Simpson's paradox is very prevalent in many areas. It characterizes the inconsistency between the conditional and marginal interpretations of the data. In this paper, we illustrate through some examples how the Simpson's paradox can happen in continuous, categorical, and time-to-event data.
Psychogenic seizures are often underdiagnosed and epilepsy is very often over-treated which leads to multiple financial, social and stigma related difficulties. The myoclonic seizure itself is a rare phenomenon and when functional movement disorder presents like myoclonus then it's extremely difficult to pinpoint the exact cause. Here, we are presenting a case who was misdiagnosed as having a myoclonic seizure disorder and treated in multiple places without any improvement which ultimately turned out to be functional movement disorder of a rare variety.
Schizophrenia is a severe mental disorder and its etiology and pathological mechanism are unknown.This article mainly introduces the progress of biological studies of schizophrenia in China in 2017,including neuroimaging,genetics,and immunology studies.It also introduces the research progress of high-risk psychotic syndrome and physiotherapy.
Background Lack of insight has been extensively studied and was found to be adversely correlated with impaired treatment compliance and worse long term clinical outcomes among patients with schizophrenia, while not much is known about this phenonmenon in patients with severe depression. Aim To explore the correlates of insight and its relation to symptom changes among the most seriously ill patients with affective disorders, those who require hospitalization. Methods Patients hospitalized in a large psychiatric hospital in south China with either major depressive disorder (MDD)(N=55) or bipolar depression (BD) (N=85) based on ICD-10 diagnostic criteria were assessed with the Insight and Treatment Attitudes Questionnaire (ITAQ) one week after admission and at the time of discharge. Clinical symptoms were measured at the same time with the Hamilton Rating Scale for Depression (HAMD-17) and the Depression subscale of the Symptom Check list-90 (SCL-90). Length of stay (LOS), duration of illness, duration of untreated mood disorder, number of previous episodes of depression and previous admissions for depression were documented during interviews with patients and their families and from a review of medical records. Bivariate correlations and multiple regression analysis were used to examine the relationship of sociodemographic characteristics, clinical symptomatology and clinical history, to insight at the time of admission. The relationships between change in clinical symptoms and change in insight from admission to discharge were also examined. Results Stepwise multiple regression models suggested that any previous admissions for depression and higher anxiety factor scores on the HAMD-17 are significant independent predictors of insight accounting for 22.9% of the variance. Multiple regression analysis residual change scores (change scores adjusted for baseline values) on the ITAQ showed that improved insight over average stays of 51 days were inversely related to the residual psychomotor retardation factor on the HAMD-17 accounting for 9.1% of the variance. Conclusions More severe anxiety symptoms and previous hospitalization for depression were associated with greater insight into illness at admission. Reduction of motor retardation symptoms during treatment was associated with greater improvement in insight to the time of discharge. The patients who are sicker at admission and who show more improvement in psycho-motor retardation show the greatest insight.
Background The impairment of cognitive function is one of the core symptoms in schizophrenia, and the degree of recovery is closely related to whether patients are able to rejoin society successfully. Objective This study was to clarify the correlation between cognitive function and cerebral grey matter volume in schizophrenia. Methods The neuro-cognitive functions of thirty-seven patients with first-episode schizophrenia (the patient group) and thirty healthy controls (the control group) was evaluated with the Clock Drawing Test, Trail Marking Test, Digit Span Test, Auditory Verbal Learning Test, Wisconsin Card Sorting Test, Verbal Fluency Test, Semantic Similarity Test and Stroop Color-Word Test. The facial emotion cognitive task was employed to assess the facial emotion cognitive functions of thirty-two patients with first-episode schizophrenia (the patient group) and 29 healthy controls (the control group). The psychotic symptoms of patients with first episode schizophrenia were evaluated using the Positive and Negative Syndrome Scale (PANSS). The brain imaging data of the patient group and control group were collected using the magnetic resonance imagine (MRI). Results The difference between the patient group and the control group in the results of Clock Drawing Test, Trail Marking Test, Digit Span Test, Auditory Verbal Learning Test, Wisconsin Card Sorting Test, Verbal Fluency Test, Semantic Similarity Test and Stroop Color-Word Test’s reaction time were significant. These two groups’ Slopes in the facial emotion cognitive task were also significantly different from each other. According to the comparison of cerebral grey matter volume between the patient group and the control group, it was found that the grey matter volume of the patient group increased in the left superior frontal gyrus, and decreased in the left occipital gyrus, lingual gyrus and upper cerebellum. Based on the analyses of neuro-cognitive data and brain imaging data of the patient group, the scores of the number of correct responses in Stroop Color-Word Test’s Card C were negatively correlated with grey matter volumes of the left upper frontal gyrus, right upper frontal gyrus and middle frontal gyrus. The analyses on the facial emotion cognitive task and brain imaging data of the patient group showed that the slope data were positively correlated with grey matter volumes of the right superior temporal gyrus, middle temporal gyrus, left middle temporal gyrus, inferior temporal gyrus and fusiform gyrus. Conclusion There are general impairments in the neuro-cognitive functions and facial emotion cognitive functions of patients with first-episode schizophrenia, and the results suggest that brain areas with abnormal grey matter volumes are likely to be the brain structure and functional basis of the cognitive impairments.
