2018 Volume 31 Issue 3
Systematic review and meta-analysis
Literature review and economic evaluation of oral and intramuscular ziprasidone treatment among patients with schizophrenia in China Yu-Chen Yeh, Xin Yu, Congpei Zhang, Wei Hao, Fen Du, Dongdong Liu, Lili Yang, Xin Gao
Background: Over 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.

Aims: The study has two aims: (1) to conduct a targeted literature review of the economic literature on oral ziprasidone in China, and (2) to develop an inpatient economic model that compared the cost of intramuscular ziprasidone with other regimens including electroconvulsive therapy (ECT) for the management of acute agitation in patients with schizophrenia from a hospital’s perspective in China.

Methods: A targeted literature review was conducted using PubMed and the Chinese literature databases for studies published between January 2007 and December 2017. Studies that assessed costs associated with oral ziprasidone treatment for schizophrenia in China were summarised. In the inpatient economic model, cost measures included hospital room and board, antipsychotics, ECT and medications for the management of extrapyramidal symptoms (EPS). Input for standard antipsychotic regimens and unit cost were obtained from the literature. Hospital length of stay (LOS), utilisation of ECT and incidence of EPS were derived from the literature and supplemented/validated with a survey of psychiatrists in China. Cost was presented in 2017 Chinese yuan.

Results: The average estimated LOS was 29 days with ziprasidone, 33 days with risperidone+benzodiazepine, 32 days with olanzapine, 35 days with haloperidol and 29 days with ECT. The cost of antipsychotics was ¥1260 with ziprasidone, ¥137 with risperidone+benzodiazepine, ¥913 with olanzapine and ¥210 with haloperidol; ECT treatment cost ¥785. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Using intramuscular ziprasidone for acute management was associated with a total cost of ¥11 157, the lowest among all antipsychotic regimens (¥11 424 with risperidone+benzodiazepine, ¥11 711 with olanzapine and ¥11 912 with haloperidol) and slightly higher than ECT (¥10 606). The cost of antipsychotics and ECT accounted for 1 %–11 % of the total cost. Varying LOS between the lower and upper bounds of the 95% CI, the total cost was comparable between these regimens.

Conclusions: Overall, the cost for the management of acute agitation was similar between intramuscular ziprasidone and other antipsychotics. Compared with other antipsychotics, the higher medication cost of intramuscular ziprasidone can be offset by savings with shorter hospital stay. The results from this economic analysis were complementary to the findings in the published literature assessing the economic outcomes of oral ziprasidone.
Original research article
Increased plasma leptin as a novel predictor for psychopathological depressive symptoms in chronic schizophrenia Jinjie Xu, Yumei Jiao, Mengjuan Xing, Yezhe Lin, Yousong Su, Wenhua Ding, Cuizhen Zhu, Yanmin Peng,
Background: Depressive symptoms are often seen in schizophrenia. The overlap in presentation makes it difficult to distinguish depressive symptoms from the negative symptoms of schizophrenia. The adipokine leptin was found to be altered in both depression and schizophrenia. There are few studies focusing on the prediction of leptin in diagnosis and evaluation of depressive symptoms in schizophrenia.

Aims: To assess the plasma leptin level in patients with schizophrenia and its relationships with depressive symptoms.

Methods: Cross-sectional studies were applied to (1) compare the levels of plasma leptin between schizophrenia (n=74) and healthy controls (n=50); and (2) investigate the relationship between plasma leptin levels and depressive subscores.

Results: (1) Plasma leptin levels were significantly higher in patients with schizophrenia than in healthy controls. (2) Correlation analysis revealed a significant negative association between leptin levels and the depressed factor scores on the Positive and Negative Syndrome Scale (PANSS). (3) Stepwise multiple regression analyses identified leptin as an influencing factor for depressed factor score on PANSS.

Conclusion: Leptin may serve as a predictor for the depressive symptoms of chronic schizophrenia.
Study of the relationship between self-stigma and subjective quality of life for individuals with chronic schizophrenia in the community Yi Guo, Shumin Qu and Hongyun Qin Author affiliations
Background: Studies conducted outside of China have found that stigma can predict low quality of life, and research in China has shown that stigma has an impact on the quality of life of convalescent patients with schizophrenia. Nevertheless, there is no indepth research on the impact of stigma on the quality of life of patients.

Aims: To research the correlation of stigma and the subjective quality of life of persons with chronic schizophrenia in the community.

Methods: We adopted a stratified sampling method. General questionnaire, quality of life scale and stigma scale were given to 602 persons with chronic schizophrenia in the community.

Results: The mean (SD) value of the Subjective Quality of Life Scale total scores was 32.99 (13.85). The mean (SD) value of the total stigma scores was 43.50 (5.02). After correlation analysis and multivariate stepwise regression analysis, it was shown that the total scores for self-stigma and each factor were positively correlated with subjective quality of life (r=0.462, p

Conclusions: The higher the stigma of persons with schizophrenia in the community, the lower the subjective quality of life is. This suggests that reduction of self-stigma should be considered in the improvement of the quality of life of persons with schizophrenia in the community.
Influencing factors of the neurodevelopment of high-risk infants Yuan Tian, Chuncao Zhang, Guangjun Yu, Xiangying Hu, Zheng Pu and Liyu Ma4 Author affiliations
Background: High-risk infants refer to newborns exposed to high-risk factors in the prenatal, natal or postnatal period. High-risk infants are at high risk of developmental retardation, and early identification of developmental abnormalities plays a vital role in improving high-risk infants’ quality of life.

