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Bipolar disorder is one of the most common mood disorders characterized by an early age of onset and high prevalence rate， and patients tent to have poor prognosis due to high misdiagnosis rate and incomplete diagnosis rate. At present， existing pharmacological treatment for bipolar disorder remains highly variable. Therefore， this paper presents a review of indications of the medications， clinical therapeutic effect and adverse drug reactions， thus providing references for the pharmaceutical treatment of bipolar disorder.
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Objective:To explore the characteristics of theory of mind(TOM) ability of adolescent depressive disorder patients with non-suicidal self-injury (NSSI) behavior, and analyze the relationship between NSSI behavior and TOM, so as to identify patients with NSSI behavioral risk early and give timely intervention.Methods:A total of 54 adolescent patients with depressive disorder who were hospitalized for the first time in Shenzhen Kangning Hospital from May to October 2021 were enrolled.They were divided into NSSI group( n=31)and non-NSSI group( n=23)according to DSM-5.Hamilton anxiety rating scale-14 item (HAMA-14) and Hamilton depression rating scale-17 item(HAMD-17)were used to evaluate the severity of anxiety and depression.Hinting task, Yoni task and reading the mind in the eyes test(RMET) were used to test TOM of the two groups.Binary Logistic regression analysis in SPSS 22.0 was used to explore the influence of TOM ability on NSSI behavior of adolescents with depressive disordor. Results:Compared with patients in non-NSSI group, patients in NSSI had significantly higher scores of HAMA-14(21.48±4.92 vs 16.35±5.61, t=3.57, P<0.05) and HAMD-17(25.61±4.08 vs 21.43±4.64)( t=3.51, P<0.05). The patients in NSSI group had lower scores on the hinting task(16.10±2.84 vs 18.17±1.15, t=-3.68, P<0.05), RMET task (21.61±2.58 vs 23.61±3.07)( t=-2.59, P<0.05), and second-order cognitive TOM((18.90±3.70) vs (20.96±2.72), t=-2.27, P<0.05) and second-order affective TOM(28.84±3.93 vs 31.04±3.04)( t=-2.24, P<0.05) in Yoni task than those in non-NSSI group.Binary Logistic regression analysis showed effective TOM ( β=-0.306, OR=0.736, 95% CI= 0.552-0.982, P=0.037)and cognitive TOM ( β=-0.485, OR=0.616, 95% CI=0.396-0.957, P=0.031) were associated with non-suicidal self-injury in patients with depressive disorder. Conclusion:The increased impairment of the emotional component (decoding component) and cognitive component (reasoning component) of TOM may be risk factors for the occurrence of NSSI behavior in adolescent depressive disorder patients.
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ObjectiveTo explore the characteristics of impulsivity in adolescent depressive disorder patients with non-suicidal self-injury （NSSI） behavior， analyze the relationship between NSSI behavior and impulsivity， so as to identify patients with NSSI behavior and provide targeted intervention at early stages. MethodsA total of 53 adolescent patients with depressive disorder who were hospitalized for the first hospitalization in Shenzhen Kangning Hospital were enrolled， diagnosed using Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Thereafter， the adolescents were divided into NSSI group （n=30） and non-NSSI group （n=23）. Hamilton Depression Scale-17 item （HAMD-17）， Adolescents Self-Harm Scale and Barratt Impulsivity Scale （BIS-11） were used to evaluate the severity of depression， NSSI and impulsivity. ResultsCompared with the non-NSSI group， the NSSI group scored higher on HAMD-17 ［（25.50±4.10） vs. （21.43±4.64）， t=3.379， P<0.01］， motor impulsiveness of BIS-11 ［（51.67±15.95） vs. （38.70±14.90）， t=3.018， P<0.01］， cognitive impulsiveness ［（52.75±13.22） vs. （43.37±18.40）， t=2.161， P<0.05］， non-planning impulsiveness ［（68.00±15.32） vs. （50.76±21.35）， t=3.424， P<0.01］ and BIS-11 ［（57.42±11.08） vs. （44.27±14.83）， t=3.695， P<0.01］. Within NSSI group， the score of Adolescents Self-Harm Scale was positively correlated with the score of motor impulsiveness in BIS-11 （r=0.691， P<0.01）. Binary Logistic regression analysis showed that HAMD-17 score （β=0.172， OR=1.187， 95% CI： 1.007~1.400） and non-planning impulsiveness of BIS-11 （β=0.044， OR=1.045， 95% CI： 1.002~1.091） were associated with NSSI in adolescent patients with depressive disorder （P<0.05）. ConclusionThe severity of depressive symptoms and non-planning impulsiveness may be risk factors for NSSI behavior in adolescent patients with depressive disorder.
