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2011 Volume 23 Issue 4
Systematic review and meta-analysis
Applications of the binocular rivalry paradigm in psychiatry YiKang ZHU,ChunBo LI,WenYuan WU Abstract Binocular rivalry is a phenomenon that assesses the ongoing exchange of visual information from an unchanging visual stimulus and the subjective perce-ption of the stimulus.Overseas researchers have used the binocular rivalry paradigm to assess mental disorders but this type of research has only just started in China.The magnitude of binocular rivalry can objectively assess the conscious state of subjects and,thus,be used to evaluate the processing of visual information by patients with mental disorders.It is a valuable research tool in the assessment of the development of symptoms in mental disorders.. Key words:Binocular rivalry;Consciousness;Nonconsciousness;Visual Information recognition;Mental disorders
Role of glycogen synthase kinase·3 in the pathogenesis oft AIzheimer's dIsease JianHua SHENG,ChunBo LI Abstract: Multiple reports suggeSt that glycogen synthase kinase-3(GSK3)plays an important role in the pathogenesis of Alzheimer7S disease(AD).The level and enzymatic activity of GSK3 is elevated in AD.Cell culture studies and animal model studies with both invertebrates and mammals find that over-activity of GSK3 causes hyper-phosphorylation of the tau protein,increased production of 13-amyloid,learning and memory impairments,and associated neurodegeneration.GSK一3B inhibitors prevent tau hyper-phosphorylation in AD transgenic animals SO they are of potential use in the prevention and treatment of AD. Key words:Glycogen synthase kinase-3;Alzheimer7S disease;tau Proteins;Beta amyloid protein
Original research article
Comparison of the l ife events, social support and defense mechan isms between patients with social phobia and normal controls in China Di Ying DONG,GuangYan ZHOU Background:It is uncertain how stressfuI Iife events.social support networks and psychological defense mecha. nisms interact with each other to amel/orate or exacerbate the impairment in sociaI functioning experienced by pa— tients with a diagnosis of sociaI phobia. . Objective:Compare the relationship of stress.sociaI support and defense mechanisms between patients with social phobia and normal control subjects. Methods:38 newly diagnosed patients with social phobia seen at the Zi Lang Hospital in Nantong between October 2009 and August 201 0 were administered a Life Event Scale,the SociaI Support Rating Scale and the Defense Style Questionnaire.The results were compared with those for 38 oormaI controls. ResuIts:There were no differences in the in the numbers of positive and negative Iire events between the two groups but the psychological impact of both positive and negative life events on the social phobia group were sig— nificantly greater than on the control group.Based Oll the results of the Social Support Rating Scale the mean(SD) scores of objective support,subjective support,total support and utilization of social support in the social phobia group were all significantly lower than those in the control group.Results of the Defense Style Questionnaire showed that compared to the controI group the totaI score for immature defenses was significantly higher(i.e.,限 spondents were more likely to report using these defenses)and the total score for the mature defenses was signifi. cantly lower in the social phobia group.The social phobia group was significantly more likely to report using the neurotic defenses of repression,avoidance,isolation,and increased sociaI association but significantly Iess Iikely to report using the neurotic defenses of reaction formation,denial,and anticipation. Conclusion:0ifferential patterns of lire events do not aopear to be important in the etiology of sociaI phobia.Com. pared to normaI control subjects,patients with social phobia have a Iess developed sociaI support network,are Iess likely to use available sociaI support and are.more Iikely to employ immature defense mechanisms. Keywords:Life events;SociaI Support;Psychological Defense Mechanism;SociaI Phobia
Effect of adjunctive treatment with repetotove transcranial magnetic stimulation on exploratory eye movements and negative symptoms in schizophrenic patients:a randomized, double-blind, sham-controlled study HaiYing CHEN,ZhiJuan ZHANG,JiJun WANG,YueMin CHEN,ZhiQing XIANG,ShenXun SHI,JianHua SHENG Background:The Ieft dorsolateral prefrontal cortex(DLPFC)is one of the crucial areas in ocular controI that may be involved in the abnormaI Exploratory Eye Movements(EEM)seen in schizophrenia.Repetitive TranscraniaI Magnetic Stimulation(rTMS)to this same region of the brain is a promising adjunctive therapy for the negative symptoms of schizophrenia. Objective:Assess the effects of rTMS stimulation on EEM abnormalities in schizophrenia and the relationship of changes in匪M to changes in the positive and negative symptoms of schizophrenia. Methods:46 inpatients with schizophrenia at the Shanghai MentaI Heahh Center