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2016 Volume 28 Issue 6
Systematic review and meta-analysis
Effects of transcranial direct current stimulation (tDCS) for auditory hallucinations: A systematic review Haibin LI, Yiran WANG, Jiangling JIANG, Wei LI, Chunbo LI Background: Transcranial direct current stimulation (tDCS) is a non-invasion brain stimulation, which has been suggested as a safe and promising treatment for auditory hallucinations, however, no systematic review has been conducted to evaluate the effects of tDCS on auditory hallucinations (AH).
Objective: To investigate the efficacy and safety of tDCS for auditory hallucinations among patients with schizophrenia.
Methods: We searched relevant randomized controlled trials (RCTs) from PubMed, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, Chinese Biological Medical Literature Database, and Taiwan Electronic Periodical Services (TEPS) before February 13, 2016. Studies were selected based on pre-defined inclusion and exclusion criteria. The quality of each included study was assessed by the risk of bias table. The levels of evidence of primary outcomes were evaluated using GRADE criteria. Data synthesis was conducted using RevMan 5.3.
Results: 304 papers were screened. Finally, three studies with a combined sample size of 87 patients were included in the meta-analysis. Two studies were classified as having ‘low risk of bias’, one study was classified as having 'unclear'. Inconsistent results and the overall level of evidence of primary outcome was graded as ‘low’.
Conclusions: The sample sizes of the published studies were small and the results were inconsistent. We could not draw any strong conclusions from these trials. Further high quality RCTs with large sample sizes are needed to assess the efficacy of tDCS for auditory hallucinations in patients with schizophrenia.
Keywords: transcranial direct current stimulation, auditory hallucination, schizophrenia
Original research article
Eye movement indices in the study of depressive disorder Yu LI, Yangyang XU, Mengqing XIA, Tianhong ZHANG, Junjie WANG, Xu LIU, Yongguang HE, Jijun WANG Background: Impaired cognition is one of the most common core symptoms of depressive disorder. Eye movement testing mainly reflects patients’ cognitive functions, such as cognition, memory, attention, recognition, and recall. This type of testing has great potential to improve theories related to cognitive functioning in depressive episodes as well as potential in its clinical application.
Aims: This study investigated whether eye movement indices of patients with unmedicated depressive disorder were abnormal or not, as well as the relationship between these indices and mental symptoms.
Methods: Sixty patients with depressive disorder and sixty healthy controls (who were matched by gender, age and years of education) were recruited, and completed eye movement tests including three tasks: fixation task, saccade task and free-view task. The EyeLink desktop eye tracking system was employed to collect eye movement information, and analyze the eye movement indices of the three tasks between the two groups.
Results: (1) In the fixation task, compared to healthy controls, patients with depressive disorder showed more fixations, shorter fixation durations, more saccades and longer saccadic lengths; (2) In the saccade task, patients with depressive disorder showed longer anti-saccade latencies and smaller anti-saccade peak velocities; (3) In the free-view task, patients with depressive disorder showed fewer saccades and longer mean fixation durations; (4) Correlation analysis showed that there was a negative correlation between the pro-saccade amplitude and anxiety symptoms, and a positive correlation between the anti-saccade latency and anxiety symptoms. The depression symptoms were negatively correlated with fixation times, saccades, and saccadic paths respectively in the free-view task; while the mean fixation duration and depression symptoms showed a positive correlation.
Conclusion: Compared to healthy controls, patients with depressive disorder showed significantly abnormal eye movement indices. In addition patients’ anxiety and depression symptoms and eye movement indices were correlated. The pathological meaning of these phenomena deserve further exploration.
Keywords: depression disorder; eye movement; saccade
Comparative analysis of results from a cognitive emotion regulation questionnaire between international students from West Asia and Xinjiang college students in China Hongxing HU, Bahargul ALSRON, Bin XU, Wei HAO Background: The Cognitive Emotion Regulation Questionnaire (CERQ) is a cognitive and emotional tool measuring how individuals deal with stressful life events. However differences exist in the results of CERQ among individuals.
Objective: This study was conducted to investigate the CERQ results and depressive symptoms of students at our university (both local and international students) in order to provide further guidance for psychological interventions.
Methods: 255 sophomore and junior international students (171 male and 84 female) and 262 sophomore and junior Chinese students (124 male and 138 female) were investigated using CERQ, ASLEC and SDS questionnaires. Results were analyzed using SPSS 16.0.
