Impact of behavioral/developmental disorders comorbid with conduct disorder

Aims: The aim of the present study was to verify the comorbidity of conduct disorder (CD) and behavioral/developmental disorders in children and adolescents, and to examine the traits of CD comorbid with them. Methods: Subjects were 64 children (60 boys, four girls) who were resident at three institutions for delinquent children or who were conduct-disordered outpatients of a university hospital aged under 18 years. A diagnostic interview was carried out by experienced child psychiatrists and the intelligence score and the Adverse Childhood Experiences score were measured by a licensed psychologist. Results: A total of 57 children were diagnosed as having CD, of whom 26 (45.6%) were diagnosed with comorbid attention-deficit-hyperactivity disorder (ADHD), 12 were diagnosed with comorbid pervasive developmental disorder (PDD, 21,1%), and 19 (33.3%) had no comorbidity of either disorder. Six children (18.8% of CD comorbid with ADHD) met the criteria for both ADHD and PDD. The group with comorbid PDD was significantly younger at onset (F = 6.51, P = 0.003) and included unsocialized type more frequently (KH2 = 6.66, P = 0.036) compared with the other two groups. Conclusions: Clinicians should be aware that not only ADHD but also PDD may be comorbid with CD. Establishment of the correct diagnosis is important because recognizing the presence of PDD will enable us to provide appropriate treatment and guidance, which may improve prognosis.ArticlePSYCHIATRY AND CLINICAL NEUROSCIENCES. 63(6):762-768 (2009)journal articl

Association between Public Assistance and Frequent Emergency Department Visits in Urban Areas of Japan: A Case-Control Study

Emergency department（ED）crowding due to frequent visitors increases medical costs and endangers the safety of patients who need prompt treatment. Although some studies have examined the social background of frequent visitors to the ED, there are few comprehensive studies of factors related to frequent ED visits in Japan. The present study examined whether public assistance status, age, and underlying conditions are associated with frequent visits to the ED. Subjects in this study were patients over 20 years of age who visited the ED of General Medicine in Showa University Hospital in Tokyo, Japan, from April 1, 2014, to March 31, 2015（n＝6,182）. Information regarding sex, age, public insurance, hypertension, diabetes mellitus, dyslipidemia, chronic obstructive pulmonary disease, cancer, dysuria, bronchial asthma, and chronic kidney disease was collected using a patient database created from medical and hospital records. Based on a previous study, subjects who visited the ED four or more times were defined as frequent visitors, while those who visited the ED less than four times were considered infrequent visitors. Logistic regression analysis was performed to calculate odds ratios（ORs）and 95％ confidence intervals（CIs）for frequent ED visits. Receipt of public assistance significantly increased the OR for frequent visits（4.26, 95％ CI: 1.90-9.56）, even after adjusting for sex, age, and potential confounding factors（OR: 3.89, 95％ CI: 1.62-9.35）. The current study found a significant association between frequent ED visits and the receipt of public assistance. Emergency physicians and medical practitioners need to share information with outpatient physicians and welfare officers and work together with patients to address their specific medical and social vulnerabilities

COVID Blindness: Delayed Diagnosis of Aseptic Meningitis in the COVID-19 Era

Diagnostic errors are a serious problem in healthcare. The diagnostic process is highly susceptible to cognitive bias and the current COVID-19 pandemic may cause normally accurate healthcare workers to make incorrect decisions. We report a case of aseptic meningitis that required five healthcare visits before it was correctly diagnosed. This case highlights the risk of anchoring bias and the importance of carefully assessing diagnostic processes during the COVID-19 pandemic

Submillimeter ALMA Observations of the Dense Gas in the Low-Luminosity Type-1 Active Nucleus of NGC 1097

We present the first 100 pc scale view of the dense molecular gas in the central ~ 1.3 kpc region of the type-1 Seyfert NGC 1097 traced by HCN (J=4-3) and HCO+ (J=4-3) lines afforded with ALMA band 7. This galaxy shows significant HCN enhancement with respect to HCO+ and CO in the low-J transitions, which seems to be a common characteristic in AGN environments. Using the ALMA data, we study the characteristics of the dense gas around this AGN and search for the mechanism of HCN enhancement. We find a high HCN (J=4-3) to HCO+ (J=4-3) line ratio in the nucleus. The upper limit of the brightness temperature ratio of HCN (v2=1^{1f}, J=4-3) to HCN (J=4-3) is 0.08, which indicates that IR pumping does not significantly affect the pure rotational population in this nucleus. We also find a higher HCN (J=4-3) to CS (J=7-6) line ratio in NGC 1097 than in starburst galaxies, which is more than 12.7 on the brightness temperature scale. Combined from similar observations from other galaxies, we tentatively suggest that this ratio appears to be higher in AGN-host galaxies than in pure starburst ones similar to the widely used HCN to HCO+ ratio. LTE and non-LTE modeling of the observed HCN and HCO+ lines using J=4-3 and 1-0 data from ALMA, and J=3-2 data from SMA, reveals a high HCN to HCO+ abundance ratio (5 < [HCN]/[HCO+] < 20: non-LTE analysis) in the nucleus, and that the high-J lines (J=4-3 and 3-2) are emitted from dense (10^{4.5} < n_H2 [/cc] < 10^6), hot (70 < Tkin [K] < 550) regions. Finally we propose that the high temperature chemistry is more plausible to explain the observed enhanced HCN emission in NGC 1097 than the pure gas phase PDR/XDR chemistry.Comment: 28 pages, 17 figures, 10 tables. Accepted to PAS