Aims: To describe the neurodevelopment of high-risk infants aged less than 1 year old, and to analyse the incidences and influencing factors of neurodevelopmental abnormalities in order to provide a basis for neurodevelopment monitoring and management of high-risk infants.

Methods: High-risk infants born between January 2016 and December 2016 in the maternity and infant health hospitals of three districts in Shanghai were followed up. The Gesell Developmental Scale was used to assess the neurodevelopmental level at the time of recruitment (0–2 months) and at 9 months. Univariate and multivariate analyses of the influencing factors were conducted.

Results: 484 high-risk infants (male 51%, female 49%) with an average gestation age of 36.5±2.2 weeks were recruited. At the time of recruitment, the average age was 2.1 (0.8) months, and the developmental quotient (DQ) scores of full-term high-risk infants in motor (t=3.542, p=0.001), cognitive (t=3.125, p=0.002), language (t=3.189, p=0.002) and social (t=3.316, p=0.001) areas were higher than those of preterm infants. The incidences of developmental abnormalities of full-term high-risk infants in motor (χ2 =9.452, p=0.002), cognitive (χ 2 =6.258, p=0.012), language (χ 2 =12.319, p =0.001) and social (χ 2 =6.811, p=0.009) areas were lower than the preterm infants. At 9 months, there was no difference in the DQ scores and incidences of developmental abnormalities in four areas between full-term and preterm high-risk infants, and the incidence of developmental abnormalities was around 10%.

Conclusion: The incidence of neurodevelopmental abnormalities in high-risk infants aged less than 1 year old is high. Preterm birth and parental bad habits are significant factors affecting the neurodevelopment. Monitoring and early interventions help to improve high-risk infants’ neurodevelopment.
Analysis of influencing factors of visual working memory in young adult patients with schizophrenia Li Zhang, Xuemei Ran, Ting Li, Yixuan Ku, Li Liu, Tingming Huang and Wenjia Yan Author affiliations
Background: Patients with schizophrenia have general cognitive impairments, and the impairment of working memory is considered to be the basis of cognitive impairments. The research on visual working memory, one of the subcomponents, is getting more and more attention. However, the influencing factors which cause the deficits of visual working memory in patients with schizophrenia have not been clearly explained. To provide evidence for cognitive impairment interventions, the present study explored the factors influencing the deficits of patients’ visual working memory.

Aim: The present study discussed the relevant factors influencing the visual working memory of patients with schizophrenia by measuring the accuracy of the visual working memory of patients with schizophrenia and healthy controls.

Methods: Colour-recall paradigm was employed to measure the accuracy of the visual working memory of 61 healthy controls and 61 patients who met the International Classification of Diseases, Tenth Revision diagnostic criteria for schizophrenia. The age range of subjects was 18–50. Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to evaluate the patients’ clinical symptoms.

Results: Compared with the healthy control group, the accuracy of visual working memory of patients with schizophrenia was significantly impaired (t=3.062, p=0.003). The accuracy of visual working memory of patients with schizophrenia was not related to age (r=0.023, p=0.860), the age of onset (r=−0.003, p=0.979), the duration of illness (r=−0.038, p=0.769), education level (r=−0.181, p=0.162), continuous working time before illness (r=−0.107, p=0.413) or the daily dose of antipsychotic drugs (r=0.062, p=0.635); however, it was positively related to the number of hospitalisations (r=0.471, p

Conclusion: The present study indicates that the visual working memory of young adult patients with schizophrenia is impaired compared with the healthy people within the same age range. The impairment is more obvious in patients who have multiple hospitalisations and suffer from severe negative symptoms. The impairment in patients with more severe positive symptoms is not very obvious. Combined drug use is likely to alleviate the impairment.
Case report
Aripiprazole augmentation in treating comorbid bipolar disorder and obsessive-compulsive disorder Andrea Amerio and Anna Odone
Summary: Obsessive-compulsive disorder (OCD) is one of the most difficult additional diagnoses to manage in patients with bipolar disorder (BD) since the gold standard treatment for one disease (antidepressants for OCD) can worsen the other. This case report describes the efficacy of aripiprazole augmentation as maintenance therapy in a young patient with comorbid BD-OCD. Our patient presented complete remission of affective and obsessive-compulsive symptoms with remarkable improvement in social and occupational functioning for 24 months. Adverse drug reactions were not severe enough to result in drug discontinuation. In consideration of the important nosological, clinical and therapeutic implications, future research efforts may lead to more grounded guidelines, which are greatly needed in patients with comorbid BD-OCD.
CADASIL syndrome (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) presenting as psychosis Dheerendra Kumar Mishra, Aman Kishore and Vijay Niranjan
Summary: Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) is the most common monogenic form of cerebral small-vessel disease characterised by recurrent strokes. Behavioural disturbance also presents in a significant proportion of subjects as neurotic spectrum disorders and psychotic features are rarely reported. In this case report, we highlight a 32-year-old man with CADASIL syndrome, who had overt psychotic symptoms with neurological signs later on.
Biostatistics in psychiatry
Sample sizes based on three popular indices of risks Hongyue Wang, Bokai Wang, Xin M Tu, Jinyuan Liu, Changyong Feng
Summary: Sample size justification is a very crucial part in the design of clinical trials. In this paper, the authors derive a new formula to calculate the sample size for a binary outcome given one of the three popular indices of risk difference. The sample size based on the absolute difference is the fundamental one, which can be easily used to derive sample size given the risk ratio or OR.