The potential shortage of psychiatrists over the next 5 - 10 years has focused attention on the need to recruit more IMGs to fill the needs rather than use nurse practitioners or physician assistants. IMGs make up abo...The potential shortage of psychiatrists over the next 5 - 10 years has focused attention on the need to recruit more IMGs to fill the needs rather than use nurse practitioners or physician assistants. IMGs make up about 1/3 of first year psychiatry residents. These individuals have been found to provide services to the poor, the elderly and the psychotic. The quality of their medical work has been found to be satisfactory. The training needs of these physicians require an understanding on the part of their teachers that they come from cultures with different values that we have. The extended families of these primarily Asian residents clash with our strong commitment to individualism. It leads to a We-self rather than our I-Self. This difference coupled with the stress of leaving to come to a new culture is a great stress. Their exposure to psychiatry has been limited. They request and need more interview demonstration and practice, ore feedback and examinations. They should have help in accent reduction. They should be exposed to the working of the hospital by sitting on departmental and hospital committees. The faculty should extend their social opportunities and work as mentors on joint projects. Courses on the history of American culture should be taught. Psychotherapy for them should be encouraged as well as teaching medical ethics. They must become the major educational concern for the department that they are in.展开更多
Backgrounds: Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to answer...Backgrounds: Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to answer the question what are the problems that are likely to bring a child or an adolescent for the admission in the child and adolescent psychiatry Unit. Methods: The case records of all inpatient children and adolescents younger than 18 years, who were admitted to the child psychiatric unit at SQUH, Muscat, Sultanate of Oman over a period of 10 years between Jan 2007 and Dec 2017, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. Result: A total of 255 cases were admitted in child psychiatry unit in a period of 10 yrs, the average age was 14.15 years, 95% patients were Omani nationals, 47.5% were male, 52.5 were females, 17.65% Acute and transient psychotic disorder, 13.7% bipolar affective disorder, current episode manic without psychotic symptoms, 12.94% Intentional self-harm by other specified means and 12.55% schizophrenia, were the most common diagnoses observed in this population who needed inpatient care;the average length of stay in the majority of cases was less than 3 weeks. Conclusion: The child and adolescent inpatient unit of SQUH from where the data was collected happens to be the only child psychiatric admitting unit in Oman till the end of 2017 and can be considered as representative;the children and adolescence in-patient unit exemplifies a short-term care set-up.展开更多
Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by ...Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.展开更多
This letter provides a concise review of the pertinent literature on visual and tactile hallucinations in elderly patients.The discussion addresses differential diagnoses and potential underlying mechanisms,as well as...This letter provides a concise review of the pertinent literature on visual and tactile hallucinations in elderly patients.The discussion addresses differential diagnoses and potential underlying mechanisms,as well as the psychopathology associated with tactile hallucinations,and emphasizes the necessity for invest-igation into the possibility of coexisting delusional infestation(parasitosis).These symptoms frequently manifest in patients with primary psychotic disorders,organic mental disorders,and substance use disorders.The proposed pathophy-siological mechanisms may involve dopaminergic imbalances and dysfunction of the striatal dopamine transporter.展开更多
Podophyllotoxin is a well-studied natural product.Because of its unique structure and ability to inhibit cancer cells,it has been changed in different ways to find out its pharmacological properties.This paper discuss...Podophyllotoxin is a well-studied natural product.Because of its unique structure and ability to inhibit cancer cells,it has been changed in different ways to find out its pharmacological properties.This paper discusses the common chemical modifications of podophyllotoxin molecules,including the C-4 and E-4 site replacements.Furthermore,its common inhibitory effects on cancer cells and antiparasitic activities,among others,are outlined by the connection between conformational changes and pharmacological activities.Importantly,Podophyllotoxin can effectively overcome the phenomenon of multidrug resistance through a dual-targeting mechanism,including inhibition of microtubule protein synthesis and topoisomerase II activity,and induces cell cycle arrest and apoptosis.Recent findings reveal its potential to modulate immune responses through the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)pathway,further extending beyond its classical mechanisms.This study finally provides a systematic summary of the activity ofpodophyllotoxin in common cancer cells,including those in the breast,lung,and prostate.展开更多
Following an acute stroke,patients often encounter a range of impairments affecting their physical,cognitive,verbal,and social capabilities.Poststroke depression(PSD)has been identified as a significant consequence of...Following an acute stroke,patients often encounter a range of impairments affecting their physical,cognitive,verbal,and social capabilities.Poststroke depression(PSD)has been identified as a significant consequence of stroke and serves as a crucial predictor of patient outcomes.The diagnosis of PSD presents a challenge,as the physical manifestations following a stroke can overlap with certain depressive symptoms,leading to a potential underdiagnosis of this condition.This review employs a narrative approach to synthesize diverse findings within this domain.PSD is categorized as an organic mood disorder,and a more accurate diagnosis may be achieved by considering the location of the stroke,the patient's specific symptoms,and the timeline of depressive symptom onset.Notably,if depressive symptoms emerge at more than one year poststroke,the likelihood of PSD diminishes.The etiology of PSD is currently understood to stem from a combination of physiological and psychosocial factors,as well as their interactions.Several mechanisms associated with PSD have been identified,including inflammation,dysregulation of the hypothalamic-pituitary-adrenal axis,oxidative stress,autophagy,apoptosis,abnormal neurotrophic responses,glutamate-mediated excitotoxicity,dysfunction within brain networks,reduced monoamine levels,locations of brain lesions,and psychosocial influences.This review also outlines potential directions for future research.展开更多
