Clinical effects of nonconvulsive electrotherapy combined with mindfulness-based stress reduction and changes of serum inflammatory factors in depression

BACKGROUND Depression is a common and serious psychological condition,which seriously affects individual well-being and functional ability.Traditional treatment methods include drug therapy and psychological counseling;however,these methods have different degrees of side effects and limitations.In recent years,nonconvulsive electrotherapy(NET)has attracted increasing attention as a noninvasive treatment method.However,the clinical efficacy and potential mechanism of NET on depression are still unclear.We hypothesized that NET has a positive clinical effect in the treatment of depression,and may have a regulatory effect on serum inflammatory factors during treatment.AIM To assess the effects of NET on depression and analyze changes in serum inflammatory factors.METHODS This retrospective study enrolled 140 patients undergoing treatment for depression between May 2017 and June 2022,the observation group that received a combination of mindfulness-based stress reduction(MBSR)and NET treatment(n=70)and the control group that only received MBSR therapy(n=70).The clinical effectiveness of the treatment was evaluated by assessing various factors,including the Hamilton Depression Scale(HAMD)-17,self-rating idea of suicide scale(SSIOS),Pittsburgh Sleep Quality Index(PSQI),and levels of serum inflammatory factors before and after 8 wk of treatment.The quality of life scores between the two groups were compared.Comparisons were made using t and χ^(2) tests.RESULTS After 8 wk of treatment,the observation group exhibited a 91.43%overall effectiveness rate which was higher than that of the control group which was 74.29%(64 vs 52,χ^(2)=7.241;P<0.05).The HAMD,SSIOS,and PSQI scores showed a significant decrease in both groups.Moreover,the observation group had lower scores than the control group(10.37±2.04 vs 14.02±2.16,t=10.280;1.67±0.28 vs 0.87±0.12,t=21.970;5.29±1.33 vs 7.94±1.35,t=11.700;P both<0.001).Additionally,there was a notable decrease in the IL-2,IL-1β,and IL-6 in both groups after treatment.Furthermore,the observation group exhibited superior serum inflammatory factors compared to the control group(70.12±10.32 vs 102.24±20.21,t=11.840;19.35±2.46 vs 22.27±2.13,t=7.508;32.25±4.6 vs 39.42±4.23,t=9.565;P both<0.001).Moreover,the observation group exhibited significantly improved quality of life scores compared to the control group(Social function:19.25±2.76 vs 16.23±2.34;Emotions:18.54±2.83 vs 12.28±2.16;Environment:18.49±2.48 vs 16.56±3.44;Physical health:19.53±2.39 vs 16.62±3.46;P both<0.001)after treatment.CONCLUSION MBSR combined with NET effectively alleviates depression,lowers inflammation(IL-2,IL-1β,and IL-6),reduces suicidal thoughts,enhances sleep,and improves the quality of life of individuals with depression.

Effects of Lycium barbarum polysaccharide on cytokines in adolescents with subthreshold depression:a randomized controlled study

Strong evidence has accumulated to show a correlation between depression symptoms and inflammatory responses.Moreover,anti-inflammatory treatment has shown partial effectiveness in alleviating depression symptoms.Lycium barbarum polysaccharide(LBP),derived from Goji berries,exhibits notable antioxidative and anti-inflammatory properties.In our recent double-blinded randomized placebo-controlled trial,we found that LBP significantly reduced depressive symptoms in adolescents with subthreshold depression.It is presumed that the antidepressant effect of LBP may be associated with its influence on inflammatory cytokines.In the double-blinded randomized controlled trial,we enrolled 29 adolescents with subthreshold depression and randomly divided them into an LBP group and a placebo group.In the LBP group,adolescents were given 300 mg/d LBP.A 6-week follow up was completed by 24 adolescents,comprising 14 adolescents from the LBP group(15.36±2.06 years,3 men and 11 women)and 10 adolescents from the placebo group(14.9±1.6 years,2 men and 8 women).Our results showed that after 6 weeks of treatment,the interleukin-17A level in the LBP group was lower than that in the placebo group.Network analysis showed that LBP reduced the correlations and connectivity between inflammatory factors,which were associated with the improvement in depressive symptoms.These findings suggest that 6-week administration of LBP suppresses the immune response by reducing interleukin-17A level,thereby exerting an antidepressant effect.

