BACKGROUND AND AIM:Adverse Childhood Experiences (ACEs) significantly raise the risk of non-suicidal self-injurious (NSSI) in adolescents with mental illnesses. However, the mechanism through which ACEs affect NSSI remains unclear. This study aims to clarify the mechanisms that influence the relationship between types of ACEs, violence exposure, and NSSI and explore the mediating role of positive coping strategies. METHOD:A multi-center, cross-sectional, descriptive study was conducted in eight provinces in China, involving 2052 adolescents with mental illness. The Adverse Childhood Experiences Questionnaire, the Simplified Coping Styles Questionnaire, and the Non-Suicidal Self-Injury Screening Scale were utilized for data collection. All data analyses were performed using R version 4.4.2. RESULTS:A survey of adolescents found that 83.8% had experienced at least one ACE. The prevalence of non-suicidal self-injury among these adolescents was 67.9%. All types of exposure to ACEs increased the likelihood of NSSI among adolescents with mental illness (aOR: 1.409-3.007). Types of violence-related ACEs demonstrated a cumulative effect (aOR: 3.494, 6.246). Positive coping strategies mediate the relationship between ACEs and NSSI (aOR: 1.017-1.039). CONCLUSION:Exposure to ACEs increases the likelihood of non-suicidal self-injurious behavior in adolescents with mental illness. In particular, it is important to focus on the effects of bullying, emotional neglect, and domestic violence. Developing and employing positive coping strategies can effectively lower the risk of NSSI in adolescents facing mental health challenges. Early screening for adolescents who have experienced ACEs, along with targeted psychological crisis intervention, are future initiatives.

INTRODUCTION:Auditory hallucinations, persistent and distressing symptoms in patients with schizophrenia, are often poorly controlled by antipsychotics. Structured non-pharmacological interventions remain limited in routine clinical practice. AIM:This study aimed to identify the challenges in translating evidence for managing auditory hallucinations in patients with schizophrenia, develop change strategies, and evaluate the effectiveness of best evidence application. METHODS:Using an evidence translation model, this study applied best practice evidence to inpatients with schizophrenia admitted to the general psychiatry ward of a tertiary psychiatric hospital in Shanghai. The intervention was conducted in four phases: evidence acquisition, baseline review, practice change, and outcome evaluation. This study compared the implementation rates of audit indicators for auditory hallucination symptom management by nurses; their knowledge, attitude, and practice levels regarding relevant knowledge; and the of auditory hallucination symptoms in patients with schizophrenia between the baseline review period (June-October 2023) and the post-evidence-based practice period (January-May 2024). RESULTS:The baseline review included 35 nurses and 61 patients, while the evidence-based practice included 35 nurses and 72 patients. After implementing evidence-based strategies, statistically significant improvements compared with baseline values (p < 0.05) were noted in the compliance rates of 30 audit indicators; nurses' knowledge, attitude, and practice levels regarding auditory hallucination symptom management; and severity of patients' auditory hallucinations. CONCLUSIONS:The application of best evidence in managing auditory hallucinations in patients with schizophrenia can enhance nursing practices, including nurses' knowledge and confidence, and effectively reduce the severity of patients' auditory hallucinations. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A573.

BACKGROUND:Effective communication is essential for accurately assessing psychiatric symptoms and improving patient outcomes in acute psychiatric care. However, little is known about the challenges that nurses face in interacting with these patients and their perspectives. AIMS:To explore the perspectives of nurses in regard to communicating with patients in acute psychiatric care. METHODS:Seventeen psychiatric ward nurses were purposively sampled and participated in face-to-face semistructured interviews. The data were analysed using thematic analysis. RESULTS:Two themes were identified. Regarding Theme 1, the perceived challenges in communication included four subthemes: perceived ineffectiveness in communication, entangled relationships and corresponding trust crisis, disempowerment related to professional identity and limited human resources and institutional constraints. Regarding Theme 2, the employed communication coping strategies included four subthemes: proactive preparation and identifying entry points, boundary setting and empathy regulation, utilising personal strengths and emotional resources and experiencing positive emotions and value. DISCUSSION:Nurses in acute psychiatric care face communication challenges due to patients' acute psychiatric symptoms, insufficient communication skills and an uneven workforce distribution. Even when coping strategies are employed, these factors hinder effective communication. IMPLICATIONS:The results indicate that a well-organised and effective communication approach tailored to the symptoms of acute psychiatric patients in China is necessary. Such an approach should incorporate nurses' practical communication skills to improve their communication abilities.