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Amisulpride,a kind of the second generation antipsychotics,was marketed in China in 2010.A series of clinical research and experience before and after listed,especially the data based on Chinese population,provided evidence for the generalization and application of amisulpride.In order to optimize the clinical application of amisulpride,and improve the prognosis of patients,Expert Advice on the Practical Use of Amisulpride in the Treatment of Schizophrenia is presented here.This advice is based on the recent evidence and clinical experience,for guiding the clinical medication of amisulpride.
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The researches on attention provide a promising framework for studying bipolar disorder pathophysiology and treatment.Previous findings have shown the negative attention bias maybe a risk factor for bipolar disorder.The current review discusses this issue in several aspects,including attention bias toward emotional information in bipolar disorder is state or trait,and whether shows mood-congruent bias;the character of attention bias in the different episodes of bipolar disorder.The article also puts forward an intervention of attention bias modification for treating bipolar disorder.
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Objective To investigate the capability of empathy for pain in bipolar disorder (BD). Methods Thirty-two patients with BD (16, 8 and 8 in depressed, manic and remitted phases, respectively) and 32 healthy controls matched for age, gender and education were recruited. Empathy for pain paradigm were used. Subjects were required to judge whether the person in the picture felt painful and rate pain degree regarding to painful and neutral pictures. Accuracy, reaction time and ratings of pain degree were used as indicators of empathy for pain. Chinese version of Interpersonal Reactivity Index (IRI-C) were used to measure empathy. Results Compared to controls, accuracy of painful pictures was significantly lower in patients [(0.74±0.16) vs.(0.83±0.10), P<0.05]. Reaction time for both painful [(903.84±167.49) ms vs. (765.06±108.21) ms] and neutral [(880.44 ± 190.36) ms vs. (750.31 ± 103.15)ms] pictures were significantly longer in patients (P<0.05). Pa?tients showed lower scores in factors of perspective taking [(9.20±5.43) vs. (12.43±4.13)], fantasy [(11.85±4.57) vs. (15.50± 5.56)] and empathy concern [(14.59±5.35) vs. (17.63±3.37)] in IRI-C (P<0.05). Accuracy of painful pictures was positively correlated with scores in fantasy (r=0.37, P=0.04) and reaction time was positively correlated with duration of disease in pa?tients (r=0.64, P<0.01). Conclusion Bipolar disorder has deficit in the capability of empathy for pain.
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Objective To investigate the characteristic of regional cerebral blood flow (r-CBF) in patients with major depression disorder (MDD) and bipolar depressed (BPD). Methods The r-CBF imaging was detected by using sin?gle emission computed tomography (SPECT) in 22 treatment naive patients with MDD, 22 treatment naive patients with BPD and 15 healthy controls. The r-CBF was compared between patients and controls. Results Compared to controls, the r-CBF in the bilateral temporal lobe, parietal lobe and basal ganglia significantly decreased in MDD and BPD pa?tients (P<0.001). The r-CBF in the basal ganglia was significantly lower in MDD patients than in BPD patients. Conclu?sion The r-CBF is abnormal in MDD and BPD at the resting state. The r-CBF in the basal ganglia is the main differ?ence between MDD and BPD. The difference might be regarded as a biomarker in distinguishing BPD patients from MDD patients.
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Objective To study the relationship between suicidal attitude and childhood trauma in bipolar disorders.Methods 67 patients with bipolar disorder and 101 healthy individuals were assessed with the Questionnaire of Suicidal Attitude (QSA) and Childhood Trauma Questionnaire(CTQ).Results There was no statistical difference between the patients group and healthy control group in the results of suicidal attitude (P＞0.05).The scores of emotional neglect (M =10)and physical neglect (M =9) in patients group were significantly higher than those of the healthy control group(M =8,M =6)(P＜0.05).The attitude to suicidal behavior was negative correlation with emotion neglect(r=-0.181,P＜0.05)in patients group.Conclusion Emotional and physical neglect are the main types of trauma in patients with BD,and may increase the risk of suicide.It is important to survey the patients with BD on childhood trauma,and intervention is necessary.
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Many studies had shown that the stigma is the important factor for diagnosis,treatment and re-covery of bipolar disorder.The stigma not only has negative effects on the patients and also on the marriage,fami-lies,study,work,medication treatment,and many other aspects.This paper reviews the development of definition of stigma,the characteristics,effects,interventions of stigma of bipolar disorder,finally,make a summary and put for-ward the prospects.
