The cost of obsessive- compulsive disorder (OCD) in China: a multi- center cross- sectional survey based on hospitals

Background Obsessive-compulsive disorder(OCD)is considered a very debilitating disorder with severe loss of quality of life and income.Aims This study estimates the quality of life and economic consequences of OCD in China.Methods The research team interviewed 639 patients with OCD in 13 hospitals in 12 cities in China.The direct method was used to get the direct cost of OCD.Indirect costs associated with OCD were estimated using the human capital approach.Linear regression analysis was conducted for quality of life and generalised linear model analysis was conducted for total cost.Sensitivity analysis was used to analyse the uncertainty of total cost.Results The mean quality of life score for OCD was 52.78(20.46).The annual total cost of OCD per capita was 24503.78(95%CI:22621.53 to 26386.03)renminbi(RMB)(US$3465.88(95%CI:US$3199.65 to US$3732.11)).The annual cost of OCD in China was estimated to be 37.74 billion(95%CI:34.95 billion to 40.53 billion)RMB(equal to US$5.34 billion(95%CI:US$4.94 billion to US$5.73 billion)).Sensitivity analysis showed that the total annual cost of OCD in China was between 23.15 billion RMB(US$3.27 billion)and 370.00 billion RMB(US$52.33 billion).Worse social function status,more psychiatric symptoms and higher Yale Brown Obsessive-Compulsive Scale(Y-BOCS)score were associated with worse quality of life.The numbers of clinic visits and hospitalisations,socioeconomic status,education,Y-BOCS scores and age were found to be significantly associated with total cost.Conclusions OCD is associated with low quality of life and high costs in China.The findings call for concerted efforts to improve services for patients with OCD.Improvements may include early detection and diagnosis,the provision of evidence-based treatments and relapse prevention strategies.

Shuganjieyu capsule increases neurotrophic factor expression in a rat model of depression

Shuganjieyu capsule has been approved for clinical treatment by the State Food and Drug Ad-ministration of China since 2008. In the clinic, Shuganjieyu capsule is often used to treat mild to moderate depression. In the rat model of depression established in this study, Shuganjieyu capsule was administered intragastrically daily before stress. Behavioral results conifrmed that depressive symptoms lessened after treatment with high-dose （150 mg/kg） Shuganjieyu capsule. Immunohistochemistry results showed that high-dose Shuganjieyu capsule signiifcantly increased phosphorylation levels of phosphorylation cyclic adenosine monophosphate response element binding protein and brain-derived neurotrophic factor expression in the medial prefrontal cortex and hippocampal CA3 area. Overall, our results suggest that in rats, Shuganjieyu capsule effec-tively reverses depressive-like behaviors by increasing expression levels of neurotrophic factors in the brain.

与氯胺酮滥用相关的短期和长期心理症状清单的编制（英文）

背景:氯胺酮滥用在中国日渐增多,但目前还没有一个方法可以将氯胺酮对依赖个体的心理影响作用进行分类。目的:编制能反映氯胺酮依赖人群中因该物质滥用所致的急性心理影响和长期心理影响的量表。方法:我们编制了一个初步的症状清单,共有35个条目("是"或"否"的二分法问题),内容是关于使用氯胺酮后即刻产生的主观感受以及氯胺酮滥用后感受到的长期作用。从中国广州市两个大医院招募氯胺酮依赖住院患者,共入组187例。随机选择一半的样本进行探索性因子分析(exploratory factor analysis,EFA),以精简条目并确定量表的基本结构。对另一半样本进行验证性因子分析(confirmatory factor analysis,CFA),以评估所提取因子结构的稳健性。结果:35个症状中常见的急性期症状是"身体的漂浮或盘旋感"(94%)、"在动感音乐的环境下心情更加舒畅、欣快感"(86%)、和"兴奋话多,精力充沛"(67%)。常见的慢性症状是"记忆力下降"(93%)、"性格变化"(86%)和"反应变慢"(81%)。探索性因子分析最终得到的最佳模型量表,共22个条目,构成四个因子:两个因子代表慢性症状(社交退缩和睡眠障碍),一个因子是关于急性精神病样症状的,而第四个因子整合了急性的药物所致的欣快感和长期的性欲下降。验证性因素分析显示这4个因子能解释最终22个条目量表总方差的50%,并且模型拟合良好(拟合指数,GFI=83.3%;近似误差均方根,RMSEA=0.072)。结论:四因子模型(社交退缩、睡眠障碍、精神病样症状和使用毒品时的欣快感)能较为客观地反映氯胺酮滥用相关的短期和长期心理症状。对这一22个条目的量表,今后的研究工作需要扩大样本量,以验证实该四因子结构的效度,评估量表的重测信度,并确定是否能将该量表用于氯胺酮依赖的鉴别诊断和治疗监测。

