Psychometrics of rating scales for externalizing disorders in Japanese outpatients: The ADHD-Rating Scale-5 and the Disruptive Behavior Disorders Rating Scale.

OBJECTIVES: This study validated the Japanese version of the Attention-Deficit/Hyperactivity Disorder-Rating Scale-5 (ADHD-RS-5) and the Disruptive Behavior Disorders Rating Scale. We extended the ADHD-RS-5 by adding the oppositional defiant disorder and conduct disorder subscales to compare the two rating scales psychometrically. METHODS: We examined the internal consistency, test-retest reliability, construct validity and criterion validity of the two rating scales in 135 Japanese outpatients aged 6-18 years. RESULTS: The internal consistency and test-retest reliability were good for all the subscales of the two rating scales except for the conduct disorder subscale of the ADHD-RS-5 extended. Good construct validity was revealed by expected correlational patterns between subscales from the two rating scales and the Children Behavior Checklist. The criterion validity was good for all the subscales of the two rating scales rated by parents, while teacher-ratings revealed substantially lower predictive ability for all the subscales. Agreement between parent- and teacher-ratings of the two rating scales was generally moderate and using predictive ratings alone of both ratings showed the best predictive ability among the integration methods examined. CONCLUSION: The two rating scales have sound psychometric properties and will aid in screening and severity assessment of externalizing disorders in Japanese clinical settings.

Validity and reliability of the Japanese versions of the coronavirus anxiety scale for adolescents and obsession with COVID-19 scale for adolescents.

Background: The coronavirus disease 2019 (COVID-19) has caused mental health issues in both adults and adolescents. The Coronavirus Anxiety Scale (CAS) and Obsession with COVID-19 Scale (OCS) questionnaires measure anxiety and persistent and disturbed thoughts (also known as obsessions) related to COVID-19. We developed Japanese versions of the CAS (i.e., CAS-JA) and OCS (i.e., OCS-JA) questionnaires to make them suitable for adolescents and validated the characteristics of these scales. Methods: Two online surveys were administered to high school students aged 15-18 years. A total of 263 students participated in the first survey and almost half of them participated in the second survey. In the first survey, participants responded to the CAS-JA, OCS-JA, generalized anxiety and obsessive-compulsive subscales of the Spence Children's Anxiety Scale (SCAS), and Kessler 6 Scale (K6). The SCAS and K6 were used to verify discriminant validity and inter-scale correlations. In the second survey, the participants completed the CAS-JA and OCS-JA again to verify test-retest reliability. We performed a confirmatory factor analysis and calculated the model fit indices. Additionally, we examined the internal consistency reliability, convergent validity, and inter-item correlations of the CAS-JA and OCS-JA. Moreover, differences in CAS-JA and OCS-JA responses by gender and region of residence (state of emergency and non-emergency areas) were examined. Results: The results of the single-factor model confirmatory factor analysis of model fit indices were above the threshold. The required criteria for internal consistency reliability, test-retest reliability, and discriminant and convergent validity were met in both the CAS-JA and OCS-JA. No statistically significant differences attributed to residence and gender were found in both questionnaires. Conclusions: The results indicate that the CAS-JA and OCS-JA questionnaires are useful in measuring COVID-19-related anxiety, and persistent and disturbed thoughts in Japanese adolescents.

Psychometrics of the kiddie schedule for affective disorders and schizophrenia present and lifetime version for DSM-5 in Japanese outpatients.

