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.

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.

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.

Objective To explore the effects of teachers' simulation standardized patients in the psychiatric anchored practice teaching. Methods The five-year undergraduate intern trainees of clinical medicine at Sun Yat-sen University were randomly divided into three groups, the classic anchored teaching group ( classic group, 34 students) , improvement of anchored teaching group ( modified group, 36 students) ,"teachers' simulation standardized patients" anchored group ( TSSP group, 32 students ) , and use"psychiatric practice teaching quality of classroom assessment questionnaire" to evaluate the teaching effect. Results Classic group of autonomous learning factor points factor, teaching methods, teaching process, curriculum design factor of factor and scale total score were (21. 47±1. 42),(17. 09±1. 19),(21. 44±1. 54), (22. 41±1. 37),(82. 41±2. 90) respectively, modified group of autonomous learning factor points factor, teaching methods, teaching process, curriculum design factor of factor and scale total score were ( 21. 83 ± 1. 50) , ( 17. 69 ± 1. 56 ) , ( 22. 25 ± 1. 75 ) , ( 22. 92 ± 1. 96 ) , ( 84. 69 ± 3. 85 ) respectively. TSSP group of autonomous learning factor points factor, teaching methods, teaching process, curriculum design factor of factor and scale total score were (23. 03±1. 62),(18. 25±1. 46),(23. 66±1. 21),(23. 41±2. 20),(88. 34± 3. 01) respectively, the three groups were statistically significant in the autonomous learning ( F=9. 57, P<0. 05), the teaching method (F=5. 56, P<0. 05), the teaching process (F=17. 73, P<0. 05) and total scores of scale ( F=26. 99, P<0. 05) . The TSSP group was superior to the modified group ( P<0. 05) in the comparison of scores of independent learning factors, teaching process factors and total scale scores. In terms of factors of independent learning, factors of teaching methods, factors of teaching process and total scores of the scale, TSSP group was superior to the classical group ( all P<0. 05) . In addition, in terms of teaching process factors and total scores of the scale, the modified group was superior to the classical group ( all P<0. 05) . Conclusions It is more effective to use "teachers simulate standardized patients" in anchorage teaching, which can be further popularized in psychiatric practice teaching.

目的:探讨改良式抛锚式教学在精神病学实习教学中的效果.方法:以中山大学临床医学专业5年制本科实习生为研究对象,随机分成两组,一组接受改良式抛锚式教学,另一组接收传统的实习教学,课后借助自编的课堂教学质量调查问卷对课堂教学效果进行学生评价.结果:实验组的量表总分以及在自主学习与教学方法因子上的得分均明显优于对照组.结论:改良式抛锚式教学在精神病学实习教学中的课堂教学效果要优于传统的实习教学.

目的:探索专家督导和Mini-CEX在临床见习带教中培养年轻教师的作用.方法:在专家督导下,采用Mini-CEX对年轻教师的临床见习授课进行评价,由学生在课后对年轻教师和副高级职称以上的教师进行授课效果评分.结果:6位年轻教师Mini-CEX评分7个项目均获7分以上,所需要的督导次数为3-6次.年轻教师和副高以上的教师在授课效果评分的得分上的差异无统计学意义.结论:通过专家督导和应用Mini-CEX,对提高年轻教师的临床见习教学能力有明显效果.

目的:编制一份适用于精神病学实习课堂教学质量评价的调查问卷.方法:基于既往文献以及精神病学实习的教学目标,形成36个条目的问卷初稿,以114名临床医学专业本科实习生为研究对象,采用相关系数法以及因子分析法进行条目筛选.结果:先后经过探索性以及验证性因素分析,最终得到由19个条目构成的4因子模型,各拟合常数分别为:CMIN/DF 2.542,CFI0.900,NFI0.847,IFI0.901,RM-SEA0.117,AIC497.194,BCC524.291,EVCI 4.400.结论:精神病学实习课堂教学质量评价调查问卷符合量表的编制要求.

