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BACKGROUND Although some studies have described the association between serum ferritin levels and specific disorders in child and adolescent psychiatry, few have focused on mental health with low serum ferritin levels in children and adolescents. This study examined the effects of iron administration on psychological state of children and adolescents with reduced serum ferritin concentration. METHODS This prospective study evaluated 19 participants aged 6-15 years with serum ferritin levels

Nocturnal enuresis (NE) is a syndrome associated with abnormal nocturnal urine production, urination mechanism, and sleep arousal. NE is strongly associated with attention-deficit/hyperactivity disorder (ADHD), and it has been reported that NE occurs in approximately 30% of children with ADHD. There have been several reports on the efficacy of atomoxetine as treatment for NE with ADHD, while the efficacy of guanfacine is still limited. We report our experience of treating an 10-year-old girl with NE with ADHD with a single dose of guanfacine. The patient first visited our hospital because of difficulty concentrating, restlessness at home and school, and nocturnal incontinence. She was diagnosed with NE with ADHD based on a review of her personal history from her mother. Her NE symptoms improved with guanfacine monotherapy (1 mg/day. The patient weighed 28 kg).

While the WHO has already published its mental health and psychosocial considerations during the COVID-19 outbreak, there has been almost no discussion of the specific measures that healthcare institutions should take with regard to the mental health of healthcare practitioners. We would like to take this occasion to propose a perspective on this matter from research on social support. Social support can be classified in various ways such as informational, appraisal, instrumental, and emotional. When battling an unknown virus such as this one, having correct informational support is necessary above all else. It is also important that appropriate evaluation for the contribution of practitioners in the institutions as appraisal support. Instrumental support, meanwhile, refers to guaranteeing a system where practitioners can get adequate rest and not excessively strain themselves, and emotional support is when practitioners are shown adequate understanding and appreciation by those around them. There is another view that categorizes social support by how it is given and received: received support and perceived support. It is important for practitioners to receive perceived support, because perceived support is confirmed to have a positive effect on physical and mental health. For the sake of the physical and mental health of healthcare practitioners, it is important for healthcare sites and organizations to take social support into account and for healthcare institutions to adopt the perspective of social support in their day-to-day operations.

Background: Few studies on gender-based diagnostic characteristics of adolescent suicide attempters in emergency departments (EDs) have included individuals with autism spectrum disorder (ASD). Objective: This study aimed to examine the clinical features of adolescent suicide attempts in EDs, focusing on gender differences and considering individuals with ASD. Method: Ninety-four adolescent patients, aged less than 20 years, who had attempted suicide and had been hospitalized in an emergency department, participated in this study. Psychiatric diagnoses according to DSM-IV criteria and clinical features were compared between male and female patients. Results: The number (%) of males was 15 (16.0), and that of females was 79 (84.0). The mean age (SD) of males was 17.1 (1.5), and that of females was 16.9 (1.6). The attempt methods were more serious, length of stay in the emergency room longer, and rate of outpatient treatment lower in males. In addition, suicide attempters with ASD were significantly more frequent in male. Adjusting for age and gender, adjustment disorder was significantly associated with the presence of suicide attempters with ASD using a multivariable logistic regression. Conclusion: Males were less likely to visit psychiatric service previous to attempting suicides, and may be likely to complete suicides. In addition, suicide attempters with ASD are characteristic in male, and likely to have comorbid adjustment disorder. ED visits offer a window of opportunity to provide suicide prevention interventions for adolescents, and therefore, psychiatrists in EDs have a crucial role as gatekeepers of preventing suicide reattempts, especially in adolescent males including individuals with ASD having adjustment disorder.

