Interoceptive sensitivity and anxiety disorders / 中华行为医学与脑科学杂志

Anxiety disorders are the most prevalent mental health condition.More and more studies have found that interoceptive sensitivity, such as the sensitivity of the body to a series of physiological activities such as heart rate, respiration, blood pressure and so on, is closely related to the susceptibility to anxiety disorders.So, understanding the role of interoception in the occurrence of anxiety disorders plays an important role in understanding the pathogenesis of the disease and guiding treatment.This article reviewed the pathogenesis of anxiety disorders, the interaction between increased interoceptive sensitivity and abnormal activation of the amygdala, which results in pathological anxiety, the insula also regulates emotional responses by regulating interoception.It is also associated with genes and neurotransmitters, which may be important biomarkers of anxiety disorders.At the same time, interoception is also associated with genes and neurotransmitters, which may also be important biomarkers of anxiety disorders.In terms of treatment, we can use respiratory therapy to regulate respiratory perception, apply rTMS to stimulate the relevant network of interoception, and use electroencephalography to reflect interoception biofeedback and other treatment methods to improve interoception, to alleviate anxiety symptoms.In conclusion, the abnormal sensitivity of interoception plays an important role in the occurrence of anxiety disorders.Currently, there are many therapeutic methods for the treatment of anxiety disorders based on interoception, but the relevant therapeutic mechanism is unclear.Therefore, future research needs to explore the mechanism of interoception in anxiety and explore the mechanism of related treatment.

Eye movement characteristics of social cognitive processing in patients with schizophrenia across different clinical stages / 中华行为医学与脑科学杂志

Objective:To explore the eye movement characteristics of social cognitive processing in schizophrenia patients across different stages and its association with clinical symptoms.Methods:Fifteen patients with first-episode schizophrenia, forty-six patients with chronic inpatient schizophrenia, thirty-six patients with psychiatric clinical high-risk syndrome, and twenty-six healthy controls were recorded using eye tracking technology when viewing social interaction pictures. Covariance analysis and partial correlation analysis were conducted by SPSS17.0.Results:When watching the pictures of person communication, there were statistically significant differences in the average fixation duration of the four groups of subjects ((294.6±36.7)ms in control group, (280.0±54.0)ms in clinical high-risk group, (268.5±34.9)ms in first-episode group, and (315.7±75.7) ms in chronic group, respectively, F=3.18, P=0.027). When viewing the pictures of no person landscape, the average saccade amplitude of the four groups of subjects was significantly different (5.3±1.1) ° in control group, (4.7±1.1) ° in clinical high-risk group, (5.2±1.0) ° in first-episode group, and (4.4±1.2) ° in chronic group, respectively, F=3.37, P=0.021). The average fixation duration of chronic patients when observing person communication pictures was positively correlated with the total score of PANSS (partial correlation coefficient=0.313, P=0.039). The average fixation duration of chronic patients when observing the other two types of pictures were also positively correlated with the total score of PANSS (partial correlation coefficient=0.320, P=0.034, no person communication pictures; partial correlation coefficient=0.372, P=0.013, no person landscape pictures) . The average fixation duration of chronic patients when observing pictures of no person landscape was positively correlated with the PANSS positive symptom score (partial correlation coefficient=0.321, P=0.034). The average fixation duration of chronic patients when observing any type of picture was positively correlated with the PANSS general symptom score (person communication pictures: partial correlation coefficient=0.385, P=0.010; no person communication pictures: partial correlation coefficient=0.409, P=0.006; no person landscape pictures: partial correlation coefficient=0.465, P=0.001). In the first-episode patient, the average saccade amplitude when observing no person communication pictures was positively correlated with the PANSS positive symptom score (partial correlation coefficient=0.555, P=0.049). In the clinical high-risk group, the average saccade amplitude when observing person communication pictures was negatively correlated with the SOPS positive symptom score (partial correlation coefficient=-0.373, P=0.030). Conclusion:There are statistically significant differences of eye movement characteristics of social cognitive processing in patients with schizophrenia across different clinical stages.The average saccade amplitude is more sensitive than the average fixation duration in predicting the severity of symptoms in clinical high-risk patients.