BACKGROUND Nervonic acid(NA,C24:1,w9)is a monounsaturated fatty acid that plays a crucial role in myelination and motor function.It also regulates cognitive and metabolic functions,suggesting that impaired NA metaboli...BACKGROUND Nervonic acid(NA,C24:1,w9)is a monounsaturated fatty acid that plays a crucial role in myelination and motor function.It also regulates cognitive and metabolic functions,suggesting that impaired NA metabolism may contribute to the pathophysiology of schizophrenia.Although several studies have measured erythrocyte membrane NA in first-episode psychosis(FEP),findings are conflicting,and the fate of NA in patients with chronic schizophrenia(CSZ)or under long-term antipsychotic treatment schedules remains unknown.AIM To measure erythrocyte membrane NA and determine its association with psychopathology and metabolic parameters in drug-naive patients with FEP and antipsychotic-treated patients with CSZ.METHODS In this study,twenty-one drug-naive patients with FEP,twenty patients with CSZ treated with atypical antipsychotics,and fourteen healthy male subjects were analyzed.Erythrocyte membrane NA was measured using ultrathin capillary gas chromatography,plasma leptin was measured using enzyme-linked immunosorbent assay,and body mass index(BMI)was calculated by using the formula:Weight(kg)/height(m^(2)).Psychiatric symptoms were evaluated using the brief psychiatry rating scale and the positive and negative syndrome scale(PANSS).Pearson correlation coefficient(r)was computed to find the association between erythrocyte membrane NA,PANSS scores,plasma leptin,and BMI.RESULTS In patients with FEP,erythrocyte NA was non-significantly increased(about 12%)and negatively correlated with negative symptoms(PANSS-negative symptom scores,r=-0.4323,P=0.023)but not with positive symptoms(PANSS-positive symptom scores,r=-0.2915,P=0.09).In patients with CSZ,erythrocyte NA was reduced considerably(about 40%,P<0.001 vs FEP and about 30%vs control(CNT)subjects,P=0.037)and negatively correlated with both PANSS-negative symptom scores(r=-0.4562,P=0.013)and PANSS-positive symptom scores(r=-0.3911,P=0.041).Additionally,in patients with FEP,erythrocyte NA was not significantly correlated either with BMI(r=-0.2532,P=0.231)or plasma leptin(r=-0.3001,P=0.102).However,in patients with CSZ,it did negatively correlate with both BMI(r=-0.4721,P=0.029)and plasma leptin(r=-0.4701,P=0.031).CONCLUSION Erythrocyte membrane NA level could be used for predicting the development of metabolic abnormalities,treatment resistance,and prognosis in schizophrenia.展开更多
Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the ha...Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the hallmarks of psychiatric disorders(PDs).In addition to insulin,de novo lipogenesis(DNL)also plays an essential role in NSC proliferation and function as it supplies fatty acids for membrane phospholipid synthesis and cell signaling.However,enhanced DNL is associated with lipid/fatty acid accumulation,IR,and impaired NSC proliferation.Intriguingly,data from lipidomic studies suggest that DNL could be enhanced before the onset of classical symptoms in patients with PDs.Further,evidence suggests that patients with PDs may develop IR during childhood or before adolescence;therefore,DNL could be enhanced preceding the development of IR.Regarding treatment,while most antidepressants and antipsychotic drugs have been shown to further deteriorate IR and stimulate DNL,various adjunctive drugs/therapies,including chemical,physical,and stem cell therapy,which have shown promising success in treating PDs,reduce DNL while enhancing insulin sensitivity,NSC proliferation,and cognitive function in laboratory animals.Preliminary clinical outcomes and future prospects of these adjunctive drugs/therapies,especially stem cell therapy in treating PDs including schizophrenia and depression,are discussed.展开更多
Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive s...Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.Aims This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.Methods This study was based on the 2017–2018 collection of data from a large national survey in China.Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale(CESD),while QoL was measured with the World Health Organization Quality of Life-brief version.Network analysis was employed to explore the structure of PSD,using expected influence(EI)to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.Results A total of 1123 stroke survivors were included,with an overall prevalence of depression of 34.3%(n=385;95%confidence interval 31.5%to 37.2%).In the network model of depression,the most central symptoms were CESD3(‘feeling blue/depressed’,EI:1.180),CESD6(‘feeling nervous/fearful’,EI:0.864)and CESD8(‘loneliness’,EI:0.843).In addition,CESD5(‘hopelessness’,EI:−0.195),CESD10(‘sleep disturbances’,EI:−0.169)and CESD4(‘everything was an effort’,EI:−0.150)had strong negative associations with QoL.Conclusion This study found that PSD was common among older Chinese stroke survivors.Given its negative impact on QoL,appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.展开更多
Background Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relation...Background Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relationships in dysmenorrhea and how they may interact with negative emotions. Aims To investigate the connection between negative affect and dysmenorrhea, and the role of interpersonal relationships plays in this relationship. Methods The Cox Menstrual Symptom Scale (CMSS), short-form of Depression Anxiety Stress Scale, Interpersonal Comprehensive Diagnostic Scale and UCLA (University of California at Los Angeles) Loneliness Scale were applied to 855 adolescent nursing students to collect information on severity and frequency of dysmenorrheal symptoms, negative emotions (including depression, anxiety and stress), interpersonal problems and subjective experience of loneliness among them, and the relationship among these variables was examined. Results (1) Both the severity and frequency of dysmenorrhea were positively correlated with negative emotions, loneliness experience and interpersonal problems, while negatively correlated with age at menarche.(2) The negative emotions, romantic relationship and menarche age, but not loneliness and interpersonal problems, significantly contributed to both the severity and frequency of dysmenorrhea.(3) Mediation analysis revealed that the effects of loneliness and interpersonal problems on dysmenorrhea were totally mediated by negative emotions. Conclusions This investigation indicates that the relationship between interpersonal relationships and dysmenorrhea is mediated by negative emotions.展开更多
It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to...It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyteaggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Thereforeplatelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.展开更多
AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS...AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.展开更多
Background There is an urgent need in clinical practice to measure the stress of parenting.The Caregiver Strain Questionnaire(CGSQ)was found to be useful to measure parenting stress,but it has not been validated among...Background There is an urgent need in clinical practice to measure the stress of parenting.The Caregiver Strain Questionnaire(CGSQ)was found to be useful to measure parenting stress,but it has not been validated among the Chinese population.Aims To assess the reliability and construct validity of the Chinese version of CGSQ among Chinese parents.Methods From 2016 to 2017,266 parents(patient group)with a child having DSM-5-defined attention deficit hyperactivity disorder(ADHD)(n=107)or autism spectrum disorder(ASD)(n=159)and 268 parents of healthy children(control group)were recruited to the present study in Kunming,Yunnan province.All the parents were asked to fill out the Chinese version of CGSQ.We conducted exploratory factor analysis and confirmatory factor analysis(CFA)to verify construct validity of CGSQ in both patient and control groups.Cronbach’s α coefficient as an index of internal consistency was assessed for each subscale.Fourteen days later,23 subjects filled out the scale again.Intra-class correlation coefficient was calculated to evaluate the test-retest reliability.Results(1)Cronbach’s alpha of the global scale was 0.901 for the control group and 0.952 for the patient group.The test-retest reliability for the whole scale was 0.890;(2)CFA indicated that the three-factor model had better fitting indices compared with the two-factor model in both groups.Besides,the fitting indices in the patient group were more favourable than those of the control group,withχ2/df=1.564,Goodness-of Fit Index=0.841,Comparative Fit Index=0.954,and root mean square error of approximation=0.065 for the patient group at three-factor model;(3)The caregiver strain of ASD parents was statistically higher than that of ADHD parents,and caregiver strain of ADHD parents was higher than that of control group.Conclusion These findings provide initial evidence to support the construct validity and reliability of CGSQ as a parenting stress measurement tool for Chinese parents,especially for parents of children with ADHD or ASD.展开更多
In this study, we aimed to （1） identify white matter （WM） deficits underlying the consciousness level in patients with disorders of consciousness （DOCs） using diffusion tensor imaging （DTI）, and （2） evaluate...In this study, we aimed to （1） identify white matter （WM） deficits underlying the consciousness level in patients with disorders of consciousness （DOCs） using diffusion tensor imaging （DTI）, and （2） evaluate the relationship between DTI metrics and clinical measures of the consciousness level in DOC patients. With a cohort of 8 comatose, 8 unresponsive wakefulness syndrome/ vegetative state, and 14 minimally conscious state patients and 25 patient controls, we performed group comparisons of the DTI metrics in 48 core WM regions of interest （ROIs）, and examined the clinical relevance using correlation analysis. We identified multiple abnormal WM ROIs in DOC patients compared with normal controls, and the DTI metrics in these ROIs were significantly correlated with clinical measures of the consciousness level. Therefore, our findings suggested that multiple WM tracts are involved in the impaired consciousness levels in DOC patients and demonstrated the clinical relevance of DTI for DOC patients.展开更多
It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function....It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.展开更多
Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the...Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure.Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist(team)within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity,instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD.Screening, treatment and monitoring is suggested as central roles for the addiction specialist(team) integrated within transplant centers.展开更多
Background Over 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.Aims The study has two aims:(1) to conduct a targeted literature review ...Background Over 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.Aims The study has two aims:(1) to conduct a targeted literature review of the economic literature on oral ziprasidone in China, and(2) to develop an inpatient economic model that compared the cost of intramuscular ziprasidone with other regimens including electroconvulsive therapy(ECT) for the management of acute agitation in patients with schizophrenia from a hospital's perspective in China.Methods A targeted literature review was conducted using PubMed and the Chinese literature databases for studies published between January 2007 and December2017. Studies that assessed costs associated with oral ziprasidone treatment for schizophrenia in China were summarised. In the inpatient economic model,cost measures included hospital room and board,antipsychotics,ECT and medications for the management of extrapyramidal symptoms(EPS). Input for standard antipsychotic regimens and unit cost were obtained from the literature. Hospital length of stay(LOS), utilisation of ECT and incidence of EPS were derived from the literature and supplemented/validated with a survey of psychiatrists in China. Cost was presented in 2017 Chinese yuan.Results The average estimated LOS was 29 days with ziprasidone, 33 days with risperidone+benzodiazepine,32 days with olanzapine, 35 days with haloperidol and 29 days with ECT. The cost of antipsychotics was $1260 with ziprasidone, $137 with risperidone+benzodiazepine, $913 with olanzapine and $210 with haloperidol; ECT treatment costs $785. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Using intramuscular ziprasidone for acute management was associated with a total cost of $11157, the lowest among all antipsychotic regimens($11 424 with risperidone+benzodiazepine, $11 711 with olanzapine and $11 912 with haloperidol) and slightly higher than ECT($10 606). The cost of antipsychotics and ECT accounted for 1 %-11 % of the total cost. Varying LOS between the lower and upper bounds of the 95% CI, the total cost was comparable between these regimens.Conclusions Overall, the cost for the management of acute agitation was similar between intramuscular ziprasidone and other antipsychotics. Compared with other antipsychotics, the higher medication cost of intramuscular ziprasidone can be offset by savings with shorter hospital stay. The results from this economic analysis were complementary to the findings in the published literature assessing the economic outcomes of oral ziprasidone.展开更多