使用仿制度洛西汀或帕罗西汀治疗抑郁症:一项多中心、双盲、双安慰剂、随机对照临床试验（英文）

背景:本研究是经国家食品药品监督管理总局批准的仿制度洛西汀注册前试验(批准号:2006L01603)。目的:比较仿制度洛西汀和帕罗西汀治疗抑郁症患者的疗效和安全性。方法:这是一项双盲双安慰剂(double dummy)、多中心、有效药物(帕罗西汀)平行随机对照临床试验。将纳入的299例抑郁症患者随机分组,使用度洛西汀(n=149;40-60 mg/d)或帕罗西汀(n=150;20 mg/d)连续治疗8周。在基线和开始治疗后的第1、2、4、6和8周使用汉密尔顿抑郁量表(Hamilton Depression rating scale,HAMD-17)评估。缓解的定义为研究终点HAMD-17评分低于8分,治疗有效的定义为研究终点HAMD-17得分较基线至少降低了50%。根据报告的不良反应的发生率、严重程度以及实验室检查结果、心电图结果的变化来评估安全性。度洛西汀组中有三例患者在开始用药前退出,采用修正的意向治疗分析(intention-to-treat,ITT)方法以比较研究组146例患者和对照组150例患者的研究结果。结果:在8周的研究期间两组有均29例患者脱落。与基线比,两组HAMD-17评分在整个试验过程中均显著降低。根据ITT分析,研究终点时度洛西汀组和帕罗西汀组在疗效方面差异无统计学意义(67.1%v.71.3%,X2=0.62,p=0.433),缓解率(41.1%v.51.3%,X2=3.12,p=0.077)及不良作用发生率56.8%v.54.7%,X2=0.14,p=0.705)等方面的差异也无统计学意义。结论:对于在国内精神科门诊就医的抑郁症患者而言,急性期使用仿制度洛西汀与使用帕罗西汀同样安全有效。

Occupational burnout in nurses:a concept analysis

Objective:This paper aims to clarify the concept of occupational burnout(OB)as well as develop appropriate methods to relieve or prevent OB in the nursing profession.Methods:Walker and Avant's eight-step approach of concept analysis was applied.Results:OB was defined as a chronic form of work-related stress.Accurately,it was characterized by emotional exhaustion,depersonalization/cynicism,and reduced personal accomplishment/inefficacy.Antecedents of burnout included(a)demographic characteristics;(b)chronic exposure to work-related stressors;(c)quantitative and qualitative job demands;(d)lack of job resources;and(e)personality traits.Consequences involved(a)individual’s unfavorable quality of life;(b)negative impact on the organization;and(c)poor services quality.Although the Maslach Burnout Inventory(MBI)is perceived as an ideal tool to measure burnout and hence,it is used worldwide,whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed.Conclusions:By proposing a comprehensive definition of the concept,this analysis contributes to recognition of the process of OB of nurses.All nurses are vulnerable to OB.Hence,burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care.It proposes that the prevention of OB would be achieved through team communication training,mindfulness group,education,etc.

