ObjectivesTo investigate the effect of aripiprazole on prolactin levels in patients with schizophrenia and analyze whether varying baseline prolactin levels affect the effectiveness and safety of aripiprazole, in a real-life diagnostic and therapeutic setting in a post-hoc analysis.MethodsIn this post-hoc analysis, patients with schizophrenia in the acute phase were divided into an elevated-prolactin group and a normal-prolactin group. After 8 weeks of aripiprazole treatment, changes in the proportion of patients with an abnormal prolactin level were analyzed in both groups, and the efficacy and safety of aripiprazole were compared between the two groups.ResultsThe elevated-prolactin group had more women, a longer duration of disease, and lower Positive and Negative Syndrome Scale (PANSS) total and subscale scores at baseline compared with the normal-prolactin group (all P < 0.05), and there was no significant difference in the proportion of patients with prior use of antipsychotic medication between the two groups. Regardless of previous antipsychotic use, patients in both groups developed hyperprolactinemia (23/168 [13.7%] in those who had taken antipsychotics vs. 43/375 [11.4%] in those who had not). After 8 weeks of aripiprazole treatment, the proportion of patients with abnormal prolactin in the elevated-prolactin group significantly decreased with prolonged treatment (P < 0.001), and aripiprazole had no significant effect on the normal-prolactin group (P = 0.250). Normal-prolactin group showed better efficacy than the elevated-prolactin group, and the differences in efficacy between the two groups was observed from week 4 to the endpoint (all p<0.05). In total, 87.2% (68/78) patients experienced mild to moderate adverse events in the elevated-prolactin group, which was significantly more frequent compared with the normal-prolactin group 71.0% (365/514).ConclusionsIn this real-world study, for patients with acute schizophrenia, aripiprazole was effective in lowering the proportion of patients with abnormal prolactin levels, while it had no significant effect on patients with normal baseline prolactin. After adjusting for factors such as sex, age, prior antipsychotic drugs use history and disease severity, effectiveness and safety of aripiprazole in patients with normal baseline prolactin was significantly better than that in patients with elevated baseline prolactin.

Background: This longitudinal study assessed the prospective link between childhood maltreatment and sleep quality in adulthood, with a specific focus on examining whether different coping style tendencies influence these associations. Methods: The baseline sample included 1600 adult participants, with 1140 participants successfully followed up 5 years later. The key variables were measured using the Childhood Trauma Questionnaire (CTQ), Simplified Coping Style Questionnaire (SCSQ), and Pittsburgh Sleep Quality Index (PSQI). Generalized linear mixed models were employed to estimate unstandardized beta estimates and 95 % confidence intervals (95%CIs). Structural equation modeling was used to test the mediation model. Results: Individuals reported childhood maltreatment at baseline were at an increased risk for sleep disturbances at follow-up. Childhood maltreatment negatively predicted the baseline coping style tendency (beta = -0.29, P < 0.001), the baseline coping style tendencies negatively predicted the follow-up sleep quality (beta = -0.10, P < 0.001), and childhood maltreatment positively predicted the follow-up sleep quality (beta = 0.42, P < 0.01). The mediating effect of baseline coping style tendencies between childhood maltreatment and the follow-up sleep quality was significant, with an effect value of 0.03. Limitations: First, the sample was from a single province (Shandong), which limits the generalizability of the findings. Second, recall bias was unavoidable in this adult sample study. Conclusions: Developing positive coping strategies is an important way to reduce the risk of sleep problems in adults with a history of childhood maltreatment.

Abstract Objective Non-suicidal self-injury (NSSI) and problematic internet use (PIU) have become widespread issues among adolescents. Behavioral inhibition/activation systems (BIS/BAS) have been utilized to explain various psychopathology. However, the reports concentrating on how PIU plays a role in the development and maintenance of NSSI, and how different BIS/BAS subcomponents act on the process that PIU influences the development and maintenance of NSSI are relatively limited, particularly for Chinese adolescents. This study aimed to investigate the incidence of NSSI, the different roles of the BIS/BAS subcomponents in NSSI, and the role of PIU in the association between BIS/BAS and NSSI in Chinese junior high school students. Methods A total of 2384 Chinese junior high school students (\({M}_{age}\) = 13.66 years, SD = 0.982) were recruited by convenient sampling. They completed self-report questionnaires, including Adolescent Self-harm Behaviors Questionnaire, Behavioral Inhibition/Activation Systems Scales, and Young’s Internet Addiction Test. Correlation, stepwise regression, and mediation analysis were completed. Results The incidence of NSSI was 37.7% in Chinese junior high school students. After controlling for gender, BIS and BAS-Fun seeking displayed positive associations with NSSI, whereas BAS-Reward responsiveness showed negative associations. PIU mediated the relationships between BIS/BAS-Fun seeking/BAS-Reward responsiveness and NSSI to varying degrees. No significant association was found between BAS-Drive and NSSI as well as PIU. Conclusion The incidence of NSSI is relatively high among Chinese adolescents. This study clarifies the risk and protective factors for NSSI.

