Norio Yasui-Furukori

Background: The Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project is a nationwide Japanese educational program promoting guideline‐concordant pharmacotherapy for schizophrenia and major depressive disorder (MDD). Psychiatrists' self‐reported clinical behavior (CB) scores after EGUIDE training are partially associated with objective quality indicators of specific practices. However, their association with comprehensive objective measures of overall guideline adherence remains unclear. Methods: This multicenter observational study included 1897 EGUIDE‐trained psychiatrists. CB was assessed online immediately after training. The Guideline Adherence Rate (GAR) was calculated for 5328 patients with schizophrenia and 3538 patients with MDD whose discharge records were linked to their psychiatrist's CB score. Associations were evaluated using unadjusted patient‐level Spearman correlations, without modeling clustering within psychiatrists or institutions. Sensitivity analyses aggregated the data to the psychiatrist‐year level, adjusted for institution type, psychiatrist experience, and patient age, and used generalized estimating equations (GEE) to correct the patient‐level inference for clustering. Results: CB scores showed positive but very weak correlations with GAR (schizophrenia, ρ = 0.09–0.14; MDD, ρ = 0.08–0.11; all p < 0.001). Squared coefficients (approximately 0.006–0.020) indicated that CB scores accounted for < 2% of the rank‐order variation in GAR. These associations remained statistically significant in psychiatrist‐year‐level, covariate‐adjusted, and clustering‐corrected (GEE) sensitivity analyses. Conclusions: Post‐training self‐reported CB scores were weakly associated with patient‐level GAR. Given the cross‐sectional, unadjusted analysis and the non‐independence of patients treated by the same psychiatrist, these findings do not establish CB as a reliable proxy for actual clinical practice. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000022645

Background: Venlafaxine (VEN) is converted to O‐desmethylvenlafaxine (ODV) mainly through CYP2D6‐mediated O‐demethylation. However, age‐related clinical factors may also influence VEN exposure in routine practice. We examined whether age and CYP2D6 genotype show different associations with parent‐drug exposure and metabolic conversion. Methods: This retrospective therapeutic drug monitoring analysis included 78 Japanese psychiatric patients with available plasma VEN and ODV concentrations and CYP2D6 genotype data. Two prespecified outcomes were analyzed without body‐weight correction: VEN concentration divided by daily dose (VEN/dose) and the ODV/VEN ratio. CYP2D6*10 and *5 were coded as reduced‐ and no‐function alleles, respectively. Log‐transformed outcomes were analyzed using regression models including age and CYP2D6 reduced/no‐function allele count. Results: Nineteen patients (24.4%) were aged 65 years or older. Age was correlated with VEN/dose (Spearman rho = 0.295, p = 0.0086), and older patients had higher VEN/dose than younger patients (median, 0.522 vs. 0.192 [ng/mL]/[mg/day], p = 0.0127). In regression analysis, the incremental R ² for age was numerically larger than that for CYP2D6 allele count for VEN/dose (incremental R ² , 0.058 vs. 0.026). Conversely, the ODV/VEN ratio was strongly associated with CYP2D6 allele count (standardized beta = −0.391, p < 0.001; incremental R ² = 0.145) but not with age. Age‐by‐genotype interactions were not significant for either outcome. Conclusions: Age appeared to be more closely related to dose‐corrected parent VEN exposure, whereas CYP2D6 genotype predominantly determined the ODV/VEN metabolic ratio. The relative contribution of age should be interpreted descriptively because no formal comparison of effect sizes was performed. Separating exposure and metabolic‐ratio outcomes may clarify how geriatric and pharmacogenetic factors contribute to VEN disposition.

Background: Conventional transcranial magnetic stimulation (TMS) neuronavigation systems provide precise guidance but depend on costly optical tracking equipment. In this study, we developed and evaluated a smartphone-based neuronavigation system that uses RGB images alone, without depth sensing, for motor evoked potential (MEP) mapping. Methods: Fifteen healthy participants underwent TMS mapping of the first dorsal interosseous muscle. A smartphone RGB camera and AprilTag-based tracking were used to estimate head and coil poses. Smartphone-derived coordinates were registered to three-dimensional head scans and transformed into Montreal Neurological Institute space using affine transformations. MEP amplitude maps and centers of mass (CoMs) were then calculated. A mannequin simulation and reanalysis of feasibility-study data were conducted to determine a practical control-point configuration. Results: Registration combining anatomical landmarks with target control points yielded MEP CoM coordinates comparable to those obtained with conventional neuronavigation, although localization errors were slightly greater. Most estimated CoMs were located in the left precentral gyrus. Additional analyses demonstrated that four spatially distributed control points reduced coordinate-estimation errors relative to anatomical landmarks alone while preserving a simple registration procedure. Conclusions: A smartphone-based neuronavigation system using RGB images alone can produce physiologically plausible MEP maps without depth sensors or multi-camera systems. Despite the need for greater localization accuracy, improved lighting robustness, and magnetic resonance imaging integration, this approach could offer an accessible and cost-effective platform for research and clinical TMS.

