Children’s screen time may affect their growth and development. However, differences in the impact of various psychiatric and psychological factors on children’s screen time is a research gap. This study aimed to explore the differences in the influence of related factors affecting children’s screen time based on their sleep, difficulties, and parental control among Japanese elementary and junior high school students. A cross-sectional survey was conducted among parents in Japan. Data on screen time duration, parent–child background, strengths and difficulties, sleep variables, and parental control types were collected from 225 households. A regression analysis revealed that high Strengths and Difficulties Questionnaire (SDQ) scores (β = 0.166, p = 0.008), sleep duration (β = −0.281, p < 0.001), and parental control (β = −0.204, p = 0.001) were significantly related to children’s screen time. Additionally, it was found that parents’ late bedtimes affect children’s screen time by mediating children’s sleep duration. This study, together with previous research, provides comprehensive insights into design interventions to decrease the screen time of children in the Japanese context.

Background: Brexpiprazole is an atypical antipsychotic drug widely used in Japan for the treatment of schizophrenia. Previous studies have investigated the therapeutic effects of some antipsychotics on sleep variables; however, to our knowledge, the effects of brexpiprazole on sleep architecture have not been examined in patients with schizophrenia. Therefore, we aimed to exploratorily investigate the effect of brexpiprazole on sleep variables measured by polysomnography in patients with schizophrenia.Methods: This study included 10 patients with schizophrenia who were originally treated with haloperidol alone. Sleep variables of the participants were measured using polysomnography. After excluding those who did not meet the study criteria, seven patients (five men and two women; mean age [SD], 59.0 [10.0] years) were eligible for further analysis. Polysomnography was repeated at 4 weeks after the participants were prescribed brexpiprazole in addition to haloperidol. We compared the sleep architecture of the participants, measured using polysomnography, before and after taking brexpiprazole.Results: Add‐on brexpiprazole significantly prolonged rapid eye movement latency, increased the duration and percentage of stage N2 and stage N3 sleep (min, %), and decreased the duration and percentage of stage rapid eye movement sleep (min, %) at a significance level of nominal p < 0.05.Conclusion: Although not significant after correcting for multiple comparisons, the present results showed that add‐on brexpiprazole could alter the sleep architecture of patients with schizophrenia. Future studies are warranted to replicate these findings and to further investigate the beneficial influence of brexpiprazole on sleep.

Objective: The Effectiveness Research on the Dissemination and Education of Psychiatric Clinical Practice Guidelines (EGUIDE Project) was launched in Japan to promote guideline‐adherent treatment for schizophrenia and major depressive disorder (MDD) through educational outreach programs. Although short‐term effects on participating physicians have been reported, the long‐term and facility‐wide effects remain unclear. This study evaluated whether guideline‐compliant treatment behaviors improved across institutions over time, indicating potential diffusion or spillover effects. Methods: We conducted a prospective observational study involving 298 psychiatric facilities between 2016 and 2023. Discharge prescriptions and treatment data were collected for 19 623 patients with schizophrenia and 9805 patients with MDD. Adherence to the guidelines was assessed using 11 schizophrenia quality indicators (QI‐S) and seven MDD quality indicators (QI‐D). We performed logistic regression analyses, adjusting for age, sex, and facility type, with Bonferroni correction for multiple comparisons. Results: For schizophrenia, significant year‐on‐year improvements were observed in seven of the 11 QI‐S, including assessment of treatment‐resistant schizophrenia (TRS) diagnosis (from 42.2% to 62.5%), use of modified electroconvulsive therapy (mECT; from 6.1% to 11.8%), and nonprescription of anticholinergics (from 70.7% to 81.7%). For MDD, three of the seven QI‐D showed improvement, including assessment of severity diagnosis (from 51.2% to 77.0%) and use of mECT (from 12.8% to 26.6%). Notably, the implementation of cognitive behavioral therapy (CBT) decreased. These findings suggest long‐term behavioral changes across all facilities, extending even to nonparticipating clinicians. Conclusion: The presence of EGUIDE‐trained psychiatrists was associated with sustained improvements in guideline‐compliant treatments at the institutional level. These results imply not only individual educational benefits but also a diffusion of practice culture—that is, a spillover effect—leading to enhanced quality of psychiatric care. Continued educational efforts are essential to improving treatment practices at scale. Trial Registration: The protocol for the EGUIDE Project is registered with the University Hospital Medical Information Network Registry (UMIN000022645)

