Adult male tree shrews vigorously defend against intruding male conspecifics. However, the characteristics of social behavior have not been entirely explored in these males. In this study, male wild-type tree shrews(T...Adult male tree shrews vigorously defend against intruding male conspecifics. However, the characteristics of social behavior have not been entirely explored in these males. In this study, male wild-type tree shrews(Tupaia belangeri chinensis)and C57 BL/6 J mice were first allowed to familiarize themselves with an open-field apparatus. The tree shrews exhibited a short duration of movement(moving) in the novel environment, whereas the mice exhibited a long duration of movement. In the 30 min social preference-avoidance test, target animals significantly decreased the time spent by the experimental tree shrews in the social interaction(SI)zone, whereas experimental male mice exhibited the opposite. In addition, experimental tree shrews displayed a significantly longer latency to enter the SI zone in the second 15 min session(targetpresent) than in the first 15 min session(targetabsent), which was different from that found in mice.Distinct behavioral patterns in response to a conspecific male were also observed in male tree shrews and mice in the first, second, and third 5 min periods. Thus, social behaviors in tree shrews and mice appeared to be time dependent. In summary,our study provides results of a modified social preference-avoidance test designed for the assessment of social behavior in tree shrews. Our findings demonstrate the existence of social avoidance behavior in male tree shrews and prosocial behavior in male mice toward unfamiliar conspecifics. The tree shrew may be a new animal model, which differs from mice, for the study of social avoidance and prosocial behaviors.展开更多
The striatum and globus pallidus are principal nuclei of the basal ganglia. Nissl-and acetylcholinesterasestained sections of the tree shrew brain showed the neuroanatomical features of the caudate nucleus（Cd）,inter...The striatum and globus pallidus are principal nuclei of the basal ganglia. Nissl-and acetylcholinesterasestained sections of the tree shrew brain showed the neuroanatomical features of the caudate nucleus（Cd）,internal capsule（ic）, putamen（Pu）, accumbens, internal globus pallidus, and external globus pallidus. The ic separated the dorsal striatum into the Cd and Pu in the tree shrew, but not in rats and mice. In addition, computerbased 3 D images allowed a better understanding of the position and orientation of these structures. These data provided a large-scale atlas of the striatum and globus pallidus in the coronal, sagittal, and horizontal planes, the first detailed distribution of parvalbumin-immunoreactive cells in the tree shrew, and the differences in morphological characteristics and density of parvalbumin-immunoreactive neurons between tree shrew and rat. Our findings support the tree shrew as a potential model for human striatal disorders.展开更多
The current study was designed to explore how disruption of specific molecular circuits in the cerebral cortex may cause sensorimotor cortico-striatal community structure deficits in both a mouse model and patients wi...The current study was designed to explore how disruption of specific molecular circuits in the cerebral cortex may cause sensorimotor cortico-striatal community structure deficits in both a mouse model and patients with schizophrenia.We used prepulse inhibition(PPI)and brain structural and diffusion MRI scans in 23 mice with conditional ErbB4 knockout in parvalbumin interneurons and 27 matched controls.Quantitative real-time PCR was used to assess the differential levels of GABA-related transcripts in brain regions.Concurrently,we measured structural and diffusion MRI and the cumulative contribution of risk alleles in the GABA pathway genes in firstepisode treatment-naı¨ve schizophrenic patients(n=117)and in age-and sex-matched healthy controls(n=86).We present the first evidence of gray and white matter impairment of right sensorimotor cortico-striatal networks and reproduced the sensorimotor gating deficit in a mouse model of schizophrenia.Significant correlations between gray matter volumes(GMVs)in the somatosensory cortex and PPI as well as glutamate decarboxylase 1 mRNA expression were found in controls but not in knockout mice.Furthermore,these findings were confirmed in a human sample in which we found significantly decreased gray and white matter in sensorimotor cortico-striatal networks in schizophrenic patients.The psychiatric risk alleles of the GABA pathway also displayed a significant negative correlation with the GMVs of the somatosensory cortex in patients.Our study identified that ErbB4 ablation in parvalbumin interneurons induced GABAergic dysregulation,providing valuable mechanistic insights into the sensorimotor cortico-striatal community structure deficits associated with schizophrenia.展开更多
Over the last decade the combination of brain neuroimaging techniques and graph theoretical analysis of the complex anatomical and functional networks in the brain have provided an exciting new platform for exploring ...Over the last decade the combination of brain neuroimaging techniques and graph theoretical analysis of the complex anatomical and functional networks in the brain have provided an exciting new platform for exploring the etiology of mental disorders such as schizophrenia. This review introduces the current status of this work, focusing on the topological properties of human brain networks - called 'small-world brain networks'- and on the disruptions in these networks in schizophrenia. The evidence supporting the findings of reduced efficiency of information exchange in schizophrenia both within local brain regions and globally throughout the brain is reviewed and the potential relationship of these changes to cognitive and clinical symptoms is discussed. Finally we propose some suggestions for future research.展开更多
Substantial evidence supports the neurodevelopmental hypothesis of schizophrenia.Meanwhile,progressive neurodegenerative processes have also been reported,leading to the hypothesis that neurodegeneration is a characte...Substantial evidence supports the neurodevelopmental hypothesis of schizophrenia.Meanwhile,progressive neurodegenerative processes have also been reported,leading to the hypothesis that neurodegeneration is a characteristic component in the neuropathology of schizophrenia.However,a major challenge for the neurodegenerative hypothesis is that antipsychotic drugs used by patients have profound impact on brain structures.To clarify this potential confounding factor,we measured the cortical thickness across the whole brain using highresolution T1-weighted magnetic resonance imaging in 145 first-episode and treatment-naive patients with schizophrenia and 147 healthy controls.The results showed that,in the patient group,the frontal,temporal,parietal,and cingulate gyri displayed a significant age-related reduction of cortical thickness.In the control group,age-related cortical thickness reduction was mostly located in the frontal,temporal,and cingulate gyri,albeit to a lesser extent.Importantly,relative to healthy controls,patients exhibited a significantly smaller age-related cortical thickness in the anterior cingulate,inferior temporal,and insular gyri in the right hemisphere.These results provide evidence supporting the existence of neurodegenerative processes in schizophrenia and suggest that these processes already occur in the early stage of the illness.展开更多
