Background Adverse childhood experiences(ACEs)are strong predictors of psychopathology across the lifespan,exerting extensive adverse effects on physical and mental health during early development.While ACEs increase the risk of childhood psychopathology,sleep quality and impair cognitive function,the early neurobiological mechanisms mediating ACE-induced cognitive impairment remain unclear.Objective To explore the association between ACEs exposure and the risk of psychopathology,sleep disorders,and cognitive function,and to examine the mediating role of the putamen volume in the relationship between ACEs and cognitive function from a neurodevelopment perspective.Methods Data were obtained from the Adolescent Brain Cognitive Development(ABCD)study,comprising 10 572 children aged 9 to 10.Participants were categorized into five groups based on the cumulative score of ACEs reported by their parents and the children themselves:no-exposure group(0 types of ACEs),the one-exposure group,the two-exposure group,the three-exposure group,and the high-risk exposure group(≥4 types of ACEs).Logistic regression analysis was employed to evaluate the association between ACEs and psychopathological symptoms[T score of the Child Behavior Checklist(CBCL)≥65].Multiple linear regression analysis was ultilized to analyze the correlations between ACEs and the scores of the Sleep Disturbance Scale for Children(SDSC),the NIH Toolbox Cognition Battery(NIHTB-CB),as well as the multiple structures in the cerebral cortex and subcortex.The Bootstrap method was applied to test the mediating effect of the putamen volume between ACEs and neurocognitive function.Results After adjusting for confounders,ACEs cumulative score was correlated with children's psychopathological symptoms in a dose-response manner.Compared with the no-exposed group,the high-risk exposure group had a 2.08-fold(OR=2.080,95%CI:1.401-3.088)increased risk of internalizing problems and a 3.13-fold(OR=3.132,95%CI:1.703-5.760)increased risk of externalizing problems,and the risk of conduct problems was 4.68 times that of the no-exposed group(OR=4.681,95%CI:2.528-8.669).ACEs cumulative score positively predicted the total score of SDSC(β=0.080,95%CI:0.059-0.102),with relatively stronger predictive effects on sleep-wake transition disorder(β=0.086,95%CI:0.063-0.109)and sleep onset and maintenance disorder(β=0.066,95%CI:0.043-0.089).In terms of neurocognition and brain structure,ACEs cumulative score negatively predicted the overall cognitive composite score(β=-0.025,95%CI:-0.050--0.001),the crystallized cognitive composite score(β=-0.035,95%CI:-0.060--0.010),the volume of the left putamen nucleus(β=-0.025,95%CI:-0.046-0.003),and the volume of the right putamen nucleus(β=-0.023,95%CI:-0.044-0.003).The total putamen volume played a partial mediating role between ACEs and the overall cognitive composite score,the effect value was-0.002(95%CI:-0.004--0.001),accounting for 7.49%of the total effect.Conclusion ACEs exposure may increase the risk of psychopathological and sleep disturbances in children and may impair neurocognitive function.Reduced putamen volume may serve a potential neurobiological pathway underlying the impact of ACEs on childhood cognition.
Background Current studies on the relationship between depressive symptoms and the risks of stroke and all-cause mortality mostly focus on the elderly population or high-risk groups with chronic diseases.The long-term impact of depressive symptoms in young and middle-aged people on the risks of stroke and all-cause mortality still lacks systematic assessment,and the relevant evidence is insufficient.Objective To explore the association between depressive symptoms and the risks of stroke and all-cause mortality in young and middle-aged adults,thereby expanding the risk evidence in this age group and providing epidemiological basis for early identification of high-risk individuals and the development of targeted intervention strategies.Methods Based on data from the National Health and Nutrition Examination Survey(NHANES)database(2009-2018),a total of 14 947 young and middle-aged respondents aged 18 to 64 were included as the research subjects.Logistic regression and restricted cubic spline(RCS)models were employed to examine the association between depressive symptoms and stroke.Cox proportional hazards model,RCS model,and Kaplan-Meier(K-M)survival curves were used to clarify the relationship between depressive symptoms and all-cause mortality risk.To verify the robustness of main findings,sensitivity analysis was conducted stratified by gender,hypertension,diabetes,hyperlipid-emia,body mass index(BMI),and age.Results Logistic regression analysis revealed that compared with the non-depressed group,the risk of stroke in the mild depression group increased by 53.50%(OR=1.535,95%CI:1.147-2.053),while the moderate-to-severe depression group showed the highest risk with a 132.90%increase(OR=2.329,95%CI:1.733-3.129).RCS analysis indicated an approximately linear dose-response relationship between PHQ-9 score and the risk of stroke(Pfor non-linearity=0.089),with stroke risk increasing as PHQ-9 scores rose.As the PHQ-9 score increased,the risk of stroke also showed an upward trend.Cox regression analysis demonstrated that compared with the non-depressed group,the risk of all-cause mortality in the mild depression group increased by 48.80%(HR=1.488,95%CI:1.164-1.902),and the moderate-to-severe depression group had a 70.60%increased risk(HR=1.706,95%CI:1.310-2.221).RCS analysis showed a linear dose-response relationship between PHQ-9 scores and all-cause mortality risk(Pfor non-linearity=0.440).K-M curves indicated that as the severity of depressive symptoms increases,the risk of all-cause mortality gradually rises(P<0.05).Sensitivity analysis confirmed that the associations between depression symptoms and risks of stroke and all-cause mortality were not modified by gender,hypertension,diabetes,hyperlipid-emia,BMI,or age,demonstrating robust findings.Conclusion Among the young and middle-aged population,both mild and moderate-to-severe depression were associated with increased risks of stroke and all-cause mortality,with the moderate-to-severe depression group showed more pronounced risk elevations.A positive dose-response relationship was observed between depressive symptoms and these risks.