Objective To study the changes of white matter in the first-episode medication-free patients with schizophrenia.MethodsDiffusion tensor image(DTI) brain scan was conducted in 40 first-episode medication-free patients with schizophrenia and 68 healthy controls.FSL software package was used to calculate fractional anisotropy(FA),mean diffusivity(MD),axial diffusivity(AD,L1) and radial diffusivity components(RD,L2 and L3).TBSS was used for voxelwise statistical analysis of the FA,MD,L1,L2 and L3 values.ResultsSignificant differences between the patient and control groups were found in the L3 map(P0.05,with FEW correction) including bilateral parts of the genu of the corpus callosum,bilateral anterior branches of the corona radiate,as well as left prefrontal projections of the corona radiate,left parts of the anterior thalamic radiation and discrete anterior portions of the left uncinate fasciculus.Conclusions There are white matter disconnections between the left and right cerebral hemisphere as well as between the frontal lobe and other encephalic regions.

Objective To investigate the neurocognitive functions in the healthy siblings of patients with schizophrenia.Methods Thirty healthy siblings of patients with schizophrenia and forty-three normal controls,collected in our hospital from October 2010 to April 2012,were assessed with five neurocognitive tests.These tests included Stroop Test,WAIS-Ⅲ Symbolic Coding,WAIS-Ⅲ Symbol Search,Paced Auditory Serial Addition Task (PASAT) and Wisconsin Card Sorting Tests (WCST).Results The results of some neurocognitive tests such as word of Stroop Test (P=0.016),word-color of Stroop Test (P=0.001),correct number of WAIS-Ⅲ symbol search (P=0.005),incorrect number of WAIS-Ⅲ symbol search (P=0.025),total score of WAIS-Ⅲ symbol search (P=0.041),correct number of WCST (P=0.015),randomly incorrect number of WCST (P=0.005) and completed grouping numbers of WCST (P=0.041) in the healthy siblings of patients with schizophrenia were significantly worse as compared with those in the normal controls.Conclusion The healthy siblings of patients with schizophrenia have general neurocognitive defects,such as executive function and information processing speed.

目的探讨位于锌指蛋白804A（zinc finger protein 804A,ZNF804A）内含子区内的多态位点rs1344706与精神分裂症的关系。方法提取来自广东省的250例精神分裂症患者和201名正常对照基因组DNA,通过聚合酶链反应扩增rs1344706位点前后250bp DNA片段,应用直接测序法确定rs1344706基因型,比较两组间以及按性别分层后两组间rs1344706的等位基因及基因型分布频率。结果患者组携带rs1344706位点C等位基因的频率高于对照组（52.0%vs.44.3%,P=0.025）,但两组间基因型分布差异无统计学意义（P=0.054）;按性别分层后进一步比较,rs1344706在患者组女性和对照组女性之间的C等位基因频率（55.3%vs.41.1%,P=0.007）及基因型分布（P=0.022）差异具有统计学意义,而患者组男性与对照组男性相比,C等位基因频率及基因型分布差异均无统计意义（均P＞0.05）。结论 ZNF804A rs1344706中的C等位基因是广东省汉族女性精神分裂症的风险因子,ZNF804Ars1344706多态性与精神分裂症存在关联。

OBJECTIVE:To detect the changes of cortical thickness and cortical surface area in untreated patients of first-episode schizophrenia.METHODS:Fifty-seven untreated patients of first-episode schizophrenia (SCZ) hospitalized from September 2009 to March 2012 at Department of Psychiatry, Third Affiliated Hospital, SUN Yat-sen University and 57 healthy controls (HC) recruited by advertising during the same period underwent a high resolution three-dimensional magnetic resonance imaging of brain structures. And cortical-surface based technique was used to analyze the cortical thickness and cortical surface area. The general linear model (GLM) was employed to detect the differences of cortical thickness and cortical surface area between two groups.RESULTS:were corrected for multiple comparisons by the Monte Carlo simulation method.RESULTS:As compared with HC, the cortical thickness of left superior frontal, left caudal middle cingulate, left lateral occipital, right superior frontal, right superior temporal and right fusiform regions in SCZ decreased by 6.0%, 7.2%, 8.2%, 5.2%, 7.1% and 6.0% respectively. And the largest reductions occurred in left lateral occipital regions. Cortical surface area of each brain regions in SCZ had no significant difference with HC.CONCLUSION:Cortical thickness reductions exist in multiple brain regions in schizophrenia. It may be the neuropathological mechanisms of schizophrenia.

