Bimonthly, Established in 1959
Open access journal


Sleep quality in university students with Premenstrual Dysphoric Disorder

Habibolah KHAZAIE, Mohammad Rasoul GHADAMI, Behnam KHALEDI-PAVEH, Azita CHEHRI, Marzieh NASOURI

Background: Up to 8% of women in their reproductive years are affected by Premenstral Dysphoric Disorder (PMDD). Sleep disturbances such as insomnia or hypersomnia are one of the DSM-IV-TR’s defining criteria for the diagnosis of PMDD and are found in about 70% of women with the disorder. However, studies are lacking that specifically address the effects of PMDD on quality of sleep.

Aim: This study was designed to evaluate the prevalence of Premenstrual DysphoricDisorder (PMDD) and its impact on sleep quality in female university students.
Methods: We developed an 18-item PMDD scale based on The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to diagnose PMDD in female university studentswho ranged in age from 18 to 30 years and had regular menstrual cycles.Participants were categorized into a PMDD group or a No/PMDD group and sleep quality was compared between the two groups. The evaluation tool used to measure sleep quality was the Pittsburgh Sleep Quality Index (PSQI).
Results: The prevalence of PMDD in female universitystudents was 25.5%. Analysis of the PSQI demonstrated that 80.5% of those in PMDD group had a PSQI that scored >5; however, only 56.4% in the No/PMDD grouphad a PSQI that scored >5 (χ2=12.459, p
Conclusions: Female university students who experience PMDD are deeply affected by sleep problems.Lower sleep quality, daytime dysfunction, and sleep disturbance are common sleep problems among female university students with PMDD.
Keywords: Premenstrual Dysphoric Disorder; Sleep quality;Pittsburgh Sleep Quality Index; female university students

Systematic review and meta-analysis

The clinical value, principle, and basic practical technique of mindfulness intervention
Tao ZOU, Chenghan WU, Xiaoduo FAN
Summary: Mindfulness intervention is a psychotherapy based on the Buddhist practice of meditation, combining the theories and methodology of contemporary psychology. The empirical research in recent years has indicated that mindfulness intervention yields favorable results including reduction of depression relapse, alleviation of the symptoms of depression and anxiety, reduction of substance abuse, relief of pain, blood pressure management, enhancement of immunity, and improvement of sleep. Currently, mindfulness therapy has become the mainstream of psychotherapy in the realm of European and American psychotherapy. The fields of psychology and psychotherapy in China have also begun to introduce mindfulness intervention in recent years. However, there is a lack of relevant practice and research in the field of clinical mental health. This article will briefly introduce the concept of mindfulness, the basic mechanism of the intervention, and the basic skills and guidelines in clinical practice.

Original research article

Psychometric properties of the Chinese version of the Arabic Scale of Death Anxiety
Qi QIU, Shengyu ZHANG, Xiang LIN, Chunxia BAN, Haibo YANG, Zhengwen LIU, Jingrong WANG, Tao WANG, Sh
Background: Death anxiety is regarded as a risk and maintaining factor of psychopathology. While the Arabic Scale of Death Anxiety (ASDA) is a brief, commonly used assessment, such a tool is lacking in Chinese clinical practice.
Aim: The current study was conducted to develop a Chinese version of the ASDA, i.e., the ASDA(C), using a multistage back-translation technique, and examine the psychometric properties of the scale.
Methods: A total of 1372 participants from hospitals and universities located in three geographic areas of China were recruited for this study. To calculate the criterion-related validity of the ASDA(C) compared to the Chinese version of the longer-form Multidimensional Orientation toward Dying and Death Inventory (MODDI-F/chin), 49 undergraduates were randomly assigned to complete both questionnaires. Of the total participants, 56 were randomly assigned to retake the ASDA(C) in order to estimate the one-week, test-retest reliability of the ASDA(C).
Results: The overall Cronbach’s alpha was 0.91 for the whole scale. The one-week, test-retest reliability was 0.96. Exploratory Factor Analysis (EFA) revealed three factors, “fear of dead people and tombs,” “fear of lethal disease,” and “fear of postmortem events,” accounted for 57.09% of the total variance. Factor structure for the three-factor model was sound. The correlation between the total scores on the ASDA(C) and the MODDI-F/chin was 0.54, indicating acceptable concurrent validity.
Conclusions: ASDA(C) has adequate psychometrics and properties that make it a reliable and valid scale to assess death anxiety in Mandarin-speaking Chinese.
Keywords: Arabic Scale of Death Anxiety; Chinese version; psychometric properties
An analysis of factors influencing drinking relapse among patients with alcohol-induced psychiatric and behavioral disorders
Rongbin ZENG, Lili WANG, Yinghong XIE
Background: Patients with alcohol-induced psychiatric and behavioral disorders have higher drinking relapse rates after treatment when compared to those without these disorders.
Aim: To investigate factors influencing drinking relapse among patients with alcohol-induced psychiatric and behavioral disorders and provide guidance for rehabilitative intervention for those being treated for substance use disorders.
Methods: Patients were randomly assigned into either the study group or the control group. We used Chisquare test to analyze their general demographics, drinking history, and hospitalizations. Factors influencing the relapse were analyzed by logistic regression analyses.
Results: The univariate analysis showed that factors included ethnicity, level of education, occupation, marital status, duration of psychiatric symptoms and deception about alcohol use; multivariate analysis showed that marital status, duration of psychiatric symptoms, and deception about alcohol use were correlated with relapse among patients with psychiatric and behavioral disorders.
Conclusions: For patients who were single, psychiatric symptoms were more likely to occur between the first and fifth year of alcohol consumption, and those who were deceptive about their alcohol use were more likely to have a relapse than those who were not.
Keywords: alcohol-induced psychiatric and behavioral disorders; relapse; enabling factors; China