Gold standard tests are usually used for diagnosis of a disease, but the gold standard tests may not be always available or cannot be administrated due to many reasons such as cost, availability, ethical issues etc. In such cases, some instruments or screening tools can be used to diagnose the disease. However, before the screening tools can be applied, it is crucial to evaluate the accuracy of these screening tools compared to the gold standard tests. In this assay, we will discuss how to assess the accuracy of a diagnostic test through an example using R program.
Nitrous Oxide, which is also called laughing gas, now ranks as the 7th most popular drug in the world. Nitrous oxide mainly disturbs B12 metabolism and damages nerves, followed by apparent neuropsychiatric symptoms. It's beneficial to the prognosis of patients if we identify and treat their symptoms early. This case report describes a 19-year-old male who presented with auditory hallucination, persecutory delusions and unstable emotions after abuse of nitrous oxide over the course of half a year. Moreover, neurological signs such as weakness and hyperesthesia also appeared. After supplementation of vitamin B12, the neuropsychiatric symptoms improved, while the lower extremities achieved partial recovery. Therapeutically, we should pay attention to nerve repair, motivation enhancement and reinforce interventions that prevent relapse.
correspondence: Bin Xie. Mailing address: 600 South Wanping Road, Shanghai, China. Postcode: 200030; E-Mail: xiebin@smhc.org.cn The article by Liang Xie et al. examines the current situation of mental disorders and mental health services in the Tibet Autonomous Region (TAR) of China, the part of China where mental health resources are the most scarce. [5] For quite a long time, the most frequently asked questions by people who were concerned about the phenomenon of this impoverished environment were: why are there no mental hospitals in Tibet? Why are there no psychiatrists?
BACKGROUND:The abuse of methamphetamine (METH) has become a public health problem worldwide. This type of new drug can not only lead to addiction but can also cause cognitive impairment. Currently, there is no effective treatment. Repetitive transcranial magnetic stimulation (rTMS) is a painless and non-invasive green physiotherapy which can be used in the clinical treatment of neuropsychiatric disorders such as depression, anxiety, schizophrenia, and Parkinson's disease. However, whether it can be used to treat methamphetamine addiction is unclear.OBJECTIVE:To explore the effect of rTMS on the relapse behavior of methamphetamine addiction.METHODS:METH-induced rats conditioned place preference (CPP) model and rTMS technique were used in this study. Rats were given high frequency(10Hz) rTMS treatment for one day (experiment 1) or three days (experiment 2) after the extinction of CPP behavior. The reinstatement test was performed 24 hours after rTMS treatment and the effects of acute and chronic rTMS on the reinstatement of METH-induced CPP in rats were explored.RESULTS:Acute rTMS treatment (1 day) had a trend of an inhibitory effect on the relapse behavior of METH-induced CPP, but it was not statistically significant compared with the sham stimulation group (t=1.48, p=0.431). However, chronic rTMS treatment (3 days) had a significant inhibitory effect on the reinstatement of METH-induced CPP compared with the sham stimulation group (t=3.33, p=0.004).CONCLUSION:Chronic rTMS treatment inhibited the relapse behavior of METH-induced CPP in rats.
