2012 Volume 24 Issue 2
In this issue
Systematic review and meta-analysis
Research in China on event-related potentials in patients with schizophrenia Jijun WANG, Qian GUO Abstract: Event-related potentials (ERPs) are objective electrophysiological indicators that can be used to assess cognitive processes in the human brain. Psychiatric researchers in China have applied this method to study schizophrenia since the early 1980s. ERP measures used in the study of schizophrenia include contingent negative variation (CNV), P300, mismatch negativity (MMN), error-related negativity (ERN) and auditory P50 inhibition. This review summarizes the main findings of ERP research in patients with schizophrenia reported by Chinese investigators.
Original research article
Hemispheric dominance during the mental rotation task in patients with schizophrenia Jiu CHEN, Laiqi YANG, Jin ZHAO, Lanlan LI, Guangxiong LIU, Wentao MA, Yan ZHANG, Xingqu WU, Zihe DEN Background: Mental rotation is a spatial representation conversion capability using an imagined object and either object or self-rotation. This capability is impaired in schizophrenia. 
Objective: To provide a more detailed assessment of impaired cognitive functioning in schizophrenia by comparing the electrophysiological profiles of patients with schizophrenia and controls while completing a mental rotation task using both normally-oriented images and mirror images. 
Methods: This electroencephalographic study compared error rates, reaction times and the topographic map of eventrelated potentials in 32 participants with schizophrenia and 29 healthy controls during mental rotation tasks involving both normal images and mirror images. 
Results: Among controls the mean error rate and the mean reaction time for normal images and mirror images were not significantly different but in the patient group the mean (sd) error rate was higher for mirror images than for normal images (42% [6%] vs. 32% [9%], t=2.64, p=0.031) and the mean reaction time was longer for mirror images than for normal images (587 [11] ms vs. 571 [18] ms, t=2.83, p=0.028). The amplitude of the P500 component at Pz (parietal area), Cz (central area), P3 (left parietal area) and P4 (right parietal area) were significantly lower in the patient group than in the control group for both normal images and mirror images. In both groups the P500 for both the normal and mirror images was significantly higher in the right parietal area (P4) compared with left parietal area (P3). 
Conclusion: The mental rotation abilities of patients with schizophrenia for both normally-oriented images and mirror images are impaired. Patients with schizophrenia show a diminished left cerebral contribution to the mental rotation task, a more rapid response time, and a differential response to normal images versus mirror images not seen in healthy controls. Specific topographic characteristics of the EEG during mental rotation tasks are potential biomarkers for schizophrenia.
Symptom severity is more closely associated with social functioning status in inpatients with schizophrenia than cognitive deficits Sai ZUO, Linda K. BYRNE, Daihui PENG, David MELLOR, Marita McCABE, Jie ZHANG, Jia HUANG, Yifeng XU Background: Prior research has determined that impairment in neurocognition and psychiatric symptoms contribute to reduced occupational and social functioning in schizophrenia. 
Objective: Evaluate the relationships of neurocognition, psychiatric symptoms, and psychosocial functioning in male inpatients with schizophrenia in China. 
Methods: Fifty-one male patients currently hospitalised at the Shanghai Mental Health Center with a diagnosis of schizophrenia were recruited and 40 of them were included in the final analysis. Participants were assessed with Chinese versions of the Personal and Social Performance Scale (PSP), Clinical Global Impression-Severity (CGI-S) scale, Positive and Negative Symptom Scale (PANSS), Letter-Number Sequencing Task, and Hong Kong List Learning Test. 
Results: Robust negative correlations were found between three clinical subscale scores derived from the PANSS and the global measures of social function (the total PSP score and the CGI-S score). Performance on the neurocognitive tasks was not associated with either symptoms or social functioning status. 
Conclusions: Among inpatients in the acute phase of schizophrenia, the severity of the clinical symptoms—not the degree of the neurocognitive impairment—is closely associated with the level of social functioning.
