Introduction:Postoperative neurological and neuropsychiatric complications (NNC) after liver transplantation (LT) have become an important research concern, but the difficulties arise with the diagnosis of the majority subclinical form of NNC. Case Report:We report a middle-aged man who developed fluctuating psychotic symptoms, marked personality change, and behavioral disturbance approximately one week after LT. No overt focal neurological deficits, such as hemiparesis, aphasia, or seizures, were observed. Brain MRI showed small periventricular/subcortical white-matter lesions with hyperintensity on T2WI and FLAIR images and punctate hyperintensity on DWI. The findings were interpreted as suggestive of suspected silent ischemic brain injury. Tacrolimus-related neurotoxicity, PRES, metabolic/hepatic encephalopathy, infection, seizure-related states, and alcohol-related encephalopathy were considered in the differential diagnosis. Contemporaneous tacrolimus trough levels and EEG data were unavailable, so tacrolimus neurotoxicity and non-convulsive seizure-related psychiatric symptoms could not be completely excluded. The patient received symptomatic psychiatric treatment and rehabilitation, and his neuropsychiatric symptoms gradually resolved, with stable liver function at the last follow-up. Conclusion:This case illustrates that suspected silent ischemic brain injury after LT may present primarily as fluctuating psychotic symptoms and personality or behavioral changes, and may be easily mistaken for postoperative delirium, calcineurin-inhibitor neurotoxicity, infection, or metabolic/hepatic encephalopathy. In atypical or high-risk patients, early brain MRI may help identify potential brain involvement and guide timely neurological and neuropsychiatric evaluation. Key Message:New-onset psychotic symptoms after LT should not be automatically attributed to postoperative delirium. Even when MRI findings do not definitively confirm acute infarction, timely neuropsychiatric assessment and early brain MRI may help identify potential structural brain involvement in high-risk or atypical patients.

This study was to describe the cognitive function status in patients with depressive disorder and to construct a nomogram model to predict the risk factors of cognitive impairment in these patients. From October 2019 to February 2021, a total of 141 patients with depressive disorder completed the survey in two hospitals. The Montreal cognitive assessment (MoCA) was used with a cutoff score of 26 to differentiate cognitive impairment. Univariable and multivariable logistic regression analyses were conducted to identify independent risk factors. A nomogram was then constructed based on the results of the multivariable logistic regression analysis. The patients had an average MoCA score of 23.99 +/- 3.02. The multivariable logistic regression analysis revealed that age (OR: 1.096, 95% CI: 1.042-1.153, p < 0.001), education (OR: 0.065, 95% CI: 0.016-0.263, p < 0.001), depression severity (OR: 1.878, 95% CI: 1.021-3.456, p = 0.043), and sleep quality (OR: 2.454, 95% CI: 1.400-4.301, p = 0.002) were independent risk factors for cognitive impairment in patients with depressive disorder. The area under receiver operating characteristic (ROC) curves was 0.868 (95% CI: 0.807-0.929), indicating good discriminability of the model. The calibration curve of the model and the Hosmer-Lemeshow test (p = 0.571) demonstrated a well-fitted model with high calibration. Age, education, depression severity, and sleep quality were found to be significant predictors of cognitive function. A nomogram model was developed to predict cognitive impairment in patients with depressive disorder, providing a solid foundation for clinical interventions.

BACKGROUND:COVID-19 lockdowns increased the risk of mental health problems, especially for children with autism spectrum disorder (ASD). However, despite its importance, little is known about the protective factors for ASD children during the lockdowns.METHODS:Based on the Shanghai Autism Early Developmental Cohort, 188 ASD children with two visits before and after the strict Omicron lockdown were included; 85 children were lockdown-free, while 52 and 51 children were under the longer and the shorter durations of strict lockdown, respectively. We tested the association of the lockdown group with the clinical improvement and also the modulation effects of parent/family-related factors on this association by linear regression/mixed-effect models. Within the social brain structures, we examined the voxel-wise interaction between the grey matter volume and the identified modulation effects.RESULTS:Compared with the lockdown-free group, the ASD children experienced the longer duration of strict lockdown had less clinical improvement (β = 0.49, 95% confidence interval (CI) [0.19-0.79], p = 0.001) and this difference was greatest for social cognition (2.62 [0.94-4.30], p = 0.002). We found that this association was modulated by parental agreeableness in a protective way (-0.11 [-0.17 to -0.05], p = 0.002). This protective effect was enhanced in the ASD children with larger grey matter volumes in the brain's mentalizing network, including the temporal pole, the medial superior frontal gyrus, and the superior temporal gyrus.CONCLUSIONS:This longitudinal neuroimaging cohort study identified that the parental agreeableness interacting with the ASD children's social brain development reduced the negative impact on clinical symptoms during the strict lockdown.

