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2011 Volume 23 Issue 3
special article
Professor Zhi Liang GUI(1900-1956): China's first female psychiatrist ZuCheng WANG Abstract:This article describes the Iire and contributions of Zhi Liang GUI(1900一1956).China7S first female psychiatrist. Born into a scholarly family.she went to the United States as an internationaI student in the 1920’S.After completing her un. dergraduate studies at Wellesley College and medicaI studies at John Hopkins University she returned to China to practice and teach medicine.During her career Dr GUi published the first textbook in psychiatry in Chinese—Modern Psychiafr铲一and severaI other important monographs.In the history of the development of psychiatry in China,Professor Gui was not only first remale psychiatric expert.she was also the first psychiatrist to address the problem of psychiatric and mental health issues in children.
Systematic review and meta-analysis
Progress in neuroimaging and electrophysioIogicaI studies of dissociative disorder Xuan ZHANG,JunHan YU,ZePing XIAO Abstract:Dissociative disorders affect consciousness,memory,identity and perception of the environment.Earlier studies focused on the epidemiologic pattern and on the role of traumatic memories in childhood.More recently,neuroimaging studies and electrophysiological studies of affected individuals have assessed the biological substrates of this condition.This review summarizes the current structural and functional neuroimaging and eIectrophysioIogicaI research regarding dissociative disorders. 
Key words:Dissociative disorder;Neuroimaging;Event—related potentials;Traumatic memories
Original research article
Efficacy and side effects of monotherapy risperidone, olanzapine and quetiapine in previously untreated patients with schizophrenia: a one-year prospective cohort study XiaoMin YANG,HongXia ZHANG,HuiFang WANG,Hui ZHOU,KaiDa JIANG Background:Second—generation antipsychotics are widely used in the initial episode of schizophrenia,but it remains unclear whether or not they have differential efficacy in this situation. 
Hypothesis:There are no significant differences in the comparative therapeutic efficacy of risperidone,olanzapine,and quetiapine over the first year of treatment in drug—naive,first—episode patients with schizophrenia or schizophremtorm disorder. 
Methods:398 previously untreated patients with a duration of illness of Iess than 5 years who met lCD-10 diagnostic criteria for schizophrenia or schizophreniform disorder and were treated with either monotherapy risperidone(n=131),olanzapine(n=136)or quetiapine(n=1 31)were foIlowed for one year.The Positive and Negative Syndrome Scale(PANSS)was used to evalute therapeutic efficacy and the Treatment Emergent Symptom Scale(TESS)was used to evaluate adverse reactions at 2 weeks and at 2,3,6,8 and 12 months after initiating treatment. 
Results:In total,267 patients(67%)completed the entire study.The discontinuation rates in the risperdone. olanzapine and quetiapine groups were 35.1%(46/131),31.6%(43/36)and 32.1%(42/31),respectively (r=O.43,P=0.809).Using the Iast observation carried forward method to assess final outcome in those who dropped out,the mean(SD)percent decrease in the total PANSS scores at the one year endpoint in the risperidone,olanzapine,and quetiapine groups were46.8%(17.0%),48.6%(19.6%)and47.3%(16.2%),respectively,(F=0.38,P=0.688).Repeated measures analysis of variance analysis found no differences between the groups over time in the total PANSS score or in PANSS subscale scores.The prevalence of tremor and akithesia in the risperidone group at week 2 of treatment was significantly higher than that in the other two groups.At the one year assessment the most common side effects in alI three groups were weight gain and drowsiness.but the prevalence of weight gain in the olanzapine group(69.9%)was much higher than in the other two groups.The persistence(i.e.the proportion of the follow—up period during which the symptoms were present)of extrapyramidal symptoms were greatest for risperidone,the persistence of weight gain was greatest for olanzapine and the persistence of tachycardia was greatest for quetiapine. 
Conclusion:There are no significant therapeutic differences when treating drug.na'fve patients with schizophrenia or schizophreniform disorder with monotherapy risperidone,olanzapine or quetiapine for one year.However.the profile of adverse reactions Is somewhat different for the three medications. 
Keywords:schizophrenia;risperidone;olanzapine,quetiapine;therapeutic efficacy
Anxiety symptoms and quality of life among children living in the Pudong district of Shanghai: a cross-sectional study Hong Liang GU,Juan FAN,Hui Lin YANG,Lan WU,Ling YAN,Jun YI,YaSong DU Background: Few studies have assessed the relationgship between anxiety and quality of life among children from mainland China. 