Correlation between insight and internalized stigma in patients with schizophrenia Ying LU, Xiaoping WANG Background: The relationship between insight and internalized stigma in patients with schizophrenia is important both for theoretical and practical reasons because of its close association with patients’ willingness to seek (or accept) care for their mental illness. 
Objective: To investigate the relationship between insight and internalized stigma in patients with schizophrenia in mainland China. 
Methods: 65 inpatients and 27 outpatients with schizophrenia who had a median duration of four years of illness completed Chinese versions of two self-report questionnaires—the Internalized Stigma of Mental Illness (ISMI) scale and the Modified Consumer Experiences of Stigma Questionnaire (MCESQ). The patients were also assessed by senior psychiatrists using the Scale for Assessment of Positive Symptoms (SAPS) and the Scale for Assessment of Negative Symptoms (SANS). Patients were divided into those with and without insight into their illness based on the score of the insight item on the Chinese version of the Brief Psychiatric Rating Scale. 
Results: 49 patients were classified as having insight and 43 classified as lacking insight. Compared to patients with insight, those without insight had a significantly shorter duration of illness, were more likely to be inpatients, and (at trend level only) had more prominent positive and negative symptoms. The ‘alienation’ subscale score of the ISMI was significantly higher in patients with insight but none of the remaining six subscales in the two instruments were different between the two groups and only 4 of the 48 separate items in the two scales were significantly different between the groups. Logistic regression analysis found no relationship between lack of insight and the scores of the two self-completion stigma scales or the scores of the two clinician-administered symptom scales. 
Conclusion: This study among inpatients and outpatients with schizophrenia in China does not support findings of previous studies that report increased experience of stigma among patients who have better insight. The measures of stigma used in the study need further revision and validation for use in China and studies with a wider spectrum of patients that make more detailed assessments of insight and that follow fluctuations in insight and experiences of stigma over time are needed to clarify the complex relationship between these two phenomena in patients with schizophrenia.
Cross-sectional survey of prevalence and personality characteristics of college students with internet addiction in Wenzhou, China Deguo JIANG, Sheng ZHU, Minjie YE, Chongguang LIN Background: Internet addiction can seriously affect the social functioning and studies of college students in China but measures for addressing this problem have not yet been developed or tested. 
Objective: Assess the personality characteristics of college students with internet addiction. 
Methods: Two self-report scales, the Tridimensional Personality Questionnaire (TPQ) and the Chen Internet Addiction Scale (CIAS), were administered to a stratified random sample of 697 college students from colleges and vocational schools in Wenzhou, China. The characteristics of 48 subjects who meet Chen’s criteria for internet addiction (score of 64 or greater out of 100 on the CIAS) were compared to those of 649 subjects who did not meet criteria for internet addiction. 
Results: The prevalence of internet addiction in the sample was 6.9% (95% CI=5.1-9.1%). Compared to students without internet addiction, those with internet addiction were more likely to be male, of Han ethnicity, to have a history of substance use (primarily tobacco and alcohol), and to be a student at a technical college. Students with internet addiction had higher mean (sd) scores on the novelty-seeking subscale of the TPQ [17.9 (1.2) v. 13.0 (1.6), t=16.75 p
Conclusion: The prevalence of internet addiction among college students in Wenzhou is similar to that in other parts of China. Significant differences in the personality characteristics assessed by the TPQ between university students with and without internet addiction become non-significant after controlling for gender, ethnicity and substance use patterns.
Proper use of clozapine: experiences in China Chuanyue WANG, Lijun LI
Current status of clozapine in the United States Deanna L. KELLY*, Heidi J. WEHRING, Gopal VYAS
Clozapine is underutilized John M. KANE
Case report
Case report on clozapine-associated neuroleptic malignant syndrome Yanqiong WANG, Ruizhe HE, Hui ZHANG Abstract: This article summarizes the clinical manifestations of one case of clozapine-associated neuroleptic malignant syndrome and discusses its diagnosis, predisposing factors and treatment based on a literature review. Early identification and treatment is critical to lower the mortality of clozapine-associated neuroleptic malignant syndrome.
Biostatistics in psychiatry
Latent variable modeling Li CAI