Systematic review and meta-analysis
Tai Chi for Schizophrenia: A Systematic Review
Wei ZHENG, Qiang LI, Jingxia LIN, Yingqiang XIANG, Tong GUO, Qiong CHEN, Dongbin CAI, Yutao XIANG
Background: Tai Chi as a form of moderate aerobic exercise originating in China, could promote balance and healing of the mind-body. Furthermore, Tai Chi has been used as an adjunctive treatment for patients with schizophrenia. However, no meta-analysis or systematic review on adjunctive Tai Chi for patients with schizophrenia has yet been reported.
Aim: A systematic review and meta-analysis was conducted to examine the efficacy of Tai Chi as an adjunctive treatment for schizophrenia using randomized controlled trial (RCT) data.
Method: Two evaluators independently and systematically searched both English- and Chinese-language databases for RCTs of Tai Chi for schizophrenia patients, selected studies, extracted data, conducted quality assessment and data synthesis. Statistical analyses were performed using the Review Manager (version 5.3). The Cochrane Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to assess the strength of the evidence.
Results: In 6 RCTs conducted in mainland China and Hong Kong, there were 483 participants including 215 subjects in the intervention group and 268 subjects in the control group. The trials lasted 16.0 (6.2) weeks. Compared to control group, we found significant differences regarding improvement of negative symptoms assessed by the Positive and Negative Syndrome Scale (PANSS) negative symptom sub-score (2 trials) and Scale for the Assessment of Negative Symptoms (SANS) (3 trials) over the study period in the intervention group (5 trials with 6 treatment arms, n=451, SMD: -0.87 (95%CI: -1.51, -0.24), p=0.007; I2=90%). Furthermore, there is no significant difference regarding improvement of positive symptoms assessed by the PANSS positive symptom sub-score (2 trials) and Scale for the Assessment of Positive Symptoms (SAPS) (2 trials) over the study period (4 trials with 5 treatment arms, n=391, SMD: -0.09 (95%CI: -0.44, 0.26), p=0.60; I2=65%). All included RCTs did not report side effects. Based on the GRADE, the strength of the evidence for primary outcome was ‘very low’.
Conclusions: The data available on the effectiveness of adjunctive Tai Chi in patients with schizophrenia who are receiving antipsychotic is insufficient to arrive at a definitive conclusion about its efficacy. Furthermore, follow-up time in the available studies was relatively short, and all studies did not use blinded assessment of outcome measures. High-quality randomized trials are needed to inform clinical recommendations.
Key words: antipsychotic; schizophrenia; Tai Chi; systematic review
Original research article
Repetitive transcranial magnetic stimulation combined with venlafaxine and lorazepam for treatment of generalized anxiety
HuiLing WU, MaoRong HU, Bin YU, QiaoSheng LIU, HuiFang WANG
Background: Generalized Anxiety Disorder (GAD) is one of common disorder in psychiatric department. However, about 25% patients are unresponsive to both drug and psychotherapy such as cognitive behaviour therapy. The repetitive transcranial magnet stimulation (rTMS) is widely applied in treatment of schizophrenia, major depression disorder, generalized anxiety disorder, obsessive-compulsive disorder and other types of mental disorders, and has a promising effect.
Aim: To evaluate the curative effect and safety using venlafaxine combined with repetitive transcranial magnet stimulation in treatment of generalized anxiety disorder.
Methods: Seventy patients with a diagnosis of GAD were recruited and randomly divided into two groups. The study group received oral administration of venlafaxine and lorazepam and stimulation of repetitive transcranial magnet. The control group only received venlafaxine and lorazepam. After 6-week observation, Hamilton Anxiety Scale (HAMA) and Clinical Global Impression Severity (CGI-SI) were performed to evaluate the effect of treatment, and Treatment Emergent Symptoms Scale to assess the side effects.
Results: While the symptoms of GAD were improved in both groups after 6-week therapy, the efficacy of the drug-rTMS combined group is superior to another.
Conclusions: The findings of this study indicate that repetitive transcranial magnet stimulation combined with venlafaxine has a significant therapeutic effect treating GAD.
