Bimonthly, Established in 1959
Open access journal

Systematic review and meta-analysis

Meta-analysis of the Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression

Yanyan WEI, Junjuan ZHU, Shengke PAN, Hui SU, Hui LI, Jijun WANG

Background: Repetitive transcranial magnetic stimulation (rTMS) is a new type of physiotherapy technology that has been widely used in the research of depression. Although many clinical trials have found that compared to the placebo interventions, rTMS has a significant effect on the improvement of depressive symptoms, the outcomes remain inconsistent due to differences in rTMS treatment frequency, parameter settings, and site for stimulation.
Aims: This study systematically evaluated the safety and efficacy of rTMS combined with antidepressants for the treatment of depression in Chinese and English randomized, double-blind and sham controlled trials and explored the possible related factors affecting the efficacy and safety.
Methods: We used keywords “depression” and “transcranial magnetic Stimulation” as filters to search for the Clinical Randomized Controlled Trials (RCTs) of rTMS treatments for depression both in Chinese electronic databases: Wan fang, Wellpresi, and China Knowledge Network and in English electronic databases: PubMed, Web of Science, Embase, PsycINFO, Cochrane Library (total 8 databases) up to January 5, 2017; assessed the quality of the included studies with Cochrane risk of bias assessment tool; and according to the trial groups performed statistical analysis of the efficacy and safety presented in the included studies with RevMan 5.3 software.
Results: A total of 9798 articles were retrieved, and finally, 29 studies were included in this study, with a total sample size of 1659, in which the sample size of the study groups was 838, and the control group sample size was 821. After Meta-analysis, we found that treatment combined rTMS with antidepressants improves depressive symptoms in patients with depression (SDM=-0.84, 95%CI=-1.19 ~ -0.48). Based on the Cochrane risk bias Assessment tool, an assessment of the bias of the included studies was conducted, one of which was assessed as having a “high risk of bias” and others as “impossible to judge”. None of the included studies reported significant adverse events, and Meta-analysis showed no statistically significant differences in dropout rate between the two groups (RR=1.27, 95%CI: 0.75~2.12, Z=0.89, p=0.37).
Conclusion: treatment that combined rTMS with antidepressant medication for depressive symptoms has a certain therapeutic advantage versus the placebo controls, demonstrated slight side effects, and attained good acceptability, but the differences between trials remained relatively large. Clinical trials with large sample sizes are required for further exploration of the possible related factors affecting the efficacy.
Key words: repetitive transcranial magnetic stimulation, depression, meta-analysis

Original research article

The Relationship between the Lifestyle of the Elderly in Shanghai Communities and Mild Cognitive Impairment

Ning SU, Wei LI, Xia LI, Tao WANG, Minjie ZHU, Yuanyuan LIU, Yanchen SHI, Shifu XIAO

Background: Those with mild cognitive impairment (MCI) are ten times more like to develop Alzheimer’s disease (AD) than the general population. MCI diagnosis and early intervention are helpful for the diagnosis and treatment of AD in its early stages, thus delaying its development and improving the quality of life for those with MCI.
Aims: To analyze the relationship between the lifestyle of the elderly in Shanghai communities and mild cognitive impairment and to look for preventative lifestyle measures for the elderly with mild cognitive impairment.
Methods: 1005 elderly persons were randomly selected from the community in Shanghai. Study participants were 265 people with an MCI diagnosis and 607 non-MCI elderly persons. The demographic and lifestyle data of these elderly people were collected for univariate and multivariate analysis to search for statistically significant indicators.
Results: The univariate analysis revealed that smoking (χ2= 10.808, p=0.001), tea drinking (χ2=11.74, p= 0.001), having hobbies (χ2= 20.815, p
Conclusions: Lifestyle is associated with the onset of MCI. Good life habits and behaviors are significant in the prevention of MCI developing into Alzheimer’s.
Key words: mild cognitive impairment; lifestyle; protective factors


Status Investigation of Outpatients Receiving Methadone Maintenance Treatment (MMT) in Shanghai from 2005 to 2016

