Evaluating outcomes of the child and adolescent psychiatric unit: A prospective study

<p>Abstract</p> <p>Background</p> <p>The aims of this prospective study are to clarify the outcomes of child psychiatric inpatient treatment and to identify factors associated with patient improvement.</p> <p>Methods</p> <p>The attending psychiatrist used the Children's Global Assessment Scale (CGAS) to assess youths at admission to and discharge from a child and adolescent psychiatric unit in Japan(N = 126, mean age = 12.8, SD = 1.9). Hospital records gathered sociodemographic and clinical variables. In addition, youths and their primary caregivers assessed themselves using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), respectively. Longitudinal analyses compared each scales' baseline and discharge scores. We also examined factors associated with changes in functioning (CGAS).</p> <p>Results</p> <p>Longitudinal comparisons revealed that CGAS, CBCL and YSR scores showed improvement over time (CGAS: t = -14.40, p = 0.00; CBCL: t = 3.80, p = 0.00; YSR: t = 2.40, p = 0.02). Linear regressions determined that the factors associated with improvement in CGAS included age, lower CGAS scores at admission, frequency of group therapy and psychiatric diagnosis.</p> <p>Conclusions</p> <p>This evaluation of children and adolescents in an inpatient unit demonstrated clinical improvement over time and identified factors associated with said improvement.</p

Poor performance on the Iowa gambling task in children with obsessive-compulsive disorder

Background: Several lines of evidence implicate orbitofrontal cortex dysfunction in the pathophysiology of obsessive-compulsive disorder (OCD). The purpose of this study was to investigate neuropsychological dysfunction of the orbitofrontal cortex in children with OCD. Methods: The Iowa Gambling Task (IGT), which reflects orbitofrontal cortex function, and the Wisconsin Card Sorting Test (WCST), which is associated with functioning of the dorsolateral prefrontal cortex, were administered to 22 children with OCD and 22 healthy controls matched for gender, age, and intelligence. Results: OCD patients displayed poor performance on the IGT. In contrast, performance on the WCST was not impaired in OCD patients compared to controls. Conclusions: These findings are in line with previous studies demonstrating that OCD in childhood is associated with a dysfunction of orbitofrontal-striatal-thalamic circuitry.ArticleANNALS OF GENERAL PSYCHIATRY. 11:25 (2012)journal articl

Exceeding classical capacity limit in quantum optical channel

The amount of information transmissible through a communications channel is determined by the noise characteristics of the channel and by the quantities of available transmission resources. In classical information theory, the amount of transmissible information can be increased twice at most when the transmission resource (e.g. the code length, the bandwidth, the signal power) is doubled for fixed noise characteristics. In quantum information theory, however, the amount of information transmitted can increase even more than twice. We present a proof-of-principle demonstration of this super-additivity of classical capacity of a quantum channel by using the ternary symmetric states of a single photon, and by event selection from a weak coherent light source. We also show how the super-additive coding gain, even in a small code length, can boost the communication performance of conventional coding technique.Comment: 4 pages, 3 figure

The reliability and validity of the Questionnaire - Children with Difficulties (QCD)

Background: The aim of this study was to evaluate the reliability and validity of the Questionnaire-Children with Difficulties (QCD), which was developed for the evaluation of children's daily life behaviors during specified periods of the day. Methods: The subjects were 1,514 Japanese public elementary and junior high school students. For the examination of reliability, Cronbach's alpha was calculated to assess the internal consistency of the questionnaire. With regard to validity, correlation coefficients were calculated to examine whether QCD scores correlated with those of the ADHD-Rating Scale (ADHD-RS) and the Oppositional Defiant Behavior Inventory (ODBI). Results: Cronbach's alpha coefficient for the total score of the QCD was .876. The correlation coefficients of the QCD score with ADHD-RS and ODBI scores were -.514 and -.577, respectively. Conclusions: The internal consistency and validity of the QCD were demonstrated. The QCD is a reliable and valid instrument for evaluating daily life problems for children during different time periods of the day.ArticleCHILD AND ADOLESCENT PSYCHIATRY AND MENTAL HEALTH. 7:11 (2013)journal articl

Study of the sleep patterns, sleep habits, and sleep problems in Japanese elementary school children using the CSHQ-J

