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Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.
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Objective To analyze the treatment trajectory and revelant factors of serotonin reuptake inhibitors (SSRIs) in patients with first-episode major depression after single-drug treatment. And to provide ideas for early optimal treatment. Methods This study was a real-world study in which 82 untreated outpa-tients with first-episode depression were enrolled for SSRIs monotherapy. The Eysenck Personality Test (EPQ),the Liebowitz Social Anxiety Scale (LSAS),Yale -Brown Forced Scale (Y-BOCS),Social Function Deficit Scale (SDSS) were used to assess all patients at baseline. Then the patients were treated with SSRIs monotherapy. Patients who did not achieve a HAMD-17 20% reduction rate in the second week switched to receive another SSRIs monotherapy application. Follow-up to the 12th week to analyze treatment trajectory and identify factors associated with treatment trajectory. Results The psychotism personality trait ( B=-0. 287,95%CI=-0. 701~-0. 071,P=0. 009) and age ( B=0. 099,95%CI=0. 014~0. 244,P=0. 017) were related to treatment trajectories. The psychotism personality trait did not directly influence the treatment trajectory but influenced the treatment indirectly through agitation and the effect value was 0. 016,which ac-counted for 10. 76% of the total effect. Social anxiety and avoidance,depression,anxiety,obsessive-compul-sive symptoms and social dysfunction at baseline were not associated with antidepressant efficacy. Conclusion Psychoticism can predict the efficacy of antidepressants treatment as a mediator at the second week of treat-ment.
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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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Objective · To detect the vitamin D2 and D3 levels in the patients with moderate and severe depression. Methods · Eighty-five patientswho met the criteria for major depressive disorder were recruited (53 patients with moderate depression, 32 patients with severe depression). Fifty agematchedhealthy volunteers were recruited as controls. Serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels were detected by using liquidchromatography-tandem mass spectrometry (LC-MS/MS). The risk factors which might influence the severity of depression were screened by Logisticregression analysis. Results · The serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in the case group was lower than those in the controlgroup (P=0.012, P=0.000, P=0.000). The patients with moderate depression presented significantly lower serum 25 (OH) D3 and total 25 (OH) D2/D3 levelsthan the controls did (P=0.000), although no significant difference in serum 25 (OH) D2 levels was found between these two groups. As well, the serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in patients with severe depression were significantly lower than those in patients with moderate depression and controls (P<0.05). The body mass index of severe depression group was much higher than that of moderate depression group and control group (P=0.002). Both overweight/obesity and the concentration of vitamin D may be the major influencing factors of depression severity (P=0.034, P=0.011). Conclusion · Vitamin D2 and D3 deficiency in depressive patients, particularly in those patients with severe depression, was shown in the present study. In addition, overweight/obesity as well as the concentration of vitamin D may exert the significant influence on the severity of depression. Vitamin D supplementation and weight control may be needed to be considered in making therapeutic strategies of major depressive disorder.
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Objective To investigate the prevalence of anxiety and depression among the persons with disabilities in Shanghai and the factors related to them. Methods From November to December, 2014, 731 persons with disabilities were consecutively enrolled in this cross-sectional study. They were assessed with Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS). Binary Logistic regression analysis was employed to reveal potential related factors of anxiety and depression. Results The prevalence rates of anxiety and depression among the disabled in Shanghai were 9.58%and 8.48%, respectively. The duration (OR=0.967, P<0.05) and severity (OR<1, P<0.05) of disability were associated with depression, whereas retiral (OR=2.047, P<0.05), living alone or in care unit (OR=3.073, P<0.01) and duration of disability (OR=0.956, P<0.01) were associated with anxiety. Conclusion The frequency of anxiety and depression is mild among the persons with disabilities in Shanghai, and a special intervention is needed.
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Objective To evaluate the effect of using standardized patients (SP) in psychiatry class teaching.Methods A standardized patient was used when giving instructions on seven years clinic medicine students of Fudan university,the effect of this teaching model was assessed.Results Totally 96.19％ of students believed that standardized patients teaching model was better than the traditional model.Students in classes of using standardized patients scored higher than students in classes without using standardized patients.Conclusion The standardized patients teaching mode,recognized by almost all students,is believed to help students to better master the knowledge of psychiatry.
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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.
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To investigate clinical features of somatization disorder. Methods Seventy-nine paeeeeee with somatization disorder (SD), diagnosed based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, version 3 ( CCMD-3 ) during September 2006 to August 2008, were selected and assessed by serf-edited somatic symptom list ( SSSL), symptom checklist-90 ( SCL-90 ), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Results Sixty-two symptoms in two to six systems were involved in SDs, with a mean and standard deviation of 12.4 ± 6.6 symptoms in 4.2 ± 0.9 systems. The skin, nervous system, gastrointestinal system, respiratory and circulatory systems were the most involved in those symptoms. Depression, anxiety and hostile mood, number and total score of somatic symptoms all correlated positively with the total scores of HAMA and scores of somatic anxiety and mental anxiety (P < 0.01 ), but not with the total score of HAMD (P > 0.05 ). Conclusions Multiple systems were involved in SD, usually with complicated symptoms including depression and anxiety, which was prone to inappropriate medical diagnoses. Number and severity of somatic symptoms positively correlated with severity of anxious symptoms.
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Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.
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0.05). The score of HAMD(38.1?4.0/33.4?4.7,t=4.35), HAMA(22.6?5.5/11.7?2.7,t=10.93), GDS(14.0?1.2/12.1?2.0,t=4.92) of comorbidity group was significantly higher than that of the depression group. The social function (SF)(70.0?21.2/50.0?22.5,t=4.02) and physical function (PF)(79.2?13.6/69.1?13.6,t=3.25) scores of SF-36 were significantly higher in depressive group than in comorbidity group. Conclusion: Comorbid depression and anxiety and anxious depression are associated with more severe overall psychopathology than nonanxious depression in elderly persons, similar to observations in younger adults.