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ObjectiveTo explore the characteristics of adolescent non-suicidal self-injury （NSSI） behavior， and to enable clinicians to further understand adolescents with NSSI behavior， so as to make better clinical diagnosis and intervention. MethodsFrom July 2022 to June 2023， 120 adolescent patients with NSSI behavior were selected from the outpatient department of our hospital by convenience sampling， and the general demographic data were collected by self-made general situation questionnaire. The characteristics and motivation of NSSI among adolescents with NSSI were analyzed by using the NSSI questionnaire and Ottawa self-injury inventory （OSI）. ResultsThe average age of the first NSSI in the adolescents was 12.90±1.233， and the most common was 13 years old. The most common site of NSSI was the lower arm or wrist （58.33%）， followed by the hand （27.5%）. The most commonly used NSSI was "intentionally cutting oneself" （68.33%）； The most common motivation for NSSI is emotional regulation. ConclusionThere are significant differences in gender among adolescents with NSSI behavior. The age of first NSSI is concentrated， and the highest incidence is in the 11‒14 years old. The common way of self-injury is cutting. NSSI is usually associated with the intention to relieve suffering and is characterized by high frequency， using variety of methods， and low mortality. Adolescents with NSSI often choose to implement NSSI with emotion regulation as the main function， including external emotion regulation and internal emotion regulation.
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ObjectiveTo systematically review the efficacy of intervention by WeChat on medication compliance， psychotic symptom and recurrence rate of schizophrenic patients in community. MethodsDatabases including PubMed， the Cochrane Library， CBM， CNKI， Wanfang Data and VIP were searched electronically from January 1， 2011 to November 1， 2020 to collect randomized controlled trials （RCTs） about the effects of WeChat intervention on community schizophrenic patients. After two reviewers independently screened literature， extracted data and assessed the risk of bias of included studies， the meta-analysis was performed with Stata 12.0 software. ResultsA total of 381 articles were retrieved and finally 10 RCTs were included， including 1 251 patients with WeChat intervention group 641 cases and routine health education group 610 cases. Meta-analysis showed that compared with the conventional health education group， the WeChat intervention group had higher medication compliance （OR=3.05，95% CI：1.98~4.69，P<0.01）， lower PANSS score （SMD=-1.05，95% CI：-1.46~-0.64，P<0.01） and relapse rate （OR=0.34，95% CI：0.24~0.48，P<0.01）. ConclusionThe interactive intervention based on WeChat platform can effectively improve the medication compliance of patients with schizophrenia in the community， help to reduce the severity of psychotic symptoms and the recurrence rate.
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Objective To explore the relationship among depression,anxiety and social support in elderly patients in community outpatient clinic. Methods A total of 551 elderly outpatients from two com-munity health service centers of Hongkou District in Shanghai were evaluated with patient health question-naire-9 (PHQ-9),generalized anxiety disorder-7 (GAD-7),perceived social support scale( PSSS) for de-pression,anxiety,physical health and social support. Results The prevalence rates of depression and anxiety were 26. 1% and 17. 2%,respectively. The scores of PHQ-9 and GAD-7 were 2. 0(4. 0) and 1. 0(2. 0). There were statistically significant differences in the scores of family support,friend support,other support and social support among the elderly patients with different degrees of depression or anxiety (P<0. 01). Fam-ily support(B=-0. 196) and friend support(B=-0. 171) were protective factors of depression in elderly pa-tients in community outpatient clinic. Age,family support and friend support were protective factors of anxiety in elderly patients,while gender and fluctuation of physical diseases were protective factors of anxiety(P<0. 05). Con-clusions The depression and anxiety is intimately related to social support in elderly outpatients. Appropriate measures should be taken to optimize social support,mitigate bad mood negative improve their quality of life.