电休克治疗用于精神分裂症的激越症状:随机对照试验的meta分析（英文）

背景:躁动在精神分裂症治疗中是一个重大挑战。电休克疗法(ECT)对各种精神疾病是一种快速、有效、和安全的治疗,但ECT对精神分裂症的躁动治疗的相关meta分析还尚未报道。目标:系统地评估单一使用ECT或ECT合并使用其他抗精神病药物(APs)的对精神分裂症的躁动治疗的有效性和安全性。方法:进行随机对照试验(RCT)的系统文献搜索。两名独立评估者筛选研究、提取结果数据与现有数据的安全性、进行质量评估和数据合成。采用建议、评估、开发、和评价的工作组等级(GRADE)来判断主要成果的证据的总体水平。结果:一共确定了中国有七个RCTs,包括ECT单一使用(4个RCTs有5个治疗组,n=240)和ECT-APs合并使用(3个RCTs,n=240)。研究对象平均年龄34.3(4.5)岁,平均治疗时间为4.3(3.1)周。所有7个RCTs非盲法,并且根据Jadad量表7项RCTs均被评为低质量。样本的Meta分析发现与APs单一治疗相比,单一使用ECT或ECT-APs合并使用阳性和阴性症状量表(PANSS)的躁动子因子评分改善均无显著性差异(ECT单一使用:weighted mean difference(WMD)=-0.90,95%confidence interval(CI):(-2.91,1.11),p=0.38;ECT-APs合并使用:WMD=-1.34,(95%CI:-4.07,1.39),p=0.33)。然而,PANSS总分(WMD=-7.13,I^2=0%,p=0.004)和兴奋子因子评分(WMD=-1.97,p<0.0001)、ECT治疗14天后的PANSS总分(WMD=-7.13,I^2=0%,p=0.004)和第7天和第14天的兴奋子因子评分(WMD=-1.97to-1.92,p=0.002 to 0.0001)均显示单一使用ECT优于APs单一治疗。ECT-APs合并治疗结束时(WMD=-10.40,p=0.03)和治疗后7天(WMD=-5.01,p=0.02)的PANSS总分显示均优于APs单药治疗。头痛(p=0.0001,number-needed-to-harm(NNH)=3,95%CI=2-4)是唯一的ECT单一治疗后不良反应,并且ECT单一治疗组比APs单药治疗发生的更频繁。根据GRADE方法,主要结果的证据水平被评为"非常低"(37.5%)和"低"(50%)。结论:基于中国7个RCTs合并的数据发现ECT单一治疗或ECT-APs合并治疗在精神分裂症患者的躁动治疗中并没有优势。然而,ECT单一治疗或ECT-APs合并治疗均与PANSS总分减低显著有关。需要高质量的RCTs验证目前的解释。

Mutation analysis of ATP13A2 in early-onset parkinsonism patients

BACKGROUND： A recent study has found that ATP13A2 is the causative gene for PARK9-linked autosomal recessive early-onset parkinsonism, described previously in Jordanian and Chilean families （Kufor-Rakeb syndrome）. OBJECTIVE： To screen eastern Asian patients with early-onset parkinsonism for mutations in ATP13A2 and to describe positron emission tomography （PET） findings of PARK9-linked parkinsonism. DESIGN, TIME AND SETTING： In total, 117 patients were selected from the Department of Neurology, Juntendo University, from February 2003 to October 2006, for this molecular genetics and case-control study. PARTICIPANTS： The patients with parkinsonism consist of two cohorts. Ninety four patients with onset age of less than 30 years were selected for the first cohort. They included 49 males and 44 females, comprising 73 Japanese, 9 Korean, 8 Taiwan Residents, and 4 Mainland Chinese. Eleven patients had parkinsonism complicated with dementia, 15 patients had family histories of parkinsonism （including 2 families）, and 5 patients were from consanguineous parents （including one family）. The second cohort of 23 patients was composed of patients with consanguineous parents （n = 15） or who had affected siblings （n = 6） or both （n = 2）, but the age at onset ranged from 30 to 50 years. METHODS： In 117 patients with parkinsonism, direct sequencing of ATP13A2 exons 13, 16, and 26, in which mutations had been reported previously, were performed. Sequencing was also performed in all 29 exons, including splice sites, in 28 probands who showed homozygosity at the PARK9 locus by haplotype analysis. Mutation analysis was also performed in 150 normal people. Linkage analysis was performed on all 3 parkinsonism families using short tandem repeat markers flanking the PARK9 locus. For patients who had ATP13A2 mutation, we performed brain MRI and ^18F-dopa PET scans. MAIN OUTCOME MEASURES： ATP13A2 DNA sequence, ^18F-dopa PET scan and brain MRI findings. RESULTS： A novel F182L mutation in a consanguineous Japanese family was identified. The patient was homozygous for the F182L mutation and her unaffected parents and two unaffected siblings were heterozygous for the F182L mutation. The patient developed early-onset atypical parkinsonism, which resembled the originally reported Kufor-Rakeb syndrome. MRI examination showed spinal cord atrophy and ^18F-dopa PET scan findings were similar to those of Parkinson＇s disease. CONCLUSION： Detection of the new PARK9 mutation, together with the previously reported cases of PARK9-linked parkinsonism, expand the clinical phenotypic spectrum of levodopa-responsive parkinsonism.