AIMS:Non-suicidal self-injury (NSSI) is a serious issue that is increasingly prevalent among children and adolescents, especially in rural areas. Developing a suitable predictive model for NSSI is crucial for early identification and intervention. METHODS:This study included 2090 Chinese rural children and adolescents. Participants' sociodemographic information, symptoms of anxiety as well as depression, personality traits, family environment and NSSI behaviors were collected through a questionnaire survey. Gender, age, grade, and all survey results except sociodemographic information were used as relevant factors for prediction. Support vector machines, decision tree and random forest models were trained and validated by the train set and valid set, respectively. The metrics of each model were tested and compared to select the most suitable one. Furthermore, the mean decrease Gini index was calculated to measure the importance of relevant factors. RESULTS:The prevalence of NSSI was 38.3%. Out of the 6 models assessed, the random forest model demonstrated the highest suitability in predicting the prevalence of NSSI. It achieved sensitivity, specificity, AUC, accuracy, precision, and F1 scores of 0.65, 0.72, 0.76, 0.70, 0.57, and 0.61, respectively. Anxiety and depression were the top two contributing factors in the prediction model. Neuroticism and conflict were the factors that contributed the most to personality traits and family environment, respectively, in terms of prediction. In addition, demographic factors contributed little to the prediction in this study. CONCLUSION:This study focused on Chinese children and adolescents in rural areas and demonstrated the potential of using machine learning approaches in predicting NSSI. Our research complements the application of machine learning methods to psychiatric and psychological problems.

This study investigates the effectiveness and safety of aripiprazole oral solution in Chinese patients with schizophrenia. This was a multicenter, single-arm phase IV study involving 134 patients in China in the acute stage of schizophrenia from May 2021 to July 2022. The patients received aripiprazole oral solution 10 − 30 mg/d for 12 weeks. The effectiveness endpoints included the Positive and Negative Symptom Scale (PANSS) and the Clinical Global Impression (CGI) scale score. The safety endpoints included adverse events, laboratory inspection indicators (including the serum prolactin level [PRL]), and waist circumferences (WC). Ultimately, 86 patients (64.18 http://www.chictr.org.cn/ ).

家庭关系是环境因素中与儿童青少年睡眠有关的因素之一.本研究搜索了中国知网、PubMed、Web of Sci-ence、EBSCOhost 和 Springer Link这些数据库内近10年探讨过家庭关系与儿童睡眠之间关系的研究,结果发现:父母间良好的婚姻关系、良好的亲子关系、夫妻间与亲子间的安全感与安全依恋对儿童睡眠有益,家庭关系可能通过下丘脑-垂体-肾上腺轴(HPA轴)及副交感神经系统的生物学变化来影响儿童睡眠.但国内外仍需更多针对不良家庭关系来改善儿童睡眠的临床研究.

Depression is a common psychiatric disorder with high prevalence and mortality rates as well as high risk of serious harm in adolescents that have significant negative impact on families and society. The feeding inhibitor Nesfatin-1 contributes to the regulation of stress and emotion. The purpose of this project was to compare the differences in the levels of Nesfatin-1 between adolescents with depression and healthy adolescents, and verify the association between the levels of Nesfatin-1 and severity of depression in adolescents. Adolescents with depression (n = 61) and healthy adolescents (n = 30) were evaluated. The Hamilton Depression Rating Scale (HAMD-17) was used to classify the adolescents with depression. Thirty-one and thirty-two was assigned to the mild-to-moderate (HAMD-17 ≤ 24) depression group and severe group (HAMD-17 > 24). Plasma Levels of Nesfatin-1 were measured by human ELISA Kit and differences among groups evaluated. Data were analyzed using the statistical software SPSS 23. HAMD-17 score was significantly higher in adolescents with depression than that in the healthy adolescents (P < 0.001). Median plasma Nesfatin-1 levels in adolescents with depression and healthy adolescents differed significantly at 37.3 pg/ml (22.1 pg/ml, 63.6 pg/ml) and 18.1 pg/ml (10.0 pg/ml, 25.7 pg/ml) (p < 0.001). A multivariate logistic regression analysis showed high plasma Nesfatin-1 concentrations were associated with increased risk of depression (OR = 0.914, 95% CI 0.87–0.96, P < 0.001). The receiver operating characteristic curve showed that the area under curve were 0.808 (95% CI 0.722–0.894, P < 0.001). Plasma Nesfatin-1 cut-off point of 32.45 pg/mL showed 59% sensitivity and 100% specificity. Median plasma Nesfatin-1 levels in the severe depression group (n = 30), mild-to-moderate depression group (n = 31), and control group (n = 30) were 53.4 pg/ml (28.2 pg/ml, 149.1 pg/ml), 29.9 pg/ml (14.5 pg/ml, 48.5 pg/ml) and 18.1 pg/ml (10.0 pg/ml, 25.7 pg/ml), and differed significantly among the three groups (P < 0.001). Median plasma level of Nesfatin-1 in males (n = 20) was 38.6 pg/ml (23.5 pg/ml, 70.1 pg/ml), while that in females (n = 41) was 37.3 pg/ml (22.0 pg/ml, 63.6 pg/ml), which was not a significant difference (P > 0.05). Plasma levels of Nesfatin-1 increased with severity of depression in adolescents and may be useful as a biomarker of depression severity. Further studies are needed in future projects.

