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Systematic review and meta-analysis

Research progress in China on the assessment of cognitive function in schizophrenia

Dengtang LIU*, Yingchan WANG, Yifeng XU, Kaida JIANG

Summary: Cognitive impairment – one of the core symptoms of schizophrenia – has become a focus of research about schizophrenia in China and elsewhere. The main reason for the interest in cognitive functioning is that the degree of cognitive impairment is associated both with the current severity of the illness and with the prognosis of the illness; cognitive functioning directly affects individuals’ ability to live independently and their occupational and social functioning. The first study on cognitive function in schizophrenia in China was conducted in the late 1970s; more recently there has been a resurgence of interest in the area because of new information that has emerged as neuroimaging technologies have improved. The current review summarizes studies on cognitive impairment in schizophrenia conducted in China and proposes directions for future research in this area.

Original research article

Number and characteristics of medical professionals working in Chinese mental health facilities

Caiping LIU, Lijin CHEN, Bin XIE, Jun YAN, Tongling JIN, Zhiguo WU

Background: Mental disorders account for a substantial proportion of the total disease burden in China but the number, distribution and characteristics of the mental health professionals available to provide services for mentally ill individuals is unknown. 

Aim: Describe the distribution and characteristics of medical professionals working in mental health facilities around China.
Methods: Information on the numbers and characteristics of health professionals working in mental health facilities in China in 2010 was obtained from the Statistical Information Center of the Ministry of Health and the population-adjusted ratios and characteristics of these mental health professionals were compared across the seven geographic regions of the country.
Results: Among the 757 specialized mental health facilities identified, 649 (86%) were psychiatric hospitals. A total of 68,796 medical professionals (5.16/100,000 population) were working in these facilities, including 20,480 psychiatrists (1.54/100,000) and 35,337 registered nurses (2.65/100,000). Over 98% of these medical professionals worked in psychiatric hospitals. Among the psychiatrists, 29% only had a technical school degree and 14% had no academic degree at all; among the nurses, 46% had no academic qualifications. The duration of employment as a psychiatrist or as a psychiatric nurse was longer among medical professionals working in the economically less dynamic northern parts of the country. The population ratios of licensed physicians and registered nurses working in mental health facilities were significantly higher than average in the relatively wealthy eastern and northeastern parts of the country.
Conclusions: Almost all mental health professionals in China work in specialty psychiatric hospitals. The numbers and geographic distribution of trained mental health professionals in China are grossly inadequate to meet the mental health needs of the population. China has a much smaller mental health workforce per 100,000 residents than other upper-middle-income countries, and the range of professionals who provide mental health services is much narrower.
Prevalence and correlated factors of lifetime suicidal ideation in adults in Ningxia, China
Zhizhong WANG, Ying QIN, Yuhong ZHANG, Bo ZHANG, Lin LI, Tao LI, Li DING

Aim: Compare the prevalence and associated factors of lifetime suicidal ideation, plans and attempts in the Hui and Han ethnic groups in the Ningxia Hui Autonomous Region of China. 

Methods: Using a probability proportionate to size sampling method and villages (in rural areas) or neighborhoods (in urban areas) as primary sampling units, 5880 residents aged 18 and over were sampled. Face-to-face interviews were conducted using a computer-administered Chinese version of the World Health Organization’s Composite International Diagnostic Interview. Factors associated with self-reported lifetime suicidal ideation were identified using logistic regression models.
Results: Of the 4789 (81.4%) persons who completed the survey, the lifetime prevalence of suicidal ideation, suicidal plans and suicide attempts were 5.30% (95% confidence interval [CI]=4.66-5.93%), 1.52% (CI=1.17- 1.86%), and 0.77% (CI=0.52-1.02%), respectively. The age standardized rate of lifetime suicidal ideation and lifetime suicidal planning were significantly higher in the largely Muslim Hui ethnic group (n=1955) than in the largely atheist Han ethnic group (n=2834); the lifetime prevalence of suicide attempt was also higher in the Hui group, but only at the trend level (p=0.20). Factors independently associated with lifetime suicidal ideation were female gender (odds ratio [OR]=2.07), being divorced or widowed (OR=2.02), rural residence (OR=1.95), mood disorder in the prior year (OR=1.96), other mental disorder in the prior year (OR=2.99), and selfreported poor physical health in the prior year (OR=2.21). After adjustment for these factors, ethnicity was not independently associated with lifetime suicidal ideation, but stratified analyses by ethnic group found some differences in the factors associated with lifetime suicidal ideation between Hui and Han respondents.
Conclusions: Contrary to previous studies, we found that lifetime suicidal ideation was more common in a Muslim ethnic group than in a non-Muslim ethnic group of Ningxia, but this difference did not persist in the multivariate analysis after adjusting for gender, mental disorders and other factors.
Using the Montreal Cognitive Assessment Scale to screen for dementia in Chinese patients with Parkinson’s disease
Ling CHEN, Cuiyu YU, Xiaosu FU, Weiguo LIU, Ping HUA, Ning ZHANG, Shenghan GUO

Background: Dementia is one of the most distressing and burdensome health problems associated with Parkinson’s disease (PD). The Montreal Cognitive Assessment scale (MoCA) is widely used to screen for dementia in PD patients, but the appropriate diagnostic cutoff score when used with Chinese PD patients is not known. 