Introduction The current study sought to compare the treatment continuation rates of asenapine and brexpiprazole while specifically investigating the factors influencing this index and the clinical efficacy of brexpiprazole. Methods Retrospective study on patients with schizophrenia who were prescribed either asenapine (n = 73) or brexpiprazole (n = 136), as part of their routine medical care. Results The treatment continuation rates for asenapine and brexpiprazole were 19.0% and 38.6% at 52 weeks, with that of brexpiprazole found to be significantly higher than that of asenapine (p = .002). Moreover, age was found to be a significant factor affecting the treatment continuation rate for brexpiprazole (p = .03). Additionally, patients with a longer continuation duration had significantly lower Clinical Global Impression‐Severity of Illness (CGI‐S) scale scores compared to those who discontinued early (p = .04). The continuation rate was also significantly higher for those who began using the drug as outpatients compared to those first administered the drug as inpatients (p = .04). Furthermore, disease duration, CGI‐S scale, and continuation duration significantly affected the clinical efficacy of brexipiprazole (p, This retrospective study sought to compare the treatment continuation rates of asenapine and brexpiprazole while examining the specific factors that affect both the continuation rates and clinical efficacy of brexpiprazole in patients with schizophrenia. Results show that brexpiprazole had a significantly higher treatment continuation rate compared to asenapine. Moreover, patients who were older, had a lower CGI‐severity of illness score, and those for whom the drug was initiated as an outpatient, had a higher continuation rate. Meanwhile, disease duration, CGI‐S scale, and continuation duration all significantly affected the clinical efficacy of brexpiprazole.

Additional file 2. Factors affecting ABC-J irritability subscale.

Additional file 3. Patient distribution of CGI-I and CGI-S score.

Additional file 4. Changes from baseline in height, weight and BMI.

Additional file 1. Treatment continuation rate (Kaplan-Meier plot).

Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke.Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS).Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke.The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.

Recent reports have indicated that gut microbiota modulates the responses to stress through the microbiota-gut-brain axis in mice, suggesting a connection between gut microbiota and brain function. We hypothesized that the gut microbiota early in life would have an effect on aggressiveness, and examined how gut microbiota affect aggressive behaviors in mice. BALB/c mice were housed in germ-free (GF) and ex-germ-free (Ex-GF) isolators. An aggression test was performed between castrated and a non-castrated mice at 8 weeks of age; the mice were allowed to confront each other for 10 min in strictly contamination-free environments. To evaluate aggressive behavior related to gut microbiota, we orally administered diluted Ex-GF mouse feces to the offspring of GF mice at 0, 6, and 10 weeks. GF mice showed more aggression than Ex-GF mice. Furthermore, GF mice who were administered feces of the Ex-GF group at 0-week-old were less aggressive than the GF mice. These findings suggested that the gut microbiota in the early stages of development was likely to have an effect on aggressiveness. Maintenance of healthy gut microbiota early in life can affect the mitigation of aggressive behavioral characteristics throughout the lifetime.

In this study, the serum metabolic profiles of 10 female patients with restricting type anorexia nervosa (ANR) were compared to those of 10 age-matched healthy female controls. While the levels of amino acids were lower among the patients than among the controls, the levels of uremic toxins, including p-cresyl sulfate (PCS), indole-3-acetic acid, and phenyl sulfate, were higher in ANR patients. The serum PCS levels correlated positively with the abundance of the Clostridium coccoides group or the C. leptum subgroup in the feces of patients, but not in those of controls. Collectively, these results indicate that the serum metabolic profiles of patients with ANR differ from those of healthy women in terms of both decreased amino acid levels and increased uremic toxins. Gut microbes including C. coccoides or C. leptum may be involved in such an increase in uremic toxins.

Serum ferritin is an iron-binding protein and is the target of the most sensitive and specific tests used for the identification of iron deficiency.1,2 In recent years, serum ferritin levels

The condition of periodic psychosis of adolescence based on the clinical features of recurrent depressive symptoms, sub-stupor, and psychotic symptoms whose features return to a normal state within 2 weeks with no residual symptoms has been often seen during adolescence. However, international recognition of periodic psychosis of adolescence is low and the condition is not recognized as an independent disease in ICD-10 or DSM-5. We presented a case report of a depressive episode central to periodic psychosis of adolescence in a 16-year old female. The symptoms presented in the case correspond to the DSM-5 classification of premenstrual dysphoric disorder. However, a diagnosis of periodic psychosis of adolescence was made due to the presence of clinical features of victim mentality, increased irritability, suicidal ideations, and changes in consciousness over short periods of time and sub-stupor. This report was focused on the medical treatment of the episode of periodic psychosis of adolescence with the aim of verifying its current significance.

