OBJECTIVE:Low heart rate variability (HRV) levels may be a susceptibility factor for major depressive disorder (MDD). Sleep-state HRV may be more likely to reveal the pathological features of MDD compared with resting state HRV (RS-HRV). This study aimed to elucidate HRV alterations in the sleep states of patients with MDD. METHODS:Physiological signal data from the resting state before sleep, first non-rapid eye movement (NREM) and rapid eye movement (REM) stages, and last NREM and REM stages were acquired using polysomnography. RESULTS:The RS-HRV indices (the standard deviation [SD] of all normal-to-normal [NN] intervals [SDNN], the square root of the mean of the sum of the squares of the differences between adjacent NN intervals [RMSSD], the percentage difference between adjacent NN intervals >50 ms [pNN50], high-frequency [HF], low-frequency [LF], very low frequency [VLF], SD1, and sample entropy [SampEn]) were lower in patients with MDD than in healthy controls (HCs). Patients with MDD had lower SDNN, RMSSD, pNN50, HF, LF, VLF, SD1, SD2, and SampEn and higher SD2/SD1, α1, and α2 than HCs in the NREM stage. They also had lower SDNN, RMSSD, pNN50, HF, LF, VLF, SD1, SD2, and SampEn and higher LF/HF than HCs in the REM stage. Fewer indices changed significantly during different sleep stages in patients with MDD than in HCs. CONCLUSIONS:Patients with MDD had a generalised reduction in HRV in both RS and sleep state and decreased dynamic changes during sleep. Altered autonomic nervous system activity has been implicated in MDD pathology.

OBJECTIVE:Vitamin D is thought to be deficient in patients with bipolar disorder. The purpose of this study is to use latent profile analysis to identify the patterns of vitamin D levels in patients with episodes of bipolar depression, and to examine the relationship among these latent profiles and demographic and clinical characteristics. METHODS:A total of 149 patients diagnosed with bipolar depression were selected in Guangzhou, China. Depression was evaluated by Zung Self-Rating Depression Scale. Serum 25-hydroxyvitamin D levels tested at baseline and after two weeks of psychiatric treatment were included in the latent profile analysis to identify subgroups. P-trend analysis was used to assess the association between subgroups and depression improvement. Multinomial logistic regression analysis was used to assess the influencing factors of subgroups. RESULTS:A three-profiles solution was found to demonstrate the best fit [low-level profile (32.9%), medium-level profile (51.0%), and high-level profile (16.1%)]. There was a significant nonlinear relationship between depression improvement and vitamin D high-level profile, compared to medium-level profile (P for trend <0.05). In multinomial logistic regression analysis, baseline and post-treatment SDS scores, admission season, age, and body mass index significantly affect the profile membership. CONCLUSIONS:This study found that individuals with high levels of vitamin D showed a significant improvement in depression severity. However, those with low levels of vitamin D remained deficient, indicating a need for targeted vitamin D supplementation. Our findings may provide valuable insights for designing tailored vitamin D supplement interventions to address vitamin D deficiency in bipolar depression.

Anxiety is a prevalent mental health issue that affects both individuals and society. Music therapy has been found effective in reducing anxiety in clinical trials. However, the available music pieces for therapy are limited and may not meet the requirements of individuals from diverse backgrounds. To overcome this limitation, we propose a novel model called the spatio-temporal therapeutic music transfer model (StTMTM) for anxiety reduction. The StTMTM can transfer a piece of music to a new therapeutic music piece that satisfies both the criteria for music therapy and the requirements of individuals. Our approach involves first developing a music feature extraction network that can extract spatio-temporal music features. We then train the network on different genres and transfer the learning results from genre classification to music transfer for anxiety reduction. We also propose a deep learning-based music transfer network with melody and accompaniment encoders and a newly designed loss function to modify a piece of music to be therapeutic. Experimental results on 92 subjects demonstrate that the transferred therapeutic music produced by the StTMTM exhibits exceptional performance in anxiety reduction. Overall, our model has the potential to make music therapy more accessible and effective for individuals with diverse backgrounds and needs.

