We conducted a questionnaire survey of members of the General Hospital Psychiatric Association electroconvulsive therapy (ECT) committee and ECT training centers to investigate the number of “difficult-to-treat with ECT cases” (DEC) in which therapeutic seizures could not be induced by 504 mC stimulation (the maximum dose of Thymatron^®︎ in Japan) of ECT, basic procedure for DEC, seizure augmentation techniques, and opinions on the introduction of a device capable of 1008 mC stimulation (200% device). Of the 42 facilities that responded, 32 had experienced at least one DEC and 11 facilities reported experiencing six or more DEC within the last 3 years. Nearly all centers reported adjustments of benzodiazepine receptor agonists, and around 90% reported the use of thorough hyperventilation and reduced anesthetic dose as basic procedures for DEC. Several strategies of seizure augmentation (e.g. use of remifentanil, switching anesthetic to barbiturate, changing the pulse width, and prolonging anesthetic-ECT interval) were commonly used by the 10 centers that did not experience any DEC. There was disagreement about the introduction of a 200% device. Further knowledge on the effectiveness and risks of the device and other methods of seizure augmentation is needed.

Purpose: This study aimed to assess the current status of drug management carried out by the Disaster Psychiatric Assistance Team (DPAT) and to consider appropriate drug management methods. Methods: A questionnaire survey was conducted in 81 facilities registered with the DPAT in 2020. Results: The results showed that the average preparation time of DPATs was 6.3±9.9 hours, which differed among the facilities. It was suggested that the ordering process contributes to a reduction in preparation time. Some facilities managed drug storage in the affected areas without locks. Moreover, many facilities were not employing appropriate measures for the quality control of the drugs. Conclusion: The DPAT is expected to be mobilized quickly after a disaster and work in the disaster areas. However, some facilities took time to prepare the drugs to be transported by the DPAT, and shortening the preparation time was an issue. It became clear that there was a potential risk of theft or loss of medicines, and that appropriate measures for the quality control of the drugs were not taken. It is necessary to consider putting in place anti-theft measures and those to ensure the quality control of the drugs used during the disaster.

The study aimed to present the demographic and clinical characteristics of 74 patients who visited a psychiatrist in a one-stop center for victims or survivors of sexual violence, as well as the psychiatric treatment they received. The expected resources and roles of psychiatrists working at the one-stop center were also discussed. Furthermore, it is advantageous for gynecologists and psychiatrists to work together in the same place since it may be difficult for patients to see a psychiatrist elsewhere. On the other hand, it is difficult for the psychiatrists to see victims and survivors of sexual assault because sessions are time-consuming and are often cancelled due to the patient’s avoidance. Therefore, some sort of reward such as incentive pay might help encourage victims or survivors to avail of the service.

A Japanese woman in her 50s was admitted twice to a psychiatric hospital because of a depressed mood, a decreased appetite, weight loss, and suicidal ideation in year X-2. She had consumed only two pieces of sweet bread and a few cups of ice cream in a day since October in year X-2 immediately after discharge from the psychiatric hospital. She had difficulties eating and drinking from June of year X. She vomited blood on June 26. She had bloody stools and suicidal ideation on July 1. She was admitted to our department on July 2. On admission, she exhibited disorientation, eye movement disturbance, and cerebellar ataxia. Blood tests showed coagulation disorders and a thiamine deficiency. Head magnetic resonance imaging, diffusion-weighted imaging, and fluid attenuation inversion recovery showed high signals around the medial thalamus, third ventricle, and midbrain aqueduct. She was diagnosed with coagulation disorders due to vitamin K (VK) deficiency and Wernicke’s encephalopathy due to a thiamine deficiency. She was administered menatetrenone and a multivitamin preparation. VK deficiency is not rare in patients receiving treatment for malnutrition and physical diseases with psychiatric disorders. It is necessary to consider the possibility of VK deficiency as well as coagulopathy associated with malnutrition in the liver in patients with severe malnutrition, as in this case. In reporting this case, we obtained consent from the patient and her family and considered privacy protection.

A case of cerebral amyloid angiopathy (CAA), which was followed up for over 7 years, is presented. The case involved a female in her early 80s, who appeared to have CAA-related inflammation/angiitis based on magnetic resonance imaging (MRI) performed at her first visit. However, the MRI findings of CAA-related inflammation completely disappeared thereafter, and she remained clinically stable for a long time. After about 5 years, symptoms of subacute leukoencephalopathy, such as left-sided hemiplegia and disturbances of consciousness, appeared, and then shoulder-hand syndrome also developed in her left upper extremity. The natural course and pathology of CAA-related inflammation are discussed based on the patient’s clinical course and MRI findings. Once CAA-related inflammation occurs, it might persist in a state of chronic inflammation, even if the patient’s clinical symptoms remain stable and any inflammation seems to have been resolved. Furthermore, it is possible that shoulder-hand syndrome can be caused by CAA-related inflammatory leukoencephalopathy as well as cerebral infarctions.