The relationship study on alexithymia and interoception in patents with panic disorder / 中华行为医学与脑科学杂志

Objective To explore the characteristics of alexithymia and interoception in patients with panic disorder(PD) and its relationship. Methods Thirty-seven patients with PD and 45 healthy con-trols who met the diagnostic criteria of DSM-Ⅳ were selected. Toronto Alexithymia Scale ( TAS) and state-trait anxiety inventory ( STAI) were used to assess the characteristics of alexithymia and anxiety symptoms respectively. The heartbeat perception levels were tested by the Mental Tracking Paradigm. Results The de-tection rate of alexithymia in patients with panic disorder was 37. 83% (14/37),but the rate in the normal control group was only 4. 44%(2/45),and the difference was statistically significant (χ2=14. 42,P<0. 05). The total score of TAS (55. 11±10. 99),factor Ⅰ (20. 62±6. 78) and factor Ⅱ (14. 68±3. 70) in the PD group were higher than those in the control group (42. 93± 9. 25,12. 82± 4. 99,11. 42±3. 04; F=20. 72, 31. 08,15. 31,P<0. 01). The levels of the heartbeat perception were higher in the PD group than that in the control group (0. 75±0. 15,0. 58±0. 19;t=4. 13,P<0. 05). In PD group,the score of STAI were positively correlated with TAS total score and factor Ⅰ and Ⅱ scores( r=0. 57,0. 61,0. 47;r=0. 54,0. 62,0. 39,P<0. 05). There was no significant correlation between the scores of STAI and the level of interoception. The mediating effect of interoception level on alexithymia and state anxiety was not significant while the mediating effect on alexithymia and trait anxiety was also not significant. Conclusions The alexithymia detection rate and interoception sensitivity in patients with panic disorder were higher than those of healthy people. There may be interaction between alexithymia and anxiety symptoms. Interoception may be a clinical feature of panic disorder.

Alternations in cortical thickness and functional connectivity in patients with generalized anxiety disorder / 中华行为医学与脑科学杂志

Objective To investigate the changes of cortical thickness and relative resting state functional connectivity in patients with generalized anxiety disorder (GAD).Methods The present study analyzed structural and eyes-open resting state functional MRI were performed in 21 patients with GAD and 22 matched healthy controls.Cortical thickness was estimated with FreeSurfer.The structurally altered regions were defined as region of interest (ROI) to analyze functional connectivity (FC) using resting state functional MRI data by DPABI.Results Cortical thickness of patients with GAD were increased in right rostral middle frontal gyrus (rMFG;MNI:x =27.9,y =53.4,z =-11.1;size:241.93 mm2;FDR corrected,P ＜ 0.1) and right inferior temporal gyrus (IGT;MNI:x =49.7,y =-57.8,z =-8.7;size:138.93 mm2;FDR corrected,P＜0.1) compared with healthy controls.FC between right rMFG and right superior/middle occipital gyrus as well as well as FC between rMFG and right precentral gyrus showed decreased in patients with GAD compared with healthy controls(AlphaSim corrected,P＜0.05).FC between right rMFG and right angular gyrus showed increased in patients with GAD compared with healthy control (AlphaSim corrected,P＜0.05).Conclusion The rMFG may play an important role in the pathophysiology of GAD,which can be used as an stimuli target in physicotherapeutics to improve anxiety symptoms.

Comparison of development of gastric insufflation related to different peak inspiratory pressures during facemask ventilation in pediatric patients: ultrasonographic measurement / 中华麻醉学杂志