Background The global prevalence of depressive disorders is high,with a significant treatment gap remaining.Escitalopram oxalate,as a commonly used antidepressant in clinical practice,has a single target and is prone to cause adverse reactions such as gastrointestinal discomfort.The traditional Mongolian medicine Zadi-5 pills has a multi-target anti-depression mechanism and unique advantages such as improving the intestinal flora.However,there is currently a lack of randomized controlled trial evidence for the combined treatment of first-episode depression,along with insufficient research on its metabolic safety and potential drug interactions.Objective To explore the efficacy and safety of Zadi-5 pills combined with escitalopram oxalate in the treatment of the first-episode depression,so as to provide references for Mongolian medicine in depression management.Methods A randomized controlled trial was conducted.A total of 103 patients with first-episode depression who were treated in the outpatient or inpatient departments of the Inner Mongolia Autonomous Region Mental Health Center from January 2023 to December 2024 and met the diagnostic criteria for depressive episode as defined in International Classification of Diseases,tenth edition(ICD-10)were included.Random numbers were generated using the RAND function in Excel software,and the patients were divided into the study group(n=52)and the control group(n=51).Both groups received escitalopram oxalate treatment,starting from 5 mg/d and gradually increasing to 20 mg/d.The study group additionally received Zadi-5 pills,13 pills per day.The treatment duration for both groups was 6 weeks.Before treatment and at the 2nd,4th,and 6th weeks of treatment,the severity of depressive symptoms was evaluated using the Hamilton Depression Scale-24 item(HAMD-24).At these time points,blood was collected on an empty stomach at 7∶00 for the detection of liver function(aspartate aminotransferase,alanine aminotransferase),triglycerides,and the blood concentration of escitalopram oxalate.Results A total of 100 patients completed the study,with 50 cases in the study group and the control group.The results of the repeated measures ANOVA showed that the interaction effect between group and time in the HAMD-24 score was statistically significant(F interaction=18.070,P<0.01).At the end of the 4th and 6th weeks of treatment,the HAMD-24 score of the study group was lower than those of the control group(P<0.05).At each time point after treatment,the reduction rate of the HAMD-24 score in the study group was higher than those of the control group,and the differences were all statistically significant(P<0.05).The interaction effect between the triglyceride level groups and time was statistically significant(Finteraction=3.381,P<0.05).After treatment,the triglyceride levels in the study group showed a downward trend,while those in the control group showed an upward trend.There was no statistically significant interaction effect between the groups and time for liver function(aspartate aminotransferase and alanine aminotransferase)and the blood concentration of escitalopram oxalate(P>0.05).Conclusion Compared with escitalopram oxalate treatment alone,the combination of Zadi-5 pills and escitalopram oxalate is more effective in treating the first-episode depression,without increasing the risk of liver damage.The combined medication may have a potential beneficial effect on lipid metabolism.
Background Non-suicidal self-injury(NSSI)behavior has become a global public health concern affecting the physical and mental health of adolescents.The experiential avoidance model posits that childhood trauma contributes to NSSI behavior through the mediating pathway of emotional dysregulation.However,existing research has predominantly focused on isolated psychological or social factors,with limited attention to their interactive effects of emotional dysregulation and social anxiety,both of which fall within the psychosocial domain.Objective To examine the relationship between childhood trauma and NSSI among adolescents,and to analyze the mediating role of emotional dysregulation and the moderating role of social anxiety,so as to provide evidence for targeted interventions for NSSI behavior of adolescents.Methods A total of 282 adolescent inpatients who consecutively admitted to the Department of Psychiatry of Guangdong Provincial People's Hospital from March to December 2025 and met the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria for NSSI were enrolled as study participants.Participants were assessed using the general information questionnaire,the Adolescent Self-Harm Questionnaire,the Childhood Trauma Questionnaire(CTQ),the Difficulties in Emotion Regulation Scale(DERS),and the Social Anxiety Scale for Adolescents(SAS-A).Pearson correlation analysis was used to examine correlations among scale scores.model 4 and model 58 of the Process 4.1 were used to test the mediating effect of emotional dysregulation and the moderating effect of social anxiety,respectively.Results CTQ score was positively associated with score of the Adolescent Self-Injury Questionnaire(r=0.279,P<0.01).Emotional dysregulation significantly partially mediated the relationship between childhood trauma and NSSI behavior,with a mediating effect of 0.112(95%CI:0.043-0.208),accounting for 40.14%of the total effect.Social anxiety moderated the association between childhood trauma and emotional dysregulation,the effect value was 0.102(95%CI:0.008-0.196),as well as the relationship between emotional dysregulation and NSSI behavior,the effect value was 0.130(95%CI:0.033-0.226).Conclusion Emotional dysregulation may mediate the relationship between childhood trauma and NSSI behavior among hospitalized adolescents,while social anxiety moderates both the first and second paths of this mediating process.
Background Negative emotions are core predictors of adolescent mental health.While existing research has predominantly focused on the impact of risk factors such as negative life events and rumination on adolescents'emotions,the protective role of the family,particularly parental involvement,has received less attention.Consequently,the integrated mechanism connecting negative life events,rumination,parental involvement and negative emotions remains insufficiently clarified.Objective To elucidate the mechanisms linking negative life events to negative emotions in adolescents,and to verify the mediating role of rumination and the moderating role of parental involvement,so as to provide a theoretical basis for relevant prevention and intervention.Methods A cross-sectional study was conducted in June 2025.A total of 600 adolescents from a middle school in Liangshan Yi Autonomous Prefecture,Sichuan Province,were recruited through cluster random sampling.Participants completed the Adolescent Self-rating Life Events Checklist(ASLEC),the Rumination Response Scale(RRS),parental involvement subscale of the Perception of Parents Scales(POPS),and the Chinese short version of Depression Anxiety and Stress Scale(DASS-21).Pearson correlation analysis was performed to examine the correlations among all variables.Model 4 and model 7 embedded in Process macro 4.1 were employed to separately test the mediating effect of rumination between negative life events and negative emotions of adolescents,as well as the moderating effect of parental involvement.Results Ultimately,534 valid questionnaires were obtained,yielding a valid response rate of 89.00%.ASLEC score and RRS score were positively correlated with DASS-21 scores(r=0.580,0.706,P<0.01),and ASLEC score was also positively correlated with RRS score(r=0.583,P<0.01).Rumination acted as a partial mediator between negative life events and negative emotions,with an indirect effect of 0.531(95%CI:0.438-0.630),accounting for 55.60%of the total effect.Parental involvement significantly moderated the first stage of the mediating pathway(β=-0.109,P<0.05).Conclusion In adolescents,rumination serves as a partial mediator in the relationship between negative life events and negative emotions,and parental involvement further moderates the predictive relationship from negative life events to rumination.
