The efficacy and safety of olanzapine combined with fluoxetine in the treatment of negative symptoms of schizophrenia:a systematic review / 中国神经精神疾病杂志

Objective To undertake a systematic review to evaluate the efficacy and safety of olanzapine combined with fluoxetine in the treatment of negative symptoms of schizophrenia. Methods Articles published before May 31, 2017 were identified by searching the PubMed, Medline,Web of science excerpta medica database (EMBASE), Cochrane Library,China national knowledge infrastructure (CNKI), WanFang data, using the key words fluoxetine, olanzapine, schizophren* and schizophrenia. Statistical analysis were conducted by Review Manager 5.3 software according to Cochrane Handbook for meta analysis. Result A total of 5 randomized,controlled studies were included(3 Chinese and 2 English). Meta analysis showed that the efficacy of olanzapine combined with fluoxetine (combination group) in the treatment of the negative symptoms in schizophrenia was not significant difference from olanzapine alone (standradization of mean difference(SMD)=-0.61,95% CI:-1.30~0.08,P=0.08).Due to the high heterogeneity of the five studies (I2=83%>75%), Subgroup analysis which was conducted in three domestic research revealed that combination group exhibited a better efficacy in the treatment of negative symptoms in negative symptoms predominant schizophrenia (defined as score of PANSS negative subscale >30)(SMD=-1.19, 95% CI:-1.52~-0.86, P<0.01) and a lower risk to develop weight gain (SMD=0.28, 95% CI:0.13~0.57, P<0.01). Conclusion Domestic studies have provided the initial evidence that olanzapine in combination with fluoxetine is more effective and has a lower risk of weight gain than olanzapine alone in the treatment of negative symptoms for schizophrenics..

The factors affecting efficacy of methylphenidate treatment for attention deficit hyperactivity disorder on / 中国神经精神疾病杂志

Objective To explore the factors affecting methylphenidate (MHP)efficacy in children with attention deficit hyperactivity disorder (ADHD). Methods One hunadard eleven DSM-Ⅳ defined ADHD patients were enrolled for 6 weeks systemic MHP titration treatmnet. ADHD Rating Scale-Ⅳ Home Version (ADHD-RS-Ⅳ) were applied as index of clinical efficacy, and Continuous Performance Task (CPT) as index of cognition efficacy. Determining potential influential factors was analyzed on MPH efficacy including demographic,baseline clinical symptoms and cognitive factors. Results Sixty-five (59.1%) were defined as responders and 45 (40.9%) as non-reponders to MHP, respectively. CPT which were conducted in 87 patient showed that 35 (40.2%) were defined as responders on commission errors, 31 (35.6%) on omission errors and 10 (11.5%) on reaction time. Logistic analysis revealed two potential influential factors that predicted better clinical efficacy (P<0.05): better parental relationship (OR=3.516, 95% CI: 1.087~11.375) and baseline ADHD-RS-Ⅳ score above 35 points (OR=3.075, 95%CI: 1.131~8.359). Higher IQ score was the potential influential factor that predicted better commission errors efficacy (OR=1.085, 95%CI: 1.013~1.162) and omission errors efficacy (OR=1.078, 95%CI: 1.008~1.153). Conclusion MHP efficacy may result in better outcomes in children with ADHD who have higher baseline ADHD-RS-Ⅳ score, poorer baseline CPT result, younger onset age, higher IQ and better parental relationship.

Association between methylation status of CpG island in DAT1 and DRD4 genes and clinical symptoms of ADHD / 中国神经精神疾病杂志

