2018 Volume 31 Issue 2
Systematic review and meta-analysis
Ziprasidone, haloperidol and clonazepam intramuscular administration in the treatment of agitation symptoms in Chinese patients with schizophrenia: a network meta-analysis Liang Su, Zheng Lu, Shenxun Shi , Yifeng Xu
Background: Agitation is very common in acute stage schizophrenia patients and injection of antipsychotics and clonazepam are widely used. Network meta-analysis of these comparisons between various injection treatments has been seldom reported.

Aim: To compare the efficacy and safety of various injections for agitation symptoms in Chinese patients with schizophrenia. 

Methods: Searches were made in PubMed, EMBase, and Web of knowledge, Cochrane Library, Wanfang data, CNKI, SinoMed and VIP databases up to Feb 18, 2018. Standard search strategies were performed by two reviewers according to the Cochrane Review Group. The CONSORT statement (Consolidated Standards of Reporting Trials) was used to assess the methodological quality of the studies. STATA were used to perform meta-analysis. The Cochrane Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were used to assess the strength of evidence. 

Results: A total of 15 studies were included in the network meta-analysis. There were 11 studies comparing ziprasidone with haloperidol, and 4 studies comparisons haloperidol with clonazepam. The results showed that ziprasidone is more effective than haloperidol and clonazepam (sucra: 77.2, 72.8, and 0) in the treatment of agitation symptoms. There was the effect size (SMD) in the three groups, haloperidol SMD= 2.278,95% CI:1.836 to 2.719; Ziprasidone SMD= 2.536,95% CI:2.082 to 2.990; and clonazepam SMD= 1.360,95% CI:0.127 to 2.593. The acceptability was assessed by the incidence of excessive sedation which showed that ziprasidone and haloperidol were similar with both being superior to clonazepam (sucra: 0.3, 0.7, and 99.0). Ziprasidone had significantly less adverse effects than haloperidol in EPS (z=5.01, p

Conclusion: Our results suggested that ziprasidone was more suitable than haloperidol and clonazepam in the treatment of agitation symptoms in Chinese patients with schizophrenia, according to the efficacy and acceptability of these three intramuscular injection medications.
Original research article
Evaluation of Paliperidone on social function in patients with chronic schizophrenia Yan Gu1, Hong Peng1, Jingjing Dai1, Hui Gao1 , Xianghong Yang1, Jialing Sheng1, Chen Zhang2*
Background: The impairment of social function is widespread in the patients with chronic schizophrenia, which seriously affects family, life and work conditions.

Aims: The main purpose of this study was to investigate the efficacy of paliperidone in the treatment of social function in chronic schizophrenia.

Methods: A total of 81 patients who met the standard criteria for schizophrenia and long-term hospitalized inpatients were randomly divided into the treatment group and normal control group following one year prospective follow-up study. Treatment group (41 cases) used  paliperidone extended-release tablets reducing dosage, as appropriate, based on the original treatment strategy; and the control group(40 cases) used in the former drugs. All patients were assessed using  the positive and negative symptom scales (PANSS) , and the Treatment Emergent Symptom Scale (TESS) was used to assess adverse drug reactions. The Hospitalized Psychiatric Patients’ Social Functions Rating Scale (SSPI) was used to assess social function of participants before and after eight weeks, six months and one year of treatment.

Results: At baseline there were no significant differences between the two groups in age, duration of illness, educational background and dosage of antipsychotic drugs (converted into chlorpromazine equivalency). There was statistically significant difference in PANSS positive symptoms by interaction effect (F=18.24, df=3237, p=21.66, df=3, p=0.68, df=1, p=0.41) was not statistically significant. The difference of grouping effect of PANSS negative symptoms (F=9.93, df=1, p=0.002), time effect (F=279.15, df=3, p  =279.15, df=3237, p =6.59, df=1, p=0.012), time effect (F=152.97, df=3, p  =148.82, df=3237, p =7.04, df=1, p=0.001), time effect (F=210.78, df=3, p  =205.20, df=3237, p=31.70, df=1, p=161.84, df=3, p  =132.74, df=3237, pp

Conclusion: Paliperone can safely and effectively improve negative symptoms and social function in patients with chronic schizophrenia.
Key words: paliperidone extended-release tablets; chronic schizophrenia;positive and negative symptoms; security; social function
Psychiatric disorders associated with intimate partner violence, and sexual violence in Thai women: A result from the Thai National Mental Health Survey Benjaporn Panyayong1*, Nopporn Tantirangsee2, Rudy R.D. Bogoian3, the Thai National Mental Health Su Background: Intimate partner violence (IPV), and sexual violence (SV), occur commonly, and are a violation of basic human rights. There are limited studies to date that examine the impact of intimate partner and sexual violence, and mental health outcomes in Thailand.

Aims: The objective of the present study was to estimate the prevalence of intimate partner physical violence, and sexual violence in Thai women, and the association between these forms of violence, and psychiatric disorders.