Objective To investigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of chronic insomnia and the improvement of cognitive function, sleep quality, sleep belief and attitude. Methods A total of 240 patients with chronic insomnia who met the inclusion criteria and were treated in the Shandong Mental Health Center from January to December 2019 were selected as the research objects. They were randomly divided into left dorsolateral prefrontal cortex (DLPFC) treatment group, right DLPFC treatment group, 1 cm behind the central point (Cz) treatment group and control group (sham stimulation group), with 60 cases in each group. Pittsburgh sleep quality index (PSQI) and sleep personal belief and attitude scale (DBAS) were used to evaluate the patients'' sleep quality, sleep belief and attitude before and at the end of treatment. The cognitive function of patients was evaluated in neuropsychological and electrophysiological aspects by Montreal Cognitive Assessment Scale (MoCA), symbol number conversion test (SDMT) and event-related potentials (ERPs). Results The PSQI scores of left DLPFC treatment group, right DLPFC treatment group and 1 cm after Cz treatment group were signifi cantly lower than those before treatment, and the DBAS scores were signifi cantly higher than those before treatment (P ＜0.05). There was no signifi cant diff erence between PSQI and DBAS before and after treatment in the control group (P ＞0.05). The PSQI and DBAS of right DLPFC treatment group were signifi cantly lower than those of left DLPFC treatment group and 1 cm after CZ treatment group; MoCA and SDMT in the left DLPFC treatment group, the right DLPFC treatment group and the treatment group 1 cm after CZ were signifi cantly higher than those before treatment (P＜0.05), but there was no signifi cant diff erence in MoCA and SDMT before and after treatment in the control group (P＞0.05); The P3 latency after treatment was signifi cantly shorter in the left DLPFC treatment group, the right DLPFC treatment group and the treatment group 1 cm after CZ, and the P3 amplitude was signifi cantly greater than that before treatment (P＜0.05). There was no signifi cant diff erence in P3 latency and P3 amplitude before and after treatment in the control group (P＞0.05). Conclusion rTMS can greatly improve the cognitive function, sleep quality, sleep belief and attitude of patients, and the eff ect is signifi cant. It is worthy to be applied in clinic.

目的 探讨初中生非自杀性自伤(NSSI)、抑郁情况,分析抑郁在行为抑制/激活系统(BIS/BAS)与NSSI之间的中介作用.方法 采用整群抽样法,于2022年6月选取山东省济宁市泗水县3所中学2900名初中生为研究对象,采用青少年自伤行为问卷、BIS/BAS量表和抑郁自评量表(SDS)进行问卷调查.采用Pearson相关分析各变量之间的相关性.采用SPSS Amos 24.0软件构建结构方程模型并进行中介效应检验.本研究共发放问卷2900份,回收有效问卷2429份,有效回收率为83.76％.结果 2429名初中生的NSSI年发生率为37.55％(912/2429),抑郁发生率为32.73％(795/2429).根据是否有过NSSI行为分为有NSSI组(n=912)和无NSSI组(n=1517).有NSSI组初中生的青少年自伤行为问卷得分为(33.01±21.24)分.有NSSI组初中生的BIS、BAS-愉悦追求、SDS得分分别为(11.08±2.93)、(7.15±2.58)、(53.17±10.67)分,高于无NSSI组的(10.16±3.15)、(6.52±2.55)、(43.16±9.77)分,差异有统计学意义(t=-7.312、-5.838、-23.098;P<0.001);有NSSI组初中生的BAS-奖赏反应得分为(11.64±2.53)分,低于无NSSI组的(12.16±2.24)分,差异有统计学意义(t=5.084,P<0.001).相关分析显示,有NSSI初中生的抑郁程度与NSSI严重程度、BIS敏感性、BAS-愉悦追求敏感性呈正相关(r=0.484、0.184、0.128;P<0.01);BAS-奖赏反应敏感性与NSSI严重程度、抑郁程度呈负相关(r=-0.203、-0.239;P<0.01).回归分析显示,抑郁对NSSI有正向影响(β=0.461,P<0.001),而BAS-奖赏反应对NSSI有负向影响(β=-0.093,P<0.01).结构方程模型结果显示,抑郁在BIS、BAS-愉悦追求与NSSI之间起完全中介作用,完全中介效应分别为0.121和0.104,占总效应的86.4％、72.7％;在BAS-奖赏反应与NSSI之间起部分中介作用,部分中介效应为-0.199,占总效应的58.2％.结论 初中生NSSI发生率较高,抑郁在BIS和BAS-愉悦追求与NSSI间起完全中介作用,在BAS-奖赏反应与NSSI之间起部分中介作用.

