Purpose:Effective antidepressant treatment is one of the most important approaches for alleviating depressive symptoms and reducing the risk of suicide. Nevertheless, the high rates of relapse and disability associated with depression are largely due to patients' poor medication adherence. This study investigated the influence of patient experience and psychological contract on medication adherence of outpatients with depression and sought to identify critical factors that could improve medication adherence and provide effective recommendations for the healthcare system. Patients and methods:A cross-sectional survey was conducted in Psychiatric Out-patient department of a tertiary general hospital. A total of 348 participants diagnosed with depression were surveyed by SERVQUAL scale, Psychological Contract Scale and Morisky Scale to assess patient experience, psychological contract and medication adherence, respectively. Results:The mean scores of patient experience, psychological contract, and medication adherence were 7.12 ± 1.25, 3.93 ± 0.36, and 5.32 ± 2.41, respectively. Patient experience and its five dimensions were positively correlated with medication adherence (P < 0.01). Although the psychological contract was not directly associated with medication adherence, it exerted an indirect effect through its influence on patient experience. Conclusions:Patient experience was positively associated with medication adherence among individuals with depression. Moreover, psychological contract exerted an indirect effect on medication adherence by influencing the quality of the patient experience. These findings highlight the importance of enhancing patient-centered service and fostering trust-based relationships to improve treatment adherence in depressive populations.

The high prevalence of recurrent depressive episodes (RDE) among patients with major depressive disorder (MDD) has resulted in substantial personal, societal, and financial burdens. Although many studies have explored the factors associated with RDE, most have important methodological limitations. This study aims to examine the factors associated with RDE within two years among young adults with first-episode MDD. A total of 324 patients aged 18 to 30 years with a first episode of MDD completed both the baseline assessment and the two-year follow-up. Personal, psychosocial, and illness-related variables were assessed at baseline. The status of RDE and medication use were evaluated at follow-up. Network analysis and logistic regression were performed to examine variables associated with RDE. The two-year prevalence of RDE among patients with first-episode MDD was 42.28

BACKGROUND:The mechanism by which synaptic plasticity mediates the occurrence of depression is unknown. Low-density lipoprotein receptor-related protein 1 (LRP1) affects axon growth and neurogenesis in the brain, but its role in depressive-like behaviors is poorly understood. METHODS:Adeno-associated virus-mediated small interfering RNA was injected into the bilateral hippocampus 14 days before chronic unpredicted mild stress (CUMS). Behavior performance was assessed for depressive-like behaviors. Western blot was conducted to detect levels of LRP1, neurogenesis-related proteins, synaptic markers, microtubule system molecules and Akt/GSK-3β signaling-related proteins. Immunohistochemical staining was performed for LRP1 protein, immunofluorescence staining was conducted to determine the Sox2 protein, Nissl's staining and transmission electron microscope staining were used to observe hippocampal morphological features. RESULTS:The expression of hippocampal LRP1 was positively correlated with depressive-like behaviors. Treatment with iAAV-LRP1 exerted protective effects on depressive-like behaviors. LRP1 Knockdown relieved the inhibition of synaptic plasticity induced by CUMS. Expression of Sox2, GluR2 and SYP was significantly increased in iAAV-LRP1 CUMS rats. LRP1 knockdown reduced the p-tau (Ser262 and Thr404) and Acet-tubule levels in depressed rats. Finally, we found that LRP1 knockdown activated the PI3K/Akt pathway and inhibited GSK-3β signal transduction. LIMITATIONS:More neurogenesis markers would be considered, and stereotactic injection into hippocampal DG region could be performed to investigate the effects of LRP1. CONCLUSIONS:These findings indicated that hippocampal LRP1 deficiency in stressed rats plays an important protective role in depressive-like behavior by increasing synaptic plasticity mediated by microtubule dynamic and activating Akt/GSK-3β signaling pathway. Therefore, LRP1 may represent a potential therapeutic target for depression.

