After the Great East Japan Earthquake, the Japanese Society of General Hospital Psychiatry planned and implemented a project to support psychiatric care in affected areas. This project is still ongoing as of October 2019 at Matsumura General Hospital in Iwaki City, Fukushima Prefecture, which was affected by many victims of the tsunami and the evacuation from the accident at the nuclear power station. In the year of the earthquake, patients from medical institutions affected by the earthquake visited the clinic, and the number of F2 and F3 patients based on ICD-10 increased temporarily. The number of F0 and F4 patients continued to increase until the following year. The population of Iwaki City has increased from the third year after the earthquake, and the number of patients returning to Iwaki City from the evacuation site has increased, thus the types of diagnosis names have increased. Five years after the earthquake, a psychiatrist at Matsumura General Hospital died suddenly of illness, and it became necessary to change the outpatient clinic system. Medical support will continue to be needed in the affected areas where the effects of evacuation from the nuclear accident and the difficulty of a shortage of doctors continue.

In Japan, advanced support systems for mental health care, such as Disaster Psychiatric Assistance Team and Disaster Mental Health Care Centers, have been established. However, there are still few reports on the role of consultation-liaison psychiatry in general hospitals immediately after disasters, and its role is not fully understood. In Miyagi Prefecture, which was devastated by a tsunami following the Great East Japan Earthquake, which occurred in 2011, many patients who were in need of emergency psychiatric care were transported to disaster-based hospitals without psychiatric departments, and the members of the medical staff were overwhelmed with their duties. Even after the mental health care teams had gathered, there were still challenges among the Disaster Medical Assistance Team, mental health care teams, psychiatric hospitals, and related organizations. Moreover, the need for psychiatric liaisons throughout the region was increasing. In Japan, where disasters occur frequently, the role of consultation-liaison psychiatry in local communities and disaster-based hospitals is expected to increase in the future. It is necessary that the staff involved in consultation-liaison psychiatry receive disaster training, considering the situation of disaster-based hospitals immediately after major disasters, and to create a system that can provide prompt support to affected communities.

The July 2018 western Japan torrential rain disaster affected many areas in Hiroshima Prefecture. With the support of DPAT secretarial staff, Yamaguchi DPAT, and Shimane DPAT, Hiroshima DPAT was established, and activities were conducted by it (57 teams, totaling 194 cases). The results of these activities were reported, and points for reflection and future issues were discussed. From the perspective of multidisciplinary cooperation, the role of general hospital psychiatrists in disaster mental health support was discussed.

Recently, as various types of disasters occur throughout Japan, the need for disaster response in general hospital psychiatric department has been pointed out. In this paper, we focus on the Emergency Medical Information System (EMIS) and the Business Continuity Plan (BCP) as the minimum knowledge psychiatric professionals involved in disaster response should have. The following is an overview of EMIS and BCP. The purpose of emergency information input of medical institutions in EMIS is to confirm the safety of the hospital itself. It is necessary to input the information reliably when a disaster occurs. In addition, by using the medical institution support status monitor, it is possible to instantly check what kind of support is being provided to the affected hospitals. The BCP is designed to rank the emergency priorities necessary to maintain hospital functions and to ensure that they are implemented along the disaster phase. The BCP is also one of the requirements for being designated as a disaster base psychiatric hospital that can also provide acute care.

Disasters, large-scale accidents and pandemics threaten our lives without warning. All over the world, disasters are not only natural but also human-made. Events where large numbers of people gather together are prone to accidents and can be the target of terrorist attacks. When a tragic incident or disaster occurs, we have made progress in dealing with it from a safety and physical point of view, but we also need to take a step forward in dealing with it from a mental point of view. It is said that the most important thing in a disaster response is to anticipate and prepare for the situation. Future responses will be affected by the coronavirus disease 2019 (COVID-19), and the risk of infection requires us to respond to large-scale events. In Japan, the Tokyo Olympics were held in 2021 in the impact of the COVID-19 pandemic, with consideration given to infection response and Expo 2025 in Osaka are coming up. The article describes the response required of the Department of General Hospital Psychiatry in anticipation of the possibility of more large-scale events to be held in Japan in the future and human-made disasters such as terrorism.

Activity restriction is a psychological difficulty often seen after cancer diagnosis, in which activities in daily life are intentionally restricted. SIP-C has been developed as a useful scale to measure activity restriction in cancer patients. However, several statistical limitations have been pointed out. This present study developed a revised version of the activity restriction scale for cancer patients (SIP-C-R), changing the Likert scale to four points from two, and tested its reliability and validity. One hundred and one cancer patients responded to SIP-C-R, QOL, and the depression scale. As a result, SIP-C-R had a two-factor structure with 11 items. The Cronbach’s α was .90, which was a sufficient value for its assessing reliability. Sufficient correlation was found with the relevant scales for demonstrating its validity. In the future, exploring relationships between SIP-CR and other psychological variables is expected to contribute to the establishment of a care method for activity restriction.

During the COVID-19 pandemic, we introduced a support system for health-care workers. Team members consist of doctors, nurses, public health nurses, and clinical psychologists. We normalized the anxiety and stress responses during the COVID-19 pandemic, enhanced self-care and care by the manager, and promoted daily meetings for peer support at work. In addition, we formed a consultation desk to deal with mental and physical care. While preparing for the next wave of COVID-19, it is necessary to continue our standard duties and maintain effective support system.

Salt poisoning is a rare but potentially fatal occurrence. In adults, it generally occurs as a result of attempted suicide by salt ingestion in the context of mental illness. Features of severe brain insult, such as intracranial hemorrhage and cerebral edema, can be observed at autopsy and are often presumed to be the cause of death. However, the clinical course remains unclear in many aspects. We report here a case of a woman in her early 40s who was being treated for depression and membranous nephropathy with antidepressants and prednisolone. She ingested 200 g salt in a suicide attempt and was emergently transferred to hospital. On arrival, she was drowsy and laboratory results revealed hypernatremia (155 mmol/L). Hypotonic fluid replacement was started. The next day her level of consciousness improved and the hypernatremia resolved. On hospital day 6, she suddenly developed subarachnoid hemorrhage due to ruptured dissecting aneurysm of the right vertebral artery. Emergent coil embolization was performed. She eventually recovered but with minor neurological sequelae. Hypernatremia from salt poisoning causes brain cell shrinkage and is thought to cause cerebrovascular rupture via wall shear stress. However, our patient developed subarachnoid hemorrhage even after hypernatremia had resolved. Little is known about the clinical course of salt poisoning, and therefore even after consciousness has improved and hypernatremia has resolved, the risk of physical catastrophe should rightly be overestimated and special attention to management is needed to forestall further physical complications.

Pellagra is a disease caused by niacin deficiency. Its main symptoms are referred to as the “three Ds”, dermatitis, diarrhea, and dementia. However, this disease is rare because food is available in abundance, and many food items include niacin. Here, we report a case of a female with anorexia nervosa and chronic alcohol intake who was diagnosed with pellagra. Pellagra is easily treatable with niacin therapy (100-300mg/day orally or via an injection). Dermatitis, diarrhea, and dementia are not specific symptom for pellagra, so patients who suffer from anorexia nervosa or chronic alcohol intake should be examined carefully in order to rule out pellagra.