Using machine learning to identify factors related to nitrous oxide(laughing gas)relapse among adolescents

Introduction Nitrous oxide(N2O/laughing gas)has been used in medical practice as an inhalational anaesthetic and analgesic for more than 150 years.1 In the past decades,N2O exhibited increasing popularity among recreational drug users for its euphoric effects,potentially through its interaction with the endogenous opioid system.2 Recreational use of N2O emerged as the seventh most used drug globally in the past decade.3 The use of N2O can cause myelopathy,myocardial injury,anaemia,severe mood disorders,sensory and motor neuropathy,and psychotic symptoms.45 Prolonged N2O intake results in vitamin B12 deficiency and inhibits methionine synthetase,folate and DNA production,leading to plasma homocysteine(HCY)level elevation and bone marrow haematopoietic dysfunction.6 This study aimed to investigate the neurological symptoms of nitrous oxide use and then explore the relapse trajectory and risk factors for relapse.

Case series associated with COVID-19 pandemic in causing psychiatric morbidity

The COVID-19 has emerged as a public health emergency across the globe.Countries all over the world have been forced to enforce nationwide lockdowns to curb the transmission of this illness,affecting millions of people.The disorder and the lockdowns enforced have resulted in a complex set of psychosocial stressors in the lives of people,affecting their resilience and causing psychological stress and mental health issues.In this case series,we aim to highlight the role of such psychosocial stressors in causing mental health problems,especially in a vulnerable individual.The first case reports the onset of first-episode mania in a healthy individual with a family history of mental illness,after the sudden demise of the patient’s mother due to COVID-19.The second case highlights the onset of psychosis in an adolescent girl following academic stress due to the inability to carry on her education through online classes.The third case demonstrates the exacerbation of dissociative episodes in a child following the financial crisis in the family during the lockdown period.In low-income to middle-income countries such as India,there is a complex interplay of the psychosocial stressors due to the COVID-19 pandemic with pre-existing issues such as poverty,socioeconomic disparity and inequity of resources leading to a‘double hit’for people from disadvantaged sections of the society and individuals with pre-existing mental illness or vulnerability for mental illness.

Increased plasma leptin as a novel predictor for psychopathological depressive symptoms in chronic schizophrenia

Background Depressive symptoms are often seen in schizophrenia. The overlap in presentation makes it difficult to distinguish depressive symptoms from the negative symptoms of schizophrenia. The adipokine leptin was found to be altered in both depression and schizophrenia. There are few studies focusing on the prediction of leptin in diagnosis and evaluation of depressive symptoms in schizophrenia.ObjectiveAims To assess the plasma leptin level in patients with schizophrenia and its relationships with depressive symptoms.Methods Cross-sectional studies were applied to(1) compare the levels of plasma leptin between schizophrenia(n=74) and healthy controls(n=50); and(2)investigate the relationship between plasma leptin levels and depressive subscores.Results(1) Plasma leptin levels were significantly higher in patients with schizophrenia than in healthy controls.(2) Correlation analysis revealed a significant negative association between leptin levels and the depressed factor scores on the Positive and Negative Syndrome Scale(PANSS).(3) Stepwise multiple regression analyses identified leptin as an influencing factor for depressed factor score on PANSS.Conclusion Leptin may serve as a predictor for the depressive symptoms of chronic schizophrenia.

Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults:a competing risk analysis