Objective:To investigate the clinical efficacy of five-element music therapy in the treatment of bipolar disorder.Methods:Eighty patients with bipolar disorder admitted to Shandong Mental Health Center from January 2018 to December 2019 were included in this study. They were randomly divided into a study group and a control group ( n = 40/group). The control group was treated with conventional drug treatment. The study group was treated with five-element music therapy based on conventional drug treatment. Before, during and after treatment, mania and depression were evaluated. Symptom self-evaluation scale and the Traditional Chinese Medicine Five State Emotion Questionnaire were completed to evaluate the curative effect. Patients were followed up by telephone call. Recurrence at 3, 6 and 12 months was recorded. Results:Before treatment, there were no significant differences in the scores of the Bech-Rafaelsen Mania Rating Scale (BRMs), Hamilton Depression Rating Scale (HAMD), Traditional Chinese Medicine Five State Emotion Questionnaire, Symptom Checklist-90 (SCL-90) between the two groups (all P > 0.05). During and after treatment, BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire, and SCL-90 scores were significantly decreased in each group compared with before treatment [Control group: BRMs score during and after treatment: (11.52 ± 1.57) points, (9.43 ± 1.05) points; HAMD score during and after treatment: (16.75 ± 3.05) points, (13.61 ± 2.51) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary (67.25 ± 5.7) points, (56.38 ± 4.97) points, physical symptoms (29.52 ± 3.94) points, (24.19 ± 3.05) points, SCL-90 score: (100.52 ± 10.26) points, (68.85 ± 7.33) points. Study group: BRMs score during and after treatment: (9.33 ± 1.09) points, (7.85 ± 0.82) points; HAMD score: (13.74 ± 2.54) points, (10.17 ± 1.97) points; Traditional Chinese Medicine Five State Emotion Questionnaire: emotional vocabulary: (58.19 ± 5.06) points, (46.85 ± 4.06) points, physical symptoms (25.14 ± 3.54) points, (20.11 ± 2.57) points; SCL-90 scores: (90.85 ± 8.97) points, (56.87 ± 5.81) points]. During and after treatment, scores of BRMs, HAMD, Traditional Chinese Medicine Five State Emotion Questionnaire and SCL-90 in the study group were significantly lower than those in the control group ( t = 3.77, 7.01, 4.48, 6.99, 8.78, 4.89, 6.05, 4.19, 7.57, all P < 0.05). Total response rate in the study group was significantly higher than that in the control group (90.0% vs. 72.5%, χ2 = 4.02, P < 0.05). At 3, 6 and 12 months after treatment, recurrence rate in the study group was 2.5%, 15.0% and 30.0%, respectively, which were significantly lower than 17.5%, 35.0%, and 52.5% in the control group ( χ2 = 5.00, 4.26, 4.17, all P < 0.05). Conclusion:Five-element music therapy for the treatment of bipolar disorder can markedly alleviate depression and mania, restore patient's emotional state, improve clinical efficacy, and decrease recurrence rate.

