Reducing parental anxiety using a family based intervention for youth mental health: A randomized controlled trial

This paper presents findings on parent anxiety and attachment relationship style from the Deakin Family Options (DFO) pilot study, a randomized controlled pilot study comparing a family-based treatment (BEST Plus), versus a youth only treatment (CBT) versus a group who received both of these treatments (COMBINED). Eligible participants were families with a young person (aged 12 - 25 years) with a high prevalence mental health problem. Youth from participating families scored in the clinical or subclinical range for depression, anxiety and/or substance misuse symptoms on standardized measures during the initial assessment. The collected sample was drawn from regional and urban centers in Victoria, Australia and allocated to treatment condition using a simple randomization procedure (parallel design). It was hypothesized that families receiving the BEST Plus would experience greater reductions in youth and parent mental health symptoms, and improved parent-child relationships, compared with those in the CBT condition. This paper describes and discusses changes in parent anxiety and parent attachment, according to whether the parent participated in a treatment (BEST Plus) or did not (NONBEST Plus). Participants were blind to the study hypotheses. In total 71 parent participants returned pre data and were allocated to a treatment group. In this paper, data from parent participants who completed pre and post measures (n = 48) and pre, post, and 6-month follow-up measures (n = 28) on anxiety and attachment were analyzed by group (BEST Plus versus NONBEST Plus). The results of this study suggest that parent anxiety decreased significantly more following parent involvement in a group treatment, than for parents that did not receive treatment. Unexpectedly, avoidant attachment increased in the no treatment group, but remained relatively stable following the BEST Plus group. There were no significant findings in relation to compulsive traits and anxious attachment. These findings are discussed in light of the study limitations.

COVID-19 mental health care toolkit:an international collaborative effort by Early Career Psychiatrists section

The collaborative effort of an international research team from the Early Career Psychiatrists section of the World Psychiatry Association has brought about an easy-to-use,quick and stepwise mental health care toolkit for the identification and appropriate referral of those in need of mental health care during the pandemic.This simple guide can be applied in the general outpatient setting and is catered for all healthcare professionals,regardless of their expertise within the mental health field with minimal training.It is our hope that by incorporating this toolkit into our daily clinical care during the pandemic for high-risk patients and patients with non-specific complaints,we will be able to bridge the mental health gap present in our society.

将WHO《心理健康差距干预指南》应用于中国全科医学服务:一项德尔菲研究

背景中国全科医生越来越期望能够识别和预防抑郁障碍,但其接受的心理健康培训有限,社区卫生服务中心(CHCs)也缺乏针对抑郁障碍的诊断和服务规范。WHO《心理健康差距干预指南》第2版(mhGAP-IG.v2)是为非心理健康专业人员提供的决策支持工具,可用于评估、管理、随访精神障碍、神经疾病及物质使用障碍患者。鉴于mhGAP-IG.v2的通用性,其在中国的应用应根据抑郁障碍在不同文化下的差异性和中国心理健康系统特点进行调整。方法开展两轮基于网络的德尔菲(Delphi)调查。邀请来自深圳市的全科医生小组对mhGAP-IG.v2中涉及抑郁障碍的199条表述进行五分制的赞同程度打分,即“如要把该表述用在深圳市,是否赞同调整其内容和结构”。如果>80%的全科医生“有些/肯定赞同”调整某表述,则视为全科医生对调整该表述达成共识;如果>80%的全科医生“有些/肯定不赞同”调整某表述,则视为全科医生对不调整该表述达成共识。结果全科医生对79%的表述达成了需要调整的共识,平均得分为4.26分,即全科医生“有些赞同”对mh GAP-IG.v2中涉及抑郁障碍的相关表述进行调整。具体调整建议包括:抑郁评估方法应考虑更广泛的抑郁症状,并考虑病情的发展阶段;增加抑郁筛查工具的使用指南;明确全科医生的作用,以及家庭参与和跨部门服务的转诊途径;药物治疗建议应与中国用药规范保持一致;指南所有章节要强调预防自杀;情境化健康教育;强调“以人为本”的服务方法。全科医生认为,应维持mhGAP-IG.v2中对经历抑郁发作的双相障碍患者的诊断和治疗建议。结论对mhGAP-IG.v2抑郁部分的调整研究反映出对指南的评估应考虑文化和国情背景,包括中国特色的初级卫生保健系统、健康优先领域、治疗可得性,以及多样化的社会心理教育需要。调整后的mhGAP-IG.v2可以给中国全科医学教育和全科医疗服务提供参考,也可以为其他国家的非精神病学专业人员开展心理健康服务提供有益借鉴。

Face and object visual working memory deficits in first-episode schizophrenia correlate with multiple neurocognitive performances

