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2011 Volume 23 Issue 5
Systematic review and meta-analysis
Current research on schizoaffective disorder Jingwei CAO,Wenxiu GENG Abstract:schizoaffective disorder is a mental disorder with concurrent psychotic and affedive symptoms that are equally prominent.This review summarizes research on the clinical characteristics|diagnostic stabilityIepidemiology|biological correlates, and treatment options for this condition. Key words:Schizoaffective disorder;Diagnosis;Epidemiology
Progress in research about h igh--risk synd romes for psychosis Lina ZHENG,Jijun WANG,Chunbo LI Abstract:There are three main types of high·-risk syndromes for psychosis:a syndrome of diminished functioning in the pres—- ence of genetic predisposition;a syndrome of attenuated positive symptoms of psychosis;and a syndrome of brief intermittent episodes of psychosis.This review summarizes current thinking about the diagnosis,epidemiology and neurobiology of these syndromes and about related ethical issues. Key words:Psychosis—risk syndrome;Epidemiology;Neurobiology;Ethics
Therapeutic effect of psychodynamic psychotherapy:A review Qiang FENG,Xudong ZHAO Abstract:There has been ongoing interest in the efficacy of psychodynamic psychotherapy,one of the most important types of clinical psychotherapy.Based on a review of Chinese and international literature this paper discusses the definition of psycho— dynamic psychotherapy|research on its efficacy and effectiveness?and the concept of t evidence-based psychotherapy‘.We conclude with some recommendations about future effectiveness research. Key words:Psychodynamic psychotherapy;Psychoanalytic psychotherapy;Efficacy
Original research article
Differences in the levels of superoxide dismutase and brain--derived neurotrophic factor in first--episode schizophren-a,CnrOnIc schIzophrenIa and normaI control subjects Dachun CHEN,Kebing YANG,Ning WANG,Ying NIE,Meihong XIU,Yanli LI,Qingtao BIAN, Xiangyang ZHANG,Zhanji Abstract Backgrollnd:Repots about the decreased concentration of brain derived neurotrophic factors(BDNF)and abnor— maI activity of superoxide dismutase(SOD)in patients with schizophrenia are inconclusive,possibly because of differences in the characteristics of the subjects included in previous studies. Objective:Compare in vivo concentrations of SOD and BDNF between patients with first—episode schizophrenia, patients with chronic schizophrenia and normal control subjects;and,in the two patient groups,assess the relation— ship of SOD and BDNF to the cIinicaI features of the IIlness. Methods:Blood concentrations of SoD and BDNF were determined in 78 patients in their first episode of schizo. phrenia(based on DSM—IV criteria),67 patients with chronic schizophrenia,and 51 normal controI subjects.The two patient groups were also administered the Positive and Negative Syndrome Scale(PANSS). Results:The concentration of both the totaI superoxide dismutase(T.SOD)and cuprozinc.superoxide dismutase (Cu.ZnSOD)was highest in patients with chronic schizophrenia,jntermediate in patients with first.episode schizophrenia and lowest in the normal control group.Conversely.the blood concentration of BDNF was lowest in the chronic schizophrenia group,intermediate in the first-episode schizophrenia group and highest in the normal con— trol group.(AI|these differences with statistically significant.)BDNF and Cu·ZnSoD were negatively correlated (r=-0.24,P=O.038)in first.episode patients but not in normaI controls or chronic patients;BDNF was not signifi. candy correlated to T·SoD in any of the three groups.In drug nai"ve.first—episode patients there is a significant negative correlation between symptom severity and serum levels of Cu.ZnSOD and a siRnificant positive correlation between symptom severity(primarily positive psychotic symptoms)and BDNF levels but these relationships are absent in chronic patients who are currently medicated. Conclusion:Compared to patients with first.episode schizophrenia,those with chronic schizophrenia have in。 creased serum activity of SOD and decreased blood concentrations of BDNF.1n first.episode patients SOD activity and blood concentrations of BDNF are associated with the symptomatic severity of the illness but this relationship fades in later stares of the illness. Keywords:Schizophrenia;Brain.derived neurotrophic factor;Free radicals;Superoxide dismutase;Case.controI study
Randomized controlled trial comparing quetiapine with lithium and clozapine with lithium in the treatment of female patients with mania Xiaowei TANG,Hui WU,Qian CHEN Abstract Background:Second—generation antipsychotics are commonly used in the treatment of mania but there remains debate about the relative benefits of the different medications in these patients,particularly in female patients with mania. objective:Compare the clinical effectiveness and safety of quetiapine and clozapine as adjunctive treatments of Iithium in the treatment of female patients with mania. Methods:Sixty.four female patients who met lCD-1 0 criteria for a current manic episode were randomly assigned to take Iithium with quetiapine(n=32)or lithium with clozapine(n=32)in a six.week,open—label