Background Depressive symptoms and cognitive impairment often interact,rendering their associations controversial.To date,their joint trajectories and associations with dementia and death remain underexplored.Aims To explore the interactions between depressive symptoms and cognitive function,their developmental trajectories and the associations with all-cause dementia,Alzheimer’s disease(AD)and all-cause death in older adults.Methods Data were from the Health and Retirement Study.Depressive symptoms and cognitive function were measured using the 8-item Centre for Epidemiologic Studies Depression Scale and the Telephone Interview of Cognitive Status,respectively.All-cause dementia and AD were defined by self-reported or proxy-reported physician diagnoses.All-cause death was determined by interviews.The restricted cubic spline,group-based trajectory modelling and subdistribution hazard regression were used.Results Significant interactions between depressive symptoms and cognitive function in 2010 in their association with new-onset all-cause dementia and AD from 2010 to 2020 were found,especially in women(p for interaction<0.05).Independent trajectory analysis showed that emerging or high(vs no)depressive trajectories and poor or rapidly decreased cognitive trajectories(vs very good)from 1996 to 2010 were at significantly higher risk of subsequent all-cause dementia,AD and all-cause death.15 joint trajectories of depressive symptoms and cognitive function from 1996 to 2010 were determined,where rapidly decreased cognitive function was more common in those with no depressive symptoms.Compared with older adults with the trajectory of no depressive symptoms and very good cognitive function,those with the trajectory of no depressive symptoms but rapidly decreased cognitive function were much more likely to develop new-onset all-cause dementia and death,with subdistribution hazard ratios(95%confidence intervals)of 4.47(2.99 to 6.67)and 1.84(1.43 to 2.36),especially in women.Conclusions To effectively mitigate the risk of dementia and death,it is crucial to acknowledge the importance of preventing cognitive decline in older adults without depressive symptoms,particularly in women.

Acute and delayed psychiatric sequelae among patients hospitalised with COVID-19:a cohort study using LIFE study data

Background Characterising the psychiatric sequelae of coronavirus disease 2019(COVID-19)can inform the development of long-term treatment strategies.However,few studies have examined these sequelae at different time points after COVID-19 infection.Aims The study aimed to investigate the incidences and risks of acute and delayed psychiatric sequelae in patients hospitalised with COVID-19 in Japan.Methods This retrospective cohort study was conducted using a database comprising healthcare claims data from public health insurance enrollees residing in a Japanese city.We analysed a primary cohort comprising patients hospitalised with COVID-19 between March 2020 and July 2021 and two control cohorts comprising patients hospitalised with influenza or other respiratory tract infections(RTI)during the same period.We calculated the incidences of acute(1–3 months after infection)and delayed(4–6 months after infection)psychiatric sequelae.These sequelae were identified using diagnosis codes and categorised as mood/anxiety/psychotic disorder,mood disorder,anxiety disorder,psychotic disorder or insomnia.Multivariable logistic regression models were used to estimate the odds ratios(ORs)of psychiatric sequelae occurrence after COVID-19 infection compared with influenza and other RTI.Results The study population with acute psychiatric sequela consisted of 662 patients with COVID-19,644 patients with influenza,and 7369 patients with RTI who could be followed for 3 months;the study population with delayed psychiatric sequelae consisted of 371 patients with COVID-19,546 patients with influenza,and 5397 patients with RTI who could be followed for 6 months.In the analysis of acute psychiatric sequelae,COVID-19 had significantly higher odds of mood/anxiety/psychotic disorder(OR:1.39,p=0.026),psychotic disorder(OR:2.13,p<0.001),and insomnia(OR:2.59,p<0.001)than influenza,and significantly higher odds of insomnia(OR:1.44,p=0.002)and significantly lower odds of anxiety disorder(OR:0.56,p<0.001)than other RTI.In the analysis of delayed psychiatric sequelae,COVID-19 had significantly higher odds of psychotic disorder(OR:2.25,p=0.007)than influenza,but significantly lower odds of anxiety disorder(OR:0.55,p=0.011)than other RTI.Conclusions COVID-19 was generally associated with an increased risk of psychiatric sequelae occurring within 3 months after infection,but had a lower risk of new psychiatric sequelae developing 4–6 months after infection.