Background Working memory(WM)deficit is considered a core feature and cognitive biomarker in patients with schizophrenia.Several studies have reported prominent object WM deficits in patients with schizophrenia,suggesting that visual WM in these patients extends to non-spatial domains.However,whether non-spatial WM is similarly affected remains unclear.Aim This study primarily aimed to identify the processing of visual object WM in patients with first-episode schizophrenia.Methods The study included 36 patients with first-episode schizophrenia and 35 healthy controls.Visual object WM capacity,including face and house WM capacity,was assessed by means of delayed matching-to sample visual WM tasks,in which participants must distribute memory so that they can discriminate a target sample.We specifically examined their anhedonia experience by the Temporal Experience of Pleasure Scale and the Snaith-Hamilton Pleasure Scale.Cognitive performance was measured by the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).Results Both face and house WM capacity was significantly impaired in patients with schizophrenia.For both tasks,the performance of all the subjects was worse under the high-load condition than under the low-load condition.We found that WM capacity was highly positively correlated with the performance on RBANS total scores(r=−0.528,p=0.005),RBANS delayed memory scores(r=−0.470,p=0.013),RBANS attention scores(r=−0.584,p=0.001),RBANS language scores(r=−0.448,p=0.019),Trail-Making Test:Part A raw scores(r=0.465,p=0.015)and simple IQ total scores(r=−0.538,p=0.005),and correlated with scores of the vocabulary test(r=−0.490,p=0.011)and scores of the Block Diagram Test(r=−0.426,p=0.027)in schizophrenia.No significant correlations were observed between WM capacity and Positive and Negative Syndrome Scale symptoms.Conclusions Our research found that visual object WM capacity is dramatically impaired in patients with schizophrenia and is strongly correlated with other measures of cognition,suggesting a mechanism that is critical in explaining a portion of the broad cognitive deficits observed in schizophrenia.

Treatment priority for suicide ideation and behaviours at an Australian emergency department

AIM: To investigate the treatment priority given to selfharmers presenting to a hospital emergency department(ED) in Queensland, Australia, over the period 2005-2010. METHODS: The main outcome measure of this study was the treatment priority given to persons presenting with suicide ideation and communication(SIC) or self-harming behaviour. Treatment priority was measured using the Australasian Triage Scale, which ranks patients from 1(in need of immediate treatment) to 5(assessment and treatment to start within 120 min). Ordered logistic regression was used to assess the broad demographic and treatment-related factors associated with more urgent triage categories and to in-vestigate which methods of non-fatal suicidal behaviour(NFSB) were prioritised as most urgent.RESULTS: Most cases of NFSB were between 15 and 34 years. A larger proportion of persons presenting for SIC were aged 35 to 44 years. Over 50% of male presentations and 38% of female presentations were for SIC. Those cases prioritised as being more urgent had significantly greater odds of being older, presented after an act of self-harm rather than SIC, and had used multiple methods of NFSB. These individuals also had greater odds of being male and having made past presentations for SIC or NFSB. Among males, those presenting after ingestion of drugs had the greatest odds of receiving immediate attention compared to SIC. "Cutters" were considered as the least "urgent" subjects, and had a greatest risk of waiting 60 to 120 min for treatment compared to suicide ideators. Among females, those presenting with chemicals, poisons and gases had the greatest odds of receiving immediate attention compared to SIC. Females who presenting after cutting themselves had lower odds of receiving immediate treatment than those who presented with SIC. CONCLUSION: ED staff seems to judge the urgency of cases based on demographic factors such as age and gender, as well as method of NFSB.

后人类时代的护理变革

由于人工智能和生物技术的快速发展,医疗保健领域发生了重大转变,给护理行业带来了机遇和挑战。文章中借鉴了后人类的论述(其核心论点是去人类中心主义和人类进化过程中人与物边界的日趋模糊)认为鉴于这些转型的力量,需要思考护理学科的核心价值和基本认识模式,重设护理范畴,重新界定与其他机构的关系,并拥抱一个技术整合的护理生态系统。

Consequences of bullying victimization in childhood and adolescence:A systematic review and meta-analysis

