Bimonthly, Established in 1959
Open access journal

In this issue

special article

Advances in molecular genetic studies of attention deficit hyperactivity disorder in China

Qian GAO, Lu LIU, Qiujin QIAN, Yufeng WANG

Summary: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in children worldwide that typically includes a combination of symptoms of inattention and hyperactivity/impulsivity. Genetic factors are believed to be important in the development and course of ADHD so many candidate genes studies and genome-wide association studies (GWAS) have been conducted in search of the genetic mechanisms that cause or influence the condition. This review provides an overview of gene-association and pharmacogenetic studies of ADHD from mainland China and elsewhere that use Han Chinese samples. To date, studies from China and elsewhere remain inconclusive so future studies need to consider alternative analytic techniques and test new biological hypotheses about the relationship of neurotransmission and neurodevelopment to the onset and course of this disabling condition. 

Keywords: ADHD, genetics, candidate gene studies, GWAS, China [Shanghai Arch Psychiatry. 2014; 26(4): 194-206. doi:]
Advances in neuroimaging research of schizophrenia in China
Dengtang LIU, Yifeng XU, Kaida JIANG

Summary: Since Hounsfield’s first report about X-ray computed tomography (CT) in 1972, there has been substantial progress in the application of neuroimaging techniques to study the structure, function, and biochemistry of the brain. This review provides a summary of recent research in structural and functional neuroimaging of schizophrenia in China and four tables describing all of the relevant studies from mainland China. The first research report using neuroimaging techniques in China dates back to 1983, a study that reported encephalatrophy in 30% of individuals with schizophrenia. Functional neuroimaging research in China emerged in the 1990s and has undergone rapid development since. Recently, structural and functional brain networks has become a hot topic among China’s neuroimaging researchers. 

Keywords: schizophrenia, magnetic resonance imaging, magnetic resonance spectroscopy, diffusion tensor imaging, China [Shanghai Arch Psychiatry. 2014; 26(4): 181-193. doi:]

Original research article

Cross-sectional study of use of electronic media by secondary school students in Bangkok, Thailand

Background: There is increasing concern about the negative psychological effects of excessive use of various electronic media by adolescents but the monitoring of these behaviors in low- and middle-income countries has some methodological flaws. 

Aim: Assess the use of all types of electronic media among secondary school students in Bangkok, Thailand.
Methods: A stratified random sample of students from four schools in Bangkok completed a modified version of a questionnaire used in a major study in the United States.

Results: Among the 768 participants, 443 (57.7%) were female and 325 (42.3%) were male; their mean (sd) age was 15.4 (1.5) years. Almost all respondents had easy access to multiple types of electronic media; 94% had mobile phones, 77% had a television in their bedroom, and 47% had internet access in their bedroom. Over the prior day 39% had watched television shows or movies for more than 3 hours, 28% spent more than 3 hours on social networking sites, 25% listened to music for more than 3 hours, and 18% played computer games for more than 3 hours. Overall, 27% reported using electronic devices for more than 12 hours in the previous day. Only 19% reported parental rules about the use of electronic devices in the home that were regularly enforced. Time engaged in the various activities was not related to parental education or, with the exception of time playing computer games, to students’ grade point average. Younger students and male students spent less time than older students and female students using these devices to engage in interactive social activities (e.g., talking on the phone or social networking), while male students spent much more time than female students playing games on the devices.

Conclusion: Adolescents spend a substantial part of every single day using different types of electronic devices. Longitudinal studies with precise time logs of device usage and descriptions of the type of content accessed are needed to determine the extent to which these activities have negative (or positive) effects on the social and psychological development of adolescents.

Keywords: social networking, computer games, internet, adolescents, Thailand [Shanghai Arch Psychiatry. 2014; 26(4): 216-226. doi:]
Case-control resting-state fMRI study of brain functioning among adolescents with first-episode major depressive disorder
Yun GONG, Lili HAO,Xiyan ZHANG, Yan ZHOU, Jianqi LI, Zhimin ZHAO, Wenqing JIANG, Yasong DU

Background: Adolescent depression results in severe and protracted suffering for affected individuals and their family members, but the underlying mechanism of this disabling condition remains unclear. 

