It is vital to provide mental health care for medical personnel who respond to new coronavirus infections (COVID-19) variants. The Self-Defense Forces Central Hospital has been engaged in COVID-19 treatment since its early stages (February 2020). Furthermore, in addition to regular clinical care, the Self-Defense Forces Tokyo Large-Scale Vaccination Center operated from May to November 2021. It provided mental health care for the personnel since February 2020, such as setting up a consultation counter, having psychiatric psychology staff visit the hospital and vaccination center to talk to and hear from personnel, introducing counseling, and reflecting on issues and requests to hospital management. Moreover, regular mental health checkups were conducted for the personnel, counseling those with high scores. Mental health checkups were conducted in May 2020 (#1), December 2020 (#2), and August 2021 (#3) for approximately 930 personnel of the hospital. Comparing the response and non-response groups of the COVID-19 patients, the rate of high Kessler 10 scorers was significantly higher in the response group in #1. However, there was no significant difference in #2 and #3. Throughout #1–#3, 80% of the personnel responded that they felt rewarded, suggesting that the mental health care provided was impactful.

Tokyo Medical and Dental University Hospital was one of the first hospitals to start accepting COVID-19 patients, and accordingly, has been working on mental health care for medical personnel from early on. A mental health care team (MHC team) was formed by the Department of Psychiatry, the Department of Palliative Care, the Nursing Department, and the Health Management Center, who divided roles and activities among themselves. The main activities of the team were to watch a video on the impact of COVID-19 on the mental health of all the employees of the hospital, to screen their mental status, and to interview them. The problems identified through these activities were addressed individually and communicated to the hospital command center to promote information sharing throughout the hospital. In addition to facilitating the identification and communication of problems, this project also resulted in various positive changes, such as the promotion of more active communication within the hospital, and increased motivation through the demonstrations of expertise of each profession. At the same time, certain issues became apparent as a result of the prolonged process. Hence, we plan to continue with these activities in the future.

The COVID-19 pandemic has dramatically changed our daily life. In paticular, it has had a huge impact on healthcare workers. Healthcare workers on the front line who have dedicatedly worked at high risk of infection were featured in TV very frequently. Although the author has treated COVID-19 patients in an ICU of Tokyo Metropolitan Bokutoh Hospital, these scenes were different from the author’s own experience. I have felt something strange with the word “healthcare worker’s stress” used on TV show. Herein, an interview with nurses and doctors was conducted to clarify real world stress experiences in this hospital. In this article, the author’s own experience together with private opinions from the colleagues through the interview is described. Furthermore, working environments in which healthcare providers can work without too much stress are discussed.

Lack of insight is a severe problem among patients with schizophrenia, who may not acknowledge their illness or the need for treatment. Insight deficits are associated with high hospital readmission rates, which are also related to various clinical symptoms, such as paranoid delusions, loss of abstractive ability or attitude, and reduced social contact. Psychosocial interventions are known to be effective treatments for insight deficits in patients with schizophrenia. Previous studies have shown that, in collaboration with clinicians, mental health nurses can support the psychosocial intervention framework for managing patients with schizophrenia with psychotic symptoms. In the present article, we provide a comprehensive review of studies on psychosocial interventions by nurses that aimed to identify effective treatments for lack of insight in patients with schizophrenia. We conducted an electronic search of PubMed, CINAHL, Ichushi Web, and PsycINFO for articles published from 2004 to 2020 using the following keywords: “insight,” “denial,” “self-awareness,” “treatment,” “intervention,” “schizophrenia,” “psychosis,” and “nursing.” The present research revealed that four psychological education sessions had been conducted in Japan, all of which showed improved insight. Furthermore, various intervention methods, intervention periods, and evaluation scales have been implemented outside of Japan, and effects were recognized in all these 14 studies. Moreover, intervention by nurses particularly impacted the improvement of insight, which suggests that the intervention led to reduced readmission rates via a better medication adherence.