To the Editor: Schizophrenia is a progressive, debilitating disease.[1] Safe and effective treatment performed during the acute phase is the first step to improve prognosis, and it is critically important. Aripiprazole is known as a dopamine system stabilizer, and it exerts partial agonism with high affinity at dopamine D2 and serotonin (1A) (5-HT1A) receptors as well as antagonism at serotonin (5-HT2A) receptors.[2] It has been shown to be efficacious in amelioration of both positive and negative symptoms of acute schizophrenia, and it shows better tolerance than most antipsychotics.[3] We conducted a real-world study to further confirm the efficacy and safety of aripiprazole in patients with acute episodes of schizophrenia in China and tried to explore the clinical variables, including various drug regimens, that may be correlated with the efficacy of aripiprazole, and provide a basis for the optimization of aripiprazole treatment for patients with acute schizophrenia. This study was a single-arm, open-label, eight-week study and was conducted in 14 psychiatric hospitals [Supplementary file, https://links.lww.com/CM9/B397]. Inpatients aged 18 to 65 years with a diagnosis of schizophrenia defined by the International Classification of Diseases, 10th Revision were included. The criteria for included patients were: (1) total Positive and Negative Syndrome Scale (PANSS) scores were ≥70 at baseline; (2) the individual item scored ≥4 for at least two of the following PANSS items: P1, P2, P3, and P6; and (3) the PANSS-positive score was higher than the PANSS-negative score. The key exclusion criteria included: (1) concomitant unstable medical conditions or other mental diseases; (2) any evidence of suicide risk or history of violence; (3) previous allergic reaction to aripiprazole; (4) any history of neuroleptic malignant syndrome or serious extrapyramidal syndrome; and (5) women who were pregnant, planning a pregnancy, or breastfeeding. Besides, patients with treatment-resistant schizophrenia who had undergone electroconvulsive therapy within the past two months and those who had been enrolled in any other clinical trials within four weeks before enrollment of the study were also excluded. The study protocol was approved by the Ethics Committees of the Peking University Institute of Mental Health (No. 2017-24). All subjects signed the written informed consent before screening. The study has been registered on ClinicalTrials.gov (No. NCT03289026). Eligible patients received orally disintegrating aripiprazole tablets (Brisking,[4] Chengdu Kanghong Pharmaceutical Group Co., Ltd., Chengdu, Sichuan, China) for eight weeks. Doses were flexibly titrated to between 10 and 30 mg once daily. Other antipsychotics, anti-depressants, and mood stabilizers were prohibited. Benzodiazepines, anti-cholinergics, and β-receptor blockers were permitted when clinical indications existed, but the duration of continuous use of benzodiazepines did not exceed seven days. The primary endpoint was mean change from baseline to week 8 in the PANSS total score. The secondary endpoints included the rate of reduction in the PANSS total score, and the scores change of Clinical Global Impression-Improvement (CGI-I) and Clinical Global Impression-Severity of Illness (CGI-S), from baseline to endpoint. Assessments were performed at baseline, and weeks 2, 4, and 8 after initiation of treatment. The response rate (defined as the rate of reduction from baseline in the PANSS total score>30%) was also evaluated. Adverse events (AEs) were recorded during interviews and the Udvalg for Kliniske Undersogelser (UKU) Side Effects Rating Scale was used to evaluate the side effects induced by aripiprazole. Physical examination and clinical laboratory tests were carried out at the initial screening, four weeks after the initiation of treatment, and the end of the eight-week treatment regimen. Effectiveness analyses were performed on the full analysis set (FAS). Besides, the safety was also described based on the safety set (SS). SAS 9.4 software (version 9.4, Cary, NC, USA) was used for statistical analysis. Categorical variables were expressed as number (percentages); continuous variables were expressed as least-square means (LSMs) and 95% confidence interval (CI) or median (P25, P75). The mixed model for repeated measures analyses was used to compare the changes from baseline to endpoint in PANSS total score, PANSS score reduction rates, and CGI-S. The missing values were not filled. The total population was divided into the treatment-effective (TE) group and the treatment-ineffective (TIE) group according to whether the PANSS total score reduction rate was >30%. The baseline clinical demographic characteristics and medication administration information of the two groups were compared using the Fisher's exact test, Wilcoxon rank sum test, or chi-squared test, as appropriate. The variables with P < 0.2 in single factor analysis were included in multivariate logistic regression analysis. The odd ratio (OR) and its 95% CI were calculated to identify the factors influencing symptom improvement. A two-tailed P < 0.05 was considered statistically significant. This work covered 803 participants and enrolled 703 who met the inclusion criteria; and 543 completed the whole research process, eventually. FAS included 640 (91.0%) subjects, and SS included 703 (100.0%). Some indicators were not recorded in all the participants during the follow-up, resulting in only 616, 584, and 543 records on PANSS at week two, four, and eight, respectively, and 610, 578, and 540 on CGI-I and CGI-S. In total, 82.3% (527/640) of patients received a dosage of 30 mg/day, and the titration was relatively fast with a mean time to target dose of 8.4 (standard deviation = 4.87) days. In the FAS, the LSM change of PANSS total score was −30.63 (95% CI: −31.83, −29.42) at the second week, −43.73 (95% CI: −44.95, −42.51) at the fourth week, and −53.52 (95% CI: −54.76, −52.27) at the end of the eighth week. The means of PANSS score reduction rates were 30.0%, 43.5%, and 53.5% at the end of the second, fourth, and eighth weeks, respectively. The response rate was 50.5% (311/616) for aripiprazole at the second week, and it rose to 84.4% (493/584) and 96.3% (523/543) at the fourth and eighth weeks, respectively. The LSM changes in CGI-S score from baseline were −1.53 (95% CI: −1.61, −1.45), −2.29 (95% CI: −2.37, −2.21), and −3.13 (95% CI: −3.21, −3.05) at the end of second, fourth, and eighth weeks, respectively. According to the CGI-I score, 48.7% (297/610) of patients had improved at the end of the second week, and 76.8% (444/578) and 90.0% (486/540) had improved by the end of the fourth and eighth weeks, respectively. The baseline demographic and clinical characteristics of patients, who completed the whole study process, were divided into TE and TIE groups, are shown in Supplementary Table 1, https://links.lww.com/CM9/B397. TE group had a significantly lower proportion of higher BMI, a higher proportion of patients with shorter duration of illness, higher baseline PANSS total scores, baseline PANSS positive scores, PANSS excitatory factors scores, PANSS anxiety and depression factors scores, and a higher cumulative drug exposure than the TIE group. Compared with TIE group, patients in TE group were more likely to experience the first episode of schizophrenia and to be previously untreated. In multivariate logistic regression analyses, we found that patients with higher baseline excitatory factors (OR = 1.37, 95% CI: 1.08–1.75, P = 0.009), greater cumulative drug exposure (OR = 1.00, 95% CI: 1.00–1.01, P = 0.015) and being previously untreated (OR = 25.97, 95% CI: 3.78–178.30; P < 0.001) were more likely to be effectively treated by aripiprazole. A total of 390 (55.5%) patients reported at least one AE associated with aripiprazole, the most common of which was akathisia (29.2% [205/703]). Four participants discontinued treatment due to AEs, but there were no reports of serious AEs. According to the UKU, the other AEs with an incidence of ≥10% included tremors, tension or inner unrest, and reduced sleep duration. Almost all of these AEs were mild to moderate. At 8 weeks, the mean change from baseline in body weight was +0.7 kg. 5.6% of patients had weight gain ≥7% of the body weight at baseline. The proportions of patients with abnormal metabolic indicators including fasting blood glucose, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were decreased from baseline, but proportion of patients with abnormal the triglyceride increased slightly [Figure 1A]. At the endpoint, the proportion of patients with normal prolactin level increased (8 weeks vs. baseline: 96.9% vs. 87.8%) and the proportion of patients with moderate and severe hyperprolactinemia reduced [Figure 1B].Figure 1: Changes in proportion of patients with abnormal metabolic indicators and hyperprolactinemia from baseline to the end of eight weeks. (A) The change in the proportion of patients with abnormal blood glucose and blood lipids. Fasting blood glucose ≥6.1 mmol/L was abnormal; triglyceride ≥1.7 mmol/L was abnormal; cholesterol ≥5.2 mmol/L was abnormal; high-density lipoprotein <1.0 mmol was abnormal; low-density lipoprotein ≥4.1 mmol/L was abnormal. (B) The change in the proportion of patients with different severity of hyperprolactinemia. Mild, moderate and sever hyperprolactinemia were defined as the level of prolactin ≥530 mIU/L and <1060, ≥1060 mIU/L and <2120, and ≥ 2120 mIU/L, respectively.In this large-sample, real-world study, aripiprazole showed satisfactory efficacy in acute episodes of schizophrenia. In the present study, high dose and fast titration strategy was taken in the most of included patients, which differs considerably from the recommendations on the drug's label. This dosing strategy may be due to the consideration that aripiprazole is a partial agonist of dopamine D2 receptors, which may require a higher dose to achieve sufficient D2 occupancy and to achieve a reduction in DA neurotransmission pronounced enough to alleviate positive symptoms and to do so earlier.[5] Logistic regression analyses indicated that in addition to being previously untreated and having higher baseline excitatory factor scores, higher cumulative drug exposure may be correlated with a better efficacy of aripiprazole. In the present study, aripiprazole showed satisfactory safety despite with a high dose and fast titration dose stratge, but the AE of akathisia needs to be paid attention to. Aripiprazole may have some positive effects on metabolic disorders, which has raised concern with other second-generation antipsychotics, but these fingings need research and validation. This study has some limitations. First, as it was a real-world study, there was no strict control of grouping and a significant difference in sample size existed between two groups. Second, some variables associated with efficacy may not have been included in this study, so the analysis of relevant factors is only preliminary, and better controlled research must be performed to verify the findings of the present study. Third, the participants were exclusively adult inpatients with schizophrenia and so the results should not be generalized to whole populations. In summary, patients receiving antipsychotics for the first time with higher baseline excitatory factor scores and higher accumulative drug exposure are more likely to respond to aripiprazole. Aripiprazole has relatively satisfactory safety, but the AE of akathisia needs to be paid attention to. Acknowledgements The authors would like to thank Medieco Group Co., Ltd. (Beijing), who provided help in generating the data statistics used in the present study, and all the clinicians who helped to organize the study in each site. Funding The current work was partially supported by a grant from the Capital Medical Development Research Fund (No. 2020-2-4113). Conflicts of interest None.