Key words: generalized anxiety; venlafaxine; transcranial magnetic stimulation; test anxiety scale; China
A comparison study of Quetiapine and Risperidone’s effectiveness and safety on treating alcohol-induced mental disorder
Bei LV, Haishui DUAN
Background: Compared with Risperidone, Quetiapine’s effectiveness and safety on treating alcohol-induced mental disorder is still unclear.
Aim: To investigate the clinical effectiveness and safety of Quetiapine on treating alcohol-induced mental disorder.
Methods: One hundred and forty-eight patients with alcohol-induced mental disorderwere divided into the experimental group (75 patients) and the control group (73 patients) by the treatments they received. The patients in the experimental group were treated with Quetiapine by taking it three times per day orally. The average maintenance dose was 151.2(27.3) mg/d, and the treatment cycle was 6 weeks. On the other hand, the patients in the control group received Risperidone once per day orally with the average maintenance dose being 2.3(0.9) mg/d, and the treatment cycle was 6 weeks too. PANSS scale was used to assess patients’prognoses before and after the treatment respectively. The researchers also observed the adverse reactions in both treatment strategies and evaluated the effectiveness and safety of both treatment strategies.
Results: The PANSS scale score of the experimental group after two weeks of treatment was 71.9 (10.2), which was clearly better than 82.6 (11.4), the score before treatment; moreover, it was significantly better than the control group’s score (76.5 (12.8)). Also, the experimental group’s scores after 4 weeks of treatment and 6 weeks of treatment were significantly better than the control group. The experimental group’s effective rate (94.7%) was higher than the control group’s (90.4%); the cure rate of the experimental group (33.3%) was obviously higher than that of the control group (24.7%), and the difference was statistically significant. The rates of adverse reactions in the experimental and control groups were 13.3% and 19.2% respectively, and they were significantly different from each other.
Conclusions: Treating alcohol-induced mental disorder with Quetiapine is more effective than treating it with Risperidone. Quetiapine can improve patients’ symptoms quickly, and lower the chance of getting adverse reactions. It is effective and safe.
Key words: mental disorder, alcohol, Quetiapine, effectiveness
Treatment effect of antipsychotics in combination with horticultural therapy on the inpatients with schizophrenia: a randomized, case-controlled study
Shunhong ZHU, Hengjing WAN, Zhide LU, Huiping WU, Qun ZHANG, Xiaoqiong QIAN, Chenyu YE
Background: As a newly developed treatment method for schizophrenia, horticultural therapy is gaining more and more attentions. However, there is by far few researches investigating it, and there is also a lack of related standardized treatment program. Aim: Investigate treatment effect of horticultural therapy on patients with schizophrenia and its possibility of standardized application in psychiatric hospitals.
Methods: 110 patients with schizophrenia who met the inclusion criteria and signed the consent form were selected at the rehabilitation ward of the Minhang District Mental Health Center from September 2015 to December 2015. We used random-number methods to classify patients into either the intervention group or the control group. While the two groups both received normal medications, the intervention group also attended horticultural therapy. Patients in the intervention group were led to implement the therapy by rehabilitation therapist who had obtained the second class psychological counselor qualification. The whole session lasted for 12 weeks. It is 3 times every week and each session lasted for 90 minutes. The specific contents included ridging, planting, watering, fertilizing and pruning for flowers; plowing, sowing, watering, fertilizing, weeding and catching pests for gardens; appreciating, collecting vegetables, cooking and tasting for flowers and grasses. Before the 10 minutes end of every session, patients mutually expressed their thoughts and experiences and rehabilitation therapist concluded. The two groups were measured by the Positive and Negative Syndrome Scale (PANSS) at the baseline, the end of the 4th week session and the end of the 12th session.
