Treatment-resistant schizophrenia (TRS) is often accompanied by poor insight and impaired decision-making capacity (DMC), complicating the initiation of clozapine (CLZ) despite clear clinical indications. In Japan, CLZ utilization is markedly lower than in many foreign countries, partly due to concerns about adverse effects, mandatory blood monitoring, and difficulties in obtaining informed consent from patients with impaired DMC. Although CLZ can legally be initiated only with family consent, sustained treatment generally requires the patient's own agreement. Electroconvulsive therapy (ECT) may alleviate acute psychotic symptoms and temporarily improve DMC, thereby enabling informed participation in treatment decisions. A woman in her late thirties with TRS persistently refused CLZ. On readmission, her Clinical Global Impression-Severity (CGI-S) score was 7. Pseudo-TRS was partly ruled out using a long-acting injectable antipsychotic (LAI). Following a multidisciplinary case conference in the psychiatric department and family proxy consent, ECT was initiated during involuntary hospitalization for medical care and protection in accordance with clinical practice recommendations for ECT endorsed by the Japanese Society of Psychiatry and Neurology (JSPN). After three ECT sessions, the patient's DMC improved sufficiently to allow voluntary consent to CLZ initiation. Twelve ECT sessions were administered while CLZ was titrated to 225 mg/day. The CGI-S score improved to 3, no serious adverse events occurred, and she was discharged approximately 120 days after admission with stable outpatient follow-up. This case demonstrates that ECT can function as a capacity-restoring intervention enabling voluntary CLZ initiation in selected TRS patients who initially lack DMC. In the context of low CLZ utilization in Japan, a staged approach combining acute stabilization and pharmacological consolidation may provide a clinically and ethically acceptable pathway when supported by multidisciplinary review and procedural safeguards.
The Early Start Denver Model (ESDM), a core Naturalistic Developmental Behavioral Intervention (NDBI), promotes developmental gains in young children with autism spectrum disorder (ASD) through socially embedded learning. Because high-intensity ESDM programs (approximately 20 h/week) are difficult to implement in many Japanese clinical settings, this study evaluated the effectiveness of a low-intensity ESDM program using standardized assessments. A non-randomized controlled design was employed with 47 toddlers aged 18-36 months with a confirmed ASD diagnosis. Thirty participants were allocated to the intervention group, while 17 participants were assigned to the control group and received treatment as usual. Unlike the original ESDM randomized controlled trial implementing approximately 20 h/week, the intervention group (ESDM group, n = 30) received 60-min ESDM sessions once weekly for 24 weeks, with parents present during sessions. Outcomes were assessed before and after intervention using the Autism Diagnostic Observation Schedule-2 (ADOS-2), Kyoto Scale of Psychological Development 2020 (KSPD-2020), and Vineland Adaptive Behavior Scales-II (Vineland-II). Analysis of covariance (ancova) controlling for baseline scores revealed a significant group difference in the KSPD-2020 all domains developmental quotient (DQ) (p = 0.0416). Trend-level differences were observed in the postural-motor domain (p = 0.0811) and the cognition-adaptation domain (p = 0.0555). No significant between-group differences were found in the other outcome measures. Adaptive behavior showed modest increases in communication and socialization, although between-group differences were not statistically significant. Although the original ESDM recommends intensive delivery exceeding 15 h per week for 2 years, the present findings provide preliminary evidence that a low-intensity ESDM program-delivered once weekly for 24 sessions-can support meaningful developmental progress, even when changes in core autism symptoms are not detected after statistical adjustment in toddlers with ASD in Japanese clinical settings. These results highlight the feasibility of adapting ESDM principles to low-intensity service environments and underscore their potential applicability within Japanese cultural and systemic contexts.
