Bimonthly, Established in 1959
Open access journal

In this issue

In This Issue

Jinghong Chen, Drew Fralick

Systematic review and meta-analysis

Alpha7 nAChR Agonists for Cognitive Deficit and Negative Symptoms in Schizophrenia: A Meta-analysis of Randomized Double-blind Controlled Trials

Ye JIN, Qi WANG, Yan WANG, Mengxi LIU, Anji SUN, Zhongli GENG, Yiwei LIN, Xiaobai LI

Background: Previous clinical trials of α7-nicotinic acetylcholine receptor agonists (α7-nAChR agonists) showed mixed results in treating the cognitive and negative symptoms of schizophrenia.
Aims: To assess the efficacy and safety of α7-nAChR agonists in treating the cognitive and negative symptoms in schizophrenia.
Methods: A literature search was conducted to identify randomized double-blind placebo-controlled trials for schizophrenia published before May 26, 2017, by searching PubMed, Embase,, the Cochrane Library and the Chinese language databases CNKI, Wanfang, and VIP Data. The effects of α7-nAChR agonists were evaluated for overall cognitive function and negative symptoms by calculating standard mean difference (SMDs) between active drugs and placebo added to antipsychotics.
Results: 8 studies with low bias were included. We found no statistically significant effects of α7 nAChR agonists on the overall cognitive function (SMD=-0.10[-0.46, 0.25], I2=88%) and negative symptoms (SMD=0.13 [-0.04, 0.30], I2=64%) in patients with schizophrenia. Sensitivity analysis showed these results to be firm. And this drug is generally safe and well tolerated with no significant difference from placebo based on adverse events (RR=1.02, [0.85, 1.23]) and dropouts (RR=1.04, [0.61, 1.78]) data. Evidence based on
outcomes from the meta-analysis was rated as ‘moderate’ as per the GRADE guidelines.
Conclusion: α7-nAChR agonists may not be effective in reversing overall cognitive impairments and negative symptoms in patients with schizophrenia as adjunctive therapies.
Key words: schizophrenia; cognitive dysfunction; nicotinic agonists; meta-analysis

Original research article

Executive Function Features in Drug-naive Children with Oppositional Defiant Disorder

Manfei XU, Wenqing JIANG, Yasong DU, Yan LI, Juan FAN

Background: Oppositional defiant disorder (ODD) that is characterized by markedly defiant, disobedient, and disruptive behavior in younger children has been regarded as disruptive behavior disorder (DBD), together with conduct disorder (CD). However, in contrast to CD, ODD does not include severe aggressive or antisocial behavior.
Aim: This study aimed to examine executive function (EF) features of children with oppositional defiant disorder (ODD).
Methods: Cross sectional design was used in this study. The EF of children with ODD and pure attention deficit hyperactivity disorder (ADHD) were compared with children without a psychiatric disorder, using the Stroop Color-Word Tests A and B, Wechsler Intelligence Scale for Children (Fourth Edition; WISCIV), Wisconsin Card Sorting Test (WCST), and Cambridge Neuropsychological Test Automated Battery (CANTAB) corrected for age. Logistic regression analysis was conducted to identify risk factors for EF deficits characteristic of ODD and ADHD.
Results: The ODD group exhibited significantly lower scores in both Stroop Color-Word Tests, the backwards digital span of the WISC-IV, and the categories completed and perseverative responses of the WCST, and significantly higher scores in spatial working memory (SWM) between errors, and the strategy in SWM of the CANTAB compared with the control group. When the ODD group was designated as 1 and the ADHD group was designated as 0, digital span (X1) fit the regression equation very well.
Conclusions: Children with ODD perform substantially worse in EF tasks. Responsive inhibition appears to be uniquely associated with ODD development, while responsive inhibition and working memory appear to be associated with ADHD.
Key words: oppositional defiant disorder, executive function deficit, risk factor


Association among Internet Usage, Body Image and Eating Behaviors of Secondary School Students