Objective To investigate the correlation of methylation status in DA T1 and DRD4 genes and severity of clinical manifestations in ADHD patients.Methods One hundrd eleven DSM-Ⅳ defined ADHD patients were enrolled in this study and the demographic data were collected.Clinical symptoms were also assessed by Attention Deficit Hyperactivity Disorder Rating Scale-Ⅳ Home Version (ADHD-RS-Ⅳ) and self-developed Oppositional Defiant Disorder (ODD) rating scale.Bisulfite genomic sequencing (BGS) was used to detect the methylation status of every CpG site in DA T1 and DRD4 promoter CpG island in peripheral venous blood.Results The DNA methylation level in total CpG island for DA T1 was higher in individuals without depression,anxiety or ADHD family history compared to individuals with above family histories (P＜0.05).The differences on methylation levels for DA T1 and DRD4 were not significant between high and low ADHD-RS-Ⅳ total score (≤30 vs.＞30),ADHD-RS-Ⅳ inattention score (≤ 17 vs.＞17),and ADHD-RS-Ⅳ hyperactivity/impulsivity score (≤13 vs.＞13) subgroups (all P＜0.05).The methylation levels in total CpG island in DA T1 was higher in individuals whose ODD score were ＜9 compared to those whose ODD score were ≥9 (P＜0.05).Conclusions Methylation status of CpG island in DAT1 may influence the severity of oppositional defiant symptom in ADHD patients,which is correlated with depression,anxiety and ADHD family histories.

Association of methylation status of CpG islands in DAT1 and DRD4 genes with attention deficit hyperactivity disorder / 中华行为医学与脑科学杂志

Objective To explore the difference of methylation status of CpG island in promoter re?gion of DAT1 and DRD4 genes between children with attention deficit hyperactivity disorder ( ADHD) and normal controls,and further understand the pathogenesis of ADHD from a epigenetics point of view. Methods 111 ADHD patients and 118 normal controls were enrolled in the present study. The demographic data and peripheral venous blood were collected from both groups. Bisulfite genomic sequencing ( BGS) was used to confirm the methylation status of every CpG site in promoter region of DAT1 and DRD4 genes. Results No significant differences were found between ADHD patients and normal controls on percentage of methylated CpG sites in total CpG islands for both DAT1 and DRD4 (P>0.05) . However,the percentage of methylation in No. 17 CpG site for DAT1 and No. 8 CpG site for DRD4 was higher in ADHD patients ( 23. 42% and 64.86% respectively)compared with that in normal controls(11.86% and 47.46% respectively)(P<0.05).In all samples,the percentage of methylated CpG site in total CpG island for DAT1 was higher in males com?pared with that in females(P<0.05),whereas that for DRD4 was higher in females compared with that in males (P<0.05);the same gender difference on methylation level for DAT1 was also found in ADHD patients and for DRD4 in normal controls(P<0.05) . In all samples and in ADHD patients,percentage of methylated CpG site in total CpG island for DAT1 was higher in individuals over 7 years old compared with that in indi?viduals younger than or equal to 7 years old(P<0.05). Conclusions Methylation status of CpG island in DAT1 and DRD4 genes promoter region might correlate with ADHD susceptibility.Methylation status of CpG island in DAT1 and DRD4 genes show differences in different age span and sex.

The association of catechol-O-methyl transferase gene polymorphism with the clinical efficacy of risperidone in the treatment and cognitive function in patients with schizophrenia / 中华行为医学与脑科学杂志

Objective To investigate the relationship between the catechol-O-methyl transferase (COMT) gene polymorphism and the clinical efficacy and cognitive function of risperidone in the treatment of schizophrenia.Methods 105 cases of Han Chinese patients with schizophrenia who were treated with risperidone for 12 weeks and healthy controls of 168 cases were collected.The effect of the drug therapy with the PANSS,digit vigilance test,Raven Standard Progressive Matrices,forward and backward subtests of the digit span test were evaluated,and then the rs 165599,rs4680,rs6267,rs737865 loci in COMT gene were detected.Results (1)rs737865 was not the polymorphic locus in this sample.(2) There was statistically significant between schizophrenia patients and controls in the distribution of allele frequency and genotype frequency in rs4680 (x2=8.16,P=0.02).Haplotype GA in rs165599-rs4680 was statistically significant in schizophrenia patients and controls (x2 =4.35,P =0.04).(3) After treatment,the total score ((47.64±5.75) points),subscale scores (positive symptoms (11.66±2.90) points,negative symptoms (13.79±3.18)points,general psychotic symptoms (22.09±3.59) points) and scores of five factors model in PANSS decreased and the difference was significant (P＜0.05);the scores of digital cancellation test increased significantly compared with those before treatment(t value respectively were 12.34,10.17,4.34,all P＜0.05);the scores of forward and backward subtests of the digit span test were significantly increased compared with those before treatment (t=-5.57,P=0.00) and Raven standard reasoning test scores had increased significant (t=-19.05,P=0.00).(4) The difference of instantaneous memory score changes among rs 165599 genotypes was statistically significant after treatment (F=4.06,P=0.02).(5) The difference of negative syndromes of PANSS among rs 165599 genotypes was statistically significant after treatment (F=3.11,P=0.049).(6) The difference of negative symptoms (F=4.64,P=0.01),cognitive impairment (F=3.21,P =0.045) and instantaneous memory (F=4.86,P=0.03) among rs 6267 genotype were statistically significant after treatment.Condusion Risperidone can effectively improve the psychotic symptoms of schizophrenia patients,and promote the recovery of cognitive function.Rs165599-rs4680 haplotype GA might be risk factor for the onset of schizophrenia.