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Objective To investigate the relationship between the serum levels of retinol-binding protein 4(RBP4),blood lipid level and glycemic control in patients with chronic schizophrenia complicated with type 2 diabetes.Methods The levels of glycated hemoglobin (HbA1c),fasting plasma glucose (FPG),cholesterol (TC),triglycerides (TG),high-density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),apolipoproteinA1 (Apo A1),apolipoprotein B(Apo B),apolipoprotein E(Apo E),lipoprotein(a)[Lp (a)],free fatty acid(FFA),RBP4,fasting insulin (FINS) were determined in 96 patients with chronic schizo-phrenia complicated with type 2 diabetes (schizophrenia group) and 50 healthy subjects (healthy control group),the insulin resistance index (HOMA IR)was calculated.The patients were divided into HbA1c<7.0% group and HbA1c≥7.0% group according to the results of the HbA1c,and the results were statistically analyzed.Results In the HbA1c<7.0% group,the levels of HbA1c,FPG,TG,Apo B,Apo E,Lp(a),RBP4 were significantly higher than those in the healthy control group,the levels of serum Apo A1 and HDL-C was lower than those in the healthy control group (P<0.05).In the HbA1c≥7.0% group,the levels of HbA1c, Body mass index (BMI),FPG,TG,Apo E,FFA,RBP4,FINS,HOMA-IR were significantly higher than those in the HbA1c<7.0% group and the healthy control group,the levels of TC,Apo B,Lp(a)were significantly higher than the healthy control group and the levels of serum Apo A 1 and HDL-C were lower than those in the healthy control group (P<0.05).Single factor Logistic regression analysis showed that BMI,TG,Apo E, FFA,RBP4,FINS and HOMA-IR were risk factors for poor control of blood glucose in type 2 diabetes pa-tients with chronic schizophrenia.Conclusion The levels of RBP4 and blood lipid in patients with chronic schizophrenia complicated with type 2 diabetes may be related to the poor control of blood sugar level.
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Objective·To compare the clinical features between different subtype bipolar patients with first mania episode, and to contribute to early identification of bipolar disorder. Methods·This study was based on the database named as National Bipolar Mania Pathway Survey (BIPAS). From November 2012 to January 2013, bipolar patients from 26 mental health facilities in China were enrolled in current study. The clinical features were compared between mania patients of different subtypes, including hypomania (groupⅠ), mania without psychotic symptoms (groupⅡ), mania with psychotic symptoms (group Ⅲ) and mixed state (group Ⅳ). Results·There was significant difference in the percentage of clinical symptoms between different subtype bipolar patients with first mania episode, especially the mania and anxiety related symptoms. Group Ⅰ, Ⅲ , Ⅳ were further compared with groupⅡ, which was considered as the typical bipolar disorder. The results showed that the mania related symptoms was significantly higher in group Ⅱ, but anxiety related symptoms was significantly higher in group Ⅰ, Ⅲ, Ⅳ. Moreover, Logistic regression analysis revealed that more eloquent or humor and unusually restless could be in favor of the diagnosis of hypomania; younger and mania or hypomania as first episode might be in favor of the diagnosis of mania with psychotic symptoms; older, national minorities and unusually restless could be in favor of the diagnosis of mixed state. Conclusion·The clinical features between different subtype bipolar patients with first mania episode are various, and analysis of the clinical features can contribute to early identification of bipolar disorder.
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Objective To explore the effect of comprehensive intervention on social function and quality of life of patients with bipolar disorder (BD) in maintenance treatment period.Methods A total of 83 patients with BD were assigned into intervention group (n=41) and control group (n=42).Based on the original drug treatment,the intervention group was given comprehensive intervention,including BD health education,drug self-management,serf-monitoring of symptoms,interpersonal skills,coping and relaxation skills,learning to seek help from medical staff and others.The control group was treated with simple drug therapy.Before grouping,at the end of the third month and twelfth month,Young Mania Rating Scale (YMRS),Hamilton Depression Scale 17 items (HAMD17),Social Disability Screening Schedule (SDSS),Short Form 36 items Health survey Questionnaire (SF-36) were assessed.Results There were no differences in YMRS,HAMD,SDSS total score between the two groups before grouping(P＞0.05).The score of YMRS in the intervention group ((0.59±1.45) was lower than that in the control group(2.07±3.87) at the end of the 12th month,the difference was statistically significant (P=0.024).The score of SDSS in the intervention group (1.63± 1.77,0.78± 1.78) were statistically lower than that in control group (3.57± 1.78,2.74± 1.27) at the end of the 3th and 12th month(P＜0.01).There were statistically differences between the two groups in rolephysical(RP) (t=2.858,P =0.005),role-emotional (RE) (t =2.956,P =0.005),social function (SF) (t =4.163,P＜0.01),vitality (VT) (t =5.150,P＜ 0.01),mental health (MH) (t =2.830,P=0.007),general health (GH) (t=4.055,P＜0.01),difference in reported health transition (HT) (t=-2.092,P=0.042)at the end of 3th month.The differences were statistically significant in RE (t =3.290,P =0.001),SF (t =2.876,P =0.006),VT(t=5.831,P＜0.01),MH(t=4.839,P＜0.01),GH(t=3.752,P＜0.01) at the end of 12th month between the two groups.Conclusion On the base of medicine treatment,comprehensive intervention can effectively improve the social function and life quality of patients with BD in maintenance treatment period.