Methods: The present study used data from a national cross-sectional, population-based, household design survey. This study analyzed data from 3,009 female respondents above the age of 18 who were interviewed in person using the World Mental Health – Composite International Diagnostic Interview version 3.0 (WMH-CIDI 3.0). We estimated the lifetime and the 12-month period prevalence of IPV, and sexual violence, the lifetime and the past 12-month period correlation of IPV/sexual violence with psychiatric disorders, and the odds ratio for psychiatric disorders associated with these types of violence. 

Results: Only 5.2% of the weighted sample reported experiencing some form of violence, including reported rates of intimate partner physical violence (IPV) of 3.5 %, and sexual violence of 2.0%. Women who had experienced IPV, have a lifetime prevalence for common psychiatric disorders of 28.9%, for suicidal behaviors 12.2%, and for substance use disorders 8.8%. Women who had experienced sexual violence have a lifetime diagnoses for common psychiatric disorders of 21.4%, for suicidal behaviors 16.5%, and for substance use disorders 19.4%.  There was a statistically significant association between IPV/sexual violence, and being diagnosed with a psychiatric disorder during the past year, and also during one’s lifetime. 

Conclusion:  The association between IPV/sexual violence, and psychiatric disorders is significant, therefore, performing a formal assessment for a history of violence in psychiatric patients is often beneficial in refining the diagnosis and treatment.
Key words: Psychiatric disorders, intimate partner violence, sexual violence, prevalence, and substance use disorders
Different Levels of Facial Expression Recognition in Patients with First-Episode Schizophrenia: A Functional Magnetic Resonance Imaging Study Chengqing YANG1, Ansi QI2, Huangfang YU3, Xiaofeng GUAN2, Jijun WANG1, Na LIU1, Tianhong ZHANG1, Hui
Background: The impairment of facial expression recognition has become a biomarker for early identification of first-episode schizophrenia, and this kind of research is increasing.

Aims: To explore the differences in brain area activation using different degrees of disgusted facial expression recognition in antipsychotic-naïve patients with first-episode schizophrenia and healthy controls.

Methods: In this study, facial expression recognition tests were performed on 30 first-episode, antipsychotic-naïve patients with schizophrenia (treatment group) and 30 healthy subjects (control group) with matched age, educational attainment, and gender. Functional magnetic resonance imaging (fMRI) was used for comparing the differences of the brain areas of activation between the two groups.

Results: The average response time difference between the patient group and the control group in the ‘high degree of disgust’ facial expression recognition task was statistically significant (1.359 (0.408)/2.193 (0.625), F=26.65, p

Conclusions: In patients with first-episode schizophrenia, the areas of facial recognition impairment are significantly different in different degrees of disgust facial expression recognition.

Key words: schizophrenia; case control study, face perception; functional magnetic resonance imaging
Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder Nattakit Praphatthanakunwong 1, Komsan Kiatrungrit 2*, Sirichai Hongsanguansri 2, Kaewta Nopmaneejum Background: The Developmental, Individual-differences, Relationship-based model (DIR/Floortime) is one of the well-known therapies for ASD, thats main principle is to promote holistic development of an individual and relationships between the caregivers and children. Parental engagement is an essential element to DIR/Floortime treatment and involved with various factors. Finding those supporting factors and eliminating factors that might be an obstacle for parental engagement are essential for children with ASD to receive the full benefits of treatment.

Aim: To examine the association between parents, children and provider & service factors with parental engagement in DIR/floortime treatment.

Methods: This is a cross-sectional study of parents with children aged 2–12 who were diagnosed with autism spectrum disorder (ASD). Data were collected using a parent, child, provider and service factors questionnaire. Patient Health Questionaire-9 (PHQ-9), Clinical Global Impressions-Severity (CGI-S) and Childhood Autism Rating scale (CARS) were also used to collect data. For parent engagement in DIR/Floortime, we evaluated quality of parental engagement in DIR/Floortime and parent application of DIR/Floortime techniques at home. Finally, Clinical Global Impressions-Improvement (CGI-I) and Functional Emotional Developmental Level (FEDL) were used to assess child development.

Results: Parents who were married, had lower income and higher knowledge of DIR/Floortime theory were more likely to have higher parent engagement (χ=4.43, p=0.035; χ=13.1, p=4.06, p=0.044 respectively). Furthermore, severity of the diagnosis and the continuation of the treatment significantly correlated with parent engagement (χ=5.83, p=0.016  and χ=4.72, p=0.030 respectively). It was found that parents who applied the techniques for more than 1  hour/day, or had a high-quality parent engagement, significantly correlated with better improvement in child development (t=−2.03, p=0.049; t=−2.00, p=0.053, respectively).

Conclusion: Factors associated with parents, children and provider & service factors had a significant correlation with parent engagement in DIR/floortime in which children whose parents had more engagement in DIR/floortime techniques had better improvement in child development.