BACKGROUND Depression is a widespread mental health condition that requires effective treatment.In the treatment of depression,traditional Chinese medicine(TCM)offers obvious advantages,fewer adverse reactions,and a l...BACKGROUND Depression is a widespread mental health condition that requires effective treatment.In the treatment of depression,traditional Chinese medicine(TCM)offers obvious advantages,fewer adverse reactions,and a lower recurrence rate.AIM To evaluate the clinical benefits of Guipi decoction combined with escitalopram oxalate tablets for individuals with depression.METHODS In total,80 patients diagnosed as having depression were enrolled in the study and divided into either an experimental group or a control group.All of the patients were orally administered escitalopram oxalate tablets.Additionally,the experimental group received Jiajian Guipi decoction and reduced Governor vessel fumigation over 4 wk.TCM syndrome scores,Hamilton depression rating scale(HAM-D)scores,self-rating depression scale(SDS)scores,and Pittsburgh sleep quality index scores were measured for the two groups and compared before and after the treatment.The two groups were monitored for any adverse reactions.RESULTS After 4 wk of treatment,both groups exhibited a significant reduction in TCM syndrome scores compared with their pre-treatment scores(P<0.05).However,the experimental group exhibited significantly lower TCM syndrome scores than the control group(P<0.05).Similarly,the post-treatment SDS and HAM-D-24 scores were significantly lower in both groups than the pre-treatment scores(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The total treatment efficiency was significantly better in the experimental group(97.14%)than in the control group(77.78%)(P<0.05).Furthermore,after 4 wk of treatment,the Pittsburgh sleep quality index scores for both groups were significantly lower than those before the treatment(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The incidence of adverse reactions was significantly lower in the experimental group than in the control group(P<0.05).CONCLUSION The combination of Guipi decoction and escitalopram oxalate tablets was found to be an effective and safe treatment for depression.This combination could reduce TCM syndrome scores,improve depressive symptoms,and enhance sleep quality.展开更多
Background Cognitive behavioural therapy(CBT)is considered to be an effective treatment for schizophrenia.In recent years,researchers have published clinical research results on CBT for schizophrenia.However,there is ...Background Cognitive behavioural therapy(CBT)is considered to be an effective treatment for schizophrenia.In recent years,researchers have published clinical research results on CBT for schizophrenia.However,there is currently a lack of bibliometric analysis on CBT for schizophrenia.Aims To understand the current situation and research trends of CBT for schizophrenia,and to provide valuable information for researchers in this field.Methods Literature was retrieved from the Web of Science Core Collection database.CiteSpace was used to visually analyse the current status of research on CBT for schizophrenia,as well as trends and points of general interest on this topic.Results A total of 1151 papers were retrieved.The annual number of publications has increased 417.65%from 2000 to 2019.Schizophrenia Research was the most active journal.McGorry enjoys considerable influence.The University of London is deemed to be the most active research institution.England and the USA retain the highest scientific productivity in this field.China and Norway might make more contributions to this field in the future.The most important research topics are randomised controlled trials of CBT for schizophrenia,meta-analysis,scale selection and research on the improvement of quality of life.Results from the following keywords‘psychoeducation’,‘insomnia’,‘individual’,‘mental illness’,‘major depressive disorder’,‘efficacy’,‘internalised stigma’and‘remediation’indicated new research frontiers in this field.Conclusions The field of CBT for schizophrenia is progressing and has great potential.The level and quality of research in this field is high.The proposal of research hotspots and frontiers serves as a direction for researchers in this field.Researchers around the world should strengthen their cooperation and communication to promote further development of this field.展开更多
文摘The potential shortage of psychiatrists over the next 5 - 10 years has focused attention on the need to recruit more IMGs to fill the needs rather than use nurse practitioners or physician assistants. IMGs make up about 1/3 of first year psychiatry residents. These individuals have been found to provide services to the poor, the elderly and the psychotic. The quality of their medical work has been found to be satisfactory. The training needs of these physicians require an understanding on the part of their teachers that they come from cultures with different values that we have. The extended families of these primarily Asian residents clash with our strong commitment to individualism. It leads to a We-self rather than our I-Self. This difference coupled with the stress of leaving to come to a new culture is a great stress. Their exposure to psychiatry has been limited. They request and need more interview demonstration and practice, ore feedback and examinations. They should have help in accent reduction. They should be exposed to the working of the hospital by sitting on departmental and hospital committees. The faculty should extend their social opportunities and work as mentors on joint projects. Courses on the history of American culture should be taught. Psychotherapy for them should be encouraged as well as teaching medical ethics. They must become the major educational concern for the department that they are in.
文摘Backgrounds: Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to answer the question what are the problems that are likely to bring a child or an adolescent for the admission in the child and adolescent psychiatry Unit. Methods: The case records of all inpatient children and adolescents younger than 18 years, who were admitted to the child psychiatric unit at SQUH, Muscat, Sultanate of Oman over a period of 10 years between Jan 2007 and Dec 2017, were retrospectively reviewed in regard to sociodemographic data, referring specialties and reason for referral. Result: A total of 255 cases were admitted in child psychiatry unit in a period of 10 yrs, the average age was 14.15 years, 95% patients were Omani nationals, 47.5% were male, 52.5 were females, 17.65% Acute and transient psychotic disorder, 13.7% bipolar affective disorder, current episode manic without psychotic symptoms, 12.94% Intentional self-harm by other specified means and 12.55% schizophrenia, were the most common diagnoses observed in this population who needed inpatient care;the average length of stay in the majority of cases was less than 3 weeks. Conclusion: The child and adolescent inpatient unit of SQUH from where the data was collected happens to be the only child psychiatric admitting unit in Oman till the end of 2017 and can be considered as representative;the children and adolescence in-patient unit exemplifies a short-term care set-up.