To standardize clinical treatment decisions and improve the comprehensive diagnosis and treatment of bipolar disorder in China, the Psychiatric Branch of the Chinese Medical Association initiated the Guidelines for the Prevention and Treatment of Bipolar disorder in China (2025 edition). This protocol summary describes the background and purpose of the guideline, the formulation method, working group members, division of responsibilities, guideline registration, conflicts of interest, collection and selection of clinical issues, the evidence-based foundation of the guideline, writing and external review, as well as publishing, dissemination, and other aspects.

ObjectiveTo examine the early outcomes, associated factors and predictive values of clinical outcomes of different tandospirone doses in patients with a generalized anxiety disorder (GAD).MethodsThis was a posthoc analysis of "a randomized, controlled multicenter clinical trial of the efficacy and safety of different doses of tandospirone on GAD". A total of 274 patients with GAD were included and randomized into the high-dose (tandospirone 60 mg/d) and low-dose (tandospirone 30 mg/d) groups for a 6-week treatment. The Hamilton Anxiety (HAMA), Clinical Global Impression-Severity (CGI-S), Short-Form-12 (SF-12) scales were used for assessment. The trial was registered at clinical trail.gov (NCT01614041).Results(1) In the first week of treatment, 35.8% of patients in the high-dose group fulfilled the early onset criteria, which was significantly higher than 19.0% found in the low-dose group (p = 0.002). In the second week of treatment, 22.6% of patients in the high-dose group achieved an early response, versus 12.4% in the low-dose group, indicating a significant difference (p = .026). (2) Factors associated with early onset at week 1 included baseline HAMA total score (OR = 0.916, 95%CI 0.882-0.952), age (OR = 0.974, 95%CI 0.950-0.998), drug dose (30 mg vs. 60 mg; OR = 0.298, 95%CI 0.156-0.568) and SF-12 physiological total score (OR = 1.030, 95%CI 1.010-1.050). (3) Early onset was significantly associated with response rate (OR = 18.34, 95%CI 12.10-27.81), remarkable response rate (OR = 27.56, 95%CI 11.65-65.17) and recovery rate (OR = 11.85, 95%CI 4.98-28.18). Group (high dose group vs. low dose group) (chi(2) = 8.535, p = .003) and baseline HAMA total score (chi(2) = 70.840, p < .001) were independent predictors of onset time.ConclusionsThe early outcomes of high-dose tandospirone in the treatment of GAD are better than those of the low-dose group. Patients with younger age at onset, milder anxiety symptoms and better physiological functions administered high-dose tandospirone showed rapid onset, great early outcomes, high recovery rate and good prognosis. Drug onset time had a good predictive effect on treatment outcome.

Background Generalized anxiety disorder (GAD) is a chronic disorder characterized by excessive, pervasive, persistent worrying that is difficult to control. Jiuwei Zhenxin granules may be safer and more effective than non-benzodiazepine anti-anxiety drugs for treating GAD. This study aimed to assess the efficacy and safety of Jiuwei Zhenxin granules alone or in combination with the benzodiazepine alprazolam. Materials and methods A total of 710 patients were recruited from outpatient clinics and were randomly divided into two groups to receive Jiuwei Zhenxin granules (single drug group) or Jiuwei Zhenxin granules and alprazolam (combination group). The primary outcome was the response rate, which was defined as a ≥ 50% reduction from the baseline total score on the Hamilton Anxiety Scale (HAMA). Secondary outcome measures included mean changes in HAMA total score, psychological and somatic factors, Hamilton Depression Rating Scale total score, and SF-36 health survey score. Results At 4 weeks after treatment, the single and combination treatment groups showed significant improvement in the HAMA total score and they did not differ significantly in response rate (77.58 vs. 79.17%) or rate of adverse drug reactions (16.22 vs. 16.07%). Conclusion Jiuwei Zhenxin granules are an effective, safe, and well-tolerated treatment against GAD. Combining them with alprazolam may not significantly improve efficacy. Clinical trial registration [www.ClinicalTrials.gov], identifier [CHICTR1800020095].