Psychometric properties of the Urdu version of the Hospital Anxiety and Depression Scale(HADS)among pregnant women in Abbottabad,Pakistan

Background The Hospital Anxiety and Depression Scale(HADS)is a widely used instrument to measure anxiety and depression symptoms.Aims This study aimed to translate,validate and test the applicability of the Urdu version of the Hospital Anxiety and Depression Scale(HADS/UV)among pregnant women.Methods The original English version of the HADS was translated into Urdu by three bilingual experts and retranslated to English using the forward-backward approach.The questionnaire was administered to a sample of 200 pregnant women availing obstetrics and gynaecology services for routine prenatal checkups of Ayub Teaching Hospital,Abbottabad,Pakistan.Psychometric properties of the instrument,including reliability(internal consistency,test-retest analysis and interitems correlation),were tested.Face and content validity were also assessed.Content Validity Index(CVI)was determined using the average approach and ItemLevel Content Validity Index(I-CVI)and Scale-Level Content Validity Index(S-CVI)were calculated accordingly.Construct validity was examined through exploratory factor analysis.Results Cronbach's alpha coefficient has been found to be 0.82 for the anxiety subscale and 0.64 for the depression subscale,while overall alpha of the HADS/UV is 0.84.The Urdu version is content valid,and the SCVI of anxiety subscale,depression subscale and HADS/UV are 0.947,948 and 0.947,respectively.Test-retest reliability is 0.884 and 0.934 as measured by Pearson correlation and intraclass correlation,respectively.HADS/UV items correlated positively with the whole scale(p<0.001).Factor analysis with varimax rotation revealed that two factors explained 42.75%of the variance.Items'distribution was quite similar to the original HADS.Conclusion The HADS/UV is a psychometrically sound instrument with satisfactory measurement,including good internal consistency.The instrument shows promise to be a sound tool to assess anxiety and depression in pregnancy.

General Psychiatry Highlights

In issues 2 and 3, some interesting and popular topics are presented and they may inspire new ideas in psychiatric research. A systematic review conducted by Dr Chen and her colleagues has drawn much attention to the worldwide media, that it was positive to treat anxiety symptoms by regulating intestinal flora (RIF).

Determination of venlafaxine and its active metabolite O-desmethylvenlafaxine in human plasma by HPLC fluorescence

Background Therapeutic drug monitoring guides clinical individualised medication by measuring plasma concentration, which could improve the curative effect, avoid drug overdose and reduce the incidence of adverse reactions. At present, there are few reports on the clinical detection of venlafaxine and its active metabolite O-desmethylvenlafaxine. In this paper, the detection method of venlafaxine and O-desmethylvenlafaxine in blood plasma was established, which provides an effective and convenient means for guiding clinical application of medication.Aim To establish a method for determination of venlafaxine and its active metabolite O-desmethylvenlafaxine in human plasma by highperformance liquid chromatography with fluorescence detection.Methods Chromatographic separation was achieved on an Agilent Eclipse XDB-C18 Column(4.6 × 150 mm, 5 μm) with water containing sodium dihydrogen phosphate(0.05 mol/L) and acetonitrile(72:28) as the mobile phases. The following parameters were employed: flow rate 0.5 mL/min, column temperature 30°C, fluorescence excitation wavelength 276 nm and emission wavelength 598 nm.Results The method showed good linearity in the concentration range 10–1000 ng/mL. The regression equation for venlafaxine was R=0.0054 C+0.0264, r2=0.99991. The regression equation for O-desmethylvenlafaxine was R=0.0034 C+0.0272, r2=0.99969. The intraday and interday precisions(relative SD) were less than 10%, and the quantitative limit was 10 ng/mL.Conclusion We established a sensitive, specific and simple method for the detection of venlafaxine and O-desmethylvenlafaxine. This method fully meets the needs of clinical trials of venlafaxine and the requirements of relevant guidelines. It provided a reference for the clinical detection of venlafaxine and O-desmethylvenlafaxine plasma concentrations and pharmacokinetic study.

Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty:a prospective,double-blind,pilot,randomised controlled trial

Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.

