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2011 Volume 23 Issue 6
Systematic review and meta-analysis
Psychosocial Interventions for Patients with Schizophrenia Goorah Deenoo BHARATHI, Nan HUANG, Zheng LU Abstract: The comprehensive treatment of schizophrenia is not limited to pharmacotherapy; it also involves the provision of ongoing support and psychosocial interventions aimed at the social rehabilitation of the patient. Research about nonpharmacological treatments for people with schizophrenia is limited in China but studies from other countries have shown that psychosocial interventions can decrease the risk of relapse and re-hospitalization. Symptom reduction remains an important treatment goal in schizophrenia but patients and their family members are often more concerned about the functional impairments in work, education, independent living and socialization. Thus, patients with schizophrenia would benefit from interventions that target reduction in their level of disability. This article reviews the main psychosocial interventions that have been used effectively in patients with schizophrenia in China—cognitive-behavioral therapy, social skills training, family intervention therapy, cognitive remediation, psycho-education, vocational training, crisis intervention, and integrated psychotherapy—and discusses differences between the use of psychosocial interventions in China and abroad. 
Keywords: Schizophrenia; Nonpharmacological treatment; Psychosocial Interventions
Applications and new research findings about event related potentials in schizophrenia Bingkui ZHANG, Yuqi CHENG, Xiufeng XU Abstract: There are many classical components in Event- Related Potentials(EVP)and some of these components show special characteristics in schizophrenia. The administration of antipsychotic medicationg can affect event-related potential in patients with schizophrenia but the precise mechanism for this effect is unkown. The combination of EVP and neuroimaging can help identify the specific location of abnormal structure and functioning in schizophrenia and it can also help specify the mechanism that has resulted in the identified abnormality. 
Key words: Event-Related Potentials; Schizophrenia; Antipsychotic drugs; Brain neuroimaging
Researdh developments about the relationgship of trauma and nightmares Saihua YANG, Xiaosi LI Abstract: In detemining the criteria for a diagnosis of post-traumatic stress disorder, scholars have considered the role of nightmares as one of the core symptoms of the disorders. This paper summarizes information on the definition of nightmares, on models of the underlying mechanism of nightmares, and on the relationgship of trauma and nightmares. 
Key words: Nightmare; Trauma; Models
Original research article
Relationship between blood levels and clinical efficacy of two different formulations of venlafaxine in female patients with depression Baohua SONG, Zhenguo FAN, Weimin SHEN, Mincai QIAN, Haizhi CHEN, Hong DAI, Shikai WANG Abstract: Background: Different formulations of the same medication can have distinct dissociation profiles and release rates resulting in different onset times and durations of action; these differences may influence the clinical efficacy and adverse reactions of the medication. Objective: Assess the relationship between the plasma concentrations and the clinical efficacy and adverse reaction profile of two formulations of venlafaxine (VL) in female patients with major depression. Methods: Sixty female patients hospitalized for depression were randomly assigned to use EFFEXOR XR®, the extendedrelease formulation of venlafaxine (hereafter, the XR group), or Bolexin®, the immediate-release formulation of venlafaxine (hereafter, the IR Group), for six weeks. The mean (SD) total daily dose in the XR group was 168 (32) mg/d administered in one oral dose in the morning and that in the IR group was 160 (67) mg/day administered in three oral doses over the day. At the end of the first, second, fourth and sixth week of treatment the plasma concentrations of VL and its active metabolite, O-desmethylvenlafaxine (ODV), were determined using high-performance liquid chromatography and the clinical efficacy and adverse reactions were accessed using the Hamilton Depression Rating Scale (HAMD) and the Treatment Emergent Symptoms Scale (TESS). A reduction in the baseline HAMD score of 50% or greater was deemed remission. Results: No serious adverse reactions were observed. There were no significant differences in the mean HAMD scores between the two groups at any of the time points evaluated. Mean HAMD scores after six weeks of treatment were significantly lower in both treatment groups; the overall remission rate was 65.6% in the XR group and 69.2% in the IR group (χ2=0.77, p=0.380). Changes in the HAMD scores from baseline were only weakly correlated with changes in the plasma concentrations of ODV (rs=-0.10, p=0.470) and VL (rs=-0.11, p=0.403). Conclusion: Both the extended-release and immediate-release formulations of VL were efficacious and well tolerated in female patients with depression. Plasma concentrations of VL and ODV are not closely related to clinical efficacy so they are not suitable as markers for the clinical effectiveness of treatment with venlafaxine. 