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Objective To explore the effect of comprehensive intervention on social function and quality of life of patients with bipolar disorder (BD) in maintenance treatment period.Methods A total of 83 patients with BD were assigned into intervention group (n=41) and control group (n=42).Based on the original drug treatment,the intervention group was given comprehensive intervention,including BD health education,drug self-management,serf-monitoring of symptoms,interpersonal skills,coping and relaxation skills,learning to seek help from medical staff and others.The control group was treated with simple drug therapy.Before grouping,at the end of the third month and twelfth month,Young Mania Rating Scale (YMRS),Hamilton Depression Scale 17 items (HAMD17),Social Disability Screening Schedule (SDSS),Short Form 36 items Health survey Questionnaire (SF-36) were assessed.Results There were no differences in YMRS,HAMD,SDSS total score between the two groups before grouping(P＞0.05).The score of YMRS in the intervention group ((0.59±1.45) was lower than that in the control group(2.07±3.87) at the end of the 12th month,the difference was statistically significant (P=0.024).The score of SDSS in the intervention group (1.63± 1.77,0.78± 1.78) were statistically lower than that in control group (3.57± 1.78,2.74± 1.27) at the end of the 3th and 12th month(P＜0.01).There were statistically differences between the two groups in rolephysical(RP) (t=2.858,P =0.005),role-emotional (RE) (t =2.956,P =0.005),social function (SF) (t =4.163,P＜0.01),vitality (VT) (t =5.150,P＜ 0.01),mental health (MH) (t =2.830,P=0.007),general health (GH) (t=4.055,P＜0.01),difference in reported health transition (HT) (t=-2.092,P=0.042)at the end of 3th month.The differences were statistically significant in RE (t =3.290,P =0.001),SF (t =2.876,P =0.006),VT(t=5.831,P＜0.01),MH(t=4.839,P＜0.01),GH(t=3.752,P＜0.01) at the end of 12th month between the two groups.Conclusion On the base of medicine treatment,comprehensive intervention can effectively improve the social function and life quality of patients with BD in maintenance treatment period.
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Objective To explore whether the process of oxidative stress exists in schizophrenia through analyzing changes of levels of malondialdehyde(MDA) and superoxide dismutase(SOD) ,and analyse the influence of age on SOD and MDA .Methods Serum levels of MDA and SOD in the schizophrenia group and healthy control group were detected by using enzyme‐linked immu‐nosorbent assay(ELISA) and were statistically analysed by using t test .Results Compared with the healthy control group ,there was an increase in serum level of MDA and a decrease in serum level of SOD in the schizophrenia group ,and had statistically signifi‐cant differences(P0 .05) .Conclu‐sion The process of oxidative stress exits in patients with schizophrenia ,and oxidative stress may be involved in the occurrence and progression of schizophrenia .Patients′age may not be significantly correlated with schizophrenia .
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Objective To evaluate the effect of assertive case management on relapse and health economic evalua?tion in schizophrenics living in communities. Methods Two hundred outpatients were randomly divided into the study group (107 enrolled, 107 completed) which received assertive case management and the control group (93 enrolled, 91 completed) which received normal management treatment for 12 months. Clinical global impression scale (CGI) and the cost of treatment were assessed every three months. Medication adherence and family burden were evaluated before treat?ment and 3, 6 and 12 months after the treatment using Medication Adherence Rating Scale (MARS) and Family Burden Instructing, respectively. Results The study group was less likely to relapse compared with the control group over the 12-month follow-up and the relapse rates were 1.9%and 11.0%in study and control groups, respectively (P<0.01). The repeated-measures analysis of variance indicated that time main effect was significant in severity of illness factor score of CGI (P<0.01). The time main effect and group main effect in factor 1 and factor 3 scores of MARS were significant (all P<0.05) and there was an interaction effect in factor1 score of MARS (P<0.01). In the study group, time effect were signifi?cant in factor 1 score of MARS (P<0.01). The time main effects in indirect cost and total cost were significant and so were interaction effects in direct cost and total cost (P<0.05). In the study group, time effects were significant in direct cost and total cost (P<0.01). Comparison of FBI dimensions before and after the intervention showed that family relation?ship was much more decreased in the study group than in the control group (P<0.01). Conclusions Assertive Case Man?agement can reduce the recurrence of schizophrenia living in communities, improve compliance medication and family re?lationship as well as reduce the cost of treatment.