To study the acute psychological effects of Coronavirus Disease 2019 (COVID-19) outbreak among healthcare workers (HCWs) in China, a cross-sectional survey was conducted among HCWs during the early period of COVID-19 outbreak. The acute psychological effects including symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder (GAD-7) questionnaire, and the Impact of Event Scale-Revised (IES-R). The prevalence of depression, anxiety, and PTSD was estimated at 15.0%, 27.1%, and 9.8%, respectively. Having an intermediate technical title, working at the frontline, receiving insufficient training for protection, and lacking confidence in protection measures were significantly associated with increased risk for depression and anxiety. Being a nurse, having an intermediate technical title, working at the frontline, and lacking confidence in protection measures were risk factors for PTSD. Meanwhile, not worrying about infection was a protective factor for developing depression, anxiety, and PTSD. Psychological interventions should be implemented among HCWs during the COVID-19 outbreak to reduce acute psychological effects and prevent long-term psychological comorbidities. Meanwhile, HCWs should be well trained and well protected before their frontline exposure.

2020年2月初,由于新型冠状病毒感染者新增病例不断攀升,为了避免流动的传染源造成交叉感染,做到“应收尽收、应治尽治”,在中央新冠肺炎防控指挥部的部署下,武汉地区于2月3日开始筹建方舱医院,2月5日,武汉展览馆、洪山体育馆、武汉客厅3家第一批方舱医院开始收治患者,随后一共筹建了16家方舱医院,收治了1.2万余名患者,为打赢这场抗疫之战起到了关键性作用.在方舱医院的运行过程中,相关专家、医务人员开展了心理干预服务,并形成了方舱心理干预方案.

目的 探讨养血清脑颗粒联合阿立哌唑治疗精神分裂症的临床疗效.方法 选择2016年1月—2018年5月武汉市优抚医院收治的精神分裂症患者94例,随机分为对照组(47例)和治疗组(47例).对照组患者口服阿立哌唑片,第一周剂量为5 mg/d,第二周剂量为10 mg/d,然后依据患者的耐受情况增加剂量至15 mg/d,1次/d.治疗组患者在对照组的基础上口服养血清脑颗粒,4 g/次,3次/d.两组患者均连续治疗8周.观察两组患者临床疗效,同时比较治疗前后两组患者阳性和阴性症状评定量表(PANSS)评分、社会认知功能评分及血清白细胞介素-2(IL-2)、IL-6、神经生长因子(NGF)及和脑源性神经营养因子(BDNF)水平.结果 治疗后,对照组临床有效率为76.60％,显著低于治疗组的93.62％,两组比较差异具有统计学意义(P<0.05).治疗后,两组PANSS和社会认知功能评分均明显小于治疗前(P<0.05),且治疗组患者这些评分明显低于对照组(P<0.05).治疗后,两组血清IL-2、IL-6、NGF及BDNF水平均明显低于治疗前(P<0.05),且治疗组血清IL-2、IL-6、NGF及BDNF水平明显低于对照组(P<0.05).结论 养血清脑颗粒联合阿立哌唑治疗精神分裂症的临床疗效显著,能够明显改善临床症状和社会认知功能,且安全性较好,具有一定的临床推广应用价值.

目的 研究二次妊娠产妇抑郁情绪与血清25-羟基维生素D(25-OH-VD)水平的关系及对分娩方式的影响.方法 选取从2016年2月-2018年2月于武汉市优抚医院进行分娩且伴有抑郁症的二次妊娠产妇100例记为研究组,另取同期于该院进行分娩不伴有抑郁症的二次妊娠产妇100例记为对照组.分别比较两组产妇焦虑自评量表(Self Rating Anxiety Scale,SAS)、汉密顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评分以及血清25-OH-VD水平,并分析二次妊娠产妇抑郁情绪与SAS评分、血清25-OH-VD水平的相关性.此外,对比两组产妇分娩方式情况,并作多因素的lo-gistic回归分析. 结果 研究组产妇SAS、HAMD评分相比对照组高(P＜0.05),而血清25-OH-VD水平相比对照组低(P＜0.05).经Pearson相关性分析可得:二次妊娠产妇HAMD评分与SAS评分呈正相关(P＜0.05),与血清25-OH-VD水平呈负相关(P＜0.05).研究组产妇顺产人数占比相比对照组低,而剖宫产人数占比相比对照组高(P＜0.05).经多因素logistic回归分析可得:SAS评分、HAMD评分较高以及血清25-OH-VD水平较低均是二次妊娠产妇不良分娩方式的独立危险因素(均P＜0.05). 结论 二次妊娠产妇抑郁情绪与血清25-OH-VD水平存在明显负相关关系,且抑郁情绪与清25-OH-VD水平的降低均会增加二次妊娠产妇不良分娩方式发生的风险.