Atypical features and bipolar disorder
Daihui PENG, Yueqi HUANG, Kaida JIANG
Summary: Bipolar Disorder (BD) features with various of clinical symptoms, leading to the misdiagnosis of major depressive disorder (MDD). The atypical features (ATFs) are regarded as one of valuable index to identify BD from depressed patients. The ATFs should be helpful to the differential diagnose of the two diseases. In this forum, we discussed the issue of the relation between the ATFs and BD.
Key words: bipolar disorder; major depressive disorder, atypical features, mood reactivity


Current problems in the research and development of more effective antidepressants
Tianmei SI, Xin YU
Summary: This commentary was stimulated by discussions held at the First China Antidepressants Research and Development Summit held in Beijing in October 2015. Hosted by the Chinese Psychiatrist Psychopharmacology Commission and including leading clinicians, neuroscientists, and representatives of the pharmaceutical industry, the summit focused on the major problems that are limiting the development of more effective antidepressant medications. In the absence of clear biomarkers of depression, clinicians must base treatment decisions on clinical phenomenology; the lack of clear biological targets results in currently available antidepressants that take a long time to be effective, have low rates of full remission, and high rates of relapse. Basic research on depression by neuroscientists in China is internationally recognized, but the vast proportion of candidate chemical compounds Chinese researchers propose as potential treatments for depression fail when tested clinically. This high failure rate of proposed agents has rapidly increased the cost of bringing new drugs to market, so pharmaceutical firms prefer to ‘tweak’currently approved medications rather than take the financial risk of supporting the development of novel antidepressants. Thus, the development of new, more effective treatments for depression is at a stalemate. Given the huge impact of depression on the economic development of China and other countries, it is essential to actively solicit the support of governments and communities in the efforts of clinicians, researchers, and the pharmaceutical industry to overcome this stalemate.

Case report

Case report of Cushing’s syndrome with an acute psychotic presentation
Yuejing WU, Jiong CHEN
Summary: A 36-year-old Chinese woman was brought to the emergency department of a general hospital with a 3-day history of mania, persecutory delusions, and suicidal ideation; she also had a 6-month history of disrupted sleep, hypervigilance, and somatic symptoms. Her physical exam on admission to the psychosomatic ward identified a moon-shaped face, exophthalmos, and purple striae on her legs, so acute psychiatric symptoms secondary to Cushing’s syndrome was suspected. Elevated plasma cortisol and adrenocorticotropic hormone (ACTH) and identification of a mass on her left adrenal gland on the computed tomography (CT) scan of her abdomen confirmed the diagnosis. Low dose quetiapine (75-125 mg/d) and alprazolam (0.4 mg/qn) were prescribed to control the psychotic symptoms and improve her sleep. After surgical removal of a benign ACTH-independent adrenal tumor, her cortisol and ACTH levels returned to normal and her psychiatric symptoms gradually diminished over a one-month period, at which point she was discharged. Low-dose quetiapine was continued for 2 months after discharge and then discontinued; by this time her psychiatric symptoms had completely disappeared. In this case the patient had pathognomonic symptoms of CS, so it was relatively easy to make the diagnosis; but acute psychotic symptoms in CS can be life-threatening and may not be associated with the typical physical symptoms of CS (if there is only modest hypercortisolemia), so psychiatric clinicians should always consider CS among the possible differential diagnoses for unexplained acute psychosis.
Keywords: Cushing’s syndrome; psychosis; differential diagnosis; case report; China
Sphenoid wing meningioma presenting as cognitive impairment
Rahul SAHA, Kiran JAKHAR, Rajneesh KUMAR
Summary: Frontal meningioma may present solely withpsychological symptoms that resemble dementia. We present the case of a 42-year-old man who initially was thought to have dementia, but he was eventually diagnosed with dementia caused by a sphenoid wing meningioma. Diagnosis of this illness is often delayed due to the insidious nature of the symptoms, which may be mistaken as symptoms of dementia. As cognitive impairment is complex and easily overlooked, it is important to accurately assess neuropsychological function in patients with large brain tumors.
Keywords: meningioma; cognitive impairment; dementia; India

Research methods in psychiatry

Literature searches in the conduct of systematic reviews and evaluations
Xiaochun QIU, Cheng WANG
Summary: Performing a literature search is an important part of performing a systematic review or a metaanalysis of biomedical literature, which have now become the gold standards for determining what qualifies as ‘evidence-based’ medicine. Combining searches of English-language databases and the large Chineselanguage databases can identify new, potentially important, sources of data that are not include in the traditional English-only reviews. Selection of a restricted subset of databases for conducting the literature search or using inappropriate methods to identify appropriate articles within each database can lead to biased results and incorrect conclusions. This article introduces common English and Chinese databases, describes the search engines available for conducting searches, discusses the basic methods and common pitfalls of conducting searches, and provides an example of a search to highlight these issues.
Keywords: literature review; publication bias; databases; bibliography; systematic review; meta-analysis

Biostatistics in psychiatry

Primary Question and Hypothesis Testing in Randomized Controlled Clinical Trials
Jiangtao LUO
Summary: We briefly reviewed and provided cautions about some of the fundamental concepts used in the design of medical and public studies, especially primary question, hypothesis testing and sample size in this short note. We also talked about some of the extensions and development in the recent years.
Keywords: hypothesis, randomize, clinical trial, primary question