Preconception care refers to health management initiatives for future pregnancy. Lifestyle habits such as maintaining appropriate weight, quitting smoking, and abstaining from alcohol contribute to having a healthier child. Evidence shows that antipsychotics and antidepressants do not affect fetal malformations or development. Valproate should not be prescribed to bipolar patients with childbearing potential as it increases the risk of fetal abnormalities and impacts development. While lithium carbonate requires caution, doses of 600mg/day or less have not shown increased risks. Sharing this information and discussing future pregnancy plans with patients and their families can help them approach pregnancy with confidence.

Preconception care (PCC) in epilepsy supports informed decision-making and improves maternal and child outcomes. Key information provided during PCC includes the impact of epilepsy on pregnancy, genetic considerations, and the relationship between antiseizure medicines and pregnancy or breastfeeding. This article reviews PCC in epilepsy and presents a case where information provision led to a second pregnancy. The case involves a teenage female with focal epilepsy, diagnosed at age 12, with irregular follow-ups. In October of year X, she revisited our clinic due to poor seizure control, and zonisamide was continued. However, she discontinued follow-ups again and reported pregnancy and AED discontinuation in June of year X+1. Comprehensive counseling was provided to her and her parents regarding epilepsy and pregnancy, leading to agreement on resuming medication. She delivered her first child in January of year X+2, remained stable thereafter, reported a second pregnancy in November, and delivered in July of year X+3. In this case, information provision alleviated anxiety towards a second pregnancy and improved adherence to epilepsy treatment.

In perinatal decision-making support in consultation-liaison psychiatry, appropriate interventions based on medical ethics are necessary while respecting women's sexual and reproductive health and rights (SRHR). In this paper, we examine approaches to decision-making support through two cases of women with mental disorders who expressed a desire to have an abortion. If decision-making is affected by psychiatric symptoms, treatment should be provided to improve symptoms, but the time available for abortion decision-making is limited. Preconception care and the provision of accurate information can help to avoid unnecessary abortions and enable women to make autonomous decisions. Mental health care related to abortion is an unmet need in the perinatal period, highlighting the need for further support structures and ongoing discussion in this area.

The Dementia Care Team (DCT) was established alongside the introduction of a sleeping pill formulary in a general hospital. This led to a study examining changes in sleeping pill prescriptions and their association with fall rates, physical restraint use, and delirium. The study found that prescriptions for the recommended drug, lemborexant, increased both before and after the DCT became operational. Meanwhile, prescriptions for benzodiazepines (BZ) and risperidone significantly decreased. There were no significant differences between falls and restraints and each drug group, but looking at the drugs alone, there was a trend towards increased falls with flunitrazepam and a significant increase in restraints with risperidone; the presence of DCT intervention reduced restraints without increasing falls. Of the 344 patients included, 41 (11.9%) developed delirium, but there was a significant difference in the presence or absence of delirium between lemborexant and other drugs, with a smaller proportion developing delirium in those on lemborexant and a statistically significant difference in delirium development between the other drug groups. Multivariate analysis of the incidence of delirium supported the results of the univariate analysis for the drug groups, with statistically significantly fewer cases in the lemborexant and Psychoactive Drug (PD) groups (risperidone/trazodone), while the odds ratio tended to increase with the degree of independence in daily living of older people with dementia. To reduce delirium, in addition to the presence of a multidisciplinary team that can be easily consulted, it is important that attending physicians and nursing staff other than psychiatrists become familiar with appropriate medication use and response methods, and that a systematic preventive care system is established that can be implemented by non-specialists.

We surveyed healthcare professionals at general hospitals, who frequently care for pregnant women with mental illness, to assess their attitudes toward perinatal mental health. The survey targeted members of the Japanese Society of General Hospital Psychiatry and was conducted using Google Forms. The total number of respondents was 544, with a response rate of 24.1%. The main findings are as follows: creating an environment where psychologists can play an active role in perinatal mental health is crucial; there is a need to educate non-physician professionals and staff at non-university hospitals about preconception care; and widely disseminating information about high-risk pregnancy and childbirth coordination fees to both younger and older generations is highly significant.

We investigated the preventive effect of Lemborexant (LEM), an orexin receptor antagonist, on delirium. From February to August 2021, we retrospectively investigated 53 hospitalized patients at high risk of delirium who received LEM for insomnia. We investigated the incidence of delirium and the incidence of delirium for 7 days after starting oral administration. In addition, we examined 23 patients in the LEM group and the RT/SUX group (receiving either ramelteon or suvorexant) for perioperative delirium. These patients were admitted to the orthopedic department for surgery and had presented with insomnia. The incidence of delirium was then compared across the 23 cases. As a result, 15% of a total of 53 cases developed delirium. The duration was 3.9±3.6 days on average. Additional investigations were conducted for a total of 23 subjects, 7 males and 16 females, in both the LEM group and the RT/SUV group. A total of 21.8% in the LEM group and 26.1% in the RT/SUV group developed delirium during the perioperative period, and there was no significant difference. The duration was 2.6±1.3 days in the LEM group and 1.8±1.0 days in the RT/SUV group, with no significant difference. The above results suggest that LEM, like RT and SUV, may be effective in preventing delirium.

This case report details pellagra encephalopathy without dermatological symptoms in a 43-year-old female patient with a history of alcohol misuse, who was undergoing treatment for vitamin deficiency neuropathy with vitamin B1 and B12 supplements. The patient's condition associated with excessive alcohol consumption triggered by interpersonal and work-related stress was diagnosed as vitamin deficiency neuropathy. She was prescribed vitamins B1 and B12 for approximately one year. In the months preceding her hospital admission, she experienced gastrointestinal distress and speech difficulties, escalating to delusions, hallucinations, disorientation, and gait disturbances a day prior to hospitalization. Treatment with a multivitamin regimen, including nicotinamide, resulted in rapid amelioration of her gastrointestinal issues and consciousness level; however, specific neurological and cognitive impairments persisted. Her serum niacin level was measured at 3.3 µg/ml, confirming a diagnosis of pellagra encephalopathy, despite the absence of dermatological manifestations. It has been pointed out that pellagra associated with alcohol dependence often presents without skin symptoms, requiring careful attention to ensure it is not overlooked during alcoholism treatment.