Objective To compare the development of gastric insufflation related to different peak inspiratory pressures (PIPs) during facemask ventilation in the pediatric patients.Methods Ninety male pediatric patients,aged 2-4 yr,of American Society of Anesthesiologists physical status Ⅰ,scheduled for elective surgery under general anesthesia,were randomly divided into 5 groups (n =18 each) using a random number table:PIP 8 cmH2O group (group P8),PIP 10 cmH2O group (group P10),PIP 12 cm H2O group (groupP12),PIP 14cmH2O group (group P14) and PIP 16 cmH2O group (group P16).Anesthesia was induced with fentanil,propofol and rocuronium in sequence.After loss of eyelash reflex,positive pressure facemask ventilation was performed for a 120 s period in pressure-controlled mode.Gastric insufflation was detected by real-time ultrasonography of the antrum,and cross-sectional antral area was measured using ultrasonography before facemask ventilation and at 120 s of facemask ventilation.The pulse oximetry (SpO2),tidal volume (VT),end-tidal pressure of carbon dioxide (PETCO2) and end-tidal oxygen concentration (ETO2) were recorded at 30,60,90,and 120 s of facemask ventilation.The development of gastric insufflation and hypoventilation was recorded.Results Compared with group P8,the incidence of gastric insufflation was significantly increased in group P16 (P＜0.01),and no significant change was found in the incidence of gastric insufflation in the other groups (P＞0.05),the incidence of hypoventilation was significantly decreased,VT and ETO2 were increased,and PET CO2 was decreased in P12,P14 and P16 groups,and PETCO2 was significantly decreased at 120 s of facemask ventilation (P＜ 0.05 or 0.01),and no significant change was found in the other parameters in group P10 (P＞0.05).Compared with P12 and P14 groups,VT was significantly increased,PEHTCO2 was decreased at 120 s of facemask ventilation (P＜0.05),and no significant change was found in the incidence of hypoventilation and ETO2 in group P16 (P＞0.05).There was no significant difference between group P12 and group P14 in the incidence of hypoventilation,VT,PETCO2 and ETO2 (P＞0.05).The pediatric patients showed a certain CO2 accumulation [PETCO2 (40.6±4.0) mmHg] at 120 s of facemask ventilation in group P8,and the pediatric patients showed excessive ventilation [PETCO2 (23.6± 1.4) mmHg],and cross-sectional antral area was not measured using ultrasonography in three cases because of excessive gastric insufflation in group P16.Conclusion PIP at 12-14 mmHg in pressure-controlled ventilation mode can not only ensure adequate preoxygenation and but also avoid excessive gastric insufflation during facemask ventilation in the pediatric patients.

Effect of integrative cognitive training on mild cognitive impairments: a one-year follow-up study / 中华老年医学杂志

Objective To evaluate the middle and short-term effects of integrative cognitive training on mild cognitive impairments(MCI).Methods All the participants with MCI aged over 70 years were selected from one sub-district of Putuo District,Shanghai and divided into cognitive intervention group (n=46) and control group (n=35).The integrative cognitive training was conducted in 24 sessions for 12 weeks.All subjects were assessed by Neuropsychological Test Battery for Elderly (NTBE) and by a questionnaire of Shanghai Health Survey for the Elderly (VER2006)at baseline,follow-up and one-year follow up phases.Results At baseline phase,semantic relations test in NTBE was better (t=2.13,P=0.037),verbal fluency test (vegetables) in NTBE was worse(t =-2.25,P=0.038) in intervention group than in control group,while there were no significant differences in scores of other neuropsychological tests between intervention group and control group(all P＞0.05).At follow up phase,16 subscales in reasoning test of NTBE were improved (t=-2.70,P=0.010)and 2 subscales were declined in cognitive intervention group(all P＜0.05).9 subscales in semantic relations test of NTBE (t=-2.27,P=0.013) were improved and 5 subscales were declined in control group (all P＜ 0.05).Comparison between groups at one year follow-up showed that 5 subscales in reasoning test of NTBE (F=16.80,P=0.000) were better in intervention group than in control group(all P＜0.05).General linear model (GLM) with repeated measures at three time points showed that 4 subscales in reasoning test of NTBE had a time-by group interaction (F=5.16,P=0.01).Conclusions Integrative cognitive training can improve cognitive function in patients with mild cognitive impairments,and the validity of reasoning ability can sustain one year.