between Iune 2009 and February 201 0 were randomly divided into an rTMS group(n=24)and a sham rTMS group(n=22).Both groups received standard antipsychotic medication.The rTMS group received five adjunctive rTMS treatments per week for four weeks using intermittent theta burst stimulation to the Ieft dorsolateral prefrontal cortex.Patients were evaluated using blinded assessments of the Positive and Negative Syndrome Scale(PANSS)and tests of EEM f including num— ber of eye fixations score(NEF),responsive search score(RSS),and the differentiation score(D)】before and after the course of treatment. Results:23 patients in the intervention group and 1 9 patients in the control group finished the study.Both groups had significant decreases in symptoms after four weeks of treatment but at the end of the treatment period both the totaI PANSS score and the PANSS negative symptom score were significantly Iower in the group that received ad. iunctive rTMS.The NEF score increased significantly(i.e.,improved)in the reaI rTMS group after four weeks of treatment but not in the sham r-rMS group;neither group had significant changes in the RSS or D scores.However, the median percent change in the NEF score for the reaI rTMS group(+1 0%)was not significantly greater than the median percent change in the sham rTMS group(一19%). Conclusion:Compared to standard antipsychotic therapy,a four.week course of antipsychotic medication with ad. Iunctive rTMS was more effective in improving both the negative symptoms of schizophrenia and one component of the abnormaI EEM seen in schizophrenia.High individuaI variability in responsiveness of EEM measures to treat. ment wilI necessitate relatively large samples to determine whether or not particular treatments are effective. Keywords:Exploratory eye movement;Repetitive transcranial magnetic stimulation;Schizophrenia
Cross-sectional study of the association between serum concentration of brain-derived neurotrophic factor and bipolar disorder ChenYu YE,YeQing XU,Hua HU,ChunBo LI,Zh Guang LIN,ShenXun SHl,LiWei WANG Background:Recent studies have reached different conclusions about the relationship of brain.derived neurotrophic factor(BDNF)and the symptoms of bipolar disorder. Objective:Examine the correlation between the serum concentration of BDNF and bipolar disorder and consider whether or not family history of bipolar disorder mediates this relationship. Methods:serum BDNF concentrations were measured in 228 patients with bipolar disorder and 1 53 normaI con. trols.Patients with bipolar disorder were assessed using the Young Mania Rating Scale(YMRS)and the Hamilton Depression Rating Scale(HAMD一1 7):85 with YMRS 1>20 were considered manic,1 4 with HAMD≥1 7 were con. sidered depressed.and 1 29 with YMRS<20 and HAMD<1 7 were considered euthymic. Results:The mean(SD)concentration of BDNF in bipolar patients was significantly Iower than that in the control group{18.75(8.98)ng/ml vs.23.72(5.60)nglml;t=6.09,P
Effects of antipsychotic drugs on pain threshold and motor behavior in rat model of schizophrenia Gang LI,MengMeng JI,Shuai YANGl,DongHong CUl,HuanJun CAO,JianFeng YU Background:Previous investigations have suggested that patients with schizophrenia have decreased pain sensitivity that is partially reversed with antipsychotic treatment.One way to assess this hypothesis is to test it in animaI mod. els of schizophrenia. Objective:Determine whether or not rats that manifest the expected behavioraI changes of a ketamine.induced rat modeI of schizophrenia have an increased pain threshold,and test whether or not pretreatment with antipsychotic medication reverses this increase in the pain threshold. Methods:30 male Wistar rats were randomly assigned to five groups:three groups received intraperitoneal anti— pscyhotics【risperidone(0.3mg/kg),risperidone(0.9rag/kg)or haloperidol(1 mg/kg)】30 minutes prior to re— ceiving intraperitoneal ketamine(1 00mg/kg);one group received normal saline followed by intraperitoneal ket· amine;and a controI group received.two injecti9ns of rlormaI saline.The threshold values for pressure pain and thermaI pain were assessed at baseline and at 5,1 5,30 and 45 minutes after the second injection.The behaviors of another 30 rats treated in the same manner were assessed using the open field test for 1 20 minutes after receiving the second injection. Results:Compared to the control group,rats in the ketamine group(without pretreatment with antipsychotics)had decreased thresholds for pressure pain and increased thresholds for.thermal pain at all time periods after adminis. tration of ketamine.Pretreatment with haloperidol significantly diminished the ketamine.induced decreased pressure pain threshold at alI time periods but low.or high—dose risperidone had no effect on pressure pain thresholds. Pretreatment with Iow—dose risperidone reduced the ketamine.induced increase in thermal pain threshold 5 minutes after the ketamine iniection but not at 1 5_45 minutes after the ketamine iniection;high—dose risperidone and halo。 