Objective:To investigate the safety of Xuhanting Granules combined with selective serotonin reuptake inhibitor（SSRI） and the effect on health-related quality of life in patients with depression by comparing with SSRI alone.Methods:Ninety-five patients with acute depressive disorder treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2019 were enrolled and randomly divided into an observation group（n=46） and a control group（n=49） according to the random number table method.The patients in the control group were treated with SSRI alone, and those in the observation group were treated with Xuhanting Granules combined with SSRI.Both groups were treated for eight weeks.Regular visits were carried out and the scores of the Self-Rating Depression Scale（SDS）,36-Item Short Form Survey（SF-36）,Columbia Suicide Severity Rating Scale（C-SSRS）,Barnes Akathisia Scale（BAS）,and Abnormal Involuntary Movement Scale（AIMS） were measured.Results:After eight weeks of treatment, the SDS score of the observation group was lower than that of the control group（P＜0.01）,but the SF-36 score had no significant difference.In terms of safety, there was no significant difference in C-SSRS score between the two groups, while BAS and AIMS scores in the observation group were significantly lower than those in the control group（P＜0.01）.Conclusion:Xuhanting Granules combined with SSRI in the treatment of depression can effectively improve the social function of patients with depression and reduce extrapyramidal side effects with good safety.

Background To explore the relationship between serum levels of inflammatory markers and symptomatic severity of bipolar disorder (BD). Materials and methods A cross-sectional study was conducted on 126 BD patients with current depressive episode (BDD), 102 BD patients with current mixed or (hypo)manic episode (BDM) and 94 healthy controls (HC). All participants were drug-naïve and had no current active physical illness associated with inflammatory response or history of substance abuse. Fasting serum levels of CRP, leptin (LEP), adiponectin (ADP), visfatin (VIS), TNF-α, IL-2, IL-6, IL-10, IL-17), and monocyte chemoattractant protein-1 (MCP-1) were measured with enzyme-linked immunosorbent assay (ELISA). Symptomatic severity of BD was assessed with HAMD-17 and YMRS. Generalized linear model was used to determine the association between the serum levels of inflammatory markers and symptomatic severity of BD. Results The serum levels of IL-6, IL-10 and IL-17, and the IL-6/IL-10 ratio were significantly lower in mild BDD than in HC. In moderate BDD, the serum levels of MCP, IL-6 and IL-17 were significantly lower than in HC. In severe BDD, the serum level of ADP, MCP-1, IL-10 and IL-17and the IL-17/IL-10 ratio were significantly lower than in HC. The serum levels of TNF-α and the IL-6/IL-10 ratio were significantly higher in mild BDM than in HC. In moderate BDM, the serum level of VIS, IL-2, and IL-17 were significantly higher than in HC, but the IL-6/IL-10 ratio was significantly lower than in control. In severe BDM, the serum levels of IL-6 and IL-17 and the ratios of IL-6/IL-10 and IL-17/IL-10 were significantly lower than in HC, but the neutrophil/lymphocyte ratio was significantly higher than in HC. Conclusion In BDD, immune-inhibition is persistently predominant, while in mild-to-moderate BDM, immune system is activated but inhibited in severe BDM. The dynamic change of serum inflammatory markers suggests that alteration of peripheral inflammatory markers in BD is state-dependent instead of trait-marked.