Influence of AT1 receptor blockade on brain-derived neurotrophic factor signaling in hippocampus of mice / 心血管康复医学杂志

Objective:To explore the alteration of brain‐derived neurotrophic factor (BDNF) signaling and the influ‐ence of irbesartan on it in hippocampus of angiotensin‐converting enzyme 2 (ACE2) knock‐out (KO) mice . Meth‐ods:The 10~11‐week ACE2 KO (Ace2/y ) mice received daily treatment with angiotensin II (Ang II) type 1 (AT1) receptor blocker irbesartan (50 mg/kg) or placebo for two weeks. The wild‐type mice (WT ,Ace2+ /y ) were regarded as normal control. Western blotting method was used to measure levels of BDNF and extracellular signal regulated kinase 1/2 (ERK1/2) in the mice hippocampus. Radioimmunoassay was used to measure plasma Ang level in mice . Results :Compared with normal WT control mice ,there were significant down‐regulations of BDNF protein expres‐sion [ (1 ± 0.16) vs .(0.54 ± 0.16)] in hippocampus and plasma Ang‐ (1‐7) level [ (55.6 ± 7.5) pg/ml vs .(42.8 ± 5.8) pg/ml] ,and significant rise in ERK1/2 phosphorylation [ (1 ± 0.28) vs .(1.79 ± 0.29)] in ACE2 KO mice (P<0.01 all). After irbesartan treatment ,there were significant rise in BDNF protein expression (0.88 ± 0.13) in hippocampus and plasma Ang‐ (1‐7) level [(59.4 ± 8.4) pg/ml] ,and significant reduction in ERK1/2 phosphoryla‐tion level (1.33 ± 0.19) in ACE2 KO mice (P<0.05 or <0.01) .Conclusion:There are BDNF protein expression down‐regulation and enhanced ERK1/2 phosphorylation in hippocampus of ACE2 KO mice. AT1 receptor blockade irbesartan can improve Ang‐ (1‐7 ) level and hippocampus BDNF expression , while reducing hippocampus ERK phosphorylation signal in ACE2 KO mice ,suggesting that AT1 receptor blockade possesses certain brain protective effect.

Construction of database for clinical cases based on evidence-based medicine / 中华医学科研管理杂志

Based on the background,conception and the core ideas of the evidence-based medicine,the construction and application of domestic clinical cases database was discussed.Problems concerning statistics,management and application in scientific research encountered in the database devel opment were presented,and suggestions were proposed.

Altered Activity and Functional Connectivity of Superior Temporal Gyri in Anxiety Disorders: A Functional Magnetic Resonance Imaging Study

OBJECTIVE: The prior functional MRI studies have demonstrated significantly abnormal activity in the bilateral superior temporal gyrus (STG) of anxiety patients. The purpose of the current investigation was to determine whether the abnormal activity in these regions was related to a loss of functional connectivity between these regions. MATERIALS AND METHODS: Ten healthy controls and 10 anxiety patients underwent noninvasive fMRI while actively listening to emotionally neutral words alternated by silence (Task 1) or threat-related words (Task 2). The participants were instructed to silently make a judgment of each word's valence (i.e., unpleasant, pleasant, or neutral). A coherence analysis was applied to the functional MRI data to examine the functional connectivity between the left and the right STG, which was selected as the primary region of interest on the basis of our prior results. RESULTS: The data demonstrated that the anxiety patients exhibited significantly increased activation in the bilateral STG than the normal controls. The functional connectivity analysis indicated that the patient group showed significantly decreased degree of connectivity between the bilateral STG during processing Task 2 compared to Task 1 (t = 2.588, p = 0.029). In addition, a significantly decreased connectivity was also observed in the patient group compared to the control group during processing Task 2 (t = 2.810, p = 0.012). CONCLUSION: Anxiety patients may exhibit increased activity of the STG but decreased functional connectivity between the left and right STG, which may reflect the underlying neural abnormality of anxiety disorder, and this will provide new insights into this disease.