The Association of Insight and Change in Insight with Clinical Symptoms in Depressed Inpatients

背景:自知力缺乏已经被广泛的研究并且发现与精神分裂症患者受损的治疗依从性和长期临床治疗效果较差相关,但是很少研究表明这种现象也存在于严重的抑郁症患者中。目的:探讨情感障碍、需要住院治疗的最严重的情感障碍患者的自知力及其与症状变化之间的关系。方法:根据ICD-10诊断标准从中国南部的一家大型精神科医院纳入了住院抑郁症患者(MDD)(N=55)或双相抑郁症患者(BD)(N=85),在他们住院一周和出院时采用自知力与治疗态度问卷(ITAQ)进行评估。同时也采用汉密尔顿抑郁量表(HAMD-17)和症状自评量表抑郁量表(SCL-90)测量临床症状。在对病人及其家属的访谈中,记录了住院时间、疾病持续时间、未治疗情绪紊乱的持续时间、既往抑郁发作次数、和以往的抑郁症入院记录。采用二分类相关分析和多元回归分析来研究社会人口学特征、临床症状、和临床病史与入院时自知力之间的相关性。对临床症状的变化和从入院到出院之间自知力的变化之间的关系也进行了研究。结果:多元逐步回归模型显示既往的抑郁症入院记录和HAMD-17中较高的焦虑因子分都是自知力的显著独立预测因素,占方差的22.9%。ITAQ的多元回归分析残差变化得分(基线值矫正后的评分变化)显示平均住院超过51天对自知力的改善与精神发育迟滞因子负相关,占方差的9.1%。结论:较严重的焦虑症状和抑郁症的既往住院史与入院时自知力方面的疾病有关。治疗期间运动迟缓症状的减轻与出院时间对自知力较大的改善之间是相关的。入院时病情更严重并且精神发育迟滞改善更大的患者表现出最大的自知力。

对成人精神分裂症患者使用二甲双胍治疗由氯氮平所致的体重增加:一项meta分析（英文）

背景:精神分裂症患者长期使用氯氮平易出现代谢综合征,尤其是抗精神病药物引起的体重增加。既往研究表明,二甲双胍可以减少由氯氮平引起的体重增加,但大多数研究的样本量相对较小。方法:通过检索多个中英文数据库,我们检索出在2015年12月15日之前发表的关于对成年精神分裂症患者使用二甲双胍治疗由氯氮平引起的体重增加的随机对照试验(randomized controlled trial,RCT)。两位研究者独立进行筛选和数据提取。我们使用RevM an5.3软件进行Meta分析与偏倚风险评估,并采用Cochrane GRADE(Cochrane Grades of Recommendation,Assessment,Development,and Evaluation)来评估证据质量。结果:共纳入六项研究(合并样本量:2治疗组207例、对照组207例),其中三项研究是双盲、安慰剂对照的RCT,另三项RCT未在对照组中使用安慰剂,也未使用盲法。meta分析发现,与对照组相比服用二甲双胍的患者体重减轻更为显著(MD=-2.89,95%CI:-4.20 to-1.59),并且体质量指数(body mass index,BMI)的降低也更为显著(MD=-0.81,95%CI:-1.16 to-0.45),但两组不良反应的发生率之间无统计学差异。根据GRADE量表,关于体重结果变化的证据强度为"中等",而关于BMI指数变化的证据强度是"高",但关于组间不良反应差异的证据强度是"低"或"非常低"。结论:对成年精神分裂症患者使用二甲双胍辅助治疗可能对治疗由氯氮平引起的体重增加和BMI指数上升是有效的。然而,有关该治疗安全性的证据质量很低,现有研究的随访时间比较短,有一半的研究并没有对结果的进行盲法评估。我们需要进行更大样本量的研究,控制安慰剂效应并随访患者至少24周,且对一系列相关结果要进行盲法评估(体重、BMI指数、血脂、胰岛素抵抗等),从而来证实这些结果。