Background Metabolic syndrome in patients with schizophrenia is a major health concern. The efficacy and safety of adjunctive rosuvastatin in treating dyslipidemia were controversial. Aims To assess the efficacy and safety of adjunctive rosuvastatin for dyslipidemia in patients with schizophrenia. Methods We systematically searched for relevant controlled clinical trials from the following databases: PubMed, PsycINFO, Cochrane Library, China Knowledge Network, WanFang Database and Chinese Biomedical Database up to September 28, 2017. Standardized mean difference (SMD) and risk ratio (RR) along with their 95% confidence intervals (CIs) were calculated. The quality of the included studies was assessed using the Cochrane risk of bias assessment tool. The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system recommendation grading method was used as the reference standard. Results Four studies (n=274) comparing rosuvastatin (n=138) and control (n=136) groups were identified and analyzed. Adjunctive rosuvastatin showed greater efficacy than control group in low density lipoprotein cholesterol (LDL-C) [4 trials, n=272, SMD: -1.31 (95%CI: -1.93, -0.70), I2=81%], total cholesterol (2 trials, n=164, SMD: -2.00 (95%CI: -2.79, -1.21); I2=76%) and triglycerides (2 trials, n=164, SMD: -1.05 (95%CI: -1.38, -0.72); I2=0%), but not in high density lipoprotein cholesterol (2 trials, n=164, SMD: 0.14 (95%CI: -0.16, 0.45); I2=0%). After removing one study without randomization for LDL-C, significance remained [3 trials, n=172, SMD:-1.07 (95%CI: -1.60, -0.53); I2=63%]. No significant group differences regarding body weight (3 trials, n=208, SMD: -0.40 (95%CI:-1.29, 0.49); I2=89%), body mass index (2 trials, n=164, SMD: -0.34 (95%CI: -1.23, 0.56); I2=87%), waist circumference (3 trials, n=208, SMD: -0.43 (95%CI: -1.31, 0.46); I2=89%), and fasting glucose (4 trials, n=272, SMD: -0.25 (95%CI: -0.65, 0.15); I2=62%) were observed. The adverse reactions and any cause discontinuation rate were similar between the groups. According to the GRADE approach, the evidence levels of main outcomes were rated as “very low” (35.3%) to “low” (64.7%). Of them, the primary outcome (LDL-C) was rated as “very low”. Conclusions The data available on the effectiveness and safety of adjunctive rosuvastatin in treating dyslipidemia for patients with schizophrenia is insufficient to come to a definitive interpretation about its efficacy and safety. Further high quality RCTs with extended treatment duration are warranted to confirm the findings. Review registration PROSPERO: CRD42017078230
Hypokalemia can cause abnormalities in multiple systems. Long term use of antipsychotic medications can lead to electrolyte imbalance, including hypokalemia. We report a 49-year-old female patient with schizophrenia who developed hypokalemia after oral quetiapine and risperidone treatments. Her blood potassium became normal after she switched to another antipsychotic drug (amisulpride). In addition, we discuss the potential mechanism of antipsychotic drugs leading to hypokalemia and clinical cautions.
Depressive disorder is one of the most common mental health problems currently. However, the mechanism-based treatments for this disorder remain elusive. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive procedure that could stimulate electrical activity by a pulsed magnetic field in the brain, is considered to be an effective treatment for depression. Here, we review the main findings from both clinical and basic research on rTMS for depression, including its antidepressant efficacy, basic principles, as well as its ability to regulate neural circuits, neurotransmitters and brain networks, neurogenesis in hippocampus, and synaptic, and molecular pathways.
Arachnoid cysts are benign congenital malformations,making up 1％ among all the space occupying lesions (SOL).[1,2] Sylvain fissure is the most common place (50％) but it can happen in any place.[2] Patients might complain of a headache,ataxia,seizures,dizziness,and visual changes etc.The common psychiatric symptoms are psychosis,alexithymia,attention deficit and hyperactivity disorder,paranoid delusions,obsessive religiosity,sense of guilt or ruin,hallucinations,depression,insomnia,irritability and cognitive alterations etc.[3,4] Recently,we presented a case of an arachnoid cyst in the right middle cranial fossa compressing temporal lobe presenting as the positive symptoms of psychosis.[1] Here,we are presenting a case of posterior fossa arachnoid cyst which presented as severe negative symptoms.
BACKGROUND:In the last decade, olanzapine became widely used in mental health service worldwide even after being criticized for its metabolic side effects. Patients with schizophrenia on olanzapine were usually found to stay on their medications longer than the other second-generation antipsychotics (SGAs) except clozapine. The reason for this is unknown.OBJECTIVE:This prospective study compared the influences of olanzapine and other SGAs except clozapine on improving insight and medication discontinuation rate in schizophrenia.METHODS:A total of 148 patients with schizophrenia medically indicated for initiation of treatment with olanzapine or other SGAs were evaluated for symptoms, insight, attitudes toward medication, side effects, body weight and fasting lipid and glucose parameters at admission and before discharge, and follow-up calls one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not.RESULTS:After an average of 72.8 days of inpatient treatment, the olanzapine and other SGAs group exhibited similar levels of symptom improvement with an average reduction of 28.7 in the Positive and Negative Syndrome Scale (PANSS) total score. The Olanzapine group exhibited better improvement in insight assessed using the G12 item of PANSS and Insight and Treatment Attitudes Questionnaire (ITAQ), more metabolic side effects indexed with total cholesterol, triglycerides levels and weight gain, and a lower medication discontinuation rate than the other SGAs group.CONCLUSION:Although general symptom improvement was similar, olanzapine significantly improved insight and presented less medication discontinuation compared to other SGAs, which might partially explain why patients on olanzapine stayed longer on their medications.