Sexual dysfunction and associated factors in Thai patients with psychiatric disorders

Background Sexual dysfunction is common among patients with psychiatric disorders but might be under-reported due to Asian sociocultural factors.Recognition of sexual dysfunction and associated factors in this vulnerable population would help clinicians properly assess and manage related conditions.Aims We aimed to examine the prevalence of sexual dysfunction and its associated factors among patients with psychiatric disorders in Thailand.Methods This was a cross-sectional study.We enrolled participants aged 18 and older who visited the psychiatry clinic at King Chulalongkorn Memorial Hospital in Bangkok,Thailand between August 2020 and December 2021.Demographic and clinical data were assessed,and all psychiatric disorders and sexual dysfunctions were diagnosed by clinical interview using the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.Statistical analysis was done to explore the association between sexual dysfunction and related factors.Results Sexual dysfunction was diagnosed in 101(50.0%)of the total 202 participants.The mean(standard deviation,SD)age was 30.2(9.0)years,and the majority of patients were men(54.5%),single(81.2%),employed(47.5%)and had a coexisting depressive disorder(48.0%).Multivariable logistic regression analysis showed a significant association between sexual dysfunction and quality of life,unemployment,and the dosage of antidepressants and benzodiazepines.Conclusions The prevalence of sexual dysfunction among this population was relatively high.However,the findings may represent only a portion of affected psychiatric patients for others with sexual dysfunction symptoms but without functional impairment did not meet the diagnostic criteria for sexual dysfunction.Improvement of quality of life and optimising antidepressant/benzodiazepine dosage should be further investigated for promoting sexual function in patients with mental disorders.

Time to treat the climate and nature crisis as one in divisible global health emergency

Over 200 health journals call on the United Nations(UN),political leaders and health professionals to recognise that climate change and biodiversity loss are one indivisible crisis and must be tackled together to preserve health and avoid catastrophe.This overall environmental crisis is now so severe as to be a global health emergency.

A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic:implications and policy recommendations

The Coronavirus Disease 2019(COVID-19)epidemic emerged in Wuhan,China,spread nationwide and then onto half a dozen other countries between December 2019 and early 2020.The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people's lives.It has also triggered a wide variety of psychological problems,such as panic disorder,anxiety and depression.This study is the first nationwide largescale survey of psychological distress in the general population of China during the COVID-19 epidemic.

HMGB1 involved in stress-induced depression and its neuroinflammatory priming role:a systematic review

Background Evidence from clinical and preclinical studies has demonstrated that stress can cause depressive-like symptoms including anhedonia and psychomotor retardation, namely, the manifestation of motivational deficits in depression. The proximate mediator of linking social-environmental stress with internal motivational deficits remains elusive, although substantial studies proposed neural endocrine mechanisms. As an endogenous danger-associated molecule, high mobility group box-1 (HMGB1) is necessary and sufficient for stress-induced sensitization of innate immune cells and subsequent (neuro)inflammation. Aim This review aims to provide evidence to unveil the potential mechanism of the relationship between motivational deficits and stress in depression. M ethods We reviewed original case-control studies investigating the association between HMGB1-mediated inflammation and stress-induced depression. The literature search of Pubmed and Web of Science electronic database from Inception up to March 28th, 2019 were conducted by two independent authors. We performed a qualitative systematic review approach to explore the correlation between HMGB1 -mediated inflammation and anhedonia/psychomotor retardation in depression. Results A total of 69 studies based on search strategy were retrieved and seven eligible studies met the inclusion criteria. Studies showed that HMGB1 was implicated with depressive-like behaviors, which are similar with motivational deficits. Furthermore, HMGB1 -mediated inflammation in depressive-like behaviors may be involved in Nod-like receptor family pyrin domain containing three (NLRP3) inflammasome and proinflammatory cytokines, abnormal kynurenine pathway and imbalance between neuroprotective and neurotoxic factors. Conclusions We found that stress-induced inflammation mediated by HMGB1 may affect motivational deficits through regulating dopamine pathway in corticostriatal neurocircuitry. The systematic review may shed light on the novel neurobiological underpinning for treatment of motivation deficits in depression.

