Metabolic complications of psychotropic medications in psychiatric disorders:Emerging role of de novo lipogenesis and therapeutic consideration

Although significant advances have been made in understanding the pathophysiology of psychiatric disorders(PDs),therapeutic advances have not been very convincing.While psychotropic medications can reduce classical symptoms in patients with PDs,their long-term use has been reported to induce or exaggerate various pre-existing metabolic abnormalities including diabetes,obesity and non-alcoholic fatty liver disease(NAFLD).The mechanism(s)underlying these metabolic abnormalities is not clear;however,lipid/fatty acid accumulation due to enhanced de novo lipogenesis(DNL)has been shown to reduce membrane fluidity,increase oxidative stress and inflammation leading to the development of the aforementioned metabolic abnormalities.Intriguingly,emerging evidence suggest that DNL dysregulation and fatty acid accumulation could be the major mechanisms associated with the development of obesity,diabetes and NAFLD after long-term treatment with psychotropic medications in patients with PDs.In support of this,several adjunctive drugs comprising of anti-oxidants and antiinflammatory agents,that are used in treating PDs in combination with psychotropic medications,have been shown to reduce insulin resistance and development of NAFLD.In conclusion,the above evidence suggests that DNL could be a potential pathological factor associated with various metabolic abnormalities,and a new avenue for translational research and therapeutic drug designing in PDs.

Feasibility Study of Assist-Linked Brief Intervention for Substance Use Disorders in a Rural Community of Plateau State, Nigeria

Objective: We studied the feasibility of using Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) linked with Brief Intervention (ALBI) in treating Substance Use Disorder in Nigeria. There is a clear gap in meeting the needs for treatment and care for people with drug use disorders in Nigeria with many users reporting a self-perceived need for treatment and about 40% of them wanting to receive drug treatment but were unable to access such services. Methods: ASSIST questionnaire was used to gather baseline data, and ALBI along with Motivational Interviewing (MI) was used to intervene for 6 weeks following which ASSIST score was repeated and compared with baseline. Results: Majority of the participants were aged 21 - 30 years, mostly males with (61.3%) lacking steady jobs. Lifetime prevalence of any drug use was (88.2%). Three months prevalence was nicotine (72.0%), alcohol (66.7%), cannabis (47.3%), opioids (11.8%) among others. The ASSIST scores were mostly on the severe ranges. ASSIST result after six weeks showed marked reduction. The Mean Difference (MD) in the ASSIST scores after intervention was significant for tobacco, opioids, alcohol, and cannabis. The Cohen’s D effect size was large for tobacco (1.08), alcohol (0.92) and cannabis (0.73) but low for other substances. Conclusion: ALBI along with MI was helpful in combating the menace of substance use.

Atypical Weight Loss in Two Patients with Schizophrenia Treated with Clozapine: A Case Report

Clozapine is widely recognized as an effective antipsychotic medication for treatment-resistant schizophrenia, but it is typically associated with significant weight gain. This case report presents two unusual cases of patients with schizophrenia who experienced substantial weight loss while on long-term clozapine therapy. The first case involves a 35-year-old male who lost 21.3% of his initial body weight, and the second case describes a 54-year-old female who lost 30.2% of her initial weight, despite having comorbid hypothyroidism. Both patients showed improvement in psychiatric symptoms concurrent with the weight loss. Comprehensive investigations did not reveal other clear etiologies for the weight reduction. These cases challenge the conventional understanding of clozapine’s metabolic effects and highlight the potential for atypical responses in some individuals. The report discusses possible mechanisms for this unusual phenomenon, including genetic factors and altered pharmacokinetics. It also emphasizes the need for individualized monitoring and management strategies in clozapine therapy. These findings contribute to the growing body of evidence suggesting that metabolic responses to clozapine may be more complex and varied than previously thought, underscoring the importance of personalized approaches in schizophrenia treatment.

Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic

Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

Increasing prevalence of eating disorders in female adolescents compared with children and young adults:an analysis of real-time administrative data

TToo tthhee eeddiittoorr::Eating disorder(ED),as defined by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5),is a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.^(1)The DSM-5 outlines criteria for EDs,including anorexia nervosa,bulimia nervosa,binge-eating disorder,pica,rumination disorder and avoidant/restrictive food intake disorder.EDs are relatively common in young people,affecting 5.5%-17.9%of young women and 0.6%-2.4%of young men by the time they reach early adulthood.