Background The mental health issues of medical staff have received increasing attention.Previous studies have mainly focused on the epidemiological characteristics and influencing factors,but there is a lack of sufficient understanding of the heterogeneity characteristics of the depression-anxiety symptoms network among medical staff.Objective To compare the differences in the depression-anxiety symptoms network between medical staff and community residents,so as to provide references for the promotion of the mental health of medical staff.Methods From June 1,2022 to December 31,2024,a stratified random sampling method was used to recruit 1 959 medical staff from public hospitals and community health centers in 9 townships(industrial parks)of Dongguan City,Guangdong Province,as well as 2 412 community residents in this area,were selected as the research subjects.The general situation questionnaire,Patients'Health Questionnaire Depression Scale-9 item(PHQ-9),and the Generalized Anxiety Disorder Scale-7 item(GAD-7)were used for investigation.The network visualization was conducted using the qgraph package of R 4.0.0.The centrality indicators of the network were calculated using the networktools package.The reliability of the network structure was evaluated using the bootnet package.The differences in the depression-anxiety symptoms network between medical staff and community residents were compared using the NetworkComparisionTest package.Results A total of 1 792 medical staff and 2 110 community residents completed the survey.The numbers of medical staff with mild,moderate and severe depressive symptoms were 381(21.26%),217(12.11%)and 169(9.43%),respectively,while the numbers of community residents were 322(15.26%),98(4.64%)and 66(3.13%),respectively.The numbers of medical staff with mild,moderate and severe anxiety symptoms were 411(22.94%),126(7.03%)and 93(5.19%),respectively,while the numbers of community residents were 320(15.17%),73(3.46%)and 18(0.85%),respectively.The comparison of the detection rates of depressive symptoms and anxiety symptoms between the two groups showed statistically significant differences(χ2=152.012,205.953,P<0.01).The network analysis results showed that the core symptom clusters of medical staff were"uncontrollable worry""psychomotor retardation""inability to relax",and"depression",while those of community residents were"uncontrollable worry""inability to relax""inferiority complex",and"depression".There was a statistically significant difference in the network structure between the two groups(M=0.275,P<0.05),and the overall connection strength of medical staff was lower than that of community residents(7.523 vs.7.950,S=0.426,P<0.05).Conclusion The detection rates of depression and anxiety symptoms among medical staff were higher than those among community residents.The depression-anxiety symptoms network of medical staff was more concentrated,and the core symptoms were more prominent.
Background Pain is one of the most common physical symptoms in patients with major depressive disorder(MDD).The high comorbidity rate of MDD and pain aggravates patients'physical and psychological distress,undermines their treatment adherence,and contributes to poor clinical outcomes,posing a critical challenge for the clinical management of MDD.Anxiety symptoms are strongly associated with the pain severity in patients with MDD,yet the underlying mechanisms of the association remain poorly elucidated.Accumulating evidence have indicated that depressive symptoms and pain vigilance and awareness are involved in the modulation of pain perception.Nevertheless,few studies have incorporated these variables into an integrated analytical framework to clarify their parallel mediating effects on the relationship between anxiety symptoms and pain severity.Objective To explore the mediating pathways linking anxiety symptoms to pain severity via depressive symptoms and pain vigilance and awareness in patients with MDD,so as to provide insights for precise intervention for MDD accompanied by pain symptoms.Methods A total of 249 patients who met the diagnostic criteria for MDD specified in the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)were recruited from Beijing Huilongguan Hospital from May to September 2025.Hamilton Depression Scale-17 item(HAMD-17),Hamilton Anxiety Scale(HAMA),Pain Vigilance and Awareness Questionnaire(PVAQ)and Numerical Rating Scale(NRS)were used for assessment.Partial correlation analyses were performed to examine correlations among these variables.Parallel mediating effects were tested using model 4 of the Process macro for SPSS,with depressive symptoms and pain vigilance and awareness as parallel mediators linking anxiety symptoms to pain severity.Results A total of 135 patients(54.22%)reported pain,comprising 59(43.70%)with mild pain,43(31.85%)with moderate pain,and 33(24.45%)with severe pain.Partial correlation analyses revealed significant positive correlations among HAMD-17,HAMA,PVAQ,and NRS scores in patients with MDD(r=0.198-0.424,P<0.05 or 0.01).Anxiety symptoms positively predicted pain severity,with a direct effect of 0.128(95%CI:0.065-0.190).Both depressive symptoms and pain vigilance and awareness acted as partial mediators linking anxiety symptoms to pain severity.The indirect effects were 0.057(95%CI:0.029-0.089)and 0.042(95%CI:0.016-0.079),accounting for 25.22%and 18.58%of the total effect,respectively.Conclusion In patients with MDD,anxiety symptoms exert a positive predictive effect on pain severity,which is partially mediated through the parallel roles of depressive symptoms and pain vigilance and awareness.
