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2013 Volume 25 Issue 6
In this issue
Systematic review and meta-analysis
Characteristics of the gastrointestinal microbiome in children with autism spectrum disorder: a systematic review Xinyi CAO, Ping LIN, Ping JIANG, Chunbo LI Background: A high prevalence of gastrointestinal (GI) symptoms has been reported in children with Autism Spectrum Disorders (ASD). However, results from studies about the GI mircobiome of such children have been inconsistent. 
Aim: Integrate the results of studies that examine the distribution of different GI microorganisms in children with ASD. 
Methods: Studies related to the GI microbiome in children with ASD were identified through PubMed, Embase, PsycINFO, ISI web of knowledge, Ovid/Medline, the Cochrane Library, the Chinese National Knowledge Infrastructure (CNKI) database, the Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the China BioMedical Literature Service System (SinoMed). Studies were screened for inclusion following pre-defined inclusion and exclusion criteria. Software Review Manager 5.2.6 was used for statistical analysis. 
Results: A total of 15 cross-sectional studies, all of which had relatively small samples, were included in the final analysis. Only one of the included studies was from China. Among the 15 studies, 11 studies (with a combined sample of 562 individuals) reported significant differences between ASD children and controls in the prevalence of GI bacteria, particularly bacteria in the Firmicutes, Bacteroidetes and Proteobacteria phyla. However, due to the substantial heterogeneity in methodology and the often contradictory results of different studies, it was not possible to pool the results into a meta-analysis. 
Conclusions: To date, studies on the GI microbiome in children with ASD are limited in quantity and quality. There does, however, appear to be a ‘signal’ suggesting significant differences in the GI microbiome between ASD children and children without ASD, so there would be value in continuing this line of research. To improve validity and decrease the heterogeneity of findings, future studies should enlarge sample sizes, standardize methods and assess relevant confounding variables, such as the severity of GI symptoms and the use of medications, special diets and supplements.
Can cognitive dissonance methods developed in the West for combatting the ‘thin ideal’ help slow the rapidly increasing prevalence of eating disorders in non-Western cultures? Gemma L. WITCOMB, Jon ARCELUS, Jue CHEN Summary: Eating disorders are common, life-threatening conditions in Western countries, but until relatively recently they were regarded as uncommon in non-Western cultures. However, the prevalence of eating disorders in many of the more affluent non-Western countries is rising rapidly as community members, particularly young women, internalize the ‘thin ideal’ that has been widely promoted by the international media. This review discusses the factors involved in the development of eating disorders in non-Western settings with a particular emphasis on the influences of urbanization, modernization, Westernization, and the resulting changes in women’s roles. The cognitive dissonance programs developed in Western countries that have proven successful in countering the negative effects of the thin idea are described and their potential application to East Asia and other non-Western countries are discussed.
Original research article
Case-control study of allele frequencies of 15 short tandem repeat loci in males with impulsive violent behavior Chun YANG, Huajie BA, Zhiqin GAO, Hanqing ZHAO, Haiying YU, Wei GUO Background: Analysis of genetic polymorphisms in short tandem repeats (STRs) is an accepted method for detecting associations between genotype and phenotype but it has not previously been used in the study of the genetics of impulsive violent behavior. 
Objective: Compare the prevalence of different polymorphisms in 15 STR loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA) between men with a history of impulsive violence and male control subjects without a history of impulsive violence. 
Methods: The distributions of the alleles of the 15 STR loci were compared between 407 cases with impulsive violent behavior and 415 controls using AmpFlSTR® Identifiler™ kits. 
Results: Compared to controls, the average frequencies of the following alleles were significantly lower in individuals with a history of violent behavior: allele 10 of TH01 (OR=0.29, 95%CI=0.16-0.52, p
Conclusions: To the best of our knowledge, this is the first behavioral genetic study that clearly demonstrates a close relationship between specific genetic markers and impulsive aggression in non-psychiatric offenders. Further prospective work will be needed to determine whether or not the alleles identified can be considered risk factors for impulsive aggression and, if so, the underlying mechanisms that result in this relationship.
