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.

Effect of buflomedil hydrochlorde on regional cerebral blood flow in different subtypes of schizophrenia / 中华神经医学杂志

Objective To investigate the effect ofbuflomedil hydrochlorde on regional cerebral blood flow in different subtypes of schizophrenia.Methods Two hundred and eighty-six patient met the diagnostic criteria of CCMD-3 for schizophrenia,admitted to our hospital from February 2007 to February 2009,were chosen in our study; patients of type Ⅰ (n=86),type Ⅱ (n=63) and type Ⅲ (n=137)were randomly divided into treatment group of type Ⅰ (n=46),placebo treatment group of type Ⅰ (n=40),treatment group of type Ⅱ (n=34),placebo treatment group of type Ⅱ (n=29),treatment group of type Ⅲ(n=72) and placebo treatment group of type Ⅲ (n=65).Patients from the treatment groups were treated with antipsychotics with buflomedil hydrochloride and those from placebo treatment groups were given antipsychotics with saline for 4 weeks.On the 1st day and at the end of the 4th week of treatment,cerebral blood flows of bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery,vertebral artery and basilar arterywere were measured by transcranial Doppler (TCD).Results No statistically significant difference of cerebral blood flow was noted between the two groups of type Ⅰ before/after treatment,neither between before and after treatment in one of the groups (P＞0.05).For type Ⅱ schizophrenia,no statistically significant difference of cerebral blood flow was noted between the two groups on the 1st day of treatment (P＞0.05); however,at the end of 4th week of treatment,cerebral blood flow in the bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery blood of the treatment group were significant greater than that in the placebo treatment group (P＜0.05); the cerebral blood flow in the bilateral anterior cerebral artery,middle cerebral artery,posterior cerebral artery blood of the treatment group at the end of 4th week of treatment was significantly higher than that on the 1 st day of treatment (P＜0.05),while no significant difference was noted in the placebo treatment group (P＞0.05).For type Ⅲ schizophrenia,at the end of 4th week of treatment,the cerebral blood flow in the treatment group in the left anterior cerebral artery,the left middle cerebral artery and right middle cerebral artery were significant greater than that in the placebo treatment group (P＜0.05); and that of the bilateral anterior cerebral artery and middle cerebral artery in the treatment group at the end of 4th week of treatment was significantly greater than that on the 1st day of treatment (P＜0.05).Conclusions Different subtypes of schizophrenia enjoys different cerebral blood flows:most significant decline in cerebral blood flow and largest number of cerebral arteries of type Ⅱ schizophrenia are noted,followed by type Ⅲ schizophrenia;cerebral blood flow of schizophrenia maybe have an order to decline and the left middle cerebral artery maybe the first; the changes of cerebral blood flow between before and after treatment show that the decline of cerebral blood flow can be inverted with drugs.

Influence of course of disease on glycolipid metabolic parameters in drug-naive schizophrenia patients / 中华神经医学杂志

Objective To explore the relationship between the course of disease and glycolipid metabolic parameters in drug-naive schizophrenia patients. Methods All 186 drug-naive schizophrenia patients,admired to our hospital from March 2010 to October 2011,were chosen in our study; relative glycolipid metabolic parameters at baseline were tested and Positive and Negative Syndrome Scale (PANSS) was performed on these patients; and the relationships between relative glycolipid metabolic indexes and both the course of disease and manipulated variable (age,gender,education level and severity of the disease) were assessed.Results Gender might play a significant role to some glycolipid metabolic parameters (waist-hip ratio [WHR]:β=0.364; high-density lipoprotein [HDL]:β=-0.248; triacyiglycerol [TG]:β=0.167 and lysophosphatidic acid (LPA):β=-0.198,P＜0.05); age might play an important role to some glycolipid metabolic parameters (body mass index [BMI]: β=0.213; WHR: β=0.286 and apolipoprotein B 100 [apoB100]:β=0.221,P＜0.05).Simultaneously,the severity of disease appeared to affect some glycolipid metabolic parameters (BMI:β-0.167; WHR:β=-0.150 and fasting blood-glucose [FBG]:β=0.172, P＜0.05). The course of disease hardly affected the majorities of relative glycolipid metabolic indices of drug-naive schizophrenia but LPa (β=0.173, P＜0.05). Conclusion The high metabolic abnormality incidence in schizophrenia patients maybe result from multi-factor interactions.

Curative effects of ziprasidone and aripiprazole at acute stage on patients with drug-naive schizophrenia and their effects on metabolism of these patients / 中华神经医学杂志

Objective To compare the curative effects ofziprasidone and aripiprazole at acute stage on patients with drug-naive schizophrenia and their effects on metabolism of these patients.Methods Forty-six patients with drug-naive schizophrenia,admitted to our hospital from February 2010 to February 2011,were divided into ziprasidone treatment group (n=24,[165±13.51] mg/d) and aripiprazole treatment group (n=22,[28.86±3.06] mg/d); these patients were given the above treatment for 6 week.The scores of positive and negative syndrome scale (PANSS),body mass index (BMI),insulin resistance index (IRI),and levels of fasting blood glucose (FBG),insulin (INS),C-Peptide (CP),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),triglyceride (TG),apolipoprotein-a (APOA) and apolipoprotein-b (APOB) were obtained before and at the end of treatment.Results At the end of treatment,2 patients (9.1％) were cured,7 (31.8％)achieved obvious improvement,9 (40.9％) achieved improvement,and only 4 (18.2％) did not achieve any improvement in the aripiprazole treatment group.However,at the end of treatment,no patient (0％)was cured,7 (29.2％) achieved obvious improvement,12 (50％) achieved improvement,and 5 (20.8％)did not achieve any improvement in the ziprasidone treatment group.The total scores of PANSS after the treatment in both groups decreased significantly as compared with those before treatment (P＜0.05).The BMI ([20.14±2.63] kg/m2) in the ziprasidone treatment group at the end of treatment was obviously increased as compared with that ([19.68±2.76] kg/m2) before treatment (P＜0.05).The FBG ([4.38±0.59]mmmol/L) at the end of treatment decreased significantly as compared with those before treatment ([4.79±0.59] mmmol/L),and the BMI ([19.65±2.15] kg/m2) was obviously increased as compared with that before treatment ([19.19±2.28] kg/m2) in the aripiprazole treatment group (P＜0.05).The metabolic index in the 2 groups was not significantly different at the end of the treatment (P＞0.05).Conclusion Both ziprasidone and olanzapine are effective in the treatment of patients with drug-naive schizophrenia;both of them have mild effects on weight of patients with drug-naive schizophrenia,but no obvious effects on other metabolic indices.

