Bimonthly, Established in 1959
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In this issue

Liwei Wang & Jinghong Chen Edited

Systematic review and meta-analysis

Meta-analysis of the Efficacy and Safety of Adjunctive Rosuvastatin for Dyslipidemia in Patients with Schizophrenia

Wei ZHENG, Wei YANG, Qing-E ZHANG, Xin-Hu YANG, Dong-Bin CAI, Jin-Qing HU, Gabor S. UNGVARI, Chee H.

Background: Metabolic syndrome in patients with schizophrenia is a major health concern. The efficacy and safety of adjunctive rosuvastatin in treating dyslipidemia were controversial.
Aims: To assess the efficacy and safety of adjunctive rosuvastatin for dyslipidemia in patients with schizophrenia.
Methods: We systematically searched for relevant controlled clinical trials from the following databases: PubMed, PsycINFO, Cochrane Library, China Knowledge Network, WanFang Database and Chinese Biomedical Database up to September 28, 2017. Standardized mean difference (SMD) and risk ratio (RR) along with their 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard.
Results: Four studies (n=274) comparing rosuvastatin (n=138) and control (n=136) groups were identified and analyzed. Adjunctive rosuvastatin showed greater efficacy than control group in low density lipoprotein cholesterol (LDL-C) [4 trials, n=272, SMD: -1.31 (95%CI: -1.93, -0.70), I2=81%], total cholesterol (2 trials, n=164, SMD: -2.00 (95%CI: -2.79, -1.21); I2=76%) and triglycerides (2 trials, n=164, SMD: -1.05 (95%CI: -1.38, -0.72); I2=0%), but not in high density lipoprotein cholesterol (2 trials, n=164, SMD: 0.14 (95%CI: -0.16, 0.45);
I2=0%). After removing one study without randomization for LDL-C, significance remained [3 trials, n=172, SMD:-1.07 (95%CI: -1.60, -0.53); I2=63%]. No significant group differences regarding body weight (3 trials, n=208, SMD: -0.40 (95%CI:-1.29, 0.49); I2=89%), body mass index (2 trials, n=164, SMD: -0.34 (95%CI: -1.23, 0.56); I2=87%), waist circumference (3 trials, n=208, SMD: -0.43 (95%CI: -1.31, 0.46); I2=89%), and fasting glucose (4 trials, n=272, SMD: -0.25 (95%CI: -0.65, 0.15); I2=62%) were observed. The adverse reactions and
any cause discontinuation rate were similar between the groups. According to the GRADE approach, the evidence levels of main outcomes were rated as ‘‘very low’’ (35.3%) to ‘‘low’’ (64.7%). Of them, the primary outcome (LDL-C) was rated as “very low “.
Conclusions: The data available on the effectiveness and safety of adjunctive rosuvastatin in treating dyslipidemia for patients with schizophrenia is insufficient to come to a definitive interpretation about its efficacy and safety. Further high quality RCTs with extended treatment duration are warranted to confirm the findings.
Review registration: PROSPERO: CRD42017078230
Key words: schizophrenia; rosuvastatin; dyslipidemia; low density lipoprotein cholesterol; meta-analysis

Original research article

A Study of The Clinical Effect and Dropout Rate of Drugs Combined with Group Integrated Psychotherapy on Elderly Patients with Depression

Bo LIU, Youguo TAN, Duanfang CAI, Yudiao LIANG, Ruini HE, Chengwen LIU, Yong ZHOU, Cuihua TENG

Background: Relevant studies have shown that group cognitive behavioral therapy is effective in treating patients with depressive disorder, but the dropout rate is high. The present study is aimed to explore the patterns of integrated group psychotherapy.
Aims: This study investigated the clinical effects of integrated group psychotherapy for elderly patients with senile depression.
Methods: One hundred elderly patients with senile depression were divided into the experiment group (n=50) and the control group (n=50) randomly. The experiment group was given regular pharmacological treatments combined with integrated group psychotherapy, while the control group was given regular pharmacological treatments combined with integrated group cognitive behavioral therapy. These two groups were assessed with the Hamilton Depression Scale (HAMD-24) and Geriatric Depression Scale
(GDS-15) before the study and at two weeks, four weeks and eight weeks after the treatments.
Results: According to the comparisons within these two groups, it was found that the HAMD and GDS total scores before treatments were all significantly higher than those after treatments (F=102.50, p=0.001; F=55.94, p
groups’ GDS total scores after two weeks, four weeks and eight weeks were also significantly different (F=4.49, p=0.009). Seven cases dropped out in the experiment group, while sixteen cases dropped out in the control group. The difference of dropout rates was statistically significant (x2=4.57, p=0.032).
Conclusion: Medication treatments combined with the group integrated psychotherapy significantly improve the clinical effect for elderly patients with senile depression. The compliance is improved and the dropout rate declines.
Key words: group integrated psychotherapy; group cognitive behavioral therapy; senile depression

