Open Dialogue (OD) is an integrative approach to schizophrenia that has been practiced in Finland since the 1980s. In Tornio, Western Lapland, where it originated, the dialogue practice has been implemented in all mental health consultations with good results. In OD, therapists organize a treatment team to visit the client within 24 hours of receiving a phone call from the client or his/her family. The team works with the client and his/her network (family, friends, and acquaintances) in an “open dialogue”. The seven principles of dialogue include “immediate help,” “flexibility and mobility,” “psychological continuity,” and “tolerance of uncertainty”. The above basic stance of OD has many elements in common with trauma-informed care (TIC), which has been the focus of much attention in recent years. I have examined those commonalities.

We introduce Open Dialogues (OD) into lectures and practical training in psychiatric nursing at nursing training institutions, as well as efforts to practice dialogue with persons living in the community with mental disorders. Through the ‘reflecting’ experience of OD, students are able to concentrate on listening, and experience conveying their thoughts and feelings to other people. On the other hand, by gaining the perspectives of others through ‘reflecting’, participants seem to transform their negative self-perceptions, which in turn energizes them to change their behavior. Furthermore, for the students who witnessed the changes in the people involved, it became a valuable opportunity to realize the importance of strength and empowerment of the people involved, and we feel that this has had a positive impact on both parties. In the future, we intend to further promote collaboration between educational and clinical settings to support the spread and practice of OD.

We have been practicing Open Dialogue (OD) at the University of Fukui Hospital since 2019. Through learning and practicing OD, we feel that its philosophy such as “Tolerance of uncertainty” and “Being transparent (not deciding on someone’s behalf without considering their desires)” can be applied to our daily psychiatric clinical practice. In this paper, we discuss the current status, challenges, and future prospects of OD practice at our hospital.

Open Dialogue (OD) was applied at Keropudas Hospital in Finnish Western Lapland in the 1970s. In the 2000s, OD has been introduced in other countries, including Japan. OD has been developed in family therapy. Furthermore, OD has been supported by the research of many experts and psychotherapists. As I have pondered the question of what OD is, I have tried to consider the ideological background of OD, as touched on in the writings of H.S. Sullivan and D.D. Jackson. I have argued in support of Sullivan by referring to indirect assurance and selective inattention, and I have investigated the vocal element of psychotherapy, which is common to both Sullivan and Jackson.

The authors encountered dialogical practice while addressing psychiatric issues such as long-term hospitalization in a single-patient psychiatric hospital; in 2019, a multidisciplinary dialogical practice unit was created with an eye toward community transitions. Through various trials and errors, the central theme was fostering a psychotherapeutic community. Treatment meetings, based on a bi-weekly basis, were held repeatedly with the individuals concerned and others involved. As the meetings continued, all voices were valued and emotions were exchanged. During the relationships, what had been considered symptoms and problematic behaviors were reinterpreted or assigned new significance. As a result, 17 of the 35 participants were discharged to their homes and other facilities in a little more than three years. The average use of antipsychotic drugs (chlorpromazine equivalent) decreased from 954.8±712.4 mg/day (September 2019) to 621.2±349.2 mg/day (March 2023). The feasibility of psychiatric care with an awareness of the dialogical practice and the resourcefulness of the client, the family, and the treatment team was experienced.

The purpose of this study is to identify the predictors of delirium symptoms (STEP 2 Symptoms) in the DELTA program. The subjects of the study were inpatients who underwent orthopedic surgery under general anesthesia. Forty-two patients assessed as “Yes” for STEP 2 Symptoms in the DELTA Program were included in the study group. In addition, 42 patients assessed as “none” were included in the control group. We matched “sex” and retrospectively investigated the predictors of STEP 2 Symptoms. The age and standard deviation of the study group was 75.3 (10.2) years and the control group was 72.2 (8.3) years. According to binomial logistic regression analysis, the predictors of STEP 2 Symptoms were room transfer (OR 3.76, 95% CI 1.24-11.38), abnormal electrolyte (OR 3.30, 95% CI 1.14-9.57), and constipation (OR 4.13, 95% CI 1.06-16.10). Attention should be paid to abnormal electrolytes and constipation as preventive measures for postoperative delirium in the orthopedic ward. Minimizing room transfers as an environmental factor may help prevent delirium.

Introduction: For those patients with cancer who suffer from psychological distress, such as depression and anxiety, combination of psychotherapy and pharmacotherapy works effective. There are few studies explored patients’ motivation for psychotherapy. This study evaluated factors influencing the motivation for psychotherapy and determined which patients may benefit from psychotherapy in clinical settings. Method: We conducted a single-center, cross-sectional study using a self-reported questionnaire. Data were collected between 2018 and 2020 from inpatients and outpatients with advanced cancer, who completed self-report questionnaires on demographic and clinical information, motivation for psychotherapy, the Hospital Anxiety and Depression Scale (HADS), and causes of worry. A multinomial logistic regression model was used to calculate the adjusted odds ratio (OR) with 95% confidence interval (CI) for causes of worry associated with motivation for psychotherapy. A multivariate logistic regression model was performed with adjustments for all potential confounding factors. Results: Of the total 217 patients, 183 responses were included in the analysis. Worry over future prospects and counseling experience were associated with motivation for psychotherapy, with an adjusted OR of 4.185 for worry over future prospects (95%CI 1.207-14.511, p=.024) and 38.743 for counseling experience (95%CI 2.090-718.051, p=.014). Other factors were not associated with motivation for psychotherapy. Conclusion: Our study showed that worry over future prospects and counseling consultation experience may be associated with patients’ motivation for psychotherapy. Worry over future prospects may be particularly difficult for patients to resolve. Future research should consider the application of psychotherapy, taking cognizance of patients’ needs.

We report a case of alcohol use disorder (AUD) in which pellagra became apparent after an administration of niacin-free vitamins (Vit) B. A man in his 50s, while being treated for AUD, was admitted to our hospital because of fractures to his left upper extremities. Upon admission, the patient was fully conscious with normal neurological findings; however, he exhibited discolored skin extending from the neck to shoulders. He received lorazepam and VitB1, B6, and B12 to prevent alcohol withdrawal symptoms and Wernicke's encephalopathy. On the 5th day after the admission, he showed gastrointestinal symptoms such as diarrhea and ileus, and neuropsychiatric symptoms such as disorientation, hyperreflexia, and myoclonus. On the 32nd day, he was diagnosed with suspected pellagra and was subsequently treated with niacin. Several days later, his dermatitis, and gastrointestinal and neuropsychiatric symptoms improved. In this case, pellagra became apparent after the administration of VitB without niacin, and it is considered that the emergence of pellagra after vitB without niacin may be mediated by increases of 5-aminolaevulinic acid and kynurenic acid and inhibition of tryptophan-2,3-dioxygenase. Clinicians should suspect and treat pellagra when a patient with AUD displays one of three pellagra symptoms, such as impaired consciousness, dermatitis, or gastrointestinal symptoms.