Background: Nightmares are common in patients with psychiatric disorders. Patients with psychiatric disorders often experience depressive symptoms. Nightmares have been associated with depressive symptoms among adolescents. Previous studies have explored the mediating role of nightmare distress in the relationship between frequent nightmares and depressive symptoms in the general adolescent population. We aimed to explore the associations between frequent nightmares, nightmare distress, and depressive symptoms in Chinese adolescent patients with psychiatric disorders.Methods: A total of 408 adolescents participated in this study. A self-administered questionnaire was used to measure nightmare frequency, nightmare distress, depressive symptoms, and covariates. Linear regressions and mediation analyses were performed to examine the associations between nightmare frequency, nightmare distress, and depressive symptoms.Results: The mean age of participants was 15.31 +/- 1.88 years, and 152 (37.3%) were boys. The prevalence of frequent nightmares in adolescent patients with psychosis was 49.3%. Girls reported more frequent nightmares and had significantly higher scores of depressive symptoms and nightmare distress. Patients with frequent nightmares had higher scores of nightmare distress and depressive symptoms. Frequent nightmares and nightmare distress were significantly associated with depressive symptoms. Nightmare distress had a full mediating effect on the correlation between frequent nightmares and depressive symptoms.Conclusions: In Chinese adolescent patients with psychiatric disorders, frequent nightmares and night-mare distress were associated with depressive symptoms, whereas the association between frequent nightmares and depressive symptoms was mediated by nightmare distress. Interventions for nightmare distress may be more useful in reducing depressive symptoms in adolescent patients with psychiatric disorders.(c) 2023 Elsevier B.V. All rights reserved.

Abstract Objectives Internet addiction is gaining attention because of the physical, psychological and social damage it can cause to individuals. There has been little systematic exploration of the relationship between Internet addiction and the influence of the family environment among junior high school students in China. Methods A whole-group sample of three county-level junior high schools in China was used to investigate the relationship between adolescents' Internet addictive behaviour and their family environment using the General Situation Questionnaire, Family Environment Scale-Chinese version, and the Internet Addiction Test (IAT). Results The prevalence of Internet addiction among junior high school students in China is 33.7%, among which 76.0% of junior high school students are mildly addicted to the Internet. The prevalence of Internet addiction among female students is 32.4%, and 35.0% among male students. the prevalence of Internet addiction among junior high school first year, junior high school second year and junior high school third year is 27.3%, 35.5% and 38%, respectively. The prevalence of Internet addiction among urban junior high school students is 27.5%, and the prevalence of Internet addiction among rural junior high school students is 34.5%. In terms of family environment, cohesion, expressiveness, independence, achievement, intellectual-cultural, active-recreational, moral-religious, organization, and control are negatively associated with Internet, family conflict is positively associated with Internet addiction (p < 0.01). The results of multiple stepwise regression analysis showed that seniority and prominent family conflict are risk factors for Internet addiction (P < 0.01), while female, good family expressiveness and organization, family intellectual-cultural, active-recreational and family control are prominent as protective factors for Internet addiction (P < 0.05). Conclusion Chinese junior high school students have a high prevalence of Internet addictive behaviours, with the highest proportion of mild Internet addictive behaviours. Males and senior students are more likely to develop Internet addictive behaviours. Family factors have a significant impact on the occurrence of Internet addiction, and interventions in the family environment of adolescents can effectively reduce the prevalence of Internet addictive behaviours.

