Bimonthly, Established in 1959
Open access journal

Systematic review and meta-analysis

Efficacy of atypical antipsychotics in the management of acute agitation and aggression in hospitalized patients with schizophrenia or bipolar disorder: results from a systematic review

Xin YU, Christoph U. CORRELL, Yu-Tao XIANG, Yifeng XU, Jizhong HUANG, Fude YANG, Gang WANG, Tianmei

Summary: Acute agitation and aggression are common symptoms in patients with bipolar disorder and schizophrenia. In this review, we discuss the prevalence, clinical assessment strategies, treatment options, and current Western and Chinese guidelines for the management of acute agitation and aggression in patients with bipolar disorder or schizophrenia. Among available approaches, we discuss in detail recent evidence supporting the use of intramuscular (IM) antipsychotics and some recently approved oral atypical antipsychotics for the management of acute aggression and agitation in hospitalized patients with bipolar disorder or schizophrenia presenting with acute agitation or aggression, highlighting some differences between individual antipsychotic agents.
Key words: Schizophrenia; Bipolar disorder; Antipsychotic; Aggression; Agitation

Original research article

A pilot longitudinal study on cerebrospinal fluid (CSF) tau protein in Alzheimer’s disease and vascular dementia

Haihong WANG, Tao WANG, Shixing QIAN, Li BA, Zhiguang LIN, Shifu XIAO

Background: Alzheimer’s disease (AD) has high a prevalence rate, high medical costs, and care difficulties, and has become a serious social and economic problem in our aging society. So far, there has not been a reliable and objective diagnostic criteria for AD found. In recent years, there have been many domestic and foreign studies on the biological markers of cerebrospinal fluid in the patients with AD, and high levels of the T-tau, P-tau found in cerebrospinal fluid (CSF) is at this point an indisputable fact. However, the relationship between these markers and the severity of dementia, as well as the development of the disease, should be further studied.
Objective: Compare the CSF level of total tau (T-tau) and phosphorylated tau at threonine 231 ( P-tau231 ) between patients with moderate to severe Alzheimer’s disease (AD) and those with vascular dementia (VD) at baseline, and 6 month follow-up. Observe the differences between patients with AD and control group, as well as the changes as the disease develops.
Methods: There were 11 patients with moderate AD (10 ≤ MMSE ≤ 20), 10 patients with severe AD (MMSE ≤ 9), and 7 age-matched patients with severe VD at baseline, among which 7 AD patients and 6 VD patients completed the 6 months follow-up. CSF levels of T-tau, P-tau231 were measured with sandwich ELISA.
Result: At baseline, the concentrations of the CSF level of T-tau were 470.08 (263.58) pg/mL in the AD group and 208.76 (42.24) pg/mL in the VD group. This difference was statistically significant (Z= -3.369, p <0.001). The concentrations of CSF level of P-tau231 were 90.94 (49.86) pg/mL in the AD group and 42.96 (13.10) pg/mL in the VD group. This difference was also statistically significant (Z = -3.237, p <0.001). Compared to patients with severe VD, the concentration of CSF T-tau in patients with severe AD was significantly higher (Z= -2.830, p = 0.005), as well as the concentration of CSF P-tau231 (Z = -2.392, p = 0.017). The concentration of CSF P-tau231 in the patients with moderate AD was significantly higher than that in the patients with severe VD (Z = -2.605, p = 0.009). At the 6 months follow-up, there were no statistically significant differences in the changes of CSF T-tau and CSF P-tau231 concentrations between the AD group and VD group.
Conclusion: The CSF level of T-tau and P-tau231 in the AD patients was significantly higher than that in the VD patients. The concentration of CSF P-tau231 in the moderate AD patients was significantly higher than that in the patients with severe AD. During the 6 months follow-up, the changes of the CSF concentrations of T-tau and P-tau231 between AD group and VD group were not statistically significant.
Key words: Alzheimer’s disease; vascular dementia; tau protein; phosphorylated tau protein