OBJECTIVE: The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) is a widely used semi-structured diagnostic interview in child and adolescent psychiatry. However, the psychometric properties of its updated version, the K-SADS-PL for DSM-5, have scarcely been examined, especially for criterion validity. This study was designed to examine the inter-rater reliability, criterion validity and construct validity of the K-SADS-PL for DSM-5 in 137 Japanese outpatients. METHODS: Two of 12 experienced clinicians independently performed the K-SADS interview for each patient in a conjoint session, and the resulting consensus diagnosis was compared with a "best-estimate" diagnosis made by two of eight experienced clinicians using all available information for the patient. RESULTS: The inter-rater reliability was excellent, as shown by κ > 0.75 for all disorders, with the exception of current separation anxiety disorder. The criterion validity was fair to good, as shown by κ > 0.40 for all disorders, with the exception of current and lifetime agoraphobia. The construct validity was also good, as shown by theoretically expected associations between the K-SADS-PL diagnoses and subscales of the child behavior checklist. CONCLUSION: The K-SADS-PL for DSM-5, now available in Japanese, generates valid diagnoses in child and adolescent psychiatry.

Guided internet-based cognitive behavioral therapy for obsessive-compulsive disorder: A multicenter randomized controlled trial in Japan.

Few studies have compared the effectiveness of internet-based cognitive behavior therapy (ICBT) for obsessive-compulsive disorder (OCD) with treatment as usual (TAU). We investigated the effectiveness of guided ICBT for patients with OCD. This prospective, randomized, controlled, assessor-blinded, multicenter clinical trial was conducted at three facilities in Japan from January 2020 to March 2021. Thirty-one patients with OCD as the primary diagnosis participated in the trial and were randomly assigned to either the intervention group or the control group. The primary outcome was the Yale-Brown obsessive-compulsive scale score; the assessors were blinded. Results of the analysis of covariance among the groups were significantly different between the groups (p < 0.01, effect size Cohen's d = 1.05), indicating the superiority of guided ICBT. The results suggest that guided ICBT is more effective than TAU for treating OCD. RCT REGISTRATION: UMIN Clinical Trials Registry (UMIN000039375).

Practical applications of brief screening questionnaires for autism spectrum disorder in a psychiatry outpatient setting.

OBJECTIVES: This study was designed to examine the diagnostic performance of the social and communication disorders checklist (SCDC) and strength and difficulties questionnaire (SDQ) to detect autism spectrum conditions (ASC), along with the social responsiveness scale-second edition (SRS-2) as reference, in a psychiatry outpatient setting. METHODS: We translated the SCDC into Japanese since its Japanese version was unavailable. We examined its test-retest reliability as well as the internal consistency reliability and diagnostic performance of the three questionnaires among 41 Japanese psychiatric outpatients, using the best-estimate diagnosis of ASC based on the diagnostic interview for social and communication disorders, as a gold standard. RESULTS: The test-retest reliability was high for the SCDC. Although the internal consistency reliability was high for the SCDC and SRS-2, that was low for the prosocial and peer problem subscales of the SDQ. The performance of the SCDC, SDQ, and SRS-2 to detect ASC was moderate: the area under the ROC curve of 0.78, 0.78, and 0.84, respectively. CONCLUSIONS: Although questionnaires to detect ASC, including the three examined, generally have only moderate performance in this setting, these can be successfully applied to high-risk populations such as psychiatry outpatients, when multi-level rather than dichotomous likelihood ratios are used.

Guided Internet-Based Cognitive Behavioral Therapy in Japanese Patients With Obsessive-Compulsive Disorder: Protocol for a Randomized Controlled Trial.