Evidence suggests that attenuated mismatch negative (MMN) waves have a close link to auditory verbal hallucinations (AVH) and their clinical outcomes, especially impaired neural oscillations such as θ, β representing attentional control. In current study, thirty patients with schizophrenia and AVH (SZ) and twenty-nine healthy controls (HC) underwent multi-feature MMN paradigm measurements including frequency and duration deviant stimuli (fMMN and dMMN). Clinical symptoms and MMN paradigm were followed up among SZ group after 8-week treatment. Results demonstrated that hallucinating patients exhibited attenuated dMMN amplitudes across Fz (p = 0.010), F1 (p = 0.020) and F2 (p = 0.014) electrodes, which were trendily recovered after treatment. Meanwhile, θ band and TBR at frontal fMMN and right temporal dMMN were significantly reduced in SZs. After treatment, SZs showed reduced scores of Hoffman's Auditory Hallucinations Rating Scale (AHRS), with a remarkable recovery in right temporal TBR of dMMN (p = 0.042) and a trending change in frontal TBR of fMMN (p = 0.090). The β band was decreased in dMMN (p = 0.035) by time. Additionally, P3 scores of Positive and Negative Syndrome Scale (PANSS) were negatively correlated with θ band of fMMN at baseline. Baseline scores of AHRS negatively predicted changes of dMMN amplitude after treatment, and changes of β band in left temporal dMMN predicted the reduction in scores of PANSS negative scale. These findings supported that deficits in θ oscillation and TBR during auditory attention process were crucial to clinical progression of schizophrenia with AVH.

Introduction:This systematic review summarizes the recommendations related to psychosocial interventions for anxiety disorders included in existing guidelines and compares their differences. Methods:Computer-based searches were conducted to identify relevant guidelines on psychosocial interventions for anxiety disorders from domestic and international guideline websites, professional association websites, and other relevant databases. The guidelines' quality was evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results:Fourteen guidelines from nine countries were included, with AGREE II scores ranging between 64.4%-96.3%. The specific recommendations were synthesized into a single evidence map, revealing that cognitive behavioral therapy demonstrated strong support for treating generalized anxiety, panic, and social anxiety disorders. Conversely, eye movement desensitization and reprocessing, exposure therapy, and virtual reality exposure therapy were not recommended for panic disorder. Additionally, no guidelines provided any recommendations for psychosocial interventions for separation anxiety disorder. Discussion:Guidelines on psychosocial interventions for adult anxiety disorders vary remarkably concerning their quality and recommended suggestions. Future guideline development or updates should strictly adhere to standardized development processes. Additionally, researchers should double their efforts to continuously explore and validate the efficacy of various psychosocial interventions in anxiety populations. Sytematic review registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD420250654358, PROSPERO, identifier CRD420250654358.

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.

目的 探讨抑郁症患者疲乏真实体验及患者应对状况.方法 采用目的抽样法,对上海市某精神专科医院 17 名住院抑郁症患者进行半结构式深入访谈,运用Colaizzi7 步分析法分析访谈资料,提炼主题.结果 共提炼出 4 个主题:抑郁症相关性疲乏症状、疲乏对患者产生消极影响、患者对疲乏缺乏正确认识和应对技能、期待多方面的理解与支持.结论 抑郁症相关性疲乏症状是压倒性的、不寻常的痛苦体验,严重影响患者社会功能和生活质量,患者缺乏正确认知及有效应对措施.广大医务工作者应加强对患者疲乏症状的重视及关注,开展专业信息支持和症状管理技能指导,协同家属、医务人员和社会媒体等多方力量,强化患者症状管理能力,构建良好氛围,促进患者全面康复.