peridol had no significant effect on thermal pain thresholds.In the open field test the groups pretreated with antipsychotics had fewer standing upright behaviors(goal·directed behavior),fewer crossed grids(1ess hyperactivity), and fewer head shakes and circuling body movements(Iess stereotyped behavior)than the rats treated with ketamine that did not receive pretreatment with antipsychotics.Falls(i.e.,ataxia)were significantly more common in the haloperidol pretreatment group than in the ketamine group(without pretreatment)and than in the two risperi— done pretreatment groups. . Conclusion:We did not confirm previous findings about the inhibition of ketamine—induced increased pain thresh— olds by antipsychotics in a rat model of schizophrenia.The surprising decrease in pressure。pain thresholds with ket. amine may be related to the increased overalI activity foIlowing ketamine injection(which made it difficult to reli. ably conduct the pressure pain threshold test).Risperidone and haloperidol effectively reduce many of the psychomimetic effects of ketamine,but haloperidol increased ketamine.induced ataxia while risperidone decreased atax。 ja,a finding that could be clinically relevant for elderly patients who are prone to falls. Keywords:Risperidone;Haloperidol;Ketamine;Schizophrenia;Pain threshold;Motor behavior;AnimaI models
Forum
China's new approaches to an old problem Graham W.MELLSOP
Recent progress in schizophrenia research ChuanYue WANG Abstract:Schizophrenia iS a chronic,disabling mentaI disorder that iS the outcome of genetic and neurodevelopmental deficits SO the integration of the two general approaches of genomics and neural circuit analysis is the most promising strategy for discovering the specific biological causes of the disorder.This article reviews the approaches to the diagnosis and subtyping of schizophrenia proposed in the draft revision of DSM-5 and discusses some of the clinicaI characteristics of catatonia.The author hypothesizes that different types of psychoses result from differences in the severity or Iocation of the brain dysfunction or impairment.Early detection.diagnosis and treatment(both with and without medication)are essentiaI to preventing the onset and development of schizophrenia,and can halt the cerebraI atrophy and disabi ity associated with the disorder. Key words:Schizophrenia;EtiologicaI factor;Diagnosis;Therapy
Hope for China's national mental health law XieHe LIU
Commentary
Antipsychotics for previously untreated individuals with schizophrenia Scott T.STROUP
Homelessness in China and the West Robert A.ROSENHECK
Case report
Case report of quetiapine--induced erythema multiforme YingChan WANG Abstract:By reviewing the characteristics and treatment of a case of quetiapine-induced erythema multiforme,this case report highlights the clinical importance of constantly being aware of the wicle range of potential adverse reactions to antipsychotic medications. Key words:Quetiapine;Erythema multiforme;Drug eruption
Case report of dysphagia caused by sertraline Yan LIU,ZheShi GAO Abstract:Extrapyramidal symptoms have been reported with the selective serotonin re—uptake inhibitor antidepressants,particularly fluoxetine and paroxetine.We report one case of dysphagia induced by sertraline and——based on a review of the litera‘ ture———propose a possible mechanism for this side effect. Key words:5ertraline;Dysphagia;Extrapyramidal adverse effects
Depressive disorder or bipolar disorder? WenZheng WANG,XiaoHua LIU,Hui LIU,YiRu FANG Abstract:Bipolar disorder often goes unrecognized or is misdiagnosed as unipolar depression.The clinical features,diagnosis and treatment strategy for the two disorders are different.This case report of a bipolar patient discusses the methods of differentiating and treating unipolar and bipolar depression. Key words:Depressive disorder;Bipolar disorder;Diagnosis
Case report of a murder by a patient with schizophrenia with impaired memory XianWen ZHU Abstract:Schizophrenia is the most common condition seen in forensic evaluations in China but few such patients have COmorbid memory problems.We discuss the case of a 40-year—old female with schizophrenia who hacked her mother-in—law to death after a quarrel.At the time of the forensic evaluation the patient had impaired long-term memory.This memory problem showed no improvement after 22 months of treatment with risperidone. Key words:Forensic assessment;Schizophrenia;Memory impairment
Research methods in psychiatry
PsychopathoIogicaI characteristic relevant to the differential diagnosis of depression ZhanPei ZHENG Abstract:Depression is a common disorder in clinical practice but there remain many gaps in our knowledge about the condition. This review discusses problems in the differential diagnosis of depression focusing on the appropriate evaluation of the psychopathological characteristics that are most likely to lead to diagnostic confusion. Key words:Depression;Differentiate diagnosis;Psychopathology
Biostatistics in psychiatry
Analysis of repeated outcome measu res from longitudinal studies Yuanjia WANG,Naihua DUAN