Catatonia is when someone does not respond to stimuli or their environment whilst awake. Catatonia can present in a variety of ways, including a change in movement, speech, and behavior. There is limited research on the causes and management of catatonia in an adult population and even more so in the pediatric population. A 13-year-old presented with a 2-week sudden onset history of distress and preoccupation regarding a child being in danger. Over the next few weeks, he was represented on multiple occasions and had a rapid weight loss due to refusing oral intake. He displayed increasing preoccupations and was admitted for intravenous fluids and commenced on nasogastric feeds. He declined rapidly, presenting with symptoms of catatonia, including stupor, catalepsy, mutism, and posturing. Physical health causes for this presentation were ruled out with imaging and bloods completed, and he was trialled on lorazepam. He responded well to the lorazepam, and after 5 days, the nasogastric tube was removed, and he commenced eating, drinking, communicating, and mobilizing. The lorazepam was reduced, and his symptoms reemerged. The lorazepam was titrated back up and reduced again at a slower rate. Whilst managing this case, it was noted that there is a lack of guidance available for catatonia in both adult and pediatric populations. There is particularly a lack of guidance on how to titrate onto and off lorazepam. This case highlighted a need for further research to support the development of guidelines for the management of pediatric catatonia.
Brexpiprazole 2-4 mg daily is a novel dopamine D2 partial agonist approved for schizophrenia and improves effectiveness and tolerance by balancing D2, 5-HT1A, and 5-HT2A effects. This review assesses current evidence on its efficacy and safety within this dose range. PubMed, ScienceDirect, and The Cochrane Library were searched for trials published between 2011 and 2025 using specific keywords. Eligibility criteria included schizophrenia patients diagnosed using DSM-IV, DSM-IV-TR, DSM-5, or ICD-10, with intervention being 2-4 mg of brexpiprazole. Positive and Negative Syndrome Scale (PANSS) score and Clinical Global Impression - Severity scale (CGI-S) were the primary efficacy endpoints, and treatment-related adverse events were used to assess efficacy. Subgroup analysis was planned between the two dosage groups. The quality of randomized controlled trials (RCTs) was evaluated using the ROB2 tool, and the protocol registration was completed in PROSPERO. Among 464 retrieved articles, five trials with 2182 participants were found to be eligible. Brexpiprazole significantly improved total PANSS scores (mean difference [MD] -5.76; 95% confidence interval [CI] -7.69 to -3.83; p < 0.00001), positive subscale scores, negative subscale scores, and CGI-S scores (MD -1.35; 95% CI -1.87 to -0.84; p < 0.00001). The treatment-emergent adverse events were similar to placebo, and the risk of discontinuation was less with brexpiprazole (risk ratio 0.58; 95% CI 0.430.77; p = 0.0002). The most usual extrapyramidal symptom was akathisia. Brexpiprazole 2-4 mg showed significant improvements in PANSS and CGI-S scores, with a lower risk of treatment discontinuation. These findings support its efficacy and tolerability in managing schizophrenia.
Awareness of mental health is important to reduce stigma and discrimination and increase access to care. From the viewpoint of mental health conditions, this study examined the relationships among highly sensitive personality (HSP) traits and neuroticism in the general population. After obtaining informed consents, an anonymous web-based survey for adult participants with equal data collection across genders and age groups (20s, 30s, and 40s) was conducted using self-report questionnaires about HSP, neuroticism, mental health conditions including depression, anxiety, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), trauma-related stress, adverse childhood experiences (ACEs), and awareness of HSP and neurodevelopmental disorders. Participants were divided into the three groups based on HSP or neuroticism, with low, medium, and high groups defined by the mean value ± 1 SD. Data from 2593 participants were analyzed. High-HSP and high-neuroticism groups exhibited higher levels of depression, anxiety, ASD, ADHD traits, trauma-related stress, and ACEs, compared to the other medium and low groups, respectively. Regarding ACEs, both the high-HSP and high-neuroticism groups showed significantly high rates of psychological abuse and neglect. While the high-neuroticism group showed broad associations across all ACE categories, the high-HSP group showed specific and comparable, or slightly stronger, associations with household mental disorders and physical abuse. In the high-HSP group, more participants answered that being HSP or having a neurodevelopmental disorder was part of their identity. High HSP and high neuroticism show mental health similarities, but HSP uniquely internalizes traits as identity.
