快感缺失是精神分裂症阴性症状的主要表现之一,其成分复杂,临床意义丰富.但其病理生理机制仍不明确,目前的评估工具尚未将主观体验与客观表现结合,且缺乏有效干预措施.未来可采用先进的神经影像技术探索快感缺失不同成分对应的神经环路结构及分子水平改变,深入研究快感缺失的病理生理机制,以尽快找到有效干预策略.

Electroacupuncture (EA) and electroconvulsive therapy (ECT) are often used in the management of schizophrenia. This study sought to determine whether additional EA and ECT could augment antipsychotic response and reduce related side effects. In this retrospective controlled study, 287 hospitalized schizophrenic patients who received antipsychotics (controls, n = 50) alone or combined with EA (n = 101), ECT (n = 55) or both (EA + ECT, n = 81) were identified. EA and ECT were conducted for 5 and 3 sessions per week, respectively, with a maximum of 12 sessions for ECT during hospitalization. The Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) were used to assess the severity of psychotic symptoms. Clinical response on SAPS and SANS, weight gain, and adverse events were compared. Survival analysis revealed that the ECT and EA + ECT groups had markedly greater clinical response rate than controls on SAPS [72.7 and 90.1% vs. 64.0%; relative risk (RR), 1.974 and 2.628, respectively, P ≤ 0.004] and on SANS (67.3 and 70.4% vs. 42.0%; RR, 1.951 and 2.009, respectively, P ≤ 0.015). A significantly greater response rate on SANS than controls was also observed in the EA group (64.4% vs. 42.0%; RR = 1.938, P = 0.008). EA-containing regimens remarkably reduced weight gain and incidences of headache, insomnia, dry mouth, and electrocardiographic abnormalities. These results suggest that EA and ECT can serve as additional treatment for enhancing antipsychotic response and reduce the side effects in hospitalized patients with schizophrenia. Clinical Trial Registration: http://www.chictr.org.cn/showprojen.aspx?proj=38901, identifier ChiCTR1900023563.

To the Editor: Drug‐induced pancreatitis (DIP) is a rare cause. According to a German retrospective study, the incidence of pancreatitis caused by drugs was 1.4%.[1] A nationwide survey conducted by Japan showed that 1.2% of all cases of acute pancreatitis were caused by drugs.[2] The DIP is caused due to the drug itself or its metabolites, or organism‐specific reactions caused by the introduction of hypersensitivity during pancreatic injury. Despite appropriate treatment, it demonstrated severe complications and high mortality.[3] Valproate (sodium valproate and divalproex sodium forms) is a commonly used medication that is approved by the U.S. Food and Drug Administration for the treatment of epilepsy, migraine, and bipolar disorders. Adverse effects associated with valproate are typically benign, but there are more serious effects that are less frequently observed. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect, and acute pancreatitis.[4] Even though acute pancreatitis is an adverse effect of very low frequency, it is very important to be noted due to a high mortality rate of patients with acute pancreatitis as a consequence of the use of valproate.

Hyperprolactinemia is a common side effect of antipsychotic drugs. Although changes of antipsychotic drugs or reduction of their doses can solve this problem, a modification of the treatment regimen can lead to instability in patients. Herein, we followed up a patient with elevated prolactin caused by paliperidone and found that the prolactin level was decreased after the administration of a combination with a low-dose aripiprazole. In addition, we summarized and analyzed the findings from the case and the literature review conducted.

Two types of cannabinoid (CB) receptors have been described in the human body: CB1 and CB2 receptors. CB1 receptor distribution may be related to the cannabinoid functions of memory and cognition regulation as well as motor control. In addition, the endocannabinoid system (ECS) related to CB1 receptors may be involved in human emotion regulation, especially depression occurrence. Indeed, CB1 receptors are all distributed in depression associated neuroanatomical structures and neural circuits. Both animal experiments and clinical studies have demonstrated that impairment of the ECS pathway is present in depression models and patients, and application of both CB1 receptor agonists and anandamide (cannabinoid-like substance) degradation inhibitors produce similar biochemical and behavioral effects as antidepressants. These findings provide a solid basis for understanding the ECS role in the formation and development of depression. Therefore, it can be inferred that the ECS may have an important function in both depression treatment and the effects of antidepressants.

Background and objective: There is a growing consensus that schizophrenia is ultimately caused by abnormal communication between spatially disparate brain structures. White matter fasciculi represent the primary infrastructure for long distance communication in the brain. In this study, we aimed to investigate the white matter connection in schizophrenia susceptible brain regions of early growth response factor 3 (EGR3) expressing rats.Methods: A rat model of schizophrenia was created by the transfection of the EGR3 gene into rat hippocampus. All animals were placed in a fixation system using a commercial rat-dedicated coil. Schizophrenia susceptible brain regions were scanned using in vivo diffusion tensor magnetic resonance imaging. The volume, quantity, average length of fiber bundles, fractional anisotropy, apparent diffusion coefficient, the relative heterosexual fraction, and volume ratio were collected in the whole brain and schizophrenia related brain areas (the hippocampus, thalamus, and prefrontal lobe). MedINRIA software was used for data processing of diffusion tensor and fiber bundles tracking. The fibronectin in relevant brain regions was also analyzed.Results: There was a significant decrease in the volume of the fiber beam through the left hippocampus dentate in the schizophrenia model group in comparison to the control group and the risperidone treatment group (P<0.05). A significant reduction in the volume and number of the fiber bundles was also observed in left prefrontal-left hippocampus, left hippocampus-left thalamus, left prefrontal-left hippocampus-left thalamus areas in the model group (all P<0.05).Conclusion: The volume of hippocampus and the number of fiber bundles were reduced in EGR3 transgenic schizophrenia rats, and are the most sensitive indicators in schizophrenia. The diffusion tensor imaging technique plays an important role in the evaluation of patients with schizophrenia.

ABSTRACT:This article summarizes the clinical manifestations of one case of clozapine-associated neuroleptic malignant syndrome and discusses its diagnosis, predisposing factors and treatment based on a literature review. Early identification and treatment is critical to lower the mortality of clozapine-associated neuroleptic malignant syndrome.