BACKGROUND: Cognitive behavioral therapy for obsessive-compulsive disorder has been established, but access to this therapy in Japan is limited. Internet-based cognitive behavioral therapy may improve treatment accessibility and sufficiently improve obsessive-compulsive symptoms. There are few randomized controlled trials examining the effectiveness of internet-based cognitive behavioral therapy in patients with obsessive-compulsive disorder. We designed a randomized controlled trial protocol to assess the effectiveness of guided internet-based cognitive behavioral therapy in Japanese patients with obsessive-compulsive disorder. OBJECTIVE: We aimed to develop a protocol for a randomized controlled trial of internet-based cognitive behavioral therapy in Japanese patients with obsessive-compulsive disorder. METHODS: The randomized controlled trial will compare internet-based cognitive behavioral therapy treatment and usual care groups, each consisting of 15 participants (n=30) diagnosed with obsessive-compulsive disorder. We will evaluate the effectiveness of a 12-week intervention. The primary outcome of symptom severity will be measured using the Yale-Brown Obsessive-Compulsive Scale. Secondary outcomes will be assessed with the Obsessive-Compulsive Inventory, Beck Anxiety Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Working Alliance Inventory-Short Form, and the Euro Qol - 5 Dimension. All measures will be assessed at weeks 0 (baseline) and 12 (follow-up). In the statistical analysis comparing treatment effects, the least-squares means and their 95% CIs will be estimated by analysis of covariance with the change in total outcomes scores at week 12. All comparisons are planned, and all P values will be two-sided, with values <.05 considered statistically significant. RESULTS: The study will be performed from January 2020 to March 2021, and results are expected to be available in mid-2021. CONCLUSIONS: The trial will demonstrate whether internet-based cognitive behavioral therapy improves access and is more effective than more usual care for patients with obsessive-compulsive disorder in Japan. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN) 000039375; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000044422. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18216.

The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) for DSM-5: A validation for neurodevelopmental disorders in Japanese outpatients.

OBJECTIVE: The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) is a widely used semi-structured diagnostic interview in child and adolescent psychiatry. However, given the extensive use of the K-SADS-PL in clinical practice and research and its adaptation for use in many languages and cultures, validation studies of the instrument are scarce. This study was designed to examine the inter-rater reliability, criterion validity and construct validity of the updated instrument, the K-SADS-PL for DSM-5, in Japanese outpatients totaling 95 children and adolescents. METHOD: We translated and adapted the updated instrument into Japanese using a standard forward-backward translation procedure. Two of nine experienced clinicians independently made diagnoses using the interview for each patient in a conjoint session. Discrepancies in diagnosis between two clinicians were resolved by consensus, and the consensus diagnosis was compared with a "best-estimate" diagnosis made by five experienced clinicians using all available data sources for patients who were blinded to the diagnosis using the K-SADS-PL for DSM-5. The "best-estimate" diagnosis of ASD was also based on the Diagnostic Interview for Social and Communication Disorders. RESULTS: The inter-rater reliability was very good, as shown by κ ≥ 0.8 for all disorders examined: autism spectrum disorder (ASD), attention-deficit hyperactivity disorder, tic disorders, selective mutism, enuresis and encopresis. The criterion validity was good, as shown by κ ≥ 0.6 for all disorders examined, except for ASD (κ = 0.59). This study also revealed good construct validity of the instrument by confirming the expected associations with each scale from the Social Responsiveness Scale-2nd edition and the Strengths and Difficulties Questionnaire. CONCLUSION: These results suggest that the K-SADS-PL for DSM-5 generates valid diagnoses in child and adolescent psychiatry.

Generalized social anxiety disorder: A still-neglected anxiety disorder 3 decades since Liebowitz's review.

In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.

Long-term outcome and preprocedural predictors of atrial tachyarrhythmia recurrence following pulmonary vein antrum isolation-based catheter ablation in patients with non-paroxysmal atrial fibrillation.

BACKGROUND: Although various empiric adjunctive ablation techniques are widely performed with pulmonary vein antrum isolation (PVAI) to enhance the procedural efficacy of catheter ablation in non-paroxysmal atrial fibrillation (NPAF) patients, they are not required in all NPAF patients. METHODS AND RESULTS: Eighty consecutive NPAF patients refractory to antiarrhythmic drugs underwent a PVAI-based ablation. Structural heart disease was present in 40% of patients and systolic dysfunction in 21%. After 31 ± 16 months of follow-up, 41% of the patients were free of atrial tachyarrhythmia recurrences after a single procedure. Finally, during a mean follow-up of 25 ± 15 months, 63 of 80 (79%) patients remained in sinus rhythm (SR) after the final procedure (two procedures in 48%, and three in 3%). A Cox regression multivariate analysis revealed that left atrial volume (LAV) was the only independent predictor of atrial tachyarrhythmia recurrences not only after single procedures (p = 0.027), but also after the final procedures (p = 0.001). Ten patients (13%) needed ablation for concomitant atrial tachycardias originating from the left atrium and right atrium other than common atrial flutter. Repeat ablation procedures increased the best cut-off value for predicting recurrences analyzed by receiver operating characteristic curves, from 86 mL (sensitivity 70%, specificity 64%) to 92 mL (sensitivity 71%, specificity 78%). CONCLUSIONS: PVAI-based ablation strategies could achieve SR maintenance in almost 80% of NPAF patients after multiple procedures during long-term follow-up. The preprocedural LAV was an important predictor of the procedural outcome.