在充满挑战和压力的现代社会,无论老年人、中年人还是青年人,谁没有经历过烦恼、不安、委屈和焦虑? 青年人:在纠结中前行 青年人智力发展迅速,观察力发达,记忆力强,思维敏捷,想象丰富,操作能力和求知欲望等都很强,但面对求学、就业、工作、恋爱、婚姻、家庭、人际关系等,必然产生多元的心理反应,妥善处理好这些心理反应,才能促进心理健康,反之则会损害心理健康,甚至造成精神创伤.

脑衰反应调节蛋白家族(collapsin response mediator proteins,CRMPs)又名二氢嘧啶相关蛋白(dihydropyrimidinase-related proteins,DRP,DPYSL)、UNC-33类似蛋白(unc-33-like proteins,Ulip)、TOAD-64及TUC,由5种同源胞浆蛋白构成,即CRMP1-5[1].CRMP2是其家族最先被发现的成员,在神经元及少突胶质细胞中广泛表达,参与多种神经功能,包括微管动态性、微丝重组及稳定性、神经元极化及迁移、轴突运输、胞吞作用、钙离子通道调节以及T淋巴细胞迁移等[2].研究发现其与阿尔茨海默病、缺血缺氧性脑病、精神分裂症、抑郁症等多种神经精神疾病的发生、进展密切相关.

随着对精神障碍研究的深入,研究者发现 ,精神障碍伴有神经病理改变 ,和有关的神经疾病有共同的病理过程[1 ] .抑郁症是最常见的精神障碍之一 ,以显著而持久的情绪低落为主要特征.研究表明 ,全球抑郁症发病率约为3.1% ,发达国家的发病率约为6% ,我国为3% ~5% .有25% ~30% 的抑郁症患者有过自杀行为 ,11% ~19% 自杀身亡[2 ] .世界卫生组织预测,到2020年抑郁症将成为最重要的致残疾病 ,对于个体和家庭都是一个沉重的负担[3 ] .痴呆是老年人常见疾病,65岁以上的老年人中约1/5有认知功能损害.65岁以后,每增加5岁 ,痴呆的风险就会翻倍.80岁以上的老年人 ,其痴呆患病率达到40% [4 ] .

目的:回顾分析精神分裂症患者的经济负担.方法:收集武汉、十堰2014年5～9月间出院的精神分裂症患者289例及照料者资料,调查经济学指标,测算精神分裂症所带来的经济费用.结果:发病次数是直接医疗费用的主要影响因素.直接非医疗费用的主要影响因素为首发到确诊时间、停药时间.间接费用的主要影响因素为停药时间.总费用的主要影响因素为发病次数、停药时间.结论:发病次数、停药时间、首发到确诊时间等对于精神分裂症经济负担有显著影响.

Objective:The purpose of this paper was to explore the distribution of psychiatric consulta-tion in general hospital. Method:Six hundred and eighty-eight cases were selected from non psychiatric de-partment in a general hospital. Self-made questionnaires were finished. Descriptive statistical analysis was used by SPSS. Results:The most patients came from the following department:department of internal neurology (19. 3% ),department of cardiology(9. 7% ),department of orthopedics(9. 3% ),department of gastroenterolo-gy(8. 9% ),department of respiratory(8. 7% )and neurosurgery(7. 0% ). The main patients ages were 40 ~ 69 years old(53. 2% )and 20 ~ 29 years old(13. 5% ). The main reasons of consultation were acute brain syn-drome(25. 7% ),psychotic symptoms(22. 8% ),medically unexplained physical symptoms(12. 9% )and the history of mental disorder without symptoms(13. 8% ). The main diagnoses were as follows:mental disorders due to physical diseases(21. 4% ),schizophrenia and other psychotic disorder(20. 9% ),brain organic mental disorders(20. 1% ). Conclusion:In current,non psychiatrists paid more attention to patient′s mental health, mainly include positive mental symptoms,especially acute main syndrome and psychotic symptoms. But depres-sion and anxiety symptoms were got less attention.

