Antipsychotic Medications in Major Depression and the Association with Treatment Satisfaction and Quality of Life： Findings of Three National Surveys on Use of Psychotropics in China Between 2002 and 2012

Background： Optimizing treatment outcomes for depression requires understanding of how evidence-based treatments are utilized in clinical practice. Antipsychotic medications concurrent with antidepressant treatment are frequently used in major depression, but few studies have investigated trends and patterns of their use over time. This study aimed to examine the prescription patterns ofantipsychotic medications for major depression in China from 2002 to 2012 and their association with treatment satisfaction and quality of life （QOL）. Methods： A total of 3655 subjects with major depression treated in 45 Chinese psychiatric hospitals/centers nationwide were interviewed between 2002 and 2012. Patients＇ socio-demographic and clinical characteristics including psychopathology, medication side effects. satisfaction with treatment and QOL were recorded using a standardized protocol and data collection. Results： The frequency ofantipsychotic use was 24.9% in the whole sample; the corresponding figures were 17.1%, 20.3%, and 32.8% in 2002, 2006, and 2012, respectively （χ^2 = 90.3, df= 2, P 〈 0.001 ）. Multiple logistic regression analyses revealed that patients on concurrent antipsychotics had significantly more delusions or hallucinations, longer illness duration, greater side effects, and more likely to be treated as inpatients and in major hospitals （i.e., Level-Ⅲ hospital）. Antipsychotic use was associated with lower treatment satisfaction while there was no significant difference with respect to physical and mental QOL between the antipsychotic and nonantipsychotic groups. Conclusions： Concurrent antipsychotic use was found in about one in four treated depressed patients in China, which has increased over a 10-year period. Considering the association of drug-induced side effects and the lack of patients＇ and relatives＇ satisfaction with antipsychotic treatment, further examination of the rationale and appropriateness of the use of antipsychotics in depression is needed.

Distinct neuroanatomic subtypes in antipsychotic-treated patients with schizophrenia classified by the predefined classification in a never-treated sample

Background:Distinct neuroanatomic subtypes have been identified in never-treated patients with schizophrenia based on cerebral structural abnormalities,but whether antipsychotic-treated patients would be stratified under the guidance of such previously formed classification remains unclear.Objective:The present study aimed to investigate alterations of brain structures in antipsychotic-treated patients with schizophrenia based on a predefined morphological classification and their relationships with cognitive performance.Methods:Cortical thickness,surface area,and subcortical volume were extracted from 147 antipsychotictreated patients with schizophrenia using structural magnetic resonance imaging for classification.The Brief Assessment of Cognition in Schizophrenia(BACS)and Positive and Negative Syndrome Scale(PANSS)were used to assess cognition and symptoms.Results:Antipsychotic-treated patients were categorized into three subtypes with distinct patterns of brain morphological alterations.Subtypes 1 and 2 were characterized by widespread deficits in cortical thickness but relatively limited deficits in surface area.In contrast,subtype 3 demonstrated cortical thickening mainly in parietal-occipital regions and widespread deficits in surface area.All three subgroups demonstrated cognitive deficits compared with healthy controls.Significant associations between neuroanatomic and cognitive abnormalitieswere only observed in subtype 1,where cortical thinning in the left lingual gyruswas conversely related to symbol coding performance.Conclusions:Similar to drug-naıve patients,neuroanatomic heterogeneity exists in antipsychotic-treated patients,with disparate associations with cognition.These findings promote our understanding of relationships between neuroanatomic abnormalities and cognitive performance in the context of heterogeneity.Moreover,these results suggest that neurobiological heterogeneity needs to be considered in cognitive research in schizophrenia.