Schizophrenia is a severe and complex mental disorder 111.Neuroimaging offers a powerful window for identifying the brain biomarkers and investigating the neuropathological mechanisms of psychiatric disorders.A study ...Schizophrenia is a severe and complex mental disorder 111.Neuroimaging offers a powerful window for identifying the brain biomarkers and investigating the neuropathological mechanisms of psychiatric disorders.A study led by Professors Jiang and Liu,published recently in Nature Medicine,developed a new neuroimaging biomarker to characterize striatal dysfunction based on a multi-site functional MRI dataset with>1000 individuals.They show that this biomarker can distinguish individuals with schizophrenia and predict the short-term effects of antipsychotic treatmem[2].展开更多
Ketamine, a rapid-acting antidepressant drug, has been used to treat major depressive disorder and bipolar disorder(BD). Recent studies have shown that ketamine may increase the potential risk of treatment-induced man...Ketamine, a rapid-acting antidepressant drug, has been used to treat major depressive disorder and bipolar disorder(BD). Recent studies have shown that ketamine may increase the potential risk of treatment-induced mania in patients. Ketamine has also been applied to establish animal models of mania. At present, however, the underlying mechanism is still unclear. In the current study, we found that chronic lithium exposure attenuated ketamine-induced mania-like behavior and c-Fos expression in the medial prefrontal cortex(mPFC) of adult male mice. Transcriptome sequencing was performed to determine the effect of lithium administration on the transcriptome of the PFC in ketamine-treated mice, showing inactivation of the phosphoinositide 3-kinase(PI3K)-protein kinase B(AKT) signaling pathway. Pharmacological inhibition of AKT signaling by MK2206(40 mg/kg), a selective AKT inhibitor, reversed ketamine-induced mania.Furthermore, selective knockdown of AKT via AAVAKT-sh RNA-EGFP in the mPFC also reversed ketamine-induced mania-like behavior. Importantly,pharmacological activation of AKT signaling by SC79(40 mg/kg), an AKT activator, contributed to mania in low-dose ketamine-treated mice. Inhibition of PI3K signaling by LY294002(25 mg/kg), a specific PI3K inhibitor, reversed the mania-like behavior in ketamine-treated mice. However, pharmacological inhibition of mammalian target of rapamycin(mTOR)signaling with rapamycin(10 mg/kg), a specific mTOR inhibitor, had no effect on ketamine-induced mania-like behavior. These results suggest that chronic lithium treatment ameliorates ketamine-induced mania-like behavior via the PI3K-AKT signaling pathway, which may be a novel target for the development of BD treatment.展开更多
Acute administration of MK-801(dizocilpine),an N-methyl-D-aspartate receptor(NMDAR)antagonist,can establish animal models of psychiatric disorders.However,the roles of microglia and inflammation-related genes in these...Acute administration of MK-801(dizocilpine),an N-methyl-D-aspartate receptor(NMDAR)antagonist,can establish animal models of psychiatric disorders.However,the roles of microglia and inflammation-related genes in these animal models of psychiatric disorders remain unknown.Here,we found rapid elimination of microglia in the prefrontal cortex(PFC)and hippocampus(HPC)of mice following administration of the dual colony-stimulating factor 1 receptor(CSF1R)/c-Kit kinase inhibitor PLX3397(pexidartinib)in drinking water.Single administration of MK-801 induced hyperactivity in the open-field test(OFT).Importantly,PLX3397-induced depletion of microglia prevented the hyperactivity and schizophrenia-like behaviors induced by MK-801.However,neither repopulation of microglia nor inhibition of microglial activation by minocycline affected MK-801-induced hyperactivity.Importantly,microglial density in the PFC and HPC was significantly correlated with behavioral changes.In addition,common and distinct glutamate-,GABA-,and inflammation-related gene(116 genes)expression patterns were observed in the brains of PLX3397-and/or MK-801-treated mice.Moreover,10 common inflammation-related genes(CD68,CD163,CD206,TMEM119,CSF3R,CX3CR1,TREM2,CD11b,CSF1R,and F4/80)with very strong correlations were identified in the brain using hierarchical clustering analysis.Further correlation analysis demonstrated that the behavioral changes in the OFT were most significantly associated with the expression of inflammation-related genes(NLRP3,CD163,CD206,F4/80,TMEM119,and TMEM176a),but not glutamate-or GABA-related genes in PLX3397-and MK-801-treated mice.Thus,our results suggest that microglial depletion via a CSF1R/c-Kit kinase inhibitor can ameliorate the hyperactivity induced by an NMDAR antagonist,which is associated with modulation of immune-related genes in the brain.展开更多
Neuroinflammation plays a significant role in inducing depression-like behavior. Tetrahedral DNA nanostructures(TDNs) are molecules that exhibit anti-inflammatory properties and can effectively penetrate the blood-bra...Neuroinflammation plays a significant role in inducing depression-like behavior. Tetrahedral DNA nanostructures(TDNs) are molecules that exhibit anti-inflammatory properties and can effectively penetrate the blood-brain barrier. Thus, researchers have hypothesized that TDNs regulate the secretion of proinflammatory cytokines and consequently alleviate depression-like behavior. To test this hypothesis, we investigated the effect of TDNs on the depression-like behavior of C57 mice induced by lipopolysaccharide(LPS). We performed open-field, tail suspension, and sucrose preference tests on LPS-and LPS/TDNtreated mice. The results indicated that the injection of TDNs into LPS-treated mice resulted in increased velocity, center zone duration, frequency to the center zone, and sucrose preference, and decreased immobility time. Immunofluorescence results indicated that peripheral administration of LPS in the mice activated inflammation, which culminated in distinct depression-like behavior. However, TDNs effectively alleviated the inflammation and depression-like behavior through the reduction of the expression levels of proinflammatory cytokines, such as interleukin-1β and tumor necrosis factor-α in the brain. Additionally, TDNs normalized the expression level of microglia cell activation markers, such as ionized calcium binding adaptor molecule 1, in the hippocampus of mice. These results indicated that TDNs attenuated the LPS-induced secretion of inflammatory factors and consequently alleviated depression-like behavior.展开更多
The catechol-O-methyltransferase（COMT） gene is a schizophrenia susceptibility gene. A common functional polymorphism of this gene,Val158/158 Met,has been proposed to influence gray matter volume（GMV）. However,the ...The catechol-O-methyltransferase（COMT） gene is a schizophrenia susceptibility gene. A common functional polymorphism of this gene,Val158/158 Met,has been proposed to influence gray matter volume（GMV）. However,the effects of this polymorphism on cortical thickness/surface area in schizophrenic patients are less clear. In this study,we explored the relationship between the Val158 Met polymorphism of the COMT gene and the GMV/ cortical thickness/cortical surface area in 150 firstepisode treatment-nave patients with schizophrenia and 100 healthy controls. Main effects of diagnosis were found for GMV in the cerebellum and the visual,medial temporal,parietal,and middle frontal cortex. Patients with schizophrenia showed reduced GMVs in these regions. And main effects of genotype were detected for GMV in the left superior frontal gyrus. Moreover,a diagnosis × genotype interaction was found for the GMV of the left precuneus,and the effect of the COMT gene on GMV was due mainly to cortical thickness rather than cortical surface area. In addition,a pattern ofincreased GMV in the precuneus with increasing Met dose found in healthy controls was lost in patients with schizophrenia. These findings suggest that the COMTMet variant is associated with the disruption of dopaminergic influence on gray matter in schizophrenia,and the effect of the COMT gene on GMV in schizophrenia is mainly due to changes in cortical thickness rather than in cortical surface area.展开更多