目的 分析我院住院双相情感障碍(bipolar disorder BPD)患者药物应用现状,为临床合理用药提供参考.方法 选择住院的224例BPD患者,分析双相躁狂及双相抑郁的心境稳定剂、非典型抗精神病药、抗抑郁药物使用比例及剂量.结果 心境稳定剂应用比例为68.3％,非典型抗精神病药应用比例为77.3％.在双相躁狂(102例)及双相抑郁(122例)中,丙戊酸盐、奥氮平使用比例分别为(80.4％ vs 45.1％;68.6％ vs 18.0％),差异有统计学意义(P＜0.05).双相躁狂与双相抑郁中丙戊酸盐、奥氮平、喹硫平的剂量分别为(0.82土0.31)g vs(0.56±0.22)g;(13.39±6.14) mg vs(7.75±4.26)mg;(380.77±278.79) mg vs (163.89±191.25) mg,差异均有统计学意义(P＜0.05).双相抑郁中抗抑郁药使用频率71.3％,使用频率依次为舍曲林、艾司西肽普兰、米氮平、文拉法辛.结论 丙戊酸盐及非典型抗精神病药(奥氮平和喹硫平)已经作心境稳定剂广泛应用于临床,且双相躁狂用药比例及剂量明显大于双相抑郁.双相抑郁治疗大多临床医生选择了在心境稳定剂的基础上合并抗抑郁药.

2015年6月1日晚21:30,“东方之星”客轮在湖北省监利江段翻沉.笔者受湖北省卫生计生委指派,作为灾难现场的心理救援人员于6月2日中午到达监利,开展心理救援工作,直至所有善后工作完成,于16日返回武汉.

目的 研究慢性不可预见性温和应激(CUMS),氟西汀治疗及再应激后大鼠大脑皮质脑源性神经营养因子(BDNF)及细胞支架微管系统的改变.方法 将32只大鼠随机分为4组:对照组(空白对照+o.9％氯化钠溶液),CUMS组(CUMS+0.9％氯化钠溶液),氟西汀组(CUMS+氟西汀),再应激组(CUMS+氟西汀+1周药物清洗期+CUMS).大鼠进行21 d CUMS后,氟西汀组给予氟西汀治疗21d,再应激组给予氟西汀治疗21d后进行1周药物清洗,再次给予CUMS.其余两组给予0.9％氯化钠溶液.实验结束后检测糖水偏好,并使用Western Blotting检测鼠大脑总皮质及额叶皮质Acet-Tub,Tyr-Tub,BDNF,总tau,磷酸化tau(Ser356及Thr231)的表达.结果 21 d慢性应激后,CUMS组糖水偏好(52.37±16.758)％与对照组(76.37±7.671)％比较差异有统计学意义(P＜0.01);氟西汀组糖水偏好与对照组比较差异无统计学意义;CUMS再应激组糖水偏好(42.00±8.03)％与对照组及CUMS组比较差异均有统计学意义(P＜0.01).与对照组比较,CUMS组大鼠额叶皮质Acet-Tub表达升高(174.53±13.7),Tyr-Tub表达降低(64.00±9.24),BDNF表达降低(67.94±9.81),p-tau(Ser356)的表达(165.49±9.68)及p-tau(Thr231)的表达(210.83±23.12)升高,差异有统计学意义(P＜0.01).经氟西汀治疗后,Acet-Tub表达降低,Tyr-Tub、BDNF的表达升高,p-tau(Ser356)及p-tau(Thr231)的表达降低,与对照组比较差异无统计学意义.再应激组Acet-Tub表达升高(250.46±15.72),Tyr-Tub表达降低(33.54±10.23),BDNF表达降低(34.77±6.24),p-tau (Ser356)表达(237.42±10.24)及p-tau(Thr231)的表达(373.69±34.14)升高,与对照组及CUMS组比较差异均有统计学意义(P＜0.01).4组之间总tau的表达比较差异无统计学意义.大鼠大脑总皮质各项指标差异无统计学意义.结论 抑郁动物模型大脑额叶皮质微管动态性减低,伴随BDNF表达减低及tau蛋白磷酸化水平升高,氟西汀可逆转这种应激导致的损伤;动物再次暴露于CUMS后,额叶皮质微管动态性损害更严重,并伴随BDNF减低更显著及tau蛋白磷酸化水平升高更甚.结果提示微管动态性改变中,BDNF及tau参与其中,即参与应激导致的神经可塑性.