Physical restraints:An ethical dilemma in mental health services in China

Given that physical restraints cause adverse effects to patients and nurses,their wide and frequent use has resulted in various clinical and ethical controversies in mental health services.The rate of physical restraints is significantly higher in China than in other countries.Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients.Therefore,this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China.This study synthesized the ethical issue according to the ethical principle of autonomy,justice,beneficence,and nonmaleficence.Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China,applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial.In regard to respect the basic rights of psychiatric patients,it is recommended to protect the their autonomy,and eliminate the adverse effects of physical restraint.This goal would be achieved by ensuring the informed consent,providing humane care,and regulating the implementation of physical restraints.

Efficacy of Lycium barbarum polysaccharide in adolescents with subthreshold depression: interim analysis of a randomized controlled study

Subthreshold depression is a highly prevalent condition in adolescents who are at high risk for developing major depressive disorder.In preclinical models of neurological and psychiatric diseases,Lycium barbarum polysaccharide(LBP)extracted from Goji berries had antidepressant effects including but not limited to anti-oxidative and anti-inflammatory properties.However,the effect of LBP on subthreshold depression is unclear.To investigate the clinical efficacy and safety of LBP for treating subthreshold depression in adolescents,we conducted a randomized,double-blind,placebo-controlled trial(RCT)with 29 adolescents with subthreshold depression recruited at The Fifth Affiliated Hospital of Guangzhou Medical University.The participants were randomly assigned to groups where they received either 300 mg LBP(LBP group,n=15,3 boys and 12 girls aged 15.13±2.17 years)or a placebo(placebo group,n=14,2 boys and 12 girls aged 15±1.71 years)for 6 successive weeks.Interim analyses revealed that the LBP group exhibited a greater change in Hamilton Depression Scale(HAMD-24)scores relative to the baseline and a higher remission rate(HAMD-24 total score≤7)at 6 weeks compared with the placebo group.Scores on the Beck Depression Inventory-II(BDI-II),Pittsburgh Sleep Quality Index(PSQI),Kessler Psychological Distress Scale(Kessler),and Screen for Child Anxiety-Related Emotional Disorders(SCARED)were similar between the LBP and placebo groups.No side effects related to the intervention were reported in either group.These results indicate that LBP administration reduced depressive symptoms in adolescents with subthreshold depression.Furthermore,LBP was well tolerated with no treatment-limiting adverse events.Clinical trials involving a larger sample size are needed to further confirm the anti-depressive effects of LBP in adolescents with subthreshold depression.This study was approved by the Medical Ethics Committee of the Fifth Affiliated Hospital of Guangzhou Medical University(Guangzhou,China;approval No.L2019-08)on April 4,2019 and was registered on ClinicalTrials.gov(identifier:NCT04032795)on July 25,2019.

Adjunctive melatonin for tardive dyskinesia in patients with schizophrenia： a meta-analysis