文摘Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.
文摘This letter provides a concise review of the pertinent literature on visual and tactile hallucinations in elderly patients.The discussion addresses differential diagnoses and potential underlying mechanisms,as well as the psychopathology associated with tactile hallucinations,and emphasizes the necessity for invest-igation into the possibility of coexisting delusional infestation(parasitosis).These symptoms frequently manifest in patients with primary psychotic disorders,organic mental disorders,and substance use disorders.The proposed pathophy-siological mechanisms may involve dopaminergic imbalances and dysfunction of the striatal dopamine transporter.
基金funded by FDCT grants from Macao Science and Technology University to PC(Project Code:0005-2023-RIA1)。
文摘Podophyllotoxin is a well-studied natural product.Because of its unique structure and ability to inhibit cancer cells,it has been changed in different ways to find out its pharmacological properties.This paper discusses the common chemical modifications of podophyllotoxin molecules,including the C-4 and E-4 site replacements.Furthermore,its common inhibitory effects on cancer cells and antiparasitic activities,among others,are outlined by the connection between conformational changes and pharmacological activities.Importantly,Podophyllotoxin can effectively overcome the phenomenon of multidrug resistance through a dual-targeting mechanism,including inhibition of microtubule protein synthesis and topoisomerase II activity,and induces cell cycle arrest and apoptosis.Recent findings reveal its potential to modulate immune responses through the cyclic GMP-AMP synthase(cGAS)-stimulator of interferon genes(STING)pathway,further extending beyond its classical mechanisms.This study finally provides a systematic summary of the activity ofpodophyllotoxin in common cancer cells,including those in the breast,lung,and prostate.
文摘Following an acute stroke,patients often encounter a range of impairments affecting their physical,cognitive,verbal,and social capabilities.Poststroke depression(PSD)has been identified as a significant consequence of stroke and serves as a crucial predictor of patient outcomes.The diagnosis of PSD presents a challenge,as the physical manifestations following a stroke can overlap with certain depressive symptoms,leading to a potential underdiagnosis of this condition.This review employs a narrative approach to synthesize diverse findings within this domain.PSD is categorized as an organic mood disorder,and a more accurate diagnosis may be achieved by considering the location of the stroke,the patient's specific symptoms,and the timeline of depressive symptom onset.Notably,if depressive symptoms emerge at more than one year poststroke,the likelihood of PSD diminishes.The etiology of PSD is currently understood to stem from a combination of physiological and psychosocial factors,as well as their interactions.Several mechanisms associated with PSD have been identified,including inflammation,dysregulation of the hypothalamic-pituitary-adrenal axis,oxidative stress,autophagy,apoptosis,abnormal neurotrophic responses,glutamate-mediated excitotoxicity,dysfunction within brain networks,reduced monoamine levels,locations of brain lesions,and psychosocial influences.This review also outlines potential directions for future research.
文摘BACKGROUND Nervonic acid(NA,C24:1,w9)is a monounsaturated fatty acid that plays a crucial role in myelination and motor function.It also regulates cognitive and metabolic functions,suggesting that impaired NA metabolism may contribute to the pathophysiology of schizophrenia.Although several studies have measured erythrocyte membrane NA in first-episode psychosis(FEP),findings are conflicting,and the fate of NA in patients with chronic schizophrenia(CSZ)or under long-term antipsychotic treatment schedules remains unknown.AIM To measure erythrocyte membrane NA and determine its association with psychopathology and metabolic parameters in drug-naive patients with FEP and antipsychotic-treated patients with CSZ.METHODS In this study,twenty-one drug-naive patients with FEP,twenty patients with CSZ treated with atypical antipsychotics,and fourteen healthy male subjects were analyzed.Erythrocyte membrane NA was measured using ultrathin capillary gas chromatography,plasma leptin was measured using enzyme-linked immunosorbent assay,and body mass index(BMI)was calculated by using the formula:Weight(kg)/height(m^(2)).Psychiatric symptoms were evaluated using the brief psychiatry rating scale and the positive and negative syndrome scale(PANSS).Pearson correlation coefficient(r)was computed to find the association between erythrocyte membrane NA,PANSS scores,plasma leptin,and BMI.RESULTS In patients with FEP,erythrocyte NA was non-significantly increased(about 12%)and negatively correlated with negative symptoms(PANSS-negative symptom scores,r=-0.4323,P=0.023)but not with positive symptoms(PANSS-positive symptom scores,r=-0.2915,P=0.09).In patients with CSZ,erythrocyte NA was reduced considerably(about 40%,P<0.001 vs FEP and about 30%vs control(CNT)subjects,P=0.037)and negatively correlated with both PANSS-negative symptom scores(r=-0.4562,P=0.013)and PANSS-positive symptom scores(r=-0.3911,P=0.041).Additionally,in patients with FEP,erythrocyte NA was not significantly correlated either with BMI(r=-0.2532,P=0.231)or plasma leptin(r=-0.3001,P=0.102).However,in patients with CSZ,it did negatively correlate with both BMI(r=-0.4721,P=0.029)and plasma leptin(r=-0.4701,P=0.031).CONCLUSION Erythrocyte membrane NA level could be used for predicting the development of metabolic abnormalities,treatment resistance,and prognosis in schizophrenia.