Children with autism spectrum disorder (ASD) are more likely to have sleep problems. Few studies have investigated the relationship between sleep problems and blood melatonin and ferritin levels. The objective of this study was to determine the correlation between sleep problems and morning serum melatonin and ferritin levels, and the differences in serum melatonin and ferritin levels between children with ASD and those without ASD. Four years of data from population-based 5-year-old checkups were referenced. Fifty-five children were divided into the ASD group (N = 45) and the non-ASD group (N = 10). Blood samples were collected at 8:30 a.m. The Japanese Sleep Questionnaire for Preschoolers (JSQP) was used to assess sleep problems. Correlation analysis, the Mann-Whitney U test, and multiple regression analysis were used. In the ASD group, the score of Sleep habit was significantly correlated with the serum ferritin level (ρ = 0.496, p < 0.001). No significant regression equation was found. However, the partial correlation coefficient calculated indicated a significant value between the score of Insomnia or Circadian rhythm disorder and serum melatonin level (β = 0.502, p < 0.05), and the score of Sleep habit and the serum ferritin level (β = 0.546 p < 0.01). The serum ferritin level in the ASD group (23.48 ± 9.14 ng/mL) was significantly higher than in the non-ASD group (14.84 ± 7.09 ng/mL) (p < 0.05). This study indicated that children with ASD were more likely to have some sleep problems and higher morning serum ferritin levels than those without ASD. Further research is recommended on the correlation between sleep problems and morning serum melatonin and ferritin levels.
Japan maintains exceptionally high psychiatric bed numbers and long hospitalization durations compared to global standards. This study examined prefecture-level associations between psychiatric bed supply, occupational therapy (OT) provision, and community welfare resources, and the average length of stay (ALOS). We performed a cross-sectional ecological analysis utilizing the 10th National Database of Health Insurance Claims (NDB) Open Data and government hospital statistics from fiscal year 2023. Dataset aggregation covered all 47 prefectures. We calculated standardized indicators per 100,000 population for psychiatric bed density, inpatient and outpatient OT claims, and community-based disability welfare facilities. Standardized multivariate regression modeling was employed to identify variables independently associated with ALOS, strictly evaluating the contributions of regional medical and welfare systems. The analysis identified that psychiatric bed density was most strongly associated with longer ALOS, which is consistent with the supply-induced demand hypothesis. Crucially, however, the regression model revealed that higher utilization rates of outpatient OT and a greater density of community-based welfare facilities were significantly and independently associated with shorter ALOS. Conversely, the volume of inpatient OT provision did not demonstrate a significant independent effect on shortening hospital stays in the adjusted model. At the prefectural level, psychiatric bed density was independently associated with longer ALOS, whereas outpatient OT utilization and community-based welfare facility density were independently associated with shorter ALOS. These findings suggest that community-based therapeutic and welfare resources may be relevant to shorter hospital stays, although causal inference is limited by the cross-sectional ecological design.
Questionnaire-based screening tools for Internet Gaming Disorder (IGD) are widely used in clinical and epidemiological research. However, discrepancies between child self-reports and parent reports may complicate the interpretation of screening results, particularly when cutoff-based classifications are applied. Participants were 58 adolescents (aged 10-18 years) attending child and adolescent psychiatry outpatient clinics and their parents. Gaming-related problems were assessed using parallel screening instruments: the Internet Gaming Disorder Scale for Children (IGDS-C) and the Parental version of the Internet Gaming Disorder Scale (PIGDS). Parent-child agreement was examined using dimensional analyses (Pearson's correlation), paired comparisons (paired t-test with Wilcoxon signed-rank test as a sensitivity analysis), and categorical agreement indices (concordance rate, Cohen's κ, and McNemar's test) based on the conventional cutoff score. Parent- and child-reported IGDS scores were moderately correlated (r = 0.61, p < 0.001), indicating substantial dimensional concordance. However, parents reported significantly higher IGDS scores than children (mean difference = -1.09, p < 0.001), a finding confirmed by the Wilcoxon signed-rank test. Categorical agreement based on cutoff-based screening classifications was low (κ = 0.16), with most discordant cases reflecting parent-positive and child-negative classifications. McNemar's test demonstrated a significant asymmetry in these discrepancies. Although parent and child IGDS scores demonstrate meaningful dimensional concordance, the application of fixed cutoff-based screening classifications substantially reduces agreement, a pattern that may reflect differences in evaluative thresholds between informants. These findings highlight limitations of relying solely on self-reported cutoff-based measures and underscore the need for multi-informant, dimensional approaches when interpreting IGD screening results in youth.