Influence of aberrant behaviors on the mental health of caregivers for patients with pervasive developmen-tal disorders / 中国神经精神疾病杂志

Objective To investigate the influence of hyperactivity, Stereotyped behaviors , self-injury and irritabili?ty on parenting stress and emotions of the caregivers for patients with pervasive developmental disorders (PDDs). Methods Abnormal behaviors during last month were assessed in 138 PDDs patients by using Aberrant Behavior Checklist (ABC) and Conners Index of Hyperactivity (CIH). The parenting stress and the emotional state of the patients’parents were evalu?ated by the Caregiver Strain Questionnaire (CGSQ) and Hospital Anxiety and Depression Scale (HAD), respectively. Re?sults Anxiety, depression and combination of anxiety and depression were present in 6.2%, 17.8%and 29.5%of PDDs caregivers, respectively. The partial correlation analysis showed that CGSQ score of patients’parents positively correlated with CIH score (r=0.201, P=0.023) and stereotyped act (r=0.189, P=0.033) of the patients, and negatively correlated with stereotyped speech (r=-0.219, P=0.013). The anxious mood of parents positively correlated with stereotyped act (r=0.206, P=0.021). Conclusions Anxiety and depression are common in caregivers of PDDs. Except for stereotyped speech, aber?rant behaviors of the PDDs increase parenting stress and worsen anxious mood of caregivers.

Incidence of aberrant behaviors in children with pervasive developmental disorders / 中华行为医学与脑科学杂志

Objective To evaluate the incidence of four aberrant behaviors in patients with pervasive developmental disorders (PDDs).Methods The abnormal behaviors during the last month in 138 PDDs patients were assessed with Aberrant Behavior Checklist and Conners Index of Hyperactivity.Results The incidence of aberrant behaviors was 61.6％ for hyperactivity,81.9％ for stereotyped behaviors,13.77％ for self-injury,and 58.70％ for irritability in PDDs patients.The occurance of irritability in autism patients was higher than that of asperger syndrome (AS) patients (x2 =5.623,P=0.018).Conclusion Stereotyped behaviors,hyperactivity and irritability are common in children with PDDs.Autism patients are more likely to exhibit irritability behaviors than AS patients.

DRD4/DAT1 mRNA expression in attention deficit hyperactivity disorder children before and after methylphenidate treatment / 中华行为医学与脑科学杂志