Saitama Medical Center, Saitama Medical University is a general hospital and which has been providing care for Coronavirus 2019 (COVID-19) disease since April 2020. In the department of psychiatry, a consultation liaison team is conducting a questionnaire survey on the psychological burden of medical healthcare workers associated with accepting COVID-19 patients, and we will report the results for the period from April to September 2020. The response rate was 55.6%. The severity of depression and the experience of stress associated with the specialty ward were significantly associated, and the severity of anxiety and the experience of stress associated with the specialty ward and the presence of family members living together were significantly related. In addition, in the group which was aware of work-related stress, the proportion of those who consciously dealt with stress was significantly higher than that in the non-stress group. As a response to COVID-19 medical care, which is expected to continue in the long term, it is necessary to build a mental health support system while taking into consideration the impact of psychosocial problems on medical healthcare workers.

This study aimed to determine whether patients with heart failure suffering from insomnia were appropriately supported by their healthcare providers. A Web-based survey of patients with heart failure aged ≧20 was conducted to assess their experiences and the effectiveness of consulting a healthcare professional about insomnia. Of the 296 participants with insomnia, 175 (59.1%) had sought help for their insomnia: 145 (49%) consulted an internal medicine physician; 101 (34.1%), an internal medicine nurse; 105 (35.5%), a psychiatrists or a psychosomatic medicine physician; 62 (20.9%), a psychologist; and 75 (25.3%), rehabilitation staff. However, only about half of them found it to be effective. The most common reasons for finding their consultation helpful were "advice on sleep," "prescribed medication,” and “providing a sense of relief." On the other hand, "advice on sleep" and "prescribed medication" were also included in the reasons why consultation was not helpful. Those who had not consulted their health professional expressed reasons such as "not considering insomnia as important or a problem," "not knowing whom to consult," and "not believing that a consultation would solve the problem," possibly because they were unaware of the harmful effects of insomnia on patients with heart failure and how effective clinical consultations were. It seems that medical professionals ought to acquire appropriate knowledge regarding insomnia and provide support according to the expertise of each profession.

Despite all available treatments, one-third of the population with depression is inadequately relieved of their condition, and approaches for patients with such treatment resistance depression have become an issue of vital importance. This study reports the case of a patient who had repeated depression and difficulty in drug treatment in whom quetiapine extended release (QTP-XR) was notably effective. A male patient in his 70s developed depression 2 years prior to presentation. Several antidepressants, including mirtazapine, venlafaxine, escitalopram, aripiprazole, and olanzapine, were administered, but his condition did not improve; as a result, his depressed mood occurred repeatedly. When he was admitted for the third time for a depressed mood relapse, QTP-XR was administered for treatment resistance depression in which drug treatment was difficult and m-ECT was repeated. He was discharged from the hospital without m-ECT. Consequently, it proved to be effective in relieving his condition and he was subsequently discharged. Therefore, QTP-XR is a potentially effective drug for the treatment of intractable depression for which drug treatment is usually difficult.

Nonconvulsive status epilepticus (NCSE) is often difficult to differentiate from psychiatric symptoms. Clinicians should consider NCSE when a patient with history of seizure has acute-onset psychiatric symptoms or bizarre behavior. Electroencephalography (EEG) is essential to diagnose NCSE. However, it is difficult to use EEG in all cases suspected. The term “100 countdown” means asking a patient to count backwards from 100 by ones and is a useful and simple bedside examination technique to detect a slightly altered state of consciousness. We report a case in which 100 countdown and emergency EEG were effective to detect and treat NCSE.

An accepting and supporting attitude is fundamental to psychotherapy for cancer patients. In addition, cognitive correction may be effective, although it can be difficult due to denial and other factors. Furthermore, characteristic psycho-oncologic methods, such as Meaning Centered Psychotherapy and Dignity Therapy, are important for existential pain. Moreover, when it comes to the terminal stage of a patient, consideration of even the "unconscious domain" of the patient, family, and the therapist himself may be required, and this can be considered in dynamic psychiatric (psychoanalytic) terms. Apart from early analysis of Freudian neuroses, in general, psychoanalysis may not be well known. Since Freud, psychoanalysis has developed and diverged in various ways, and it is important for patients with advanced cancer to embrace it and be supported in the manner of Winnicott to provide a sense of security. The healer then ponders deeply what is occurring both in their and the patient’s mind. Here I review the treatment process of cancer patient A and the process applied to support the family, of which I was in charge, and examined it in psycho-oncologic and psychoanalytic terms.