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Objective To compare the cost-effectiveness and cost-utility of venlafaxine and mirtazapine in patients with treatment-resistant major depression (TRD).Methods One hundred and five patients with TRD were enrolled in this study and grouped into venlafaxine treatment (n=50) and mirtazapine treatment (n=55) based on the double-blind randomization scheme generated by computer.The treatment costs of antidepressants during 8 weeks were calculated,the rates of clinical response and remission were taken as treatment effectiveness,and the quality-adjusted life years (QALYs) as treatment utility.The descriptive analysis and nonparametric test were used to compare the cost-effectiveness and cost-utility of different groups.Results During 8 weeks,the treatment cost of antidepressant was ￥ 1 396.44 for venlafaxine and ￥ 1 206.90 mirtazapine,and the difference between two groups was ￥ 189.54.The cost-effectiveness ratios between venlafaxine and mirtazapine were very close (differed ￥ 0.06 for remission rate and ￥ 1.08 for response rate respectively).There was no significant difference for cost-utility ratios between two groups (physical functioning Z=-0.15,P＞0.05 ; mental health Z=-0.54,P＞0.05).Conclusion Both cost-effectiveness and cost-utility of venlafaxine in patients with TRD are close between venlafaxine and mirtazapine.
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Objective To discuss the operative techniques of endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma in elderly patients.Methods From June 2003 to June 2012,a retrospective analysis of 42 elderly patients with pituitary adenoma was conducted.Computed tomography (CT) scan,magnetic resonance imaging (MRI) scan,and endocrinological examinations were performed in all patients before operation.All patients underwent endoscopic endonasal transsphenoidal surgery for the resection of pituitary adenoma.Results The tumors were totally removed in 25 cases (59.5％),sub-totally removed in 8 cases (19.1％) and partly removed in 9 cases (21.4％).1 patient died after operaion.Patients were followed up for 6-36 months.The visual acuity and visual field were improved.Hormone replacement therapy were needed in 20 patients due to hypopituitarism.Tumor residuals were found in 12 patients,among whom 5 patients were treated by γ-knife radiosurgery.Conclusions The endoscopic endonasal transsphenoidal operation is minimally invasive and safe for the treatment of pituitary adenoma in elderly patients.The strengthening of perioperative management is the key to the successful operation.
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Objective To evaluate the efficacy of antidepressants plus cognitive-behavioral education and self-management preventing the recurrent or deterioration of depression.Methods Outpatients with non-episode depression,Hamilton Rating Scales of Depression 17 items (HAMD17 ≥3),entered openly intervention group (n =30) and control group (n =30),and were followed up one year.Patients in intervention group received intervention,including treatment as usual,group education of cognitive behavior,self-help group attendance and self-management of depressive mood.Patients in control group only received treatment as usual.The primary outcome was time to recurrent or deterioration of depression.Kaplan-Meier methodology was used to evaluate differences of survival curves between two different groups.Results There were significant differences for risk of recurrent or deterioration (x2 =5.70,P ＜ 0.05) and one-year rate of recurrent or deterioration (intervention group 27％ (8/30),control group 53％ (16/30),x2 =4.44,P ＜ 0.05) between two groups,but not for average time of recurrent or deterioration (intervention group (4.75 ± 2.49) months,control group (6.63 ± 3.10) months,t =-1.48,P ＞0.05).There were no significant differences for risk of drop-out (x2 =1.66,P ＞ 0.05),one-year rate of drop-out (intervention group 13％ (4/30),control group 23％ (7/30),x2 =1.00,P ＞ 0.05) and average time of drop-out (intervention group (7.25 ± 3.78) months,control group (4.00 ± 2.58) months,t =1.71,P ＞ 0.05) between two groups.Conclusion Antidepressants plus cognitive-behavioral education and self-management can effectively prevent the recurrent or deterioration of depression.