SPECT检测精神分裂症病人的局部脑血流研究(英文)

目的 了解精神分裂症病人的局部脑血流特征 ,探讨局部脑血流与精神病临床症状和疗效的关系。方法 采用PANSS量表评定患者的精神症状 ,应用99mTC -ECD -SPECT技术 ,对 17例从未接受过抗精神病药物治疗的精神分裂症病人 ,在接受治疗前与治疗后测量局部脑血流 ,并与11例正常对照组比较。结果 治疗前病例组右侧额叶与右侧颞叶rCBF低于对照组 (各P <0 .0 5 ) ,治疗后右侧额叶与右侧颞叶rCBF较治疗前明显增加 (各 P <0 .0 5 ) ;治疗前不同脑区rCBF与精神病理症状 (含单个症状评分和因子分 )和疗效均无显著性相关。结论 结果提示精神分裂病人存在右侧额叶与右侧颞叶局部脑功能减退 。

Genes in the serotonin pathway are associated with bipolar affective disorder in a Han Chinese population

Serotonin plays an important role in mood regulation, but the involvement of serotonin pathway genes in the development of bipolar I disorder. （BP-I）, a mood disorder, is not clear. We selected 21 single- nucleotide polymorphisms （SNPs） within the HTR2A gene, 8 within the SLC6A4 gene and 23 within the TPH2 gene for genotyping using the GoldenGate genotyping assay. A total of 375 patients with BP-I and 475 normal controls were recruited. Two out of 21 SNPs （rs1475196 and rs9567747） in the HTR2A gene and 1/23 SNPs （rs17110566） in the TPH2 gene were significantly associated with BP-I, both genotype-wise and allele-wise. Furthermore, a specific haplotype in the HTR2A gene showed a significant association with BP-I. Our results indicate that the HTR2A and TPH2 genes in the serotonin pathway play important roles in susceptibility to BP-I.

Prospective, naturalistic study of open-label OROS methylphenidate treatment in Chinese school-aged children with attention-deficit/hyperactivity disorder

Background Attention deficit hyperactivity disorder （ADHD） is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great burden on children themselves, their families and the society. Osmotic release oral system methylphenidate （OROS-MPH） is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate （IR-MPH）. It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles. The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting. Methods This 6-week, multi-center, prospective, open-label study enrolled 1447 ADHD children to once-daily OROS-MPH （18 mg, 36 mg or 54 mg） treatment. The effectiveness measures were parent-rated Inattention and Overactivity With Aggression （IOWA） Conners I/O and O/D subscales, physician-rated CGI-I and parent-rated global efficacy assessment scale. Blood pressure, pulse rate measurement, adverse events （AEs） and concomitant medications and treatment review were conducted by the investigator and were served as safety measures. Results A total of 1447 children with ADHD （mean age （9.52＋_2.36） years） were enrolled in this trial. Totally 96.8% children received an OROS-MPH modal dose of 18 mg, 3.1% with 36 mg and 0.1% with 54 mg at the endpoint of study. The parent IOWA Conners I/O score at the end of week 2 showed statistically significant （P 〈0.001） improvement with OROS-MPH （mean： 6.95±2..71） versus the score at baseline （10.45±2.72）. The change in the parent IOWA Conners O/D subscale, CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment. Fewer than half of 1447 patients （511 （35.3%）） reported AEs, and the majority of the events reported were mild （68.2%）. No serious adverse events were reported during the study. Conclusion This open-label, naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice.