Objective The literature on large-scale studies of Chinese patients with adolescent-onset bipolar disorder (adolescent-onset BD) was limited. Based on the analysis of the National Bipolar Mania Pathway Survey (BIPAS) Phase II data, we examined the demographic and clinical characteristics of adults with adolescent-onset BD. Methods Among 899 participants diagnosed with BD from 20 mental health services, demographics and clinical data were collected at screening. Comparisons were made using chi-square (or Fisher's exact) tests and ANOVA. Multivariate logistic regression identified independent factors for adolescent-onset BD, and a CHAID decision tree analysis (SPSS) was constructed to detect risk factors. Results In the sample, 360 (40%) had adolescent-onset BD and 539 (60%) adult-onset BD. Significant differences between the two groups were observed in current age, number of episodes, years of education, gender, age of onset, education level, marital status, occupation, comorbid chronic physical illness, and first episode type. Stratified analysis also revealed significant differences between adolescent-onset BD I and BD II. Multivariate logistic regression identified younger onset age, more frequent episodes, lower education level, marital status, occupation, first episode type, and prior hospitalization as independent factors for adolescent-onset BD. The decision tree model selected current age as the first splitting variable, followed by occupation and marital status as the second, and years of education and prior hospitalization as the third. Conclusions Adolescent-onset BD exhibits distinct demographic and clinical features compared to adult-onset BD. Early recognition and tailored treatment strategies may improve prognosis and outcomes in this population.

There is a high prevalence of suicidal ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI) in bipolar disorder (BD). Understanding the nature of suicidality and NSSI in BD is an important way to inform optimal intervention for reducing suicide risk. We aimed to investigate the prevalence and correlates of SI, SA, and NSSI in patients with BD using data from a national survey. We used network analysis to explore the associations among suicidality, NSSI, addictive features of NSSI, and symptoms of BD. Participants with BD were recruited from 20 research centers in China. Suicidality, NSSI, addictive features, and symptoms of BD were measured via a standardized electronic case report form. We used logistic regression and network analysis for data analysis. Of the 1,055 participants recruited, over 50

OBJECTIVE:We collected maintenance treatment medication information from Chinese multicenter bipolar disorder patients, exploring the characteristics of medication use and related factors. We analyzed medication guideline adherence and compared trends in medication use with a study from 2014. METHODS:323 patients receiving maintenance therapy for bipolar disorder across 20 hospitals have been recruited. Their prescription information was collected to compare with the recommended drug protocols outlined by CANMAT to assess consistency. Additionally, descriptive statistics were conducted to document the quantities and percentages of different classes of medications used. Regression analysis was employed to explore factors influencing medication choices. RESULT:The rate of medication inconsistency in this study was 12.38 %, characterized by inappropriate use of antidepressants and mood stabilizers. The rate of using additional drugs was 67.80 %, with antipsychotics being the most common adjunctive treatment in the Bipolar I group and antidepressants in the Bipolar II group. Factors influencing the occurrence of adjunctive therapy included previous hospitalization, most recent episode type, and gender. The rate of polypharmacy was 47.10 %, with previous hospitalization and most recent episode type being the main influencing factors. CONCLUSION:There has been a noticeable improvement in guideline concordance in medication use compared to 2014; however, improper use of antidepressants remains a significant clinical issue. The increasing prevalence of adjunctive medication use underscores the need for more personalized medication recommendations in clinical guidelines.

Background: DSM-5 proposes the concept of bipolar disorder with “mixed features ”, which is of great benefit to clinical practice. However, the clinical management of BD with mixed features is more challenging.This investigation examined the prescribing patterns and factors influencing guidelines disconcordance for the acute treatment of bipolar disorder with mixed features in mainland China. Methods:This real-world study enrolled 688 patients with acute bipolar disorder through the National Bipolar Pathway Survey Replication (BIPAS-R). We used CUDOS-M and MINI-M scales based on DSM-5 criteria to improve the sensitivity of screening for bipolar disorder with mixed features. Guideline inconsistency judgments were determined by comparison with the Canadian Network for Mood and Anxiety Treatments(CANMAT) guidelines for treatment recommendations for bipolar disorder with mixed features. Logstic regression was used to analyze the influencing factors of guideline disconcordance. Results: Among 688 cases of acute bipolar disorder, 235 cases (34.2%) were (hypo) mania with mixed features and 213 cases (30.9%) were depression with mixed feature. Without considering the order of treatment, the inconsistency rates of (hypo) mania and depression with mixed features with the guidelines were 29.4% and 55.4%, respectively. (Hypo) mania with mixed features BD-II (OR=0.52; 95% CI 0.29-0.93), age at study entry > 24 years (OR=2.4; 95% CI 1.3-4.3), and the number of episodes > 4 in the past year in depression with mixed features (OR=1.9; 95% CI 1.08-3.6), which increased the risk of treatment disconcordance of guidelines. Conclusions:Our findings suggest that BD with mixed features is more common.

Background Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. Methods NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. Results The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were “cutting” (41.2 %) and “hitting” (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). Limitations As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. Conclusion Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Objective:This study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.Methods:Based on the Phase Ⅰ (2012) and Phase Ⅱ (2021) databases of National Bipolar Mania Pathway Survey (BIPAS), patients with bipolar disorder were included. General demographic data, clinical characteristics, symptomatic phenotypes, and mixed characteristics were retrieved. The detection rates and symptomatic performances of patients with or without mixed states in Phase Ⅰ and Ⅱ were compared using the chi-square test.Results:For patients with mixed states, the detection rate during Phase Ⅱ (2021) using DSM-5 (18.79%, 199/1 059) criteria was significantly higher than that during Phase Ⅰ (2012) using ICD-10 (6.78%, 199/2 934; χ 2=125.05, P<0.001). Whether using ICD-10 or DSM-5 criteria, patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations. Conclusion:The DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states. The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.

Background School attendance problems (SAPs), whether absenteeism or dropout, are strongly associated with poor outcomes for adolescents. We examined multiple variables that influence SAPs to identify potential leverage points for improving school attendance. Methods Self-reported SAPs and demographic information was collected from 392 adolescents in adolescents presenting to the general hospital for psychological services. PHQ-9 and GAD-7 were applied to assess the severity of depressive and anxious symptoms. We constructed logistic regression analysis and the Chi-Square Automatic Interaction Detection (CHAID) segmentation analysis via SPSS Decision Tree to identifying risk factors for the development of SAPs in adolescents. Results SAPs were self-reported by 252 (64.3%) adolescents. The SAPs group and non-SAPs group showed a significant difference in age, PHQ9 total scores, GAD7 total scores, schools, siblings, residence, parental marital quality, general health, regular exercise, and regular diet. A post hoc comparison between the two groups showed that the frequency of SAPs was significantly higher in the moderately-severe and severe depressive groups compared with other three groups (none, mild, moderate). The frequency of SAPs in severe anxious groups was significantly different from the none-anxious group. According to the binary logistic regression analysis, the depressive severity, siblings, residence, marital quality of parents, general health, and regular diet were correlated with the SAPs among adolescents. The adjusted OR of SAPs according to moderately-severe depressive symptoms was 10.84 (95%CI: 1.967–59.742) and severe depressive symptoms was 6.659 (95%CI: 1.147–38.666). In the decision tree model, PHQ-9 severity was extracted as the first splitting variable, with regular exercise and residence as the second, and siblings as the third. The ROC curves for predicting SAPs showed a fair diagnostic accuracy of the model with AUCs of CHAID model (0.705,95%CI:0.652–0.759, P = 0.000) and logistic regression model (0.777,95%CI:0.729–0.824, P = 0.000). Conclusion Our study provides insights into the associations between depressive symptoms and poor school attendance and identifies a number of risk factors associated with SAPs. Effective intervention by mental health practitioners, more attention by policy makers, and further research in this area are urgently needed for adolescents.

抑郁症具有高患病率、高复发率和疾病负担重等特点,经规范治疗,仍有部分患者疗效欠佳或存在残留症状.阿戈美拉汀作为一种新的抗抑郁药,其作用机制突破了传统单胺递质系统,特异性激动褪黑素受体,同时拮抗5-HT2c受体.由于其独特的作用机制,阿戈美拉汀除了改善抑郁情绪,还具有调节睡眠和生物节律、性功能影响少、耐受性好、不影响体重、撤药反应小等优势.因为阿戈美拉汀潜在肝功能损害的风险,临床使用中需定期监测肝功能,注意与某些药物联用禁忌等问题.本文重点介绍国内外阿戈美拉汀临床应用中的循证证据、用药方法、安全性、临床应用特色、临床相关问题和处理等,结合广大专家的用药经验,为临床医生提供用药参考,从而促进抑郁症患者治疗结局和预后的改善,促进患者回归社会.

Objective To compare the effects of escitalopram and venlafaxine on the social function in patients with de-pression.Methods A total of 100 patients who met the diagnostic criteria of depression were randomly divided into two groups and treated with escitalopram and venlafaxine respectively.The therapeutic efficacy was measured with Hamilton depression scale ( HAMD-17);the improvement of social function was measured with Sheehan disability scale (SDS) and the short form-36 health survey (SF-36).The side effects were evaluated by the treatment emergent symp-tom scale ( TESS) .Results There were no significant differences in the HAMD scores between the two groups at each interview time (P>0.05), but the scores of HAMD in both groups decreased significantly compared with the baseline (P<0.01).There were no significant differences in the effective rate and remission rate after 8 weeks of treatment be-tween the two groups (P>0.05).There were marked differences in scores of SDS and social functions factor scores of SF-36 at the end of the 8th week and the baseline in both groups (P<0.01), but no significant differences before treat-ment and after 8 weeks of therapy (P>0.05).Conclusion Both escitalopram and venlafaxine can effectively improve the social function in patients with depression, with no statistically significant differences between them.

Objective To investigate the alexithymia, mental health condition and their relationship in female rheumatoid arthritis patients. Methods Fifty-four female patients with rheumatoid arthritis and 50 healthy women were enrolled and assessed with Chinese version of the 20-item Toronto Alexithymia Scale (TAS-20) and the symptom checklist-90(SCL-90). Disease duration and DAS28 of the patients were also recorded and calculated. The data were statistical analyzed by t test between the two groups and other block groups. The association between TAS-20, SCL-90, duration and DAS28 was assessed using Spearman corre-lations. Results ① The TAS-20 total score and Tf1, Tf2, Tf3 factors score of female rheumatoid arthritis patients were significantly higher than those of the control group (57±9, 51±7, t=4.15, P<0.01); it was also the same with the total score and factors score of SCL-90 (beside the paranoid factor) between patients and control groups (165±50, 138±41, t=3.06, P<0.05). ② Correlation analysis showed significantly positive correlation between Tf1 factor and all factors of SCL-90, also between Tf3 factor and obsession-compulsion, interpersonal sensitivity, phobias and paranoid factors(P<0.05). ③ Only hostility factor was different between the higher TAS-20 total score group and the lower one. However, the obsession-compulsion, anxiety and phobias factors scores of the higher Tf1 score group were significantly higher than those of the lower one (P<0.05); The higher Tf3 score group was significantly different from the lower one in obsession-compulsion, interpersonal sensitivity, depression, hostility, paranoid and psychoticism factors (P<0.05). The Tf1 factor score of higher SCL-90 total score group was significant higher than that of the lower one (P<0.05). ④ There were significantly positive correlation between duration and depression and paranoid factors, also between <br> DAS28 and anxiety and paranoid factors (P <0.05). Conclusion There is obvious alexithymia and psychological problems in female rheumatoid arthritis patients; the Tf1 and Tf3 factors of TAS-20, duration and DAS28 are all major factors related to the psychological state.