Background: Presently, the internet plays a big role in daily life, especially for adolescents. In this age group, they are more concerned about their face and body shape. Despite the numerous studies on the effect traditional media has on body image, very few have focused on the effect of newer forms of media ( media). And almost none have looked at the relationship between time spent online and body image.
Aims: To study the associations between time spent on the internet, body image satisfaction and eating behaviors of students grades 7 to 12 in the Thai educational system.
Methods: The sample group included 620 students, who were selected using simple random sampling from 6 secondary schools in Bangkok. Data were collected using the Media and Internet use behavior questionnaires, The Body-Esteem Scale for Adolescents and Adults: Thai version (BESAA), Drive for Muscularity Scale (DMS: males only), The Rosenberg Self-Esteem Scale: Thai version, Eating Attitude Test-26: Thai version (EAT-26) and the eating behaviors at risk of obesity questionnaire.
Results: Mean (sd) age of the sample was 15.7 (1.9) years, 246 participants (39.7%) were male and 374 (60.3%) were female. Using the internet and social networks for content related to body image and eating behaviors, was negatively associated with body image satisfaction but positively associated with inappropriate eating attitudes/behaviors, binging, purging, use of laxatives/diuretics and drive for muscularity with respect to behaviors and attitudes, and was associated with eating behaviors that carried a
risk for obesity.
Conclusions: Time spent on internet, especially engaged in activities related to self-image, and eating attitudes and behaviors, were associated with a decrease in body image satisfaction and problematic eating behaviors.
Key words: internet, body image, eating disorder, eating behaviors, body dysmorphia, obesity


Validity and Reliability of Adult ADHD Self-Report Scale Thai Version (ASRS-V1.1 TH)


Background: The adult ADHD Self–Report Scale Thai version (ASRS-V1.1) (18 items) is a questionnaire for screening adult ADHD.
Aim: To test the validity and reliability of the 18-question ASRS-V1.1 Thai version (ASRS-V1.1 TH) as a screening tool for adult ADHD
Methods: The original 18-question ASRS-V1.1 version was translated into Thai. The process was composed of forward-translation, synthesis of the translation, and back translation. Cross cultural adaptation, field testing, and final adjustment were completed consecutively. The 18-question ASRS-V1.1 TH were sent to 1,500 parents of kindergarten and elementary school students in Bangkok, Thailand. The diagnostic interview was randomly selected for 50 parents from the positive result group and 50 parents from the negative result group. The clinical interview for confirming diagnosis was run by 3 psychiatrists who were blinded to the results and used DSM-5 ADHD criteria for diagnosis.
Results: The 18-question ASRS-V1.1 TH had satisfactory internal consistency (Cronbach’s alpha = 0.92: Cronbach’s alpha = 0.87 for inattentive scale, Cronbach’s alpha = 0.84 for hyperactive / impulsive scale). For testing the criteria validity, the questionnaire has an adequate. The AUC from the first 6 questions was 0.80 (95% CI: 0.68-0.92) while from the 18 questions was 0.71(95% CI: 0.55-0.86).
Conclusions: The 18-question ASRS-V1.1TH is a psychometrically reliable and valid measure for screening adult ADHD in Thai clinical samples, especially the first 6 questions of the questionnaire.
Key words: adult ADHD, screening, Thailand, validity and reliability, ASRS-V1.1


The Latent Class Structure of Chinese Patients with Eating Disorders in Shanghai

Yuchen ZHENG, Qing KANG, Jiabin HUANG, Wenhui JIANG, Qiang LIU, Han CHEN, Qing FAN, Zhen WANG, Jue C

Background: Eating disorder is culture related, and the clinical symptoms are different between eastern and western patients. So the validity of feeding and eating disorders in the upcoming ICD-11 guide for Chinese patients is unclear.
Aims: To explore the latent class structure of Chinese patients with eating disorder and the cross-cultural validity of the eating disorder section of the new ICD-11 guide in China.
Methods: A total of 379 patients with eating disorders at Shanghai Mental Health Center were evaluated using the EDI questionnaire and a questionnaire developed by researchers from 2010 to 2016. SPSS 20.0 was used to enter data and analyze demographic data, and Latent GOLD was employed to conduct latent profile analysis.
Results: According to the results of latent profile analysis, patients with eating disorder were divided into five classes: low-weight fasting class (23.1%), non-fat-phobic binge/purge class (21.54%), low-fat-phobic binge class (19.27%), fat-phobic binge class (19.27%), and non-fat-phobic low-weight class (16.76%). Among the clinical symptoms extracted, there were significant differences in Body Mass Index (BMI), binge eating behavior, self-induced vomiting, laxative use and fat-phobic opinion; while there was no significant difference
in restrictive food intake.
Conclusions: Based on the clinical symptoms, there are five latent classes in Chinese patients with eating disorder, which is in accordance with the diagnostic categories of feeding and eating disorder in ICD-11. However, further work is needed in improving the fat-phobic opinion of patients with eating disorder and clarifying the BMI standard of thinness in the Chinese population.
Key words: eating disorders; latent class modeling; ICD-11; anorexia nervosa