Time-dependent variation in coronary flow velocity reserve induced by adenosine triphosphate: comparison to low-dose dipyridamole.

BACKGROUND: Measuring the coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) has been widely performed using adenosine. Although adenosine infusion is known to induce transient variation of hyperemia, the timing to measure the CFVR has not been well addressed. Therefore, we aimed to clarify the difference between the peak CFVR and at 2 min following adenosine triphosphate (ATP) infusion compared to the CFVR after low-dose dipyridamole infusion. METHODS AND RESULTS: A total of 26 patients with coronary artery diseases underwent TTDE. The coronary flow velocity (CFV) of the left anterior descending artery (LAD) was monitored during ATP infusion at 0.14 mg/kg/min. The CFVR was measured both at the first peak and at 2 min following ATP infusion, and after dipyridamole infusion at 0.56 mg/kg/min for 4 min. The first peak of hyperemia occurred 63.7 ± 8 s after starting ATP infusion. The value of the peak CFVR was significantly higher than the CFVR at 2 min following ATP stress, which was equivalent to the CFVR after dipyridamole infusion (2.30 ± 0.92, 1.83 ± 0.77, and 1.70 ± 0.68, respectively, P < 0.001). Applying a cut-off value of 2.0 to predict angiographic LAD stenosis, the CFVR at 2 min following ATP stress was significantly correlated to the angiographic findings. However, the peak CFVR after ATP infusion did not correlate with the angiographic findings. CONCLUSIONS: During ATP infusion, the peak CFVR was significantly higher than the CFVR at 2 min, which was equivalent to the CFVR after low-dose dipyridamole. This finding should be considered for the standardization of CFVR measurements.

[The neurotic disorders].

The clinical practice of child and adolescent psychiatry includes encounters with disorders not particular to childhood and adolescence, but seen in adulthood as well. For example, among the neurotic disorders, obsessive-compulsive disorder can be seen from around 3 years of age, with rapid rise in prevalence from around age 10. Increase is also seen in cases of anorexia nervosa from around age 11. This report examines the association between disorders in childhood and adolescence, in comparison to that in adulthood, with focus on obsessive-compulsive disorder. To start with, the characteristics of childhood onset cases with onset under age 7 were reviewed, revealing a relatively large proportion of subjects with experience of separation anxiety. Analyses revealed the possibility of anticipating obsessional tendencies in the parents of such subjects. Further clarification of the features of such early onset cases is hoped for in future. Next, we conducted a literature review comparing the characteristics of child and adolescent obsessive-compulsive disorder with that in adulthood. It has been determined that obsessive-compulsive symptoms in childhood and adolescence have a relatively unyielding 4-factor construct that persists through life, namely: 1) symmetry factor, 2) forbidden thoughts factor, 3) cleaning factor, and 4) hoarding factor. Of these, children with primary symptoms of hoarding are said to have poorer long-term diagnoses than children with other symptoms. Another point of note is the presence of large disparity regarding the prognosis of cases with concomitant tics. While the prognosis of childhood-obsessive compulsive disorder is generally favorable in many reports, the need for caution has also been noted regarding the possibility of transition on to schizophrenia in more than just a few cases.