Training Needs of International Medical Graduates [IMGs] in Psychiatry

The potential shortage of psychiatrists over the next 5 - 10 years has focused attention on the need to recruit more IMGs to fill the needs rather than use nurse practitioners or physician assistants. IMGs make up about 1/3 of first year psychiatry residents. These individuals have been found to provide services to the poor, the elderly and the psychotic. The quality of their medical work has been found to be satisfactory. The training needs of these physicians require an understanding on the part of their teachers that they come from cultures with different values that we have. The extended families of these primarily Asian residents clash with our strong commitment to individualism. It leads to a We-self rather than our I-Self. This difference coupled with the stress of leaving to come to a new culture is a great stress. Their exposure to psychiatry has been limited. They request and need more interview demonstration and practice, ore feedback and examinations. They should have help in accent reduction. They should be exposed to the working of the hospital by sitting on departmental and hospital committees. The faculty should extend their social opportunities and work as mentors on joint projects. Courses on the history of American culture should be taught. Psychotherapy for them should be encouraged as well as teaching medical ethics. They must become the major educational concern for the department that they are in.

Profile of Inpatient Child and Adolescent Psychiatry in Sultanate of Oman

Backgrounds: Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to answer the question what are the problems that are likely to bring a child or an adolescent for the admission in the child and adolescent psychiatry Unit. Methods: The case records of all inpatient children and adolescents younger than 18 years, who were admitted to the child psychiatric unit at SQUH, Muscat, Sultanate of Oman over a period of 10 years between Jan 2007 and Dec 2017, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. Result: A total of 255 cases were admitted in child psychiatry unit in a period of 10 yrs, the average age was 14.15 years, 95% patients were Omani nationals, 47.5% were male, 52.5 were females, 17.65% Acute and transient psychotic disorder, 13.7% bipolar affective disorder, current episode manic without psychotic symptoms, 12.94% Intentional self-harm by other specified means and 12.55% schizophrenia, were the most common diagnoses observed in this population who needed inpatient care;the average length of stay in the majority of cases was less than 3 weeks. Conclusion: The child and adolescent inpatient unit of SQUH from where the data was collected happens to be the only child psychiatric admitting unit in Oman till the end of 2017 and can be considered as representative;the children and adolescence in-patient unit exemplifies a short-term care set-up.

Psycho-Social Hazards for Staff in Geriatrics and Geriatric Psychiatry

Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.

Clinical efficacy and safety of Guipi decoction combined with escitalopram oxalate tablets in patients with depression

BACKGROUND Depression is a widespread mental health condition that requires effective treatment.In the treatment of depression,traditional Chinese medicine(TCM)offers obvious advantages,fewer adverse reactions,and a lower recurrence rate.AIM To evaluate the clinical benefits of Guipi decoction combined with escitalopram oxalate tablets for individuals with depression.METHODS In total,80 patients diagnosed as having depression were enrolled in the study and divided into either an experimental group or a control group.All of the patients were orally administered escitalopram oxalate tablets.Additionally,the experimental group received Jiajian Guipi decoction and reduced Governor vessel fumigation over 4 wk.TCM syndrome scores,Hamilton depression rating scale(HAM-D)scores,self-rating depression scale(SDS)scores,and Pittsburgh sleep quality index scores were measured for the two groups and compared before and after the treatment.The two groups were monitored for any adverse reactions.RESULTS After 4 wk of treatment,both groups exhibited a significant reduction in TCM syndrome scores compared with their pre-treatment scores(P<0.05).However,the experimental group exhibited significantly lower TCM syndrome scores than the control group(P<0.05).Similarly,the post-treatment SDS and HAM-D-24 scores were significantly lower in both groups than the pre-treatment scores(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The total treatment efficiency was significantly better in the experimental group(97.14%)than in the control group(77.78%)(P<0.05).Furthermore,after 4 wk of treatment,the Pittsburgh sleep quality index scores for both groups were significantly lower than those before the treatment(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The incidence of adverse reactions was significantly lower in the experimental group than in the control group(P<0.05).CONCLUSION The combination of Guipi decoction and escitalopram oxalate tablets was found to be an effective and safe treatment for depression.This combination could reduce TCM syndrome scores,improve depressive symptoms,and enhance sleep quality.