This study examined temporal changes in patterns of clinically treated psychiatric conditions during the first year after the 2024 Noto Peninsula Earthquake. Although post-disaster psychiatric symptoms often peak within the first year, prior studies have frequently lacked standardized phase definitions. We applied disaster-response phases defined in the Ministry of Health, Labour and Welfare manual to clarify phase-specific diagnostic trends and inform allocation of psychiatric resources. Among 869 new outpatients and 133 new inpatients recorded at Kanazawa Medical University Hospital, the tertiary medical center closest to the epicenter, between January and December 2024, we analyzed 80 first-time outpatients and 29 newly admitted inpatients reporting earthquake-related damage. Medical records were reviewed for demographics, ICD-10 primary diagnoses, disaster-related stressors, and timing of presentation categorized by disaster-response phases. Psychiatric presentations were concentrated within the first month after the disaster, with secondary increases around 7 months and a modest rise at 12 months among outpatients. Most cases occurred during Stage 4 (mid-term recovery; Months 2-12). Among outpatients, neurotic, stress-related, and somatoform disorders (F4; 37.5%) and mood disorders (F3; 27.5%) were most frequent, whereas among inpatients, mood disorders (F3; 44.8%) and schizophrenia spectrum disorders (F2; 24.1%) predominated. Mood disorders were prevalent from the early phase, while F4 disorders increased later. Relocation and housing-related problems were common stressors. Clinically treated psychiatric conditions showed phase-dependent patterns, underscoring the need for phase-specific interventions, including early management of mood disorders, mid-term support for displacement-related stress, and long-term monitoring for symptom re-emergence.
St John's wort (SJW) is widely used as an herbal supplement for depressive symptoms and is generally regarded as safe. However, although extremely rare, manic and psychotic reactions have been reported, typically in individuals taking high doses, using psychotropic agents, or having a psychiatric history. We report a case of a Japanese male in his early twenties with only one prior psychiatric visit for interpersonal stress, who developed acute manic and psychotic symptoms while taking standard doses of SJW. Shortly after returning to a university training program following COVID-19 infection, he developed emotional instability, prominent grandiose and persecutory delusions, reduced sleep, and dangerous behavior. Blood tests, cerebrospinal fluid analysis, brain imaging, and cerebrospinal fluid antibody testing were normal. Upon admission, we provisionally diagnosed him with schizoaffective disorder and initiated treatment with aripiprazole, which led to rapid improvement and near remission within 1 week. During pre-discharge psychoeducation, he reported taking SJW for several months, suggesting a possible association between SJW use and symptom onset. SJW was discontinued, and aripiprazole long-acting injectable treatment was initiated after discharge. After 2 months of sustained clinical stability, antipsychotic treatment was discontinued based on shared decision-making with the patient. Outpatient follow-up is ongoing to monitor for any recurrence of symptoms. This case demonstrates that acute manic and psychotic symptoms may occur even in young adults with no notable psychiatric history who take standard doses of SJW. Although SJW is regarded as safe, this case highlights that severe psychiatric reactions may still arise.