Key words: Parent engagement, DIR/Floortime, Autism spectrum disorder
Determination of Venlafaxine and Its Active Metabolite O-Desmethylvenlafaxine in Human Plasma by HPLC Fluorescence Shujuan SHEN, Chen ZHANG, Yemeng MAO* Shanghai Mental Health Center, Shanghai, China
Background: Therapeutic drug monitoring (TDM) guides clinical individualized medication by measuring plasma concentration, which could improve the curative effect, avoid drug overdose, and reduce the incidence of adverse reactions. At present, there are few reports on the clinical detection of venlafaxine and its active metabolite O-desmethylvenlafaxine. In this paper, the detection method of venlafaxine and O-desmethylvenlafaxine in blood plasma was established, which provides an effective and convenient means for guiding clinical application of medication. 

Aim: To establish a method for determination of venlafaxine and its active metabolite O-desmethylvenlafaxine in human plasma by high performance liquid chromatography (HPLC) with fluorescence (FL) detection.  

Methods: Chromatographic separation was achieved on an Agilent Eclipse XDB-C18 Column (4.6 × 150 mm, 5 um) with water containing sodium dihydrogen phosphate (0.05 mol/L) and acetonitrile (72:28) as the mobile phases. The following parameters were employed: flow rate 0.5 mL/min, column temperature 30°C, fluorescence excitation wavelength 276 nm, emission wavelength 598 nm. 

Results: The method showed good linearity in the concentration range 10-1000 ng/mL. The regression equation for venlafaxine was R = 0.0054C + 0.0264,r2 = 0.99991. The regression equation for O-desmethylvenlafaxine was R = 0.0034C+ 0.0272,r2 = 0.99969. The intra-day and inter-day precisions (RSD) were less than 10%, and the quantitative limit was 10 ng/mL. 

Conclusion: We established a sensitive, specific, and simple method for the detection of venlafaxine and O-desmethylvenlafaxine. This method fully meets the needs of clinical trials of venlafaxine and the requirements of relevant guidelines. It provided a reference for the clinical detection of venlafaxine and O-desmethylvenlafaxine plasma concentrations and pharmacokinetic study. 

Key words: HPLC, fluorescence detection, venlafaxine; O-Desmethylvenlafaxine; plasma concentration
Case report
A case of clozapine-induced skin picking behavior Balaswamy Reddy*1, Soumitra Das2, Srinivas Guruprasad3
Summary: There is some evidence consistently linking the occurrence of denovo OCD (Obsessive compulsive disorder) with clozapine. This skin-picking disorder is also known as Impulsive Compulsive Disorder-unspecified, which with an increasing convergence with OCD has been placed in the current DSM-5, in the category of the Obsessive-Compulsive and Related Disorders. To the best of our knowledge, there is no literature relating anti-psychotics like clozapine with the occurrence of skin-picking behavior. Here we present a case in whom skin-picking behavior emerged during the upward dose-titration of clozapine and was successfully treated with escitalopram.  
Key words: clozapine; skin picking; obsessive-compulsive
Olanzapine induced leucopenia and thrombocytopenia in an elderly patient: A case report and review of the evidence Yogender Kumar Malik, Swapnajeet Sahoo*, Ajit Avasthi Summary: Hematological adverse effects of antipsychotics are rare but life threatening. Existing literature is limited to case reports only which is mostly reported with second generation antipsychotics (clozapine, olanzapine, risperidone, quetiapine). Elderly individuals are at risk of developing side effects with any psychotropics. Olanzapine is commonly used for the management of psychotic symptoms as well as for the management of behavioral and psychological problems with dementia in the elderly. In this case report, we report thrombocytopenia and leucopenia in an elderly individual with schizophrenia which developed after initiation of olanzapine and reverted back after stoppage of the drug. This case report highlights that the elderly are susceptible to develop hematological side effects with olanzapine and hence monitoring may be essential.
Research methods in psychiatry
Viral vectors as a novel tool for clinical and neuropsychiatric research applications Yao Wang1*, Zhiwei Hu1, Peijun Ju2, Shan Yin1, Fujie Wang1, Oudong Pan1, Jinghong Chen2*
Background: Viral vector is a genetically modified vector produced by genetic engineering. As pathogenic genes in the virus are completely or largely eliminated, it is safe to be widely used in multidisciplinary research fields for expressing genes, such as neuroscience, metabolism and oncology, etc. Neuroscience and psychiatry are the most closely related interdisciplines in either basic research or clinical research, but the application of viral vectors in neuropsychiatry has not received much attention and been widely accepted.
Objective: This article will focus on the application of viral vectors in the basic and clinical research of neuropsychiatric science.
Methods: By using viral vectors, scientists can perform neurological labeling, gene expression regulation, and physiological manipulation for investigating from molecular mechanisms to behaviors. At the same time, to treat mental or neurological disorders, viral vectors can be designed for gene therapy, which alter gene expression levels or repair mutated genes in the brain of patients.
Perspective: Viral vectors play an important role in basic research and clinical applications. To further understand the brain function and prevent it from suffering mental and neurological diseases, we supposed that viral vector could be used along with various advanced technologies, such as sequencing and high throughput expression analysis in the neuroscience research field. 

Key words: viral vector, tracing neural circuits, gene manipulation, optogenetics, gene therapy