Introduction Network theory conceptualizes somatic symptoms as a network of individual symptoms that are interconnected and influenced by each other. In this conceptualization, the network's central symptoms have the strongest effect on other symptoms. Clinical symptoms of patients with depressive disorders are largely determined by their sociocultural context. To our knowledge, no previous study has investigated the network structure of somatic symptoms among Chinese patients with depressive disorders. The aim of this study was to characterize the somatic symptoms network structure in patients with depressive disorders in Shanghai, China. Method A total of 177 participants were recruited between October 2018 and June 2019. The Chinese version of the Patient Health Questionnaire-15 was used to assess somatic symptoms. In order to quantify the somatic symptom network structure, indicators of “closeness,” “strength,” and “betweenness” were employed as identifiers for network-central symptoms. Result The symptoms of “feeling your heart pound or race,” “shortness of breath,” and “back pain” had the highest centrality values, indicating that these symptoms were central to the somatic symptom networks. Feeling tired or mentally ill had the strongest positive correlation with insomnia or other sleep problems (r = 0.419), followed by chest pain and breathlessness (r = 0.334), back pain, and limb or joint pain (r = 0.318). Discussion Psychological and neurobiological research that offers insights into somatic symptoms may focus on these central symptoms as targets for treatment and future research.

Introduction: Cerebral infarction is one of the most common cerebrovascular diseases. The sequelae caused by cerebral infarction, including limb paralysis, crooked mouth corners, language barriers, etc., seriously affect the patient’s physical and mental health and enthusiasm for rehabilitation training. Therefore, psychological intervention has important positive significance for the rehabilitation and nursing of patients with cerebral infarction. Methods: This is a single-blind controlled study. 168 patients with cerebral infarction who met the inclusion criteria and visited our hospital from January 2018 to January 2020 were randomly divided into a control group (n = 84) and an intervention group (n = 84). The patients in the intervention group received an additional 3-month psychological treatment on the basis of the patients in the control group. The National Institutes of Health Stroke Scale (NIHSS), Activities of Daily Living (ADL) scale, Mini-Mental State Examination (MMSE), and Hamilton Depression Rating Scale (HAMD) were measured before and after the psychological intervention. Results: The 3-month psychological intervention we designed significantly reduced the NIHSS and HAMD scores of patients with cerebral infarction compared with traditional rehabilitation care for cerebral infarction, implying that our psychological intervention courses can improve patients’ cognitive function and suppress patients’ depression. Consistently, our psychological intervention also significantly improved ADL and MMSE scores 3 months after the onset of cerebral infarction patients, implying that this psychological intervention helped patients recover their daily functions relative to conventional care. Conclusion: Psychological intervention can be used as an adjunct therapy in the treatment and nursing of patients with cerebral infarction.

Objective:To initially construct the index system of core competence for psychiatric mental health advanced practice registered nurses, and clarify the importance of indicators at all levels, so as to provide reference for further training of psychiatric mental health advanced practice registered nurses in China.Methods:A research group was established in October 2021 to determine the content of the index system of core competence for psychiatric mental health advanced practice registered nurses through literature search and discussion of the research group. From November 2021 to February 2022, 18 experts were consulted by Delphi method in the form of email and WeChat to adjust and modify the items.Results:The enthusiasm of experts in the two rounds of expert consultation was 100.0% (18/18) . After two rounds of expert consultation, the index coefficient of variation was less than 0.25. The Kendall 's coefficients of indicators at all levels in the first round of expert consultation were 0.117, 0.158, 0.100 ( P<0.01) , and the Kendall 's coefficients of indicators at all levels in the second round of expert consultation were 0.250, 0.213, 0.189 ( P<0.01) . An index system consisting of 6 first-level indicators, 16 second-level indicators and 56 third-level indicators were formed. Conclusions:The index system of core competence for psychiatric mental health advanced practice registered nurses has a high degree of enthusiasm, authority and coordination of opinions of consulting experts, which can provide a scientific basis for further training psychiatric mental health advanced practice registered nurses in China.