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During past 50 years,has achieved a great progress and derived some profound lessons worthy of learning and studying for our country.This article introduces the deinstitutionalization processes of mental health institutions,reinstitutionalization and the inspiration for Chinese mental health reform.Introduced the paper are the reform of deinstitutionalization of mental health institutions in USA and some other countries,and the concept of such a reform,pointing out inspirations of such a reform for mental health reform in China.
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ObjectiveTo investigate the effects of sleep deprivation on expressions of Mir-132,mir-134 in the different regions of rat brain.MethodsAll the male SD rats were divided into control group ( normal sleep group),sleep deprivation (SD).The modified multiple platform method (MMPM) was used to establish sleep deprivation model.Mir-132,mir-134 level was detected by real time PCR.ResultsMir-132 were significantly increased in SD groups in hippocampus compared with the control groups ( 51.87 ± 8.13 vs 67.25 ± 7.59 ) (P ＜0.01 ).Mir-134 were significantly decreased in SD groups compared with the control groups( 1.82 ±0.15 vs 1.45± 0.12 )(P ＜ 0.01 ).There were no statistically significant differences in cortex and thalamus (P ＞ 0.05 ).Cortex mir-132 level in SD group and control group was 1.57 ±0.10,1.48 ±0.11 respectively,and it was 1.37 ±0.09,1.36 ±0.11 in thalamus;Cortex mir-134 level in SD group and control group was 98.26 ± 5.17,100.80 ±4.15respectively,and it was 97.56 ± 6.28,91.01 ± 4.07 in thalamus.ConclusionThe upregulation of mir-132 and downregulation of mir-134 implies that two miRNAs did opposite actions in the processes of sleep deprivation.This findings indicate that hippocampus mir-132,mir-134 levels in the SD rat may reflect associated depressive patho-physiological processes.
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Objective To develop the bipolar depression index scale (BDIS) and test the validity and reliability of BDIS.Methods The original bipolar depression index scale (BDIS) was developed by the clinical features of bipolar depression reported by the studies focused on comparing the bipolar depression (BP) and unipolar depressive disorder (UP).46 patients with bipolar depression and 44 patients with unipolar depression were rated the original BDIS and enrolled consecutively by DSM-IV.Results There were eleven items in the BDIS.The interrater reliability between eleven items and BDIS score ranged from 0.61 to 0.87.The correlation coefficients between eleven items and BDIS score ranged from 0.53 to 0.73.The Cronbach's alpha of BDIS was 0.68.The mean BDIS score of BP(7.26 ± 3.12 ) was significantly higher than that of UP( (4.80 ± 3.08 ), (P ＜ 0.01 ).The BDIS scores were significantly correlated with the scores of Mood Disorder Questionnaire ( coefficient 0.56) and 32-item hypomania checklist ( coefficient 0.45).The BDIS score could discriminate between BP patients and UP patients by the ROG curve analysis and 5 was the best cutoff score ( sensitivity 0.80, specificity 0.64).Conclusions The validity and reliability of BDIS are fit for the requirements of psychometrics.BDIS may use to differentiate between bipolar depression and unipolar depression in the practice.
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Objective To investigate the validity and reliability of the Chinese version HCL-32(CV-HCL-32) in the patients with bipolar disorder(BP) and the best cut-off between the patients with BP and patients with major depression disorder (unipolar depression disorder, UP). Methods The English version HCL-32 was translated into Chinese version after the agreement of the author of the HCL-32. 300 consecutive patients with BP and 156 consecutive patients with UP in outpatients and inpatients departments diagnostically interviewed with DSM-Ⅳ were rated by CV-HCL-32. The test-retest reliability with interval of eight to fourteen days was investigated in 155 patients (51.7%) with BP in the bipolar patients. Results A two-factor solution was preferred by the factors analysis. The Eigenvalues of the two factors were 6.32, 3.00 respectively. The two factors together accounted for 29.1% of the total variance. The internal consistency( Cronbach's alpha) of the CV-HCL-32 was 0.86.The test-retest reliability of the CV-HCL-32 was 0.62(P＜ 0.01 ). The frequency of positive responses to various items ranged from 11.6% to 89.7%. The mean score of CV-HCL-32 was statistically higher in patients with BP( 16.6 ± 6.2) than that of UP ( 10.9 ± 6.4). A CV-HCL-32 screening score of 14 was chosen as the optimal cutoff between the patients with BP and UP, as it provided good sensitivity (0.74) and specificity (0.66). The positive and negative predictive power for this cut-off was 0.81 and 0.57. Conclusions The study demonstrated the suitable validity and reliability of CV-HCL-32, suggested that the CV-HCL-32 is useful questionnaire for screening bipolar disorder in China.