文摘Insulin plays a crucial role in the metabolic priming and proliferation of neural stem cells(NSCs).However,insulin resistance(IR)is associated with impaired NSC proliferation and cognitive dysfunction,which are the hallmarks of psychiatric disorders(PDs).In addition to insulin,de novo lipogenesis(DNL)also plays an essential role in NSC proliferation and function as it supplies fatty acids for membrane phospholipid synthesis and cell signaling.However,enhanced DNL is associated with lipid/fatty acid accumulation,IR,and impaired NSC proliferation.Intriguingly,data from lipidomic studies suggest that DNL could be enhanced before the onset of classical symptoms in patients with PDs.Further,evidence suggests that patients with PDs may develop IR during childhood or before adolescence;therefore,DNL could be enhanced preceding the development of IR.Regarding treatment,while most antidepressants and antipsychotic drugs have been shown to further deteriorate IR and stimulate DNL,various adjunctive drugs/therapies,including chemical,physical,and stem cell therapy,which have shown promising success in treating PDs,reduce DNL while enhancing insulin sensitivity,NSC proliferation,and cognitive function in laboratory animals.Preliminary clinical outcomes and future prospects of these adjunctive drugs/therapies,especially stem cell therapy in treating PDs including schizophrenia and depression,are discussed.
基金supported by Beijing High Level Public Health Technology Talent Construction Project(Discipline Backbone-01-028)the Beijing Municipal Science&Technology Commission(No.Z181100001518005)+2 种基金the Capital's Funds for Health Improvement and Research(CFH 2024-2-1174)the University of Macao(MYRG-GRG2023-00141-FHS,CPG2025-00021-FHS)the Science and Technology Plan Foundation of Guangzhou(No.202201011663).
文摘Background Post-stroke depression(PSD)is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life(QoL).To date,few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.Aims This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.Methods This study was based on the 2017–2018 collection of data from a large national survey in China.Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale(CESD),while QoL was measured with the World Health Organization Quality of Life-brief version.Network analysis was employed to explore the structure of PSD,using expected influence(EI)to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.Results A total of 1123 stroke survivors were included,with an overall prevalence of depression of 34.3%(n=385;95%confidence interval 31.5%to 37.2%).In the network model of depression,the most central symptoms were CESD3(‘feeling blue/depressed’,EI:1.180),CESD6(‘feeling nervous/fearful’,EI:0.864)and CESD8(‘loneliness’,EI:0.843).In addition,CESD5(‘hopelessness’,EI:−0.195),CESD10(‘sleep disturbances’,EI:−0.169)and CESD4(‘everything was an effort’,EI:−0.150)had strong negative associations with QoL.Conclusion This study found that PSD was common among older Chinese stroke survivors.Given its negative impact on QoL,appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.
基金the Sichuan Provincial Science and Technology Department (2017JY0324)Joint Project of Southwest Medical University and Sichuan Luzhou (2017LZXNYD-Z02)+3 种基金Natural Science Foundation of China (81701322)Humanity and Social Science Youth Foundation of Ministry of Education of China (17YJC190001,17YJC190009)the joint project of Southwest Medical University & Affiliated Hospital of Southwest Medical University (2015-QB-003)Sichuan Applied Psychology Research Center Project (CSXL-172012).
文摘Background Good interpersonal relationships can improve the negative mood and, to a certain extent, may help relieve dysmenorrhea symptoms. However, there has been no study examining the role of interpersonal relationships in dysmenorrhea and how they may interact with negative emotions. Aims To investigate the connection between negative affect and dysmenorrhea, and the role of interpersonal relationships plays in this relationship. Methods The Cox Menstrual Symptom Scale (CMSS), short-form of Depression Anxiety Stress Scale, Interpersonal Comprehensive Diagnostic Scale and UCLA (University of California at Los Angeles) Loneliness Scale were applied to 855 adolescent nursing students to collect information on severity and frequency of dysmenorrheal symptoms, negative emotions (including depression, anxiety and stress), interpersonal problems and subjective experience of loneliness among them, and the relationship among these variables was examined. Results (1) Both the severity and frequency of dysmenorrhea were positively correlated with negative emotions, loneliness experience and interpersonal problems, while negatively correlated with age at menarche.(2) The negative emotions, romantic relationship and menarche age, but not loneliness and interpersonal problems, significantly contributed to both the severity and frequency of dysmenorrhea.(3) Mediation analysis revealed that the effects of loneliness and interpersonal problems on dysmenorrhea were totally mediated by negative emotions. Conclusions This investigation indicates that the relationship between interpersonal relationships and dysmenorrhea is mediated by negative emotions.
文摘It is well established that various mental stress conditions contribute, or at least influence, underlying pathophysiological mechanisms in somatic, as well as in psychiatric disorders; blood platelets are supposed to represent a possible link in this respect. The anculeated platelets are the smallest corpuscular elements circulating in the human blood. They display different serotonergic markers which seem to reflect the central nervous serotonin metabolism. They are known as main effectors in haematological processes but recent research highlights their role in the innate and adaptive immune system. Platelets are containing a multitude of pro-inflammatory and immune-modulatory bioactive compounds in their granules and are expressing immune-competent surface markers. Research gives hint that platelets activation and reactivity is increased by mental stress. This leads to enhanced cross talk with the immune system via paracrine secretion, receptor interaction and formation of platelet leucocyteaggregates. Recently it has been demonstrated that the immune system can have a remarkable impact in the development of psychiatric disorders. Thereforeplatelets represent an interesting research area in psychiatry and their role as a possible biomarker has been investigated. We review the influence of mental stress on what is termed platelet bioactivity in this article, which subsumes the mainly immune-modulatory activity of platelets in healthy volunteers, elderly persons with chronic care-giving strain, patients with cardiovascular diseases who are prone to psychosocial stress, as well as in patients with posttraumatic stress disorder. Research data suggest that stress enhances platelet activity, reactivity and immune-modulatory capacities.