Objective To investigate mRNA expression level changes of dopamine transporter gene (DAT1) and dopamine receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) children's peripheral blood before and after methylphenidate treatment,and to explore associations between the mRNA expression level and symptom severity,as well as methylphenidate response.Methods Forty five ADHD children by DSM-Ⅳ diagnostic criteria,aged six to fifteen years old participated in a six-week drug titration treatment of metbylphenidate.ADHD-RS-Ⅳ Home Version, WCST and VCPT were used to evaluate the ADHD clinical symptoms and cognitive functions.RNA Simple Total RNA Kit was used to extract the total RNA.After reverse transcription, the obtained c-DNA was used in the following qRT-PCR to evaluate relative mRNA expression of the candidate genges before and after medication.Results The DRD4 mRNA relative expression level after taking methylphenidate was significantly higher than that before methylphenidate treatment (0.23 ± 0.23 vs 0.16± 0.18, P =0.041).There was no significant difference between DAT1 mRNA relative expression level before (0.43 ± 0.40) and after (0.43±0.40) methylphenidate treatment.No significant difference was found on eitber basal DAT1/DRD4 mRNA expression or fold change of DAT1/DRD4 mRNA expression before and after medication between methylphenidate treatment responders and non-responders groups.There was a positively significant correlation between baseline DRD4 mRNA relative expression level and erroneous T score of CPT(r=0.424, P=0.025) , however, no other statistically significant correlation was found between basal DRD4 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level, CPT missing T score, and CPT reaction T sco~ (all P＞0.05).There was also no statistical significant correlation between basal DAT1 mRNA relative expression level and ADHD-RS-Ⅳ total score,WCST conceptual level,and CPT T scores(all P＞0.05).Conclusion DRD4 gene function may be increased after methylphenidate treatment and play an important role in impulsivity behavior of ADHD.Therefore, DRD4 mRNA expression level might be a biomarker for ADHD diagnosis and a predicting indicator of drug efficacy.

A survey on sleep conditions of Jinuo People / 中国心理卫生杂志

Objective:To study the sleep conditions, the prevalence of insomnia and the treatment problems in Jinuo People.Methods: 126 Jinuo People were investigated with “questionnaire of sleep conditions" which was designed for this study. Results: Sleep duration of Jinuo people decrease as they get old. The rate of siesta in people under 30-year-old was significantly higher than that of over 30-year-old. Among 126 Jinuo people,43 suffered from insomnia (34.12%). Psychiatric diseases(41.86%)and alcohol dependence(30.23%) were the two most common causes of insomnia. Among the patients with insomnia, 11(25.58%) sought for treatment. Conclusion: Compared with the general population, the prevalence of insomnia in Jinuo people was relatively higher. In view of the sampling bias and small sample, this results need to be validated by further study.

DSM-IV and ICD-10: A Comparison of Clinical Features of Attention Deficit-Hyperactivity Disorder and Hyperkinetic Disorder / 中国心理卫生杂志

Objective: To examine the differences on clinical features between DSM-Ⅳ ADHD and ICD-10 HKD patients. Methods:516 children referred to psychiatric clinic because of overactivity, inattention, and impulsivity symptoms were divided into two groups: Children meeting both criteria ( HKD-ADHD group, n=199), and children meeting only DSM-Ⅳ ADHD criteria (ADHD group, n=317). Diagnoses were confirmed by structured interview with parents using Clinical Diagnostic Interview Scale. Results: Whereas the combined type is predominant in HKD-ADHD group (75.4%), predominately inattentive type take account of the majority in ADHD group (67.2%). Compared to ADHD group, HKD-ADHD group includes the patients with younger referral age(9.6?2.2 vs 10.7?2.6) and earlier onset of age(4.6?1.9 vs 5.9?2.5), more opposite defiant disorder comorbidity (41.2% vs 26.2%), more disturbed behaviors, and higher sensory integrative dysfunction prevalence (72.6% vs 56.9% ). However, among the patients not older than 9-year-old there is higher prevalence of learning disability in ADHD group (26.7% vs 14.8%).Conclusion: ICD-10 criteria identified a severe group of patients than those identified by DSM-Ⅳ.However, the patients satisfied only DSM-Ⅳcriteria has exhibited more academic difficulty and behavioral disturbance compared with normal children, so we recommend DSM-Ⅳ as clinical diagnostic tool so that earlier interventions could be possible.

Behavior Problems and Relevant Factors of School Aged Children in Kunming / 昆明医科大学学报

Objective To explore the prevalence and correlated factors of behavior problems among primary students.Methods Rutter Child Behavior Check list was applied to 956 primary students.Results Primary students with behavior disorder accounted for 30.4%: antisocial type(A) 12.8%,neurotic type 10.0% and mixed types(M) 7.6%.The main correlated factors included sex,rapport of family,the time spent with family members and friendship.Conclusion Parents,teachers and government should pay more attention to the primary students with behavior disorder.