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Global smartphone penetration has led to unprecedented addictive behaviors. The aims of this study are to develop diagnostic criteria of smartphone addiction and to examine the discriminative ability and the validity of the diagnostic criteria. We developed twelve candidate criteria for characteristic symptoms of smartphone addiction and four criteria for functional impairment caused by excessive smartphone use. The participants consisted of 281 college students. Each participant was systematically assessed for smartphone-using behaviors by psychiatrist's structured diagnostic interview. The sensitivity, specificity, and diagnostic accuracy of the candidate symptom criteria were analyzed with reference to the psychiatrists' clinical global impression. The optimal model selection with its cutoff point of the diagnostic criteria differentiating the smartphone addicted subjects from non-addicted subjects was then determined by the best diagnostic accuracy. Six symptom criteria model with optimal cutoff point were determined based on the maximal diagnostic accuracy. The proposed smartphone addiction diagnostic criteria consisted of (1) six symptom criteria, (2) four functional impairment criteria and (3) exclusion criteria. Setting three symptom criteria as the cutoff point resulted in the highest diagnostic accuracy (84.3%), while the sensitivity and specificity were 79.4% and 87.5%, respectively. We suggested determining the functional impairment by two or more of the four domains considering the high accessibility and penetration of smartphone use. The diagnostic criteria of smartphone addiction demonstrated the core symptoms \"impaired control\" paralleled with substance related and addictive disorders. The functional impairment involved multiple domains provide a strict standard for clinical assessment.

Aim Real‐world data (RWD) for paliperidone palmitate (PP) three‐monthly (PP3M) is lacking based on Japan label requirements. This study evaluated the clinical effectiveness of PP3M versus PP once‐monthly (PP1M) in patients with schizophrenia administered according to Japan label requirements. Methods Retrospective analyses were conducted using RWD from Merative™ MarketScan® Multi‐State Medicaid (MDCD) claims database (June 2015–December 2022). Adult patients with schizophrenia switching from PP1M to PP3M were included. Patients transitioning to PP3M were matched with patients who continued with PP1M using propensity score matching (PSM) at 1:1 ratio. Primary hypothesis aimed to investigate non‐inferiority of PP3M versus PP1M in terms of relapse‐free status at 24 months from index PP injection. Outcome measures were proportions of relapse‐free patients at 24 months, time to relapse, treatment persistence, and adherence. Results Total 4252 eligible adult schizophrenia patients on PP (PP3M:582; PP1M:3670) were identified. After PSM, each PP cohort comprised 562 matched individuals. Estimated proportion of relapse‐free patients was higher in PP3M (85.7%) versus PP1M (77.9%), per Japan PP label. PP3M demonstrated superiority to PP1M after testing for non‐inferiority in terms of achieving relapse‐free status at 24 months, with an estimated difference of 7.8% (95% CI: 1.7%–13.9%). PP3M cohort had lower risk of relapse (HR: 0.605; CI: 0.427–0.856), longer treatment persistence, and higher treatment adherence versus PP1M cohort. Conclusions Findings suggests that patients who switched to PP3M might be able to reduce risk of relapse compared to those who continued PP1M after aligning particularly with Japan's label requirements. Japan's label requirements for PP3M prohibit the concurrent use of antipsychotic medication during the transition to PP3M and after initiating PP3M treatment. Analysis using the Merative™ MarketScan® Multi‐State Medicaid claims database revealed that adult patients with schizophrenia who switched to PP3M had a significantly lower risk of relapse compared to those who remained on PP1M. The risk difference at 24 months was 7.8% (95% CI: 1.7–13.9), with a hazard ratio (HR) of 0.605 (95% CI: 1.7–13.9), when using analytical methods consistent with Japan's label.

AimThe aim of this study is to summarize the spontaneous reports of tardive dyskinesia (TD) and extrapyramidal symptoms (EPSs) that occurred in Japan over the past decade. MethodsThe study analyzed TD and EPS cases reported in the Japanese Adverse Drug Event Report database between April 2011 and March 2021. The cases were stratified by the diagnoses of schizophrenia, bipolar disorders, and depressive disorders. ResultsIn total, 800 patients including a total of 171 TD cases and 682 EPS cases were reported in the JADER database across psychiatric diagnosis. The cases were caused by first‐generation antipsychotics (FGA, TD: n = 105, EPS: n = 245) and second‐generation antipsychotics (SGA, TD: n = 144, EPS: n = 598). The SGA were categorized based on Neuroscience‐based Nomenclature (NbN) regarding pharmacological domain and mode of action, which were reported evenly as the offending agents. Among reported treatment and outcome in TD cases (n = 67, 37.6%) and EPS cases (n = 405, 59.3%), the relatively limited number of TD cases were reported as recovered/improved was also limited (n = 32, 47.8%) compared to those of EPS cases (n = 266, 65.7%). Some cases still had residual symptoms or did not recover fully (TD: n = 21, 31.3%, EPS: n = 77, 19.0%). Conclusion Tardive dyskinesia and EPS have been widely reported in Japan over the past decade across psychiatric diagnoses and antipsychotic classes. Limitations It is important to acknowledge the presence of reporting bias and the lack of comparators to accurately assess risks. Owing to the nature of spontaneous reporting, the estimation of prevalence is not feasible. This study is a summary of the spontaneous reports of tardive dyskinesia (TD) and extrapyramidal symptoms (EPSs) in Japanese clinical practice during the last decade. This study demonstrates that TD and EPS have been widely reported in Japan over the past decade across psychiatric diagnoses including schzophrenia, bipolar disorder, and mood disorder, regardless of antipsychotic classes.