Keywords: Depression; Venlafaxine; O-desmethylvenlafaxine; High-performance liquid chromatography
Cost of treating medical conditions in psychiatric inpatients in Zhejiang, China Shengliang YANG, Mincai QIAN, Wei LU, Chunsheng WAN, Haizhi CHEN, Jinfeng FEI, Xinhua SHEN Abstract: Background: Few studies in China assess the relative costs of treating psychiatric and non-psychiatric medical conditions among psychiatric patients. This information is important for the planning of mental health services and of health insurance packages. Objective: Assess the breakdown of the 2010 costs of psychiatric inpatient care in a representative sample of psychiatric hospitals in Zhejiang Province, China. Methods: A two-stage stratified sampling method was used to select 14 of the 42 psychiatric hospitals in Zhejiang and then discharges for three randomly selected months (March, July and November) in 2010 at these hospitals were selected for assessment. A standardized form was used to collect information about the demographic and clinical characteristics of the patients and about the various components of the costs of inpatient care. Results: 7,684 inpatient admissions were included. The median (interquartile range) length of stay was 30 (20-52) days and the median total cost of admission was 10,005 (6,419-14,728) Chinese Yuan (1,539 $US). The median cost of medication was 2,512 (1,161-4,182) Yuan, 65% of which was for non-psychiatric medications. 1,798 (24.3%) of the admissions had one or more co-morbid medical condition that required treatment, including hypertension, leucopenia, diabetes and different types of infections. The prevalence and type of medical condition varied significantly for patients with different classes of psychiatric diagnoses. After adjustment for other factors the presence of a co-morbid medical condition significantly increased the cost of hospitalization but not the duration of hospitalization. For inpatients with schizophrenia the cost of their psychiatric medications was significantly higher than the cost of their non-psychiatric medications but the opposite was true for patients with other diagnoses. Conclusion: Treatment of somatic conditions account for a high proportion of the cost of inpatient treatment in psychiatric hospitals. Plans to revise the reimbursement mechanisms for mental disorders, to develop diagnostic-related group payment schemes, and to establish diagnostic-specific treatment guidelines need to take into consideration the high prevalence and associated costs of treating somatic conditions that frequently accompany psychiatric illnesses. And the in-service training of psychiatrists needs to ensure that they are up-to-date on recent advances in the diagnosis and treatment of common physical disorders. 
Keywords: Psychiatric disease; Medical cost; Complication; Survey
Mental health literacy in Changsha, China Yuan PENG, Xiaoling WANG, Pingfei LI, Kun LIU Abstract: 
Objective: Assess public awareness about mental health and the prevention of mental illnesses in Changsha, China. 
Methods: A multistage cluster-sampling method identified 1 660 households in two rural and two urban communities in the Changsha Municipality. One family member 15 years of age or older randomly selected from each household was asked to complete a standardized 20-item survey about mental health awareness developed by the Chinese Ministry of Health (MOH). 
Results: 1 563 valid surveys were completed by 676 males and 887 females who had a mean (SD) age of 41.9 (15.9) years. The mean (SD) proportion of correct responses in the total sample was 68.5% (46.4%); the proportion correct in urban respondents [70.5% (13.6%)] was higher than that in rural respondents [66.2% (13.5%)] (t=6.18, p
Conclusion: The overall level of awareness about mental health issues in Changsha residents is relatively high but there are still some areas, particularly regarding the causes of mental disorders, that are in need of improvement. The level of mental health literacy varies substantially by demographic characteristics so cohort-specific educational interventions will be needed to effectively improve community awareness. Further revision of the MOH survey will be needed to improve its reliability, validity and internal consistency. 