背景:迟发性运动障碍(TD)的临床特征是异常不自主运动。TD具有严重的不可逆的致残性和社会功能损害。目的 :此荟萃分析基于随机对照试验(RCTs)文献系统评估褪黑素对精神分裂症患者迟发性运动障碍的临床疗效和安全性。方法 :两位独立评估者从以下数据库对相关的临床随机对照试验(RCT)文献进行检索(万方数据、中国知网(CNKI)、中国生物医学文摘数据库和PubM ed、PsycI NFO、Embase、Cochrane Library数据库),检索时间截止于2017年6月8日。以TD症状严重程度为主要结局指标,采用Rev Man 5.3版本进行统计分析,对RCTs的质量评估采用Cochrane风险评估偏倚和Jadad量表来评估各种偏倚的风险性。采用GRADE(Grades of Recommendation,Assessment,Development,and Evaluation)系统推荐分级方法对meta-分析结果的整体证据质量水平进行分级评价。结果 :最终筛选确定4个RCTs(n=130)。3个RCTs采用双盲法,1个RCT单盲,根据Cochrane风险评估偏倚和Jadad量表显示3个RCTs的疗效评估指标的证据质量被评定为"高质量"。与对照组相比,根据不自主运动量表(AIMS)评定褪黑素可改善TD严重程度(4个RCTs,n=130,加权平均差值(WMD):-1.52(95%CI:-3.24,0.20),p=0.08;I2=0%),但尚没有达到显著差异。根据等级方法,改善TD症状的meta分析结果的整体证据质量被评为"低",而关于不良反应和认知损害方面则数据太少。结论 :荟萃分析表明,褪黑素或可改善精神分裂症TD症状。但仍有待今后更高质量和更大样本的RCTs验证。

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。

太极拳治疗精神分裂症:系统综述（英文）

背景:太极拳起源于中国,是一种适度的有氧运动,可促进身心的平衡和康复。这一运动已用作精神分裂症患者的辅助治疗。然而,还没有关于太极拳辅助治疗精神分裂症患者的meta分析或系统综述的报告。目的:用随机对照试验(RCT)的数据进行系统综述和meta分析来检验太极拳辅助治疗精神分裂症患者的疗效。方法:两位评估者各自系统地检索中英文数据库中用太极拳治疗精神分裂症患者的RCT研究,并进行研究项目的选择、数据提取、质量评估和数据合并。采用Review Manager(版本5.3)进行统计分析。采用推荐分级的评估、制定与评价(Cochrane Grades of Recommendation,Assessment,Development,and Evaluation,GRADE)来评估证据的强度。结果:在中国大陆和香港进行的6项RCTS研究中,共有483名参与者,其中干预组215例,对照组268例。试验平均持续16.0(6.2)周。我们发现在研究期间,干预组阴性症状改善情况与对照组相比有显著差异[5项试验,6个治疗组,n=451,SMD:-0.87(95%CI:-1.51,-0.24),p=0.007;I2=90%],其中2项研究用阳性和阴性症状量表(PANSS)中的阴性症状分量表评估,另外3项用阴性症状评定量表(SANS)评估。此外,研究期间研究组与对照组间阳性症状的改善没有显著性差异[4项试验,5个治疗组,n=391,SMD:-0.09(95%CI:-0.44,0.26),p=0.60;I2=65%],其中2项研究用PANSS阳性症状分量表评估,2项用阳性症状评定量表(SAPS)。所有纳入的RCT研究均未报告不良反应。根据GRADE评估,主要结局指标的证据强度"很低"。结论:抗精神病药辅以太极拳治疗精神分裂症患者的疗效的数据尚不足,难于得出该疗效如何的明确结论。此外,纳入研究的随访时间相对较短,所有的研究评估结局指标时都没有使用盲法。需要有高质量的随机试验才能做出临床建议。

Attitude and practice toward physical restraint among psychiatric nurses in Guangdong,China:a cross-sectional survey