目的 检索、评价并整合国内外神经性厌食患者饮食行为管理的相关证据,为临床护理提供参考.方法 系统检索国内外数据库中有关神经性厌食患者饮食行为管理的临床决策、推荐实践、证据总结、临床实践指南、系统评价/Meta分析和专家共识.检索时限为建库至2022年2月,由3名研究者对文献进行方法学质量评价,并根据主题对证据进行提取和汇总.结果 共纳入16篇文献,其中临床决策2篇,证据总结2篇,指南9篇,系统评价3篇.从多学科团队、管理目标、评估、管理实践、心理治疗、健康教育6个方面汇总26条最佳证据.结论 该研究总结了神经性厌食患者饮食行为管理的最佳证据,在后续证据转化过程中应结合国内临床具体情境,有针对性地选择证据,以规范患者饮食行为,改善其临床结局.

BackgroundMental health literacy (MHL) is crucial to address issues related to mental illness. Nurses' MHL is even more important because they are expected to deal with both the physical and psychological consequences of mental disorders. ObjectiveThis study investigated the level, discrepancy, and characteristics of MHL among Chinese nurses from both public general and psychiatric hospitals; identified influential factors; and explored the relationship between MHL and mental health status. MethodsUsing a stratified cluster sampling method to select participants, a cross-sectional survey was conducted to describe the MHL of 777 nurses from 13 general and 12 psychiatric hospitals using the Chinese version of the Mental Health Literacy Scale, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a demographic questionnaire. A multiple regression analysis was used to determine the factors influencing MHL among the nurses recruited. ResultsThe participants' total score on the Chinese version of the Mental Health Literacy Scale was 93.25 (SD = 10.52). Multiple regression analysis revealed that nurses who worked in psychiatric or higher-level hospitals, with higher professional titles or higher education had higher levels of overall MHL and core MHL, while those working in general hospitals, with shorter work duration, or who were unmarried had higher social acceptance of patients. Nurses' MHL was closely correlated with their mental health status. ConclusionThe overall and core MHL of Chinese nurses were at a moderate level, with social acceptance remaining at a relatively low level. There is an urgent need for MHL promotion programs to improve the MHL of clinical nurses. The focus must be given to overall MHL, especially core MHL, for non-psychiatric nurses to enhance their competence in mental health promotion and identification; more emphasis should be placed on the social acceptance of patients with mental illnesses for psychiatric nurses to improve their provision of professional services. Better MHL would be a formula for improving nurses' own mental health and their mental health service competence.

Objective:To adapt and build Guideline for Management of Antipsychotic Medication Adherence in Schizophrenics which is suitable for China's national conditions. Methods:Guided by the ADAPTE guideline adaptation method, and combined with the current status of antipsychotic medication adherence of schizophrenics in China, we systematically searched the existing antipsychotic medication adherence management guidelines and systematic evaluation, and evaluated, selected, and integrated the best evidence. We conducted usability research on the adapted guidelines, conducted discussions among experts and external evaluations to form the final version of the guideline.Results:A total of 9 guidelines and 14 systematic evaluations were included. The adapted guideline contained 30 pieces of evidence, including 4 themes of policy and decision support, medication adherence assessment, medication adherence management plan, and medication adherence management measures.Conclusions:The adapted guideline for nursing management of antipsychotic medication adherence in schizophrenics can provide evidence support for clinical nursing practice.

目的 汉化进食障碍患者家庭顺应量表,并检验其信效度.方法 根据Brislin翻译模式将量表翻译成中文,通过专家函询和预调查对量表进行文化调适和修订.将量表应用于300例进食障碍患者照顾者检验信效度.结果 中文版进食障碍患者家庭顺应量表的量表水平内容效度指数为0.918.探索性因子分析结果显示5个因子可解释总变异量的49.862％.量表的各维度得分与量表总分呈中高度相关,各维度得分之间呈中低度相关或不相关.量表总Cronbach's a为0.877,重测信度为0.883.结论 中文版进食障碍患者家庭顺应量表具有较好的信效度,可用于测量进食障碍患者的家庭顺应情况.