Introduction: Understanding factors related to generalized anxiety disorder pathogenesis is critical for elucidating the mechanism and preventing its establishment. Intestinal flora and hereditary factors such as brain-derived neurotrophic factor (BDNF) gene polymorphism may have a role in the development of generalized anxiety disorder. This work explored the relationship between intestinal flora, inflammatory changes and BDNF gene polymorphisms and the occurrence of generalized anxiety disorder. Methods: Forty-eight patients with generalized anxiety disorder and 57 healthy people were included in the study. As the disease group and control group, the polymorphisms of rs10767664 and rs7124442 of the BDNF gene, differences in the distribution of intestinal flora, and changes in inflammatory and immune indicators were analyzed. Results: The distribution of BDNF gene alleles, genotypes and haplotypes in the disease group were different from those in the control group. The levels of TNF-α (P = .000), interleukin-4 (P = .000), interleukin-10 (P = .043) and IgG (P = .008) in patients with generalized anxiety disorder in the disease group were different from those in the control group. The distribution of gut microbes in patients with generalized anxiety disorder in the disease group was different from that in the control group. Conclusion: The onset of generalized anxiety disorder is related to BDNF gene polymorphism, and is accompanied by changes in intestinal flora and inflammatory immune status in the body.

Objective:This study aims to explore the relationship between non-suicidal self-injurious (NSSI) behaviors and childhood trauma and peer rejection in adolescents with depressive disorders and, to examine whether childhood trauma and peer rejection can predict NSSI behaviors in these adolescents.Methods:A total of 412 depressed adolescents (263 with NSSI and 149 without NSSI) were included in the test data set, while another 161 depressed adolescents (99 with NSSI and 62 without NSSI) were in the validation set. This study firstly analyzed the differences in the scores of the Children's Depression Inventory (CDI), Childhood Trauma Questionnaire (CTQ), and Social Peer Rejection Scale (SPR) between the two groups using the test set. Then, a hierarchical logistic regression model was used to analyze the independent effects of these environmental factors on NSSI behaviors and to determine the diagnostic model. Finally, the diagnostic model was applied using the validation data set to calculate the actual predictive efficacy of the model.Results:Compared to those without NSSI, adolescent patients with NSSI showed significantly higher scores in CDI ( t=10.04, P<0.001), CTQ ( t=9.11, P<0.001), SPR ( t=5.30, P<0.001), and their subscale scores. Then, the scores of the low self-esteem factor of CDI ( OR=1.12, P=0.002), the emotional neglect factor of CTQ ( OR=1.08, P=0.037), and the insult factor ( OR=1.10, P=0.050) and somatic aggression factor ( OR=0.89, P=0.049) of SPR were significantly associated with NSSI behaviors. The diagnostic model was well established (area under the ROC curve=0.84, P<0.001). In addition, in the validation data set, the diagnostic model had a significant predictive effect (area under the ROC curve=0.85, P<0.001). Conclusion:Childhood emotional neglect and peer insult might be crucially influential factors triggering NSSI behaviors among adolescents with depressive disorders. Childhood trauma and peer rejection were of considerable importance when diagnosing and predicting the development of NSSI behaviors in depressive adolescents.

目的 探讨高中生自尊在生活事件与学校适应之间的中介作用,为提高高中生学校适应提供实证依据.方法 采用方便抽样法,于2019年11月抽取山东省济南市2所中学的1192名高一、 高二学生为研究对象.采用高中生学校适应量表(QSAHSS)、高中生自尊量表以及中学生生活事件多维评定问卷进行问卷调查.采用Pearson相关分析高中生自尊、生活事件与学校适应的相关性.采用SPSS 24.0软件和Process v3.3插件中的模型4进行中介效应分析.结果 高中男生的QSAHSS得分高于高中女生[(238.04±22.76)分比(235.01±20.38)分)],重点高中生的QSAHSS得分高于普通高中生[(237.98±20.51)分比(234.05±23.23)分)],差异有统计学意义(t=2.420、3.041;P<0.05);高一、高二高中生的QSAHSS得分比较[(237.30±20.24)分比(235.59±23.15)分)],差异无统计学意义(t=1.358,P>0.05).相关分析结果显示,高中生生活事件与自尊、学校适应均呈负相关(r=-0.41、-0.19;P<0.05),自尊与学校适应呈正相关(r=0.16,P<0.05).高中生自尊在生活事件与学校适应之间起到部分中介作用,中介效应占总效应的24.73％.结论 高中生自尊在生活事件与学校适应中起部分中介作用.在教育过程中,有针对性地提高高中生自尊水平在一定程度上可以提高其学校适应水平.