Objective:To explore the correlation between nurses’attitude and practice toward physical restraint(PR)in psychiatric settings and identify the factors that influence the use of PR.Methods:A cross-sectional survey was conducted.A self-designed questionnaire containing a PR scale was used to assess the attitude and practice of registered psychiatric nurses in Guangdong,China,from November 1,2018 to December 31,2018.Descriptive statistics,the Mann–Whitney U test,the Kruskal–Wallis test,and ordinal regression analysis were used to analyze the data.Results:The response rate was 74.6%.The nurses’responses showed neutral attitude and a moderate level of practice regarding the use of PR.Factors such as age,gender,marital status,professional position,nightshift,and the frequency of training programs on PR showed a significant association with nurses’attitude and practice concerning PR(P<0.05).In addition to these factors,this study found that the practice of PR was associated with nurses’attitude toward it(P<0.05).Our results showed that nurses with a largely negative attitude toward PR were more likely to use it(OR=1.91,P<0.001).Conclusions:Clinically,psychiatric nurses with negative attitude are more likely to practice PR.Training and education programs are highly recommended for nursing managers to change the nursing staff’s attitude,since their attitude may have an impact on the PR what they practice.

石杉碱甲对重度抑郁症患者认知功能障碍的治疗:一项随机对照试验的系统综述（英文）

背景:乙酰胆碱酯酶(Acetylcholinesterase,AChE)抑制剂在重性抑郁障碍(Major Depressive Disorder,MDD)的动物模型和人类患者中已被证实可以有效地治疗认知障碍。石杉碱甲(Huperzine A,HupA)是一种来自于被称为蛇足石杉(Huperzineserrata)的石松属传统中医药,是一种强有力的AChE抑制剂,已被用于抑郁症的辅助治疗,但有尚无关石杉碱甲对MDD的强化治疗作用的meta分析。目标:对有关石杉碱甲强化治疗抑郁症的随机对照试验进行系统综述和meta分析,评估其疗效及安全性。方法:两位评估者独立检索9个英文和中文数据库,选择符合预先确定的纳入标准的相关研究,提取有关疗效和安全性的数据,并进行质量评估和数据拟合合成。结果:纳入了三项中国低质量的随机对照试验(总共n=238),这些试验比较了单用抗抑郁药治疗抑郁症与抗抑郁药和石杉碱甲的联合治疗,试验中的被试从16岁到60岁。研究中石杉碱甲辅助抗抑郁药治疗的平均时间仅为6.7周。这三项研究都是公开标签未使用盲法,所以他们的总体质量评定为差。总体样本的Meta分析发现两组抑郁症状的改善没有显著性差异(差异加权差为-1.90,95%CI可信区间为-4.23至0.44,p=0.11)。然而,石杉碱甲辅助治疗组比单用抗抑郁药治疗组在认知功能和生活质量方面有显著改善(如威斯康星卡片分类测验、韦氏记忆量表修订的评估)。组间药物不良反应的发生率无显著性差异。结论:有关在接受抗抑郁药的MDD患者使用HupA辅助治疗的疗效和安全性的可获取数据不足,难以得出有关其疗效和安全性的明确结论。汇集国内3项低质量的RCT数据没有发现采用辅助使用HupA治疗抑郁症状的优势,但辅助使用HupA与更快改善经常伴随MDD出现的认知症状相关。

Self-experience of buried seeds at auricular points in depressive patients with sleep disorder: a qualitative research

Objective To explore the self-experience of burying seeds at auricular points in depressive patients with sleep disorder,so as to seek possible approaches to improve the quality of care.Methods Eleven patients involved in a three-week randomized controlled clinical trial were purposefully interviewed by the experienced,qualified counselor.The process of thematic analysis was applied in this study,the self-experience was discussed and recorded,transcribed,and analyzed accordingly.Results Four themes related to self-experience were extracted,these included the deficiency in relevant support,passive acceptance,distrust,expectation and further advice.Conclusion There was an urgent demand of humane care and emotional support,which might improve compliance of the treatment to some extent in terms of health education.Additionally,medical practitioners should provide the patient with comprehensive support,professional health education,as well as standardize training program for TCM operator and control the operation’s quality.