The effect of antipsychotics on reduced oscillatory gamma-band responses in schizophrenic patients / 中华行为医学与脑科学杂志

ObjectiveTo explore gamma resonance signals in acute medication-free schizophrenics,and the effects of antipsychotics on gamma activity.MethodsSchizophrenia patients( n=56) and normal controls ( n =18 ) underwent auditory steady-state event-related potential testing and were evaluated of their psychopathic syndromes with the positive and negative syndrome scale (PANSS) before and after 8 weeks of medication with oral chlorpromazine or clozapine.Click trains varying in rate of stimulation 40 Hz were presented; EEG-evoked power and intertrial phase synchronization were obtained in response to stimulation frequency.ResultsSchizophrenic patients showed reduced evoked power( Fz:( 5.08 ± 1.48) μV2 vs (6.91 ± 1.64) μV2 ; Cz:(4.70 ± 2.03 ) μV2 vs ( 6.93 ± 1.43 ) μV2 ; P ＜ 0.01 ) and a tendency of reduction in phase synchronization ( Fz:0.14 ± 0.04 vs 0.13 ± 0.04,P =0.051 ; Cz:0.18 ± 0.06 vs 0.17 ± 0.06,P =0.056) in response to 40 Hz stimulation.However significant correlations were not observed between oscillatory responses and clinical parameters in schizophrenic patients.There were no significant differences of gamma power and ITC in patients before and after chlorpromazine or clozapine administered.ConclusionSchizophrenia patients have deficits in the power and coherent of gamma oscillations,and can not be normalized by medication with antipsychotics.

Effects of compositive cognitive training for healthy community elders in reasoning ability: a controlled trial / 中华行为医学与脑科学杂志

Objective To evaluate the effects of compositive cognitive training on reasoning ability for healthy community elderly.Method All the participants were selected from one district in Shanghai by every 50 samples.151 community healthy elderly who accorded with the standard were collected at last.They were divided into cognitive intervention group ( n =90) and control group ( n =61 ) by sequence.The interventions ( includes reasoning,memory training,et al) were conducted in 24 sessions over 12 weeks.All individuals were assessed by Neuropsychological Test Battery for Elderly (NTBE) at baseline,follow-up,half a year follow-up and one year follow-up phase,and Raven' s Standard Progressive Matrices on reasoning classes.Results The scores of Raven' s Standard Progressive Matrices were significantly higher after reasoning training in intervention group( (15.54 ±5.70),(10.35 ± 5.10),t =3.595,P ＜ 0.01 ).Compared with baseline,the reasoning test scores of NTBE were significantly higher after cognitive intervention in treatment group at follow-up phase,and were also significantly higher than control group (P ＜ 0.05 or P ＜ 0.01 ).Conclusion Results support the effectiveness of compositive cognitive training in improving reasoning ability are positive,and can last for one year.

Follow-up survey on psychological health status in persons bit by dogs / 中华全科医师杂志

Objective To investigate psychological health status and its change in short term among persons bit by dogs.Methods Psychological health status was evaluated with patient health questionnaire (PHQ-15) Chinese version for the 613 wounded persons bit by dogs,including 368 males and 245 females with average age of 36 years plus or minus 14 years (standard deviation),meanwhile their wounds were handled routinely at clinics,as well as health education and cognitive psychological intervention were provided for them.Results All of the 613 persons with dog bites had mild or moderate somatic syndrome in their initial visits and 478 of them (78.0%) still presented mild somatic syndrome and only 23 (3.7%)with moderate symptoms four week after dog bites by PHQ-15 scores.One hundred and fifty-two of 613 (24.8%) followed-up at their initial visits had depressive symptoms,which could remain in 61 of them (10.0%) four weeks after bites.Two hundred and eighty-four of them (46.3%) had anxiety symptoms at initial visits,and 258 (42.1%) still had mild and nine (1.5%) had moderate symptoms four weeks after bites.Conclusions Psychological symptoms were popular in wounded persons by dog bites,which can persist for a certain time.PHQ-15 can be used for evaluating their psychological status.