trial.ClinicaI efficacy was evaluated at baseline and weekly thereafter by administering the Beck Rafaelson’s Mania Rating Scale (BRMS).Adverse reactions were assessed by administering the Treatment Emergent Symptom Scale(TESS)at baseline and at 1,2,4,and 6 weeks after starting treatment. Results:Two patients in the clozapine group did not complete the trial due to Iow white blood counts.Among subjects who completed the 6 weeks of treatment there were no significant differences in the mean BRMS values be— tween the two groups at any time during the trial.At the end of the trial 87.5%(28/32)of the patients taking quetiapine and 90.O%《27/30)of those taking clozapine meet criteria for remission(i.e.,a 50%drop in BMRS score from baseline)(z2=0.76,P=o.385).During the course of treatment a significantly higher proportion of subjects in the clozapine group experienced dizziness,weight gain,somnolence,constipation,excessive salivation,and ab— normal blood glucose and electrocardiogram results.The overalI severity of adverse effects was significantly higher in the clozapine group after two weeks of treatment but there were no differences in the overall severity of adverse effects at other time periods.Despite the 23.foId higher cost for quetiapine versus clozapine,the overalI cost efffectiveness of the two medication regimens was similar because of the much high use of expensive auxiliary drugs in the clozapine group. Conclusion:The clinicaI efficacy of quetiapine and clozapine as adjunctive treatment in women with mania taking lithium is similar but the two treatment regimens have different side.effect profiles.The cost benefit o using generic clozapine may be over shadowed by the costs associated with treating the adverse effects of clozapine. Keywords:Quetiapine;Clozapine;Lithium carbonate;Manic episode
Comparison of the neuropsychoIogicaI characteristics of two subtypes of mild cognitive impairment Zhongiie HU,linhui WANG,Yue LANG,Xiaoling ZHAO,Jianping JIA,Ying HAN Abstract Background:Characterizing the differences between two proposed subtypes of mild cognitive impairment(MCl)一 amnestic mild cognitive impairment(aMCt)and mild cognitive impairment due to smalI vesseI disease(sv.MCI) 一may help jn the effort to prevent progression of MCI to AIzheimer’s dementia and vascular dementia. Objective:Identify neuropsychoIogicaI characteristics that discriminate aMCI and sv.MCl. Methods:50 individuals with aMCI based on Petersen 7s criteria and 65 individuals with sv.MCl based on Hachinski 7s criteria were identified from a general hospital neurology clinic and from a household survey in a ruraI district in Beijing.These subjects and 49 community members 55 and older without any cognitive problems were administered the Mini Mental State Examination(MMSE),the Clock Drawing Test(CDT)and the Auditory Verbal Learning Test(AVLT)which assesses immediate recall,delayed recalI and delayed recognition.Mean scores of these measures in the three groups of subjects were compared using a one—way analysis of variance(ANOVA) and,if significant,follow·up pairwise comparisons using Tukey tests. Results:Mean scores on alf five measures were significantly Iower;n the two patient groups than in the controJ group,and the mean subscale scores of the AVLT—immediate recalI,delayed recal|and delayed recognition— were significantly lower in the aMCI group than in the sv—MCI group,a difference that remained significant after ad. justing for age,gender and years of education. Conclusion:These results support previous findings of significantly greater disruption in memory functions among aMCI patients than in sv—MCt patients,Measures of memory functioning,particularly the AVLT,may be usefuI in distinguishing these two subtypes of MCI. Keywords:Amnesic mild cognitive impairment;Mlid cognitive impairment associated with smalI vesseI disease; Mild cugnitive impairment
Changes in the level of micro RNA·-206 gene expression in patients with type I bipolar disorder before and after treatment and comparison with a controI population Zuowei WANG,Zezhi LI,Lingxiao WANG,Zhiguo WU,Chengmei YUAN,Wu HONG,Shunying YU,Yiru FANG Abstract Background:Micro RNA.206(miRNA-206)is a potential biomarker of bipolar disorder that has not yet been fully investigated. objective:Assess the relationship between the IeveI of miRNA.206 in peripheral blood and the clinicaI state of pa. tients jn the manic phase of bipolar disorder. Methods:Thirty—six newly admitted patients in the manic phase of type I bipolar disorder(diagnosed using the Structured Clinical Interview for DSM IV Axis I disorders)and 30 age and gender matched healthy controls were enro||ed.miRNA.206 Ievels in peripheral blood lymphocytes were assessed at the tim6 of enrolIment in control subjects and at baseline and at the end of the second,fourth and eighth week of treatment in the patient group.The severity of manic symptoms in the patient group was evaluated at the same time as the miRNA一206 assessments using the Young Mania Rating Scale. Results:There were no statistically significant differences in baseline miRNA.206 Ievels between patients and con. trois(Z=旬.02,P=0.988)or,in the patient group,between baseline levels and those at the end of the second (Z=-0.17,P=0.864),fourth(Z=-0.86,P=0.392)and eighth(Z=.1.29,P=0.197)weeks after initiating treatment.There were also no statistically significant correlations between the miRNA.206 IeveI and the severity of manic symptoms at any of the four time points(r:=O.13,P=0.518;r。