Adjunctive aripiprazole for antipsychotic-related hyperprolactinaemia in patients with first-episode schizophrenia:a metaanalysis

Background Hyperprolactinaemia is a common antipsychotic(AP)-induced adverse effect,particularly in female patients.Aims This meta-analysis examined the efficacy and safety of adjunctive aripiprazole in preventing AP-related hyperprolactinaemia in patients with first-episode schizophrenia.Methods PubMed,PsycINFO,EMBASE,Cochrane Library,WanFang and China Journal Net databases were searched to identify eligible randomised controlled trials(RCTs).Primary outcomes were the reductions of serum prolactin level and prolactin-related symptoms.Data were independently extracted by two reviewers and analysed using RevMan(V.5.3).Weighted/standardised mean differences(WMDs/SMDs)±95%Cis were reported.Results In the five RCTs(n=400),the adjunctive aripiprazole(n=197)and the control groups(n=203)with a mean of 11.2 weeks of treatment duration were compared.The aripiprazole group had a significantly lower endpoint serum prolactin level in all patients(five RCTs,n=385;WMD:-50.43 ng/mL(95%Cl:-75.05 to-25.81),p<0.00001;l2=99%),female patients(two RCTs,n=186;WMD:-22.58 ng/mL(95%Cl:-25.67 to-19.49),p<0.00001;l2=0%)and male patients(two RCTs,n=127;WMD:-68.80 ng/mL(95%Cl:-100.11 to-37.49),p<0.0001).In the sensitivity analysis for the endpoint serum prolactin level in all patients,the findings remained significant(p<0.00001;l2=96%).The aripiprazole group was s叩erior to the control group in improving negative symptoms as assessed by the Positive and Negative Syndrome Scale(three RCTs,n=213;SMD:-0.51(95%Cl:-0.79 to-0.24),p=0.0002;l2=0%).Adverse effects and discontinuation rates were similar between the two groups.Conclusions Adjunctive aripiprazole appears to be associated with reduced AP-induced hyperprolactinaemia and improved prolactin-related symptoms in first-episode schizophrenia.Further studies with large sample sizes are needed to confirm these findings.

Altered heartbeat perception sensitivity associated with brain structural alterations in generalised anxiety disorder

Background Palpitation is a common complaint in generalised anxiety disorder(GAD).Brain imaging studies have Investigated the neural mechanism of heartbeat perception in healthy volunteers.This study explored the neuroanatomical differences of altered heartbeat perception in patients with GAD using structural MRI.Aims Based on the strong somatic-interoceptive symptoms in GAD,we explored the regional structural brain abnormalities involved in heartbeat perception in patients with GAD.Methods This study was applied to the a priori regions using neuroanatomical theories of heartbeat perception,including the insula,anterior cingulate cortex,supplementary motor area and prefrontal cortex.A total of 19 patients with GAD and 19 healthy control subjects were enrolled.We used the FMRIB Software Library voxel-based morphometry software for estimating the grey matter volume of these regions of interest and analysed the correlation between heartbeat perception sensitivity and the volume of abnormal grey matter.Results Patients with GAD showed a significantly decreased volume of grey matter in their left medial prefrontal cortex,right orbital frontal cortex and anterior cingulate cortex.The grey matter volume of the left medial prefrontal cortex negatively correlated with heartbeat perception sensitivity in patients with GAD.Conclusions It should be the first study that shows heartbeat perception is associated with brain structure in GAD.Our findings suggest that the frontal region may play an important role in aberrant heartbeat perception processing in patients with GAD,and this may be an underlying mechanism resulting in the abnormal cardiovascular complaints in GAD.This is hypothesised as a'top-down'deficiency,especially in the medial prefrontal cortex.This will provide the foundation for a more targeted region for neuromodulation intervention in the future.

Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia:a meta-analysis of randomised controlled trials

Background Hyperprolactinaemia is a common adverse effect of antipsychotics(APs). The results of PeonyGlycyrrhiza decoction(PGD) as a potentially useful adjunctive treatment for hyperprolactinaemia are inconsistent.Aim This meta-analysis of randomised controlled trials(RCTs) examined the efficacy and safety of adjunctive PGD therapy for AP-induced hyperprolactinaemia.Methods English(PubMed, Embase, Cochrane Library,PsycINFO) and Chinese(Chinese National Knowledge Infrastructure, Wanfang Data) databases were systematically searched up to 10 June 2018. The inclusion criteria were based on PIC0 S一/^rticipants: adult patients with schizophrenia; Aitervention: PGD plus APs; Cbmparison: APs plus placebo or AP monotherapy;(Xjtcomes: efficacy and safety; Study design: RCTs. The weighted mean difference(WMD) and risk ratio(RR) along with their 95% CIs were calculated using Review Manager(RevMan) V.5.3 software.Results Five RCTs(n=450) were included and analysed.Two RCTs(n=140) were double-blind and four RCTs(n=409) reported ‘random' assignment with specific description. The PGD group showed a significantly lower serum prolactin level at endpoint than the control group(n=380, WMD:-32.69 ng/mL(95% Cl-41.66 to 23.72),/X0.00001, ^=97%). Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale(n=403,WMD:-0.62(95% Cl-2.38 to 1.15), p=0.49, ^=0%). There were similar rates of all-cause discontinuation(n=330, RR0.93(95% Ci 0.63 to 1.37),/t=0.71, ^=0%) and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low'(14.3%),‘low'(42.8%),‘moderate'(14.3%),to ‘high,(28.6%>.Conclusions Current evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactininduced symptoms without significant adverse events in adult patients with AP-induced hyperprolactinaemia. Highquality RCTs with longer duration are needed to confirm these findings.Trial registration number 42016037017.

对精神分裂症患者血脂异常的瑞舒伐他汀辅助治疗的疗效与安全性的的Meta分析（英文）

背景:精神分裂症患者的代谢综合征是一个重要的健康问题。瑞舒伐他汀对血脂异常的辅助性治疗的有效性和安全性存在争议。目的:评价瑞舒伐他汀对精神分裂症患者血脂异常的辅助性治疗的有效性和安全性。方法:我们从以下数据库中系统地检索了2017年9月28日以前相关的临床对照试验:Pub Med、Psyc INFO、Cochrane图书馆、中国知网、万方数据库、中国生物医学文献数据库。我们计算了标准平均差(SMD)、风险比(RR)及其95%的可信区间(CIs)。使用偏移评估工具中的Cochrane风险评估来评价所纳入研究的质量。并采用GRADE系统推荐的等级方法(推荐、评估、发展、评价的等级)作为参照标准。结果:确认和分析了4项比较瑞舒伐他汀组(n=138)和对照组(n=136)的研究(n=274)。瑞舒伐他汀辅助治疗显示对低密度脂蛋白胆固醇(LDL-C)[4项试验,n=272,SMD:-1.31(95%CI:-1.93,-0.70),I^2=81%]、总胆固醇(2项试验,n=164,SMD:-2.00(95%CI:-2.79,-1.21);I^2=76%)、和甘油三酯(2项试验,n=164,SMD:-1.05(95%CI:-1.38,-0.72);I^2=0%)的疗效比对照组更有效,但对高密度脂蛋白胆固醇(2项试验,n=164,SMD:0.14(95%CI:-0.16,0.45);I^2=0%)的疗效没有显著差异。去除一项没有随机试验的LDL-C研究之后,显著差异仍然存在[3项试验,n=172,SMD:-1.07(95%CI:-1.60,-0.53);I^2=63%]。体重(3项试验,n=208,SMD:-0.40(95%CI:-1.29,0.49);I^2=89%)、身体质量指数(2项试验,n=164,SMD:-0.34(95%CI:-1.23,0.56);I^2=87%)、腰围(3项试验,n=208,SMD:-0.43(95%CI:-1.31,0.46);I^2=89%)、空腹血糖(4项试验,n=272,SMD:-0.25(95%CI:-0.65,0.15);I^2=62%)方面组间没有显著的差异。两组之间的不良反应及停药率相近。根据GRADE分级方法,主要结果的证据水平低被评为"非常低"(35.3%)到"低"(64.7%)。其中,主要结果(LDL-C)被评为"非常低"。结论:对精神分裂症患者血脂异常的瑞舒伐他汀辅助性治疗的现有数据尚不足以对其有效性和安全性做出明确的解释。需进一步针对高质量的延长治疗时间的随机对照试验来验证该结论。

