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Original Article, Introduction: In recent years, various interventions for early stages of psychosis, such as first-episode psychosis (FEP) and an at-risk mental state for psychosis (ARMS), have been reported worldwide. Although the importance of psychosocial treatment has been emphasized, few studies have examined the effects of psychiatric day treatment for patients with early psychosis. The aim of the present study was to examine the effects of psychiatric day treatment, which is a comprehensive psychosocial service, for early psychosis. Methods: Eighty-one subjects with early psychosis (59 FEP and 22 ARMS) who regularly participated in a psychiatric day treatment service known as “Il Bosco" were consecutively recruited. The subjects underwent various clinical assessments at baseline and after 12 months. Cognitive function, psychiatric symptoms, social functioning, quality of life (QOL), global functioning, and dosage of antipsychotics at the two time points were then evaluated. Results: Significant improvements were observed in various domains, such as cognitive function, psychiatric symptoms, social functioning, QOL, and global functioning, at the follow-up time point, compared with the baseline. There were significant correlations in the frequency of attendance, with changes in memory, positive and negative symptoms, QOL, and global functioning. Conclusions: Psychiatric day treatment specific for young people with early psychosis can contribute to improvements in various clinical domains.

Original Article, Introduction: The criteria for “at-risk mental state" have been advocated as a preventive approach to psychosis treatment although their pathophysiological mechanisms remain unclear. Reliable biomarkers to predict transitions from at-risk mental state to psychosis are urgently needed. Since abnormalities in N-methyl-D-aspartate receptor co-agonists have been reported in the serum of patients with schizophrenia, several of these metabolite levels in individuals with at-risk mental state were investigated and these levels with clinical symptoms were correlated. Methods: Serum levels of glutamate, cysteine, glycine, γ-glutamylcysteine, glutathione, D-serine, and L-serine were investigated in antipsychotic-naïve individuals with attenuated psychotic symptoms (n = 28) and compared with those in antipsychotic-naïve individuals with first-episode psychosis (n = 13) and those in healthy controls (n = 41). The serum metabolite levels were measured using high-performance liquid chromatography with fluorescence detection or liquid chromatography with tandem mass spectrometry. Correlations between clinical symptoms and serum metabolite levels in individuals with at-risk mental state were also examined. Results: The glutathione and D-serine levels were significantly lower, whereas glutamate levels were significantly higher in individuals with attenuated psychotic symptoms than in healthy controls. Additionally, glutathione levels were significantly decreased in individuals with first-episode psychosis compared with those in healthy controls. In individuals with attenuated psychotic symptoms, clinical scores were not correlated with serum levels of metabolites related to the N-methyl-D-aspartate receptor. Conclusions: The results of this study suggest that abnormally altered levels of metabolites related to the N-methyl-D-aspartate receptor can already occur in individuals with attenuated psychotic symptoms.

Takashi Uchino,1,2 Takahiro Nemoto,1 Taiju Yamaguchi,1 Naoyuki Katagiri,1 Naohisa Tsujino,1 Yoshitaka Murakami,3 Kuniaki Tanaka,2 Masafumi Mizuno1 1Department of Neuropsychiatry, Toho University Graduate School of Medicine, Tokyo 143-8540, Japan; 2Tokyo Adachi Hospital, Tokyo 121-0064, Japan; 3Department of Medical Statistics, Toho University School of Medicine, Tokyo 143-8540, JapanCorrespondence: Takahiro NemotoDepartment of Neuropsychiatry, Toho University Graduate School of Medicine, 5-21-16 Omori-Nishi, Ota-ku, Tokyo 143-8540, JapanTel +81 3 37624151Fax +81 3 54715774Email takahiro.nemoto@med.toho-u.ac.jpObjective: Functional capacity, which indicates one’s ability to perform everyday living tasks, contributes to real-world functional performance in patients with schizophrenia. However, functional capacity is sometimes not comparable with functional performance in clinical settings. We hypothesized that specific personality traits are related to this capacity-performance discrepancy of functional outcome.Methods: The measures in this study were the UCSD Performance-based Skills Assessment Brief (UPSA-B) for functional capacity, the Social Functioning Scale (SFS) for functional performance, and the Temperament and Character Inventory-140 (TCI-140) for personality traits. A total of 94 stable outpatients with schizophrenia were divided into four groups based on combinations of their UPSA-B and SFS cut-off points, as follows: a high capacity and high performance (HH) group, a high capacity but low performance (HL) group, a low capacity but high performance (LH) group, and a low capacity and low performance (LL) group.Results: There were no significant differences in demographics among the four groups. The LH group showed a significantly lower harm avoidance level than the LL group. The HL group showed a significantly lower persistence level than the HH group.Conclusion: Lower harm avoidance may enhance functional performance, and lower persistence can limit functional performance, regardless of the primary levels of functional capacity in patients with schizophrenia. Novel and individualized psychosocial treatments considering the individual’s personality traits seem to be helpful for maximizing their functional performance in the community.Keywords: functional capacity, performance-based assessment, real-world functioning, social functioning, Temperament and Character Inventory

Aim: Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs. Methods: Four hundred thirteen out of 461 psychiatrists attended two 1‐day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants’ clinical knowledge of the treatment guidelines using self‐completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants’ demographics and their clinical knowledge scores. Results: The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder. Conclusion: Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants’ clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.