INTRODUCTION:Several studies have demonstrated that patients with major depressive disorder (MDD) commonly show reductions in heart rate variability (HRV) parameters. Thus, interventions for the improvement of low HRV may be advantageous in treating MDD. This systematic review and meta-analysis aimed to explore the improvement effects of current clinical treatments on low HRV in patients with MDD. METHODS:Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, EMBASE, PsycINFO, and CNKI databases were searched for relevant literature. Interventional studies of patients with confirmed MDD, which included baseline and post-intervention data and at least one HRV parameter as an outcome indicator, were included for meta-analysis. RESULTS:Twenty-one studies were included in the review. Several studies affirmed the role of psychotherapy in improving low HRV in patients with MDD showing a significant increase in high-frequency and low-frequency power after psychotherapy in the meta-analysis. However, both pharmacotherapy studies and physiotherapy studies included in the meta-analysis showed significant heterogeneity. LIMITATIONS:The main limitation of this study was the relatively small samples for the meta-analysis, and more high-quality randomized controlled trials in this field are wanted. CONCLUSIONS:Psychotherapy was effective for improving low HRV in patients with MDD. However, the effect of pharmacotherapy or physical therapy on low HRV in MDD remains unclear. Regarding research methods, it is necessary to formulate and standardize operational guidelines for future HRV measurements.

目的:探索Mini-CEX联合360度考核在精神科实习生医患沟通、人文关怀能力培养中的作用.方法:将71名实习生随机分成实验组和对照组.采用Mini-CEX联合360度考核对实验组的医患沟通、人文关怀能力进行评估,对照组仅进行360度考核.结果:实验组的Mini-CEX各因子分、出科前评分均高于入科后评分.360度考核中,实验组除实习医生评价以外的各项分值均高于对照组.结论:Mini-CEX联合360度考核可以较好地评价和提高精神科实习生的医患沟通、人文关怀能力.

Study objectives: Based on a cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we aimed to evaluate the relationship between sleep duration and the incidence of cognitive impairment among older Chinese adults. Methods: We conducted a prospective analysis based on 3692 participants from the CLHLS at baseline (in 2011), and as a 3-year follow-up (till 2014), 531 participants (14.4%) had cognitive impairment, which was defined as a Mini-Mental State Examination score <24. Sleep duration was classified into three groups: short (<= 5 hours/day), normal (>5 but <10 hours), and long (>= 10 hours/day). A logistic regression model was used to examine the association between baseline sleep duration and cognitive impairment after adjusting for sociodemographic data, living habits, and health conditions. Results: Five hundred sixty-two participants (15.2%) were in the short-duration group, and 608 participants (16.5%) were in the long-duration group. After adjusting for multiple potential confounders, compared with normal sleep duration, long sleep duration was associated with the incidence of cognitive impairment (OR = 1.309, 95% CI: 1.019-1.683), especially among men (OR = 1.527, 95% CI: 1.041-2.240) and those having a primary and above education level (OR = 1.559, 95% CI: 1.029-2.361). No significant association was observed between short sleep duration and cognitive impairment (OR = 0.860, 95% CI: 0.646-1.145). Conclusions: Excessive sleep may increase the risk of cognitive impairment in older individuals. It may be a suggestive sign of early neurodegeneration and may be a useful clinical tool to identify those at a higher risk of progressing to cognitive impairment.

The present study aimed to evaluate the efficacy and safety of aripiprazole once-monthly (AOM) compared to oral aripiprazole in treating acute schizophrenia. This randomized, double-blind, non-inferiority study recruited patients from 15 trial sites across China from May 2017 to April 2019. Patients with an acute psychotic episode received AOM at 400 mg or oral aripiprazole at 10–20 mg for 12 weeks. The primary and secondary efficacy endpoints were the difference in scores from baseline to week 10, as assessed on the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions—Severity (CGI-S) scores, respectively. A total of 436 patients were randomized. Among them, 159/218 (72.9%) and 165/218 (75.7%) in the AOM and oral aripiprazole groups completed 10 weeks of treatment, respectively. The least-squares (LS) mean changes from baseline to endpoint (week 10) in PANSS were − 33.6 for the AOM group and − 34.8 in the oral aripiprazole group, respectively, with a difference of − 1.2 (95% CI: − 4.1, 1.7). The non-inferiority margin of AOM to oral aripiprazole was − 4.1, which was above the lower limit of the pre-defined margin. The altered CGI-S score was − 2.2 and − 2.3 in the AOM and oral aripiprazole groups, respectively. The incidence of treatment-emergent adverse events (TEAEs) was similar in both groups. The rate of discontinuation due to TEAEs was 2.3% and 3.2% in the AOM and oral aripiprazole groups, respectively. This study confirmed the efficacy and safety of AOM for the treatment of Chinese patients with acute schizophrenia. The non-inferiority of AOM to oral aripiprazole was established, with comparable efficacy and tolerability. These findings suggested that AOM could be used as a treatment option for patients experiencing an acute episode of schizophrenia. ClinicalTrials.gov identifier: NCT03172871.