Cognition is divided into neurocognition and social cognition,both of which are interconnected with each other and yet are mutually independent.Neurocognition,which is based on neuroanatomical structures,function connections,neuroelectrophysiology and molecular biology,is the basis of the human brain and the reflection of advanced integrative neural function in behavioral science.Social cognition is the cognitive process of perceiving others' emotions or intentions and making responses.
BACKGROUND:Both patients with methamphetamine-associated psychosis (MAP) and patients with schizophrenia suffer from obvious cognitive deficits in working memory, and this affects the functional prognosis of patients.AIM:This study is to investigate the difference of working memory deficits between patients with MAP and patients with schizophrenia, especially the difference of central executive system function, and the relevance of working memory deficits and clinical characteristics.METHODS:Twenty-eight male patients with MAP and twenty-eight patients with schizophrenia were recruited. The working memory of subjects was evaluated with the n-back task edited and adapted from English language materials. The positive syndrome scale of PANSS and CGI were employed to assess psychotic symptoms and the severity of patients.RESULTS:According to the results of repeated measure variance analysis, it was found that both the between-group variable (group) and within-group variable (n) had significant main effects, and the interaction between the between-group variable and the within-group variable was also significant. After Z-transformation, mean (sd) working memory scores of patients with MAP and schizophrenia were 0.91 (0.77) and -0.91 (2.11) respectively, and the difference between these two groups were statistically significant (F=19.253, p<0.001). The relevance between working memory deficits and clinical characteristics was low in both the patients with MAP and patients with schizophrenia.CONCLUSION:Patients with MAP were better at regulating, updating, executing and controlling active information than patients with schizophrenia.
Psychogenic dystonia is one of the most common problems encountered in movement disorder patients and accounted mostly for misdiagnosis, management confusion and treatment resistance. Psychiatric morbidities often are the culprit, hence proper psychiatric history taking is of utmost importance. Here we report one case where dystonia was the main presenting complaint of an underlying depressive episode and discuss how managing the cause alleviated the symptoms.
BACKGROUND:The incidence of depressive symptoms is higher in cancer patients. And depression can also affect the occurrence, development and outcome of cancer through the neuroendocrine-immune-network system.OBJECTIVE:To study the level of Nesfatin-1 in the plasma and brain tissue and its role in the pathogenesis in gastric cancer comorbid with depression using a mouse gastric cancer model.METHODS:18 mice were randomly divided into the normal control group (NCG), gastric cancer without stress model group (GCNS), and gastric cancer combined with stress model group (GCS). The mice of the GCNS group were inoculated subcutaneously with mouse forestomach carcinoma (MFC) after 5 weeks of nomal feeding to establish a model of subcutaneous transplantation tumor. After 5 weeks of chronic unpredicted mild stress (CUMS) in the GCS group, subcutaneous inoculation of MFC was used to establish a subcutaneous transplantation tumor model for 1 week. Evaluation of mice behavior was performed by open field test, sucrose preference test and forced swimming test (FST). Determination of Nesfatin-1 concentration in plasma and brain tissue was carried out using enzyme linked immunosorbent assay (ELISA) and Western Blot.RESULTS:The weight increment in the GCS group was significantly lower than that in the GCNS group (t=-3.39, p<0.001). And both GCS and GCNS were lower than the NCG group (t=-6.33, p<0.001; t=-2.94, p=0.01). In the open field test, the horizontal moving distance of the GCS group was less than that of the GCNS group (t=-2.50, p=0.025), and both GCS and GCNS were smaller than the NCG group (t=-5.87, p<0.001; t=-3.38, p=0.004). The dead time of the GCS group was longer than that of the GCNS and the NCG groups (t=2.56, p=0.022; t=3.84, p=0.002). The Nesfatin-1 level in the middle brain, hippocampus and plasma was significantly higher in NCG group and GCS group than in the GCNS group. The concentration of Nesfatin-1 in the GCS group was significantly higher than that in the NCG group.CONCLUSIONS:There is a decrease of Nesfatin-1 level in brain tissue and plasma in mice with gastric cancer without stress. CUMS stress can induce depressive behavior in gastric cancer mice, and increase the level of Nesfatin-1 in brain tissue and plasma. Therefore, Nesfatin-1 may be related to the pathogenesis of gastric cancer stress related depression.
