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Background: Along with the improved life prognosis of patients with congenital heart disease, their diverse complications have come under scrutiny. Due to the various medical restrictions attendant on their upbringing, patients with congenital heart disease often have coexisting mental disorders. However, reports of patients with congenital heart disease and coexisting eating disorders are very rare. In this paper the authors report the case of a patient who developed anorexia nervosa following surgery for Ebstein’s anomaly.Case Presentation: A 21-year-old female with Ebstein’s anomaly who underwent a Fontan surgery was transferred to our institution with suspected anorexia nervosa after a more than 2-year intermittent stay in a medical hospital for decreased appetite. Initially, she did not express a desire to lose weight or a fear of obesity, and we suspected that she was suffering from appetite loss due to a physical condition associated with the Fontan circulation. But gradually the pathology of the eating disorder became apparent.Conclusions: Patients with congenital heart disease are more likely to have a psychological background as well as physical problems that might contribute to eating disorders. Indeed, it is unclear why there are not more cases of eating disorders in association with congenital heart diseases.

Background: Prolonged grief disorder (PGD), a new category related to bereavement, is a prolongation of grief and is distinct from depression, although its symptoms such as depressive state and a strong desire to die resemble those of depression. Until the concept of PGD was raised, many clinicians did not recognize PGD and regarded it as a form of depression. Here we examined the prevalence of PGD among older inpatients with and without PGD following their bereavement, and we analyzed the patients' clinical features.Methods: We examined all depressive patients >50 years old who were admitted to the psychiatric ward of Jichi Medical University Hospital between January 2009 and December 2014. The concomitant depression with PGD was assessed based on the proposed diagnosis of persistent complex grief disorder in DSM-5 and the Brief Grief Questionnaire.Results: Twenty-eight individuals (75.7%) consented to participate. The prevalence of PGD with depression was 57.1%. All individuals had lost a close relative. Suicide death, sudden death and death from chronic disease among the deceased relatives were more frequent in the PGD group than the non-PGD group. The rate of females, somatic symptoms in a limited body area, the use of tricyclic antidepressants or tetracyclic antidepressants, and lower number of educational years were more prevalent in the PGD group compared to the non-PGD group. The mean Global Assessment of Functioning (GAF-F) score at discharge was significantly lower in the PGD group.Conclusions: PGD was prevalent in the patients with late-life depression following the death of a close relative. The development of PGD appears to be affected by both the death of a close relative and the cause of that relative's death. Clinicians should be aware of the possibility of concomitant PGD with depression, especially among older patients who respond poorly to antidepressant treatments.

Background: It is generally accepted that functional impairments are found in the course of patients with mental disorders who have exhibited vulnerability to a disaster. However, there has been no study examining post-disaster functional changes among them. The aim of the present study is to evaluate functional changes related to the 2011 Great East Japan Earthquake among patients with mental disorders living in the peripheral area of the earthquake zone, i.e., Tochigi Prefecture just adjacent to Fukushima Prefecture. Methods: A total of 612 outpatients with schizophrenic disorders (n=163), mood disorders (n=299), and neurotic disorders (n=150) were evaluated in terms of their post-disaster functional changes using the function subscale of the Global Assessment of Functioning (GAF-F) assessed before and after the 2011 Great East Japan Earthquake. Results: Seventeen percent of the subjects showed a decline of their GAF-F scores after the disaster, compared to those before the disaster. The frequencies of the declined GAF-F score were 22％ for the patients with neurotic disorders, 19％ for those with mood disorders, and 7％ for those with schizophrenic disorders with a significant difference among the 3 diagnostic groups. In 102 subjects who showed a decline of their GAF-F scores after the disaster, the net changes of the decline of the GAF-F scores after the disaster in patients with mood disorders and those with neurotic disorders were significantly greater than those in patients with schizophrenic disorders, respectively. The multivariate logistic regression analysis revealed that patients with mood disorders (F3) (OR=4.28, 95％ CI=2.03-9.02) and those with neurotic disorders (F4)(OR=4.56, 95％ CI=2.09-9.95) were more than 4 times as likely to decline their GAF-F scores after the disaster than those with schizophrenic disorders (F2). Conclusion: We found that in the peripheral area of the earthquake zone 17％ of the outpatients with mood disorders, neurotic disorders and schizophrenic disorders developed a significant functional decline after the 2011 Great East Japan Earthquake. Patients with mood disorders and neurotic disorders were more vulnerable to the disaster, compared to those with schizophrenic disorders. Close monitoring of the psychiatric conditions of individuals with mental disorders, in particular mood disorders and neurotic disorders, may be of critical importance after a major disaster.