Objective To observe the therapeutic effect of escitalopram on severe depressed patients accompany with insomnia. Methods We chose compatible patients through consulting medical history, physical examination, laboratory examination, Pittsburgh sleep quality index (PSQI) and Hamilton Depression Scale (HAMD) et al, and the patients were graded by index scale(ISI), Montgomery Depression Scale(MADRS), generalized anxiety scale(GAD-7) and the Clinical Global Impression Scale(CGI) the previous day, in addition began to record sleep diary. Meanwhile Patients were given oral escitalopram after breakfast, the initial dosage was 5~10 mg/d, recorded sleep diary in the morning and evening which gave researcher in the next visit. The clinical follow-up on the seventh day, fourteenth day and thirtieth day respectively, and graded by ISI, MADRS, PSQI GAD-7 and CGI again, including record adverse events also. The dosage of escitalopram was adjusted according to therapeutic effect, the highest dosage was 20mg/day. ANOVA analysis of demographic characteristics, vital signs and scale based on SSPS10.0. Results In 160 cases of patients, 67 males, mean age(42±12)years old, 93 females, mean age(41±12)years old. In the four visit, weight, pressure and heart rate hadno statistically difference. The scores of PSQ, ISI, MADRS, GAD-7 and CGI decreased, andeach of the two visits had significant difference. The therapeutic effect was obvious after the seventh day, which continued to strengthen on the thirtieth day. The dosage of escitalopram gradually increased from (9.7±1.5) mg to (14.8 ± 4.0) mg, and in (14.8 ± 4.0) mg level, it played an ideal effect, only 2 patients had a little discomfort of dizziness and palpitation. Conclusion Insomnia is the most common symptom of depressed patients, escitalopram can improve the symptom of severe depressed patients, and their insomnia furthermore. This study suggests that the best effective dose of escitalopram in the treatment of severe depressive patients with insomnia is about 15mg/day.

Objective To investigate the clinical features and curative effects in the treatment of depression patients with or without anxiety symptoms.Methods 319 depression disorder patients were divided into 2 groups according to the the Hamilton anxiety scale(HAMA):the patients in the group A suffered from depression without anxiety(HAMA14,n=134)and the patients in the group B suffered from depression with anxiety(HAMA≥14,n=185).All the patients received the open anti-depression treatment for 8 weeks.The Hamilton depressive scale(HAMD17),HAMA and the treatment emergent symptom scale(TESS) were used to evaluate the efficacy and side effects before the treatment and at the end of the 1st,2nd,4th and 8th week.Results There was significant difference between group A and group B in the suicide risk(P0.01).The baseline mean scores of HAMD had significant difference between the two groups(P0.01).After 8 weeks of treatment,the HAMD and HAMA scores in both groups decreased significantly compared with those before the treatment(P0.01).The effective rates were 65.3% and 47.5% in group A and group B respectively(P0.01).At the end of 2nd week,the onset rates of the two groups were 75.2% and 50.0%(P0.01).There were significant differences in the mean scores of HAMD and HAMA between the two groups at every time point during treatments(P0.01).There were no significant differences between groups A1(depression without anxiety symptoms and treatment with Escitalopram) and A2(depression without anxiety symptoms and treatment with Venlafaxine) in the onset rate at 2nd week,the efficient rate and the clinical cure rate at 8th week(P0.05).There were no significant differences between groups B1(depression with anxiety symptoms and treat with Escitalopram)and B2(depression with anxiety symptoms and treat with Venlafaxine) in the onset rate at 2nd week and the efficient rate at the 8th week(P0.05),but there was significant difference in the clinical cure rate at 8th week between group B1 and group B2(P0.05),and the rates were 3.7% and 12.8%.Conclusion The patients suffered from depression with anxiety have worse pathogenetic conditions,higher risk of suicide,poorer response to antidepressants,as well as poorer prognosis contrast with those without anxiety.Venlafaxine has better prognosis than Escitalopram in the treatment of the depression patients with anxiety symptoms.

Objective To explore the relationship between childhood traumatic experiences and OCD patients.Methods DSM-IV was administrated to diagnose OCD patients.Childhood traumatic experiences of the sample were measured with Childhood Trauma Questionnaire(CTQ).Results Logistic regression analysis showed that OCD could be accounted for by emotional neglect.(Wald χ2=13.473,P<0.001)and physical neglect(Wald χ2=4.602,P<0.05)and physical abuse(Wald χ2=9.977,P<0.05).emotional neglect was(b=0.429,exp(b)=1.536),physical neglect was(b=0.242,exp(b)=1.273) Whereas physical abuse was(b=-0.559,exp(b)=0.572).Conclusion Emotional neglect and physical neglect may be the risk factors for the development of OCD.However,physical abuse may not be the risk factor for the development of OCD.

Background: Tryptophan hydroxylase-2 (TPH2) is the rate-limiting enzyme in the synthetic pathway for brain serotonin and is considered key factor for maintaining normal serotonin transmission in the central neuron system (CNS). Gene-disease association studies have reported a relationship between TPH2 and major depressive disorder (MDD) in different populations, however subsequent studies have produced contradictory results.Objectives: We performed a systematic overview and a meta-analysis with all available data up-to-date.Methods: We scrutinized PubMed, Embase, HuGNet and China National Knowledge Infrastructure (CNKI) and last update was held on October 2011. We also searched the manuscripts and the supplementary documents of the published genome-wide association studies in the field. Effect sizes of independent loci that have been studied in more than 3 articles were synthesized using fixed and random effects models.Results: We found 27 eligible articles that studied a total of 74 single nucleotide polymorphisms (SNPs). Finally, 12 independent loci were included in the meta-analysis. The synthesis of the data shown that two SNPs (rs4570625 and rs17110747) were associated with MDD using fixed effects models. SNP rs4570625 had low heterogeneity and remained significant using the more conservative random effects calculations with a summary OR = 0.83 (95% CI: 0.73-0.96).Conclusion: The current study identified a SNP (rs4570625) with strong epidemiological credibility; however more studies are required to provide robust evidence for other weak associations.

Objective To explore the correlation between personality traits and clinical efficacy in patients with depression.Methods A total of 80 depressive patients were assessed with NEO Personality Inventory(NEO-PI-R) before the treatment.They were randomly divided into two groups,one group were treated with antidepressant single(pharmacotherapy group) and the other group were treated with antidepressants combined with cognitive behavioral therapy(therapeutic alliance group).The clinical efficacy was evaluated by using the reducing score rate of Hamilton Depression Scale(HAMD).Correlation between personality traits and clinical efficacy was analyzed at the 8th weekend of the treatment.Results The reducing score rate of HAMD in therapeutic alliance group were significantly higher than those in pharmacotherapy group at the end of 4th,6th,8th weekend.There were significant differences in the changing trend of lower N dimension,higher O dimension and higher A dimension between the twe groups as time went by.Conclusion Antidepressants combined with cognitive behavioral therapy should be more effective for depression than the antidepressants alone.Psychotherapy may have good effect in a short time in depressive patients with lower score of N dimension,higher score of O dimension and higher score of A dimension.

产后抑郁症由Pitt(1986)首次提出,根据DSM-W诊断标准[1],现指产后4周内发生的抑郁发作.主要表现为情绪的持久低落,兴趣的丧失、思维迟钝、意志行为减少,重者出现幻觉或自杀行为等情绪障碍.