Objective. This study focused on mood regulations and their association with sociodemographic status, exercise pattern, and physical conditions of adults and older adults in China who did not undergo interventions. Method. Data were based on the 2016 to 2018 Guangdong National Physique Monitoring data, in which 5242 participants aged 20-69 years were recruited. Multiple statistical analysis methods, such as descriptive and logistic regression analyses, were used to study each exercise motivation and its association with influencing factors, including sociodemographic characteristics, exercise measurements, and physical conditions. An exercise index for mental health was also used to investigate the number and types of people who were more likely to meet the index. Results. We observed that 44.9% (2355/5242) of participants did not engage in physical exercise in this study. Only older participants (40 to 69 years old) and those with an average level of education (high school/technical secondary school) showed a significant association with exercising for mood regulation. Few people met the index that is good for mental health (16.64% [872/5242] met index 1, and 2.84% (149/5242) met index 2), and higher education showed a significant association with a reduction in the mental health burden and the prevention of depression. Conclusion. This study found that motivating people to be more active and educating them on the potential mental health benefits of exercise could help them to exercise more.

Objectives To survey anxiety and depression symptoms to COVID-19 outbreak in the public, medical staff and patients during the initial phase of the pandemic. Design Cross-sectional online survey administered through WeChat Mini Program using Chinese versions of Zung Self-rating Depression Scale and Zung Self-rating Anxiety Scale. Setting Guangzhou, China. Participants 47 378 public, 1512 medical staff and 125 patients with COVID-19. Results Higher rates of depression (47.8%) and anxiety symptoms (48.7%) were shown by patients who were screened positive compared with those of the public (35.6%, 25.7%) or medical staff (15.4%, 13.3%). The professional identity of a nurse, conditions of ‘with an infected family member’ and ‘working at the frontline’ were risk factors to depression or anxiety symptoms for the medical staff. Younger age, lower educational level, female and not having adequate masks were the risk factors for the public. Conclusion The COVID-19 outbreak increased people’s depression or anxiety emotion responses, which varied extensively among the patients, public and medical staff.

A large number of people suffer from anxiety in modern society. As an effective treatment with few side effects, music therapy has been used to reduce anxiety for decades in clinical practice. Yet therapists continue to perform music selection, a key step in music therapy, manually. Considering the growing need for music therapy services and social distancing amid public emergencies, an automatic method for music selection would be of great practical utility. This paper marks the first effort to identify music with therapeutic effects on anxiety reduction via a novel music scoring model. We formulate the calculation of a therapeutic score as a quadratic programming problem, which minimizes score variance among known therapeutic songs while maintaining their superiority over other songs. The proposed model can uncover common features that contribute to anxiety reduction by learning from small and unbalanced data. Using a music therapy experiment, we find that the proposed model outperforms existing techniques in predicting therapeutic songs. Feature analysis is also conducted, revealing that high‐frequency spectrums are important in therapeutic scoring.

