In psychiatry, where a significant part of medical treatment is based on conversations between patient and physician, telemedicine using video calls has long been utilized. The COVID-19 pandemic that began in 2020 has further accelerated the use of telemedicine worldwide. Moreover, with the development of information and communication technology, remote monitoring of patients’ conditions outside of hospitals is expected to increase in all medical fields. Wearable devices are also expected to be used in psychiatry for patient monitoring and prevention. A pragmatic trial was initiated to compare the effects of telemedicine and face-to-face care in 17 hospitals and clinics, including five universities, as a research project commissioned by the Japan Agency for Medical Development (AMED). A depression screening technology is also developed using machine learning with wearable devices in an AMED-commissioned study. This paper aimed to introduce J-PROTECT and the use of a wearable device. Furthermore, we discuss the future prospects and issues of telemedicine and AI-based medicine in psychiatry.

Over the past decade, the main complaints of people with type 1 diabetes visiting the Department of Psychosomatic Medicine at Kyushu University Hospital have changed dramatically. Previously, the majority of patients with type 1 diabetes mellitus had concurrent eating disorders, with overeating and insulin omission. In recent years, however, the number of referrals with co-occurring eating disorders has decreased, and more patients are presenting with medically unexplained symptoms. Naturally, each person with type 1 diabetes mellitus has a different pathophysiology, and the treatment methods differ accordingly. The first half of this article introduces the concept of self-stigma and the three levels of psychosocial care for people with type 1 diabetes. In the second half of the paper, people with type 1 diabetes who have visited our department in recent years are divided into four types of patients according to their condition on a trial basis. We then discuss the treatment methods that may be effective and the role that the therapist should play.

Diabetes education is often problem-oriented, that is, “sustaining hyperglycemia increases the risk of future complications (problems), so change your current lifestyle to the acceptable lifestyle (promote solution actions).” However, in some cases, this is insufficient. If you have a psychological problem of experiencing loss of subjects due to diabetes or if you have difficulty maintaining motivation unless you focus on the goal of achieving the treatment index, you can flexibly engage with them using counseling and coaching. It is preferable.

For medical professionals, the places to learn practical communication skills are few, and they undergo a trial and error to learn these skills. Therefore, we developed a medical interview sheet called “Waku Waku Health Map.” This is a guide map for interviews and supports dialogue focused on increasing self-affirmation while assessing lifestyle (lifestyle) and the joy in a person’s life.

Type 1 diabetes is a type of diabetes in which insulin secretion is impaired due to the destruction of pancreatic beta cells by autoimmune mechanism. Insulin injection is the only treatment method for type 1 diabetes. Recently, the treatment for type 1 diabetes has made remarkable progress with new insulin products and blood glucose monitoring devices. Nevertheless, patients with type 1 diabetes must maintain insulin therapy throughout life, and inadequate glycemic control results in an extremely high incidence of diabetic complications, which worsens the prognosis. Patients with type 1 diabetes, which often develops during childhood and adolescence, tend to have insufficient glycemic control. I have been managing patients with type 1 diabetes for a long time, and often faced difficultly in motivating them to control blood glucose levels. I found motivational interviewing (MI) through the translation of the international guideline. MI was developed from counseling alcoholic clients, and its usefulness is recognized in a wide range of fields, including medicine, education, justice, and corrections. In MI, change talk (good remarks) was focused. The counselors in MI try to draw out the client’s change talk and aim to nurture talk toward change. With a spirit of compassion, MI guides clients in the direction of change, like dancing with them. I have experienced many positive changes in patients through learning MI. Currently, I am promoting the usefulness of MI as a trainer.

Introduction : Although osteoporosis is a well-known complication of anorexia nervosa (AN), osteomalacia is presented in a few reports. We herein describe a case of vitamin D deficiency osteomalacia related to hypophosphatemia in a patient with AN.

Case report : A woman in her 50s had a history of weight loss, with her body mass index (BMI) at one time decreasing to 10 kg/m². She was diagnosed with AN and underwent treatment as an outpatient. She began to withdraw from society and isolated herself at home. Her serum phosphorus level decreased to 0.5 mg/dl, and she was admitted to our department on an emergency basis. She was diagnosed with vitamin D deficiency osteomalacia related to hypophosphatemia. She had high bone ALP level (bone specific alkaline phosphatase〔BAP〕, 29.5 µg/l), decreased bone density (lumbar spine young adult mean〔YAM〕, 47%), increased bone scintigraphic uptake (ribs and spine), vitamin D deficiency (25 [OH] D, 5.2 ng/ml), normal fibroblast growth factor 23 (FGF 23) level (15.0 ng/ml), and normal urine. After regaining weight through nutritional therapy, supplemental vitamin D therapy, and sunbathing, the serum phosphorus and ALP levels normalized ; subsequently, she was discharged from the hospital.

Discussion : We speculate that the patient’s long-term low nutritional status and home isolation caused vitamin D deficiency osteomalacia. No serious symptoms developed because the hypophosphatemia allowed the diagnosis of the disease at an early stage. Because patients with AN are at high risk for vitamin D deficiency, the risk of osteomalacia as well as osteoporosis, should be considered.