2017 Volume 29 Issue 2
Systematic review and meta-analysis
Efficacy towards negative symptoms and safety of repetitive transcranial magnetic stimulation treatment for patients with schizophrenia: a systematic review Junjie WANG, Yingqun ZHOU, Hong GAN, Jiaoyan PANG, Hui LI, Jijun WANG, Chunbo LI Background: Negative symptoms are one of the most difficult areas in the treatment of schizophrenia because antipsychotics are often less effective towards them. Repetitive transcranial magnetic stimulation (rTMS) is a new technique for cerebral cortex stimulation and is believed to be a safe and promising method for the treatment of mental disorders. As the clinical research and new treatment models have increased in recent years, the efficacy towards negative symptoms and safety evaluation of rTMS treatment should also be updated.
Aims: To explore the efficacy and safety of rTMS in the treatment of negative symptoms for patients with schizophrenia.
Methods: We searched for relevant controlled clinical trials from the following databases: PubMed, EMBASE,the Cochrane Library, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), VIP, Wanfang Data, SINOMED, and Airiti Library. The retrieval time went up to January 2, 2017. The research literature was screened according to the predefined inclusion and exclusion criteria. After data extraction, statistical analysis was conducted by using RevMan 5.3 and Stata 14. Quality evaluation was done on the included research articles. The Cochrane risk of bias assessment tool was adopted for assessing risk of bias. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard.
Results: A total of 3500 articles were retrieved. In the end, there were 29 articles included in the metaanalysis with a total sample size of 1440. After the meta-analysis, it was found that the use of antipsychotic treatment combined with rTMS could improve the negative symptoms of patients (SMD=-0.40, 95% CI=-0.62~-0.18). Based on the bias of the efficacy evaluation assessed by the Cochrane risk of bias assessment tool, there were 6 studies rated as having “high risk of bias” and the rest were rated as “unable to determine”. According to the assessment, development and evaluation criteria of the GRADE classification,the evidence quality for the efficacy evaluation index was “moderate”. The acceptability of rTMS treatment was better (RR= 0.75, 95% CI= 0.49~1.15, based on the 1492 samples from the 28 studies), however, the patients who received the rTMS treatment had a higher rate of mild adverse effects (RR= 2.20, 95% CI= 1.53~
Original research article
Factors related to acute anxiety and depression in inpatients with accidental orthopedic injuries Hui WU, Fang ZHANG, Wenhong CHENG, Ying LIN, Qian WANG Background: Those injured in accidents commonly have strong emotional reactions to their situation.However, despite the large number of patients who are admitted to general hospitals each year for orthopedic injuries due to an accident, research focusing on psychological disorders due to these injuries is lacking.
Objective: To investigate the presentation and factors related to depression and acute anxiety among inpatients being treated for injury on a Trauma Orthopedics Unit.
Methods: 323 patients with orthopedic trauma were evaluated using the Injury Severity Score (ISS), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD).
Results: In this study, a total of 323 inpatients (213 males and 110 females) had a mean (sd) age of 44.3(13.2) years old. Mean (sd) time in the hospital was 11.1 (5.7) days with a range of 2 to 40 days. Among these patients, 299 had mild trauma, 20 had moderate trauma, and 4 had severe trauma. Patients had a mean (sd)score of 8.1 (4.9) with a range of 1 to 38. The top three most reported symptoms from the HAMA were sleep disorder, gastrointestinal symptoms and anxiety. The top three most reported symptoms from the HAMD were sleep disorder, depression and anxiety. Non-conditional logistic regression analysis showed that being female (anxiety: OR=2.738, 95%CI=1.511-4.962; depression: OR=2.622, 95%CI=1.504-4.570) and duration of hospitalization (anxiety: OR=1.091, 95%CI=1.040-1.145; depression: OR=1.093, 95%CI=1.044-1.144) were risk factors for anxiety and depression among these orthopedic trauma patients.