It is well established that complex networks are responsible for the high-level information processing in the human brain.The topology of complex networks allows efficient dynamic interactions between spatially distin...It is well established that complex networks are responsible for the high-level information processing in the human brain.The topology of complex networks allows efficient dynamic interactions between spatially distinct brain areas,which may be studied by analyzing the topological展开更多
Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatme...Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatment for the psychotic symptoms of schizophrenia[3].Because of the severe sideeffects of first-generation antipsychotics(FGAs),secondgeneration antipsychotics(SGAs)have become more widely used in the treatment of schizophrenia.展开更多
BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspe...BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.展开更多
Dear Editor,A few studies have focused on exploring APOE gene- related effects on cognitive functions and brain activities in healthy populations. Bondi et aL found that ε4 carriers perform significantly worse on the...Dear Editor,A few studies have focused on exploring APOE gene- related effects on cognitive functions and brain activities in healthy populations. Bondi et aL found that ε4 carriers perform significantly worse on the California Verbal Learning Test than non-carriers in non-demented old subjects （mean age, 72 years）ε11. But the results are not entirely consistent. For example, Scarmeas et aL found no effect of the E4 allele on neuropsychological performance[2] in young adults, and Jochemsen et al. found that the ε4 allele is associated with age-related cognitive decline[3]. Furthermore, protective and negative effects of the E2 allele on cognition are inconsistent[4＇ s]. APOE E2 is thought to be a protective allele for AD in the elderly population due to its role in the superior cognitive performance of ε2 carriers compared to E3 or E4 carriers[5]. However, the ε2 allele has also been found to have a negative effect on AD pathology[4].展开更多
Background Elevated platelet count(PLTc)is associated with first-episode schizophrenia and adverse outcomes in individuals with precursory psychosis.However,the impact of antipsychotic medications on PLTc and its asso...Background Elevated platelet count(PLTc)is associated with first-episode schizophrenia and adverse outcomes in individuals with precursory psychosis.However,the impact of antipsychotic medications on PLTc and its association with symptom improvement remain unclear.Aims We aimed to investigate changes in PLTc levels following antipsychotic treatment and assess whether PLTc can predict antipsychotic responses and metabolic changes after accounting for other related variables.Methods A total of 2985 patients with schizophrenia were randomised into seven groups.Each group received one of seven antipsychotic treatments and was assessed at 2,4 and 6 weeks.Clinical symptoms were evaluated using the positive and negative syndrome scale(PANSS).Additionally,we measured blood cell counts and metabolic parameters,such as blood lipids.Repeated measures analysis of variance was used to examine the effect of antipsychotics on PLTc changes,while structural equation modelling was used to assess the predictive value of PLTc on PANSS changes.Results PLTc significantly increased in patients treated with aripiprazole(F=6.00,p=0.003),ziprasidone(F=7.10,p<0.001)and haloperidol(F=3.59,p=0.029).It exhibited a positive association with white blood cell count and metabolic indicators.Higher baseline PLTc was observed in non-responders,particularly in those defined by the PANSS-negative subscale.In the structural equation model,PLTc,white blood cell count and a latent metabolic variable predicted the rate of change in the PANSS-negative subscale scores.Moreover,higher baseline PLTc was observed in individuals with less metabolic change,although this association was no longer significant after accounting for baseline metabolic values.Conclusions Platelet parameters,specifically PLTc,are influenced by antipsychotic treatment and could potentially elevate the risk of venous thromboembolism in patients with schizophrenia.Elevated PLTc levels and associated factors may impede symptom improvement by promoting inflammation.Given PLTc’s easy measurement and clinical relevance,it warrants increased attention from psychiatrists.Trial registration number ChiCTR-TRC-10000934.展开更多
The tree shrew(Tupaia belangeri)has long been proposed as a suitable alternative to non-human primates(NHPs)in biomedical and laboratory research due to its close evolutionary relationship with primates.In recent year...The tree shrew(Tupaia belangeri)has long been proposed as a suitable alternative to non-human primates(NHPs)in biomedical and laboratory research due to its close evolutionary relationship with primates.In recent years,significant advances have facilitated tree shrew studies,including the determination of the tree shrew genome,genetic manipulation using spermatogonial stem cells,viral vector-mediated gene delivery,and mapping of the tree shrew brain atlas.However,the limited availability of tree shrews globally remains a substantial challenge in the field.Additionally,determining the key questions best answered using tree shrews constitutes another difficulty.Tree shrew models have historically been used to study hepatitis B virus(HBV)and hepatitis C virus(HCV)infection,myopia,and psychosocial stress-induced depression,with more recent studies focusing on developing animal models for infectious and neurodegenerative diseases.Despite these efforts,the impact of tree shrew models has not yet matched that of rodent or NHP models in biomedical research.This review summarizes the prominent advancements in tree shrew research and reflects on the key biological questions addressed using this model.We emphasize that intensive dedication and robust international collaboration are essential for achieving breakthroughs in tree shrew studies.The use of tree shrews as a unique resource is expected to gain considerable attention with the application of advanced techniques and the development of viable animal models,meeting the increasing demands of life science and biomedical research.展开更多
DearEditor,Schizophrenia(SCZ),bipolar disorder(BD),and major depressive disorder(MDD)are common psychiatric disorders that share several characteristics such as risk genes,and cognitive,neural,and structural abnormali...DearEditor,Schizophrenia(SCZ),bipolar disorder(BD),and major depressive disorder(MDD)are common psychiatric disorders that share several characteristics such as risk genes,and cognitive,neural,and structural abnormalities[1-3].Despite this,the boundaries between the three disorders are not clearly defined in clinical practice,and the"crosscutting"dimensional assessment of symptoms and clinical phenomena is controversial[2,4].To improve the classification criteria,it is essential to explore the underlying relationships among these disorders and address the fuzzy divergence that exists.展开更多
Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.P...Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.Previous studies with limited sample sizes have examined the effectiveness of specific treatments(e.g.,antidepressants)rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients.To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals,this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay(LOS)and rate of long LOS(LLOS,i.e.,LOS>30 days)in a large sample of non-psychiatric inpatients.Methods:This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital.They were divided,according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index(HEI)for brief screening with grading psychological services(BS-GPS),into BS-GPS(n=178,883)and non-BS-GPS(n=308,988)cohorts.The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression(CSAD,i.e.,HEI score≥11 on admission to the hospital)in the BS-GPS cohort were compared using univariable analyses,multilevel analyses,and/or propensity score-matched analyses,respectively.Results:The detection rate of CSAD in the BS-GPS cohort varied from 2.64%(95%confidence interval[CI]:2.49%-2.81%)to 20.50%(95%CI:19.43%-21.62%)across the 20 departments,with a average rate of 5.36%.Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD(12.7 days,535/9590)and without CSAD(9.5 days,3800/169,293)and between the BS-GPS(9.6 days,4335/178,883)and non-BS-GPS(10.8 days,11,483/308,988)cohorts.These differences remained significant after controlling for confounders using propensity score-matched comparisons.A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.Conclusion:Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals.These impacts were moderated by the implementation of BS-GPS.Thus,BS-GPS has the potential as an effective,resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.展开更多
Background Major depressive disorder is a major cause of disability and health-related burden globally.Repetitive transcranial magnetic stimulation(rTMS)has emerged as a promising alternative therapy for major depress...Background Major depressive disorder is a major cause of disability and health-related burden globally.Repetitive transcranial magnetic stimulation(rTMS)has emerged as a promising alternative therapy for major depressive disorder in adults,but its efficacy and safety in 10–25 years(youth)with depression remains inconclusive.We aim to evaluate the efficacy and safety of rTMS in youth with depression in randomized sham-controlled trials.Methods A comprehensive search of nine databases was conducted from inception to April 30,2025.Trials using random assignment with a sham control group were selected.Heterogeneity among studies was assessed using the I2 and Cochran Q test.A random-effects model was employed when I2>50%.Standard mean deviation(SMD)for depression rating scale scores and risk difference(RD)with corresponding 95%confidence intervals(CIs)of adverse event were used to evaluate efficacy and safety,respectively.Results Sixteen studies with 1295 patients aged 10–25 years were included.Meta-analysis showed that active rTMS significantly reduced depression scale scores(SMD=–0.93,95%CI=–1.31 to–0.55).Subgroup analysis revealed significant relief of depressive symptoms at the second week(SMD=–0.66,95%CI=–1.25 to–0.07)and persisting at the fourth week(SMD=–1.28,95%CI=–1.82 to–0.75)when compared to sham stimulation.Pooled RR was 1.24(95%CI=1.06–1.45)for response rate and 1.63(95%CI=1.11–2.39)for remission rate(with an associated number needed to treat of 10).Conclusions Evidence indicates that rTMS is effective,safe and exhibits a relatively rapid onset of action for treating youth depression.Larger-scale studies with longer treatment durations and extended follow-up periods are essential to understand and characterize the short-and long-term neuromodulatory effects within this vulnerable population.The effect of rTMS in treatment-resistant depression and its use across diverse populations also need further investigation.展开更多
基金the National Natural Science Foundation of China(81671344,31500859)Major International(Regional)Joint Research Project of the National Natural Science Foundation of China(81920108018)+1 种基金1.3.5 Project for Disciplines of Excellence,Special Foundation for Brain Research from the Science and Technology Program of Guangdong(2018B030334001)West China Hospital of Sichuan University(ZY2016103,ZY2016203)。
文摘Adult male tree shrews vigorously defend against intruding male conspecifics. However, the characteristics of social behavior have not been entirely explored in these males. In this study, male wild-type tree shrews(Tupaia belangeri chinensis)and C57 BL/6 J mice were first allowed to familiarize themselves with an open-field apparatus. The tree shrews exhibited a short duration of movement(moving) in the novel environment, whereas the mice exhibited a long duration of movement. In the 30 min social preference-avoidance test, target animals significantly decreased the time spent by the experimental tree shrews in the social interaction(SI)zone, whereas experimental male mice exhibited the opposite. In addition, experimental tree shrews displayed a significantly longer latency to enter the SI zone in the second 15 min session(targetpresent) than in the first 15 min session(targetabsent), which was different from that found in mice.Distinct behavioral patterns in response to a conspecific male were also observed in male tree shrews and mice in the first, second, and third 5 min periods. Thus, social behaviors in tree shrews and mice appeared to be time dependent. In summary,our study provides results of a modified social preference-avoidance test designed for the assessment of social behavior in tree shrews. Our findings demonstrate the existence of social avoidance behavior in male tree shrews and prosocial behavior in male mice toward unfamiliar conspecifics. The tree shrew may be a new animal model, which differs from mice, for the study of social avoidance and prosocial behaviors.
基金supported by the National Natural Science Foundation of China (31500859 and 91432305)the Strategic Priority Research Program of the Chinese Academy of Science (XDB02030001)
文摘The striatum and globus pallidus are principal nuclei of the basal ganglia. Nissl-and acetylcholinesterasestained sections of the tree shrew brain showed the neuroanatomical features of the caudate nucleus（Cd）,internal capsule（ic）, putamen（Pu）, accumbens, internal globus pallidus, and external globus pallidus. The ic separated the dorsal striatum into the Cd and Pu in the tree shrew, but not in rats and mice. In addition, computerbased 3 D images allowed a better understanding of the position and orientation of these structures. These data provided a large-scale atlas of the striatum and globus pallidus in the coronal, sagittal, and horizontal planes, the first detailed distribution of parvalbumin-immunoreactive cells in the tree shrew, and the differences in morphological characteristics and density of parvalbumin-immunoreactive neurons between tree shrew and rat. Our findings support the tree shrew as a potential model for human striatal disorders.