Developing of somatic self-rating scale and its reliability and validity / 中华行为医学与脑科学杂志

Objective To assess the reliability and validity of the Somatic Self-rating Scale(SSS). Methods The sample consisted of 589 outpatients and 64 inpatients, which all the patients completed Zung's Scales at the same time to test criterion validity of the SSS. And 24 inpatients were selected randomly to take a retest after two weeks without antidepressant treatment. Result The test-retest reliability of the SSS was 0.96 and the Cronbach' s αcoefficients was 0.89. The correlation coefficients of the four factors with the total scale score ranged from 0.76 to 0.88, the correlation coefficients of the four factors ranged from 0. 56 to 0.70. The confirmatory factor analysis showed that the fit index for GFI, NFI, NNFI, CFI, IFI were all approaching 0.9, REMEA = 0. 064,x2/df = 3.67. The factor loadings ranged from 0. 427 to 0.732. Correlations with Zung's Scales were in range of 0.74to 0. 80 while the four factors were in range of 0.55 to 0.74. Drawing the ROC curve and the area under the curve was 0.841. Conclusion The SSS has a high reliability and a good validity and can be used in general hospital.

Depression and quality of Life before and after diagnosis of lung cancer / 中华胸心血管外科杂志

Objective The aim of the present study was to assess the frequency of depression and quality of life(QoL)in lung cancer patients before and after diagnosis , and to investigate the potential related factors. Methods The subjects consisted of 115 consecutive adult patients newly diagnosed for lung cancer in Shanghai Pulmonary Hospital between April 2008 and October 2008. Depression and QoL were evaluated before the diagnosis for baseline; the same evaluation was repeated after surgery. The median interval was 34.6 days (ranged 28-44 days). Patients' biomedical characteristics were noted from patients' medical records, while the demographic factors were obtained during the interview at the out-patients department. Statistical analysis was used to identify the significant predictors. Results The overall incidence of depression before final diagnosis and after surgery was 22.6% and 17.4 %, respectively. No significant change in the prevalence of depression was found in our study. Education, cost of hospitalization, and smoking status were associated with an increased risk of depression before final diagnosis. Age, having confidant, performance status, and type of surgery were found related with postoperative depression. Patients' QoL had a decrease in every subscale after surgery. Changes in role, social functioning scales and fatigue, pain symptom scales were found significantly. In QoL subsc ales, preoperative dyspnea, postoperative role functioning, fatigue , and pain were associated with changes of depression. Conclusion Depression may be present prior to final diagnosis in lung cancer patients and it does not seem to decrease significantly after surgery, indicating the need for psychological screening and appropriate intervention during theperioperative period. A poorer QoL was detected after surgery, which maybe partly contributed to depression symptoms.

The reliability and validity of the SF-36 health survey for patients with chronic soft tissue pain / 中华物理医学与康复杂志

Objective To explore the reliability and validity of the Chinese version of the 36-item Short Form Health Survey (SF-36) for evaluating the health-related quality of life of patients with chronic soft tissue pain, (CSTP). Methods Two hundred and ten CSTP patients were rated with the SF-36 and the Medical Outcomes Study Pain Measurement (MOSPM) instrument and retested 2 weeks later. The internal consistency, test-retest relia-bility and parallel validity of the SF-36 were analyzed. Results The SF-36 showed good internal consistency and test-retest reliability. Most repeated reliability internal correlation coefficients were between 0.44 and O. 66 (P≤0.01) except that of the SF sub-scale of the SF-36, which was O. 336 (P≤0.05). All the internal consistency Cronbach's a coefficients were >0.70. In the assessment of validity, there was significant correlation among all eight sub-scales of the SF-36, and between items 4-11 and total MOSPM scores. The correlation coefficients were between -0.145 and 0. 635 (P≤0.05 or P≤0.01), except between GH of the SF-36 and item 4 of the M OSPM (pain in-fluence on walking) and between MH and item 10 (pain influence days). Conclusion The Chinese version of the SF-36 has good reliability and validity in assessing the health related quality of life of CSTP patients.

