Patients with neuropsychiatric systemic lupus erythematosus (NPSLE) frequently show neurological and psychiatric symptoms. When NPSLE is comorbid with a psychiatric disorder, symptoms often overlap leading to a delayed NPSLE diagnosis. Herein, we present the case of a 39-year-old male patient presenting various neuropsychiatric symptoms, who was subsequently diagnosed with NPSLE. Severe neuropsychiatric symptoms, including persecutory delusions, visual hallucinations, depressed mood, psychomotor excitement, and cognitive impairments, persisted after NPSLE was treated with prednisolone and cyclophosphamide in combination with antipsychotics and anticonvulsants. We also discuss the changes in enhanced MRI findings that did not reflect the patient's neuropsychiatric symptoms.

Atypical antipsychotics cause hypoglycemia as a rare metabolic adverse effect in patients without diabetes. However, its mechanism is not sufficiently clarified. In the present case, a patient with schizophrenia presented with hypoglycemia induced by risperidone and olanzapine after becoming generally debilitated, but not by haloperidol. A complex interaction of serotonergic and adrenergic pathways with atypical antipsychotics may play a role in hypoglycemia. When prescribing atypical antipsychotics for patients, clinicians should be careful not only about the amount and character of the antipsychotics, but also the general status of the patients.

Methylphenidate (MPH) is the main psychostimulant drug for children and adolescents with ADHD. The long-acting stimulant of osmotic controlled-release oral delivery system (OROS) MPH has been designed to release gradually increasing concentrations of MPH over a period of 10-12 hours. Febrile seizure (FS) is a seizure associated with high body temperature, typically due to a viral infection. In this case report, a 17-year-old boy with a history of ADHD who experienced a febrile seizure while taking OROS-MPH is reported.

Antipsychotics are the most common psychotropic drugs associated with blood dyscrasias, and clozapine is the most notably implicated when agranulocytosis occurs, although other antipsychotic agents can cause this serious side effect at different levels of risk. We present the case of a 26-year-old man with a treatment-resistant schizophrenia who developed agranulocytosis while under treatment with the combination of paliperidone and clozapine. We discuss the individual and combined implications of both antipsychotics in the development of agranulocytosis and the importance of haematological monitoring for combined antipsychotic treatment in general, and not only when clozapine is used. To the authors' knowledge this is the first report of agranulocytosis with the combination of clozapine and paliperidone.

This review introduces the treatment guidelines of acute mania by the Japanese Society of Mood Disorders (JSMD) and compares it with that of the Canadian Network for Mood and Anxiety Treatments (CANMAT). Lithium alone for mild mania and the combination of lithium and some atypical antipsychotic drugs for more severe mania are recommended by the JSMD guidelines. This recommendation is different from that of the CANMAT. As maintenance treatment after treatment of the acute phase should be considered from the start of treatment and lithium is the most recommended drug for maintenance treatment in the JSMD guideline, lithium becomes the critical drug for the treatment of mania in the JSMD guidelines. The so-called "drug lag" accounts for the difference between the two guidelines. Safer drugs for extrapyramidal symptoms and cognitive function should be preferred, because these adverse effects interfere with the functional recovery of bipolar patients. The adverse effects of hypnotics or alcohol on cognitive function should be noted carefully, because cognitive impairment influences disabilities and quality of life (QOL) in bipolar patients. New understanding of the pathophysiology of bipolar disorder, that is circadian rhythm dysfunction, may lead to its new diagnosis and treatment.

Objective: Patients with schizophrenia have higher morbidity and mortality rates than the general population and a shorter life expectancy. While increased plasma triglyceride levels constitute a risk factor for cardiovascular diseases, metabolic disturbances are seen in patients with schizophrenia and in those on antipsychotics. This study assessed the triglyceride levels of patients with schizophrenia who were administered antipsychotic monotherapy in various treatment settings as a post-hoc analysis of a previous nationwide survey.

Methods: The final study population comprised 2416 inpatients and 1159 outpatients selected using questionnaire surveys were administered at facilities within the Japan Psychiatric Hospitals Association. Analysis of covariance was performed to compare the triglyceride levels among the three antipsychotic groups: olanzapine, risperidone or aripiprazole.

Results: The triglyceride levels of inpatients were significantly different among the three antipsychotic groups after adjusting for body mass index, age, sex and chlorpromazine-equivalent dosage. In the post-hoc analysis, inpatient triglyceride levels were significantly higher in the olanzapine group (106.5 ± 61.8 mg/dL) than the risperidone group (97.1 ± 50.4 mg/dL). In contrast to inpatient hospitalisations, outpatient settings may mask the antipsychotic treatment effects on triglyceride levels.

Conclusions: Triglyceride levels differ based on the type of antipsychotic treatment in inpatients but not outpatients.

Purpose: Previous studies have established that metabolic syndrome (MetS) is associated with an increased risk of mortality. Several studies have demonstrated that the assessment of patients' attitudes or behaviors regarding their physical health problems is an important parameter in initiating positive health behaviors and providing patients with metabolic control. To determine whether schizophrenia patients' attitudes towards physical health affect the prevalence of MetS, we conducted a questionnaire survey of schizophrenia patients.