The Study of White Matter Hyperintensity (WMH) and Factors Related to Geriatric Late-Onset Depression

Jinghua WANG, Wei LI, Ling YUE, Bo HONG, Na AN, Guanjun LI, Shifu XIAO

Background: Geriatric depression is one of the most common and harmful mental illnesses seen in the elderly. However, there are few studies focusing on the relationship between late-onset depression (LOD) and social and psychological factors, as well as brain structure.
Aims: To explore factors related to late-onset depression (LOD) in elderly patients.
Methods: 24 first onset LOD patients over 60 years old (meeting ICD-10 diagnostic criteria for depression) and 23 non-depressed elders were selected for inclusion into this study. Scale assessments, including Fazelasscale for white matter hyperintensity (WMH) high signal level and the MTA-scale for medial temporal lobe atrophy levels, were combined with general demography and sociology data to find factors related to LOD.
Results: There was no significant difference in age (t=0.419, p=0.678), gender (X2=1.705, p=0.244), or years of education (t=1.478, p=0.146) between the two groups. However, statistical differences were shown on scores on the WMH, (X2=7.817, p=0.008), periventricular white matter hyperintensity (PWMH)(Fisher exact test: p=0.031), having or not having religious beliefs (Fisher exact test: p=0.265) and family harmony (yes or no) (Fisher exact test: p=0.253) between the LOD group and control group. The results of linear regression analysis showed that the total score for WMH, religious beliefs (with or without) and family harmony (yes or no) were associated with depressive symptomology.
Conclusion: Scores on the WMH, religious beliefs and family harmony are all potentially related to LOD in elderly patients.
Key words: Geriatric depression, Late onset, MRI, White matter hyperintensity, Religious belief, Family harmony

Risk Factors of Nocturnal Enuresis in Children with Attention Deficit Hyperactivity Disorder

Habibolah KHAZAIE, Farshid EGHBALI, Houshang AMIRIAN, Mahmoud Reza MORADI, Mohammad Rasoul GHADAMI

Background: Presence of attention deficit hyperactivity disorder (ADHD) has a negative effect on the resolution of incontinence; however, there are few studies which investigated the risk factors of nocturnal enuresis (NE) in patients with ADHD.
Aims: This study was conducted to investigate the prevalence of NE and its risk factors in children with ADHD.
Methods: 331 children, aged 6 to 10 years, diagnosed as having ADHD were enrolled in this study. The diagnosis of ADHD was confirmed by an experienced child and adolescent psychiatrist according to DSM-IVTR. NE was defined as nighttime wetting with or without daytime incontinence, at least twice a week over a period of 3 months or longer in children 5 years old and older without anatomical abnormalities. Details on demographic data, perinatal history, medical history and developmental history were collected from parents or medical records.
Results: Most of the ADHD patients with inattentional subtype (77.5%) had NE, compared to 31.7% in the hyperactive/Impulsive subtype and 22.5% in the combined subtype (p
Conclusion: Children with ADHD have a high prevalence of NE. Male sex, low education level of parents, history of neonatal sepsis, positive family history of NE, low birth weight and caesarian delivery may be risk factors for NE in ADHD children. Most ADHD patients with inattentional subtype had NE.
Key words: nocturnal enuresis, ADHD, risk factors

Defects of Gamma Oscillations in Auditory Steady-State Evoked Potential of Schizophrenia

Chenhui SUN, Ping ZHOU, Changming WANG, Yu FAN, Qing TIAN, Fang DONG, Fuchun ZHOU, Chuanyue WANG

Background: Patients with schizophrenia have many cognitive deficits. Gamma oscillations exist in the human brain and are closely related to neurocognition. Auditory Steady-State Responses (ASSRs) is an electroneurophysiological index that could reflect gamma oscillations. It was found that the energy evoked by 40 Hz ASSRs in schizophrenic patients was significantly lower than that in healthy subjects. However, the correlation between ASSRs phase index and clinical symptoms and neurocognitive deficits has yet to be systematically studied. The purpose of this study was to investigate the dysfunction of neural activity of gamma rhythmdys function and its association with clinical symptoms and neurocognition in patients with schizophrenia.
Aims: To compare and verify the difference in energy and phase coherence of 20 Hz and 40 Hz ASSRs between schizophrenia and healthy participants, and to explore the correlation between schizophrenia ASSRs and neurocognitive deficits.
Method: Auditory steady-state evoked potentials by repeated auditory stimuli in 24 patients with schizophrenia and 30 healthy controls were recorded. The Positive and Negative Syndrome Scale (PANSS) was used to assess the clinical symptoms of the patients. MATRICS Consensus Cognitive Battery (MCCB) was used for the assessment of neurocognitive function. The correlation between indices, such as ASSRs energy, phase locking factor and phase coherence, and clinical and cognitive assessment was also systematically
compared between two groups.
Results: Compared with the control group, the patient group had differences in cognitive domains including information processing speed (t=-2.39, p=0.021), attention/vigilance (t=-2.36, p=0.023), verbal learning (t=-3.11, p=0.003), and reasoning and problem solving (t=-2.60, p=0.012). The energy of 40 Hz ASSRs in the patient group was significantly lower than that in the control group (t=-2.291, p=0.032), and their phase locking factor and inter-trial phase coherence index were lower than control group (t=-3.017, p=0.004
and t=3.131, p=0.003), which was also significantly correlated to reasoning and problem solving function deficits.
Conclusion: Patients with schizophrenia had defects in multiple cognitive domains, and their 40 Hz ASSRs energy was low. Specifically, their phase locking characteristics and phase coherence were poor, which was to some extent related to reasoning ability and thinking disorder.
Key words: schizophrenia, auditory steady-state response, neurocognition, Gamma oscillation