China's mental health service system is transitioning from an expansion-oriented stage focused primarily on addressing resource shortages and improving access to care toward a more mature stage that places greater emphasis on service quality， operational efficiency， patients' rights， and long-term outcomes. The principal challenge is no longer merely an insufficient overall supply of mental health resources， but rather inadequate alignment among service goals， the structure of service provision， payment incentives， allocation of responsibilities， and professional capacity. Recent incidents involving inappropriate psychiatric admissions and misuse of medical insurance funds in a small number of institutions， although not representative of the mental health sector as a whole， have exposed several structural risks within an inpatient-dominated service model. These include misalignment between inpatient services and medical insurance payment incentives， expansion of institutions and beds outpacing the development of professional capacity and quality governance， excessive concentration of social-risk management responsibilities in medical institutions， and inadequate continuity of care across hospitals， communities， and families. In practice， psychiatric hospitalization may simultaneously serve the multiple functions of clinical treatment， institutional financing， and the management of social risks. When the boundaries among these functions are unclear， and outpatient care， day services， community-based rehabilitation， and social support lack stable institutional and financial support， hospitalization may become systematically overused. The next stage of reform should shift mental health services from a hospital- and inpatient-dominated model toward a stratified and continuous system centered on patients' needs； establish medical insurance payment and evaluation mechanisms that balance costs， quality， functional outcomes， and long-term value； clarify the responsibilities of medical institutions， communities， families， and relevant government sectors； and make professional competence， ethical standards， patients' rights， and institutional governance the foundations of quality improvement. The key to the high-quality development of mental health services in China lies neither in simply increasing or reducing the number of psychiatric beds nor solely in strengthening post hoc regulation， but in aligning institutional incentives with patients' interests and promoting symptom improvement， functional recovery， and social participation.
Background The prevalence,disability rate and mortality rate of cerebral small vessel disease(CSVD)are relatively high among the elderly population,imposing a heavy burden on families and society.Among the various clinical manifestations of CSVD,cognitive impairment is the most common,and it is also the most closely related neuro-psychiatric syndrome to clinical practice in psychiatry.Previous studies on CSVD-related cognitive impairment(CSVD-CI)have mostly focused on the field of imaging,while studies on non-invasive electrophysiological and cerebral hemodynamic assessments are relatively scarce.Objective To analyze the characteristics of event-related potential(ERP)and functional near-infrared spectroscopy(fNIRS)in patients with CSVD-CI,and to explore their correlations with the severity of white matter lesions,in order to provide references for the objective assessment and early identification of CSVD-CI.Methods A total of 40 patients with CSVD who met the diagnostic criteria of the Chinese Guideline for Diagnosis and Treatment of Cerebral Small Vessel Disease(2020)and had cognitive impairment,as well as were admitted to the Affiliated Hospital of North Sichuan Medical College from December 2024 to December 2025,were enrolled as the case group.Meanwhile,40 healthy volunteers matched for gender,age and education level were recruited as the control group.Both groups underwent assessment using the Mini-Mental State Examination(MMSE),ERP-P300 detection,and fNIRS examination.The ERP-P300 indicators,functional connectivity strength of the whole brain and cognitive-related regions of interest(ROI)in fNIRS of the two groups were compared.The severity of the patients'white matter lesions was classified as follows:the Fazekas grade Ⅰ group(mild white matter lesions)and the Fazekas grades Ⅱ to Ⅲ group(moderate to severe white matter lesions).Spearman correlation analysis was employed to investigate the correlation between the Fazekas grading of brain white matter lesions and the latency of ERP-P300,as well as the strength of functional connectivity measured by fNIRS.Results The MMSE score of the CSVD-CI group was lower than that of the control group(Z=-6.250,P<0.01),and ERP-P300 lantency was significantly longer than that of the control group(t=12.291,P<0.01).The MMSE score of the sub-group with Fazekas grade Ⅰ was higher than that of the sub-groups with grades Ⅱ to Ⅲ(Z=-2.420,P<0.05),and showed a shorter P300 latency than that of the sub-groups with grades Ⅱ to Ⅲ(Z=-4.210,P<0.01).All the differences were statistically significant.The resting-state whole-brain functional connectivity strength in the CSVD-CI group was lower than that in the control group,and the difference was statistically significant(t=10.243,P<0.05).Compared with the control group,the differences in the functional connectivity strength within the left premotor cortex(PMC),right PMC,left frontopolar cortex(FPC),right FPC,left dorsolateral prefrontal cortex(DLPFC),right DLPFC,left orbitofrontal cortex(OFC),and right OFC regions in the CSVD-CI group were all statistically significant(PFDR correction<0.01).The differences in the functional connectivity strength between multiple prefrontal-related brain regions between the CSVD-CI group and the control group were all statistically significant(PFDR correction<0.01).The severity of white matter lesions in CSVD-CI patients was positively correlated with the P300 latency(rs=0.891,P<0.05),and negatively correlated with the fNIRS functional connectivity strength(rs=-0.359,P<0.05).Conclusion Patients with CSVD-CI exhibit prolonged P300 latency,as well as decreased functional connectivity strength in multiple brain regions including the whole brain and the prefrontal lobe during the resting state.Moreover,these indicators are correlated with the severity of white matter lesions.