Methods: We obtained 7,655 and 15,461 questionnaire responses from 520 and 247 facilities for outpatients and inpatients, respectively. The final analysis included data from a total of 6,576 subjects (2,213 outpatients and 4,363 inpatients). We assessed the effects of patients' attitudes as risk factors for having MetS using multivariate logistic regression analysis.

Results: The prevalence of MetS was higher in outpatients compared with inpatients (34.7% and 13.2%, respectively). Multivariate logistic regression analysis indicated that positive attitudes towards disease prevention and health care were related to a lower prevalence of MetS for outpatients and inpatients. In addition, greater knowledge of, and interest in, physical risk were associated with a lower prevalence of MetS only in outpatients.

Conclusions: We detected substantial gaps in knowledge and negative health attitudes among respondents, suggesting that educational programs should be incorporated into current management protocols for patients with a high risk of MetS.

Purpose: Although attention-deficit/hyperactivity disorder (ADHD) has historically been thought to be predominantly a childhood disorder, many cases of ADHD persist into adulthood. Therefore, it is necessary to assess the symptoms and efficacy of medication using objective assessment tools in adults with ADHD. The aim of this study was to assess usefulness of the Clinical Assessment for Attention Test (CAT) comprising Span, Cancellation and Detection Test, Symbol Digit Modalities Test, memory updating test, paced auditory serial addition test, position Stroop test, and continuous performance test (CPT) for adults with ADHD.

Methods: ADHD outpatients without intellectual disorders (IQ ≥ 80) with age range of 20-39 years were recruited (15 males and 10 females; mean age 27.7 ± 5.5). The participants did not receive any psychopharmacological treatment and were assessed with CAT at baseline.

Results: The patients showed significantly decreased attention scores in Cancellation and Detection Test (Visual Cancellation Task and Auditory Detection Task) and CPT, although this decrease was not correlated to age or intelligence quotient. The effect of psychopharmacological treatment was assessed in two participants using CAT.

Discussion: Cancellation and Detection Test and CPT are useful tools to support the diagnosis of adults with ADHD as well as evaluation of the efficacy of psychopharmacological treatment.

Childhood abuse, trait anxiety, and neuroticism are associated with depression, and activation of the amygdala has been hypothesized as the biological basis of these predisposing factors. Anxiety disorder often coexists with major depressive disorder, and this comorbidity has been postulated to occur owing to the above predisposing factors. However, this possibility has not yet been fully confirmed in clinical studies. A history of childhood abuse, and anxiety disorder or anxiety symptoms have been reported to coexist in patients with treatment-resistant depression. Therefore, the above hypothesis may also apply to treatment-resistant depression. Large-scale studies are needed to test whether childhood abuse, propensity for trait anxiety/neuroticism, amygdala activation, and the coexistence of anxiety disorder/anxiety symptoms are more pronounced in patients with treatment-resistant depression than those with non-treatment-resistant depression. At present, it is clinically clear that treatment-resistant depression more frequently occurs in patients with comorbid anxiety disorders and a history of childhood abuse. The clinical care of patients with treatment-resistant depression keeping this information in mind may lead to a better understanding of these patients, and may also assist in the development of effective treatment strategies.

Generalised anxiety disorder (GAD) displays a variety of psychological and physical symptoms. These are difficult to rapidly control with currently available pharmacological options. This review summarises the evidence for an acute use of microbiological modification drugs targeting vagal nerve stimulation.

A systematic search was conducted in Medline, Pubmed, and PschInfo for all pre-clinical and human studies concerning the use of Lactobacillus and Bifidobacterium in the treatment of GAD.

Twenty-five studies were eligible for inclusion. In mice, modification therapy resulted in improved behaviour that was at least non-inferior to standard therapy (antidepressants). Brain histopathology revealed further anti-inflammatory and neuroprotective benefits. Vagotomy abolished the anti-GAD properties of the treatment.

In humans, several species demonstrated significant reductions in palpitations, shortness of breath, headaches, flu-like symptoms, and abdominal pains vs. placebo within 4 to 12 weeks. B. bifidum, B. lactis, L. acidophilus and S. thermophiles showed alleviation of physical symptoms to population baseline when added to an antidepressant. No significant side effects were reported in the studies.

As physical symptoms are typically the presenting medical complaint of GAD, there is potential to control the disease with the administration of bacteria-containing pharmaceutical agents as an adjunct to current antidepressant options.

This study aimed to examine the effect of discontinuation of antipsychotic medication on the relapse of psychiatric symptoms in pregnant women with schizophrenia. We investigated the medical records of all consecutive pregnant women with schizophrenia who continuously visited and delivered their children at Chiba University Hospital from January 2007 to January 2019. We retrospectively assessed the scores on the Clinical Global Impression of Change scale (CGI-C) during the period when psychiatric symptoms changed most during the pregnancy. A CGI-C score of 5 or more was defined as a relapse. Twenty-eight patients consisting of the maintained treatment group (n = 18) and the discontinuation group (n= 10) were recruited. During pregnancy, the relapse rate in the maintained treatment group (16.7%) was significantly lower than that in the discontinuation group (90.0%). This study demonstrates a high relapse rate in pregnant women discontinuing their antipsychotic medication, as well as during the non-pregnancy period.