基金supported by the National Natural Science Foundation of China(81630030,81130024,and 81528008)the National Natural Science Foundation of China/Research Grants Council of Hong Kong Joint Research Scheme(81461168029)+2 种基金the National Basic Research Development Program of China(2016YFC0904300)the Science and Technology Project of the Health Planning Committee of Sichuan(19PJ090)the National Natural Science Foundation of China for Distinguished Young Scholars(81501159).
文摘The current study was designed to explore how disruption of specific molecular circuits in the cerebral cortex may cause sensorimotor cortico-striatal community structure deficits in both a mouse model and patients with schizophrenia.We used prepulse inhibition(PPI)and brain structural and diffusion MRI scans in 23 mice with conditional ErbB4 knockout in parvalbumin interneurons and 27 matched controls.Quantitative real-time PCR was used to assess the differential levels of GABA-related transcripts in brain regions.Concurrently,we measured structural and diffusion MRI and the cumulative contribution of risk alleles in the GABA pathway genes in firstepisode treatment-naı¨ve schizophrenic patients(n=117)and in age-and sex-matched healthy controls(n=86).We present the first evidence of gray and white matter impairment of right sensorimotor cortico-striatal networks and reproduced the sensorimotor gating deficit in a mouse model of schizophrenia.Significant correlations between gray matter volumes(GMVs)in the somatosensory cortex and PPI as well as glutamate decarboxylase 1 mRNA expression were found in controls but not in knockout mice.Furthermore,these findings were confirmed in a human sample in which we found significantly decreased gray and white matter in sensorimotor cortico-striatal networks in schizophrenic patients.The psychiatric risk alleles of the GABA pathway also displayed a significant negative correlation with the GMVs of the somatosensory cortex in patients.Our study identified that ErbB4 ablation in parvalbumin interneurons induced GABAergic dysregulation,providing valuable mechanistic insights into the sensorimotor cortico-striatal community structure deficits associated with schizophrenia.
基金partly supported by National Natural Science Foundation of China (81130024, 30530300 and 30125014, TL)the National Basic Research Program of China (973 Program 2007CB512301, TL)+1 种基金the PhD Programs Foundation of the Ministry of Education of China (20110181110014, TL)National Key Technology R & D Program of the Ministry of Science and Technology of China during the 12th Five-Year Plan (2011BAZ02530, TL)
文摘Over the last decade the combination of brain neuroimaging techniques and graph theoretical analysis of the complex anatomical and functional networks in the brain have provided an exciting new platform for exploring the etiology of mental disorders such as schizophrenia. This review introduces the current status of this work, focusing on the topological properties of human brain networks - called 'small-world brain networks'- and on the disruptions in these networks in schizophrenia. The evidence supporting the findings of reduced efficiency of information exchange in schizophrenia both within local brain regions and globally throughout the brain is reviewed and the potential relationship of these changes to cognitive and clinical symptoms is discussed. Finally we propose some suggestions for future research.
基金supported by the National Basic Research Development Program of China (2016YFC0904300)National Natural Science Foundation of China (81630030, 81130024 and 81528008)+1 种基金the National Natural Science Foundation of China/Research Grants Council of Hong Kong Joint Research Scheme (81461168029)the ‘‘135’’ Project for Disciplines of Excellence, West China Hospital of Sichuan University, China (ZY2016103 and ZY2016203)
文摘Substantial evidence supports the neurodevelopmental hypothesis of schizophrenia.Meanwhile,progressive neurodegenerative processes have also been reported,leading to the hypothesis that neurodegeneration is a characteristic component in the neuropathology of schizophrenia.However,a major challenge for the neurodegenerative hypothesis is that antipsychotic drugs used by patients have profound impact on brain structures.To clarify this potential confounding factor,we measured the cortical thickness across the whole brain using highresolution T1-weighted magnetic resonance imaging in 145 first-episode and treatment-naive patients with schizophrenia and 147 healthy controls.The results showed that,in the patient group,the frontal,temporal,parietal,and cingulate gyri displayed a significant age-related reduction of cortical thickness.In the control group,age-related cortical thickness reduction was mostly located in the frontal,temporal,and cingulate gyri,albeit to a lesser extent.Importantly,relative to healthy controls,patients exhibited a significantly smaller age-related cortical thickness in the anterior cingulate,inferior temporal,and insular gyri in the right hemisphere.These results provide evidence supporting the existence of neurodegenerative processes in schizophrenia and suggest that these processes already occur in the early stage of the illness.
基金This highlight article was supported by the National Natural Science Foundation of China(81630030,81920108018,and 81801326)the 1.3.5 Project for Disciplines of Excellence,West China Hospital of Sichuan University(ZY2016103,ZY2016203,and ZYGD20004).
文摘Schizophrenia is a severe and complex mental disorder 111.Neuroimaging offers a powerful window for identifying the brain biomarkers and investigating the neuropathological mechanisms of psychiatric disorders.A study led by Professors Jiang and Liu,published recently in Nature Medicine,developed a new neuroimaging biomarker to characterize striatal dysfunction based on a multi-site functional MRI dataset with>1000 individuals.They show that this biomarker can distinguish individuals with schizophrenia and predict the short-term effects of antipsychotic treatmem[2].
基金supported by the Key Project of the National Natural Science Foundation of China(81920108018 to T.L.and P.S.)Ministry of Science and Technology of the People’s Republic of China(2022ZD0205200)+4 种基金Natural Science Foundation of Sichuan Province(2022NSFSC1607)Key R&D Program of Zhejiang(2022C03096 to T.L.)Special Foundation for Brain Research from Science and Technology Program of Guangdong(2018B030334001)Project for Hangzhou Medical Disciplines of Excellence&Key Project for Hangzhou Medical Disciplines。
文摘Ketamine, a rapid-acting antidepressant drug, has been used to treat major depressive disorder and bipolar disorder(BD). Recent studies have shown that ketamine may increase the potential risk of treatment-induced mania in patients. Ketamine has also been applied to establish animal models of mania. At present, however, the underlying mechanism is still unclear. In the current study, we found that chronic lithium exposure attenuated ketamine-induced mania-like behavior and c-Fos expression in the medial prefrontal cortex(mPFC) of adult male mice. Transcriptome sequencing was performed to determine the effect of lithium administration on the transcriptome of the PFC in ketamine-treated mice, showing inactivation of the phosphoinositide 3-kinase(PI3K)-protein kinase B(AKT) signaling pathway. Pharmacological inhibition of AKT signaling by MK2206(40 mg/kg), a selective AKT inhibitor, reversed ketamine-induced mania.Furthermore, selective knockdown of AKT via AAVAKT-sh RNA-EGFP in the mPFC also reversed ketamine-induced mania-like behavior. Importantly,pharmacological activation of AKT signaling by SC79(40 mg/kg), an AKT activator, contributed to mania in low-dose ketamine-treated mice. Inhibition of PI3K signaling by LY294002(25 mg/kg), a specific PI3K inhibitor, reversed the mania-like behavior in ketamine-treated mice. However, pharmacological inhibition of mammalian target of rapamycin(mTOR)signaling with rapamycin(10 mg/kg), a specific mTOR inhibitor, had no effect on ketamine-induced mania-like behavior. These results suggest that chronic lithium treatment ameliorates ketamine-induced mania-like behavior via the PI3K-AKT signaling pathway, which may be a novel target for the development of BD treatment.
基金supported by the National Natural Science Foundation of China(81920108018,82230046,82001432)Ministry of Science and Technology of the People’s Republic of China(2022ZD0211700,2022ZD0205200)+5 种基金Natural Science Foundation of Sichuan Province(2022NSFSC1607)Key Research and Development Program of Science and Technology Department of Sichuan Province(22ZDYF1531,22ZDYF1696)Key R&D Program of Zhejiang(2022C03096)Special Foundation for Brain Research from Science and Technology Program of Guangdong(2018B030334001)China Postdoctoral Science Foundation(2020TQ0213,2020M683319)Sichuan University(2022SCUH0023)。
文摘Acute administration of MK-801(dizocilpine),an N-methyl-D-aspartate receptor(NMDAR)antagonist,can establish animal models of psychiatric disorders.However,the roles of microglia and inflammation-related genes in these animal models of psychiatric disorders remain unknown.Here,we found rapid elimination of microglia in the prefrontal cortex(PFC)and hippocampus(HPC)of mice following administration of the dual colony-stimulating factor 1 receptor(CSF1R)/c-Kit kinase inhibitor PLX3397(pexidartinib)in drinking water.Single administration of MK-801 induced hyperactivity in the open-field test(OFT).Importantly,PLX3397-induced depletion of microglia prevented the hyperactivity and schizophrenia-like behaviors induced by MK-801.However,neither repopulation of microglia nor inhibition of microglial activation by minocycline affected MK-801-induced hyperactivity.Importantly,microglial density in the PFC and HPC was significantly correlated with behavioral changes.In addition,common and distinct glutamate-,GABA-,and inflammation-related gene(116 genes)expression patterns were observed in the brains of PLX3397-and/or MK-801-treated mice.Moreover,10 common inflammation-related genes(CD68,CD163,CD206,TMEM119,CSF3R,CX3CR1,TREM2,CD11b,CSF1R,and F4/80)with very strong correlations were identified in the brain using hierarchical clustering analysis.Further correlation analysis demonstrated that the behavioral changes in the OFT were most significantly associated with the expression of inflammation-related genes(NLRP3,CD163,CD206,F4/80,TMEM119,and TMEM176a),but not glutamate-or GABA-related genes in PLX3397-and MK-801-treated mice.Thus,our results suggest that microglial depletion via a CSF1R/c-Kit kinase inhibitor can ameliorate the hyperactivity induced by an NMDAR antagonist,which is associated with modulation of immune-related genes in the brain.
基金supported by the National Key R&D Program of China (No. 2019YFA0110600)the National Natural Science Foundation of China (Nos. 82001432, 81970916)+1 种基金the China Postdoctoral Science Foundation (Nos. 2020TQ0213, 2020M683319)the West China Hospital Postdoctoral Science Foundation (No.2020HXBH104)。
文摘Neuroinflammation plays a significant role in inducing depression-like behavior. Tetrahedral DNA nanostructures(TDNs) are molecules that exhibit anti-inflammatory properties and can effectively penetrate the blood-brain barrier. Thus, researchers have hypothesized that TDNs regulate the secretion of proinflammatory cytokines and consequently alleviate depression-like behavior. To test this hypothesis, we investigated the effect of TDNs on the depression-like behavior of C57 mice induced by lipopolysaccharide(LPS). We performed open-field, tail suspension, and sucrose preference tests on LPS-and LPS/TDNtreated mice. The results indicated that the injection of TDNs into LPS-treated mice resulted in increased velocity, center zone duration, frequency to the center zone, and sucrose preference, and decreased immobility time. Immunofluorescence results indicated that peripheral administration of LPS in the mice activated inflammation, which culminated in distinct depression-like behavior. However, TDNs effectively alleviated the inflammation and depression-like behavior through the reduction of the expression levels of proinflammatory cytokines, such as interleukin-1β and tumor necrosis factor-α in the brain. Additionally, TDNs normalized the expression level of microglia cell activation markers, such as ionized calcium binding adaptor molecule 1, in the hippocampus of mice. These results indicated that TDNs attenuated the LPS-induced secretion of inflammatory factors and consequently alleviated depression-like behavior.
基金supported by the National Nature Science Foundation of China (81130024,30530300,and 30125014)the National Key Technology R&D Program of the Ministry of Science and Technology of China during the 12th Five-Year Plan (2012BAI01B06)+1 种基金the Ph.D. Program Foundation of the Ministry of Education of China (20110181110014)the National Basic Research Development Program(973 Program) of China (2007CB512301)
文摘The catechol-O-methyltransferase（COMT） gene is a schizophrenia susceptibility gene. A common functional polymorphism of this gene,Val158/158 Met,has been proposed to influence gray matter volume（GMV）. However,the effects of this polymorphism on cortical thickness/surface area in schizophrenic patients are less clear. In this study,we explored the relationship between the Val158 Met polymorphism of the COMT gene and the GMV/ cortical thickness/cortical surface area in 150 firstepisode treatment-nave patients with schizophrenia and 100 healthy controls. Main effects of diagnosis were found for GMV in the cerebellum and the visual,medial temporal,parietal,and middle frontal cortex. Patients with schizophrenia showed reduced GMVs in these regions. And main effects of genotype were detected for GMV in the left superior frontal gyrus. Moreover,a diagnosis × genotype interaction was found for the GMV of the left precuneus,and the effect of the COMT gene on GMV was due mainly to cortical thickness rather than cortical surface area. In addition,a pattern ofincreased GMV in the precuneus with increasing Met dose found in healthy controls was lost in patients with schizophrenia. These findings suggest that the COMTMet variant is associated with the disruption of dopaminergic influence on gray matter in schizophrenia,and the effect of the COMT gene on GMV in schizophrenia is mainly due to changes in cortical thickness rather than in cortical surface area.