Metabolic abnormality of patients with first-episode schizophrenia and effect of olanzapine on them / 中华神经医学杂志

Objective To explore the metabolic abnormality in patients with first-episode schizophrenia and effect of atpical antipsychotics olanzapine on them.Methods Thirty patients with first-episode schizophrenia,admitted to our hospital from February 2010 to February 2011,and 40healthy controls were chosen in our study; patient group was given oral olanzapine for 4 week.The height,weight,waistline and hipline were measured before and after treatment,and the total cholesterol (TC),triglyceride(TG),high-density lipoprotein(HDL),low-density lipoprotein(LDL),apolipoprotein AI(aPOAI),apolipoprotein B100(aPOB100),lipoprotein a(LPa),fasting blood-glucose,fasting insulin and C peptide levels were detected before and after treatment; and the insulin resistance(IR)index,waist hip ratio(WHR)and body mass index(BMI)were calculated before and after treatment; metabolic index were compared between patients and controls,and patients before and after the treatment.Results The HDL and aPOA1 levels in patient group were significantly lower,and the WHR,IR index,fasting insulin and C peptide levels were obviously higher as compared with those in the controls(P＜0.05).The BMI,waist circumference,WHR,the IR index,the insulin,TC,TG,LDL and aPOB100 levels after treatment were significantly increased as compared with those before treatment(P＜0.05).Conclusion There may be some inborn metabolic abnormality factors in patients with first-episode schizophrenia; the high incidence of metabolic abnormality in patients with schizophrenia may be the result of combined action from antipsychotics and inherit susceptibility.

Duration of untreated psychiatry affecting white matter integrity in first-episode medication-free patients with schizophrenia / 中华神经医学杂志

Objective To investigate the effects of duration of untreated psychiatry (DUP) on the white matter integrity in first-episode medication-free patients with schizophrenia. Methods The Chinese version of Nottingham Onset Schedule was used to assess the DUP of 39 first-episode medication-free patients with schizophrenia. According to the median of DUP, the 39 patients were grouped into long-DUP group and short-DUP group. Diffusion weighted images of the 39 patients' whole brains were acquired with a Half-Fourier Acquired Single-Shot Turbo Spin Echo (HASTE) sequence.After being preprocessed with DTI-studio and statistical parametric mapping software (SPM5), the fractional anisotropy (FA) images of the 2 groups were compared by two-sample t-test with SPM5 software. The differences of gender, age, education level and total scores of Positive and Negative Syndrome Scale (PANSS) scores between the 2 groups were also detected. Results No significant difference was noted on gender, age, education level, PANSS scores between the 2 groups (P＞0.05).Subjects of long-DUP group showed significantly reduced FA value in the right anterior cingulate fasciculus (x=8, y=40, z=24) and left prefrontal white matter thresholded (x=32, y=34, z=4) as compared with that of short-DUP group at a level of P＜0.001 (uncorrected). Conclusion Extension of the duration of DUP will reduce the white matter integrity in first-episode medication-free patients with schizophrenia.

Dexamethasone suppression test in inpatients with unipular depression or bipolar disorder:a comparison study / 中华神经医学杂志

ObJective To study the hypothalamic-pituitary-adrenal (HPA) axis function with dexamethasone suppression test (DST) in inpatients with unipolar depression or bipolar disorder at different mood states. Methods DST was performed in 38 inpatients with unipolar depression and 63 with bipolar disorder ([19 with type Ⅰ, 44 with type Ⅱ], [33 with depressive episode, 18 with manic episode and 12 with combined episodes]). After 4 weeks' treatment, DST was performed again on 17 patients with unipolar depression and 35 with bipolar disorder to compare the negative suppression ratio. Results Before treatment, the negative suppression rate of DST was significantly different between unipolar depression (36.8%) and bipolar disorder (14.3%), type Ⅰ bipolar disorder (10.5%), type Ⅱ bipolar disorder (15.9%) or bipolar disorder with current depressive episode (15.2%) (P<0.05). However, no statistic differences were showed among type Ⅰ bipolar disorder and type Ⅱ bipolar disorder, depressive episode of bipolar disorder (15.2%), manic episode of bipolar disorder (16.7%) or combined episodes of bipolar disorder (11.1%) (P>0.05). After treatment, the same comparison was performed, but negative suppression rate of DST was not significantly different among all the groups (P>0.05). With the clinical improvement, negative suppression rate of DST decreased in patients with unipolar disorder;while no significant differences were found between pre-treatment and post-treatment in patients with both unipolar and bipolar disorders (P>0.05). Conclusion At the status of illness, the negative suppression rate of DST in the unipolar depression, being independent from the clinical subtypes, types of episode and severity of the illness in bipolar disorder, is much higher than that in the bipolar disorder.