Correlation between serum lipid profiles and cognitive impairment in old age:a cross-sectional study

Background The correlation between cognitive function and lipid profiles,including total cholesterol,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and triglycerides,is inconsistent.Aims This cross-sectional study investigated the association between serum lipid levels and the prevalence of cognitive impairment among community-dwelling older adults and explored this difference in association by gender and urban-rural residency.Methods Participants aged 65 and above in urban and rural areas were recruited between 2018 and 2020,selected from the Hubei Memory and Aging Cohort Study.Detailed neuropsychological evaluations,clinical examinations and laboratory tests were conducted in community health service centres.Multivariate logistic regression was used to analyse the correlation between serum lipid profiles and the prevalence of cognitive impairment.Results We identified 1336 cognitively impaired adults(≥65 years)-1066 with mild cognitive impairment and 270 with dementia-from 4746 participants.Triglycerides level was correlated with cognitive impairment in the total sample(χ2=6.420,p=0.011).In gender-stratified multivariate analysis,high triglycerides in males reduced the risk of cognitive impairment(OR:0.785,95%CI:0.623 to 0.989,p=0.040),and high LDL-C in females increased the risk of cognitive impairment(OR:1.282,95%CI:1.040 to 1.581,p=0.020).In both gender-stratified and urban-rural stratified multivariate analyses,high triglycerides reduced the risk of cognitive impairment in older urban men(OR:0.734,95%CI:0.551 to 0.977,p=0.034),and high LDL-C increased the risk of cognitive impairment in older rural women(OR:1.830,95%CI:1.119 to 2.991,p=0.016).Conclusions There are gender and urban-rural differences in the correlation of serum lipids with cognitive impairment.High triglycerides levels may be a protective factor for cognitive function in older urban men,while high LDL-C levels may be a risk factor for cognitive function in older rural women.

Major depressive disorder and the gut microbiome:what is the link?

Introduction Major depressive disorder(MDD)manifests by persistent depressed mood,anhedonia,changes in sleep and appetite,fatigue,guilt as well as hopelessness and suicidality.1 MDD is quite prevalent and remains a leading cause of disease burden worldwide.2 Antidepressants in combination with psychotherapies are helpful but do not work for all persons with MDD.

Euphoric effect induced by zolpidem:a case study of magnetoencephalography

Initially,zolpidem,a non-benzodiazepine hypnotic agent,was considered to have fewer adverse reactions than traditional benzodiazepines.However,after zolpidem was approved for medical use,an increasing number of case reports have described abuse or dependence complications.We were especially interested in the cases of dependence that presented a paradoxical‘euphoric’effect of zolpidem.This article reports the case of a female zolpidem-dependent patient who presented with 6 years of daily use of 400-1400 mg of zolpidem.She reported subjective effects of euphoria,intense craving and the inability to stop drug ingestion.Her diagnoses were zolpidem dependence and a depressive episode induced by substance abuse.To explore the neural mechanisms of the euphoric effect caused by high-dose zolpidem,we performed repeated magnetoencephalography(MEG)recordings.Before undergoing detoxification,her MEG results indicated that cerebellar electrical signal activation increased when taking high zolpidem doses.However,the prefrontal and parietal lobes’electrical signal activity showed a tendency to recover to a normal state as the withdrawal time progressed to completion.This case suggests that the cerebellum plays a role in the euphoria induced by high zolpidem doses and provides clues for further research.

Prevalence of excessive internet use and its correlation with associated psychopathology in 11th and 12th grade students

Background Globally, the number of internet users has crossed the three-billion mark, while in India users grew over 17% in the first 6 months of 2015 to 354 million. This study presented a background on internet use and the existence of excessive internet use. Aim To study the extent of internet use in 11th and 12th grade students and the psychopathology, if any, associated with excessive internet use. Methods 426 students who met the inclusion criteria were recruited from 11 th and 12th grade classes from Kendriya Vidyalaya, New Delhi, India, and were assessed by Young's Internet Addiction Test and the Strength and Difficulties Questionnaire. Results Among the 426 students, the mean internet addiction total score was 36.63 (20.78), which indicated mild level of internet addiction. 1.41%(six students) was diagnosed as excessive internet users, while 30.28% and 23.94% were classified as moderate and mild internet users, respectively. The prevalence of internet addiction between gender was 58.22% in males and 41.78% in females. While both positive (prosocial) and negative (hyperactivity, emotional, conduct and peer problem) impacts of internet use were reported by students, in the current study excessive use of internet had a negative impact on students' lives as compared with positive impact, which was statistically significant (p<0.0001). Conclusion Excessive internet use led to abnormal behaviours which cause negative consequences to users. Early diagnosis of risk factors related to excessive internet use, provides education about responsible use and supervision of students by family members.