Aim: Determine the appropriate diagnostic cutoff value of the Chinese version of the MoCA (MoCA‑C) for Chinese PD patients and describe the characteristics of PD patients screened positive for dementia using the MoCA‑C.
Methods: The presence of dementia in 616 PD patients and 85 community controls was determined using the Movement Disorder Society Task Force (MDS-TF) criteria (the gold standard diagnosis). We administered the MoCA‑C to these individuals and used a receiver operating characteristic (ROC) curve to identify the cutoff score of the MoCA‑C that most efficiently identified dementia in both PD patients and community controls. Demographic and clinical characteristics of PD patients who were screened positive or negative for dementia using the MoCA‑C were compared.
Results: A MoCA‑C score of 23 was the optimal cutoff score for dementia in both patients and controls. Using this cutoff score, the sensitivity and specificity of the MoCA‑C in PD patients were 0.70 and 0.77, respectively; the positive and negative predictive values were 0.59 and 0.85, respectively; and the overall concordance of the MoCA‑C screening result with the MDS-TF diagnosis (kappa value [95% confidence interval]) was 0.45 (0.39-0.52). The concordance of the MoCA‑C screening result with the MDS-TF diagnosis in community controls was only 0.25 (0.05-0.45). Compared to PD patients who screened negative for dementia, those who screened positive for dementia were significantly more impaired in all cognitive domains, including visuospatial and executive functioning, naming, attention, language, abstraction, delayed recall and orientation (all p
Conclusions: The commonly recommended cutoff screening score for dementia of 26 on the MoCA it too high for PD patients in China; a cutoff score of 23 is more appropriate. Potential risk factors for dementia in Chinese PD patients include older age, less education, and more severe motor symptoms of PD.
Depressive symptoms among the visually disabled in Wuhan: an epidemiological survey
Wenxue LI, Baoliang ZHONG*, Xiujun LIU, Xian’e HUANG, Xiaoyan DAI, Qiongfang HU, Huishi ZHANG, Hanmi

Background: There are no representative studies on the mental health status of persons with disabilities in China. 

Aim: Estimate the prevalence of depressive symptoms and identify the factors associated with depressive symptoms in a representative sample of individuals with serious visually disabilities in Wuhan, China.
Methods: A multi-stage stratified cluster sampling method was used to identify 1200 visually disabled individuals from among the 22,000 persons with serious visual disabilities who were registered with the Wuhan Disabled Persons’ Federation. Identified individuals were administered the Center for Epidemiological Studies Depression Scale (CES-D) and the Revised Eysenck Personality Questionnaire-Short Scale for Chinese (EPQ-RSC) by trained interviewers.
Results: The adjusted prevalence of mild, moderate and severe depressive symptoms among the 1003 individuals who successfully completed the survey were 8.8% (95% confidence interval [CI]=5.7-11.8%), 15.6% (CI=12.8-18.5%) and 16.0% (CI=13.7-18.3%), respectively. Factors significantly associated with more severe depressive symptoms in the multivariate logistic regression analysis (in order of importance) were emotional instability (OR=5.84, CI=4.19-8.14), introverted personality (OR=2.94, CI=2.10-4.12), having religious beliefs (OR=2.03, CI=1.06-3.90), being blind (versus those who were only visually impaired) (OR=1.52, CI=1.09-1.95), being unmarried (OR=1.51, CI=1.06-2.15), and having less than 10 years of formal education (OR=1.49, CI=1.06- 2.10).
Conclusions: Over one-third of all individuals with visual disabilities registered with the Disabled Persons’ Federation in Wuhan have clinically significant depressive symptoms. Therefore, services for persons with serious visual disabilities – and for individuals with other types of serious physical or sensory disabilities – should include activities aimed at improving psychological wellbeing, periodic screening for psychological problems and, when needed, professional treatment for mental disorders.


The multifaceted question of the prescription of antidepressants during pregnancy
Gisèle APTER, Emmanuel DEVOUCHE
rTMS in the management of auditory hallucinations in patients with schizophrenia
Mara Fernandes MARANHÃO
Use of antidepressants during pregnancy: a better choice for some
Hongxia ZHANG, Liwei WANG

Case report
Case report of adjunctive use of olanzapine with an antidepressant to treat sleep paralysis
Jinfeng DUAN, Wanli HUANG, Mincong ZHOU, Xujuan LI, Wei CAI
Summary: Sleep paralysis (SP) is a condition of unknown etiology that usually occurs when falling asleep or when awakening in which the individual remains conscious but is unable to control their voluntary movements. This case report is about a 68-year-old man with a 40-year history of symptoms of SP and associated panic attacks upon awakening. Neurological examination and neuroimaging identified no abnormalities. Five years before the current evaluation he had been diagnosed with depression and treated with various anti-depressants which ameliorated, but did not cure, his SP. However, this 40-year history of SP was abruptly terminated – and did not return over the subsequent two years—after adjunctive treatment with 2.5 mg olanzapine each night was added to his antidepressant.

Biostatistics in psychiatry

From pilot studies to confirmatory studies
Naihua DUAN