文摘It is well established that complex networks are responsible for the high-level information processing in the human brain.The topology of complex networks allows efficient dynamic interactions between spatially distinct brain areas,which may be studied by analyzing the topological
基金supported by the National Basic Research Development Program (2016YFC0904300)the National Natural Science Foundation of China (81630030 and 81461168029)the 1.3.5 Project for Disciplines of Excellence of West China Hospital, Sichuan University (ZY2016103 and ZY2016203), China
文摘Dear Editor,Schizophrenia is a chronic and debilitating brain disorder,which has a strong genetic component with heritability ranging from 66%to 85%[1,2].Currently,antipsychotic drugs remain the most effective treatment for the psychotic symptoms of schizophrenia[3].Because of the severe sideeffects of first-generation antipsychotics(FGAs),secondgeneration antipsychotics(SGAs)have become more widely used in the treatment of schizophrenia.
基金Supported by 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZYJC21004.
文摘BACKGROUND Cyclic vomiting syndrome(CVS)is a chronic functional gastrointestinal disorder involving the gut–brain interaction that is characterized by recurring episodes of nausea,vomiting,abdominal pain,and interspersed complete normal periods.Superior mesenteric artery(SMA)syndrome(SMAS)is a vascular condition in which the horizontal portion of the duodenum is compressed due to a reduced angle between the aorta and the SMA.This condition presents with symptoms similar to CVS,posing challenges in distinguishing between the two and often resulting in misdiagnosis or inappropriate treatment.CASE SUMMARY A 20-year-old female patient presented with recurrent episodes of vomiting and experienced a persistent fear of vomiting for the past 2 years.She adopted conscious dietary restrictions,which led to severe malnutrition.Initially,she was diagnosed with SMAS,as revealed by computed tomography angiography.Despite efforts to increase the angle between the aorta and the SMA through weight gain,her vomiting did not improve.Finally,she was diagnosed with comorbidities including CVS,SMAS and anxiety disorder.She underwent comprehensive interventions,including enteral and parenteral nutritional supplementation,administration of antiemetic and anti-anxiety agents,and participation in mindfulness-based cognitive therapy.The patient eventually experienced a notable improvement in both body weight and clinical symptoms.CONCLUSION We present a rare case of CVS in an adult complicated with SMAS and propose additional treatment with nutritional support,pharmacological intervention,and psychotherapy.
基金supported by the National Natural Science Foundation of China (81130024)the National Key Technology R & D Program of the Ministry of Science and Technology of China during the 12th Five-Year Plan (2012BAI01B06)
文摘Dear Editor,A few studies have focused on exploring APOE gene- related effects on cognitive functions and brain activities in healthy populations. Bondi et aL found that ε4 carriers perform significantly worse on the California Verbal Learning Test than non-carriers in non-demented old subjects （mean age, 72 years）ε11. But the results are not entirely consistent. For example, Scarmeas et aL found no effect of the E4 allele on neuropsychological performance[2] in young adults, and Jochemsen et al. found that the ε4 allele is associated with age-related cognitive decline[3]. Furthermore, protective and negative effects of the E2 allele on cognition are inconsistent[4＇ s]. APOE E2 is thought to be a protective allele for AD in the elderly population due to its role in the superior cognitive performance of ε2 carriers compared to E3 or E4 carriers[5]. However, the ε2 allele has also been found to have a negative effect on AD pathology[4].
基金This work was partly supported by the National Natural Science Foundation of China(grant number 81920108018 to TL,82001409 to YZhang)the Key R&D Programme of Zhejiang(2022C03096 to TL)Project for Hangzhou Medical Disciplines of Excellence&Key Project for Hangzhou Medical Disciplines(grant number 202004A11 to TL).
文摘Background Elevated platelet count(PLTc)is associated with first-episode schizophrenia and adverse outcomes in individuals with precursory psychosis.However,the impact of antipsychotic medications on PLTc and its association with symptom improvement remain unclear.Aims We aimed to investigate changes in PLTc levels following antipsychotic treatment and assess whether PLTc can predict antipsychotic responses and metabolic changes after accounting for other related variables.Methods A total of 2985 patients with schizophrenia were randomised into seven groups.Each group received one of seven antipsychotic treatments and was assessed at 2,4 and 6 weeks.Clinical symptoms were evaluated using the positive and negative syndrome scale(PANSS).Additionally,we measured blood cell counts and metabolic parameters,such as blood lipids.Repeated measures analysis of variance was used to examine the effect of antipsychotics on PLTc changes,while structural equation modelling was used to assess the predictive value of PLTc on PANSS changes.Results PLTc significantly increased in patients treated with aripiprazole(F=6.00,p=0.003),ziprasidone(F=7.10,p<0.001)and haloperidol(F=3.59,p=0.029).It exhibited a positive association with white blood cell count and metabolic indicators.Higher baseline PLTc was observed in non-responders,particularly in those defined by the PANSS-negative subscale.In the structural equation model,PLTc,white blood cell count and a latent metabolic variable predicted the rate of change in the PANSS-negative subscale scores.Moreover,higher baseline PLTc was observed in individuals with less metabolic change,although this association was no longer significant after accounting for baseline metabolic values.Conclusions Platelet parameters,specifically PLTc,are influenced by antipsychotic treatment and could potentially elevate the risk of venous thromboembolism in patients with schizophrenia.Elevated PLTc levels and associated factors may impede symptom improvement by promoting inflammation.Given PLTc’s easy measurement and clinical relevance,it warrants increased attention from psychiatrists.Trial registration number ChiCTR-TRC-10000934.
基金supported by the STI2030-Major Projects(2021ZD0200900 to Y.G.Y.)"Light of West China" Program of the Chinese Academy of Sciences(xbzg-zdsys-202302 to Y.G.Y.)
