搜索结果：PCN reports : psychiatry and clinical neurosciences

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.

To describe clinical characteristics associated with antidepressant non-use among patients presenting with depressive states in routine psychiatric practice and to explore factors associated with antidepressant prescription among patients with high diagnostic certainty for major depressive disorder (MDD). This multicenter cross-sectional observational study used retrospectively collected routine clinical data from 35 psychiatric facilities in Japan. Eligible patients were those who attended participating facilities during March 2023 and were considered by their treating psychiatrist to be under clinical management for a depressive presentation or depressive episode at the index clinical assessment. All variables, including antidepressant use, current clinical state, symptom severity, and diagnostic certainty, were assessed at that single time point. At each site, when a patient not receiving antidepressants was identified, the next consecutively seen patient receiving antidepressants was enrolled as a comparator to facilitate contemporaneous between-group comparison. Physicians completed a standardized case report form including demographics, current clinical state, depressive symptom severity, and diagnostic certainty ratings for MDD and alternative diagnoses. Group comparisons were performed in the full cohort. Analyses restricted to patients with high diagnostic certainty for MDD were prespecified as exploratory, and a multivariable logistic regression model was fitted within this subgroup to examine factors associated with antidepressant prescription. A total of 1342 patients were enrolled (antidepressant use, n = 669; no antidepressant use, n = 673). High diagnostic certainty for MDD was less frequent in the no-antidepressant group than in the antidepressant group (22.1% vs. 38.5%). In the no-antidepressant group, commonly reported reasons for non-prescription included lack of diagnostic certainty (74.0%), clinical stability or absence of current symptoms (60.3%), and concerns about adverse effects (17.7%) (multiple responses allowed). In exploratory analyses restricted to patients with high diagnostic certainty for MDD (n = 400), remitted status and less severe symptom profiles were more frequent in the no-antidepressant group. In the multivariable model within this subgroup, severe or very severe symptoms (vs. no symptoms) were associated with higher odds of antidepressant prescription (odds ratio [OR] = 4.317, 95% CI 1.067-17.462, p = 4.0 × 10-2), whereas age, sex, current state, and developmental disorder certainty were not statistically associated. In this multicenter observational sample, antidepressant non-use among patients presenting with depressive states was associated with lower diagnostic certainty for MDD and with lower current symptom burden at the time of observation. Among patients with high diagnostic certainty for MDD, greater symptom severity was associated with antidepressant prescription. These findings may help contextualize conservative treatment decisions under diagnostic uncertainty in routine psychiatric practice.

Although pre- and post-ictal psychiatric symptoms (PS) in patients with epilepsy are well known, the prevalences and pathophysiologies remain unclear. We investigated the prevalences and durations of pre- and post-ictal PS, related factors, and associations between pre- and post-ictal PS. In the Neuropsychiatry Department of Kurume University Hospital, patients with epilepsy were interviewed regarding pre- and post-ictal PS. Multivariate logistic regression analyses were performed on clinical variables and pre- or post-ictal PS. McNemar analyses were performed to clarify differences in the occurrence of pre- and post-ictal PS. Five percent of patients had only pre-ictal PS, 29% had only post-ictal PS, and 10% had both pre- and post-ictal PS. The most common symptoms were depressive symptoms (25%) and anxiety symptoms (16%) in the post-ictal period, and irritability symptoms (7%) and anxiety symptoms (5%) in the pre-ictal period. The duration of PS was more than 1 day but less than 1 week in many patients. Post-ictal PS showed a substantially higher ratio of a history or comorbidities of inter-ictal psychiatric disorders (IPD). In addition, post-ictal psychotic symptoms and post-ictal irritability symptoms were significantly associated with psychosis in IPD. Furthermore, while the incidence of PS was significantly higher with post-ictal PS alone than with pre-ictal PS, cases with pre-ictal PS had a significantly higher rate of post-ictal PS. Post-ictal PS appeared relevant to IPD, and pre-ictal PS was associated with the expression of post-ictal PS.

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.

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.

This study aimed to classify patients with bipolar disorder (BD) and normal controls (NCs) using machine-learning models that incorporate wearable-derived core body temperature (CBT) and actigraphy-derived sleep indices. We enrolled 23 euthymic patients with BD and 43 NCs. Sleep parameters were collected via wrist actigraphy for 14 days, and CBT was measured with a wearable device for 3 days to estimate the CBT nadir and its phase differences with sleep indices. Models were constructed with a base model using CBT- and sleep-derived features, and an extended model that included sociodemographic variables. Features were standardized (StandardScaler), and classifiers (random forest, LightGBM, and XGBoost) were evaluated. Hyperparameters were optimized using cross-validation within the training data. Performance was evaluated using repeated nested cross-validation. SHapley Additive exPlanations (SHAP) values were computed in the extended model to quantify relative feature contributions to the model output. In nested cross-validation at the MaxF1 operating point, the mean area under the receiver operating characteristic curve (ROC-AUC) was 0.771 ± 0.162 for the base model and 0.930 ± 0.050 for the extended model. In the extended model, SHAP suggested that total sleep time, wake time, and the wake time-CBT nadir phase difference were features potentially associated with the model output. In this small-sample study, a classification approach combining wearable-derived CBT indices and actigraphy-based sleep parameters suggested preliminary discrimination between BD and NC. Further validation is warranted in larger cohorts with balanced background characteristics, including disorders requiring differential diagnosis.