Antipsychotic Drugs and Liver Injury

Qinyu LV, Zhenghui YI

Summary: In October 2015, the drug-induced liver diseases group of the Chinese Society of Hepatology drafted and published the first Diagnosis and Treatment Guidelines on Drug-induced Liver Injury in China, giving suggestions on the diagnosis and treatment of drug-induced liver injury (DILI). As a psychiatrist, I have found that in clinical practice both typical and new antipsychotic drugs can induce
liver injury to varying degrees. Therefore, it is necessary to quickly and accurately determine the cause of liver injury and the type and severity of injury and establish a solution. This article reviewed relevant literature including the common pathogenesis and clinical manifestations of drug-induced liver injury caused by antipsychotic drugs, laboratory tests, diagnostic criteria and classification, and clinical management strategies. This paper also includes a summary and a perspective on liver injury caused by antipsychotic drugs.
Key words: antipsychotic drugs, drug-induced liver injury

Case report

“Neuro-psycho- BS”: A Case Report of Rare Association with Bipolar Disorder

Mustafa ALI, Soumitra DAS

Summary: Bechet’s Disease is an inflammatory disease characterized by recurrent oral ulcers (OU), genital ulcers (GU) and uveitis which can develop a neurobehavioral syndrome, also defined as ‘neuro-psycho- BS’. Depending on vascular or parenchymal lesions, the presentations could be varied. Due to sparse literature, there is no consensus on management of psychiatric illness comorbid with Bechet’s disease. Bipolar disorder in Bechet’s disease is extremely rare. Here, we are presenting a case of episodic exaggeration of Bipolar disorder along with Bechet’s disease which imposed both clinical and management challenges.
Key words: Bechet’s Disease; Neurobehavioral; Bipolar Disorder.

Neuropsychiatric Symptoms Induced by Large Doses of Nitrous Oxide Inhalation: A Case Report

Tianzhen CHEN, Na ZHONG, Haifeng JIANG, Min ZHAO, Zhikang CHEN, Haiming SUN

Summary: Nitrous Oxide, which is also called laughing gas, now ranks as the 7th most popular drug in the world. Nitrous oxide mainly disturbs B12 metabolism and damages nerves, followed by apparent neuropsychiatric symptoms. It’s beneficial to the prognosis of patients if we identify and treat their symptoms early. This case report describes a 19-year-old male who presented with auditory hallucination, persecutory delusions and unstable emotions after abuse of nitrous oxide over the course of half a year. Moreover, neurological signs such as weakness and hyperesthesia also appeared. After supplementation of vitamin B12, the neuropsychiatric symptoms improved, while the lower extremities achieved partial recovery. Therapeutically, we should pay attention to nerve repair, motivation enhancement and reinforce interventions that prevent relapse.
Key words: nitrous oxide; vitamin B12; neurologic impairment; mental disorders

Biostatistics in psychiatry

Relationship between Omnibus and Post-hoc Tests: An Investigation of performance of the F test in ANOVA

Tian CHEN, Manfei XU, Justin TU, Hongyue WANG, Xiaohui NIU

Summary: Comparison of groups is a common statistical test in many biomedical and psychosocial research studies. When there are more than two groups, one first performs an omnibus test for an overall difference across the groups. If this null is rejected, one then proceeds to the next step of post-hoc pairwise group comparisons to determine sources of difference. Otherwise, one stops and declares no group difference. A common belief is that if the omnibus test is significant, there must exist at least two groups that are significantly different and vice versa. Thus, when the omnibus test is significant, but no post-hoc between-group comparison shows significant difference, one is bewildered at what is going on and wondering how to interpret the results. At the end of the spectrum, when the omnibus test is not significant, one wonders if all post-hoc tests will be non-significant as well so that stopping after a nonsignificant omnibus test will not lead to any missed opportunity of finding group difference. In this report, we investigate this perplexing phenomenon and discuss how to interpret such results.
Key words: Omnibus test, post-hoc test, F test, Tukey’s test