First‐ and second‐generation antipsychotics (FGAs and SGAs, respectively) with dopamine‐antagonizing properties may cause involuntary movement‐related adverse drug reactions (ADRs). However, the risk in the Japanese population is not well characterized. In this study, we analyzed spontaneous ADR reports from the Japanese Adverse Drug Event Report (JADER) database and evaluated the reporting odds ratios (RORs) of tardive dyskinesia (TD) and other extrapyramidal symptoms (EPS) associated with antipsychotics. SGAs were evaluated both as a whole class and as subgroups based on their primary pharmacological mode of action. From 1 April 2011 to 31 March 2020, 1 197 065 ADRs, including 760 TD and 6059 EPS cases, were identified for this study. By calculating RORs, risk signals were detected with both FGAs and SGAs for TD and EPS compared with non‐antipsychotics, with an ROR (95% confidence interval (CI)) of 153.9 (125.64–188.34) with FGAs for TD and 95.3 (80.61–112.65) with SGAs total for TD. No risk signals were detected for SGAs total data or any SGA subgroups versus FGAs. The ROR (95% CI) with SGAs total versus FGAs for TD was 0.62 (0.51–0.75), for dyskinesia: 0.55 (0.42–0.72), and for parkinsonism: 0.43 (0.35–0.52), showing that SGAs were associated with lower reporting frequency versus FGAs, but not for akathisia and dystonia. In conclusion, both FGAs and SGAs were associated with risks for TD and EPS compared with non‐antipsychotics in the Japanese population, and SGAs total or all SGA subgroups showed no risk signals compared with FGAs. From April 1, 2011 to March 31, 2020, 1 197 065 adverse drug reactions, including 760 TD and 6059 EPS cases, were identified for this study. By calculating reporting odds ratios, both First‐ and second‐generation antipsychotics (FGAs and SGAs) were associated with risks for tardive dyskinesia and extrapyramidal symptoms compared with non‐antipsychotics in the Japanese population, and SGAs total or all SGA subgroups showed no risk signals compared with FGAs.

Aim To examine treatment persistence rates of paliperidone palmitate 3‐month (PP3M) for schizophrenia in Japan because evidence in real‐world settings is limited. Methods A retrospective population‐based cohort study was conducted using the Japan Medical Data Center claims database. The overall cohort comprised schizophrenia patients aged ≥ 18 years, who received paliperidone palmitate 1‐month (PP1M) within 180 days before initiating PP3M. Of patients in the overall cohort, those who received PP1M ≥ 4 times within 180 days at 21–42‐day intervals with the same dosage strength as the last two PP1M doses before switching to PP3M initiated PP3M with a dose equivalent to 3.5‐fold the last PP1M dose and took no other concomitant antipsychotics within 112 days before initiating PP3M were included in the per protocol cohort (PPC). The Kaplan–Meier method was used to calculate PP3M persistence rates in the overall cohort and PP3M monotherapy persistence rates in the PPC. Results In the overall cohort and PPC, 121 patients and 87 patients, with a mean age of 41.5 years and 48%–53% being employed, were followed up for ≤ 27 months. At 365 days and 730 days, the PP3M persistence rate was 76.9% and 71.7% in the overall cohort, and that for PP3M monotherapy was 73.1% and 64.6% in the PPC. Conclusion Treatment persistence rates for PP3M in Japan were relatively high among schizophrenia patients transitioned from PP1M. High persistence rates can be achieved with PP3M monotherapy in patients who have been sufficiently stabilized with PP1M monotherapy prior to initiating PP3M. In Japan, schizophrenia patients need to be stabilized with paliperidone palmitate 1‐month (PP1M) monotherapy prior to switching to paliperidone palmitate 3‐month (PP3M) treatment. However, evidence for the treatment persistence rates of PP3M in real‐world settings is limited. Our results demonstrated high persistence rates for PP3M monotherapy, indicating that such rates can be achieved in patients who have been sufficiently stabilized with PP1M monotherapy before initiating PP3M.