Result: Compared to Chinese students, international students more often used cognitive adjustment methods such as “positive refocusing”,“re-focus on planning” and “catastrophizing”. In regression equations where depression symptoms were used as the dependent variable, “self-blaming” and “catastrophizing”positively contributed to depression symptoms in international students, while“acceptance” was negatively correlated with depression symptoms.In Chinese students, “life events score” and “catastrophizing”were positively correlated withdepression symptoms, while “positive re-evaluating” was negatively correlated with depression symptoms.
Conclusion: Among students of different races, positive coping methods were negatively correlated with depression symptoms and could possibly prevent the occurrence of depression, while negative coping methods were positively correlated with depression.Encouraging students to use adaptive coping methods during psychological intervention is an effective way to adjust cognitions and behavior for depression prevention.
key words: cognitive emotion regulation, life events, depression, international students, Chinese students
Effect of repetitive transcranial magnetic stimulation on cigarette smoking in patients with schizophrenia Wanli HUANG, Fang SHEN, Jiangtao ZHANG, Baoping XING Background: The high smoking rate among patients with schizophrenia is an important public health problem, and researchers have been studying how to change the status quo.
Objective: We investigated the effects of high frequency (10Hz) repetitive transcranial magnetic stimulation on the amount of cigarette smoking in patients with schizophrenia.
Method: This study enrolled 37 male patients with schizophrenia who were at a stable stage of treatment. Patients were randomly divided into a treatment group (n=19) and a control group (n=18). The treatment group received repetitive transcranial magnetic stimulation (rTMS) on the left prefrontal dorsolateral cortex (DLPFC), and the control group received placebo treatment. The number of cigarettes smoked were recorded at 7 days before treatment, during the course of treatment (i.e. for 21 days), and 3 weeks after treatment had ended. Assessments using the Positive and Negative Syndrome Scale (PANSS), Wisconsin Card Sorting Test (WCST), and Montgomery Asberg Depression Rating Scale (MADRS) were applied before and after treatment.
Result: Compared to the control group, the number of cigarettes smoked in the treatment group showed a statistically significant reduction in the first week after treatment. However, there was no significant correlation between the scores on PANSS, WCST and MADRS and the number of cigarettes smoked before and after treatment in both groups.
Discussion: High frequency (10Hz) repetitive transcranial magnetic stimulation on the left prefrontal cortex can reduce the number of cigarettes smoked in patients with schizophrenia.
Key words: Repetitive transcranial magnetic stimulation; schizophrenia; cigarette smoking
Effect of clonazepam co-administered with clozapine on the serum clozapine and norclozapine concentration of patients with schizophrenia: A Retrospective Survey Ping JIANG, Zhiguang LIN, Yi JIN, Juanjuan REN, Hongmei LIU, Huiru CUI, Jijun WANG, Chunbo LI Background: For patients with schizophrenia clozapine (CLZ) is sometimes co-prescribed with clonazepam (CLNAZ). However, the impact of administration of CLZ along with CLNAZ on the serum concentration of CLZ and its major metabolite N-CLZ in schizophrenia is not well understood.
Aim: To investigate the effects of CLNAZ co-medication, patient gender, age and CLZ dosage on serum concentration of CLZ and norclozapine (N-CLZ) in individuals with schizophrenia.
Methods: Serum CLZ and N-CLZ concentrations and demographic data were retrospectively analyzed for 341 patients with schizophrenia. We used SPSS 21.0 to perform stepwise regression to analyze the concentration data and demographics. Variables included in the analysis were: serum concentration of CLZ, N-CLZ, and CLZ dosage, gender, age and CLNAZ co-medication.
Results: (1) CLNAZ co-medication significantly affects serum CLZ and N-CLZ concentration in schizophrenics (p=0.010, p=0.020); (2) CLNAZ co-medication, gender and CLZ dosage significantly affect serum CLZ concentration in patients with schizophrenia (p=0.010, p=0.009, p<0.001). Serum CLZ concentration is negatively correlated with CLNAZ co-medication, and is positively correlated with being female and CLZ dosage; (3) CLNAZ co-medication and CLZ dosage were significantly related to serum N-CLZ concentration in participants (p=0.020, p<0.001). Serum N-CLZ concentration was negatively correlated with CLNAZ comedication, and positively correlated with CLZ dosage.