Relationship of hypersensitivity to anxiety and depression in children with high-functioning pervasive developmental disorders.

AIMS: Sensory-perceptual abnormalities, which include hyper- and hyposensitivity, have been identified by numerous researchers as prevalent in individuals with pervasive developmental disorders (PDD). Hypersensitivity has a greater impact on PDD patients' daily lives than hyposensitivity. The purpose of the present study was to clarify the relationship of hypersensitivity to anxiety, depression and other psychopathology in children with PDD. METHODS: Sixty-four children were divided into a hypersensitivity group (HG; n = 43) and a non-hypersensitivity group (non-HG; n = 21), and compared for anxiety, depression and other psychopathology on the Child Behavior Checklist (CBCL), State-Trait Anxiety Inventory for Children (STAIC) and Children's Depression Inventory (CDI). RESULTS: The HG group had significantly higher scores than the non-HG group in Total, Internalizing, and Somatic complaints on the CBCL. On STAIC, the mean sore of Total Score, State Score and Trait Score in the HG group tended to be higher than in the non-HG group, but the difference was not significant. The score on the CDI in the HG group was significantly higher than that in the non-HG group. CONCLUSION: PDD children with hypersensitivity have more serious psychopathologies, especially internalizing symptoms including depression.

Evaluation of attention-deficit/hyperactivity disorder symptoms in male children with high-functioning pervasive developmental disorders.

BACKGROUND: Although there are many reports of high rates of hyperactivity and attention deficits in children with Pervasive Developmental Disorders (PDD), controversy remains about the applicability of the diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) to PDD children. The present study elucidates the similarities and differences of ADHD symptoms in PDD children compared to ADHD children. METHODS: Twenty-seven male children with PDD+ADHD Combined type (ADHD-C), 17 males with ADHD-C, and 9 males with PDD without ADHD-C, were compared on measures of ADHD symptoms and related behaviors using parent ratings and teacher ratings on the ADHD Rating Scale (ADHDRS), the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). RESULTS: The PDD+ADHD-C and the ADHD-C groups had significantly higher ratings than the PDD only group for all the scores on both the parent-rated and the teacher-rated ADHDRS. The ADHD-C and PDD+ADHD-C groups had significantly higher scores than the PDD group on Delinquent Behavior, Aggressive Behavior, and Externalizing Behavior of the CBCL and on Delinquent Behavior of the TRF; there were no significant differences between the ADHD-C and PDD+ADHD-C groups on any scores of the CBCL and TRF. CONCLUSIONS: The PDD+ADHD-C and ADHD-C groups share a similar profile of ADHD symptoms and externalizing behaviors, and the comorbidity of ADHD and PDD should be suspected when ADHD symptoms are present in PDD children.

Hyperactivity and comorbidity in Japanese children with attention-deficit/hyperactivity disorder.

No previous study about comorbidity of attention-deficit/hyperactivity disorder (ADHD) in Japan have carried out both a comprehensive investigation using a structured interview and a comparison between ADHD subtypes. The aim of the present study was to clarify the relationship between hyperactivity and disruptive behavior disorder (DBD) in ADHD by comparing a hyperactivity group (HG) with a non-hyperactivity group (non-HG). After diagnosis was carried out by strict exclusion, the 41 ADHD subjects (6-14 years old; IQ, 70-121) diagnosed according to DSM-IV were divided into HG (n = 24) and non-HG (n = 17), and compared for comorbidities and psychopathologies. This was done via semistructured interview with children and parents and questionnaires to parents and teachers. The results demonstrate that (i) most ADHD children had comorbidity (e.g. DBD or anxiety disorder); (ii) the HG had a significantly higher rate of DBD than the non-HG, but the total number of anxiety disorders was not different between subgroups, and (iii) the HG generally had more serious psychopathologies both at home and at school than the non-HG. Both groups had more serious externalizing and internalizing problems at home than at school. The present study provides evidence of a strong relationship between hyperactivity and DBD.