Objective: Conduct a cross-sectional study about anxiety and quality of life ina representative smple of primary school students from the Pudong district of Shanghai. 
Method:A stratified random cluster sample of 3,685 students in grades 3 to 5 from seven primary schools in the Pudong District of Shanghai were administered the Screen of Child Anxiety Related Emotional Disorders(SCARED) and the Children and Adolescents7 Quality of Life scale(CAQOL). 
Result:Among the 3,628 students who completed the SCARED,864(23.8%,95%Cl=22.4%-25.2%)had clinically significant anxiety symptoms(total SCARED score>23).Scores orl the SCARED were negatively correlated with the overall CAQOL score and with most of the CAQOL subscale scores(teacher-student relationship,peer re— lationships,parent,child relationship,academic aptitude and attitude,self-awareness,access to transportation from home,extra.curricular activities,athletic ability,and self.esteem);but SCARED subscale scores were positively col'· related with three CAQOL subscale scores--physical discomfort,negative emotions,and attitudes about homework. After adjusting for other factors in a muItivariate model,girls reported a higher quality of Iife than boys,older children reported a higher quality of life than younger children,children whose parents had higher levels of educa— tion reported a higher quality of life,and children who reported more symptoms of generalized anxiety or schooI phobia reported a lower quality of life. 
Conclusion:A relatively high proportion of primary school students in Shanghai report clinically significant syruptoms of anxiety.Along with age.gender and Ievel of parental education,the severity of self-reported anxiety symptoms is closely associated with children’s self.reported quality of life. 
Keywords:Children;Anxiety symptoms;Quality of Iife
Retrospective comparison of the characteristics of 98 homeless psychiatric inpatients in Shanghai with those of 98 inpatients who were not homeless Qing CHEN,JianNeng XU,JinJuan WANG Background:With the rapid development of Shanghai’s economy and the gradual increase in the transient work-force,the number of homeless individuals with psychiatric disorders who get hospitalized has been increasing.But there are few assessments of the characteristics of this growing sub—population of psychiatric patients in China. 
Objectives:Compare the characteristics of homeless persons with mental illnesses who are hospitalized in Shanghai with those of psychiatric inpatients who Iived with family members prior to admission. 
Methods:Ninety-eight homeless individuals with mental iIlnesses consecutively referred to the Jiading District MentaI Health Center for inpatient treatment by the Bureau of Public Security(n=42)or by the Iocal welfare agency(n=56)between May 2007 and April 2009 were enrolled in the study.Their characteristics were compared with those of 98 inpatients at the Center randomly selected from alI inpatients admitted over the same period who had lived with family members or guardians prior to admission. 
Results:There were no differences in the age between the two groups of patients,but there were significant differences in almost all other demographic variables considered.Compared to inpatients who Iived with their family, homeless psychiatric inpatients were more likely to be male(76.5%vs.59.2%,x2=6.76,P=0.009),single (88.2%vs。56.1%,x2=15.91,P
Conclusions:The number of homeless psychiatric patients hospitalized in Shanghai is rapidly increasing.The characteristics of these patients are quite different from those of patients who are hospitalized on the recommendation of their families.and from the homeless mentally.1I in other countries.Different treatment and follow up strategies must be developed for this vulnerable subgroup of mentally川individuals.
Keywords:Homeless psychiatric patients;Hospitalization;Trouble—making
Comparison of the effects of clozapine and chlorpromazine on auditory sensory gating in patients with schzophrenia:a case-control study I l Liang SU,Shen Xun SHI,liJun WANG,Hui LI,LiWei WANG,MingYuan ZHANG Background:Patients with schizophrenia have deficits in their P50 auditory sensory gating but the effect of different antipsychotic medications on patients7 P50 sensory gating remains controversial. 
Hypothesis:The improvement in P50 auditory sensory gating of patients with schizophrenia is greater when they are treated with the second generation antipsychotic clozapine than when treated with the first generation antipsychotic chlorpromazine. 
Metlmds:This prospective case.control study of inpatients with schizophrenia enrolled at the time of admission included 26 patients treated by their attending physician with clozapine(cases)and 30 patients treated with chlorpromazine(controls).23 patients in the clozapine group and 20 patients in the chlorpromazine group completed the 8-week trial a.nd were included in the analysis.The P50 was measured using auditory double click stimuli【the conditioning stimuli(S1).testing stimuli(S2)pa卜 adigml;this assessment was conduced at baseline and at 4 weeks and 8 Weeks after initiation of treatment.ClinicaI symptoms were assessed with the Positive and Negative Syndrome Scale(PANSS). 