Objectives: The long-term outcome of childhood-onset schizophrenia (COS) and its influencing factors remain unclear. The current study aimed to assess the long-term outcomes of COS and identify possible outcome predictors. Methods: We retrospectively investigated 276 patients with COS. Diagnosis made according to the ICD-10 criteria for schizophrenia, and the age of the first onset was ≤ 14 years. Follow-up was completed for 170 patients, with a median follow-up period of 5.6 years. Outcome variables included occupational/education status and readmission. Spearman correlation was performed to assess the relationship between predictors and outcome variables. Binary logistic regression was conducted to detect possible predictor variables for outcome variables. Results: At the end of the follow-up, 89 patients (52.3%) were at school, 70 patients (41.2%) were employed, and only 11 patients (6.5%) were dropped out of school or unemployed. The duration to the first admission and depressive symptoms were identified as predictors of occupational/educational status. The length of follow-up and obsessive-compulsive symptoms (OCS) were distinguished as predictors of readmission. Duration to the first admission and length of follow-up were risk factors, and depressive symptoms and OCS were protective factors for the outcomes of COS. Conclusion: We found a favorable long-term outcome on occupational/education status in COS, and depressive symptoms and OCS may be associated with more positive long-term outcomes in COS. Our findings suggest that COS patients may benefit from early intervention and require appropriate treatment.

@# Emergencies refer to those events that cause serious social harm, including natural disasters and public health events, and require emergency response. Medical rescue team is the main emergency rescue team. While carrying out the rescue mission, they are under great pressure both physically and mentally due to the unadaptability of the rescue environment, the lack of protective materials, overwork and other reasons, often resulting in fear, tension, anxiety, pessimism, self-blame and even acute stress disorder. Without timely and effective psychological support, long-term psychological problems such as post-traumatic stress disorder will remain after the event. Comprehensive psychological support includes psychological measurement of the whole rescue process, team formation before rescue and detailed psychological support intervention training, self-relaxation during rescue, basic life and safety guarantee, drug treatment, online psychological assistance, withdrawal of stressors after rescue and lifestyle reconstruction.

Background: This study focused on different exercise motivations, especially mood regulation and their relation to the sociodemographic status, exercise pattern and physical conditions of adults and older adults in China who did not undergo interventions.Methods: A total of 5242 participants aged 20-69 years from 2016 to 2018 were recruited in this cross-sectional study to finish the questionnaire of Guangdong National Physique Monitoring organized by the Guangzhou Institute of Sports Science. Multiple statistical analyses methods were used to study each exercise motivation and its sociodemographic characteristics (gender, age, education and job), exercise measurements (frequency, duration and intensity) and physical conditions (BMI, abdominal obesity and basic diseases). An exercise index that is good for mental health (index 1: 45 min per session and 3-5 times per week; index 2: exercise motivation of mood regulation and exercise 60-120 min per week) was also used to investigate the number and type of people who were more likely to meet the index. Results: In our study, 44.9% (2355/5242) of participants showed exercise inactivity. No gender difference was observed among those who exercised for mood regulation. Only older participants and those with an average level of education showed a significant association with mood regulation. Few people met the index that is good for mental health (16.64% (872/5242) met index 1 and 2.84% (149/5242) met index 2), and higher education showed a significant association with a reduction in the mental health burden and the prevention of depression. Conclusion: This investigation suggests motivating people to be more active, educating people on the mental health benefits of exercise.

Objective:To explore the application of various teaching methods in improving the doctor-patient communication skills of medical students.Methods:It was a prospective self-control study. From January 2017 to December 2017, Before entered into psychiatry department of the Third Affiliated Hospital of Sun Yat-sen University, medical students were evaluated for "the Communication Skills Attitude Scale" and "the Medical Students' Doctor-Patient Communication Behavior Scale" , within the following six months a variety of ways of communication skills training, including internship lectures, interactive teaching and new media teaching, scale assessment again after 6 months. The most effective teaching methods were chosen by students.Results:After training, the communication skill of medical students in all aspects was improved, the negative attitude was reduced (35.22±4.35 vs 28.40±3.54), the positive attitude was increased (53.20±5.35 vs 60.84±2.72), the difference was statistically significant ( P<0.05); the medical students' communication behavior scale before and after training (151.78±5.33 vs 166.27±4.36), the difference was statistically significant ( P<0.05). Before training, male students' positive attitude score towards doctor-patient communication were worse than female students (51.41±4.88 vs 54.91±5.33), while malestudents' negative attitude score was higher than female students(36.68±4.80 vs 33.83±3.42). After training, the support score of male students were worse than female students(16.86±1.52 vs 17.83±1.27), and the differences were statistically significant ( P<0.05). The most effective training method favored student was simulation teaching 46.7% (63/135), followed by WeChat 28.9% (39/135). Conclusions:Various teaching methods can improve doctor-patient relationship, students of different genders have different communication abilities and preferences for teaching methods. Among them, simulation teaching in interactive teaching and WeChat platform as the new media teaching facilites are relatively effective, which are worthy of further improvement.