Background Individuals with chronic multimorbidity exhibit a high prevalence of sleep disturbances,which impair their physical and psychological well-being and impede chronic disease management.Although sleep quality is closely influencing with psychological functioning,empirical evidence regarding the longitudinal trajectories of sleep quality and their influencing factors in this population remains insufficient.Objective To investigate the longitudinal trajectories of sleep quality and associated factors among patients with chronic multimorbidity from hospitalization through 6 months post-discharge,aiming to facilitate the early identification of high-risk individuals and the development of personalized sleep interventions.Methods A total of 228 inpatients with chronic multimorbidity,primarily with cardiovascular and metabolic chronic conditions,were enrolled via random sampling at The Third People's Hospital of Fuyang from January 2023 to September 2024.Baseline assessments were conducted during hospitalization using the general socio-demographic questionnaire,the Sleep Dysfunction Rating Scale(SDRS),the Ruminative Response Scale(RRS),and the Hospital Anxiety and Depression Scale(HADS).Sleep quality was further evaluated using the SDRS at 1-,3-,and 6-month post-discharge.Latent class growth model was employed to delineate trajectories of sleep quality.Multivariate logistic regression analysis was subsequently performed to identify influencing factors of sleep quality.Results A total of 201 patients with chronic diseases were included.Based on four predefined assessment time points(baseline,1 month,3 months,6 months post-discharge),the latent class growth model identified three distinct trajectories of sleep quality:persistent high sleep disturbance(n=72,35.82%),moderate sleep disturbance-progression(n=73,36.32%),and low sleep disturbance(n=56,27.86%).Multivariate logistic regression analysis revealed that,compared with the low sleep disturbance group,multiple factors increased the odds of membership in the persistent high sleep disturbance group:per capita monthly household income of<3 000 yuan(β=13.131,P<0.01)or 3 000-5 000 yuan(β=5.913,P<0.05),aged 45-65 years(β=9.536,P<0.05),presence of 3(β=7.792,P<0.05)or>3 comorbid chronic conditions(β=6.626,P<0.05),as well as higher RRS(β=0.334,P<0.01)and HADS score(β=1.628,P<0.01).Additionally,patients aged 45-65 years(β=2.777,P<0.05),with 3(β=3.802,P<0.01)or>3 comorbid chronic conditions(β=2.463,P<0.01),and with higher RRS(β=0.111,P<0.01)and HDAS scores(β=0.350,P<0.05)also demonstrated significantly increased odds of belonging to the moderate sleep disturbance-progression group.Conclusion There is significant population heterogeneity in sleep quality trajectories among patients with chronic multimorbidity,with age,per capita household monthly income,number of comorbidities,rumination,and anxiety/depression symptoms being identify as the primary influencing factors.
Background Obstructive sleep apnea(OSA)represents a prevalent sleep disordered breathing condition characterized by complex pathophysiology.The arousal threshold(ArTH),a core non-anatomical contributor to OSA pathogenesis,is intimately tied to the disease severity and clinical phenotypes.To date,research regarding factors associated with ArTH has yielded inconsistent findings,and ArTH profiles and disparities across populations with different genetic backgrounds are not fully elucidated.Objective To explore the differences of ArTH in OSA patients with different genetic backgrounds and analyze the key factors affecting ArTH,thereby providing evidence for understanding OSA pathophysiology and formulating targeted treatment regimens.Methods A total of 285 patients who met the diagnostic criteria for OSA,as defined by the Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea,were retrospectively enrolled in this study.All participants underwent overnight polysomnography(PSG)at the Sleep Medicine Center of Inner Mongolia Mental Health Center from December 2022 to May 2024.Based on the study design,the cohort was stratified into two distinct genetic background subgroups(group A and group B).Demographic and clinical characteristics,the Epworth Sleepiness Scale(ESS)score,and overnight PSG data were collected.The apnea hypopnea index(AHI),the lowest pulse oxygen saturation(LSpO2),and fraction of hypopneas(FHypopneas)were utilized as surrogate indicators to estimate ArTH in OSA patients.The influencing factors of low ArTH were tested by binary Logistic regression analysis.Results Among the 285 OSA patients,there were 227 cases(79.65%)in group A and 58 cases(20.35%)in group B.Comparisons between the two genetic background subgroups revealed no statistically significant differences in the proportion of low ArTH,ESS score,PSG parameters,and the three markers for low ArTH(AHI<30 events/h,LSpO2>82.5%,FHypopneas>58.3%)(P>0.05).Binary Logistic regression analysis identified sex(OR=2.421,95%CI:1.070-5.478),BMI(OR=0.847,95%CI:0.770-0.932),N1 sleep duration(OR=0.974,95%CI:0.963-0.985),and hypertension(OR=0.348,95%CI:0.143-0.848)as independent factors associated with low ArTH in the total cohort.Stratified analysis by genetic backgrounds revealed that sex(OR=3.799,95%CI:1.389-10.392),BMI(OR=0.819,95%CI:0.723-0.929),and N1 sleep duration(OR=0.973,95%CI:0.961-0.986)were independent factors of low ArTH in group A.In contrast,only N1 sleep duration(OR=0.951,95%CI:0.911-0.993)remained a significant factor in group B.Conclusion Arthur may have conservative characteristics in patients with OSA with different genetic backgrounds,but the pathophysiological mechanism of OSA may have population heterogeneity.
Background Obsessive-compulsive disorder(OCD)carries a considerable disability burden.Intolerance of uncertainty(IU)is associated with the severity of obsessive-compulsive symptoms,yet its neural underpinnings remain unclear.The cerebellum has been implicated in uncertainty processing and demonstrates structural and functional abnormalities in OCD,but direct evidence linking its spontaneous activity to the relationship between IU and obsessive-compulsive symptoms is still lacking.Objective To explore the pathway through which spontaneous cerebellar neural activity mediates the relationship between IU and obsessive-compulsive symptoms in OCD patients,with the aim of providing a new perspective for understanding the neural mechanisms of OCD.Methods A total of 51 patients with OCD who visited the Mental Health Center outpatient clinic of the General Hospital of Ningxia Medical University from November 2022 to November 2024 and met the diagnostic criteria for OCD according to the International Classification of Diseases,tenth edition(ICD-10).During the same period,43 community-based volunteers matched for gender and age were enrolled as the control group.Resting-state functional magnetic resonance imaging data were collected from two groups.Amplitude of low-frequency fluctuation(ALFF)analysis was used to compare whole-brain spontaneous neural activity between two groups.Clinical assessments were conducted using the Yale-Brown Obsessive Compulsive Scale(Y-BOCS)and the Intolerance of Uncertainty Scale-12(IUS-12).Pearson correlation analysis was used to examine correlations between cerebellar ALFF values and scale scores in OCD patients.Using IU as the independent variable,obsessive-compulsive symptoms as the dependent variable,and ALFF values from between-group difference brain regions as the mediator,Process 4.0 for SPSS 24.0(model 4)was used to examine the mediating role of these ALFF values between IU and obsessive-compulsive symptoms.The Bootstrap method was used to test the mediation effect.Results A total of 47 OCD patients and 40 controls completed this study.Compared with the control group,the OCD group showed decreased ALFF values in the right cerebellar Crus Ⅱ(t=-5.254,FWE-corrected P<0.01).Correlation analysis revealed that ALFF value in the right cerebellar Crus Ⅱ was negatively correlated with Y-BOCS total score(r=-0.851),compulsive behavior subscale score(r=-0.647),IUS-12 total scores(r=-0.617),and prospective IU subscale scores(r=-0.717)in OCD group(P<0.01).Prospective IU subscale scores were positively correlated with Y-BOCS total scores(r=0.811)and compulsive behavior subscale score(r=0.535)(P<0.01).Mediation analysis showed that ALFF value in the right cerebellar Crus Ⅱ region partially mediated the effect of prospective IU on obsessive-compulsive behavior,with a mediation effect of 0.064(95%CI:0.004-0.136),accounting for 24.57%of the total effect.Conclusion Patients with OCD showed reduced spontaneous neural activity in the right cerebellar Crus Ⅱ region,which was significantly associated with IU and obsessive-compulsive symptoms.This region partially mediated the effect of IU on compulsive behaviors.