AIM To identify health and psychosocial problems associated with bullying victimization and conduct a meta-analysis summarizing the causal evidence.METHODS A systematic review was conducted using Pub Med, EMBASE, ERIC and Psyc INFO electronic databases up to 28 February 2015. The study included published longitudinal and cross-sectional articles that examined health and psychosocial consequences of bullying victimization. All meta-analyses were based on qualityeffects models. Evidence for causality was assessed using Bradford Hill criteria and the grading system developed by the World Cancer Research Fund.RESULTS Out of 317 articles assessed for eligibility, 165 satisfied the predetermined inclusion criteria for meta-analysis.Statistically significant associations were observed between bullying victimization and a wide range of adverse health and psychosocial problems. The evidence was strongest for causal associations between bullying victimization and mental health problems such as depression, anxiety, poor general health and suicidal ideation and behaviours. Probable causal associations existed between bullying victimization and tobacco and illicit drug use. CONCLUSION Strong evidence exists for a causal relationship between bullying victimization, mental health problems and substance use. Evidence also exists for associations between bullying victimization and other adverse health and psychosocial problems, however, there is insufficient evidence to conclude causality. The strong evidence that bullying victimization is causative of mental illness highlights the need for schools to implement effective interventions to address bullying behaviours.

Glutamate transporters, EAAT1 and EAAT2, are potentially important in the pathophysiology and treatment of schizophrenia and affective disorders

Glutamate is the predominant excitatory neurotransmitter in the human brain and it has been shown that prolonged activation of the glutamatergic system leads to nerve damage and cell death. Following release from the pre-synaptic neuron and synaptic transmission, glutamate is either taken up into the presynaptic neuron or neighbouring glia by transmembrane glutamate transporters. Excitatory amino acid transporter(EAAT) 1 and EAAT2 are Na+-dependant glutamate transporters expressed predominantly in glia cells of the central nervous system. As the most abundant glutamate transporters, their primary role is to modulate levels of glutamatergic excitability and prevent spill over of glutamate beyond the synapse. This role is facilitated through the binding and transportation of glutamate into astrocytes and microglia. The function of EAAT1 and EAAT2 is heavily regulated at the levels of gene expression, post-transcriptional splicing, glycosylation states and cell-surface trafficking of the protein. Both glutamatergic dysfunction and glial dysfunction have been proposed to be involved in psychiatric disorder. This review will present an overview of the roles that EAAT1 and EAAT2 play in modulating glutamatergic activity in the human brain, and mount an argument that these two transporters could be involved in the aetiologies of schizophrenia and affective disorders as well as represent potential drug targets for novel therapies for those disorders.

The impact of vitamin D deficiency on neurogenesis in the adult brain

There is increasing evidence from epidemiological studies indicating that vitamin D deficiency during adulthood is associated with adverse brain outcomes in humans（Ginde et al.,2009）and rodents（Groves et al.,2014）,however,a causal relationship has not yet been established.

Voxel-based magnetic resonance imaging investigation of poor and preserved clinical insight in people with schizophrenia

AIM To define regional grey-matter abnormalities in schizophrenia patients with poor insight(Insight-),relative to patients with preserved clinical insight(Insight+),and healthy controls.METHODS Forty stable schizophrenia outpatients(20 Insight-and 20 Insight+) and 20 healthy controls underwent whole brain magnetic resonance imaging(MRI).Insight in all patients was assessed using the Birchwood Insight Scale(BIS;a self-report measure).The two patient groups were preselected to match on most clinical and demographic parameters but,by design,they had markedly distinct BIS scores.Voxel-based morphometry employed in SPM8 was used to examine group differences in grey matter volumes across the whole brain.RESULTS The three participant groups were comparable in age [F(2,57) = 0.34,P = 0.71] and the patient groups did not differ in age at illness onset [t(38) = 0.87,P = 0.39].Insight-and Insight+ patient groups also did not differ in symptoms on the Positive and Negative Syndromes scale(PANSS):Positive symptoms [t(38) = 0.58,P = 0.57],negative symptoms [t(38) = 0.61,P = 0.55],general psychopathology [t(38) = 1.30,P = 0.20] and total PANSS scores [t(38) = 0.21,P = 0.84].The two patient groups,as expected,varied significantly in the level of BIS-assessed insight [t(38) = 12.11,P < 0.001].MRI results revealed lower fronto-temporal,parahippocampal,occipital and cerebellar grey matter volumes in Insightpatients,relative to Insight+ patients and healthy controls(for all clusters,family-wise error corrected P < 0.05).Insight+ patient and healthy controls did not differ significantly(P > 0.20) from each other.CONCLUSION Our findings demonstrate a clear association between poor clinical insight and smaller fronto-temporal,occipital and cerebellar grey matter volumes in stable long-term schizophrenia patients.

Therapeutic use of melatonin in schizophrenia-more than meets the eye!

Adjunctive melatonin use in schizophrenia, as supported by a modicum ofevidence, has multiple transcending chronobiotic actions, including fixingconcurrent sleep problems to bona fide augmentative antipsychotic actions,mitigating the risk of tardive dyskinesias, curbing the drastic metabolic syndromeand ultimately providing neuroprotective actions. Its use is rather an art thanscience!