Anorexia nervosa (AN) results in gut dysbiosis, but whether the dysbiosis contributes to AN-specific pathologies such as poor weight gain and neuropsychiatric abnormalities remains unclear. To address this, germ-free mice were reconstituted with the microbiota of four patients with restricting-type AN (gAN mice) and four healthy control individuals (gHC mice). The effects of gut microbes on weight gain and behavioral characteristics were examined. Fecal microbial profiles in recipient gnotobiotic mice were clustered with those of the human donors. Compared with gHC mice, gAN mice showed a decrease in body weight gain, concomitant with reduced food intake. Food efficiency ratio (body weight gain/food intake) was also significantly lower in gAN mice than in gHC mice, suggesting that decreased appetite as well as the capacity to convert ingested food to unit of body substance may contribute to poor weight gain. Both anxiety-related behavior measured by open-field tests and compulsive behavior measured by a marble-burying test were increased only in gAN mice but not in gHC mice. Serotonin levels in the brain stem of gAN mice were lower than those in the brain stem of gHC mice. Moreover, the genus Bacteroides showed the highest correlation with the number of buried marbles among all genera identified. Administration of Bacteroides vulgatus reversed compulsive behavior but failed to exert any substantial effect on body weight. Collectively, these results indicate that AN-specific dysbiosis may contribute to both poor weight gain and mental disorders in patients with AN.

It was previously established that anorexia nervosa (AN) results in gut dysbiosis; however, whether this can actually contribute to AN-specific pathologies such as poor weight gain and neuropsychiatric abnormalities remains unclear. Therefore, germ-free mice were reconstituted with the microbiota of anorexia nervosa restricting-type patients (gAN mice) and healthy control individuals (gHC mice), and the effects of gut microbes on weight gain and behavioral characteristics were examined. Fecal microbial profiles in recipient gnotobiotic mice clustered with those of the human donors. Despite no difference in food intake between the two groups, body weight gain was impaired in gAN mice. In addition, anxiety-related behavior was increased only in gAN mice compared to that in corresponding gHC animals, and this phenotype was reversed through the administration of Bacteroides vulgatus. Collectively, these results indicate that AN-specific dysbiosis might contribute to both poor weight gain and mental disorders identified in AN patients.

Background: Schizophrenia is a chronic disease that requires long-term management with antipsychotics. Antipsychotic drugs are given by tapering their dose, extending the dosing interval, and so on, as part of a treatment strategy to minimize the adverse effects while at the same time maintaining efficacy. Methods: We report the case of one patient with schizophrenia in whom the clinical symptoms were alleviated after treatment with 6 mg paliperidone. However, the patient developed extrapyramidal syndrome, for which 3 and 6 mg paliperidone were administered alternately every other day. Extrapyramidal syndrome was assessed using the Drug-Induced Extrapyramidal Symptoms Scale, Abnormal Involuntary Movement Scale, or Barnes Akathisia Scale. Results: There was improvement in Drug-Induced Extrapyramidal Symptoms Scale score and Abnormal Involuntary Movement Scale score. However, there was almost no change in the Positive and Negative Syndrome Scale total score, positive score, negative score, or general score. Conclusion: The results indicate the possibility of lessened adverse effects as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day in the maintenance phase.

