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2017 Volume 29 Issue 1
Systematic review and meta-analysis
Electroconvulsive therapy for agitation in schizophrenia: meta-analysis of randomized controlled trials Xiaojing GU, Wei ZHENG, Tong GUO, Gabor S. UNGVARI, Helen F.K. CHIU, Xiaolan CAO, Carl D’ARCY, Background: Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. Aims: To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Methods: Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment,Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Results: Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score (WMD=-1.97, p<0.0001) as well as the PANSS total score at 14 days (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p=0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days (WMD=-5.01, p=0.02). Headache ( number-neededto-harm (NNH)=3, 95%CI=2-4) was more frequent in the ECT alone group compared to AP monotherapy. According to the GRADE approach, the evidence levels of main outcomes were rated as ‘‘very low’’ (37.5%) and “low” (50%). Conclusion: Pooling of the data based on 7 RCTs from China found no advantage of ECT alone or ECT-APs combination in the treatment of agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations. Key words: Electroconvulsive therapy; agitation; schizophrenia; headache, meta-analysis
Original research article
Relationship of mean platelet volume to MDD: a retrospective study Liqiang CAI, Luoyi XU, Lili WEI, Wei CHEN Background: Results of numerous studies show that major depressive disorder (MDD) is associated with a chronic low-grade inflammation, but the underlying mechanism remains unclear. Aim: To compare the results of blood cell analysis of MDD patients with healthy controls, and explore the potential value of it as an indicator of immune-inflammation in MDD, especially the mean platelet volume. Methods: 103 MDD patients and 106 healthy controls with matched age and gender were recruited.We collected peripheral blood samples from both groups and gathered basic data. For comparison ofnormally distributed data (age, body mass index, lymphocyte count, white blood cell count, red blood cell count, hematocrit, platelet count and mean corpuscular volume) between groups, single t-test wereused; and for comparison of non-normally distributed data (Neutrophil count, neutrophil count, platelet/ lymphocyte ratio, hemoglobin, red blood cell distribution width, mean platelet volume, mean hemoglobin concentration, mean hemoglobin and platelet distribution width), we used Mann-Whitney U-test. Results: Compared with healthy controls, the MDD groups showed significantly higher white blood cell count (F=0.443, p=0.004), plateletcrit (F=8.3, p<0.001), neutrophil and lymphocyte ratio (Z=-6.063,p<0.001), neutrophil count (Z=-5.062, p<0.001), platelet/lymphocyte ratio (Z=-2.469, p=0.014), red blood cell distribution width (Z=-2.481, p=0.013) and mean platelet volume (Z=-2.668, p=0.008). In addition they had significantly lower hemoglobin (Z=-3.876, p<0.001), mean hemoglobin amount (Z=-3.005, p=0.003),red blood cell count (F=0.248, p<0.001), lymphocyte count (F=3.826, p=0.004) and hematocrit (F=0.000, p>0.001). Conclusions: The results suggest that serum inflammatory response probably exists in people with MDD,and indicators of blood analysis especially mean platelet volume have a potential value as biomarker for inflammation. Key words: major depressive disorder; mean platelet volume; inflammation; China
Personality characteristics and neurocognitive functions in parents of children with Autism Spectrum Disorder Xiaojing LI, Qiang WANG,Yuejing WU, Sherrie WANG, Yi HUANG, Tao LI Background: The increasing prevalence of autism spectrum disorder in children and the huge family burdens have caused concern in the academic field as well as society. Aim: To study the personality characteristics and neurocognitive functions in the Chinese parents of children with autism spectrum disorder (ASD) and compare them with the parents of well-developed children. Method: This study recruited 41 Chinese children who met the diagnostic criteria of autism spectrum disorder according to Diagnostic and Statistical Manual of mental disorders-IV (DSM-IV). Their 79 biological parents were evaluated by means of Eysenck Personality Questionnaire (EPQ) and a set of neuropsychological tests. The normal control group consisted of 80 parents of well-developed children, and they were matched by age and gender. Results: We found that the EPQ scores in the P scale for parents of children with ASD were significantly higher than the parents of well-developed children (t=1.68, p=0.039), while their scores in E scale and L scale were significantly lower (t=1.84, p=0.035; t=2.07, p=0.023). We also identified that the parents of children with ASD took significantly longer time than the normal control to complete Trail Making Test (TMT) Part A and Part B-M (t=1.57, p=0.013; t=0.83, p=0.019). Conclusion: Compared to the parents of well-developed children, the parents of children with ASD were more likely to be unconcerned, rigid, stubborn, introverted, and reticent. They displayed less novelty and thrill-seeking behaviors, and had limited social skills and maturity. Although the general cognitive functions including IQ were relatively intact in the parents of children with ASD, there were impairments in their planning, flexibility and visual processing functions. Key words: autism spectrum disorder; personality characteristics; neurocognitive function; executive function