Brexpiprazole 2-4&#x2009;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&#x2009;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&#x2009;<&#x2009;0.00001), positive subscale scores, negative subscale scores, and CGI-S scores (MD -1.35; 95% CI -1.87 to -0.84; p&#x2009;<&#x2009;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&#x2009;=&#x2009;0.0002). The most usual extrapyramidal symptom was akathisia. Brexpiprazole 2-4&#x2009;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.

Digital harassment, including workplace cyberbullying, online defamation, and social media attacks, has been reported among healthcare professionals. This scoping review systematically maps existing evidence on digital harassment and its mental health consequences among healthcare professionals. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we searched MEDLINE, Google Scholar, and Ichushi-Web through December 2025. Twenty-four studies from 12 countries were included. Workplace cyberbullying prevalence ranged from 1.5% to 46.6%. Across studies, digital harassment was reported in association with depression, anxiety, burnout, post-traumatic stress disorder (PTSD) symptoms, and moral injury-related experiences, although causal relationships could not be established. Seven included studies (28%) addressed pandemic-related digital harassment, including online abuse and stigmatization of healthcare workers during the COVID-19 period. Within the English- and Japanese-language literature identified in this review, Japanese studies were limited (three studies). From a consultation-liaison psychiatry perspective, harassment following ethically mandated actions may relate to moral injury-related experiences and may warrant further attention to institutional support. Evidence for effective interventions remains scarce. This review suggests that digital harassment may represent an emerging occupational concern with potential mental health implications. The evidence base was predominantly cross-sectional and methodologically heterogeneous, and findings should therefore be interpreted cautiously. Important needs include institutional policies, legal protections, psychological support systems, and further research on intervention effectiveness and cross-cultural patterns.

Hikikomori is a behavior characterized by prolonged social withdrawal, identified in 1990s Japan, and with increasing global recognition. Over two decades of research, the phenomenon remains clinically ambiguous; debate persists over whether hikikomori represents a psychiatric disorder, a behavioral response, or an adaptive coping strategy. This review examines the intersection between hikikomori and neurodivergent traits, focusing on autism spectrum characteristics, and ecological and cultural contexts that shape presentation. Two-stage literature review. Stage 1 comprised a scoping review of diagnostic criteria for autism and behavioral features of hikikomori, identifying overlapping social communication differences, sensory sensitivities, and restricted interests. Stage 2 employed a targeted Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) approach, synthesizing international literature across quantitative, qualitative, and mixed-method studies. Findings followed three research questions: overlap between autism and hikikomori; Japanese environmental and societal triggers; and whether hikikomori can be understood as an adaptive response. Results indicate nuanced convergence between autistic traits and hikikomori behaviors. Social communication difficulties, engagement in repetitive activities, and sensory sensitivities appear in both populations. Developmental trajectories differ; hikikomori emerge in adolescence/early adulthood. Environmental pressures, including academic expectations, family dynamics, and cultural norms around conformity, exacerbate withdrawal behaviors. Adaptive perspectives suggest that withdrawal is a protective mechanism, facilitating sensory regulation, psychological coping, and engagement in preferred activities. Pathological outcomes arise when isolation is prolonged/unsupported. This review underscores important ecological and neurodiversity-informed frameworks in understanding hikikomori. Implications for practice include flexible support strategies, culturally sensitive assessment, and recognizing potential adaptive functions of withdrawal. Future research should be longitudinal, first-person experiences, and interaction between neurodivergence and environmental stressors across cultures.

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.

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.

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&#x2009;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&#x2009;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.