Mood stabilizer augmentation is frequently used in treatment-resistant schizophrenia despite limited guideline recommendations. Evidence for its efficacy and safety in the residual phase, however, remains insufficient. A 49-year-old Japanese woman with treatment-resistant residual schizophrenia exhibited persistent agitation and aggression despite antipsychotic therapy. Valproate augmentation (800 mg/day) improved irritability and psychomotor agitation but was complicated by hypoglycemia, suggestive of relative carnitine deficiency, and subsequent pancytopenia. Both adverse events resolved after discontinuation. Behavioral symptoms markedly worsened following withdrawal. Clozapine and electroconvulsive therapy were declined. Lithium augmentation (600 mg/day; serum level 0.8 mEq/L) was initiated, resulting in improvement of dangerous behaviors and agitation. The Brief Psychiatric Rating Scale total score improved from 80 to 64, particularly in the hostility and excitement items. No readmission to the psychiatric ward occurred during a 3-month follow-up. This case highlights the clinical dilemma of mood stabilizer augmentation in residual-phase schizophrenia. While valproate demonstrated behavioral efficacy, serious adverse events necessitated its discontinuation. Lithium may represent a potential alternative for managing aggression and agitation, but further research is warranted.
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system often accompanied by psychological comorbidities such as depression and anxiety, which may aggravate physical disability. This study aimed to assess the relationship between depression, anxiety, and disability among patients with MS in western Iran. A cross-sectional analytical study was conducted among 180 MS patients attending the Boustan MS Clinic in Kermanshah, Iran. Participants completed the Persian versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Disability was evaluated using the Expanded Disability Status Scale (EDSS). Data were analyzed using Spearman correlation and stepwise multiple regression. The mean age of participants was 41.33 ± 9.09 years, and 75% were female. The mean EDSS score was 3.28 ± 1.56, BDI score 19.87 ± 10.21, and BAI score 13.28 ± 9.96. Depression and anxiety were significantly correlated with disability (r = 0.404 and r = 0.399, respectively; p < 0.01), and with each other (r = 0.702, p < 0.01). Regression analysis showed that depression alone explained 17.6% of disability variance, which increased to 36.2% when anxiety was added. Lower education level and positive family history of MS were associated with higher psychological distress. Depression and anxiety are common and strongly associated with greater physical disability in MS patients. Integrating psychological assessment and intervention into MS management may help improve functional outcomes and quality of life.
To evaluate the safety and tolerability of repeating 14-day treatment with zuranolone (30 mg) followed by a 6-week follow-up period (one treatment cycle) for a maximum of six treatment cycles in Japanese participants with major depressive disorder. This multicenter Phase 3 study was conducted in two parts (70 sites; Japan). Part B was an open-label study for participants who completed the initial double-blind study (Part A; zuranolone vs. placebo) in which all eligible participants received zuranolone regardless of their assignments in Part A. Endpoints included treatment-emergent adverse events (TEAEs) and efficacy using the 17-item Hamilton Depression Rating Scale (HAMD-17). A total of 271, 213, 170, 147, 126, and 99 participants were evaluated in Cycles 1-6, respectively. TEAEs occurring in ≥5% of participants were somnolence and dizziness during the treatment period and nasopharyngitis during the follow-up period, and no new safety signals were observed with increased numbers of treatment cycles. Additionally, no TEAEs suggestive of drug dependence or withdrawal symptoms were identified. The HAMD-17 total score decreased by 8 and 15 days after the initiation of zuranolone in all six cycles, and there were no meaningful differences in the HAMD-17 total score reduction across treatment cycles. In this open-label part of the Phase 3 study in Japan, zuranolone decreased the HAMD-17 total scores from baseline over 15 days during repeated treatment cycles in patients with major depressive disorder, without any new safety signals.
Previous studies have documented a decline in the mental health of university students during the Coronavirus Disease 2019 pandemic; however, only a few studies have investigated the underlying causes. This study examined longitudinal changes in learning environments and physical and mental health among Japanese university students during the post-pandemic period. The yearly survey on mental health and learning conditions between 2022 and 2023 involved 855 university students. The survey assessed the Kessler Psychological Distress Scale 6, the proportion of classes using digital technology, physical fatigue areas, and current health issues. The Wilcoxon signed-rank test was used to compare changes in distress scores and digital class proportions between years. Distribution patterns were investigated using a chi-square test, and factors related to mental health shifts were explored through multiple logistic regression analyses. The mean score for psychological distress increased from 3.0 to 3.3, whereas the median proportion of technology-based classes decreased from 2.5 to 0.8 (p < 0.0001). Yearly comparison revealed less physical fatigue after classes across several body areas. The previous year's distress score was associated with later mental health decline. Further, factors including the share of technology-based instruction, physical symptoms after classes, and time spent on health-related activities were associated with both mental health improvement and worsening. In the coming year, health guidance for university students should reflect both physical and mental health needs, and shifts in learning approaches.