Results of the parent-rated Strengths and Difficulties Questionnaire in 22,108 primary school students from 8 provinces of China Xin GAO, Wenhui SHI, Yi ZHAI, Liu HE, Xiaoming SHI* Background: A valid screening tool for behavioral and emotional problems in children and adolescents is needed to promote psychological wellbeing and to prevent mental disorders in China’s children. 
Aim: Assess the use of the Chinese version of the internationally recognized Strengths and Difficulties Questionnaire (SDQ) – which assesses emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviors – in a large sample of urban and rural children from different parts of China. 
Methods: The Chinese version of the parent-reported SDQ was administered to legal guardians (primarily parents) of a stratified random sample of 22,108 primary school children 5 to 13 years of age from eight provinces in China. The association between SDQ scores and socio-demographic characteristics was assessed and the percentile cutoff scores for ‘abnormal’, ‘borderline’ and ‘normal’ results in China were compared with those for Japan and the United Kingdom. 
Results: The internal consistency of the 4 of the 5 SDQ subscales were satisfactory but that for the ‘peer relationships problems’ subscale was quite poor (alpha=0.22). Guardians reported that boys were more likely than girls to have hyperactivity/inattention problems and that girls were more likely than boys to have problems with emotional symptoms. For both boys and girls hyperactivity/inattention problems decreased with age while peer relationship problems increased with age. Emotional symptoms, conduct problems and peer relationship problems were more common in children from rural areas and in children whose identified guardian was not a parent (i.e., a grandparent or other relative). The 90th percentile cutoff score for abnormal results was higher in Chinese children than the cutoff scores reported for children in Japan and the United Kingdom. 
Conclusions: This study suggests that prevention programs for hyperactivity/inattention problems in boys need to start before the age of 10 and that training in methods of reducing the stress associated with peer relationships should start in early adolescence. Further work is needed to improve the cultural validity of the SDQ in China and to determine its sensitivity and specificity for identifying children who are in need of mental health services.
Health provider perspectives on mental health service provision for Chinese people living in Christchurch, New Zealand Qiuhong ZHANG, Jeffrey GAGE, Pauline BARNETT Background: Migration imposes stress and may contribute to the incidence of mental illness among natives of mainland China living overseas. Both cultural norms and service inadequacies may act as barriers to accessing needed mental health services. 
Objective: Assess New Zealand health providers’ perspectives on the utilization of mental health services by immigrants from mainland China. 
Methods: A qualitative study in Christchurch, New Zealand involved in-depth interviews with nine mental health professionals with experience in providing services to Chinese clients. The interviews were transcribed and thematically analysed. 
Results: Four main themes emerged from the interviews: (1) specific mental health concerns of Chinese migrants; (2) subgroups of migrants most likely to manifest mental health problems; (3) barriers to accessing services; and (4) the centrality of social support networks to the mental health of Chinese migrants. 
Conclusions: Qualitative research with health providers in high-income countries who provide mental health services to the growing numbers of migrants from mainland China can identify areas where improved cultural sensitivity could increase both the utilization of mental health services by Chinese immigrants and the effectiveness of these services.
Forum
Operationalizing the involuntary treatment regulations of China’s new mental health law Yang SHAO, Bin XIE
Case report
A case of neuroleptic malignant syndrome induced by perospirone Jing CHEN*, Shengli ZHI Summary: Neuroleptic malignant syndrome (NMS) is a rare but life-threatening condition induced by neuroleptic medications. Its main symptoms include the rapid onset of fever, severe extrapyramidal symptoms, autonomic nervous system dysfunction, and impaired consciousness. In severe cases, acute renal failure and circulatory failure can develop, which can rapidly lead to death. In this case report, we discuss the etiology, pathophysiology and management of this condition in a female patient with NMS induced by perospirone. The case highlights the need for clinicians to be vigilant: rapid identification of NMS and vigorous symptomatic treatment of NMS symptoms is the key to decreasing the case-fatality of this rare but serious adverse reaction to antipsychotic medications.
Biostatistics in psychiatry
Introduction to mediation analysis with structural equation modeling Douglas GUNZLER, Tian CHEN, Pan WU, Hui ZHANG