Background Bipolar disorder is a severe mental disorder characterized by alternating episodes of mania and depression.It has a high recurrence rate and a high rate of disability.Elderly patients often suffer from more severe cognitive impairment due to neurodegenerative changes.The clinical intervention for bipolar disorder mainly relies on drug treatment,but drugs have limited effects on improving cognitive function,and some drugs may even aggravate cognitive impairment.Aerobic exercise,as a non-drug intervention method,has shown positive effects in improving cognitive function in patients with mental disorders.However,there are still insufficient studies on elderly patients with bipolar disorder.Objective To explore the impact of aerobic exercise on the cognitive function of elderly patients with bipolar disorder,so as to provide references for the formulation of strategies to improve the cognitive function of this population.Methods A randomized controlled trial was conducted.A total of 60 elderly patients who were hospitalized at the Third People's Hospital of Lanzhou from January 2024 to March 2025 and met the diagnostic criteria for bipolar disorder as defined in the International Classification of Diseases,tenth edition(ICD-10)were selected.They were divided into the study group and the control group,with 30 cases in each group,based on the random number table method.Both groups were given quetiapine fumarate tablets and magnesium valproate sustained-release tablets.The study group additionally received aerobic exercise(including slow walking,doing exercises,and running),three times a week,for 30 minutes each time.At the baseline and at the end of the 3rd,6th,9th,and 12th week of the intervention,the Hamilton Depression Scale-24 item(HAMD-24),the Young Manic Rating Scale(YMRS),the Montreal Cognitive Assessment(MoCA),and Wechsler Adult Intelligence Scale Revised in China(WMS-RC)were used for assessment.Results The time effect of the HAMD-24 score was statistically significant(Wald χ2=124.564,P<0.01).The time effect of the YMRS score was also statistically significant(Wald χ2=145.608,P<0.01),and the interaction effect between time and group was statistically significant(Wald χ2=14.968,P<0.05).At the 3rd,9th,and 12th week of the intervention,the YMRS score of the study group was lower than that of the control group in the same period,and the differences were statistically significant(P<0.05).The time effect and group effect of the MoCA score were both statistically significant(F=99.347,16.623,P<0.01).The time effect,group effect,and interaction effect between time and group of the WMS-RC memory quotient were all statistically significant(F=64.678,10.197,12.472,P<0.01).At the 6th,9th,and 12th weeks of the intervention,the MoCA score and WMS-RC memory quotient of the study group were higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Aerobic exercise may help improve the manic symptoms and cognitive functions(especially memory ability)of elderly patients with bipolar disorder.
Background Schizophrenia,as a common chronic mental disorder,although second-generation antipsychotic drugs have shown significant efficacy in alleviating positive symptoms,the widespread cognitive dysfunction among patients remains a challenge in clinical treatment.Traditional Chinese medicine has unique advantages in the treatment of mental disorders.However,the current clinical research on the combination of Wendan Decoction and antipsychotic drugs for schizophrenia varies in quality,and there is a lack of systematic reviews evaluating its effects on cognitive improvement and safety.Objective To systematically evaluate the effects of modified Wendan Decoction combined with antipsychotic drugs on schizophrenia symptoms and cognitive improvement,providing evidence-based support for the clinical application of Wendan Decoction.Methods Literature searches were conducted in China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP Information,China Biomedical Literature Service System,China Clinical Trial Registry,PubMed,Web of Science,the Cochrane Library,and Embase to collect randomized controlled trials(RCTs)of modified Wendan Decoction combined with antipsychotic drugs for the treatment of schizophrenia.The search period was from the establishment of the databases to March 19,2026.The quality of the included literature was evaluated using the Cochrane 6.3.Meta-analysis was performed using RevMan 5.3 software.Results A total of 11 studies were included,involving 1 130 patients with schizophrenia.Among them,566 cases were in the study group(receiving modified Wendan Decoction combined with antipsychotic drugs),and 564 cases were in the control group(receiving antipsychotic drugs only).Meta-analysis showed that the effective rate of improvement in psychotic symptoms in the study group was higher than that in the control group(RR=1.21,95%CI:1.15-1.27,P<0.01).In terms of psychotic symptoms,the Positive and Negative Symptom Scale(PANSS)positive symptom score(MD=-3.69,95%CI:-5.87--1.51,P<0.01)and PANSS total score(MD=-9.20,95%CI:-11.80--6.59,P<0.01)of the study group were lower than those of the control group.In cognitive function assessments,the Mini-Mental State Examination(MMSE)score(MD=2.51,95%CI:1.33-3.68,P<0.01)and the Loewenstein Occupational Therapy Cognitive Assessment(LOTCA)score(MD=11.85,95%CI:2.55-21.15,P=0.010)of the study group were higher than those of the control group,and the Wisconsin Card Sorting Test(WCST)score was lower than that of the control group(MD=-9.34,95%CI:-12.57--6.11,P<0.01).The levels of brain-derived neurotrophic factor(BDNF)(SMD=1.34,95%CI:0.63-2.05,P<0.01)and nerve growth factor(NGF)(MD=6.94,95%CI:4.00-9.89,P<0.01)of the study group were higher than those of the control group.In terms of safety,there was no statistically significant difference in the incidence of adverse reactions between the two groups(RR=0.60,95%CI:0.31-1.18,P=0.14).Conclusion The modified Wendan Decoction combined with antipsychotic drugs may be more effective than antipsychotic drugs alone in improving positive symptoms and cognitive function in patients with schizophrenia,and it also exerts a favorable neurotrophic regulatory effect.