BACKGROUND:We have developed a structured cognitive behavioral therapy manual for anxiety disorder in China, and the present study evaluated the applicability of simplified cognitive behavioral therapy based on our previous research.AIMS:To evaluate the applicability of simplified cognitive behavioral therapy (SCBT) on generalized anxiety disorder (GAD) by conducting a multi-center controlled clinical trial.METHODS:A multi-center controlled clinical trial of SCBT was conducted on patients with GAD, including institutions specializing in mental health and psychiatry units in general hospitals. The participants were divided into 3 groups: SCBT group, SCBT with medication group and medication group. The drop-out rates of these three groups, the therapy satisfaction of patients who received SCBT and the evaluation of SCBT from therapists were compared.RESULTS:(1) There was no significant difference among the drop-out rates in the three groups. (2) Only the duration and times of therapy were significantly different between the two groups of patients who received the SCBT, and the therapy satisfaction of the SCBT group was higher than that of the SCBT with medication group. (3) Eighteen therapists who conducted the SCBT indicated that the manual was easy to comprehend and operate, and this therapy could achieve the therapy goals.CONCLUSION:The applicability of SCBT for patients with GAD is relatively high, and it is hopeful that SCBT can become a psychological treatment which can be applied in medical institutions of various levels.
BACKGROUND:Bipolar disorder is a mental illness with a high misdiagnosis rate and commonly misdiagnosed as other mental disorders including depression, schizophrenia, anxiety disorders, obsessive-compulsive disorders, and personality disorders, resulting in the mistreatment of clinical symptoms and increasing of recurrent episodes.AIMS:To understand the reasons for misdiagnosis of bipolar disorder in an outpatient setting in order to help clinicians more clearly identify the disease and avoid diagnostic errors.METHODS:Data from an outpatient clinic included two groups: those with a confirmed diagnosis of bipolar disorder (CD group) and those who were misdiagnosed (i.e. those who did in fact have bipolar disorder but received a different diagnoses and those without bipolar disorder who received a bipolar diagnosis [MD group]). Information between these two groups was compared.RESULTS:There were a total of 177 cases that met the inclusion criteria for this study. Among them, 136 cases (76.8%) were in the MD group and 41 cases (23.2%) were in the CD group. Patents with depression had the most cases of misdiagnosis (70.6%). The first episode of the patients in the MD group was more likely to be a depressive episode (χ2=5.206, p=0.023) and these patients had a greater number of depressive episodes during the course of the disease (Z=-2.268, p=0.023); the time from the onset of the disease to the first treatment was comparatively short (Z=-2.612, p=0.009) in the group with misdiagnosis; the time from the onset of disease to a confirmed diagnosis was longer (Z=-3.685, p<0.001); the overall course of disease was longer (Z=-3.274, p=0.001); there were more inpatients for treatment (χ2=4.539, p=0.033); and hospitalization was more frequent (Z=-2.164, p=0.031). The group with misdiagnosis had more psychotic symptoms (χ2=11.74, p= 0.001); particularly when depression occurred (χ2=7.63, p= 0.006), and the incidence of comorbidity was higher (χ2=5.23, p=0.022). The HCL-32 rating was lower in the misdiagnosis group (t=-2.564, p=0.011). There were more patients diagnosed with bipolar and other related disorders in the misdiagnosis group than in the confirmed diagnosis group (11.0% v. 4.9%) and there were more patients in the MD group diagnosed with depressive episodes who had a recent episode (78.7% v. 65.9%).CONCLUSIONS:The rate of misdiagnosis of patients with bipolar receiving outpatient treatment was quite high and they often received a misdiagnosis of depression. In the misdiagnosis group the first episode tended to manifest as a depressive episode. In this group there were also a greater number of depressive episodes over the course of illness, accompanied by more psychotic symptoms and a higher incidence of comorbidity. Moreover, these patients apparently lacked insight into their own mania and hypomania symptoms, resulting in difficulties in early diagnosis, longer time needed to confirm the diagnosis, higher rate of hospitalization, and greater number of hospitalizations.