基金funding from NIMH, AHRQ, Marriott Foundation, Mayo Foundation
文摘AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.
基金This work was supported by the National Natural Science Foundation of China(Grant No.81460218,30900488)National Key Technology Research and Development Program of the Ministry of Science and Technology of China(Grant No.2015BAI13B01).
文摘Background There is an urgent need in clinical practice to measure the stress of parenting.The Caregiver Strain Questionnaire(CGSQ)was found to be useful to measure parenting stress,but it has not been validated among the Chinese population.Aims To assess the reliability and construct validity of the Chinese version of CGSQ among Chinese parents.Methods From 2016 to 2017,266 parents(patient group)with a child having DSM-5-defined attention deficit hyperactivity disorder(ADHD)(n=107)or autism spectrum disorder(ASD)(n=159)and 268 parents of healthy children(control group)were recruited to the present study in Kunming,Yunnan province.All the parents were asked to fill out the Chinese version of CGSQ.We conducted exploratory factor analysis and confirmatory factor analysis(CFA)to verify construct validity of CGSQ in both patient and control groups.Cronbach’s α coefficient as an index of internal consistency was assessed for each subscale.Fourteen days later,23 subjects filled out the scale again.Intra-class correlation coefficient was calculated to evaluate the test-retest reliability.Results(1)Cronbach’s alpha of the global scale was 0.901 for the control group and 0.952 for the patient group.The test-retest reliability for the whole scale was 0.890;(2)CFA indicated that the three-factor model had better fitting indices compared with the two-factor model in both groups.Besides,the fitting indices in the patient group were more favourable than those of the control group,withχ2/df=1.564,Goodness-of Fit Index=0.841,Comparative Fit Index=0.954,and root mean square error of approximation=0.065 for the patient group at three-factor model;(3)The caregiver strain of ASD parents was statistically higher than that of ADHD parents,and caregiver strain of ADHD parents was higher than that of control group.Conclusion These findings provide initial evidence to support the construct validity and reliability of CGSQ as a parenting stress measurement tool for Chinese parents,especially for parents of children with ADHD or ASD.
基金supported by the Natural Science Foundation of China (81571025)International Cooperation Project from Shanghai Science Foundation (18410711300)+13 种基金the National Science Foundation for Distinguished Young Scholars of China (81025013)National Basic Research Development Program (973 Program) of China (2012CB720700, 2010CB945500, 2012CB966300, and 2009CB941100)the National Natural Science Foundation of China (81322021)the Beijing Nova Program (Z121110002512032)the Project for National 985 Engineering of China (985III-YFX0102)the ‘‘Dawn Tracking’’ Program of Shanghai Education Commission (10GG01)the Shanghai Natural Science Foundation (08411952000 and 10ZR1405400)the National Natural Science Young Foundation in China (81201033)the grants of Shanghai Health Bureau (20114358)the National High-Technology Development Project (863 Project) of China (2015AA020501)the Program for New Century Excellent Talents in University of China (NCET-10-0356)the National Program for the Support of TopNotch Young Professionalssupported by the Michael Smith Foundation, the CRC, and the CIHRsupported by the China Scholarship Council
文摘In this study, we aimed to （1） identify white matter （WM） deficits underlying the consciousness level in patients with disorders of consciousness （DOCs） using diffusion tensor imaging （DTI）, and （2） evaluate the relationship between DTI metrics and clinical measures of the consciousness level in DOC patients. With a cohort of 8 comatose, 8 unresponsive wakefulness syndrome/ vegetative state, and 14 minimally conscious state patients and 25 patient controls, we performed group comparisons of the DTI metrics in 48 core WM regions of interest （ROIs）, and examined the clinical relevance using correlation analysis. We identified multiple abnormal WM ROIs in DOC patients compared with normal controls, and the DTI metrics in these ROIs were significantly correlated with clinical measures of the consciousness level. Therefore, our findings suggested that multiple WM tracts are involved in the impaired consciousness levels in DOC patients and demonstrated the clinical relevance of DTI for DOC patients.
文摘It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.
文摘Although liver transplantation(LT) is performed increasingly for patients with end-stage alcoholic liver disease(ALD), the topic remains controversial. Traditionally, the role of an addiction specialist focused on the screening and identification of patients with a high risk on relapse in heavy alcohol use. These patients were in many cases subsequently excluded from a further LT procedure.Recently, awareness is growing that not only screening of patients but also offering treatment, helping patients regain and maintain abstinence is essential, opening up a broader role for the addiction specialist(team)within the whole of the transplant procedure. Within this context, high-risk assessment is proposed to be an indication of increasing addiction treatment intensity,instead of being an exclusion criterion. In this review we present an overview regarding the state of the art on alcohol relapse assessment and treatment in patients with alcohol use disorders, both with and without ALD.Screening, treatment and monitoring is suggested as central roles for the addiction specialist(team) integrated within transplant centers.