=0。12,P=0.532;r。=旬.18,P=0.361; and f。=O.02,P=O.912:respectively). Conclusion:The activity of miRNA·206 in peripherally blood lymphocytes does not appear to be a biomarker of type I bipolar disorder or a biomarker for treatment efficacy during the treatment of a manic episode.But the power to detect differences between patients and controls in the study was only 22%so further research with larger sam— ples(possibly using different techniques to assess miRNA-206 activity)are needed to confirm these findings. Keywords:Bipolar disorder;Manic episode;MicroRNA-206;Lymphocytes;Gene expression
Case.controI study of changes in bone mineral density in drug.naive patients in the first episode of schizophrenia during the first year of treatmentwith risperidone Xiaoyi LI, Hong CHEN, Xingli CHEN, Fangzhong XU, Baoping XING Abstract Background:The long.term effect of risperidone treatment on bone mineral density remains unclear. Hypothesis:Long.term treatment with risperidone in patients with schizophrenia has adverse effects on bone rain— eral density. Methods:28 drug.naYve patients in their first episode of schizophrenia(diagnosed according to Chinese diagnostic criterial were treated with risperidone for a one.year period.Bone density assessments reported as T·values(that compare the subject7s bone density to a reference value for young persons of the same gender and race)were made at baseline and at 3,6 and 1 2 months after initiating treatment.Bone density measurements were also conducted in 32 healthy controI subjects at the time of enrollment and I year after enrollment. Results:There were no statistically significant differences in the age,gender or bone density of patients and con— trois at the time of the baseline assessment.but after 1 2 months the decrease in bone density in the patient group (who received risperidone treatment)was significantly greater than in the control group(F=15.21,P<0.001).In the patient group there was a non-significant gradual drop in bone mineral density during the first six months of treatment and a statistically significant rapid drop during the second six months of treatment.Among the 20 patients who completed 1 2 months of risperidone treatment,1(5%)met WHO criteria for osteoporosis and another 8 (40%)n;eet WHO criteria for bone mass loss. Conclusion:Long.term treatment with risperidone in patients with schizophrenia is associated with reduced bone mineraI density.The most pronounced drop in bone density OCCURS after six months of treatment so follow·up studies that last less than one year may not identify clinically important changes in bone mineral density associated with use of antipsychotics medications. Keywords:Risperidone;Schizophrenia;Bone mineral density
Forum
Research in schizophrenia using genome-wide association study methodology Donghong CUI,Kaida JIANG Abstract:The genome-wide association study(GWAS)methodology uses high-throughput genotyping technology to geneti— cally classifv the hereditary characteristics of the entire Renome.Case.controI studies or family Iineage studies that employ GWAS analyses can identify specific genes associated with diseases or traits.The wide use of this technique to assess geneti. caIly complex diseases has already Ied to major advances in severaI diseases.The use of GWAS in the study of schizophrenia —一a typical example of a genetically complex disease—一has identified several new candidate genes.Despite the potential util— ity of the GWAS methodology,it has some|_mitations such as the increased risk of faIse.positive results due to the large num. ber of hypotheses being tested.This overview discusses the benefits and problems in the use of the GWAS methodology and summarizes the progress in the application of this methodology in research about schizophrenia. Key words:Schizophrenia;Genome.wide Association Study
Are drug holidays in the treatment of attention deficit/hyperactivity disorder (ADHD) justified? Yasong DU, Minjie WANG
Drug holidays and attention deficit/hyperactivity disorder Christopher P.SZABO
Case report
High vulnerability to adverse reactions to antipsychotics:a case report Ying QIAO,Xinyi CAO,Jianhua SHENG Abstract:This patient had antipsychotic.induced extrapyramidal symptoms and leucopenia.We use both psychiatric and neu— rological approaches to managing these side effects.We adopted the neurological approach to treating the extrapyramidal side.effects when the psychiatric approach proved ineffective.1n addition。we found that prior ieukopenia iS a relative--but not absolute--contraindication for using clozapine:patients with a prior history of leukopenia(but not agranulocytosis)can be carefully re.chalIenged with clozapine while their blood counts are being closely monitored. Key words:Antipsychotics;Adverse reactions;Clozapine;Extrapyramidal syndrome;Schizophrenia
Biostatistics in psychiatry
Binary outcome variables and logistic regression models Xinhua LIU