Jiayi BAO, Lei ZHANG, Zhen NING, Jie FU, Min ZHAO, Jiang DU

Background: Methadone maintenance treatment (MMT) is an effective measure to control drug abuse, prevent AIDS, and improve family and social functions among those with heroin addiction. Relevant surveys in recent years show that the number of outpatients receiving MMT has a downward trend.
Aims: To understand variation in maintenance treatment rates and causes of withdrawal for outpatients receiving MMT in Shanghai since initiation of this program.
Method: This study was a retrospective investigation, with data from the AIDS Comprehensive Prevention and Control Data Information Management System of the China AIDS Prevention and Control Center. Descriptive statistics were used to describe demographic data, treatment maintenance rate, and number of new outpatients receiving MMT in Shanghai From May 2005 to June 2016. The causes of withdrawal were summarized and analyzed.
Results: From May 2005 to June 2016, there were a total of 7181 outpatients receiving MMT in Shanghai. These patients were primarily male (male to female ratio around 3:1), young adults (more than 90% of these patients were 25 to 54 years old), with junior high school education level and below (65.4%), single (total of unmarried, divorced and widowed: 63.1%), and unemployed or underemployed (81.5%). The daily dose of methadone in MMT patients showed an upward trend since 2008, and gradually declined after reaching its
peak in 2013. The mean (sd) dose of methadone taken in the years studied was 56 (2.75) ml/d. The number of new outpatients increased sharply in 2007 and 2008 (more than 1500), and then decreased year by year. The number of outpatients had increased continuously from 2005 to 2011, with the peak in 2011 (3840 patients), and then decreased gradually. The maintenance rate was stable at over 80% since 2010. The main causes of withdrawal: 1) arrested due to unrelated criminal causes (19.89%), 2) sent to compulsory isolated rehabilitation center due to occasional drug use, and 3) physical reasons (disease/pregnancy/death, 11.80%).
Conclusion: The maintenance rate has been kept at a relatively good level since the initiation of the MMT outpatient clinic service in Shanghai. The number of patients receiving treatment showed an increase-thendecrease trend. The main causes of patients’ withdrawal were mainly related to “crime” and “relapse”. In order to make MMT outpatient service better, subsequent studies need to carry out related investigations to understand the causes of these changes and patients reasons for withdrawal.
Key words: Methadone maintenance treatment, heroin dependence, maintenance rate


Analysis of Family Functioning and Parent-Child Relationship between Adolescents with Depression and their Parents

Qing CHEN, Wenyong DU, Yan GAO, Changlin MA, Chunxia BAN, Fu MENG

Background: Drug therapy combined with family therapy is currently the best treatment for adolescent depression. Nevertheless, family therapy requires an exploration of unresolved problems in the family system, which in practice presents certain difficulties. Previous studies have found that the perceptual differences of family function between parents and children reflect the problems in the family system.
Aims: To explore the characteristics and role of family functioning and parent-child relationship between adolescents with depressive disorder and their parents.
Methods: The general information and clinical data of the 93 adolescents with depression were collected. The Family Functioning Assessment Scale and Parent-child Relationship Scale were used to assess adolescents with depressive disorder and their parents.
Results: a) The dimensions of family functioning in adolescents with depressive disorder were more negative in communication, emotional response, emotional involvement, roles, and overall functioning than their parents. The differences were statistically significant. Parent-child relationship dimensions: the closeness and parent-child total scores were more negative compared with the parents and the differences were statistically significant. b) All dimensions of parent-child relationship and family functioning in adolescents with depression except the time spent together were negatively correlated or significantly negatively correlated. c) The results of multivariate regression analysis showed: the characteristics of family functioning, emotional involvement, emotional response, family structure, and income of the adolescents with depressive disorder mainly affected the parent-child relationship.
Conclusions: There were perceptual differences in partial family functioning and parent-child relationship between adolescents with depressive disorder and their parents. Unclear roles between family members, mutual entanglement, too much or too little emotional investment, negligence of inner feelings, parental divorce, and low average monthly family income were the main factors causing adverse parent-child relationship. These perceptual differences have a relatively good predictive effect on family problems, and
can be used as an important guide for exploring the family relationship in family therapy.
Key words: depression; adolescent; family functioning; parent-child relationship; perceptual difference; triangle relationships; family treatment


CHN2 Promoter Methylation Change May Be Associated With Methamphetamine Dependence