文摘The tree shrew(Tupaia belangeri)has long been proposed as a suitable alternative to non-human primates(NHPs)in biomedical and laboratory research due to its close evolutionary relationship with primates.In recent years,significant advances have facilitated tree shrew studies,including the determination of the tree shrew genome,genetic manipulation using spermatogonial stem cells,viral vector-mediated gene delivery,and mapping of the tree shrew brain atlas.However,the limited availability of tree shrews globally remains a substantial challenge in the field.Additionally,determining the key questions best answered using tree shrews constitutes another difficulty.Tree shrew models have historically been used to study hepatitis B virus(HBV)and hepatitis C virus(HCV)infection,myopia,and psychosocial stress-induced depression,with more recent studies focusing on developing animal models for infectious and neurodegenerative diseases.Despite these efforts,the impact of tree shrew models has not yet matched that of rodent or NHP models in biomedical research.This review summarizes the prominent advancements in tree shrew research and reflects on the key biological questions addressed using this model.We emphasize that intensive dedication and robust international collaboration are essential for achieving breakthroughs in tree shrew studies.The use of tree shrews as a unique resource is expected to gain considerable attention with the application of advanced techniques and the development of viable animal models,meeting the increasing demands of life science and biomedical research.
基金supported by the National Natural Science Foundation of China(81920108018 and 82230046)the Key R&D Program of Zhejiang(2022C03096)+1 种基金the Special Foundation for Brain Research from Science and Technology Program of Guangdong(2018B030334001)Project for Hangzhou Medical Disciplines of Excellence&Key Project for Hangzhou Medical Disciplines(202004A11).
文摘DearEditor,Schizophrenia(SCZ),bipolar disorder(BD),and major depressive disorder(MDD)are common psychiatric disorders that share several characteristics such as risk genes,and cognitive,neural,and structural abnormalities[1-3].Despite this,the boundaries between the three disorders are not clearly defined in clinical practice,and the"crosscutting"dimensional assessment of symptoms and clinical phenomena is controversial[2,4].To improve the classification criteria,it is essential to explore the underlying relationships among these disorders and address the fuzzy divergence that exists.
基金This work was supported by a grant from the Department of Science and Technology, Sichuan, P.R. China This work was supported by a grant from the Department of Science and Technology, Sichuan, China. We would like to thank JIN Mei, LUO Dan, SANG Mu, WANG Mu, and Luo-sang-Jian-cai from Medical School of Tibet university for their assistance with the data collection.
基金funded by the National Natural Science Foundation of China Key Project(Nos.81630030 and 81920108018)the Special Foundation for Brain Research from Science and Technology Program of Guangdong(Nos.2018B030334001)+1 种基金the National Key Research&Development Program,Ministry of Science and Technology,China(Nos.2016YFC0904300)1.3.5 Project for Disciplines of Excellence,West China Hospital of Sichuan University(Nos.ZY2016103,ZY2016203,and ZYGD20004).
文摘Background:While emotional distress,encompassing anxiety and depression,has been associated with negative clinical outcomes,its impact across various clinical departments and general hospitals has been less explored.Previous studies with limited sample sizes have examined the effectiveness of specific treatments(e.g.,antidepressants)rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients.To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals,this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay(LOS)and rate of long LOS(LLOS,i.e.,LOS>30 days)in a large sample of non-psychiatric inpatients.Methods:This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital.They were divided,according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index(HEI)for brief screening with grading psychological services(BS-GPS),into BS-GPS(n=178,883)and non-BS-GPS(n=308,988)cohorts.The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression(CSAD,i.e.,HEI score≥11 on admission to the hospital)in the BS-GPS cohort were compared using univariable analyses,multilevel analyses,and/or propensity score-matched analyses,respectively.Results:The detection rate of CSAD in the BS-GPS cohort varied from 2.64%(95%confidence interval[CI]:2.49%-2.81%)to 20.50%(95%CI:19.43%-21.62%)across the 20 departments,with a average rate of 5.36%.Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD(12.7 days,535/9590)and without CSAD(9.5 days,3800/169,293)and between the BS-GPS(9.6 days,4335/178,883)and non-BS-GPS(10.8 days,11,483/308,988)cohorts.These differences remained significant after controlling for confounders using propensity score-matched comparisons.A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge.Conclusion:Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals.These impacts were moderated by the implementation of BS-GPS.Thus,BS-GPS has the potential as an effective,resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
基金funded by the Central Funds Guiding the Local Science and Technology Development of Sichuan Province(No.2023ZYD0123)to Author Yi HuangAuthor Yi Huang is also supported by the National Key Research and Development Program of China(No.2022ZD0209104)the Achievement Transformation Demonstration Project of Chengdu City(No.2022-YF09-00010-SN)and 1·3·5 Projects for Artificial Intelligence(No.ZYAI24057)at West China Hospital,Sichuan University.
文摘Background Major depressive disorder is a major cause of disability and health-related burden globally.Repetitive transcranial magnetic stimulation(rTMS)has emerged as a promising alternative therapy for major depressive disorder in adults,but its efficacy and safety in 10–25 years(youth)with depression remains inconclusive.We aim to evaluate the efficacy and safety of rTMS in youth with depression in randomized sham-controlled trials.Methods A comprehensive search of nine databases was conducted from inception to April 30,2025.Trials using random assignment with a sham control group were selected.Heterogeneity among studies was assessed using the I2 and Cochran Q test.A random-effects model was employed when I2>50%.Standard mean deviation(SMD)for depression rating scale scores and risk difference(RD)with corresponding 95%confidence intervals(CIs)of adverse event were used to evaluate efficacy and safety,respectively.Results Sixteen studies with 1295 patients aged 10–25 years were included.Meta-analysis showed that active rTMS significantly reduced depression scale scores(SMD=–0.93,95%CI=–1.31 to–0.55).Subgroup analysis revealed significant relief of depressive symptoms at the second week(SMD=–0.66,95%CI=–1.25 to–0.07)and persisting at the fourth week(SMD=–1.28,95%CI=–1.82 to–0.75)when compared to sham stimulation.Pooled RR was 1.24(95%CI=1.06–1.45)for response rate and 1.63(95%CI=1.11–2.39)for remission rate(with an associated number needed to treat of 10).Conclusions Evidence indicates that rTMS is effective,safe and exhibits a relatively rapid onset of action for treating youth depression.Larger-scale studies with longer treatment durations and extended follow-up periods are essential to understand and characterize the short-and long-term neuromodulatory effects within this vulnerable population.The effect of rTMS in treatment-resistant depression and its use across diverse populations also need further investigation.