Conclusion: The main acute symptoms of anxiety and depression in these orthopedic trauma inpatients were sleep disorder, gastrointestinal symptoms, anxious mood and depressed mood. Female patients had stronger emotional reactions to injuries than males. Persistent anxiety and depression symptoms were associated with the duration of hospitalization. All these suggest the need for early psychological assessment and intervention for orthopedic trauma inpatients.
Key words: accidental injury, anxiety, depression, inpatient
Placement instability among young people removed from their original family and the likely mental health implications Simon RICE, Sue COTTON, Kristen MOELLER-SAXONE, Cathrine MIHALOPOULOS, Anne MAGNUS, Carol HARVEY, Ca Background: Young people in out-of-home care are more likely to experience poorer mental and physical health outcomes related to their peers. Stable care environments are essential for ameliorating impacts of disruptive early childhood experiences, including exposure to psychological trauma, abuse and neglect. At present there are very few high quality data regarding the placement stability history of young people in outof-home care in Australia or other countries.
Objectives: To undertake the first systematic census of background, care type and placement stability characteristics of young people living in the out-of-home care sector in Australia.
Methods: Data was collected from four non-government child and adolescent community service organisations located across metropolitan Melbourne in 2014. The sample comprised 322 young people (females 52.8%), aged between 12 – 17 years (mean age=14.86 [SD=1.63] years).
Results: Most young people (64.3%) were in home-based care settings (i.e., foster care, therapeutic foster care, adolescent care program, kinship care, and lead tenant care), relative to residential care (35.7%).However, the proportion in residential care is very high in this age group when compared with all children in out-of-home care (5%). Mean age of first removal was 9 years (SD=4.54). No gender differences were observed for care type characteristics. Three quarters of the sample (76.9%) had a lifetime history of more than one placement in the out-of-home care system, with more than a third (36.5%) having experienced ≥5 lifetime placements. Relative to home-based care, young people in residential care experienced significantly greater placement instability (χ2=63.018, p<0.001).
Conclusions: Placement instability is common in the out-of-home care sector. Given stable care environments are required to ameliorate psychological trauma and health impacts associated with childhood maltreatment, well-designed intervention-based research is required to enable greater placement stability,including strengthening the therapeutic capacities of out-of-home carers of young people.
Key words: out-of-home care, residential care, foster care, adolescent mental health
A study of the characteristics of alexithymia and emotion regulation in patients with depression Hao ZHANG, Qing FAN, Yan SUN, Jianyin QIU, Lisheng SONG Background: Even though patients with depression often show significant alexithymia, the underlying mechanism of their alexithymia remains unclear. Furthermore, few experimental studies have explored their ability to regulate emotions.
Objective: To explore the characteristics of alexithymia in patients with depression, and the relationship of depressive symptoms, alexithymia and emotion regulation.
Methods: A total of 36 patients with depression and 31 healthy controls were enrolled. HAMD-24 and HAMA were used to evaluate depressive and anxious symptoms. Toronto Alexithymia Scale (TAS) was employed to assess alexithymia. A computer experiment was used to evaluate emotion regulation.
Results: 66.67% of the patients with depression were considered as having alexithymia, but the rate in the control group was only 3.23%. The rates showed a significant difference (χ2=28.661, p<0.001).The score of TAS was higher in patients with depression than healthy controls (t=7.378, p<0.001).In a computerized emotional regulation experiment, under watch-neutral conditions, the emotion experience ratings of patients with depression were higher than those of controls (t=2.080, p=0.043);while under watch-negative, negative-reappraisal and negative-suppression conditions, the ratings of patients with depression showed no difference from those of the controls. The scores of TAS were correlated with the HAMD-24 scores and the HAMA scores significantly in patients with depression.However, the ratings on the emotional regulation experiment had no correlation with the HAMD-24 scores, the HAMA scores or the TAS scores.