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 &#x3ba;, and McNemar's test) based on the conventional cutoff score. Parent- and child-reported IGDS scores were moderately correlated (r&#x2009;=&#x2009;0.61, p&#x2009;<&#x2009;0.001), indicating substantial dimensional concordance. However, parents reported significantly higher IGDS scores than children (mean difference = -1.09, p&#x2009;<&#x2009;0.001), a finding confirmed by the Wilcoxon signed-rank test. Categorical agreement based on cutoff-based screening classifications was low (&#x3ba;&#x2009;=&#x2009;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 addressed a significant gap in the literature on disaster responders' mental health. Numerous studies have examined disaster victims' mental health. However, reviews on the mental health of disaster responders are limited. Thus, this study reviewed the existing literature and clarified the mental health effects according to disaster type and occupation in Japan. The PubMed, CiNii, Web of Science, Google Scholar, and PsycInfo databases were searched. The inclusion criteria were natural disasters in Japan and reports on the mental health status of disaster support workers. The search period was from 1997 to 2025. Among 664 studies, 55 met the inclusion criteria. The research methods included 39 cross-sectional and 16 longitudinal studies. Various types of disasters were identified. The main reported mental health symptoms were post-traumatic stress state (PTSS) and psychological distress. The prevalence of and factors contributing to worsening PTSS and psychological distress varied across occupations. PTSS and psychological distress were relatively high among medical personnel, local government employees, and nuclear power plant workers and relatively low among firefighters and Japan Ground Self-Defense Force personnel. Several personal, disaster-related, and occupational factors were identified as exacerbating PTSS and psychological distress. These included home damage, experiences of discrimination and abuse, long working hours, lack of rest, and poor workplace communication. The prevalence rates and identified stressors should be used to enhance training and preparedness measures during peacetime.

Suicide among young adults has become a serious public health concern. In Japan, suicide is a leading cause of death among adolescents and young adults. Suicidal ideation is a clinically meaningful psychological burden among young adults. However, the associations of suicidal ideation with help-seeking anxiety, psychological distress, and subjective well-being among healthcare students have not been explored sufficiently. This study aimed to examine the cross-sectional associations of help-seeking anxiety, psychological distress, and subjective well-being with suicidal ideation among first-year healthcare students. A cross-sectional web-based survey was conducted among 142 first-year medical and nursing university students in Japan. Suicidal ideation was assessed using the Suicidal Ideation Questionnaire, psychological distress was assessed using the Kessler Psychological Distress Scale, subjective well-being was assessed using the World Health Organization 5-item Well-Being Index (WHO-5), and help-seeking anxiety was assessed using the Thoughts About Therapy Survey. Associations among help-seeking anxiety, psychological distress, subjective well-being, and suicidal ideation were examined using Spearman's correlation analysis and multivariable regression analyses. Higher help-seeking anxiety was associated with higher levels of suicidal ideation and psychological distress. Psychological distress was also associated with suicidal ideation, whereas subjective well-being was not clearly associated with suicidal ideation. In the multivariable regression analyses, help-seeking anxiety remained associated with suicidal ideation after accounting for psychological distress and subjective well-being. Additionally, most students reported having someone to consult when experiencing distress; however, awareness of university mental health services was limited. These findings highlight suicidal ideation as a clinically meaningful psychological burden among first-year healthcare students and suggest that psychological distress and help-seeking anxiety are associated with suicidal ideation.

Some features of neurodevelopmental disorders (NDDs) have been discussed as potential factors related to criminal behavior, and addressing their characteristics may help prevent recidivism among forensic patients. However, evidence from Japan remains limited. This study examined the association between NDDs and recidivism among forensic outpatients receiving treatment under Japan's Medical Treatment and Supervision Act (MTSA). This retrospective cohort study used the national database of Japanese forensic outpatients who received treatment under the MTSA between 2005 and 2017. Generalized linear models analyzed the association between NDDs, including intellectual disability (ID), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), and recidivism during outpatient treatment. A total of 2135 patients were included in the analysis, of whom 221 (10.4%) exhibited recidivism. ID, ASD, and ADHD were observed in 10.0%, 3.9%, and 0.3% of patients, respectively. Both ID (adjusted odds ratio [aOR] = 1.92, 95% confidence interval [CI]: 1.29-2.87) and ASD (aOR = 2.94, 95% CI: 1.64-5.27) were associated with an increased risk of recidivism. ID was associated with a higher risk of physical violence (aOR = 2.01, 95% CI: 1.28-3.14) and arson (aOR = 3.43, 95% CI: 1.01-11.71), whereas ASD was associated with physical violence (aOR = 2.87, 95% CI: 1.51-5.46). Among Japanese forensic outpatients, ASD and ID were associated with an increased risk of recidivism during outpatient treatment. These findings highlight the importance of developing tailored support and multidisciplinary interventions that address the specific needs of individuals with NDDs.