Background Arrhythmia and obsessive-compulsive disorder(OCD)frequently co-occur in clinical and epidemiological settings,yet their shared genetic basis and potential heart-brain axis mechanisms remain unclear.Objective To systematically evaluate the genetic correlation between arrhythmia and OCD,and to elucidate their underlying molecular genetic mechanisms,so as to provide molecular evidence for the"heart-brain axis"to support risk assessment and integrated clinical strategies for these comorbidities.Methods The aggregated data from the genome-wide association study(GWAS)of arrhythmia in the UK Biobank(7 207 cases and 477 391 controls)and the GWAS data of OCD released by the Psychiatric Genomics Consortium(2 688 cases and 7 037 controls)were integrated,all of which were limited to individuals of European ancestry.The genome-wide genetic correlations were estimated using the linkage disequilibrium score regression(LDSC)and the high-definition likelihood(HDL).Local genetic correlation analysis was conducted using the local analysis of variance annotation(LAVA).Multi-trait analysis of GWAS(MTAG)was employed to identify pleiotropic loci.Shared risk genes were identified by combining summary-data based Mendelian randomization(SMR)and transcriptome-wide association study(TWAS).Functional enrichment analysis was performed based on the functional mapping and annotation(FUMA)platform.Results Both LDSC(rg=0.248,95%CI:0.159-0.336,P=4.82×10-3)and HDL(rg=0.294,95%CI:0.237-0.351,P=5.87×10-4)revealed significant positive genetic correlation between arrhythmia and OCD.LAVA identified 23 significantly local correlated regions in the genome(P<2.0×10-5).MTAG discovered 11 genome-wide significant pleiotropic SNPs,among which rs12754189(intron of KCNN3)had potential functional harmfulness(CADD>12.37).SMR and TWAS jointly identified 20 shared genes,enriched in neural-cardiovascular tissues such as the cerebral cortex,amygdala,and left ventricle,and involved in DNA damage response,RNA metabolism,transcriptional regulation,and FAS signaling pathway(FDR<0.05).Conclusion Arrhythmia and OCD share a common genetic basis.The co-morbidity mechanism may involve the common vulnerability of neurons and cardiac muscle cells in terms of gene expression regulation and stress response,supporting the role of the brain-heart axis in the pathophysiology of both conditions.
This article reports a case of a male patient with anti-N-methyl-D-aspartate receptor(NMDAR)encephalitis comorbid with early-onset Alzheimer's disease(AD).The patient presented with depression,hallucinations and delusions syndrome,and cognitive impairment,and was admitted to a psychiatric hospital.Through multidisciplinary consultation,the diagnosis was confirmed based on positive biological and pathological biomarkers.The patient's symptoms improved after receiving a therapeutic regimen comprising high-dose glucocorticoid therapy and psychiatric-related treatments.Based on relevant current research findings domestically and internationally,this article reviews the pathogenesis and clinical manifestations of early-onset AD and anti-NMDAR encephalitis,in order to enhance the discrimination ability of psychiatric specialists for such patients and improve the diagnosis and treatment level.
Background Currently,the incidence of depression among teenagers is on the rise,and the related academic problems are becoming increasingly serious.Short video addiction has a negative impact on teenagers'emotional issues and academic achievements.However,few studies have explored the relationship between this addiction and the learning burnout of teenagers with depression,and even fewer have focused on the role paths of impulsivity and coping disposition in this process.Objective To explore the relationship between short video addiction and learning burnout in adolescent patients with depression,as well as the pathway of impulsivity and coping disposition,so as to provide references for the intervention of learning burnout in adolescent patients with depression.Methods A total of 191 adolescent patients who were hospitalized at The Affiliated Brain Hospital of Guangzhou Medical University from December 2024 to April 2025 and met the diagnostic criteria for depression according to the International Classification of Diseases,tenth edition(ICD-10)were selected consecutively.The Short Video Addiction Measurement Scale(SVAMS),the Brief Barratt Impulsiveness Scale(BBIS),the Simplified Coping Style Questionnaire(SCSQ),and the Adolescent Student Burnout Inventory(ASBI)were used for assessment.Pearson correlation analysis was employed to examine the correlations of the scores of each scale.Model 6 of the SPSS macro Process 4.2 was employed to analyze the chained mediation pathway of impulsivity and coping disposition between short video addiction and learning burnout.Results A total of 173 cases(90.58%)of adolescent patients with depression completed the valid questionnaire survey.Correlation analysis showed that SCSQ coping disposition score was negatively correlated with the SVAMS score,the BBIS score,and the ASBI score(r=-0.282,-0.341,-0.431,P<0.01),the SVAMS score was positively correlated with the BBIS score and the ASBI score(r=0.339,0.262,P<0.01),and the BBIS score was positively correlated with the ASBI score(r=0.486,P<0.01).The pathway analysis showed that the direct effect of short video addiction on learning burnout was not statistically significant,but the total effect and the indirect effect were statistically significant.The effect values were 0.275(95%CI:0.207-0.343)and 0.193(95%CI:0.143-0.246),respectively,with the indirect effect accounting for 70.18%.Impulsivity and coping disposition both played independent mediating roles between short video addiction and learning burnout,with effect values of 0.122(95%CI:0.090-0.156)and 0.054(95%CI:0.032-0.079),accounting for 44.36%and 19.64%of the total effect,respectively.The chained mediation effect of impulsivity and coping disposition was significant,with an effect value of 0.017(95%CI:0.011-0.026),accounting for 6.18%of the total effect.Conclusion Although short video addiction does not directly affect learning burnout in adolescent patients with depression,it may indirectly influence learning burnout through independent and chain paths of impulsivity and coping disposition.