Objectives: Compare resting-state brain functioning between first-episode, drug-naïve adolescents with major depressive disorder and matched controls.
Methods: Fifteen adolescents with major depressive disorder and 16 controls underwent a resting-state fMRI scan performed using a 3T magnetic resonance scanner. The amplitude of low frequency fluctuation (ALFF) was used to assess resting-state brain function.
Results: Adolescents with depression had higher mean (sd) scores on the Children Depression Inventory (CDI) than controls (22.13 [9.21] vs. 9.37 [5.65]). Compared with controls, adolescents with depression had higher ALFF in the posterior cingulate gyrus, left inferior temporal gyrus, right superior temporal gyrus, right insula, right parietal lobe, and right fusiform gyrus; they also exhibited lower ALFF in the bilateral cuneus, the left occipital lobe, and the left medial frontal lobe.
Conclusions: Adolescent depression is associated with significant changes in the functioning of several regions of the brain.
Key words: major depressive disorder, magnetic resonance imaging, case-control studies, adolescents, China [Shanghai Arch Psychiatry. 2014; 26(4): 207-215. doi:]


Comorbidity of depressive and anxiety disorders: challenges in diagnosis and assessment
Zhiguo WU, Yiru FANG

Summary: Comorbid anxiety is common in patients with depressive disorders. It complicates the clinical presentation of depressive disorders and can contribute to treatment resistance. Clinicians can assess the degree of overlap between depressive and anxiety symptoms either by measuring the severity of anxiety symptoms in individuals who meet diagnostic criteria for depression or by determining whether or not an individual with depression simultaneously meets criteria for an anxiety disorder. However, multiple factors in the Chinese clinical setting make it difficult to accurately assess patients with comorbid conditions. The resultant under-diagnosis of comorbid depression and anxiety – the most common type of comorbid psychiatric condition in China – seriously diminishes the effectiveness of treatments for common mental disorders in the country. We argue that the widespread use of valid and reliable dimensional assessment tools in Chinese clinical settings will help improve the diagnosis and treatment of the many individuals who have concurrent depressive and anxiety symptoms. 

Keywords: depressive disorders, anxiety disorders, comorbidity, diagnosis, assessment, China [Shanghai Arch Psychiatry. 2014; 26(4): 227-231. doi:]

Case report

Case report of narcolepsy in a six-year-old child initially misdiagnosed as atypical epilepsy
Jinquan ZHOU, Xi ZHANG, Zaiwen DONG

Summary: This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy – paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis – and they often have a more prolonged onset and diverse symptoms. To decrease the time lag between initial presentation and accurate diagnosis, we recommend that in all cases in which children report excessive sleep of unknown etiology – regardless of the associated symptoms – that sleep monitoring and sleep latency tests be conducted to rule out the possibility of narcolepsy. The case highlights the wide variety of presentations of uncommon psychiatric conditions, particularly in children, and the need for clinicians to be aware of the atypical presentations of these conditions when collecting medical histories. 

Keywords: narcolepsy, hypnagogic hallucinations, misdiagnosis, epilepsy, children, China [Shanghai Arch Psychiatry. 2014; 26(4): 232-235. doi:]

Biostatistics in psychiatry

Summary: This report describes a case of first-onset narcolepsy in a six-year-old female that was misdiagnosed as atypical epilepsy and other diagnoses at eight different hospitals over a period of 10 months before the correct diagnosis was made. The diagnosis of narcolepsy is more difficult in children because very few of them experience all four cardinal symptoms of narcolepsy – paroxysmal sleep, cataplexy, hypnagogic hallucination, and sleep paralysis – and they often have a more prolonged on

Summary: In psychosocial and behavioral studies count outcomes recording the frequencies of the occurrence of some health or behavior outcomes (such as the number of unprotected sexual behaviors during a period of time) often contain a preponderance of zeroes because of the presence of ‘structural zeroes’ that occur when some subjects are not at risk for the behavior of interest. Unlike random zeroes (responses that can be greater than zero, but are zero due to sampling variability), structural zeroes are usually very different, both statistically and clinically. False interpretations of results and study findings may result if differences in the two types of zeroes are ignored. However, in practice, the status of the structural zeroes is often not observed and this latent nature complicates the data analysis. In this article, we focus on one model, the zero-inflated Poisson (ZIP) regression model that is commonly used to address zero-inflated data. We first give a brief overview of the issues of structural zeroes and the ZIP model. We then given an illustration of ZIP with data from a study on HIV-risk sexual behaviors among adolescent girls. Sample codes in SAS and Stata are also included to help perform and explain ZIP analyses. 

Keywords: count response, structural zeroes, random zeroes, zero-inflated models [Shanghai Arch Psychiatry. 2014; 26(4): 236-242. doi:]


Lithium-related neurotoxicity despite serum concentrations in the therapeutic range: risk factors and diagnosis