Characteristics of aggressive behavior among male inpatients with schizophrenia

Xiaomin ZHU, Wen LI, Xiaoping WANG

Background: The incidence of the aggressive behavior is higher among the patients with severe mental disorder such as schizophrenia than the general population. The study of factors related to aggressive behavior has great meaning in designing prevention and intervention methods with this population of patients.
Aims: To understand the characteristics of assaultive behavior of male patients with schizophrenia who have been hospitalized.
Methods: Using a continuous sampling method, data from 75 male inpatients with a diagnosis of schizophrenia was collected at the psychiatric unit of Central South University Second Xiangya Hospital (Changsha, China) from August 2015 to February 2016.On the third day after hospitalization participants were given a general questionnaire as well as being assessed using the modified overt aggression scale (MOAS), historical clinical risk management-20 (HCR-20) questionnaire, hare psychopathic checklist-revised (PCL-R), and positive and negative syndrome scale (PANSS).Based on results of the MOAS participants were group into an ‘aggressive behavior’ group (39 cases) and ‘non-aggressive behavior’ group (36 cases). The differences in socio-demographic characteristics and scores on the other evaluation tools were then compared between these two groups.
Results: Participants in the ‘aggressive behavior’ group had significantly different scores in the HCR-20 in the H1 (past violence events), H2 (violent events when young), H10 (disobedience in the past), and C4 (impulsiveness) sections; as well in the anti-social section of PCL-R; and significantly higher PANSS scores in the positive symptom, depressive symptoms and paranoid symptom sections than those in the ‘nonaggressive behavior’ group.
Conclusions: A combination of adverse and traumatic life events such as a history of violence, vulnerabilities in ones personality (e.g. impulsive or antisocial tendencies) and psychopathology of current illness (e.g. significant anxiety and depressive symptoms) contribute to aggressive behavior in male inpatients with schizophrenia. Our results contribute to the literature that will hopefully aid in ensuring patient and staff safety, as well as providing more information in working with this vulnerable population.
Keywords: aggressive behavior; schizophrenia; inpatients; psychosocial characteristics; case-control study


Factors associated with significant anxiety and depressive symptoms in pregnant women with a history of complications

Jing CHEN, Yiyun CAI, Yue LIU, Jieyan QIAN, Qing LING, Wei ZHANG, Jianfeng LUO, Yan CHEN, Shenxun SH

Background: The occurrence of complications during the gestation period is higher among pregnant women with a history of complications than among pregnant women without previous complications. High-risk pregnancy can cause negative emotional symptoms such as anxiety and depression in pregnant women. Current research on anxiety and depression symptoms in pregnant women is sparse.
Aims: To examine the incidence of anxiety and depression symptoms in pregnant women with a history of previous complications or high risk pregnancy and related risk factors.
Methods: Women with a history of previous complications in pregnancy or current ‘high risk’ pregnancy (e.g. test tube fertilization, etc.) were classified as ‘high risk’. 197 of these ‘high risk’ women who were in their second trimester (16 to 20 weeks) underwent a monthly comprehensive assessment using the Hospital Anxiety and Depression Scale (HAD) in the last 4 months of the gestation period. The Edinburgh Postnatal Depression Scale (EPDS) was used for assessment and risk factor investigation 3 to 7 days, 42 days, and 3 months after childbirth.
Results: The mean (sd) HAD anxiety score among ‘high-risk’women at the time of enrollment was 3.69 (2.76) and depression score was 3.42 (2.53). Significant anxiety symptoms and depression symptoms were found in 14 cases (7.18 %) and 10 cases (5.13%), respectively. Multivariate analysis showed a correlation between anxiety symptoms and history of miscarriage (OR: 8.162, 95%CI: 1.213 to 54.914)and testing positive for hepatitis (OR: 8.912, 95%CI: 1.052 to 75.498). Depressive symptoms were correlated with glucose positive urine (OR: 30.529, 95%CI: 1.312 to 710.610) and history of hemorrhaging (OR: 7.122, 95%CI: 1.015 to 49.984). General factors associated with anxiety and depression symptoms include patients’ health status in the recent 3 months, concerns about fetal health, quality of marital relationship, and relationship with inlaws.
Conclusions: Anxiety and depression symptoms are commonly seen in pregnant women with a history of previous complications or current ‘high risk’ pregnancy. Patients’ recent health status, relationship with inlaws, marital quality and concerns about fetal health are associated with anxiety and depression symptoms during pregnancy.
Keywords: high-risk pregnancy; anxiety; depression