Intermediary roles of prospective memory and retrospective memory in the comorbidity of depression and pain

Background Patients who suffer comorbidity of major depressive disorder(MDD)and chronic pain(CP)maintain a complex interplay between maladaptive prospective memory(PM)and retrospective memory(RM)with physical pain,and their complications are still unknown.Aims We aimed to focus on the full cognitive performance and memory complaints in patients with MDD and CP,patients with depression without CP,and control subjects,considering the possible influence of depressed affect and chronic pain severity.Methods According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria given by the International Association of Pain,a total of 124 participants were included in this cross-sectional cohort study.Among them,82 depressed inpatients and outpatients from Anhui Mental Health centre were divided into two groups:a comorbidity group(patients with MDD and CP)(n=40)and a depression group(patients with depression without CP)(n=42).Meanwhile,42 healthy controls were screened from the hospital’s physical examination centre from January 2019 to January 2022.The Hamilton Depression Rating Scale-24(HAMD-24)and Beck Depression Inventory-II(BDI-II)were used to evaluate the severity of depression.The Pain Intensity Numerical Rating Scale(PI-NRS),Short-Form McGill Pain Questionnaire-2 Chinese version(SF-MPQ-2-CN),Montreal Cognitive Assessment-Basic Section(MoCA-BC),and Prospective and Retrospective Memory Questionnaire(PRMQ)were used to assess pain-related features and the global cognitive functioning of study participants.Results The impairments in PM and RM differed remarkably among the three groups(F=7.221,p<0.001;F=7.408,p<0.001)and were severe in the comorbidity group.Spearman correlation analysis revealed the PM and RM were positively correlated with continuous pain and neuropathic pain(r=0.431,p<0.001;r=0.253,p=0.022 and r=0.415,p<0.001;r=0.247,p=0.025),respectively.Regression analysis indicated a significant positive relationship between affective descriptors and total BDI-II score(β=0.594,t=6.600,p<0.001).Examining the mediator pathways revealed the indirect role of PM and RM in patients with comorbid MDD and CP.Conclusions Patients with comorbid MDD and CP presented more PM and RM impairments than patients with MDD without CP.PM and RM are possibly mediating factors that affect the aetiology of comorbid MDD and CP.

Risk Factors for COVID-19 Related Death during the First Three Waves of the Pandemic in an Epidemic Treatment Center at Dakar, Senegal

Introduction-Objective: COVID-19 is a highly transmissible but often mild viral infection. However, some patients can present severe COVID-19 and subsequently die. The aim of the present study was to assess the risk factors for COVID-19 related death during the first three waves of the disease at the Epidemic Treatment Center (ETC) of Dakar Principal Hospital (DPH). Method: We conducted a descriptive and analytical perspective survival study from April 4, 2020 to September 25, 2021, including adult patients with COVID-19, hospitalized at the ETC of DPH. Log Rank test and multivariate Cox model were performed to identify risk factors for death. Results: We included 556 COVID-19 patients with mean age of 57 ± 17 years and a male-to-female ratio of 1.26. The number of deaths during one month of follow-up was 41, representing a cumulative risk of 7.4%. The log Rank test showed that being from the third wave (p = 0.0056), advanced age (p = 0.00098), presence of at least one comorbidity (p = 0.034), High blood pressure (p = 0.024), d-dimer level ≥ 1000 IU/L (p Conclusion: Our study showed that elderly and third-wave of COVID-19 patients were more at risk to die. Knowledge of risk factors for COVID-19 related death could improve the prognosis of these patients.