Results: There was no statistically significant difference in gender, age, course of disease, marital status, the mean dosage of using antipsychotic medications and the PANSS score before the intervention among two groups. The PANSS score in the intervention group was statistically significant lower than in the control group both at the end of the 4th week session (t=-4.03, p<0.001) and the end of the 12th session (t=-5.57, p<0.001). There was statistically significant difference before and after intervention in the intervention group (F=253.03, p<0.001); there was statistically significant difference before and after intervention in the control group (F=67.66, p<0.001). There was statistically significant difference in the positive scale score among the two groups both at the end of the 4th week session (t=-3.69, p<0.001) and the end of the 12th session (t=-3.55, p<0.001); there was statistically significant difference in the general psychopathology scale score among the two groups both at the end of the 4th week session (t=-3.67, p<0.001) and the end of the 12th session (t=-3.34, p<0.001). Likewise, there were statistically significant differences in the positive scale scores at the baseline, the end of the 4th week session and the end of the 12th session both among the intervention group (F=13.76, p<0.001) and the control group (F=5.12, p=0.02); there were statistically significant differences in the general psychopathology scale scores at the baseline, the end of the 4th week session and the end of the 12th session both among the intervention group (F=156.40, p<0.001) and the control group (F=56.72, p<0.001). There was statistically significant difference in the negative scale score at the end of the 12th session among two groups (t=-2.76, p<0.001). There were statistically significant differences in the positive scale scores at the baseline, the end of the 4th week session and the end of the 12th session both among the intervention group (F=103.94, p<0.001) and the control group (F=34.03, p<0.001).
Conclusions: Although antipsychotic medications can alleviate the psychiatric symptoms of patients with schizophrenia, the treatment effect for both positive and negative symptoms would be sounder if it is combined with horticultural therapy.
Key words: horticultural therapy; schizophrenia; randomization; placebo-controlled; China
Forum
The prospects for the clinical application of exploratory eye movement among patients with psychotic disorders
Tianhong ZHANG, Yangyang XU, Yu LI, Jijun WANG
Summary: The present study analyses recent reports on exploratory eye movement characteristics in patients with psychotic disorders and predicts the future value of using eye tracking in clinical settings as a laboratory examination tool. We hope researchers will gain further understanding about the characteristics and clinical importance of this new examination tool.
Key words: psychotic disorders; exploratory eye movements; free-viewing mode; visual scanpaths; eye-tracking
Editorial
Some thoughts on the common issue of psychotherapy in different cultures — report on the China conference of psychoanalysis
Zeping Xiao
Case report
Malignant syndrome or withdrawal reaction?
Wenzheng WANG, Hui WEN, Jianhua SHENG
Summary: We reported that a female patient occurred serious side effects in the treatment of antipsychotic drug, clozapine and chlorpromazine, and then appeared withdrawal reactions after she suddenly withdrew clozapine. During the treatment process, she was misdiagnosed as malignant syndrome, so clinicians need to identify the malignant syndrome and withdrawal reaction, and be familiar with the methods of treatment and prevention.
Key words: clozapine, schizophrenia, malignant syndrome, withdrawal reaction
Primary delusion and the sociopolitical milieu in India – A case report & short review
Rahul SAHA, Aastha SHARMA
Summary: Delusion has always been a central topic for psychiatric research with regard to its etiology, pathogenesis, diagnosis, treatment, and forensic relevance. Among these, primary delusion seems to be the interest of many psychiatrists. Content of delusion has always been the area of interest of cultural psychiatry. We have tried to discuss the various aspects of primary delusion and also tried to explain how cultural and sociopolitical environment in a country like India can shape the formation of primary delusion and influence its psychopathology.
Key words: prodrome, primary delusion, culture, sociopolitical environment, behavior
A case report of psychoactive drugs aggravating and alleviating Meige syndrome
Shimiao ZHAO, Yingchun ZHANG, Luoyi XU, Lili WEI, Wei CHEN
Summary: The present case report described a 61-year-old female patient who was diagnosed as Meige syndrome with double eyelid spasm, anxiety and insomnia. After she was treated with psychoactive drugs, it was found that clonazepam tablets in the benzodiazepine class and dopamine antagonist olanzapine tablets aggravated double eyelid spasm; while eszopiclone tablets as a specificity γ-aminobutyric acid receptor binding drug alleviated this condition. The present case suggests that psychoactive drugs have both positive and negative effects on treating Meige syndrome. As for the patients who also have emotion disorder, their conditions should be observed carefully when choosing which psychoactive drug to use. The specificity γ-aminobutyric acid receptor binding drugs should be the prime choice, such as eszopiclone.
Key words: psychoactive drug; Meige syndrome; clonazepam; eszopiclone