Actual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. A questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. As school grade increased, children’s bedtimes were delayed and sleep duration was reduced by 2.0 h over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems. Status of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.

While depression has been recognized as a risk factor for venous thromboembolism (VTE), the prevalence of VTE in depressed inpatients has never been investigated. The aim of this study was thus to examine VTE prevalence and factors associated with VTE in depressed inpatients. Patients and Methods: We conducted a retrospective cross-sectional study of consecutive depressed inpatients (n = 94) from January 1, 2018, to June 30, 2019, at the psychiatry department of Akita University Hospital. As part of our clinical routine, depressed inpatients were screened for VTE using D-dimer, and patients who screened positive underwent enhanced CT to examine VTE. A variety of data was extracted from medical records, including, amongst others, age, sex, body mass index, diagnoses of psychiatric disorders, total scores on the 17-item Hamilton Depression Rating Scale, duration of current depressive episode, daily dosages of antidepressants and antipsychotics, catatonia, and physical restraint. Results: VTE was detected in 8.5% of depressed inpatients. There were no significant differences between VTE-positive and VTE-negative inpatients regarding any of the considered factors. Conclusion: Our analysis shows a VTE prevalence of 8.5% in depressed inpatients, higher than that of 2.3% reported in a previous study in hospitalized patients with psychiatric disorders including depression. This emphasizes the importance of VTE screening for depressive inpatients.

Changes in rest or active states were clinically observed in persons with depression. However, the association between symptoms of depression and 24 h rest-activity rhythm (RAR) components that can be measured using wearable devices was not clarified. This preliminary cross-sectional study aimed to clarify the 24 h RAR components associated with symptoms of depression in middle-aged and older persons. Participants were recruited from among inpatients and outpatients requiring medical treatment at Akita University Hospital for the group with depression and from among healthy volunteers living in Akita prefecture, Japan, for the healthy control group. To assess RAR parameters including inter-daily stability (IS), intra-daily variability (IV), relative amplitude (RA), and average physical activity level for the most active 10 h span (M10) or for the least active 5 h span (L5), all the participants were instructed to wear an Actiwatch Spectrum Plus device on their non-dominant wrist for seven days. Twenty-nine persons with depression and 30 controls were included in the analysis. The results of a binomial regression analysis showed that symptoms of depression were significantly associated with a high IS value (odds ratio [OR], 1.20; 95% confidence interval [95% CI], 1.01–1.44; p = 0.04) and a low M10 value (OR, 0.85; 95% CI, 0.74–0.96; p = 0.01). Our findings suggest potential components of 24 h RAR are associated with depression.

To the Editor: Treatment of antipsychotics-induced restless legs syndrome (RLS) is conducted primarily by decreasing or discontinuing dosage of responsible medication [1]. However, the concurrent need to treat the underlying psychiatric disorder renders decreasing or discontinuing medication difficult. In such cases, antipsychotics-induced RLS is treated in line with idiopathic RLS, using medications such as dopamine agonists and benzodiazepines [2]. The effect of dopamine agonists and benzodiazepines for secondary RLS were reported in several studies [2], but the effect of gabapentin enacarbil (GE) for secondary RLS was reported in only one study [3]. In the present report, we detail a case wherein GE proved effective in treating clozapine (CLZ)-induced RLS. The written consent has been obtained from the patient for submission of the report.The subject of the case study was a 40-year-old male with no history of notable conditions, including idiopathic RLS. He also had no history of typical risk factors for secondary RLS, including hypoferric anemia, renal failure, or diabetes. At age 16, the patient began to experience persecutory delusions, and at age 23, according to DSM-IV-TR criteria, he was diagnosed as suffering from paranoid schizophrenia. Antipsychotic monotherapy with 15 mg/day haloperidol, 250 mg/day chlorpromazine, and 50 mg/2-week risperidone long acting injections was initiated, but none of these treatments proved effective. At age 36, because of resistance to other therapies, the patient was placed on CLZ as the primary treatment. When the dosage was increased to 300 mg/day, the patient reported paresthesia in his lower limbs accompanied by the irresistible urge to move his legs. These symptoms worsened at night and were ameliorated by touching his feet or walking. Antipsychotic induced akathisia was ruled out because the patient's symptoms were restricted only to the legs and diurnal variation. Based upon structured evaluation, the patient was fulfilled the International Restless Legs Syndrome Study Group diagnostic criteria for RLS [4]. The patient was diagnosed CLZ-induced RLS as the patient had no previous history of idiopathic RLS and developed RLS after CLZ administration. At this time, the patient's psychiatric symptoms were highly marked, making it difficult to decrease CLZ dosage. The patient was unsuccessfully treated for CLZ-induced RLS, with a combination of 1 mg/day clonazepam and 3 mg/day lorazepam. After obtaining the patient's consent, 600 mg/day GE was added to his treatment regimen, leading to complete resolution of his RLS symptoms within several days, following which the dose of CLZ was increased from 300 mg/day to 600 mg/day, although no recurrence of RLS was observed. Clonazepam and lorazepam were successfully discontinued, and the increased dosage of CLZ aided in controlling the patient's neuropsychiatric symptoms.To our knowledge, the present report is the second

ObjectivesActual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. MethodsA questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. ResultsAs school grade increased, children’s bedtimes were delayed and sleep duration was reduced by 2.0 hours over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems.ConclusionsStatus of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.