Liu HAO, Tao LUO, Huixi DONG, Aiguo TANG, Wei HAO

Background: Methamphetamine (MA) abuse is becoming increasingly serious in China. The mechanism of MA dependence remains unclear. CHN2 gene encodes chimeric protein-2 that regulate axonal pruning via the Rac-GTPase system and play a pivotal role in the formation of nervous circuits. Genetic studies suggest that the polymorphism of the CHN2 gene was related to substance dependence.
Aims: The aim of this study was to investigate the association between the methylation of CHN2 gene promoter with MA dependence.
Methods: According to SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders, SCID-I) used for investigating MA dependence, 224 male MA addicts were recruited into the case group. In addition, 109 healthy men were recruited into the control group. Blood samples were collected with the purpose of detecting the methylation levels of CHN2 gene promoter by methylight qPCR. The association between the methylation of CHN2 gene promoter with MA dependence was analyzed.
Results: The mean (sd) methylation levels of CHN2 gene promoter in the case group were significantly higher than in the control group, which were 2795.55 (733.19) and 1026.73 (698.73), respectively, showing significant differences between the two groups (t=21.25, P
Conclusions: The abnormal methylation of CHN2 gene promoter was significantly correlated with MA dependence.
Key words: Methamphetamine dependence; DNA methylation; epigenetic; CHN2 gene


The Application of Cognitive Remediation Therapy in The Treatment of Mental Disorders

Qing FAN, Liwei LIAO, Guihua PAN

Summary: Cognitive impairment is ubiquitous in patients with mental disorders. At present, one of the only effective ways to improve cognitive impairment is cognitive remediation therapy. This article reviews the application of cognitive remediation therapy in the treatment of mental disorders.
Key words: cognitive remediation therapy, mechanism of action, mental disorders


Toward International Collaboration on ICD-11- WHO Mental Health Collaborating Center in China 2017

Jinghong CHEN

Case report

Senile Depression with Somatization Symptoms and Insomnia is Diagnosed as Multiple System Atrophy: A Case Report

Ling YUE, Hai YU, Guanjun LI, Shifu XIAO

Summary: Patients who have senile depression with somatization symptoms are commonly encountered in clinical practice. The present case reports on a patient with senile depression who was repeatedly hospitalized and had somatic symptoms. Although the patient recovered after the first hospitalization, she suffered from a relapse one year later. As we followed up, due to the neurological findings and the response to treatment, we found that the patient is in line with the diagnoistic criteria for multiple system atrophy (MSA). The process of diagnosis and treatment of this case reminds us that clinicians need to consider differential diagnosis for refractory senile depression, especially in those patients with prominent somatization. In this case, rapid eye movement sleep behavior disorder (RBD) serves as a characteristic feature of the organic mental disorder.
Key word: senile depression; multiple system atrophy; case report; rapid eye movement sleep behavior


A Case Report of A Patient with Treatment-Resistant Depression Successfully Treated with Repeated Intravenous Injections of A Low Dosage of Ketamine

Shikai WANG, Mincai QIAN, Liang LI, Qi YANG

Summary: Depression is a highly prevalent and severely disabling disease. The treatment effects, intensity and onset time of antidepressants have been highlighted in many studies. Recent studies on the rapidonset of antidepressant response focused on the effect of a single low dose of intravenous ketamine. However, there are still some problems with treatment, including safety, efficacy, ethics, dose, frequency of administration and their effect in treatment-resistant depression. In the present study, we treated one case of treatment resistant depression with repeated intravenous injections with a low dosage of ketamine.
Key words: Treatment-resistant depression, Ketamine

Biostatistics in psychiatry

Comparisons of Superiority, Non-inferiority, and Equivalence Trials

Bokai WANG, Hongyue WANG, Xin M. TU, Changyong FENG

Summary: Efficacy of a new drug or treatment is usually established through randomized clinical trials. However, specifying hypotheses remains a challenging problem for biomedical researchers. In this survey we discuss superiority, non-inferiority, and equivalence trials. These three types of trials have different assumptions on treatment effects. We compare the assumptions underlying these trials and provide sample size formulas.
Key words: Randomized clinical trial, margin of clinical significance, sample size calculation