Research training is important for the development of clinical competency of psychiatrists and psychiatry.This paper introduces the training experience of research capacity of psychiatrists in North America,such as reading report meeting,scientific research theory training,participation in scientific research projects,writing of funds application and papers,academic report,and analyzes the enlightenment to the training of research capacity of psychiatrists in China.To improve the policies and measures for the training of the scientific research capacity of psychiatrists,such as strengthening the requirements for scientific research training,improving the allocation of teachers,ensuring the time of scientific research training,making the curriculum of research training,making the incentive policies for scientific research participation,and participating in research practice,in addition to enriching the training methods and contents of scientific research capacity of psychiatrists.

突发事件是指包含自然灾害、公共卫生事件等在内的造成严重社会危害，需要应急应对的事件。医疗救援队伍是突发事件的主力救援队伍，他们在进行救援任务的同时，由于救援环境不适应，防护物资不足、过度工作等原因，身心都承受着巨大的压力，常出现恐惧、紧张、焦虑、悲观、自责，甚至出现急性应激障碍。若得不到及时有效的心理支持，在事件结束后仍会遗留如创伤后应激障碍等长期的心理问题。全方位的心理支持包括救援全程的心理测量，救援前的队伍组建和详尽的心理支持干预培训，救援期间的自我放松、基本的生活和安全保障、药物治疗、在线心理援助和救援后的撤离应激源、重建生活方式等。

目的:探讨双相障碍(BD)患者自杀意念的危险因素.方法:采用DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(病人版)对264例BD患者进行定式访谈,筛查自杀意念并对有/无自杀意念组进行对照研究,调查其人口学资料、自杀家族史、精神疾病家族史、病程中是否出现过精神病性症状、应付方式及社会支持等资料.结果:264例患者中有自杀意念的比率为74.2％,多自变量Logistic回归分析发现女性、以抑郁发作为首发临床相及不成熟的应付方式均是产生自杀意念的危险因素.结论:BD患者自杀预防应重点关注女性、应付方式不成熟和首发为抑郁相者.

目的 探讨缓解期双相障碍患者的社会认知损害情况,并了解对社会功能的影响.方法 纳入符合《美国精神疾病诊断及统计手册》第Ⅳ版双相障碍诊断标准的107例患者(患者组),同时纳入91例健康对照者(正常组).使用自制一般情况调查表、失言识别测验、眼区基本情绪识别任务、爱荷华博弈任务、社会功能缺陷筛选量表等收集研究资料.采用SPSS 13.0统计软件对数据进行统计分析.结果 (1)患者组社会认知功能与正常组相比,其中失言识别测验、爱荷华博弈任务、眼区情绪识别任务中悲、恐、怒、喜面孔的测验成绩差异有统计学意义(P＜0.05);而眼区情绪识别任务中惊、厌面孔的测验成绩相比差异无统计学意义(P＞0.05).(2)失言识别测验成绩(r=-0.278,P＜0.05)与社会功能缺陷筛选量表(SDSS)得分呈负性相关,而爱荷华博弈任务(P＞0.05)、眼区情绪识别任务成绩(P＞0.05)未发现与SDSS得分相关.结论 缓解期双相障碍患者存在社会认知功能缺陷,情绪识别、心理理论能力、决策能力均有受损,提示患者社会信息感知能力与社会问题解决能力下降.社会功能低下与心理理论能力下降有关,心理理论受损可能是影响社会功能的关键因素.