pneumonia, and seven with others. The liaison team intervened during the same period.There was no significant difference in mortality between the COV-pd and non-COV-pd groups. This result is surprising since from the significant differences in the rates of endotracheal intubation, ICU admission, and transvenous sedative use, it can be inferred that pneumonia was more severe in the COV-pd group.The COV-pd group also had a lower mean age and significantly higher rates of behavioral restrictions, including the use of physical restraints, and oral benzodiazepines, such as lorazepam. The non-COV-pd group had a 100% rate of comorbidities (Table 1) and significantly higher score on the Carlson Comorbidity Index (CCI). 2 To compare the severity of the comorbidities between the two groups, the CCI was calculated using records from the Japanese Diagnosis Procedure Combination data. 3 Patients in the COV-pd group were younger, had critical complications, including COVID-19 encephalopathy, more severe pneumonia, and a higher percentage of them were behaviorally restricted; whereas, the non-COV-pd patients were older, had more chronic diseases, and they had a higher score on the CCI. COVID-19 pneumonia is more likely to cause delirium due to the severity of the pneumonia itself, COVID-19 encephalopathy, and behavioral restrictions. Therefore, successful acute treatment of COVID-19 pneumonia will improve pneumonia itself and complications and reduce behavioral restrictions, resulting in improvement of delirium. However, this is limited by the fact that pneumonia patients without delirium have not been studied. Also, our hospital accepts all patients without refusal, which may have led to the admission of more patients with COVID-19 severe pneumonia and delirium. As a single-center study, our results are limited by the fact that the severity of delirium varies with the severity of patients admitted to the hospital.The liaison team intervened in 10 patients (nine males and one female; mean age, 66.3 AE 11.4 years [range, 40-83 years]) with delirium associated with COVID-19 encephalopathy; their delirium was overlooked in the early stages of treatment because the symptoms of pneumonia required immediate intervention. The frequency of COVID-19 encephalopathy varies from 36.4 to 82.3% and is responsible for delirium, disturbed consciousness, epileptic seizures, and syncope. 4,5 Patients in the COV-pd group received more behavioral restrictions, either quarantine to the isolation ward or physical restraints, or both, than patients in the non-COV-pd group. Physical restraints are usually used to prevent medical accidents, such as falls and stumbles, and to protect patient safety. Physical restraints may also have to be used in cases of COVID-19 delirium to prevent the spread of infection, which has been reported to increase in hospitals that have COVID-19 patients, 6 but they exacerbate delirium.Mortality was not significantly different between the two groups; however, the COV-pd group showed more severe pneumonia and a higher c...

Background: Obsessive-compulsive disorder (OCD) is often resistant to treatment and may be complicated by tardive dystonia (TDt) with the use of neuroleptics. Furthermore, patients with TDt often have an inadequate response to pharmacotherapy. Although electroconvulsive therapy (ECT) is considered a common treatment option for both TDt and OCD, its efficacy has not been well established for either condition.Case Presentation: Our case was a 37-year-old Japanese woman who showed improvement in both refractory TDt and severe OCD following ECT. A total of 12 ECT sessions resulted in an improvement in both diseases. To the best of our knowledge, this is the first report of a case in which ECT was effective for both TDt and OCD. Conclusion:Our report highlights the following two points: when TDt is associated with severe OCD, and the effect of pharmacotherapy is inadequate, ECT may be considered as a treatment option; given the common mechanism of frontal cortex-basal dysfunction reported in both dystonia and OCD, ECT may have an effect on this pathway.

BACKGROUND B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/cHL), also referred to as gray zone lymphoma (GZL), is known to share features with cHL and DLBCL. However, GZL is often difficult to diagnose. There is no consensus regarding the optimal therapeutic regimen. Most reported cases of GZL have been in Caucasian and Hispanic individuals, and its incidence is lower in African-American and Asian populations, including the Japanese population. CASE SUMMARY A 69-year-old female presented at our hospital with a growing mass on the right side of her neck. An elastic, soft mass measuring 9 cm × 6 cm was palpable in the right cervical region. Laboratory analyses showed pancytopenia, increased serum lactate dehydrogenase levels, and markedly increased levels of soluble interleukin-2 receptor. Enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography (PET)/CT revealed multiple lesions throughout her body. She was diagnosed with GZL based on the characteristic pathological findings, the immunophenotype [CD20+, PAX5+, OCT2+/BOB1 (focal+), CD30+, CD15-], and the strong positive expression of neoplastic programmed cell death protein ligand 1 (PD-L1) in her lymphoma cells. The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma. The patient received cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (R-CHOP) chemotherapy because the tumor cells were CD20+. She has remained in complete remission for 3 years. CONCLUSION GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity. R-CHOP chemotherapy was an effective treatment.