Pregnancy is one of the major life events in any woman's life. The process of transitioning to motherhood involves various changes in psychological, social, and biological domains. Pregnancy is known to cause the recurrence or deterioration of symptoms in women with psychiatric disorders. Therefore, intensive and extensive interventions are required for the perinatal management of patients with psychiatric disorders. We herein described our prospective non-randomized trial on an interprofessional collaborative intervention for pregnant women with psychiatric disorders during the perinatal period and reviewed related studies. Our intervention consisted of 4 processes: 1) psychoeducation, 2) support for risk-benefit decision making regarding drug treatments during pregnancy and lactation, 3) management of social support, and 4) parenting skills training. In order to evaluate the effectiveness of the intervention, several instruments were used to measure pre- and post-intervention outcomes during the perinatal period and 1 month after delivery, including the Hospital Anxiety and Depression Scale (HADS), Self-Rating Depression Scale (SDS), Global Assessment of Functioning Scale (GAFS), and Brief Psychiatric Rating Scale (BPRS).

To identify and manage problems relating to pregnant women with psychiatric disorders, we reviewed the clinical records of 30 pregnant women who gave birth at our hospital between January 2011 and October 2014. The most common major psychiatric disorder was depression (10 cases), followed by 5 cases each of panic disorder and schizophrenia. Of 30 cases, 20 were in need of medication. Most births resulted in a good outcome, with only 2 cases of late preterm delivery and 4 cases of controlled gestational diabetes mellitus. There were no malformations and only one baby was diagnosed with neonatal poor adaptation syndrome, which resolved without treatment. Their psychiatric disorders were generally stable, suggesting that where a psychiatric disorder is well managed, perinatal outcome will largely turn out well. However, in many cases there were problems in child rearing. Mothers were offered support, including pre-pregnancy counseling, counseling provided by medical social workers to provide information about social support, and counseling by a clinical psychotherapist. Provision of perinatal care for women with psychiatric disorders, particularly regarding support with child rearing, requires the cooperation of multiple clinical professionals. In future, it will be necessary that greater cooperation among regional healthcare services during long-term follow up of such women.

Psychiatric problems such as puerperal psychosis, perinatal depression, and psychogenic conditions due to obstetric complications, infant admission, and perinatal loss, have been reported to occur during the perinatal period. Psychiatric problems that occur before pregnancy can be detected by the medical staff. It is useful to detect the risk factors of mental health problems during the perinatal period so as to identify women ‘at high risk’ and intervene preventively. A multidisciplinary approach is required for promoting perinatal mental health. The role of psychiatrists is to make appropriate diagnoses, administer prompt treatment, promote psychoeducation, encourage child rearing, be involved in multi-disciplinary team management, and render technical and emotional support to the staff.

Early intervention to help mothers incapable of child rearing has recently become one of the most important issues in maternal and child health. For the purpose of preventing failure to child rearing and encouraging attachment between the mother and child, we created a system to foster sustained cooperation between psychiatric services and maternal and child health sectors. We realized that it would be necessary to resolve some issues so that psychiatric physicians may take responsibility for the system. One of these issues is the lack of understanding in regard to child-rearing support and another is the issue of privacy protection in relation to personal medical data.

Since Olds and Miller discovered the space preference phenomenon and related brain structures in 1952, the so-called pleasure center or reward system was identified during animal experiments to test brain function by self-stimulation. Due to advances in brain imaging technology, a large body of evidence now indicates that addiction is a disease of the brain. Thereafter, substance dependence was determined to be closely related with the reward system and parts of the prefrontal cortex. Recent studies in behavioral addiction, such as pathological gambling and internet gaming disorder, demonstrated that the neural substrate for cue-induced craving is similar to that of cue-induced craving in substance dependence. These substrates include the orbitofrontal and dorsolateral prefrontal cortices, the nucleus accumbens, the cingulate cortex, and the caudate nucleus, suggesting that substance and behavioral addiction could share the same neuropathophysiology. Based on this neuroscientific evidence, we developed education materials to prevent addiction. The basic concepts of addiction, including craving, withdrawal and tolerance, loss of impulse control, and social or occupational dysfunction are explained in the material based on results from neuroscience studies In additional, a legislative bill to prevent, manage, and treat addiction was introduced in 2013, regardless of the debate and controversy in Korea. The education material and bill will be helpful to understand and manage patients suffering from addiction.

The objective of this study was to investigate changes in sociodemographics, clinical features, and responses of patients who attempted suicide using psychotropic medications after the placement of a psychiatric social worker (PSW) at the emergency department. We retrospectively analyzed the medical records of 499 patients (117 males, 382 females) who attempted suicide and who had been admitted to and were treated at the Kitasato University Hospital Emergency Medical Center between January 2009 and December 2013. We examined and compared the sociodemographic and clinical data of all patients before and after the PSW placement. After the PSW placement, the proportion of patients with unknown work, psychiatric diagnosis, and/or suicide attempt history data, which are essential clinical features required for psychiatric evaluation and risk assessment, was reduced. The proportion of discharged patients decreased, whereas that of transferred patients increased; however, no difference was found in the number of stays at the emergency department before and after the PSW placement. We found that the variation in the Lethality of Suicide Attempt Rating Scale (LSARS) score in transferred patients decreased, and patients with higher LSARS scores were properly transferred to other hospitals by the PSW. These findings suggested that psychosocial interventions by the PSW were effective in preventing subsequent suicidal behaviors in patients attempting suicide with psychotropic medications.