Objective To explore the potential glycometabolism abnormality and the related factors of schizophrenia patients in China. Methods This cross-sectional study included 44 healthy controls（group 1） and 178 inpatient

Objective To investigate the abnormalities of free radical metabolism and oxidative stress in schizophrenic patients.Methods 208 inpatients with schizophrenia were evaluated using the Positive and Negative Syndrome Scale(PANSS),the Brief Psychiatric Rating Scale(BPRS)and Wechsler Adult Intelligence Scale(WAIS-RC).Serum levels of albumins,uric acid,bilirubin and γ-glutamyl transpeptadase were detected in both 208 schizophrenic patients and 84 normal controls.Results Serum levels of albumins,bilirubin and γ-glutamyl transpeptadase [(44.07±3.78)g/L,(11.57±6.84)μmol/L,(20.26±10.87)U/L]were markedly lower in patient group compared with normal controls(P<0.05).Serum uric acid levels was not significantly different between the patients with schizophenia and normal controls [(338.89±105.95)μmol/L,(319.60±98.82)μmol/L,P>0.05].Serum levels of uric acid,bilirubin and γ-glutamyl transpeptadase were significantly lower in female patients than those in male patients[(293.80±92.63)μmol/L,(10.01±4.85)μmol/L,(17.68±8.36)U/L,P<0.05].Serum levels of albumins,bilirubin and γ-glutamyl transpeptadase were significantly lower in female patients[(42.92±4.17)g/L,(10.01±4.85)μmol/L,(17.68±8.36)U/L]than those in female control(P<0.05),but serum uric acid levels [(293.80±92.63)μmol/L]was significantly higher than those in female control.The negative symptom subscore and total score of BPRS were negatively correlated with serum levels of albumins(r=-0.267,P=0.023,r=-0.243,P=0.043).The VIQ and PIQ were positively correlated with serum of levels of γ-glutamyl transpeptadase(r=0.388,P=0.001;r=0.348,P=0.004).Conclusions Female patients with schizophrenia have abnormal free radical metabolism and oxidative stress.The lower glutamic acid and oxidative stress may be involved in the pathology of schizophrenia by means of effect of cognitive function.

Objective To explore the changes of white matter integrity in first-episode medication-flee patients with schizophrenia. Methods Diffusion tensor images (DTI) of whole brains of 40 first-episode medication-flee patients with schizophrenia and 68 healthy controls were acquired with a single-shot echo planar imaging (EPI) sequence aligned to the straight axial plane. Two-sample t-test by with voxel-based analysis in SPM5 software was performed on the fractional anisotropy (FA)images of the 2 groups after being preprocessed with DTI-studio and SPM5 software.Results Subjects of schizophrenia showed reduced white matter FA in these regions: the right amygdale (MNI:24, 2, -14; cluster=347 voxels), bilateral anterior cingulate (MNI: 6, 42, 2; cluster=586 voxels), right orbitofrontal (MNI: 20, 18, -10; cluster=166 voxels) as compared with healthy controls. Conclusion Abnormal white matter in the corticolimbic system circuit exists in patients with schizophrenia, which maybe involve in the neural mechanism of schizophrenia.

[Objective]To investigate the changes of the gray matter volumes in patients with early-onset schizophrenia(EOS).[Methods] The subjects were 21 patients with EOS(the onset of psychotic symptoms occurred before 18 years of age) and 22 healthy controls(age,sex,and years of received education were no significantly different from those of patients).All the subjects underwent T1 weighted magnetic resonance imaging.After transformed with MRIcro software,all the images underwent standardization,segmentation,modulation,and smoothing with Statistical Parametric Mapping 5(SPM5) software.The gray matter volumes of the two groups underwent two-sample t-test with a Voxel-based morphometry(VBM) using SPM5 software.Symptoms were assessed using the Positive and Negative Syndrome Scale(PANSS).[Results] EOS patients presented significantly reduced GM volume in the right inferior frontal cortex(MNI:43,20,-14;cluster = 407 voxels),left superior frontal cortex(MNI:-28,-3,65;cluster = 176 voxels) and right superior frontal cortex(MNI:48,-10,54;cluster = 141voxels),compared with the healthy controls.[Conclusions] Volumes of gray matter in EOS were decreased in right inferior and bilateral superior frontal cortex.These abnormal changes may be involved in the neuropathology of schizophrenia.