Background Non-suicidal self-injury (NSSI) is more common in adolescents and its occurrence may be influenced by personality traits. Children and adolescents are a high-risk group for NSSI. Although there are some studies on the prevalence of NSSI, however, there are fewer studies on the factors associated with the severity of NSSI and the specific causes of the influence of NSSI and personality traits. Methods Participants of this study were junior high school students enrolled in three different schools of a Chinese province. NSSI was evaluated using the Adolescents Self-Harm Scale and their personality traits were assessed using the Neuroticism Extraversion Openness Five-factor Inventory (NEO-FFI). Results 2376 junior high school students participated, and the annual incidence of NSSI was 37.1% (n=881). The mean age of the NSSI-detected individuals was 13.61 years (SD=1.017). Out of total number of detections, 56.6% (n=499) were female and 67.4% (n=594) were individuals who self-injured using multiple means. Hair pulling, scratching the skin, and whacking harder objects with the hand were the most common modes of NSSI, with incidences of 51.0%, 43.0%, and 42.8% respectively in the NSSI-detected population. There was a negative association between grade and NSSI severity (p < 0.05), and NSSI was more severe in females. The scores in the Neuroticism dimension were higher in the group with NSSI than in the group without NSSI, while the scores in the extraversion, openness, agreeableness and conscientiousness dimensions were lower than in the group without NSSI (p < 0.01). Neuroticism and openness were significantly positively correlated with NSSI severity, and extraversion, agreeableness, conscientiousness were significantly negatively correlated with NSSI severity (p < 0.01). Conclusion The severity of NSSI was relatively higher in lower grades among junior grades and females, and the number of self-injury using multiple means was significantly higher; hair pulling, skin scratching and whacking harder objects with hands were the most common NSSI modalities. Among the personality traits, for the incidence of NSSI, high neuroticism was a risk factor, and high extraversion, openness, agreeableness, and conscientiousness were protective factors. For the severity of NSSI, high neuroticism and high openness were risk factors, and high extraversion, high agreeableness, and high conscientiousness were protective factors.

创伤后应激障碍(PTSD)常与精神病性障碍共病.共病精神病性障碍的PTSD患者常有病程长,症状重及社会功能差等特点.眼动脱敏与再加工(EMDR)治疗是PTSD的推荐治疗方法之一.但大多数EMDR治疗PTSD患者的研究都未纳入合并精神病性障碍患者,本文总结了至今为止EMDR治疗精神病性障碍的研究,为更好地在精神病性障碍患者中应用EMDR治疗提供参考.

The functions of nonsuicidal self-injury (NSSI) consist of social and emotional aspects (Social influence, Sensation seeking, Internal and External emotion regulation). Previous studies have indicated that dysfunction in reward-related brain structures especially the striatum might drive this habitual behavior. However, no studies to date have investigated the associations between striatum and different functions for adolescents engaging in NSSI behaviors. Here, we recruited 35 depressed adolescents with recent NSSI behaviors and 36 healthy controls and acquired structural brain images, depressive symptoms, social, academic and family environments assessments, in addition to NSSI functions in patients only. Subcortical volumes and cortical thickness were estimated with FreeSurfer. Mixed linear regressions were performed to examine associations between striatal structures (caudate, putamen, nucleus accumbens, pallidum) and NSSI functions, with age, sex, total intracranial volume, hemisphere and depression severity included as covariates. Effect of environmental factors and potential associations with cortical thickness and other subcortical volumes were also tested. We found that, among the four functions, external emotional regulation represented the main function for NSSI engagement. Increased external emotion regulation was significantly associated with smaller putamen volume. No environmental factors biased the association with putamen. No associations with other cortical or subcortical regions were observed. Our findings suggested that smaller putamen might be a biomarker of NSSI engagement for depressed adolescents when they regulated frustrated or angry emotions. The results have potentially clinical implications in early identification and brain intervention of NSSI in youth.

Background Adolescent non-suicidal self-injury (NSSI) is common and adolescence is the most common period of first self-injury, and the occurrence of NSSI is influenced by negative life events and emotional symptoms. The mediating role of emotional symptoms in the interaction between negative life events and NSSI has not been carefully investigated yet. Methods For middle school students in three schools in a Chinese province, the Adolescents Self-Harm Scale was used to investigate NSSI, the Adolescent Self-Rating Life Events Check List was used to investigate adolescent negative life events, and the Self-Rating Anxiety Scale and Self-Rating Depression Scale were used to assess their emotional symptoms. After the description of general data and the test for differences between groups, the relationship between negative life events, emotional symptoms and NSSI was analyzed using Pearson correlation analysis. Structural equation modeling was used to analyze the mediating role of emotions in negative life events and NSSI. Results A total of 2376 junior high school students completed this survey, which revealed an annual NSSI prevalence of 37.1% ( n = 881) and a higher prevalence of NSSI among girls and rural adolescents. Among adolescents who developed NSSI, 67.4% ( N = 594) used multiple means of self-injury. The most common means of self-injury was hair pulling (51.0%), and the most common NSSI purpose and external factors/events were venting bad emotions or feelings (57.5%) and poor academic performance (44.9%), respectively. Negative life events, emotional symptoms and NSSI were positively associated ( P < 0.05). Structural equation modeling with negative life events, emotional symptoms and NSSI as variables showed that the model-fit index matched the data well, with RMSEA = 0.073, AGFI = 0.945, GFI = 0.980, CFI = 0.985, NFI = 0.982, TLI = 0.968, IFI = 0.985, and negative life events, emotional symptoms (anxiety, depression) and NSSI all had direct effects with standardized path coefficients of 0.16, 0.19, and 0.23, respectively, with negative life events playing an indirect role in NSSI through emotional symptoms and emotional symptoms playing an incomplete mediating role in negative life events and NSSI. Conclusion The prevalence of NSSI was higher among Chinese junior high school students. Both negative life events and emotional symptoms were direct risk factors for NSSI. In addition, negative life events were also indirect risk factors for NSSI, and emotional symptoms played an incomplete mediating role in the relationship between the effects of negative life events and NSSI. This indicates that the combination of reducing the frequency of negative life events while maintaining individual emotional stability during adolescent development can effectively reduce the prevalence of NSSI in adolescents.