OBJECTIVES: To examine the effect of BDNF on F-actin during the stimulation of IL-1β in hippocampal neurons. MATERIALS & METHODS: We cultured hippocampal neurons from rat embryos. Cell stimulation was induced by IL-1β. Cell culture success was evaluated by an activity analysis of CCK-8, staining of gliocyte by immunohistochemistry. Changes in F-actin, BDNF and NF-ĸB were examined using molecular analyses. RESULTS: Our results demonstrate that a high concentration of IL-1β exaggerates the stimulation-induced degradation of F-actin by BDNF, whereas a low concentration of IL-1β protects F-actin against this degradation. These beneficial effects might be associated with the inhibition or exaggeration of the NF-ĸB signaling cascade. CONCLUSIONS: Taken together, our findings indicate that BDNF acts as an F-actin-protective regulator during stimulation by IL-1β and that this function largely occurs via the regulation of NFĸB signaling. These results suggest that interventions targeting the BDNF signaling system may be of therapeutic value against major depressive disorder (MDD).

Objective To provide a reference for mental health of the clinical medical graduate student,we studied the relationship between mental health status and social support.Methods Symptom Check List 90 (SCL-90),Eysenck Personality Questionnaire (EPQ),social support rating scale were used to cluster sampling survey of 264 medical graduate students in a university.Results According to EPQ,the P scores,N scores,E scores,L scores of male and female were different with normal.According to SCL-90,the 9 factors scores were all significant lower than normal (P ＜ 0.01).According to social support scales,the support scores were significant higher than normal (P ＜0.01).Negative correlation existed between 9 factors of SCL-90 and the social support.Social support in each factor of personality in regression analysis,only the spirit of P scores,social support factors were entered into the regression equation.That showed social support had great influence on the spirit of quality.Conclusions The graduate students have good mental health.Social support has a positive correlation with mental health.

Objective To investigate behavior and hippocampal tau alterations following chronic unpredictable mild stress (CUMS),treatment of fluoxetine and re-exposure to CUMS.Methods 32 male SpragueDawley (SD) rats were divided into four groups,with 8 exposed to 21 consecutive days of chronic unprcdicted mild stresses (CUMS) and treated with vehicle,8 exposed to CUMS and treated with fluoxetine,8 exposed to CUMS and treated with fluoxetine and re-exposed to CUMS after washout,and 8 as normal controls treated with vehicle.Behavioral changes in these rats were analyzed.The expression of hippocampal tau and phospho-tau were analyzed using Western Blot.Results (1) Compared with the normal rats,sucrose preference ((52.37 ± 16.76) ％),total traveling distance((2736.59 ± 511.20) cm),velocity((5.69 ± 1.09) cm/s) and frequencies of rearing(2.50 ±2.00) were reduced (P ＜ 0.01) in the depressed rats.These behavioral changes could be reversed after 21d fluoxetine treatment.Compared with the control and CUMS group,sucrose preference ((42.00 ± 8.03)％),total traveling distance ((763.48 ± 457.29) cm),velocity ((2.64 ± 0.97) cm/s) and frequencies of rearing (0.25 ± 0.46)were reduced (P＜0.01 for both) in the re-exposure to CUMS group.(2) Compared with the normal rats,the ptau(Ser356) expression ((152.31 ± 12.34) ％) and p-tau (Thr231) expression ((166.72 ± 17.58) ％) of CUMS group showed a significant increase (P＜ 0.01 for both) in rats submitted to CUMS.These changes could be also reversed after 21d fluoxetine treatment.Compared with the control and CUMS group,the p-tau (Ser356) expression ((221.86 ± 14.34) ％) and p-tau (Thr231) expression ((302.01 ± 20.31) ％) of re-exposure to CUMS group showed a significant increase (P＜ 0.01 for both).The total tau expression of four groups did not change significantly.Conclusion These findings provide evidence that rats exposed to CUMS and re-exposed to CUMS show increased p-tau expression,which suggest that changes in tau phosphorylation may play an important role in the link between depression and AD.

Gene therapy is currently developing rapidly in research and clinical applications,it has brought people more and more hope for disease curing.However,there are lots of ethical problems appeared such as effectiveness and safety of gene therapy technology,the selection of the patient and the patient's informed consent,patients' information privacy protection,health care costs and bioethical issues.Based on gene therapy technology and laws and regulations,this paper proposed the ethical countermeasures: advocating the researchers and doctors of self-discipline,strengthening the construction and the perfection of the laws and regulations,from a technical point of view to improve the safety of gene therapy,developing gene therapy efficacy evaluation system,fully informed consent of patients so as to promote the healthy development of gene therapy under the ethical norms and guidance.