Objective:To investigate the comorbidity of obsessive-compulsive disorder(OCD)with Axis II personality disorders(PD).Methods:Forty-four patients who met the DSM-IV(Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition)criteria for OCD were screened with the Personality Diagnostic Questionnaire(PDQ+4).And the PD positive subjects were assessed and diagnosed with the Personality Disorder Interview(PDI-IV).Results:Thirty-six of the 44 patients showed positive results in the PDQ+4 screening,with the positive rate of 82%.Thirty-two of 44(73%)OCD patients also met DSM-IV criteria for Axis II personality disorders.Twenty-five of 44(57%)OCD patients were diagnosed with two or more kinds of Axis II disorders.The most common three personality disorders were obsessive & compulsive(64%),avoidant(57%),and paranoid(21%).No subjects were diagnosed with antisocial and schizoid.Conclusion:Comorbidity of obsessive-compulsive disorder with personality disorders occurs pervasively.Patients with OCD are often diagnosed with Axis II personality disorders with the exception of antisocial and schizoid,especially with obsessive & compulsive and avoidant of cluster-C.

Objective To investigate the comorbidity of OCD and Axis I disorders.Methods DSM-IV was administrated to subjects to diagnose OCD,SCID-I/P was administrated to 44 OCD patients diagnosed clinically to formally determine whether they meet DSM-IV criteria for Axis I disorders.Results Totally 41%(18/44) of the 44 OCD patients met the criteria for mood disorders,32%(14/44) were diagnosed with major depression disorder(MDD),27%(12/44) of the OCD patients met the criteria for other anxiety disorders,11%(5/44) were diagnosed with panic disorder with/without agoraphobia.Conclusion Comorbidity of OCD and major depression disorder occurs pervasively,so does OCD and other anxiety disorders.

目的 研究强迫障碍(OCD)共病轴Ⅰ及其与童年期创伤性经历的关系.方法 符合DSM-Ⅳ临床诊断标准的44例OCD患者为被试,应用DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查病人版(SCID-I/P)半定试检查OCD患者共病轴Ⅰ心境障碍、焦虑障碍的情况,确定共病轴Ⅰ障碍患者.用童年期创伤问卷(CTQ-SF)测查OCD患者的童年期创伤性经历.结果 有25例OCD患者共病轴Ⅰ心境障碍和或焦虑障碍.OCD共病轴Ⅰ障碍除了情感虐待、躯体虐待、情感忽视和躯体忽视外,只有性虐待(Wald χ2=4.036,P＜0.05)1个因子进入Logistic回归方程.其中性虐待b=1.813,exp(b)=6.131,exp(b)95%的C.I.为(1.045～35.960),性虐待因子的回归系数(b)＞0,比值比(OR)=exp(b)＞1.结论 OCD患者童年期的性虐待是OCD共病轴Ⅰ心境障碍和或焦虑障碍的危险因素.

Objective:To explore the relation between childhood traumatic experiences and the comorbidity of obsessive-compulsive disorder and personality disorders.Methods:DSM-IV was administrated to subjects to diagnose OCD patients.PDQ+4 and PDI-IV were then administrated to 44 OCD subjects to determine whether they also suffered from personality disorders.Childhood traumatic experiences of the sample were measured with Childhood Trauma Questionnaire(CTQ).Results:32 of 44 OCD patients also met DSM-IV criteria for Axis II personality disorders.Logistic regression analysis showed that comorbidity of OCD and personality disorders could be accounted for by emotional abuse(Wald χ2=6.428,P0.05) and physical negelect(Wald χ2=4.608,P0.05) and physical abuse(Wald χ2=5.031,P0.05),emotional abuse(b=1.021,exp(b)=2.776) physical negelect(b=0.617,exp(b)=1.853) Whereas the regressive coefficient of physical abuse(b=-1.435,exp(b)=0.238) was 0.Conclusion:Emotional abuse and physical neglect are the risk factors for comorbidity of OCD and personality disorders.