New Drug Research and Development for Alzheimer’s Pathology: Present and ProspectTao WANGSummary: Cholinesterase inhibitors and N-methyl-D-aspartic receptor antagonists are currently the main treatments for Alzheimer’s disease (AD), targeting the clinical symptoms of AD. β-amyloid (Aβ) deposition and the highly-phosphorylated Tau protein-induced neurofibrillary tangles are some of the common pathological features of AD. In the past 20 years, many new drugs that focus on the pathogenesis of Alzheimer’s disease have been assessed in clinical trials. Drugs such as β-amyloid monoclonal antibody and
gamma-secretase inhibitor target the Aβ pathological pathway. New drugs targeting the Tau pathological pathway inhibit the generation of neurofibrillary tangles and the Tau protein antibodies. But until now, none of these drugs has brought a fundamental breakthrough. This initial breakthrough may come out of China as there are several groups here which already have disease-modifying drugs in phase II and phase III of clinical trials.
Key words: Dementia, β-amyloid, Tau protein, disease-modifying, treatment, clinical trial


More is Needed before Alzheimer’s Disease can be Conquered

Xin YU


Planning Mental Health Needs of China – A Great Leap Forward


Case report

Diagnosis and Treatment of Rash Fever with Anxiety

Yueyun ZHU

Summary: A patient was admitted to our hospital with irregular rash, fever, fatigue, night sweats, and insomnia. The patient’s condition showed no improvements with routine testing and treatments. In this paper, a successful treatment is presented for future therapeutic reference of this type of patient.
Key words: Rash, fever, Yin Deficiency

Case Study of An Adopted Chinese Woman with Bulimia Nervosa: A Cultural and Transcultural Approach

Marion Vu-Augier de MONTGREMIER, Liangliang CHEN, Jue CHEN, Marie Rose MORO

Summary: For a long time, eating disorders were considered as culture-bound syndromes, specific to Western countries. This theory has been refuted for anorexia, but few transcultural studies have been carried out on bulimia nervosa. As a result, knowledge concerning this disorder is limited. On the basis of a clinical case involving a bulimic Chinese girl, we attempt to demonstrate the impact of cultural factors on the disorder. We discuss the atypical characteristics of her symptom profile, in particular the absence of preoccupations concerning her appearance and the psycho-pathological impact of the secrecy surrounding her adoption. In this particular case, bulimia triggered a search for filiation and identity that could have later enabled her to restore harmonious family ties and to gain autonomy. We also examine the case in the context of adoption in China. This clinical case points out how important it is to take cultural factors into account and how useful a transcultural approach is in order to understand bulimia, and suggest effective methods of care.
Key words: Bulimia Nervosa, Transcultural Psychiatry, Adoption, Family Relationship, Individuation

Biostatistics in psychiatry

Sample Size Calculations for Comparing Groups with Continuous Outcomes

Julia Z. ZHENG, Yangyi LI, Tuo LIN, Angelica ESTRADA, Xiang LU, Changyong FENG

Summary: Sample size justification is required for all clinical studies. However, to many biomedical and clinical researchers, power and sample size analysis seems like a magic trick of statisticians. In this note, we discuss power and sample size calculations and show that biomedical and clinical investigators play a significant role in making such analyses possible and meaningful. Thus, power analysis is really an interactive process and scientific researchers and statisticians are equal partners in the research enterprise.
Key words: sample size, continuous outcome, clinical study, power