Games of Chance and Money of the Togolese National Lottery in Lomé

Introduction: The addiction to games of chance and money is frequently encountered among some players. The general objective of this study was to describe the level of the gambling addiction among the players of the Togolese National Lottery (LONATO) in the city of Lomé. Method: This was a descriptive cross-sectional study through non-random sampling by convenience surveys, conducted on October 09, 2019 in 20 LONATO plying sites which affected 611 players. The screening was done using the South Oaks Gambling Screen (SOGS) questionnaire. Results: Of the 611 players surveyed, 55% were aged 18 to 35 years with an average age of 36 years and the extremes ranging from 14 to 78 years. The male gender was in the majority (84.26%). The prevalence of pathological gambling was 62.52%. Among the pathological gamblers, 16.89% had a family history of pathological gambling, 19.00% had a mood disorder, 28.50% had excessive alcoholism, and 17.15% consumed another psychoactive substance. Cannabis was the most consumed substance (6.87%) followed by tobacco (6.07%) and soporific (6.07%). More than half of players (62.03%) thought that pathological gambling is not a disease. Conclusion: The pathological gambling is a global phenomenon and a reality in Togo. Raising everyone’s awareness will reduce its negative impact on the players.

Prevalence and Factors Associated with HIV Serodiscordance among Infected Couples in the City of Parakou (Benin)

Introduction: Achieving the goal of “zero new human immunodeficiency virus (HIV) infections by 2030” requires the elimination of HIV transmission within serodiscordant couples. In Benin, the phenomenon of HIV serodiscordance remains poorly documented. Objective: the aim of this study was to determine the prevalence of HIV serodiscordance and its associated factors among infected couples in the city of Parakou. Study Framework and Method: This was a descriptive cross-sectional study with an analytical focusing on qualitative and quantitative plans. It was carried out on thirty approved sites in the city of Parakou between July and December 2022. We used a non-exhaustive convenience sample of people living with HIV (PLHIV) whose partner’s status was known. Data collection took place in two phases: an interview phase during which sociodemographic, economic, behavioral and marital/social data were collected. The second phase focused on clinical and therapeutic data which were collected from the patients’ personal records. Results: A total of 417 study subjects were recruited. The average age (SD) of the subjects was 38.17 (±10.25) years [37.19 - 39.16]. Females accounted for the largest proportion (79.62%). Most respondents (74.11%) were married. Monogamous unions were the most frequent, involving 67.87% of participants, most of whom (44.60%) had been infected for between 1 and 5 years. Couples in union for less than 10 years were the most numerous (218 people or 52.28%). The respondent was head of household among only 140 respondents (33.57%) of which 84 men (60.00%) and 56 women (40.00%). Female heads of household were mainly divorcees and widows. Around 75% of PLHIV had monthly incomes of less than 50,000F CFA (81.16 USD). Prevalence of HIV serodiscordance was 71.70%. It was 70.91% [65.54% - 76.28%] at care sites and 73.24% [65.95% - 80.52%] at sites involved in preventing mother-to-child transmission (PMTCT sites). Potential predictors of HIV serodiscordance were: household head status;serostatus of last child;duration of relationship;multiple and occasional sexual partners;sharing serostatus with spouse;duration of couple relationship;spouse’s extramarital relationships and strained relations with children. Conclusion: Response strategies against the HIV pandemic need to be reshaped to better supervise the follow-up of HIV serodiscordant couples in the city of Parakou specifically and in Benin in general.

利培酮或喹硫平治疗女性首发精神分裂症患者12个月中血清催乳素及体重变化的随机对照研究(英文)

背景:血清催乳素升高和体重增加是非典型抗精神病药物常见的副作用,但很少有研究评估这些副作用的长期情况。目标:比较利培酮或喹硫平治疗女性首发精神分裂症患者12个月后对血清催乳素及体重变化的影响。方法:80例女性首发精神分裂症住院患者被随机分配接受利培酮(N=40)或喹硫平(N=40)为期12个月的治疗。在开始治疗前一天和开始治疗后第1,3,6,9和12个月分别进行催乳素浓度,体重和身高的测定。在每一个时间段同时采用阳性和阴性症状量表(PANSS)评估症状的严重程度。结果:利培酮组31例患者和喹硫平组33例患者完成12个月的治疗。两组PANSS评分在每次后续的评估中都有所下降;利培酮组在治疗3个月和6个月时的改善显著,但在治疗第9个月两组的水平改善相似。喹硫平组血清催乳素在12个月内保持稳定,但利培酮组的血清催乳素水平在一年的随访中升高3.5至5.2倍。两组均出现体重增加,特别是在治疗的头3个月:两组的体重指数在治疗3个月时增加了62%。体重变化组间没有显著差异。体重变化和催乳激素水平变化之间的相关性呈弱阳性:利培酮组rs=0.17(p=0.104),喹硫平组r=0.07(p=0.862)。结论:虽然利培酮更迅速有效,但利培酮和喹硫平在治疗首发精神分裂症的第一年有相似的疗效。慢性高泌乳素血症与利培酮使用有关,但喹硫平没有。长期服用这两种药物与体重持续增加有关;两种药物在体重增加的时间性和幅度上相似。体重增加和催乳素水平变化不是密切相关的。

