In this issue
Systematic review and meta-analysis
Using aripiprazole to reduce antipsychotic-induced hyperprolactinemia: meta-analysis of currently available randomized controlled trials
Meiling MENG, Wei LI, Shaowei ZHANG, Hongyan WANG, Jianhua SHENG, Jijun WANG, Chunbo LI
Background: Hyperprolactinemia (HPL) is a common side effect of antipsychotic medications.Recent reports suggest that aripiprazole can ameliorate antipsychotic-induced HPL, but results are inconsistent and the single available systematic review only considered five studies.
Original research article
Background: Suicide is a leading cause of death, particularly among young adults. The rapid growth of social media and its heavy use by young adults presents new challenges and opportunities for suicide prevention. Social media sites are commonly used for communicating about suicide-related behavior with others, which raises the possibility of using social media to help prevent suicide. However, the use of social media varies widely between different suicide prevention advocates. The role this type of intervention should play in a community’s overall suicide prevention strategy remains a matter of debate.
Aim: Explore the ways in which stakeholders use social media for suicide prevention and assess their views about the potential utility of social media as a suicide prevention tool.
Aim: Evaluate the guardianship services provided by family members to persons with mental illnesses living in the Changning District of Shanghai.
Methods: The legal guardians of 4034 of the 4283 community-dwelling persons with psychiatric disorders living in Changning District who are registered in the Shanghai Information Management System of Mental Health were interviewed by local community health doctors and local neighborhood committee officials. The adequacy of guardianship was assessed based on standardized criteria (including the guardian’s regular attendance at mental health training sessions, and their level of assistance in the treatment, daily life, and rehabilitation of the patient) and the main reasons for inadequate guardianship were recorded.
Results: The majority of guardians (3331, 83.6%) adequately fulfilled their guardianship duties. Advanced age and ill-health of the guardian was the main contributing factor in 87% of the 703 cases in which the guardianship was classified as inadequate. Other factors associated with inadequate guardianship included the patient’s unstable clinical condition or failure to adhere to medication, and when the guardian did not live in the same household as the patient. The patient’s diagnosis, the guardian’s level of education, and the relationship between the guardian and patient were also associated with the adequacy of guardianship.
Conclusions: The guardianship-based community services for mentally ill individuals in urban China works reasonably well. But the rapid aging of China’s population may gradually decrease the ability of China’s families to continue to assume this heavy burden. Alternative models of providing high-quality, community-based services for persons with mental disorders need to be developed as part of the roll-out of China’s new mental health law.
Key words: psychiatric patients; guardianship; community care; mental health law; China
Aim: Assess the psychological correlates of social dysfunction among individuals with internet addiction.
Methods: A total of 133 students who sought treatment at the Guangji Psychiatric Hospital from July 2011 to December 2013 for psychological problems related to excessive internet use and who currently met Young criteria for internet addiction were identified; 31 of the 38 students who meet rigorous criteria for concurrent internet-related social dysfunction and a random sample of 44 of the 95 students without concurrent social dysfunction completed a battery of psychosocial measures: seven supplementary scales of the Minnesota Multiphasic Personality Inventory (MMPI), the Egna Minnen av Barndoms Uppfostran perceived parenting scale, the Perceived Social Support Scale, the Trait Coping Style Questionnaire, and the Symptom Checklist 90.
Results: Compared to persons with internet addiction without accompanying social dysfunction, those with social dysfunction had higher levels of interpersonal sensitivity, hostility, and paranoia; lower levels of social responsibility, anxiety, self-control, and family social support; and they were more likely to employ negative coping strategies. There were however, no differences in perceived parenting styles between the two groups.
Conclusions: A relatively small proportion of individuals who meet the physiological markers of internet addiction simultaneously report significant internet-related social dysfunction. There are several psychosocial measures that distinguish persons with internet addiction who do or do not have concurrent social dysfunction. Further research is needed to determine whether or not these are two distinct subtypes of internet addiction and whether or not persons with internet addiction without concurrent social dysfunction should be classified as suffering from a ‘mental disorder’.
Keywords: addictive behavior; internet addiction; social function; mental disorder; students; China
Forum
Attenuated psychosis syndrome: benefits of explicit recognition
Jason SCHIFFMAN, William T. CARPENTER
Summary: Given the unique characteristics of people who meet criteria for attenuated psychosis syndrome (APS) and the growing literature on the clinical benefits of providing services to individuals who meet these criteria, the APS diagnosis serves an important, and previously missing, role in psychiatry. The promotion of the APS diagnosis should help reduce the over-diagnosis and over-treatment of individuals with prodromal psychotic conditions and it should also encourage expanded training about attenuated psychosis among clinicians who primarily provide services to youth (a primary group who are diagnosed with APS). Only some of the individuals with APS subsequently develop psychosis, but all have existing clinical needs – regardless of subsequent conversion. The formal recognition of APS in DSM-5 will facilitate the research needed to identify and meet those needs.
Summary: One of the most exciting trends in schizophrenia research is the shift in focus from treatment studies to studies about the early identification and prevention of schizophrenia. These studies have primarily focused on adolescents or young adults with prodromal symptoms or on clinically high-risk individuals who show similar impairments in cognitive and social functioning to those seen in individuals with schizophrenia and, thus, are considered at high risk of developing schizophrenia or other psychotic disorders. Some researchers have labeled this condition as psychosis risk syndrome (PRS). There are moves in some circles to re-define the condition as a disorder in its own right: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), lists ‘attenuated psychosis syndrome’ (APS) in the appendix as a condition for further study. Individuals with PRS are certainly at higher risk of developing a psychotic disorder than those without PRS, but the majority of those with PRS do not subsequently develop a psychotic disorder, so we argue against the inclusion of PRS or APS as a subtype of schizophrenia spectrum disorder.
Research methods in psychiatry
Background: Caregiver burden is an important issue that needs to be addressed when developing management programs for persons with chronic mental illnesses, but there is, as yet, no reliable way for assessing this in China.
Biostatistics in psychiatry
Summary: In mental health and psychosocial studies it is often necessary to report on the between-rater agreement of measures used in the study. This paper discusses the concept of agreement, highlighting its fundamental difference from correlation. Several examples demonstrate how to compute the kappa coefficient – a popular statistic for measuring agreement – both by hand and by using statistical software packages such as SAS and SPSS. Real study data are used to illustrate how to use and interpret this coefficient in clinical research and practice. The article concludes with a discussion of the limitations of the coefficient.