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Objective To evaluate the short-term and mid-term outcomes in geriatric patients with idiopathic normal pressure hydrocephalus treated with adjustable valve. Methods The 29 patients were selected for the ventriculo-peritoneal shunt by the means of preoperative lumbar tap test and external lumbar drainage test. All patients were assessed by Mini Mental State Examination (MMSE) and timed 10-meter walk test. Results Short-term improvement in gait disturbance and cognitive function could be achieved obviously, and mid-term improvement could not be sustained. The 3 patients had shunt obstruction, 1 had subdural hygroma. 1 case died of pulmonary infection and 2 died of cardiac disease. Conclusions The lumbar tap test and external lumbar drainage test are highly prognostic procedures for identifying patients with idiopathic normal pressure hydrocephalus who mostly likely benefit from shunt surgery. The short-term improvement can be achieved, whereas mid-term improvement can not be sustained. Surgical outcome can be improved by the use of adjustable valve.
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Objective To evaluate the effectiveness of different medicine treatment strategies on the social functions promotion on the patients with treatment-resistant depression (TRD). Methods 375 Patients with TRD were randomly grouped into 8 groups, and each group was received 8 weeks different treatment for paroxetine,venlafaxine, mirtazapine, paroxetine plus risperidone, paroxetine plus sodium valproate, paroxetine plus buspirone, paroxetine plus trazodone,or paroxetine plus thyroxine, respectively. The efficacy and social functions were evaluated with HAMD-17, SDSS and SF-36. Results There were significant difference in SDSS scores between 8th week and the baseline( P＜0.01 ) , and for social functions factor scores of SF-36 there was significant difference between 4th ,8th week and the baseline in each groups( P＜0.01 ). There were significant difference in social functions factor scores of SF-36 and subtracting scores between 4th and 8th week in all groups except group paroxetine and group venlafaxine(P ＜ 0.05 or P ＜ 0.01 ). There were significant difference in SDSS subtracting scores at 8th week among 8 groups( paroxetine plus risperidone group 7.05 ± 6.39, mirtazapine group 6.53 ± 4.75, paroxetine plusthyroxine group 5.14 ± 4.94, paroxetine group 5.13 ± 4.94 ,paroxetine plus trazodone group 5.00 ± 4.94, paroxetine plus sodium valproate group 4.60 ± 4.09, venlafaxine group 4.57 ± 4.18, paroxetine plus buspirone group 4.24 ± 4.95 ) ( Z = 2.076, P ＜ 0.05 ), between group paroxetine plus risperidone and group venlafaxine , group paroxetine plus sodium valproate, group paroxetine plus buspirone,as group mirtazapine and group paroxetine plus buspirone(P＜ 0.05 ), respectively. The influencing factors on improving social functions are the severity, improvement of depressive symptoms and latest onset time. Conclusions These 8 treatment strategies all can promote social functions on the patients with TRD. But the intensity and chronological order of improvement werent the same among 8 groups. The influencing factors on improving social functions are the severity, improvement of depressive symptoms and latest onset time.
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Objective To investigate the assistant effect of modified Morita therapy on depression. Methods 60 outpatients of depression were selected and grouped by registration order,research group (RG) was given antidepressant and Morita therapy,control group (CG) as antidepressant. Scales HAMD and SF-36 were evaluated before treatment and after 12 weeks. Results There was no significant difference on sex,age,marriage,education,scores of HAMD and SF-36 between two groups ( P> 0.05 ). After treatment, HAMD and SF-36 of two groups were improved notably (P<0.01). HAMD(RG:7.60±5.76,CG:13.70±8.46, P<0. O1) and GH(RG:68.13 ±15.77,CG:59.00 ± 17.12, P<0.05) ,VT( RG:68.83 ± 18.67 ,CG:47.17 ± 18.18, P<0. 01 ) ,SF( RG:86.23± 18.67,CG:77.03 ±12.28, P<0.01) ,RE(RG:74.44 ± 35.76,CG:51.12 ±41.74, P<0.05) ,MH (RG:75.47 ± 16.16, CG :61.73 ± 15.75, P< 0.01 ) of SF-36 in research group were improved significantly than those in control group. Conclusion Modified Morita therapy could increase the effect of antidepressants and improve outcome of diseases.
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<p><b>OBJECTIVE</b>To report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.</p><p><b>METHODS</b>Eighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.</p><p><b>RESULTS</b>With the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.</p><p><b>CONCLUSIONS</b>Brain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.</p>