Brain gamma-aminobutyric acid (GABA) concentration of the prefrontal lobe in unmedicated patients with Obsessivecompulsive disorder: a research of magnetic resonance spectroscopy

Zongfeng ZHANG, Qing FAN, Yanle BAI , Zhen WANG, Haiyin ZHANG, Zeping XIAO

Background: In recent years, a large number of neuroimaging studies found that the Cortico-Striato-Thalamo-Cortical circuit (CSTC), including the prefrontal lobe, a significant part of CSTC, has disturbance metabolically in patients with Obsessive-Compulsive Disorder (OCD).
Aim: Explore the correlation between the neuro-metabolic features and clinical characteristics of OCD patients using magnetic resonance spectroscopy technology.
Methods: 88 patients with OCD who were not received medication and outpatient treatment for 8 weeks and 76 health controls were enrolled, there was no significant difference in gender, age or education level between the two groups. SIEMENS 3.0T MRI scanner was used to measure the spectral wave of Orbito Frontal Cortex (OFC) and Anterior Cingulate Cortex (ACC) of participants, setting mega-press sequences. Meanwhile, the concentrations of gamma-aminobutyric acid (GABA), glutamine/glutamate complex (Glx) and N-Acetyl Aspartate (NAA) were measured relative to concentration of water, on the ACC and OFC of participants, for statistical analysis via LC model version 6.3 software. The concentration of metabolic substances of the OCD group compared to the healthy control group was analyzed using two sample t-test. The correlation between substance concentration and scores on the scales, including Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Anxiety scale (HAMA) and Hamilton Depression scale (HAMD) was carried out using the Pearson correlation method.
Results: Compared with healthy controls, the GABA/W and NAA/W concentration in individuals with OCD are significantly decreased (p=0.031, t=2.193, p=0.002, t=3.223). Also, the concentration of GABA/W had a trend of decrease in the ACC. The GABA/W of the OFC had a negative correlation with Y-BOCS-O, Y-BOCS-C and Y-BOCS-T scores (p=0.037, r=0.221; p=0.007, r=0.283; p=0.014, r=0.259).
Conclusions: These results support that GABA concentration in the OFC area of patients with OCD is significantly decreased and the concentration in the ACC has a trend of decreasing. All of these indicate that there is a relationship between the GABA concentration and the psychopathology of OCD.
Key words: obsessive-compulsive disorder; magnetic resonance spectroscopy; orbitofrontal cortex; anterior cingulate cortex; gamma-aminobutyric acid; China


The history, diagnosis and treatment of disruptive mood dysregulation disorder

Jun CHEN, Zuowei WANG, Yiru FANG

Summary: Disruptive mood dysregulation disorder was newly included as a diagnostic category in Diagnostic and statistical manual of mental disorders fifth edition (DSM-5), but the knowledge about it in the clinical practice field is still limited. Therefore, the aim of the present article is to introduce this diagnostic category’s history, key points of diagnosis, treatment and its impact on clinical practice for clinical reference.
Key words: Disruptive mood dysregulation disorder; DSM-5

Biostatistics in psychiatry

Modern methods for longitudinal data analysis, capabilities, caveats and cautions

Lin GE, Justin X. TU, Hui ZHANG, Hongyue WANG, Hua HE, Douglas GUNZLER

Summary: Longitudinal studies are used in mental health research and services studies. The dominant approaches for longitudinal data analysis are the generalized linear mixed-effects models (GLMM) and the weighted generalized estimating equations (WGEE). Although both classes of models have been extensively published and widely applied, differences between and limitations about these methods are not clearly delineated and well documented. Unfortunately, some of the differences and limitations carry significant implications for reporting, comparing and interpreting research findings.
In this report, we review both major approaches for longitudinal data analysis and highlight their similarities and major differences. We focus on comparison of the two classes of models in terms of model assumptions, model parameter interpretation, applicability and limitations, using both real and simulated data. We discuss caveats and cautions when applying the two different approaches to real study data.
Key words: binary variables, correlated outcomes, generalized linear mixed-effects models, weighted generalized estimating equations, latent variable models, R, SAS