intervened in about one-third of all dialysis cases, less than half of which had psychiatric disorders. The needs of the medical staff for the services of a psychologist were also high. The types of psychological problems identified were diverse, such as mental illness, those with dialysis-specific symptoms, as well as other daily issues, highlighting the wide range of needs for a psychologist. Flexible settings for discussions, such as at the bedside during dialysis or in an interview room, were used as a framework for providing psychological care, underscoring how the skills of a psychologist were adapted into a form suitable for each patient. The roles of a psychologist included acting as a support for patients, boosting the mental health of medical teams, assessing and triaging all patient interventions with the introduction of dialysis, and in making referrals to a psychiatrist. Thus, in a specialized medical setting, such as that for dialysis, psychologists perform a variety of roles useful for the welfare of patients and medical staff alike.

Clozapine is commonly accepted as an effective therapeutic agent for treatment-resistant schizophrenia. However, widespread clozapine use in recent years has led to an increase in the number of patients who experience various adverse effects associated with its administration. We describe two patients who were transferred to our hospital with acute kidney injury secondary to the combined use of clozapine and lithium carbonate. Case 1: The patient developed renal dysfunction caused by lithium carbonate-induced diabetes insipidus approximately 5 weeks after clozapine initiation. This patient received modified electroconvulsive therapy for the management of psychotic symptoms after discontinuation of clozapine. Case 2: The patient developed renal dysfunction caused by acute interstitial nephritis secondary to clozapine use, approximately 2 weeks after clozapine initiation. This patient also developed lithium poisoning. We discontinued the administration of clozapine and lithium carbonate in both patients, and infusion management alone improved the patients’ renal function. Patients with treatment-resistant schizophrenia often have mood swings. Therefore, as the use of clozapine becomes more widespread in Japan, the number of patients receiving combination therapy with clozapine and lithium carbonate is expected to increase in the future. Psychiatrists should be aware of the risk of renal dysfunction associated with this therapy, and careful renal function monitoring is warranted in such cases. The efficacy and safety of clozapine and lithium carbonate combination therapy should be carefully evaluated in patients who receive this treatment.

We report a case of meningeal carcinomatosis caused by lung adenocarcinoma in a 72-year-old man who was admitted to the hospital for rapidly progressing dementia. His main complaint was forgetfulness. He had a history of two surgeries for lung adenocarcinoma at least three years before dementia started. Three months prior to the onset, his imaging and blood tests were normal and he was able to live on his own. Within about a month, he became rapidly forgetful and visited a hospital. His score on the Mini-Mental State Examination was 15. Over the next few weeks, gait disturbance and urinary incontinence appeared. He was suspected to be suffering from Alzheimer's disease and was admitted to our hospital for examination about two months after the onset of the symptoms. MRI showed disproportionate enlargement of the subarachnoid space. CSF examination showed markedly increased pressure(>35cmH2O). CSF cytology revealed adenocarcinoma cells (Class V), and a diagnosis of meningeal carcinomatosis due to lung adenocarcinoma was made 18 days after admission. The patient's level of consciousness gradually worsened due to increased intracranial pressure, and head CT showed multiple microhemorrhages. EGFR mutation was positive, and we considered administration of targeted molecular drugs and shunting, but the patient's general condition deteriorated so rapidly that we abandoned treatment and transferred him to a palliative care hospital about 3 months after the onset of his illness, and he died two weeks later. In rapidly progressive dementia with a history of malignancy, testing with meningeal carcinomatosis in mind should be done.