Prior structural magnetic resonance imaging (MRI) studies of attention-deficit/hyperactivity disorder (ADHD) have primarily focused on clinically diagnosed samples, whereas the neuroanatomical correlates of dimensional ADHD traits in healthy young adults (aged 18-27 years) remain insufficiently characterized, and it is unclear whether neuroanatomical patterns reported in clinically diagnosed samples generalize to subclinical trait variability in young adulthood. We therefore examined whole-brain voxelwise associations between gray matter volume (GMV) and the Conners' Adult ADHD Rating Scales (CAARS) Hyperactivity/Restlessness subscale as the primary analysis, and evaluated associations with other CAARS scales on an exploratory basis, using voxel-based morphometry (VBM). Participants were 534 healthy young adults (304 males, 230 females; aged 18-27 years) without an ADHD diagnosis. ADHD traits were assessed using CAARS. High-resolution T1-weighted structural MRI data were acquired on a 3-Tesla scanner. GMV was analyzed using VBM implemented in SPM12. Voxelwise multiple-regression analyses were conducted, with Hyperactivity/Restlessness as the primary scale of interest and other CAARS scales examined in separate exploratory models. Statistical significance was set at p&#x2009;<&#x2009;0.05 (cluster-level family-wise error [FWE]-corrected), using a voxelwise cluster-forming threshold of p&#x2009;<&#x2009;0.001 (uncorrected). GMV in the right dorsolateral prefrontal cortex (DLPFC) showed a small but statistically significant positive association with Hyperactivity/Restlessness scores (cluster-level FWE-corrected p&#x2009;=&#x2009;0.017). No significant associations were observed for other CAARS subscales, and no significant sex-stratified effects were detected. These findings are consistent with a dimensional perspective on ADHD-related traits and suggest that interindividual differences in Hyperactivity/Restlessness may be reflected in subtle GMV variation in the right DLPFC among healthy young adults. Further multimodal and longitudinal studies are warranted to clarify developmental and mechanistic interpretations.

Depressive symptoms are highly prevalent in early-stage dementia with Lewy bodies (DLB) and are associated with impaired quality of life, functional decline, and increased caregiver burden. However, effective and well-tolerated treatment options for depression in this population remain limited because of marked drug sensitivity and autonomic dysfunction. Theta burst stimulation (TBS), a brief form of repetitive transcranial magnetic stimulation, may represent a promising non-pharmacological intervention; however, its feasibility and safety in patients with DLB have not been systematically investigated. This single-center, single-arm, open-label feasibility study will be conducted over four weeks. Participants with prodromal and mild DLB and clinically relevant depressive symptoms will receive intermittent TBS targeting the left dorsolateral prefrontal cortex three times per week for four weeks (12 sessions in total). The primary outcome is the completion rate of the 12-session TBS protocol. Secondary outcomes include safety and changes in depressive symptoms, neuropsychiatric symptoms, sleep quality, global clinical severity, cognitive function, cognitive fluctuations, extrapyramidal motor symptoms, activities of daily living, and caregiver burden. This study will evaluate the feasibility and tolerability of TBS in patients with prodromal and mild DLB and will provide descriptive data on changes in clinical outcomes following the intervention. This study will generate critical pilot data regarding the safety and practicality of TBS for depressive symptoms in early-stage DLB. The findings will inform the design of future multicenter, randomized, sham-controlled trials aimed at establishing evidence-based non-pharmacological treatment strategies for this population with limited therapeutic options.

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an immunotherapy-responsive inflammatory central nervous system disorder. Psychiatric manifestations include delirium, cognitive or behavioral change, apathy, depressive symptoms, and anxiety; however, frank delusional psychosis before corticosteroid exposure is rarely characterized. Timing is critical because corticosteroids can themselves cause psychosis. A 42-year-old man with no previous psychotic disorder developed a progressive subacute syndrome over several months, beginning with headache and followed by impaired fine motor function, dysarthria, dysphagia, tremor, and cognitive decline. Cerebrospinal fluid (CSF) showed inflammation, and CSF GFAP-immunoglobulin G (IgG) was confirmed by qualitative cell-based and tissue-based assays. Before corticosteroid pulse therapy or oral prednisolone, his family observed a new persecutory delusion that someone was outside the window. Immunotherapy was led by neurologists, and psychiatric symptoms were assessed by psychiatrists through consultation and later psychiatric hospitalization. After corticosteroid therapy, neurological symptoms partially improved, but persecutory ideas, grandiosity, insomnia, irritability, aggression, and escape behavior became prominent. Prednisolone was continued because of the autoimmune neurological disease. Olanzapine was titrated to 15&#x2009;mg/day. Behavioral dyscontrol improved markedly despite continued prednisolone, and physical restraint was no longer required; however, residual grandiose delusional ideas persisted. This case suggests that delusional psychosis can be an early manifestation of autoimmune GFAP astrocytopathy. Because the first delusion preceded corticosteroid exposure, steroid-induced psychosis was excluded as the mechanism of onset. Olanzapine may stabilize severe behavioral dyscontrol while necessary corticosteroid therapy is maintained, although residual delusions may persist.