Conclusion: The incidence of alexithymia is higher in patients with depression than the general population. The depressive symptoms may have interplay with alexithymia in patients with depression.Emotion regulation ability may be an independent trait and have nothing to do with the depressive state.
Key words: depression; alexithymia; emotion regulation; emotion reappraisal; emotion suppression
Efficacy and metabolic influence on blood-glucose and serum lipid of ziprasidone in the treatment of elderly patients with first-episode schizophrenia Jing CHEN, Xingen PAN, Mincai QIAN, Shoukai YANG Background: As the age of the population in China rises, the occurrence of first-episode of schizophrenia in elderly persons is also gradually increasing. However, studies examining selection of therapeutic drugs for this population are relatively few.
Objective: To examine the therapeutic efficacy and metabolic influence on blood-glucose and serum lipid of ziprasidone in the treatment of elderly patients with first-episode schizophrenia.
Methods: Using randomized grouping, 38 elderly patients with first-episode schizophrenia were randomly divided into the ziprasidone treatment group (i.e. the study group) and the olanzapine treatment group (i.e.the control group), with 19 cases in either group respectively. The positive and negative symptoms scale(PANSS) was used to evaluate the efficacy, and adverse drug reaction scale (TESS) was used to evaluate adverse drug reactions, at the points prior to the treatment, at the end of 4th, 8th, and 12th weeks of treatment, respectively. Fasting blood glucose (FBG), total cholesterol (TC), triglyceride (TG), and low density lipoprotein (LDL-c) were also measured.
Results: There was no significant difference between the two groups in PANSS score at the end of week 4,week 8 and week 12. The curative effect on the two groups was similar. The results of repeated measure ANOVA showed that there were significant differences in FBG( Ftime×group=7.539, p=0.001), TC(Ftime×group=32.194,p<0.001), TG(Ftime×group=488.312, p<0.001), and LDL-c(Ftime×group=9.380, p<0.001)between the study group and the control group across the different time points.
Conclusion: Ziprasidone in the treatment of first episode schizophrenia in elderly patients has efficacy and less effect on blood-glucose and serum lipid metabolism.
Key words: ziprasidone, late onset schizophrenia, curative effect, blood glucose, blood lipid
Objectives of China and the global mental health work plan Xiangdong WANG
Strategic mental health planning and its practice in China: retrospect and prospect Bin XIE
The current situations and needs of mental health in China Norman SARTORIUS
Case report
Factitious disorder - A rare cause for unexplained epistaxis Soumitra DAS, Shabna MOHAMMED, Nimisha DOVAL, Arjun KARTHA Summary: Epistaxis or nasal bleeding is a common condition which may be severe enough to warrant an urgent medical or surgical treatment. Factitious epistaxis is a rare entity. Due to a lack of exposure in complex behavioral issues during undergraduate training, it is quite natural on the part of a surgeon to miss the underlying emotional phenomena. Here, we present a case of factitious disorder which presented to the surgical causality with nasal bleeding. After proper evaluation and liaison with the department of otorhinolaryngology, we were able to manage the patient with antidepressants and cognitive behavioral therapy.
Key words: Psychogenic, epistaxis, factitious, stress
Biostatistics in psychiatry
Inconsistency between univariate and multiple logistic regressions Hongyue WANG, Jing PENG, Bokai WANG, Xiang LU, Julia Z. ZHENG, Kejia WANG, Xin M. TU, Changyong FENG Summary: Logistic regression is a popular statistical method in studying the effects of covariates on binary outcomes. It has been widely used in both clinical trials and observational studies. However, the results from the univariate regression and from the multiple logistic regression tend to be conflicting. A covariate may show very strong effect on the outcome in the multiple regression but not in the univariate regression, and vice versa. These facts have not been well appreciated in biomedical research. Misuse of logistic regression is very prevalent in medical publications. In this paper, we study the inconsistency between the univariate and multiple logistic regressions and give advice in the model section in multiple logistic regression analysis.
Key words: Conditional expectation; model selection; logistic regression