Conclusion: CLNAZ co-medication is associated with changes in serum CLZ and N-CLZ concentration. It is indicated that gender and/or CLZ dosage are also related to serum CLZ and N-CLZ concentration. Therapeutic drug monitoring and dosage regulation of CLZ should be performed for patients with schizophrenia who are also taking CLNAZ to maintain a safe and effective serum concentration of CLZ and N-CLZ.
Keywords: serum concentration; co-medication; clozapine; norclozapine ; clonazepam
Forum
Why is diagnosing MDD challenging? Xiaohua LIU, Kaida JIANG Summary: Depression is highly prevalent and one of the major contributors to disability worldwide. However, one of the findings from the DSM-5 field trials was that inter-rater reliability for diagnosing major depressive disorder was very poor. Why is diagnosing MDD so challenging? This article attempts to explain why undefined pathogenesis and complicated phenotypes complicate the diagnosis of MDD. However, further biomarker and translational research is still necessary to help clinicians screen and diagnose depression in the future rather than relying solely on current subjective diagnostic criteria.
Key words: depression; diagnosis; pathogenesis; phenotype; biomarker
Case report
Choking phobia : an uncommon phobic disorder, treated with behavior therapy : A case report and review of the literature Swapnajeet Sahoo, Nandita Hazari, Susanta Kumar Padhy Summary: Choking phobia is a relatively uncommon phobic disorder which is often encountered by otorhinolaryngologists and referred to psychiatrists as a cause of psychogenic dysphagia. If not diagnosed early and treated appropriately, it can have severe detrimental effects on the physical and psychological health of an individual. We present a case of a 20 year old female who presented with choking phobia and was treated with behavior therapy. Additionally, we discuss the differential diagnosis and treatment strategies of this rare anxiety disorder. Keywords: Choking, Phobia, Psychogenic dysphagia, Behavior therapy, India
Psychogenic blepharospasm: a diagnostic dilemma Soumitra DAS, Roopchand Pandrantil SREEDHARAN, Prasanth Sudhakaran REMADEVI, Cheruvallil Velayudhan Summary: Blepharospasm is an uncontrolled spasmodic contraction of the orbicularis muscles of the eye resulting in an abnormal tic or twitch of eyes. It usually lasts for seconds to minutes but in severe cases eyes may be closed for hours. It may be essentially benign or secondary due to a lesion in basal ganglia, pyramidal tract, and trauma, local pathology in the eyes or drug induced. Here we are presenting a case of psychogenic blepharospasm. A 65 year old woman presented with a history of episodic inability of opening her eyes for the past 6 months. She had repeated abrupt closure of eyes which would persist for 1 hour. It made her socially and interpersonally disabled. Systemic and neurological causes were ruled out by detailed physical examinations and investigations including neuroimaging. Following poor response to oral medications she was injected with 7 units of Botox only in the muscles of the right eye. But within seconds she received relief in both eyes. During the next session she received a needle prick in one eye with no medication and immediately both of her eyes opened from a tightly closed position. In this case the patient reported stress due to increased workload around the house. From our case it depicts that a true movement disorder is often difficult to distinguish from functional disorder. So evaluation and management of patient’s external and internal stress will be of immense help before conducting any invasive treatment.
Key words: Blepharospasm, psychogenic, movement disorder, functional disorder, India
Biostatistics in psychiatry
Two Paradoxes in Linear Regression Analysis Ge FENG, Jing PENG, Dongke TU, Julia Z. ZHENG, Changyong FENG Summary: Regression is one of the favorite tools in applied statistics. However, misuse and misinterpretation of results from regression analysis are common in biomedical research. In this paper we use statistical theory and simulation studies to clarify some paradoxes around this popular statistical method. In particular, we show that a widely used model selection procedure employed in many publications in top medical journals is wrong. Formal procedures based on solid statistical theory should be used in model selection.
Key words: Forward selection, backward elimination, univariate regression; multiple regression
Correspondence
Comment on "Disability, psychiatric symptoms, and quality of life in infertile women: a cross-sectional study in Turkey" Salvatore Giovanni Vitale, Valentina Lucia La Rosa, Agnese Maria Chiara Rapisarda, Antonio Simone La Summary: The aim of this work is to comment on the study about disability, psychiatric symptoms and quality of life in infertile women of Turkey that was published in this Journal. We suggest that future studies use larger samples, consider the influence of factors such as cause of infertility and assisted reproductive techniques (ARTs) and, last but not least, exclude other comorbidities which may influence the data analysis.
Key words: infertility; disability; quality of life