Keywords: General public; Mental health; Mental disorders; Knowledge and awareness; Survey
Eight-week follow-up of depressive and anxiety symptoms in patients with chronic hepatitis B, patients with hepatitis B cirrhosis and normal control subjects Qinyi LIU, Zheng LU, Lin SUN, Jun YE Background: Patients with Chronic Hepatitis B (CHB) and Hepatitis B Cirrhosis (HBC) often have associated depressive and anxiety symptoms, but the relationship of these psychological symptoms to the course and severity of CHB and HBC remain unclear. 
Objective: Assess the changes in depressive and anxiety symptoms among patients receiving treatment for acute exacerbations of CHB and HBC. 
Methods: 71 patients with CHB and 75 patients with HBC were enrolled at the time of admission and followed during the subsequent eight weeks of treatment. These subjects and 65 volunteer control subjects were administered the 90-item Symptom Checklist (SCL-90) on enrollment and eight weeks later; they were also administered the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS) at enrollment and two, four, six and eight weeks after enrollment. 
Results: In each group 60 subjects completed the study. At baseline the mean SCL-90 total score, most of the SCL-90 subscale scores and the mean scores for the HAMA, HAMD, SAS and SDS were all significantly higher in patients with CHB and HBC than in the control subjects. Based on the HAMA and HAMD results, 40% of CHB patients and 80% of HBC patients had clinically significant anxiety and 78% of CHB patients and 87% of HBC patients had clinical significant depression at the time of admission. In both patient groups total SCL-90 score and most of the SCL-90 subscale scores decreased significantly over the eight weeks of treatment; there was also a significant decline in the mean scores of the HAMA, HAMD, SAS and SDS over the first six weeks of treatment. After eight weeks of treatment 5% of CHB patients and 28% of HBC patients still had clinically significant anxiety and 7% of CHB patients and 36% of HBC patients still had clinical significant depression. At baseline and at all four follow-up assessments the severity of psychological symptoms was significantly greater in the HBC group than in the CHB group. 
Conclusion: Self-reported and interviewer-assessed psychological symptoms in patients with CHB and HBC are significantly more severe than in normal control subjects both at the time of acute exacerbations of the illness and after the acute symptoms have resolved. The psychological symptoms in HBC patients are more severe than those in CHB patients. Treatment of the physical symptoms of acute CHB and HBC over an eight-week period is associated with improvement— but not full resolution—of these psychological symptoms. 
Keywords: Chronic Hepatitis B; Hepatitis B Cirrhosis; Depression;Anxiety
Forum
Treating the behavioral and psychological symptoms of senile dementia with antipsychotic drugs Shifu XIAO
Management of Behavioral and Psychological Symptoms of Dementia (BPSD)—no easy solution Helen F. K. CHIU, S. W. LI
Diagnosis and clinical management of amphetamine-induced psychosis Min ZHAO, Wei HAO Abstract: Psychosis induced by amphetamine-type stimulants(ATS)has become an important challenge in psychiatric practice in China over recent years because of the rapid increase in the prevalence of ATS abuse. The authors introduce research on the genetic and pathological mechanisms underling ATS-induced psychosis and summarize fingdings on its clinical features, diagnosis and pharmacological treatment.They also discuss issues that need to be addressed in future research to increase understanding of ATS-induced psychosis and to improve the efectiveness of the clinical management of this condition. 
Key words: Amphetamine; Amphetamine-type stimulant-induced psychosis; Genetic and pathological mechanisms; Clinical feature; Medication
Biostatistics in psychiatry
Estimating treatment effects in observational studies Julia Y. LIN, Ying LU