ObjectiveTo examine the disparities in psychiatric service utilisation over a 10-year period for patients with first admission for psychosis in relation to urban–rural residence following the implementation of universal health coverage in Taiwan.DesignPopulation-based retrospective cohort study.SettingTaiwan's National Health Insurance Research Database, which has a population coverage rate of over 99% and contains all medical claim records of a nationwide cohort of patients with at least one psychiatric admission between 1996 and 2007.Participants69 690 patients aged 15–59 years with first admission between 1998 and 2007 for any psychotic disorder.Main exposure measurePatients’ urban–rural residence at first admissions.Main outcome measuresAbsolute and relative inequality indexes of the following quality indicators after discharge from the first admission: all-cause psychiatric readmission at 2 and 4 years, dropout of psychiatric outpatient service at 30 days, and emergency department (ED) treat-and-release encounter at 30 days.ResultsBetween 1998 and 2007, the 4-year readmission rate decreased from 65% to 58%, the 30-day dropout rate decreased from 18% to 15%, and the 30-day ED encounter rate increased from 8% to 10%. Risk of readmission has significantly decreased in rural and urban patients, but at a slower speed for the rural patients (p=0.026). The adjusted HR of readmission in rural versus urban patients has increased from 1.00 (95% CI 0.96 to 1.04) in 1998–2000 to 1.08 (95% CI 1.03 to 1.12) in 2005–2007, indicating a mild widening of the urban–rural gap. Urban–rural differences in 30-day dropout and ED encounter rates have been stationary over time.ConclusionsThe universal health coverage in Taiwan did not narrow urban–rural inequity of psychiatric service utilisation in patients with psychosis. Therefore, other policy interventions on resource allocation, service delivery and quality of care are needed to improve the outcome of rural-dwelling patients with psychosis.

Falling Weight Deflectometer (FWD) produces pavement responses using a falling mass drop. This study investigated the features involved in the finite element modeling of FWD tests to help in the calibration of backcalculation. Falling mass, model size, subgrade damping, and boundary conditions were studied to reveal the significances of these factors on pavement responses. By modeling the falling mass in finite element models, this study has justified the idea that field-measured time history of impact force can be used as an alternative to falling mass. It is also concluded that subgrade damping, self-weight of slab, and boundary conditions are significant in modeling and interpretation of FWD finite element analysis. Finite element model with at least six times radius of relative stiffness is required to simulate dynamic responses of a continuously reinforced concrete slab.

Purpose To examine the trend in annual first admission rates for psychotic disorders as a whole as well as individual psychotic disorders in Taiwan from 1998 to 2007, and influences of age, sex, and geographic region on the trend. Method Using the inpatient claims records in the National Health Insurance Research Database, we estimated the yearly first admission rates for schizophrenia and other psychotic disorders, including voluntary (1998–2007) and involuntary (2004–2007) admissions. Both narrow and broad definitions of psychotic disorders were examined. Results While involuntary first admission rates were stable, a crescendo–decrescendo change in voluntary first admission rates for psychotic disorders was observed, peaking in 2001. The increase from 1998 to 2001 was closely associated with health insurance expansion. Before 2001, the voluntary first admission rates in males aged 15–24 were underestimated as military personnel records were not included in the database. From 2001 to 2007, voluntary first admissions for psychotic disorders decreased 38%; the decrease could not be accounted for by the mild diagnostic shifts away from schizophrenia to affective psychosis or substance-induced psychosis. During the entire observation period, first admission rates for schizophrenia decreased 48%, while affective psychosis increased 84%. Gender disparities in the first admission rates gradually diminished, but geographic disparities persisted. Conclusions First admission rates for psychosis significantly reduced in Taiwan between 1998 and 2007, mainly driven by the reduced hospitalization risk for schizophrenia. Special attention should be paid to the increased hospitalization for other types of psychotic disorders (especially affective psychosis) and the unresolved geographic disparities.

The broadcast scheduling problem (BSP) in packet radio networks is a well-known NP-complete combinatorial optimization problem. The broadcast scheduling avoids packet collisions by allowing only one node transmission in each collision domain of a time division multiple access (TDMA) network. It also improves the transmission utilization by assigning one transmission time slot to one or more nodes; thus, each node transmits at least once in each time frame. An optimum transmission schedule could minimize the length of a time frame while minimizing the number of idle nodes. In this paper, we propose a new iterated local search (ILS) algorithm that consists of two special perturbation and local search operators to solve the BSPs. Computational experiments are applied to benchmark data sets and randomly generated problem instances. The experimental results show that our ILS approach is effective in solving the problems with only a few runtimes, even for very large networks with 2,500 nodes.

Olanzapine-induced hyponatremia is probably more frequent than has been thought. A case report of an autism patient in which the initiation and resolution of hyponatremia were clearly related to olanzapine exposure status is presented.