Risk Factors for Anxiety in Major Depressive Disorder Patients

OBJECTIVE: To analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD). METHODS: This study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively. RESULTS: Compared with the non-anxious group, the anxious-depression group had an older age at onset (t=-4.39, p<0.001), were older (t=-4.69, p<0.001), reported more lifetime depressive episodes (z=-3.24, p=0.001), were more likely to experience seasonal depressive episodes (chi2=6.896, p=0.009) and depressive episodes following stressful life events (chi2=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (chi2=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression. CONCLUSION: These findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD.

Processing environmental stimuli in paranoid schizophrenia: recognizing facial emotions and performing executive functions / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the contribution of executive function to abnormal recognition of facial expressions of emotion in schizophrenia patients.</p><p><b>METHODS</b>Abnormal recognition of facial expressions of emotion was assayed according to Japanese and Caucasian facial expressions of emotion (JACFEE), Wisconsin card sorting test (WCST), positive and negative symptom scale, and Hamilton anxiety and depression scale, respectively, in 88 paranoid schizophrenia patients and 75 healthy volunteers.</p><p><b>RESULTS</b>Patients scored higher on the Positive and Negative Symptom Scale and the Hamilton Anxiety and Depression Scales, displayed lower JACFEE recognition accuracies and poorer WCST performances. The JACFEE recognition accuracy of contempt and disgust was negatively correlated with the negative symptom scale score while the recognition accuracy of fear was positively with the positive symptom scale score and the recognition accuracy of surprise was negatively with the general psychopathology score in patients. Moreover, the WCST could predict the JACFEE recognition accuracy of contempt, disgust, and sadness in patients, and the perseverative errors negatively predicted the recognition accuracy of sadness in healthy volunteers. The JACFEE recognition accuracy of sadness could predict the WCST categories in paranoid schizophrenia patients.</p><p><b>CONCLUSION</b>Recognition accuracy of social-/moral emotions, such as contempt, disgust and sadness is related to the executive function in paranoid schizophrenia patients, especially when regarding sadness.</p>

Event-related potentials P₃₀₀ with memory function and psychopathology in first-episode paranoid schizophrenia / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the variability of event-related potentials P(300) and the relationship with memory function/psychopathology in patients with first-episode paranoid schizophrenia.</p><p><b>METHODS</b>Thirty patients with first-episode paranoid schizophrenia (patient group) and twenty health subjects (control group) were enrolled in the study. The auditory event-related potentials P₃₀₀ at the scalp electrodes Cz, Pz and Wechsler Memory Scale (WMS) were examined in both groups, Positive And Negative Syndrome Scale (PANSS) was evaluated in patient group.</p><p><b>RESULTS</b>In comparison with control group, patients had longer latency of P₃₀₀ [(390.6 ± 47.6)ms at Cz and (393.3 ± 50.1)ms at Pz] (P<0.01), lower amplitude of P₃₀₀ [(7.7 ± 3.4) μV at Cz and (8.5 ± 3.9)μV at Pz] (P<0.05-0.01). The memory quotient (88.1 ± 10.0) scores and short-term memory, immediate memory in patient group were damaged significantly (P<0.05-0.01). In patient group, the latency of P300 was correlated positively with PANSS scores and negatively with WMS scores (P<0.05-0.01).</p><p><b>CONCLUSION</b>First-episode paranoid schizophrenia has memory deficit, which can be evaluated comprehensively by P₃₀₀ and WMS. The longer latency of P₃₀₀ might be associated with the increased severity of first-episode paranoid schizophrenia.</p>

Association between painful physical symptoms and clinical outcomes in Chinese patients with major depressive disorder: a three-month observational study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Painful physical symptoms (PPS) may present as a component of major depressive disorder (MDD). Their effect in Chinese patients has not been investigated. This analysis reports the changes in disease severity, treatment patterns, quality of life and outcomes in a Chinese cohort according to the presence (PPS+) or absence (PPS-) of painful physical symptoms.</p><p><b>METHODS</b>A subgroup of Chinese patients from a large observational 3-month study of patients from Asian countries and regions of China were classified using the modified Somatic Symptom Inventory (SSI) as PPS+ (mean score >or= 2) or PPS- (mean score < 2). Depression severity was assessed with the Clinical Global Impression of Severity (CGI-S) scale and 17-item Hamilton depression rating scale (HAMD(17)). Pain severity was measured using a visual analogue scale (VAS), while the EuroQoL (EQ-5D) assessed patient well-being. Antidepressants were compared with regard to their efficacy.</p><p><b>RESULTS</b>Of the 299 Chinese patients enrolled in the study, 105 were classified as PPS+ (73/105, 70% women). At baseline, PPS+ patients reported greater pain severity (VAS, mean (SD): 49.56 (26.49) vs. 16.60 (20.99) for PPS-, P < 0.01), were more depressed (HAMD(17), mean (SD): 25.32 (5.47) vs. 23.33 (5.24) for PPS-, P = 0.002) and had poorer quality of life (EQ-5D Health State, mean (SD): 38.48 (22.38) vs. 49.57 (18.54) for PPS-, P < 0.001). PPS+ patients showed less overall improvement in depressive symptom severity (HAMD(17), change from baseline (95%CI): -17.38 (-18.65, -16.12) vs. -19.20 (-20.05, -18.35) for PPS-, P = 0.032; CGI-S, change from baseline (95%CI): -2.85 (-3.11, -2.58) vs. -3.20 (-3.38, -3.02) for PPS-, P = 0.044).</p><p><b>CONCLUSIONS</b>PPS were less frequent than expected compared with previous studies of Asian populations. PPS+ were associated with greater MDD severity and less improvement than PPS- when antidepressants were given.</p>