Purpose To determine the relative safety and efficacy of different doses of tandospirone in treating generalized anxiety disorder (GAD). Patients and Methods This parallel randomized controlled trial enrolled patients with GAD from eight centers in China. The patients were randomly assigned to 60 mg/day or 30 mg/day tandospirone groups. The primary endpoint was the overall response rate after receiving 6-week treatment. The secondary endpoints included significant response rate, clinical recovery rate, change in the Hamilton Anxiety Scale (HAMA) total score, HAMA subscale score, Hamilton Depression Scale-17 (HAMD-17), Clinical Global Impression-Severity Scale (CGI-S) score, and Impression-Improvement scale (CGI-I) score. Results No significant difference was found in the overall response rate between the two groups (65.7% vs 58.4%, p = 0.213). A higher significant response rate and change in the HAMA total score were found in the 60 mg/day group. The reduction in the CGI-S score and percentage of patients with a CGI-I score of ≤2 were higher in 60 mg/day group. The reduction in HAMA somatic anxiety factor, cardiovascular symptom factor, gastrointestinal symptom factor, and HAMD-17 score were more significant in the 60 mg/day group. The incidence of total adverse events was higher in the 60 mg/day group than in the 30 mg/day group. No significant difference was found in the proportion of withdrawal due to adverse events. Conclusion Both 60 mg/day and 30 mg/day tandospirone show good efficacy in treating patients with GAD. High doses of tandospirone may have advantages in relieving the somatic symptoms but also present disadvantages due to their high level. Trial Registration The trial registration no. was NCT01614041.

共病是指患者当前或者既往任何一段时间内同时出现两种或者两种以上的精神问题和(或)躯体问题.双相障碍与其他精神障碍之间的共病率较高,共病对双相障碍的治疗和预后均造成了不利影响,是当前的研究热点之一.本文主要对双相障碍与其他常见精神科疾病共病的研究进展予以综述,为精神科临床提供参考.

Benzodiazepines have been on the market for more than half a century and are widely used in clinical practice. Their use in many countries has been limited in recent decades due to drug dependence and dose tolerance in some patients. Currently, benzodiazepines are still effective in treating many mental disorders, but some patients and doctors refuse to use them for fear of drug dependence and dementia caused by long-term use. The author suggests that benzodiazepines should be objectively evaluatedand rationally used.

抗抑郁药治疗抑郁症患者的早期改善(early improvement)是在治疗起效前判断疗效以指导换药的症状改善指标,目前最广为使用的定义是治疗第2周17项汉密尔顿抑郁量表(HAMD-17)总分的减分率大于等于20％,然而评估早期改善的量表选择、阈值选择以及早期改善这个概念的含义本身仍有争议.本研究梳理抗抑郁药早期改善概念的发展史,综述评估早期改善的量表以及阈值选定的研究进展,为涉及早期改善的研究的量表选用以及阈值选择提供参考.

[目的]基于已发表的齐拉西酮速效针剂对精神分裂症患者激越症状治疗的中英文文献,综合分析齐拉西酮针剂治疗激越症状的疗效及其相关影响因素.[方法]检索PubMed、EMBASE、Web of Knowledge、Cochrane Library、万方数据,中国期刊全文数据库,中国生物医学文献数据库(CBMdisc)和维普网,应用随机临床试验报告的声明(CONSORT)为参照标准进行入组和评价文献,采用STATA软件进行Meta分析,以疗效的效应值为因变量,性别、年龄、治疗前PANSS量表总分、是否合并口服抗精神病药物等为协变量,进行Meta回归模型分析.[结果]根据GRADE方法,主要结局指标的证据水平为"中度".共有14项研究纳入Meta分析和Meta回归,其中英文5篇、中文9篇.治疗前后样本量分别为1197和1149.随机效应Meta分析结果显示齐拉西酮针剂疗效显著[SMD=2.04,95％CI(1.47,2.61),P=0.000].Meta回归分析显示,疗效与基线PANSS分数(t=5.57,P=0.011)、合并使用口服抗精神病药物(t=4.07,P=0.027)有关,与文献发表语种(t=-0.57,P=0.625)、年龄(t=0.74,P=0.539)无关,女性相对于男性有疗效更优的统计学差异趋势(t=-2.95,P=0.060).[结论]齐拉西酮速效针剂治疗精神分裂症患者激越症状疗效良好,Meta回归模型显示治疗前病情较重、合并口服抗精神病药物的患者疗效更好.

Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.