Living alone and loneliness are recognized risk factors for neuropsychiatric symptoms in older adults. However, the distinct of the objective condition of living alone and subjective loneliness on specific neuropsychiatric symptoms in individuals with mild cognitive impairment (MCI) remains unclear. In this retrospective study, we analyzed data from 312 older adults with MCI (74 living alone and 238 living with family) who attended a university psychiatry clinic. Neuropsychiatric symptoms and subjective loneliness were assessed using the Neuropsychiatric Inventory and the UCLA Loneliness Scale, respectively. Living arrangement (living alone vs. living with family) was recorded. Negative binomial regression with a log link function examined associations of depression, anxiety, delusions, and hallucinations with living alone and loneliness, adjusting for potential confounders. Furthermore, sensitivity analyses were performed by excluding variables with highly unbalanced distributions. Patients living alone showed significantly higher delusions, hallucinations, and disinhibition scores than those living with family, whereas apathy scores were significantly lower. Multivariate analyses showed that loneliness, but not living alone, was significantly associated with depression and anxiety. Delusions were significantly associated with both loneliness and living alone. In contrast, no significant associations were found between hallucinations and either living alone or loneliness. The significant associations for all neuropsychiatric symptoms were maintained in the sensitivity analysis, except for hallucinations. Neuropsychiatric symptoms in individuals with MCI show differential associations with loneliness and living alone. These findings suggest that useful non-pharmacological interventions may differ depending on the symptoms.
Avoidance is a key maintaining factor in major depressive disorder (MDD); however, longitudinal evidence remains limited, and its association with personality traits is not fully understood. This study aimed to (1) examine the longitudinal associations among avoidance, depressive symptoms, and rumination and (2) explore the relationship between avoidance and personality traits in outpatients with MDD. In this 10-month prospective study, 53 adult outpatients diagnosed with MDD were assessed while receiving routine outpatient psychiatric care. Avoidance, depressive symptoms, and rumination were measured at baseline and follow-up using the Cognitive Behavioral Avoidance Scale (CBAS), 17-item GRID-Hamilton Depression Rating Scale (GRID-HAMD-17), and Ruminative Responses Scale (RRS), respectively. Personality traits were assessed at baseline using the Temperament and Personality Questionnaire (T&P). Patients were dichotomized into an Avoidance Improvement (AI) group (≥9-point reduction in CBAS scores) or a Non-Avoidance Improvement (NON-AI) group based on a median split. Univariate and multivariate regression analyses were conducted to identify factors associated with Avoidance Improvement. The AI group demonstrated greater reductions in depressive symptoms (p = 0.001) and rumination (p = 0.031) than the NON-AI group. In multivariate analysis, greater improvement in depressive symptoms (odds ratio [OR] = 1.130, 95% confidence interval [CI] = 1.016-1.257) and lower baseline Personal Reserve (OR = 0.848, 95% CI = 0.724-0.968) were independently associated with improvement in avoidance. Reductions in depressive symptoms and lower Personal Reserve may contribute to decreased avoidance in MDD. These findings highlight the importance of targeting depressive symptoms not only for direct relief but also to disrupt maladaptive avoidance cycles.