Influence of mental stress on platelet bioactivity

It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyteaggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Thereforeplatelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.

Mediating effect of interpersonal relations on negative emotions and dysmenorrhea in female adolescents

Background Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relationships in dysmenorrhea and how they may interact with negative emotions. Aims To investigate the connection between negative affect and dysmenorrhea, and the role of interpersonal relationships plays in this relationship. Methods The Cox Menstrual Symptom Scale (CMSS), short-form of Depression Anxiety Stress Scale, Interpersonal Comprehensive Diagnostic Scale and UCLA (University of California at Los Angeles) Loneliness Scale were applied to 855 adolescent nursing students to collect information on severity and frequency of dysmenorrheal symptoms, negative emotions (including depression, anxiety and stress), interpersonal problems and subjective experience of loneliness among them, and the relationship among these variables was examined. Results (1) Both the severity and frequency of dysmenorrhea were positively correlated with negative emotions, loneliness experience and interpersonal problems, while negatively correlated with age at menarche.(2) The negative emotions, romantic relationship and menarche age, but not loneliness and interpersonal problems, significantly contributed to both the severity and frequency of dysmenorrhea.(3) Mediation analysis revealed that the effects of loneliness and interpersonal problems on dysmenorrhea were totally mediated by negative emotions. Conclusions This investigation indicates that the relationship between interpersonal relationships and dysmenorrhea is mediated by negative emotions.

How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?

AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.

Psychometric properties of the Caregiver Strain Questionnaire among Chinese parents of children with ADHD or ASD

Background There is an urgent need in clinical practice to measure the stress of parenting.The Caregiver Strain Questionnaire(CGSQ)was found to be useful to measure parenting stress,but it has not been validated among the Chinese population.Aims To assess the reliability and construct validity of the Chinese version of CGSQ among Chinese parents.Methods From 2016 to 2017,266 parents(patient group)with a child having DSM-5-defined attention deficit hyperactivity disorder(ADHD)(n=107)or autism spectrum disorder(ASD)(n=159)and 268 parents of healthy children(control group)were recruited to the present study in Kunming,Yunnan province.All the parents were asked to fill out the Chinese version of CGSQ.We conducted exploratory factor analysis and confirmatory factor analysis(CFA)to verify construct validity of CGSQ in both patient and control groups.Cronbach’s α coefficient as an index of internal consistency was assessed for each subscale.Fourteen days later,23 subjects filled out the scale again.Intra-class correlation coefficient was calculated to evaluate the test-retest reliability.Results(1)Cronbach’s alpha of the global scale was 0.901 for the control group and 0.952 for the patient group.The test-retest reliability for the whole scale was 0.890;(2)CFA indicated that the three-factor model had better fitting indices compared with the two-factor model in both groups.Besides,the fitting indices in the patient group were more favourable than those of the control group,withχ2/df=1.564,Goodness-of Fit Index=0.841,Comparative Fit Index=0.954,and root mean square error of approximation=0.065 for the patient group at three-factor model;(3)The caregiver strain of ASD parents was statistically higher than that of ADHD parents,and caregiver strain of ADHD parents was higher than that of control group.Conclusion These findings provide initial evidence to support the construct validity and reliability of CGSQ as a parenting stress measurement tool for Chinese parents,especially for parents of children with ADHD or ASD.

Functional brain imaging of gastrointestinal sensation in health and disease

It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.

Addiction specialist's role in liver transplantation procedures for alcoholic liver disease

Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure.Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist(team)within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity,instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD.Screening, treatment and monitoring is suggested as central roles for the addiction specialist(team) integrated within transplant centers.