Abstract This study investigated the level of mental health literacy (MHL) among Chinese nurses, identifying the influential factors and exploring the relationship between mental health literacy and mental health status. A descriptive cross-sectional survey was undertaken of 777 nurses in 13 general hospitals and 12 psychiatric hospitals using the Mental Health Literacy Scale-Chinese version, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a demographic questionnaire, with stratified cluster sampling method employed. The total score on the Mental Health Literacy Scale-Chinese version among the nurses was 93.25 (SD = 10.52). Psychiatric nurses had higher levels of core MHL with more knowledge of mental disorders, higher ability to seek professional help, as well as recognize mental illness than nurses in general hospitals did, while they also had a lower level of acceptance of patients with mental illness. A multiple regression analysis revealed that nurses who have fewer depressive symptoms, being unmarried or divorced, with more education or higher professional titles had higher levels of core MHL, and that those nurses with longer work duration had lower acceptance of patients with mental illness. Therefore, the mental health literacy of Chinese nurses is moderate to low, and more mental health education programs or actions emphasizing knowledge, ability, recognition, and especially acceptance need to be implemented to improve the mental health literacy of nurses, with more focus on core MHL for general nurses and social acceptance for psychiatric nurses. Nurses with more depressive symptoms, less education, lower professional titles, longer work duration, and being married should be the given more attention in promotion programs.

目的 研究综合护理干预措施对精神分裂症合并骨质疏松患者骨密度和生活质量的影响.方法 选取我院收治的精神分裂症合并骨质疏松患者90例,随机分为对照组和实验组,各45例.对照组采用常规护理方法,实验组采用综合护理干预.实施6个月干预措施后比较两组对象的骨密度和生活质量变化.结果 干预后,实验组患者骨密度T值优于对照组(P＜0.05);干预后,两组患者生活质量评分均优于干预前,且实验组评分优于对照组(P＜0.05).结论 综合护理干预措施可改善患者的骨密度及生活质量.

介绍国际上推荐的进食障碍病人饮食行为评估工具,阐述相关工具的发展过程及应用现状等内容,旨在为临床正确选择评估工具提供依据,为研发符合我国国情的进食障碍病人饮食行为量表提供参考.

目的:分析基于情绪智力模型的情绪管理方案对双相情感障碍抑郁发作患者正、负性情绪及自伤行为的影响.方法:选取2019年11月至2021年4月在上海市某精神专科三级医院住院治疗的双相情感障碍抑郁发作患者为研究对象,其中2019年11月至2020年6月的50名患者为对照组,2020年7月至2021年4月的53名患者为干预组.对照组进行常规治疗和护理,干预组在对照组的基础上实施为期8周的情绪管理方案.采用汉密尔顿抑郁量表-24项、正性负性情绪自评量表、伯克利情绪表达量表及自伤行为监测结果评价干预前、后的效果.结果:干预组患者在入组8周时的抑郁量表评分低于对照组(P<0.001),正、负性情绪体验及正性情绪表达倾向优于对照组(P<0.001),自伤行为发生例次数少于对照组(P<0.05).结论:情绪管理方案有助于改善双相情感障碍抑郁发作患者的情绪,减少自伤行为,提升患者正性情绪体验及表达意愿,帮助患者稳定情绪,促进康复.

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin’s translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named “knowledge of mental disorder,” “ability to seek information and help,” “recognition of mental disorder,” and “acceptance of patients with mental illness,” with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach’s α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50th percentile for the MHLS-C was 99, with 50th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

目的:构建抑郁症护理质量评价指标。方法:使用德尔菲法由22名专家对提出的抑郁症护理质量评价指标进行两轮函询，获得了专家的一致意见，初步构建抑郁症护理质量评价指标体系。结果:通过两轮专家问卷咨询，初步建立的抑郁症护理质量评价指标包括一级指标3个、二级指标11个、三级指标59个。两轮专家咨询的积极系数为95.45%、100%，权威系数分别为0.891和0.895，协调系数分别为0.248和0.206，说明各级指标选择意见逐步趋同。结论:构建的指标符合抑郁症的特点，各指标具有很强的临床操作性，可以为临床护理人员工作程序的规范、抑郁症护理质量的提高提供评价依据，但仍需要理论和实证的进一步研究及验证。