Immune checkpoint inhibitors (ICIs) can cause a range of immune-related adverse events (irAEs), including rare neuropsychiatric complications. However, these events often present with diverse and non-specific symptoms, making diagnosis difficult. A 64-year-old man with Stage IV gastric cancer receiving nivolumab developed impaired consciousness, delusions, and dissociative behavior, and reduced instrumental activities of daily living during and after ICI therapy. During chemotherapy, the patient was suspected of having dementia and was referred to a psychiatrist. However, the possibility of irAE was not mentioned at that time. Despite normal magnetic resonance imaging (MRI) and cerebrospinal fluid findings, a multidisciplinary assessment due to clinical features and exclusion of other etiologies led to the clinical suspicion of an immune-related encephalopathy. Steroid pulse therapy and antipsychotics (risperidone, later olanzapine) improved symptoms. Psychiatric relapse occurred after discontinuing risperidone and resolved with olanzapine. In patients undergoing ICI therapy, new-onset psychiatric symptoms should raise suspicion for irAEs. Timely multidisciplinary intervention is essential for accurate diagnosis and effective symptom management.
To evaluate the impact of assigning a dual-boarded emergency-psychiatry physician to the emergency department (ED) on the frequency, timing, and nature of psychiatric consultations. Access to psychiatric evaluations in EDs is often limited, particularly in Japan, where general hospitals with psychiatric services are declining. Integrating dual-boarded physicians in emergency medicine and psychiatry may address unmet psychiatric needs. This retrospective, single-center, pre-post study was conducted at a secondary emergency hospital in Tokyo, Japan. All patients transported by ambulance between October 2020 and September 2024 were included in this study. An a priori sample size calculation was not performed; instead, the study size was determined by all consecutive eligible patients during this predefined observation period. The intervention involved the continuous assignment of a dual-boarded physician in October 2022. The primary outcome was the number of psychiatric consultations initiated by emergency physicians. Secondary outcomes included reasons for consultation, patient characteristics, physiological indicators at ED presentation, emergency procedures at admission, consultation setting, time from admission to consultation, and clinical outcomes; for patients with multiple consultations during the same hospitalization, only the initial consultation was analyzed. Among 23,916 patients, 137 psychiatric consultations were analyzed. Consultations increased 3.41-fold post-intervention (31 vs. 106), with the consultation rate increasing from 0.29% to 0.81%. High-risk psychiatric presentations, including suicidal ideation (40.6% vs. 12.9%, p = 0.005), self-harm (42.5% vs. 19.4%, p = 0.019), and overdose (33.0% vs. 12.9%, p = 0.040), were significantly more common post-intervention, whereas delirium was less frequent (2.8% vs. 25.8%, p < 0.001). Vital signs at ED presentation and emergency procedures at admission were comparable between groups. Time from admission to consultation was shorter post-intervention (median 1 vs. 3 days, p = 0.007). The median hospital stay was also shorter from 22 to 8 days (p = 0.001). There was no significant change in the psychiatric hospital transfer rates. This study demonstrated that the 2-year assignment of one dual-boarded emergency-psychiatry physician was associated with an increased acceptance of more complex psychiatric cases in the ED, particularly those involving self-harm and suicidal ideation.
Neurofeedback, a technique enabling individuals to regulate their brain activity in real time, has gained momentum as both a clinical intervention and a tool for cognitive and performance enhancement. This review synthesizes findings from 65 studies to evaluate the current state of neurofeedback research. We outline its historical development, methodological approaches, and technological innovations, including advances in connectivity-based and multimodal feedback paradigms. Applications across clinical disorders, such as attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, and autism, as well as performance optimization, are critically examined, with emphasis on efficacy, limitations, and translational challenges. To enhance transparency, we summarize methodological trends and provide integrative insights that cut across individual studies. We further discuss persistent limitations, including methodological heterogeneity and placebo-related concerns, and highlight future directions such as personalization, multimodal integration, and interdisciplinary collaboration. By consolidating evidence across diverse domains, this review positions neurofeedback as a rapidly evolving field with significant therapeutic and translational potential.
In Psychiatry and Mental Health, physical exercise and sport have been neglected as essential tools in preventing the occurrence of mental disorders, in improving health and mental health, and in treating mental patients. This paper advocates for a better knowledge of this field by mental health workers in the best interest of care of mental patients.