Aim: Clinical practice guidelines have improved the quality and standardization of psychiatric care; however, their long‐term implementation in real‐world settings remains limited. The Effectiveness of the Guidelines for Dissemination and Education (EGUIDE) project was established to promote sustained evidence‐based practice through a multilayered educational program for psychiatrists in Japan. Methods: This multicenter observational study longitudinally tracked psychiatrists' self‐rated clinical behavior (CB) scores related to guideline adherence for up to 8 years after initial EGUIDE participation. CB was assessed using a validated questionnaire covering general guideline use (CB‐G), schizophrenia (CB‐S), and major depressive disorder (CB‐D), with a comprehensive index (CB‐C) representing the mean of all domains. Data were analyzed using the Kruskal–Wallis test, the Mann–Whitney U test, and the Bonferroni correction (two‐tailed p < 0.05). Results: A total of 1562 psychiatrists (mean age, 32.7 ± 7.1 years) were included. All CB indices (CB‐C, CB‐G, CB‐S, and CB‐D) significantly improved post training compared with the baseline (H = 831.2–984.0; all p < 10 ⁻⁷² ), with small‐to‐moderate effect sizes ( r = 0.09–0.29). These improvements were maintained throughout the 8‐year follow‐up, with no significant decline, and several domains showed small but continued increases between 3 and 7 years post training. Conclusion: The EGUIDE program achieved long‐term, sustained improvements in psychiatrists' guideline‐adherent clinical behaviors through an integrated system combining education, supervision, feedback, and follow‐up. This autonomous, cyclical framework represents a high‐impact model for continuous quality improvement and may be adaptable to other medical specialties.

Aim: Psychiatrists often perceive their clinical practices as guideline‐concordant; however, discrepancies frequently exist between perceived and actual prescribing behaviors. To explore this gap, we examined the association between self‐assessed clinical behavior scores (CBs) and prescribing practices objectively evaluated using quality indicators (QIs) within the EGUIDE educational program framework for schizophrenia and major depressive disorder. Identifying such associations is essential for improving care quality and developing interventions fostering evidence‐based practice. Methods: A prospective observational multicenter study was conducted across Japan involving 820 psychiatrists from university, public, and private hospitals participating in EGUIDE, along with patients diagnosed with schizophrenia ( n = 6714) or major depressive disorder ( n = 3692) treated at these institutions. The outcome measures were associations between psychiatrists' CB scores and quality indicators (QIs) based on discharge prescriptions; these were analyzed using logistic regression adjusted for age, sex, and institution type. Results: For schizophrenia, CBs were significantly associated with 8 of 11 QIs, including treatment‐resistant assessment, antipsychotic monotherapy (with/without other psychotropics), absence of anxiolytics/hypnotics, mood stabilizers, anticholinergics, PRN psychotropics, and clozapine use. For major depressive disorder, 3 of 7 QIs showed significant associations: severity assessment, no anxiolytic/hypnotic prescriptions, and use of modified electroconvulsive therapy. Conclusion: Self‐assessed clinical behavior scores partially reflect actual prescribing practices. These findings highlight the value of incorporating subjective evaluations into clinical performance assessment tools to promote guideline adherence. Moreover, our results suggest that collecting self‐assessments may offer a feasible and scalable strategy for identifying areas where additional education or system‐level support is needed to enhance evidence‐based prescribing in diverse clinical settings. Trial Registration: University Hospital Medical Information Network registry identifier: UMIN000022645

Schizophrenia is a known risk factor for coronavirus disease (COVID-19) infection and severity, and certain psychotropic drugs have been linked to increased mortality in infected patients with schizophrenia. However, little evidence exists regarding this risk. We retrospectively examined the association between mood stabilizers and the risk of pneumonia in patients with schizophrenia. This study included 99 patients with schizophrenia or schizoaffective disorder who were infected with COVID-19 in 2022 and met the inclusion criteria. After conducting propensity score matching to align patient backgrounds and concomitant medications, we assessed the impact of mood stabilizers, specifically sodium valproate, on the risk of pneumonia development. Univariate analysis revealed that patients with schizophrenia and COVID-19 who developed pneumonia were more likely to be older (64.5 [14.2] vs. 57.4 [11.5] years, p = 0.008) and using sodium valproate (44.4% vs. 16.7%, p = 0.004). Even after propensity score matching, patients who developed pneumonia were still more likely to be receiving sodium valproate than not (58.8% vs. 20.0%, p = 0.003). Sodium valproate use may be a risk factor for the development of pneumonia in patients with chronic schizophrenia who are infected with COVID-19 during long-term hospitalization.