The psychometric properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) in patients with HBV-related liver disease Mei LIU, Yuanyuan WANG, Jing ZHAO, Sujun ZHENG, Gabor S. UNGVARI, Chee H. NG,Zhong-ping DUAN, Yutao Background: Comorbid depression in Hepatitis B virus (HBV) is common. Developing accurate and time efficient tools to measure depressive symptoms in HBV is important for research and clinical practice in China. Aims: This study tested the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR) in HBV patients. Methods: The study recruited 245 depressed patients with HBV and related liver disease. The severity of depressive symptoms was assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) and the QIDS-SR. Results: Internal consistency (Cronbach’s alpha) was 0.796 for QIDS-SR. The QIDS-SR total score was significantly correlated with the MADRS total score (r=0.698, p<0.001). The QIDS-SR showed unidimensional measurement properties in exploratory factor analysis. Conclusions: The QIDS-SR (Chinese version) has good psychometric properties in HBV patients and appears to be useful in assessing depression in clinical settings. Key words: Depressive symptoms, psychometric properties, QIDS-SR, Hepatitis B Virus
Linking anger trait with somatization in low-grade college students: Moderating roles of family cohesion and adaptability Liang LIU, Cuilian LIU, Xudong ZHAO Background: Between 22% and 58% of patients in primary care settings complain of somatic symptoms.Previous research has found that somatization was associated with anger traits and family functions.However, studies that specifically assess the moderating effect of family function in how anger traits become somatic complaints are lacking. Aim: This study was designed to examine whether the variances in family cohesion and family adaptability moderated the strength of the relationship between anger traits and somatization. Methods: A cross-section design was conducted and 2008 college students were recruited from a comprehensive university in Shanghai. All participants finished questionnaires including Symptom Check List-90 (SCL-90), State-Trait Anger Expression Inventory 2 (STAXI-2, Chinese version) and Family Adaptability and Cohesion Scale, second edition (FACES II, Chinese Version) to assess their degree of current somatization,anger trait and family function. Hierarchical linear regression analysis (Enter) was conducted respectively for men and women to examine the moderation effect of family cohesion and family adaptability in the association between anger and somatization. Results: Somatic symptoms were significantly linked in the expected directions with depression and anger trait for both genders. Family cohesion and family adaptability were negatively associated with somatic symptoms. For female college students family cohesion was found to moderate the link between anger trait and somatization, but for male college students the moderation effect of family cohesion was marginally significant. The moderating role of family adaptability was significant for neither male nor female after current depressive symptoms were accounted for. Conclusion: Proneness to anger is an independent predictor of somatization. For women, a high level of family cohesion was a protective factor which could reduce the influence of anger trait on somatic symptoms. Without comorbidity of current depression, family adaptability to some degree exempted individuals with anger proneness from developing somatic complaints. Interventions that integrate family cohesion cultivation, family flexibility fostering and depression treatment might be more effective for somatic patients high in anger trait. Key words: family cohesion, family adaptability, family conflict, anger proneness, anger trait, moderation,somatization
The use of psychotropic drugs during pregnancy Dengtang LIU, Peiwei XU, Kaida JIANG Summary: Patients with severe psychotic disorders face at least two challenges during pregnancy: the genetic risk of psychotic disorders and the risk of teratogenicity caused by psychotropic drugs. This paper reviewed the relevant literature regarding the issues surrounding use of antipsychotics, antidepressants in pregnant patients. The latest treatment guidelines and FDA recommendations are introduced. Key words: pregnancy, antipsychotics, psychotropic drug
Case report
The development of the mind: A three month old infant Simone Setterberg Summary: Infant mental development occurs in interplay with a caregiver. The infant establishes an inner world, a psyche, by using his or her caregiver as transitional mental space for the development of a sense of self. This mental progress occurs simultaneously with motor elaboration, pre-conditioned by neurophysiological maturation. The bodily holding function of the caregiver, through initial skin-to-skin contact, enables the infant to develop a sense of bodily self. The pivotal role of the body as a first place of ego development is illustrated by the vignette of Nino, a 3-month-old infant whose caregiver is unable to provide the necessary physical contact, and therefore insufficiently containing the young infant. This lack of physical holding limits the infant from developing a sense of bodily self, a primary sense of self. Without the caregiver’s holding function, it is impossible for the infant to establish a relationship to a whole person. Key words: Infant, psychic development, dyadic interaction, clinical vignette
Biostatistics in psychiatry
Win ratio –An intuitive and easy-to-interpret composite outcome in medical studies Hongyue WANG, Jing PENG, Juila Z. ZHENG, Bokai WANG, Xiang LU, Chongshu CHEN, Xin M. TU,Changyong FE Summary: In medical studies with multiple outcomes, researchers always need to make choices as to whether to use a composite outcome (after combining multiple outcomes) as their primary outcome. In this paper we review a new measurement of the treatment effect – win ratio, which can be easily used in studies with prioritized multiple outcomes. We also propose some research topics to be done in this area. Key words: time-to-event data; survival functions; proportional hazards model