非痴呆患者的记忆主诉预测未来的阿尔茨海默病的病理诊断

The validity of memory complaints as a predictor of Alzheimer disease (AD) was assessed in 237 Japanese- American men autopsied at ages 74 to 97 years. These men were free of dementia at the time memory complaints were assessed 1 to 11 years earlier. Memory complaints were found to predict the neuropathologic diagnosis of AD after adjusting for age, time to death, education, depression, and cognitive functioning.

High-intensity Interval Training for the Management of Nonalcoholic Steatohepatitis: Participant Experiences and Perspectives

Background and Aims:High-intensity interval training(HIIT)is a therapeutic option for people with nonalcoholic steatohepatitis(NASH).However,the perspectives and experiences of HIIT for people with NASH are unknown,limiting translation of research.We explored the experiences and perspectives of both professionally supervised and self-directed HIIT in people with NASH and evaluated participant-reported knowledge,barriers,and enablers to commencing and sustaining HIIT.Methods:Twelve participants with NASH underwent 12 weeks of supervised HIIT(3 days/week,4×4 minutes at 85–95%maximal heart rate,interspersed with 3 minutes active recovery),followed by 12-weeks of selfdirected(unsupervised)HIIT.One-on-one,semistructured participant interviews were conducted by exercise staff prior to HIIT and following both supervised and self-directed HIIT to explore prior knowledge,barriers,enablers,and outcomes at each stage.Interviews were audio-recorded,transcribed,coded,and thematically analyzed by two independent researchers.Results:Four dominant themes were identified:(1)no awareness of/experience with HIIT and ambivalence about exercise capabilities;(2)multiple medical and social barriers to commencing and continuing HIIT;(3)exercise specialist support was a highly valued enabler,and(4)HIIT was enjoyed and provided holistic benefits.Conclusions:People with NASH may lack knowledge of and confidence for HIIT,and experience multiple complex barriers to commencing and continuing HIIT.Exercise specialist support is a key enabler to sustained engagement.These factors need to be addressed in future clinical programs to augment the uptake and long-term sustainability of HIIT by people with NASH so they can experience the range of related benefits.

Metformin for Antipsychotic-Related Metabolic Syndrome in Children： Fact or Fiction？

Use of atypical antipsychotics （AAPs） in child/adolescent psychiatry （CAP） population is rife to address a wide array of indications. Apart from the Food and Drug Administration approval in schizophrenia, bipolar mood disorders, irritability in autism spectrum disorder, and Tourette＇s syndrome, AAPs are commonly prescribed off-label for aggression in intellectual disability or attention-deficit/hyperactivity disorder, augmentation in depression and obsessive-compulsive disorder.

成年精神病与精神分裂症患者的管理：MCE最新指南概要

这是新指南系列BMJ概述中的一个，这些指南都是基于现有的最佳证据制定的；他们突出了临床实践中的重要建议，尤其是那些不确定或具争议性的方面。

指南双相障碍的评估与管理：NICE指南更新概要

本文是英国医学杂志（TheBMJ）最新指南系列文章之一，新指南基于现有的最佳证据编写；着重解读对临床实践重要的建议，特别是存在不确定和争议的部分。

实践要点如何处理侵袭性妄想

侵袭性妄想（以前也被称之为寄生虫妄想或埃科布姆综合征）是一种罕见的疾病，但它常常会给医疗保健系统造成很大的现实问题’。它的特征是，尽管缺少医学证据，但患者始终坚信他／她的皮肤、身体或生存环境被小的、活的（较少数为非生命体）病原体感染。侵袭性妄想既不是某种单一的疾病，也不是某种独立的诊断单元。

Imipramine-precipitated status epilepticus

Frontal lobe epilepsy has a complex and atypical semiology that may masquerade as psychiatric or parasomnias[1].An electroencephalography(EEG)and sleep lab workup should be an integral part of clinical assessment of these cases to avoid potential pitfalls in management with serious conse-quences as evidenced in this clinical vignette.By mistak-ing epilepsy for anxiety,imipramine,a tricyclic antidepres-sant,known to lower seizure threshold,was prescribed and resulted in status epilepticus.This letter concludes with a brief literature review of antidepressants and seizure risk.

Lithium is Clearly Underutilized in Child Psychiatry

To the Editor： Frederick Goodwin, an influential figure in bipolar mood disorder, famously said, if you can＇t, or you won＇t use lithium, get out from the business of treating bipolar disorders! Lithium remains the gold standard treatment of bipolar mood disorder.But, sorely, it is underutilized in Child/Adolescent Psychiatry, despite Food and Drug Administration＇s approvalfor age 12 and above.