Objective: This study aimed to examine the sleep patterns, sleep habits, and sleep problems in Japanese elementary school children from the aspect of their developmental age. Methods: The Japanese version of the Children&apos;s Sleep Habits Questionnaire (CSHQ-J) was distributed to the parents of 330 students of which 296 (154 boys and 142 girls) questionnaires were returned. The subjects were divided into 3 groups by grade (Low-grade [1st−2nd graders], Middle-grade [3rd−4th graders], and High-grade [5th−6th graders]). Results: Bedtime was significantly later and sleep duration was significantly shorter in the older students. The total CSHQ-J score was significantly higher in the Low-grade group compared with that in the High-grade group. Regarding the sub-items of the CSHQ-J, the scores for &quot;bedtime resistance&quot; and &quot;sleep anxiety&quot; were significantly higher in the Low-grade group compared with those in the High-grade group. Conclusions: That sleep duration was significantly shorter in the older students was attributable to their later bedtimes. Differences in the total and sub-item scores of the CSHQ-J were largely attributable to the autonomy of sleep

Implementation of generalized quantum measurements: superadditive quantum coding, accessible information extraction, and classical capacity limit

Quantum information theory predicts that when the transmission resource is doubled in quantum channels, the amount of information transmitted can be increased more than twice by quantum channel coding technique, whereas the increase is at most twice in classical information theory. This remarkable feature, the superadditive quantum coding gain, can be implemented by appropriate choices of code words and corresponding quantum decoding which requires a collective quantum measurement. Recently, the first experimental demonstration was reported [Phys. Rev. Lett. 90, 167906 (2003)]. The purpose of this paper is to describe our experiment in detail. Particularly, a design strategy of quantum collective decoding in physical quantum circuits is emphasized. We also address the practical implication of the gain on communication performance by introducing the quantum-classical hybrid coding scheme. We show how the superadditive quantum coding gain, even in a small code length, can boost the communication performance of conventional coding technique.Comment: 15 pages, 14 figure

Digenic inheritance of mutations in EPHA2 and SLC26A4 in Pendred syndrome

Enlarged vestibular aqueduct (EVA) is one of the most commonly identified inner ear malformations in hearing loss patients including Pendred syndrome. While biallelic mutations of the SLC26A4 gene, encoding pendrin, causes non-syndromic hearing loss with EVA or Pendred syndrome, a considerable number of patients appear to carry mono-allelic mutation. This suggests faulty pendrin regulatory machinery results in hearing loss. Here we identify EPHA2 as another causative gene of Pendred syndrome with SLC26A4. EphA2 forms a protein complex with pendrin controlling pendrin localization, which is disrupted in some pathogenic forms of pendrin. Moreover, point mutations leading to amino acid substitution in the EPHA2 gene are identified from patients bearing mono-allelic mutation of SLC26A4. Ephrin-B2 binds to EphA2 triggering internalization with pendrin inducing EphA2 autophosphorylation weakly. The identified EphA2 mutants attenuate ephrin-B2- but not ephrin-A1-induced EphA2 internalization with pendrin. Our results uncover an unexpected role of the Eph/ephrin system in epithelial function

Clozapine and Antipsychotic Monotherapy

Background: Although clozapine is effective for treatment-resistant schizophrenia (TRS), the rate of clozapine prescription is still low. Whereas antipsychotic monotherapy is recommended in clinical practice guidelines, the rate of antipsychotic polypharmacy is still high. There is little evidence on whether a clozapine prescription influences changes in the rate of monotherapy and polypharmacy, including antipsychotics and other psychotropics. We therefore hypothesized that the rate of antipsychotic monotherapy in patients with TRS who were prescribed clozapine would be higher than that in patients with schizophrenia who were not prescribed clozapine. Methods: We assessed 8306 patients with schizophrenia nationwide from 178 institutions in Japan from 2016 to 2019. We analyzed the psychotropic prescription data at discharge in patients diagnosed with TRS and with no description of TRS (ND-TRS) based on the diagnosis listed in the discharge summary. Results: The rate of antipsychotic monotherapy in the TRS with clozapine group (91.3%) was significantly higher than that in the TRS without clozapine group (45.9%; P < 2.0 × 10−16) and the ND-TRS without clozapine group (54.7%; P < 2.0 × 10−16). The rate of antipsychotic monotherapy without any other concomitant psychotropics in the TRS with clozapine group (26.5%) was significantly higher than that in the TRS without clozapine group (12.6%; P = 1.1 × 10−6) and the ND-TRS without clozapine group (17.0%; P = 5.9 × 10−6). Conclusions: Clozapine prescription could be associated with a high rate of antipsychotic monotherapy. Patients will benefit from the correct diagnosis of TRS and thus from proper clozapine prescription

EGUIDE project and treatment guidelines

Background Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. Aims The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. Method A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. Results All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. Conclusions All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists

EGUIDE project and treatment guidelines

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