The impact of depressive symptoms on psychological and physical outcomes: a 5-year follow-up study of elderly at the community level / 中华流行病学杂志

<p><b>OBJECTIVE</b>To explore the impact of depressive symptoms on psychological and physical outcomes among elderly living in the residential areas.</p><p><b>METHODS</b>A five years follow-up survey of health outcome was carried out among people aged 55 years or above in community without dementia. The outcome measurements included CES-D (center for epidemiological survey, depression scale), MMSE (mini-mental state examination), ADL (activity of daily living), LSIA (life satisfaction index A), index of physical disease and self-rated health questionnaire. A multiple regression analysis was administered to explore the correlation between depressive symptoms and indices of psychological and physical outcomes.</p><p><b>RESULTS</b>(1) Data from 2 927 subjects having completed two surveys were analyzed. Baseline data showed significant distribution difference of MMSE, ADL, gender and education among the four CES-D score levels. (2) No significant correlation between CES-D score at baseline and MMSE, ADL, LSIA score at five-year follow up was found after controlling the age, gender, educational level and baseline score of MMSE and ADL. (3) Self-rated general health and memory change were significantly correlated to baseline CESD score under controlling the effects of other baseline variables. (4) The score of CESD was found to be a significant predictor for risks of physical disease and mortality by logistic regression model. The odds ratios were 1.52 (95% CI: 1.19 - 1.95) and 2.68 (95% CI: 1.41 - 5.06) respectively.</p><p><b>CONCLUSION</b>Depressive symptoms play an important role on both psychological and physical health outcomes among elderly living in the community.</p>

A study on psychosocial risk factors of vascular dementia / 中国神经精神疾病杂志

Objective 　To explore the relationship between psychosocial factors and risk of vascular dementia. Methods　A cohort study of people 55 years old and over were followed up 10 years after a baseline screening. 5055 older subjects in Shanghai were stratified and cluster sampled from community. Information about psychosocial factors was collected during the baseline screening with an interview in 1987. The clinical diagnosis of dementia and vascular dementia (VD) were made according to DSM-Ⅲ-R and Hachinski Ischemic Score (HIS). In 1997,the elders who were not having dementia in 1987 were surveyed; Clinical diagnosis terms of that was made in above mentioned criteria. Then we analyzed the relationship between the psychosocial factors and VD in community elderly population by means of Logistic regression and estimated the incidence of VD.Results　1203 subjects were re-surveyed in 1997 and among them 124 new cases of dementia including 36 cases of VD were identified. By calculating the relative risk (RR) of psychosocial factors to the VD, we found that several psychosocial factors were correlated with the VD including not taking group activities, unsatisfying life, negative life events and depression (RR＞1). ADL total score are also good predictive points for VD.Conclusions　Psychosocial factor may play an important role in the vascular dementia developed.

A multi-factor analysis of the relationship between changes of item scores of MMSE and the incidence of dementia in community elderly / 中华老年医学杂志

Objective To study the rule of dynamic change of cognitive function in community elderly and predicting for dementia through using items of MMSE. Methods A 10 year follow up of cognitive function survey was carried out in the non dementia old people using Chinese version Mini Mental State Examination(MMSE). The elder people were divided into two groups (dementia group and non dementia group) according to the DSM Ⅲ R diagnostic criteria 10 years later. Results (1) A total of 1 192 subjects completed all data sheets by two surveys and 124 cases(10 4%)were identified in the second survey 10 years later. (2)Almost all the baseline item scores and its change of MMSE of the dementia group were higher than that of the non dementia group. (3)Orientation of time, serial subtration by seven, reading items of MMSE were effective predictors for the dementia, resding and orientation of time were significant predictors for Alzheimer's disease through logistic regression model. Conclusions The item analysis of MMSE is important information for the epidemiological research.

Current situation of mental health service in domestic general hospitals and measures for improvement / 中华医院管理杂志

By analyzing the scope and demands of mental health service in general hospitals, the authors point out that at present domestic general hospitals are confronted with such problems as insufficiency of resources for mental health service, low recognition rate of dysphrenia, and lack of systematic consultations and liaison in psychiatric work. Then they put forward a number of measures for improving mental health service in general hospitals: ①establishing a department of psychiatry in each general hospital; ②widely conducting consultations so as to maintain a strong liaisom in psychiatric work; ③genuinely achieving the transformation of the medical mode; ④strengthening education in psychological medicine and the spread of popular science so as to broaden the channel and coverage of mental health service and meet the needs of reform and development of the health cause in the contemporary era.