Results:There were no statistically significant differences between the groulos in age,gender,educationaIlevel,duration of iIIness, or baseline PANSS totaI score;the mean(SD)daily therapeutic dose of chlorpromazine and clozapine were 389(96)mg and 345(117)mg.respectively.Repeated measures analysis of variance showed that the mean PSO ratio(S2/St)at the vertex (centraI zone,Cz)decreased more rapidly in the clozapine group than in the chlorpromazine group(108%VS.106%at base- Iine,94%VS.102%at 4 Weeks,and 84%VS.95%at 8 weeks;F=4.91,P=0.029).The amplitude of SI and S2 did not di仟er significantly between the two groups.The pre·versus post—treatment P50 ratio decreased significantly in the clozapine group(F =4.39,P=0.014)but not in the chlorpromazine group. 
Conclusion:Clozapine treatment can significantly reduce the auditory sensary gating dysfunction experienced by patients with schizophrenia;the improvement with clozapine treatment iS significantly greater than that with chlorpromazine. 
Key words:Schizophrenia;Auditory evoked potentials;P50 sensory gating;Clozapine;Chlorpromazine
Forum
Antidepressants in bipolar depression:Chicken ribs? Kyooseob HA,Jae Seung CHANG
IS the use of antidepressants essential when treating bipolar depression? YiRu FANG
Antidepressants are necessary in the treatment of bipolar depression Shen Xun SHI
The use of antidepressants for treating bipolar depression:a clinical controversy Albert YEUNG
Immune dysfunction in schizophrenia DongFeng ZHOU,YunLong TAN Abstract:The exact causes and pathological mechanisms of schizophrenia are not yet fully understood.Genetically regulated immune mechanisms may play a key role in the pathogenesis of schizophrenia.Viral infection in pregnancy or during post-natal development may cause pathological changes in brain structure and fundion.The augmentation of antipsychotics with immunosuppressant medications in the treatment of schizophrenia may enhance their therapeutic effect.Future research should assess the therapeutic effect of antibodies and drugs that regulate immune function in patients with schizophrenia. 
Key words:Schizophrenia;Immunity;Infection
Case report
Substituting quetiapine for clozapine in 15 treatment-·resistant patients with schizophrenia HongXiao JIA,Hong Zhu,Bin CHEN,ZhenKang JIANG,JiZhi ZHANG Abstract:Fifteen treatment.refractory patients with schizophrenia who continued to have active psychotic symptoms after be— ing converted to treatment with clozapine because of prior unsatisfactory results with at Ieast three other tvpes of antipsychotics were subsequently withdrawn from clozapine and converted to treatment with quetiapine.The outcome of the conversion was assessed using the ClinicaI GlobaI Impression(CGI)scale three month later.Among the 15 patients,4(27%)successfully converted to quetiapine and 4(27%)partially converted to quetiapine;at three months these patients symptoms had improved or remained stable.However,7 patients(47%)were not successfully converted to quetiapine;their symptoms got worse.Patients who successfully converted or partially converted to quetiapine were more likely to have prominent mood symptoms, impulsiveness.and a history of suicidaI ideation or behavior. 
Key words:Schizophrenia;Clozapine;Quetiapine;Conversion of medication
Amphetamine-related mental disorder HanHui CHEN,YanLing HE,SuoYu ZHU,Min ZHAO Abstract:A 35-year.old male with a 4-year history of amphetamine abuse was admitted after 10 days of psychotic symptoms. The symptoms resolved after 10 days of treatment with olanzapine and he remained abstinent from amphetamine use for 5 months after discharge.as verified by urine tests at three clinic visits.This case is used to discuss several related issues:the source and classification of amphetamine drugs,the prevalence of amphetamine abuse in youth,the differential diagnosis in drug abusers,clinical problems in managing amphetamine abuse,and the mechanisms underlying the brain changes associated. with amphetamine Use. 
Key words:Amphetamine;Mechanism;Treatment;Abstinence
Research methods in psychiatry
Effect size for dichotomous outcome measures Yuanjia WANG,Naihua DUAN
Use of instruments and scales in mental health research in China Michael R.Phillips