Psychosis as an indicator of recurrent non-Hodgkin's lymphoma:a rare presentation

Psychotic manifestations of brain tumours are rare but described in the literature mostly along with other neurological deficits. Memory loss, difficulty in attention and concentration, depression, anxiety, and mood symptoms are commonly described in brain tumours. A schizophrenia-like picture without a deficit in motor or sensory function may land the clinician into a diagnostic dilemma. Primary central nervous system lymphoma(PCNSL) is a highly malignant disease with high mortality and needs immediate attention. Our case which had a unique recurrence in the postoperative period with psychotic symptoms can be an eye-opener to be more vigilant about underlying clinical extension.

Navigating personal recovery:multinomial logistic regression analysis of schizophrenia outcomes in community-dwelling individuals

Background Schizophrenia is a chronic mental disorder affecting individuals globally,emphasising the significance of personal recovery in mental healthcare.Understanding the recovery stages and the associated factors can provide essential insights for targeted interventions.Aims This study aimed to discern the stages of personal recovery in Thai patients with schizophrenia and elucidate the associated factors with each stage.Methods A multistage sampling technique was employed,selecting 231 patients with schizophrenia from mental health outpatient departments of general and psychiatric hospitals.Data collected from March to May 2023 included screening for psychotic symptoms using the Brief Psychiatric Rating Scale and six self-report questionnaires—Stage of Recovery Scale,Beck Cognitive Insight Scale,Brief Resilience Scale,Family Support,Therapeutic Relationship-Patients Version and Social Support Questionnaire—along with personal data sheets.Pearson correlation and multinomial logistic regression were performed.Results The predominant personal recovery stage among participants was stage 3,‘living with disabilities’,comprising 42.4%of the participants.Key factors contributing to personal recovery,explaining approximately 38.4%of the variance,included resilience,family support,therapeutic alliance,hospitalisations since onset and recovery-oriented nursing service utilisation.Logit equations for stages 3 and 4 are as follows:stage 3(living with disability):logit=−4.44+0.74×resilience+0.07×therapeutic alliance+0.02×recovery-oriented nursing service utilisation;stage 4(living beyond disability):logit=−11.57-0.05×hospitalisation since onset+1.96×resilience+0.11×family support+0.06×therapeutic alliance.Conclusion The findings emphasise the significance of mental health nursing interventions.In conjunction with recovery-oriented nursing services,strengthening resilience,therapeutic alliances and family support may accelerate personal recovery and reduce hospitalisations among individuals with schizophrenia.

Chinese version of the Perth Alexithymia Questionnaire:psychometric properties and clinical applications

Background The alexithymia trait is of high clinical interest.The Perth Alexithymia Questionnaire(PAQ)was recently developed to enable detailed facet-level and valence-specific assessments of alexithymia.Aims In this paper,we introduce the first Chinese version of the PAQ and examine its psychometric properties and clinical applications.Methods In Study 1,the PAQ was administered to 990 Chinese participants.We examined its factor structure,internal consistency,test-retest reliability,as well as convergent,concurrent and discriminant validity.In Study 2,four groups,including a major depressive disorder(MDD)group(n=50),a matched healthy control group for MDD(n=50),a subclinical depression group(n=50)and a matched healthy control group for subclinical depression(n=50),were recruited.Group comparisons were conducted to assess the clinical relevance of the PAQ.Results In Study 1,the intended five-factor structure of the PAQ was found to fit the data well.The PAQ showed good internal consistency and test-retest reliability,as well as good convergent,concurrent and discriminant validity.In Study 2,the PAQ was able to successfully distinguish the MDD group and the subclinical depression group from their matched healthy controls.Conclusions The Chinese version of the PAQ is a valid and reliable instrument for comprehensively assessing alexithymia in the general population and adults with clinical/subclinical depression.