Recently, the number of natural disasters, man-made disasters, COVID-19 pandemic, and various other disasters have been increasing, and the importance of mental health is being discussed. We have considered what is required of general hospital psychiatrists from various perspectives, including disaster, public health, and occupational medicine in this new era. In Japan, a country where disasters are common, hospitals must be able to provide medical care even in times of a disaster. Assuming and responding to disasters even in normal times will ultimately help hospitals, their staff, and local medical care teams. This will also lead to public mental health awareness. It is also important to maintain the perspective of occupational mental health in the hospital, especially during disasters. We believe that personnel from general hospital psychiatry departments with the knowledge and experience to deal with these issues are needed. As community leaders, it is necessary to develop leaders who can design the medium- and long-term future of community mental health care. Human resources needs to be nurtured in general hospital psychiatry departments to help contribute to the community based on multidisciplinary cooperation and collaboration.

The Public Relations Committee continues to spread the appeal of the General Hospital Psychiatry (GHP) Department through SNS, e-mail magazines, and symposium. In addition to patients and physical department staff, it is necessary to be aware of the point of view that "the public is easy to understand when undergoing medical examination" in the future. In order to continue public relations that are easy for anyone to understand, this article introduced various initiatives.

Psychiatry division in general hospitals have not been considered important from the standpoint of administrators. However, with the government's emphasis on suicide patients, perinatal psychiatry, and palliative care, and the new insured medical treatment in these areas, the status of psychiatric staff within general hospitals is expected to improve. But what about staff in a psychiatry division who have no involvement with the patients in psychiatric beds? The author therefore surveyed the current status of psychiatric departments in general hospitals without psychiatric beds throughout Japan, based on a survey conducted by the Japanese Society of General Hospital Psychiatry in 2020. The results showed that, on average, there is only one full-time psychiatrist per psychiatric department, and that the treatment resources by psychiatrists has hardly improved. Our task is to compile data on the current status of psychiatry in general hospitals that do not have psychiatric beds, and to disseminate this information widely.

I described the following attractions of general hospital psychiatry and liaison psychiatry from the perspective of a liaison nurse. Consultation liaison activities are characterized by the highly individualized nature of each case. This means that in addition to assessing the patient's mental status, we need to consider a wide range of assessment perspectives, such as social background (e.g., family relationships), relationship with the treatment team, and intentions. Consultation liaison activities are inductive in nature, making it difficult to visualize the results of these activities. In addition, stress reactions and psychiatric symptoms that emerge during the physical treatment process tend to be underestimated. However, consultation liaison activities not only have educational value for nurses, but also have a ripple effect of reducing the isolation of nurses who are confused in hospital wards and improving patients' psychiatric symptoms at an early stage.

The Junior Section of Ultimate Liaison (JSOUL) is a community of young psychiatrists involved in consultation and liaison psychiatry, with the goals of mutual improvement, promotion, and network building. Since its establishment and activities to date, JSOUL has been continuously developing through various information dissemination centering on presentations at academic conferences, steadily increasing its membership, and leading to the establishment of the Young Members Committee. The contents of the questionnaire revealed a wide variety of opinions and highly individualized attitudes of those who want to commit to its goals. We hope to continue to develop a structure that allows young psychiatrists to feel comfortable belonging to the committee and to acquire information and build a network according to their needs, while respecting the diversity of each member. We intend to continue to serve as a bridge between the Young Members Committee and the members/non-members of our society, and to enliven the society and general hospital psychiatry as a whole.

The role of the Japanese Society of General Hospital Psychiatry is extremely diverse, and recruiting young psychiatrists is considered to be one of the most important tasks. The author has been trying to convey to many young psychiatrists how rewarding liaison psychiatry is by focusing on clinical, educational, and research activities related to delirium. In this paper, the author looks back on my steps and discusses how to recruit young psychiatrists. In addition, a questionnaire survey conducted among the members of the Young Psychiatrists Committee revealed that role models are a major factor in recruiting young psychiatrists. Based on the results of this survey, I discussed the qualities required of liaison psychiatrists, including my personal opinion.

Only a few studies have described the pathological effects of IgG4-related disease (IgG4-RD) on the central nervous system. This is because the condition is relatively rare, and examining the cerebral parenchyma is difficult. Two cases of IgG4-RD patients with a chief complaint of forgetfulness are presented. I describe their clinical symptoms together with their cranial magnetic resonance imaging features, especially those seen on fluid-attenuated inversion recovery and T2* imaging. In addition, the possible pathology of this condition is discussed based on the literature. The following findings were obtained: 1) IgG4-RD can cause not only pachymeningitis and/or leptomeningitis, but also cerebral parenchymal inflammation. 2) IgG4-RD that affects the cerebral parenchyma causes cerebral small vessel vasculitis/vasculopathy in some cases, but not in other cases. 3) It is presumed that the cerebral parenchyma can also be organically damaged by the occurrence of cerebral microbleeds (CMB) caused by the rupturing of cerebral small blood vessels, especially capillaries. 4) Due to these mechanisms, IgG4-RD patients sometimes exhibit neuropsychiatric symptoms and cognitive decline. 5) As the pathogenesis of IgG4-RD-induced CMB has not been elucidated, no methods for preventing and treating IgG4-RD-induced CMB have been established. It is expected that methods for preventing/treating this condition will be developed in the future.

Diffuse neurofibrillary tangles with calcification (DNTC) is a type of non-Alzheimer’s dementia that belongs to the tauopathy disease group. There have been few reports of DNTC worldwide and less than 30 autopsy and clinical reports in Japan. The bilateral obvious calcification in the basal ganglia of DNTC, are similar to those of idiopathic basal ganglia calcification (IBGC). Differential diagnosis between DNTC and IBGC is thus difficult. We report a male patient with DNTC onset in his 50s. He first visited our clinical department in X year and was aware of forgetfulness since X-1 year. Examinations showed mild forgetfulness but no other neuropsychiatric symptoms. Simple computed tomography (CT) showed marked calcification in the bilateral basal ganglia and dentate nuclei of the cerebellum, and single-photon emission computed tomography (SPECT) showed decreased blood flow with frontal predominance. Neuropsychological examination revealed mild cognitive impairment and mild decline in frontal lobe function according to Wechsler Memory Scale-Revised (WMS-R); however, the Hasegawa Dementia Scale-Revised (HDS-R) score was 30/30. This was a solitary case. Based on the test results and clinical findings, we diagnosed early DNTC with mild memory disability. The course of the disease has progressed slowly with mild deterioration WMS-R in X+2 years; he is still able to continue working with the strong support of his colleague.

Hyperthyroidism is known to present both psychiatric and physical symptoms. Some studies suggest that hyperthyroidism may predispose patients to depression or anxiety. However, the psychological symptoms of hyperthyroidism remain unclear in elderly patients. We report a case of a 79-year-old man with Alzheimer’s disease concomitant with hyperthyroidism, who was admitted for evaluation of sudden onset of agitation and violence. He was initially treated with risperidone (2 mg/day) for agitation; however, this antipsychotic medication was ineffective. In addition to antipsychotic medication, he received mercazole (10 mg/day) for treatment of hyperthyroidism. The patient’s thyroid hormone levels returned to the normal range 2 weeks later, and his agitation diminished. We observed that hyperthyroidism caused agitation and irritability as psychiatric symptoms, and these symptoms tend to be misdiagnosed as behavioral and psychological symptoms of dementia (BPSD). In this case, an antithyroid medication was effective against agitaion. The treatment of thyroid dysfunction may often be effective in dementia patients with hyperthyroidism exhibiting psychiatric symptoms.