Ethical consideration on use of seclusion in mental health services

Seclusion was widely used in mental health service,which had caused various negative effects on patients and nurses.In China,the clinical use of seclusion was gradually increasing,which had led to ethical dilemma and had gained public concern.This article aimed to synthesize the ethical issue according to the principle of autonomy,justice,beneficence,and non-maleficence.Given that nursing workforce was limited and work burden among psychiatric nurses was heavy,seclusion was one of coercive interventions managing aggressive behavior.In relation to cope with ethical dilemma,it was proposed to improve therapeutic environment,and to apply de-escalation technique.Additionally,reducing clinical use and adverse effects of seclusion was also important,this goal would be achieved by building appropriate patient-nurse relationship,increasing staff engagement,and promoting guideline of seclusion.

CircFhit Modulates GABAergic Synaptic Transmission via Regulating the Parental Gene Fhit Expression in the Spinal Dorsal Horn in a Rat Model of Neuropathic Pain

Effective treatments for neuropathic pain are lacking due to our limited understanding of the mechanisms.The circRNAs are mainly enriched in the central nervous system.However,their function in various physiological and pathological conditions have yet to be determined.Here,we identified circFhit,an exon-intron circRNA expressed in GABAergic neurons,which reduced the inhibitory synaptic transmission in the spinal dorsal horn to mediate spared nerve injury-induced neuropathic pain.Moreover,we found that circFhit decreased the expression of GAD65 and induced hyperexcitation in NK1R^(+) neurons by promoting the expression of its parental gene Fhit in cis.Mechanistically,circFhit was directly bound to the intronic region of Fhit,and formed a circFhit/HNRNPK complex to promote Pol II phosphorylation and H2B monoubiquitination by recruiting CDK9 and RNF40 to the Fhit intron.In summary,we revealed that the exon-intron circFhit contributes to GABAergic neuron-mediated NK1R^(+) neuronal hyperexcitation and neuropathic pain via regulating Fhit in cis.

An Overview of the Expert Consensus on the Prevention and Treatment of Gaming Disorder in China(2019 Edition)

Gaming disorder has gained considerable attention worldwide,including in China[1],where epidemiological surveys have found that its prevalence is as high as 17%[2].The Bureau of Disease Control and Prevention run by the National Health and Health Commission in China recently released an expert consensus[2]that systematically describes the definition,clinical presentation,assess-assessment,diagnosis,treatment,rehabilitation,and related areas of gaming disorder.

The Role of Frontal and Occipital Cortices in Processing Sustained Visual Attention in Young Adults with Attention-Deficit/Hyperactivity Disorder:A Functional Near-Infrared Spectroscopy Study

Dear Editor,Attention deficit/hyperactivity disorder(ADHD),characterized by age-inappropriate symptoms of inattention,hyperactivity,and impulsivity,is a highly prevalent and heritable childhood-onset neurodevelopmental disorder,with impairing symptoms that persist into adulthood in up to 65%of patients[1].Adults with persistent ADHD symptoms since childhood have been found to have neurocognitive impairments in multiple domains,especially in attention and cognitive control,which significantly contribute to an increased risk of social disability,educational and occupational failure,and other comorbid psychiatric disorders,resulting in significant economic burdens to the affected individuals, their families, andsociety [2, 3].