Chronic mild stress stimulates nitric oxide production in rat brain cortex and hippocampus / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To evaluate the nitric oxide (NO) levels in rat brain cortex and hippocampus after chronic mild stress.</p><p><b>METHODS</b>Sixteen male Sprague-Dawley rats were allocated into control group and model group randomly. Model rats were induced by consecutive chronic mild stress; weight gain, open field test and sucrose solution consumption were investigated before and after procedure. Nitric oxide contents in prefrontal cortex and hippocampus were determined by spectrophotometric assays.</p><p><b>RESULT</b>Decreased locomotion, loss of interest and anhedonia were observed in chronic mild stress rat model group. Nitric oxide contents in prefrontal cortex and hippocampus were significantly higher in chronic mild stress group [(31.00 +/-2.55)nmol/mg.pro and (38.11 +/-1.73)nmol/mg.pro, respectively] than those in control group [(26.97 +/-1.38)nmol/mg.pro and (36.06 +/-0.87)nmol/mg.pro, respectively] (P <0.05).</p><p><b>CONCLUSION</b>Chronic stress can stimulate NO release, and dysfunction of nitric oxide pathway may be involved in development of depression.</p>

Imbalanced free radicals and antioxidant defense systems in schizophrenia: a comparative study / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To examine changes of blood oxidative-antiovidative level in schizophrenic patients and its relationship with clinical symptoms.</p><p><b>METHODS</b>Forty-six Chinese patients met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-IV) criteria for schizophrenia and fifty age- and sex-matched healthy controls were enrolled in the present study. Baseline psychiatric symptom severity was assessed with brief psychiatric rating scale, positive and negative syndrome scale on the blood draw day. Fresh blood samples were collected to measure levels of nitric oxide and lipid peroxide in plasma as well as activities of superoxide dismutase, catalase and glutathione peroxidase in red blood cells by spectrophotometric assays simultaneously.</p><p><b>RESULTS</b>Comparison of the biochemical parameters indicated that the level of nitric oxide and lipid peroxide increased in patient group, which represented a positive correlation with positive scale scores; while the activities of three critical enzymes decreased and showed a negative linear correlation.</p><p><b>CONCLUSION</b>This study showed that there are dysregulation of free radical metabolism and poor activities of the antioxidant defense systems in schizophrenic patients. Excess free radicals formation may play a critical role in the etiology of schizophrenia. Using antioxidants might be an effective therapeutic approach to partially alleviate or prevent the symptoms of schizophrenia.</p>

Hemodynamic changes in depressive patients / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients.</p><p><b>METHODS</b>The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were determined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA).</p><p><b>RESULTS</b>In patients with depression without anxiety, LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV.</p><p><b>CONCLUSION</b>The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.</p>

Study on anxiety and depressive disorder of inpatients in general hospital / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To assess the co-morbidity of anxiety and depression in hospitalized patients and to analyze the degree of symptoms and the influential factors.</p><p><b>METHODS</b>Thirty patients with malignant tumor were injected with thymosin alpha 1 subcutaneously at the dose of 1.6 mg q.d. for the first month and q.o.d. for the following month. The number of T cell subgroups and the activity of NK cell in peripheral blood were detected and the quality of life of the patients were evaluated before treatment and at the end of treatment.</p><p><b>RESULT</b>(1) About 39.9 % of the patients presented the symptoms of anxiety and depression and out of them 6.7 % were taken psychotropic medication. (2) Stepwise Logistic Regression showed that the factors related to anxiety and depression could be classified into four categories: economic factor, sleeping status, cognition of disease, the other factors such as course of disease and the environment of hospital. (3) Data analysis of oncology patients showed that the cognition of disease would be an important factor, which would affect anxiety and depression status.</p><p><b>CONCLUSION</b>Multiple factors can affect anxiety and depression symptoms of inpatients. The results suggest that psychological intervention such as cognitive therapy should be considered in clinical practice.</p>