Objective:To assess acute stress disoder(ASD) symptoms and study the optimal cutoff value of Stanford acute stress reaction questionnaire(SASRQ) among victims of earthquake in temporary settlements.Methods:Two hundred and twenty-three victims were randomly chosen and measured by SASRQ.Then data were analyzed according to symptom criteria of DSM-IV ASD,and the result of symptomatology analysis was taken as actual state variable of ROC curve and total score of SASRQ as the test variable.The point on ROC curve having the highest Youden Index was considered as the optimal cutoff value.Results:Sixteen cases(7.2%) of victims met symptom criteria of DSM-IV ASD among victims.There were 69 cases(30.9%)with dissociative symptoms,98 cases(44.0%)with re-experiencing trauma,70 cases(31.4%)with avoidance and 117cases(52.5%)with arousal or anxiety.Area under the curve(AUC) of ROC was 0.907±0.021(95%CI:0.865～0.939),P<0.01.The point of 40 had the highest Youden Index of 0.771,and had a sensitivity of 0.938 and specificity of 0.773.Conclusion:ASD symptoms are common among victims in temporary settlements still the second week after Wenchuan Earthquake,and 40 may be the optimal cutoff value of SASRQ for screening ASD symptoms.

Objective To investigate the changes of the brain structural connectivity in patients with early-onset schizophrenia (EOS, the onset of psychotic symptoms occurs before 18 years of age).Methods The subjects were 26 patients with EOS and 23 healthy controls (age, sex and years of received education were no significantly different from those of patients). Diffusion weighted images of the whole brains were acquired with a single-shot echo planar imaging (EPI) sequence aligned to the straight axial plane. After preprocessed with DTI-studio and Statistical Parametric Mapping-V (SPM5) software, the fractional anisotropy (FA) images of the two groups underwent two-sample t-test with the methods of voxel-based analysis (VBA) using SPM5 software package. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Results EOS patients had significantly reduced FA of white matter in the truncus corporis callosi (MNI: 3,16,23; cluser = 1003 voxels) , left temporal lobe (MNI:-28,28,30;cluser = 170 voxels) , left prefrontal lobe (MNI:-28,28,30; cluser = 99 voxels) and right prefrontal lobe (MNI:48,-10,54; cluser =81 voxels) , compared with the healthy controls. Conclusions There is structural disconnectivity of white matter in several brain regions. These abnormal changes may be involved in the neuropathology of schizophrenia. Key words: Schizophrenia; Brain; Diffusion magnetic resonance imaging; Voxel-based analysis; Structural connectivity

Concurrence of psychosis and Dandy–Walker complex (DWC) has been reported in some medical literature. Here, we reported four patients with concurrent psychosis and DWC of all four subtypes. Some clinical features found were juvenile or young adult age onset, high frequency of family history of psychosis, atypical psychotic symptoms, and high prevalence of cognitive deficit and refractoriness to treatment, in line with the cases in previous reports. These findings might help further illuminate the role that the cerebellum plays in the etiology of schizophrenia or bipolar disorder.

Objective To explore the changes of the white matter integrity in paranoid schizophrenia.Methods Diffusion weighted images of the 19 patients' with paranoid schizophrenia and 30 healthy controls'whole brains were acquired with a single-shot echo planar imaging ( EPI ) sequence aligned to the straight axial plane. After preprocessed with DTI-studio and SPM5 software, the fractional anisotropy (FA) images of the two groups were compared by two-sample t-test with SPM5 software. Results Subjects of paranoid schizophrenia demonstrated reduced FA in the right thalamus white matter(x = 18 ,y = - 10,z = 14,cluster = 194, t= -3.27, P=0.000 ) and demonstrated increased FA in the right insula white matter ( x = 34, y = -10, z = 12, cluster = 113, t =4.50, P = 0.004 ). Conclusion Schizophrenia has conflicting changes of white matter integrity in some brain areas.

Objective:To study the personality trait and psychological status of patients with ACL reconstruction.Methods:EPQ,SCL-90,HAMD and HAMA were performed in 42 patients with ACL reconstruction and 30 health subjects.Results:① N and P scores in EPQ in the patients with ACL reconstruction and healthy controls were 55±11 and 55±11,and 45±11 and 49±9,respectively.Significant differences were observed in N and P scores between the two groups(P0.05).② SCL-90 revealed that somatization,anxiety,depression,phobic anxiety,paranoid ideation and psychoticism were significantly more prominent in patients with ACL reconstruction(P0.05).③ Anxiety and depression were presented in 38(90%)and 36(86%) patients with ACL reconstruction,respectively.Conclusion:Unstable emotion,sensitiveness,suspiciousness,anxiety and depression are presented in patients with ACL reconstruction,thus providing psychological intervention in rehabilitation patients is necessary.