基金funded by Pfizer Investment.DL and LY are employees of Pfizer Investment and were involved in the design and write-up of the study
文摘Background Over 10 million Chinese are affected by schizophrenia. The annual cost of schizophrenia in China was estimated at US$2586 per patient.Aims The study has two aims:(1) to conduct a targeted literature review of the economic literature on oral ziprasidone in China, and(2) to develop an inpatient economic model that compared the cost of intramuscular ziprasidone with other regimens including electroconvulsive therapy(ECT) for the management of acute agitation in patients with schizophrenia from a hospital's perspective in China.Methods A targeted literature review was conducted using PubMed and the Chinese literature databases for studies published between January 2007 and December2017. Studies that assessed costs associated with oral ziprasidone treatment for schizophrenia in China were summarised. In the inpatient economic model,cost measures included hospital room and board,antipsychotics,ECT and medications for the management of extrapyramidal symptoms(EPS). Input for standard antipsychotic regimens and unit cost were obtained from the literature. Hospital length of stay(LOS), utilisation of ECT and incidence of EPS were derived from the literature and supplemented/validated with a survey of psychiatrists in China. Cost was presented in 2017 Chinese yuan.Results The average estimated LOS was 29 days with ziprasidone, 33 days with risperidone+benzodiazepine,32 days with olanzapine, 35 days with haloperidol and 29 days with ECT. The cost of antipsychotics was $1260 with ziprasidone, $137 with risperidone+benzodiazepine, $913 with olanzapine and $210 with haloperidol; ECT treatment costs $785. The base-case analysis suggested that higher antipsychotic cost with ziprasidone was offset by savings with shorter LOS. Using intramuscular ziprasidone for acute management was associated with a total cost of $11157, the lowest among all antipsychotic regimens($11 424 with risperidone+benzodiazepine, $11 711 with olanzapine and $11 912 with haloperidol) and slightly higher than ECT($10 606). The cost of antipsychotics and ECT accounted for 1 %-11 % of the total cost. Varying LOS between the lower and upper bounds of the 95% CI, the total cost was comparable between these regimens.Conclusions Overall, the cost for the management of acute agitation was similar between intramuscular ziprasidone and other antipsychotics. Compared with other antipsychotics, the higher medication cost of intramuscular ziprasidone can be offset by savings with shorter hospital stay. The results from this economic analysis were complementary to the findings in the published literature assessing the economic outcomes of oral ziprasidone.
基金The study was approved by the Ethics Committee of Beijing Changping Hospital of Traditional and Western Medicine.
文摘BACKGROUND Depression is a widespread mental health condition that requires effective treatment.In the treatment of depression,traditional Chinese medicine(TCM)offers obvious advantages,fewer adverse reactions,and a lower recurrence rate.AIM To evaluate the clinical benefits of Guipi decoction combined with escitalopram oxalate tablets for individuals with depression.METHODS In total,80 patients diagnosed as having depression were enrolled in the study and divided into either an experimental group or a control group.All of the patients were orally administered escitalopram oxalate tablets.Additionally,the experimental group received Jiajian Guipi decoction and reduced Governor vessel fumigation over 4 wk.TCM syndrome scores,Hamilton depression rating scale(HAM-D)scores,self-rating depression scale(SDS)scores,and Pittsburgh sleep quality index scores were measured for the two groups and compared before and after the treatment.The two groups were monitored for any adverse reactions.RESULTS After 4 wk of treatment,both groups exhibited a significant reduction in TCM syndrome scores compared with their pre-treatment scores(P<0.05).However,the experimental group exhibited significantly lower TCM syndrome scores than the control group(P<0.05).Similarly,the post-treatment SDS and HAM-D-24 scores were significantly lower in both groups than the pre-treatment scores(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The total treatment efficiency was significantly better in the experimental group(97.14%)than in the control group(77.78%)(P<0.05).Furthermore,after 4 wk of treatment,the Pittsburgh sleep quality index scores for both groups were significantly lower than those before the treatment(P<0.05),with the experimental group exhibiting lower scores than the control group(P<0.05).The incidence of adverse reactions was significantly lower in the experimental group than in the control group(P<0.05).CONCLUSION The combination of Guipi decoction and escitalopram oxalate tablets was found to be an effective and safe treatment for depression.This combination could reduce TCM syndrome scores,improve depressive symptoms,and enhance sleep quality.
基金This work was supported by Sichuan science and technology program(grant number 2017JY0322).
文摘Background Cognitive behavioural therapy(CBT)is considered to be an effective treatment for schizophrenia.In recent years,researchers have published clinical research results on CBT for schizophrenia.However,there is currently a lack of bibliometric analysis on CBT for schizophrenia.Aims To understand the current situation and research trends of CBT for schizophrenia,and to provide valuable information for researchers in this field.Methods Literature was retrieved from the Web of Science Core Collection database.CiteSpace was used to visually analyse the current status of research on CBT for schizophrenia,as well as trends and points of general interest on this topic.Results A total of 1151 papers were retrieved.The annual number of publications has increased 417.65%from 2000 to 2019.Schizophrenia Research was the most active journal.McGorry enjoys considerable influence.The University of London is deemed to be the most active research institution.England and the USA retain the highest scientific productivity in this field.China and Norway might make more contributions to this field in the future.The most important research topics are randomised controlled trials of CBT for schizophrenia,meta-analysis,scale selection and research on the improvement of quality of life.Results from the following keywords‘psychoeducation’,‘insomnia’,‘individual’,‘mental illness’,‘major depressive disorder’,‘efficacy’,‘internalised stigma’and‘remediation’indicated new research frontiers in this field.Conclusions The field of CBT for schizophrenia is progressing and has great potential.The level and quality of research in this field is high.The proposal of research hotspots and frontiers serves as a direction for researchers in this field.Researchers around the world should strengthen their cooperation and communication to promote further development of this field.