Background: Schizophrenia is characterized by positive symptoms, negative symptoms, and cognitive impairment and is primarily treated with antipsychotic medications. However, a subset of patients responds inadequately to treatment and is classified as having treatment‐resistant schizophrenia (TRS). The prevalence of TRS among patients with schizophrenia remains insufficiently characterized. This study aimed to determine the prevalence of TRS using nationwide data and standardized diagnostic criteria. Methods: This study included patients with schizophrenia who were discharged between 2016 and 2024 from 205 institutions participating in the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project and authorized to prescribe clozapine. TRS was defined according to standardized diagnostic criteria used in Japan. The prevalence of TRS was calculated among patients who underwent a TRS examination by their treating psychiatrist. Results: Among 18 914 patients, 9870 (52.2%) underwent a TRS examination. Among these 9870 patients, 2819 were classified as having TRS, corresponding to a prevalence of 28.6%. Among the 2819 patients with TRS, 1307 were prescribed clozapine at discharge, corresponding to a clozapine treatment rate of 46.4%. Conclusions: This study had the largest sample size among single‐cohort studies investigating the prevalence of TRS. The prevalence of TRS was 28.6% among patients with schizophrenia who underwent a TRS examination and was nearly identical to the pooled prevalence reported in studies at low risk of bias in a previous meta‐analysis. These findings may provide important evidence regarding the prevalence of TRS in routine clinical practice.

Aim: Anxious distress is common in major depressive disorder (MDD), but real‐world data are limited on its burden and relationship to depressive symptom domains. This study examined the prevalence and symptom‐domain correlates of self‐reported anxious distress in MDD outpatients. Methods: This cross‐sectional study used routinely collected questionnaire and clinical data from Dokkyo Medical University Hospital. Depressive severity was assessed using the Japanese version of the Quick Inventory of Depressive Symptomatology (QIDS‐J). Anxious distress was assessed using five self‐rated items aligned with the Clinically Useful Depression Outcome Scale‐Anxious Distress (CUDOS‐A) and DSM‐5 framework. Of 309 respondents, the primary analytic cohort comprised 206 participants with QIDS‐J total scores of 6 or higher and complete anxious‐distress item data. Results: A lower anxious‐distress threshold (at least two items scored > = 2) was met by 153 participants (74.3%), and a stringent threshold (at least two items scored > = 3) by 85 (41.3%). QIDS‐J total score correlated with anxious‐distress burden ( r = 0.614 for > = 2 count, r = 0.669 for > = 3 count, and r = 0.697 for summed score; all p < 0.001). In forced‐entry Poisson models, sad mood, negative self‐view, and psychomotor symptoms were associated with anxious‐distress burden. Post hoc decomposition suggested that this psychomotor association was driven mainly by psychomotor agitation rather than retardation. Conclusion: Self‐reported anxious distress was common among MDD outpatients and was closely associated with depressive severity and specific symptom domains, supporting further evaluation of anxious distress as a clinically relevant psychopathological dimension in MDD.

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Aim: This study aimed to describe the nationwide reach, longitudinal growth, and geographic dissemination of the Effectiveness of Guideline for Dissemination and Education in Psychiatric Treatment (EGUIDE) project in Japan from 2016 to 2024. Methods: The EGUIDE project is a nationwide, multicenter implementation initiative designed to promote the dissemination of clinical practice guidelines, specifically the Guidelines for Pharmacological Treatment of Schizophrenia and the Treatment Guidelines II: Major Depressive Disorder. The project provides educational lectures primarily for psychiatrists and other mental health professionals. We descriptively summarized the cumulative numbers of lectures delivered, participants enrolled, and participating institutions from 2016 to 2024. In addition, we calculated the proportion of hospitals with psychiatric departments that participated in each prefecture. Results: Between 2016 and 2024, a total of 194 guideline lectures on schizophrenia and major depressive disorder were conducted. The cumulative number of participants reached 4785 across 763 institutions, of which 592 were hospitals with psychiatric departments, corresponding to approximately 20% of all such hospitals nationwide. Participating hospitals were distributed across most prefectures in Japan, indicating broad geographic coverage. Conclusion: Over the 9‐year period, the EGUIDE project continuously delivered guideline lectures and steadily expanded its participant and institutional base. The nationwide distribution of participating institutions suggests that the project has established a broad implementation platform for psychiatric guideline dissemination in Japan. Continued efforts may further strengthen this dissemination network and support future evaluations of its impact on psychiatric practice.