Background Emotional disorders in adolescents have emerged as a prominent issue in recent years.Current mainstream clinical assessment approaches for such conditions predominantly rely on interviews and rating scales,which are limited by inherent drawbacks such as high subjectivity and recall bias.Accordingly,there exists an urgent clinical need for the development of objective,quantifiable auxiliary diagnostic tools.In previous studies,frontal electroencephalography(EEG)has demonstrated significant value in assessing depressive and anxiety.However,the lack of standardized quantitative metrics and intuitive visual analytical approaches has severely restricted clinical interpretability of EEG data and diminished patient engagement.To address these key limitations,the present study proposes an innovative analytical framework that converts frontal EEG signals into quantifiable visual metrics to enhance clinical comprehension and acceptance.Objective To explore the value of frontal EEG in assessing anxiety,depression,and sleep quality in adolescents with emotional disorders,with the aim of providing objective auxiliary tools for clinical diagnosis and assessment of adolescents with emotional disorders.Methods This cross-sectional study recruited 105 adolescents aged 12-18 years who visited the outpatient department of a specialized mental hospital in Beijing from April 2023 to April 2024.All participants met the diagnostic criteria for mood(affective)disorders or anxiety disorders in the International Classification of Diseases,tenth edition(ICD-10).Frontal EEG signals were collected within a big data analytics-driven framework and further processed by EEG system to generate six quantitative cerebral function indices,namely brain load,tension and excitement,emotional stress,sleepiness index,cerebral vitality,and cerebral fatigue.In addition,validated standardized scales,including the Self-rating Anxiety Scale(SAS),the Self-rating Depression Scale(SDS),and the Pittsburgh Sleep Quality Index(PSQI),were administered for anxiety,depressive symptoms,and sleep quality,respectively.Results In adolescent patients with emotional disorders,the SAS score exhibited significant positive correlations with brain load(rs=0.328,P<0.01),emotional stress(rs=0.341,P<0.01),and cerebral fatigue(rs=0.286,P<0.01).The SDS score was positively correlated with brain load(rs=0.275,P<0.01),emotional stress(rs=0.241,P<0.05),and cerebral fatigue(rs=0.311,P<0.01),while showing a significant negative correlation with cerebral vitality(rs=-0.212,P<0.05).Additionally,the PSQI total score demonstrated positive correlations with brain load(rs=0.340,P<0.01),emotional stress(rs=0.322,P<0.01),and cerebral fatigue(rs=0.229,P<0.05).Conclusion Frontal EEG-derived indices,including brain load,emotional stress,cerebral fatigue and cerebral vitality,may serve as objective markers for reflecting anxiety,depression,and sleep quality in adolescents with emotional disorders.
In recent years,the incidence of depression among adolescents has increased significantly,becoming a serious global public health problem.There is a close relationship between adolescent depression and lipid metabolism abnormalities.However,the mechanisms underlying this association have not been fully elucidated.This article provides a review of the mechanisms and interventions linking adolescent depression and lipid metabolism abnormalities,aiming to offer new ideas for interventions in adolescent depression.Using computerized searches of the China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,and Web of Science,studies on the mechanisms and interventions related to adolescent depression and lipid metabolism were collected,with the search period extending up to October 10,2025.Two researchers independently conducted literature screening and extracted basic information from the included studies.A total of 12 original studies were included.The results indicate that adolescent depression is associated with certain lipid metabolites.Neurobiological factors,immune inflammation,oxidative stress,and gut microbiota imbalance play important roles in this association.In addition,lipid metabolites such as omega-3 polyunsaturated fatty acids(ω-3 PUFAs)have a significant ameliorating effect on adolescent depression.
Background Addictive non-suicidal self-injury(NSSI)behaviors among adolescents have become increasingly prominent,although previous studies have identified multiple related risk factors and have examined the association between screen time and NSSI behaviors,the impact of screen time on NSSI behaviors addiction,as well as the mediating role of family dysfunction in this relationship,remain to be further clarified.Objective To investigate the mediating role of family dysfunction in the relationship between screen time and NSSI behaviors addiction among adolescent female patients with depression disorder,with the aim of providing references for reducing NSSI behaviors addiction.Methods From September 2024 to November 2025,a total of 652 adolescent female patients with depression disorder were enrolled from both outpatient and inpatient departments of Xiamen Xian-yue Hospital,all of whom met the diagnostic criteria for depressive episode(F32)or recurrent depressive disorder(F33)according to the International Classification of Diseases,tenth edition(ICD-10).Assessments included a self-developed demographic questionnaire,screen use questionnaire,Chinese Family Assessment Instrument(C-FAI),and Ottawa Self-injury Inventory Chinese Revised version(OSIC).Among participants with NSSI behaviors,Spearman correlation analysis was used to examine the correlation between screen time and scale scores.Model 4 of the Process 4.1 for SPSS 26.0 was then applied to test the mediating role,and Bootstrapping procedure involving 5 000 replicates was employed to confirm the statistical significance.Results Among the 652 patients,569(87.27%)exhibited NSSI behaviors.Among them,398 cases(69.95%)belonged to the addictive NSSI group,and 171 cases(30.05%)belonged to the non-addictive NSSI group.The OSIC addiction dimension score was positively correlated with screen time and C-FAI scores(rs=0.114,0.224,P<0.01).Family dysfunction mediated the relationship between screen time and NSSI addiction,with an indirect effect value of 0.036(95%CI:0.016-0.062),accounting for 35.88%of the total effect.Conclusion Screen time may affect the NSSI behaviors addiction in adolescent female patients with depression disorder through family dysfunction.