Objective? To investigate the effect of raloxifene combined with olanzapine on negative symptoms in postmenopausal women with schizophrenia, and to further analyze the relationship between serum estradiol levels and negative symptoms during treatment. Methods? A total of 80 consecutive postmenopausal women with schizophrenia were randomly divided into the study group and the control group according to the random number table. The study group received 12 weeks of olanzapine and raloxifene (60 mg/d) treatment, and the control group received olanzapine and placebo treatment. Serum estradiol levels were measured before treatment and at 12 weeks of treatment. Psychiatric symptoms were assessed using the Positive and Negative Symptoms Scale (PANSS). Results? There was no significant difference in total score of PANSS, positive symptom score P, negative symptom score N, general psychiatric symptom G and serum estradiol level between the study group and the control group before treatment (P＞0.05); after 12 weeks of treatment, total score of PANSS and negative symptom score N in the study group were significantly lower than those in the control group (P＜0.05), while serum estradiol level was significantly higher than the control group (P＜0.05). The difference of serum estradiol level before and after the treatment in the study group was positively related to the difference of the negative symptom scores N (r=0.434,P＜0.05). Conclusions? Raloxifene can significantly improve the negative symptoms of postmenopausal women with schizophrenia and change the serum estradiol content, and the change of estradiol content in vivo may be related to the improvement of negative symptoms.

This article examines the possibility of using non-linear models(Support Vector Regression) to model the single channel EEG signals from psychiatric patients and a group of normal participants, to predict psychology trait ratings, like attention, anxiety, alertness, fatigue, sleepiness and depression. It used linear models as benchmarks, and the results showed non-linear models outperformed the benchmarks, as well as more advanced linear methods, like principle component regression. It is thus concluded that using single channel in practical situations to monitor these traits would be possible.

Both glucose metabolism and resting-state fMRI (RS-fMRI) signal reflect hemodynamic features. The objective of this study was to investigate their relationship in the resting-state in healthy elderly participants (n = 18). For RS-fMRI signal, regional homogeneity (ReHo), amplitude of low frequency fluctuations (ALFF), fractional ALFF (fALFF), and degree of centrality (DC) maps were generated in multiple frequency bands. Glucose uptake was acquired with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Linear correlation of each pair of the FDG-PET and RS-fMRI metrics was explored both in across-voxel way and in across-subject way. We found a significant across-voxel correlation between the FDG-PET and BOLD-fMRI metrics. However, only a small portion of voxels showed significant across-subject correlation between FDG-PET and BOLD-fMRI metrics. All these results were similar across all frequency bands of RS-fMRI data. The current findings indicate that FDG-PET and RS-fMRI metrics share similar spatial pattern (significant across-voxel correlation) but have different underlying physiological importance (non-significant across-subject correlation). Specifically, FDG-PET measures the mean glucose metabolism over tens of minutes, while RS-fMRI measures the dynamic characteristics. The combination of FDG-PET and RS-fMRI provides complementary information to reveal the underlying mechanisms of the brain activity and may enable more comprehensive interpretation of clinical PET-fMRI studies. Future studies would attempt to reduce the artifacts of RS-fMRI and to analyze the dynamic feature of PET signal.

The cognitive impairment associated with schizophrenia is highly prevalent and affects the overall functioning of subjects. The stimulation of the serotonin 1A receptor is a primary characteristic of some atypical antipsychotic drugs. We measured the levels of cognitive impairment using the Morris water maze test and protein kinase A activity in hippocampal neurons on presynaptic and postsynaptic serotonin 1A receptors to investigate the effect of dizocilpine-induced cognitive impairment associated with atypical antipsychotic drugs in rats treated by quetiapine alone or combined with WAY100635/tandospirone. The results of the Morris water maze test presented evidence that quetiapine alone alleviated the cognitive impairment associated with atypical antipsychotic drugs induced by dizocilpine. However, quetiapine plus WAY100635 induced no improvement of cognitive impairment associated with atypical antipsychotic drugs. The results of protein kinase A assay suggested that neither quetiapine alone nor in combination with tandospirone, but not quetiapine plus WAY100635, raised protein kinase A activity in hippocampus neurons. The present study demonstrated the key role of presynaptic serotonin 1A receptors on the therapeutic effect of quetiapine on cognitive impairment associated with atypical antipsychotic drugs. Moreover, that protein kinase A activity in hippocampal cells is involved in the mechanism of quetiapine's effect on cognitive impairment associated with atypical antipsychotic drugs.