Objective We investigated the relationship between the plasma concentration of paliperidone (PAL) and clinical and drug-induced extrapyramidal symptoms (EPS) in elderly patients with schizophrenia. Methods In this study, 15 patients with schizophrenia receiving risperidone were switched to PAL and treated for 12 weeks. Their clinical symptoms were assessed using the Positive and Negative Syndrome Scale and the Clinical Global Impression-Severity of Illness Scale. Their EPS were assessed using the Drug-induced EPS Scale, Abnormal Involuntary Movement Scale, and Barnes Akathisia Scale at baseline and 12 weeks. Plasma concentrations were measured by the liquid chromatography-mass spectrometry/mass spectrometry method. Results The results revealed that there were significant correlations between the plasma concentration of PAL and improved Positive and Negative Syndrome Scale total, negative, and general psychopathology scores (p

Objective Apathy occurs frequently following stroke and prior studies have demonstrated the negative effect of apathy on recovery from stroke. This study was a secondary analysis examining the efficacy of escitalopram, problem-solving therapy (PST), or placebo administered for 1 year to prevent the onset of apathy among patients with recent stroke. Methods Patients within 3 months of an index stroke who did not meet DSM-IV diagnostic criteria for major or minor depression and who did not have a serious comorbid physical illness were enrolled. Patients were recruited from three sites: University of Iowa, University of Chicago, and Burke Rehabilitation Hospital. One hundred fifty-four patients without evidence of apathy at initial evaluation were included in the randomized controlled trial using escitalopram (10 mg patients ≤65 years; 5 mg patients >65 years) (N = 51) or placebo (N = 47) or non-blinded PST (12 total sessions) (N = 56) over 1 year. At 3, 6, 9, and 12 months, patients were assessed for diagnosis and severity of apathy using the Apathy Scale. Results Using a Cox proportional hazards model of time to onset of apathy, participants given placebo were 3.47 times more likely to develop apathy than patients given escitalopram and 1.84 times more likely to develop apathy than patients given PST after controlling for age, sex, cognitive impairment, and diabetes mellitus status (adjusted hazard ratio: 3.47, 95% CI: 1.79–6.73 [escitalopram group]; adjusted hazard ratio: 1.84, 95% CI: 1.21–2.80 [PST group]). Conclusion Escitalopram or PST was significantly more effective in preventing new onset of apathy following stroke compared with placebo.

Aim We investigated the clinical efficacy and safety of switching to paliperidone (PAL) in elderly schizophrenia patients receiving risperidone. Methods The subjects were 27 inpatients who had been diagnosed with schizophrenia according to the DSM-IV. The patient's clinical symptoms were assessed using the Positive and Negative Syndrome Scale and the Clinical Global Impression-Severity of Illness Scale, and their safety was assessed using the Drug-induced Extrapyramidal Symptoms Scale, bodyweight, body mass index, and laboratory tests. We also investigated patient satisfaction using the Drug Attitude Inventory, a subjective outcome measure. Results No significant differences in clinical symptom improvement efficacy were seen between the PAL-switching group and the control group. The mean changes from baseline on the Drug-induced Extrapyramidal Symptoms Scale total score, Drug Attitude Inventory score, and prolactin level were significantly greater in the PAL-switching group than in the control group. Furthermore, patients with PAL needed less biperiden, even though they had similar risperidone-equivalent daily dosages to the control group. Conclusions The results of this study suggest that switching elderly patients from risperidone to PAL may result in superior safety and patient satisfaction, and may also make it possible to reduce the dosage of biperiden.

The objective of this study was to investigate the frequency and clinical features of suicide attempts in adults with autism spectrum disorders (ASDs).We enrolled 587 consecutive patients aged 18 or over who attempted suicide and were hospitalized for inpatient treatment. Psychiatric diagnoses, suicide attempt frequency and clinical features were compared between ASD and non-ASD patients.Forty-three (7.3%) of the 587 subjects who attempted suicide had ASDs. The incidence of patients with mood disorders was significantly lower (Fisher's Exact Test, P=.043) and that of those with an adjustment disorder was significantly higher (Fisher's Exact Test, P.001) in the ASD group than in the non-ASD group. The average length of stay at both the hospital and intensive care unit in the ASD group was longer than that in the non-ASD group (z=-2.031, P=.042; z=-2.322, P=.020, respectively).ASDs should always be a consideration when dealing with suicide attempts in adults at the emergency room.