Objectives: The nature of the diagnostic classification of mood disorder is a typical dichotomous data problem and the method of combining different dimensions of evidences to make judgments might be more statistically reliable. In this paper, we aimed to explore whether peripheral neurotrophic factors could be helpful for early detection of bipolar depression. Methods: A screening method combining peripheral biomarkers and clinical characteristics was applied in 30 patients with major depressive disorder (MDD) and 23 patients with depressive episode of bipolar disorder. By a model-based algorithm, some information was extracted from the dataset and used as a "model" to approach penalized regression model for stably differential diagnosis for bipolar depression. Results: A simple and efficient model of approaching the diagnosis of individuals with depressive symptoms was established with a fitting degree (90.58%) and an acceptable cross-validation error rate. Neurotrophic factors of our interest were successfully screened out from the feature selection and optimized model performance as reliable predictive variables. Conclusion: It seems to be feasible to combine different types of clinical characteristics with biomarkers in order to detect bipolarity of all depressive episodes. Neurotrophic factors of our interest presented its stable discriminant potentiality in unipolar and bipolar depression, deserving validation analysis in larger samples.

强迫症病因尚不明确,神经环路异常是研究热点.正电子发射断层扫描(PET)作为一种新的影像技术,可以在活体状态及整体水平对大脑功能、受体、代谢进行评估.目前基于PET技术的研究结果显示,强迫症患者5-羟色胺转运蛋白结合潜力改变,5-羟色胺能、多巴胺能功能异常;强迫症患者治疗前后脑血流灌注和葡萄糖代谢发生改变.未来研究可联合多种脑成像技术,探索不同亚型﹑不同药物﹑不同治疗方法等对强迫症大脑功能及结构的影响.

Background: Early improvement (EI) following treatment with antidepressants is a widely reported predictor to the treatment response. This study aimed to identify the resting-state functional connectivity (rs-FC) and its related clinical features that link the treatment response at the time of EI. Methods: This study included 23 first-episode treatment-naive patients with MDD. After 2 weeks of anti-depressant treatment, these patients received 3.0 Tesla resting-state functional magnetic resonance imaging scanning and were subgrouped into an EI group (N = 13) and a non-EI group (N = 10). Using the anterior insula (rAI) as a seed region, this study identified the rs-FC that were associated with both EI and the treatment response at week 12, and further tested the associations of the identified rs-FC with either the clinical features or the early symptom improvement. Results: Rs-FC between rAI and the left dorsolateral prefrontal cortex (dlPFC) was associated with EI (t(21) = - 6.091, p = 0.022 after FDR correction for multiple comparisons). This rs-FC was also associated with an interaction between EI and the treatment response at the week 12 (t(21) = -5.361, p = 6.37e-5). Moreover, among the clinical features, this rs-FC was associated with the early symptom improvement in the insomnia, somatic symptoms, and anxiety symptoms, and these early symptom improvements were associated with the treatment response. Conclusion: Rs-FC between the rAI and the left dlPFC played a crucial role in the early antidepressant effect, which linked the treatment response. The early treatment effect relating to rAI may represent an early symptom improvement in self-perceptual anxiety, somatic symptoms and insomnia.

The essence of my talk is to identify the changes in psychiatric clinical services over this designated time and illustrate my personal conjecture on what the field of psychiatry will be like in 10 years’ time. To put it simply, that is to tell the difference between visiting a psychiatrist today and visiting one 10 years from now. The main pieces of a doctor's visit are the patient, the doctor, plus the space for the visit (ie, the hospital). The content of a doctor’s visit is diagnosis and treatment. First, let’s look at the conditions of the medical services and services of today’s psychiatric departments, followed by reviewing our service status (ie, our current mental health service capacity broken into number of hospitals, hospital beds, doctors and nurses that we have for psychiatry). According to the 2015 National Mental Health Resource Survey,1 the service capacity of psychiatry in China currently has the characteristics of ‘three less and one poor’. The ‘three less’ signifies the insufficiency of psychiatric professional institutions, psychiatric specialist beds and psychiatric specialists, whereas ‘one poor’ represents that the conditions of existing psychiatric professional institutions are worse than those of general hospitals and other specialised hospitals. At present, there are nearly 3000 mental health service institutions in China, including psychiatric specialist hospitals, general hospital psychiatry, primary healthcare institutions, general clinics, mental health clinics and rehabilitation hospitals. Among them, psychiatric specialist hospitals and psychiatric units in general hospitals account for 85% of the total number. There are only about 430 000 psychiatric beds and nearly 30 000 psychiatry specialists in China, which is far from meeting the growing needs.1 Furthermore, there is a large shortage in the supply of specialist psychotherapists, psychological counsellors, rehabilitation physicians, social workers and public health professionals. Seventy-eight per cent of the existing …