Patterns and correlates of insight among patients with schizophrenia in China：A network perspective.

OBJECTIVE: To explore the patterns and correlates of insight among patients with schizophrenia in a large Chinese population. METHOD: A multi-center cross-sectional study was conducted in Guangdong province, China. Patients with schizophrenia were included. Basic socio-demographic and clinical characteristics were collected in this study. Univariate analyses, multivariate logistic regression, and network analysis were conducted. RESULTS: A total of 6090 participants (58.8% were male, and 41.2% were female) met the study criteria and completed all the assessments. 63.5% (n = 3869) patients with schizophrenia had impaired insight. Fewer drug sides effect, higher psychological and environment domains scores in quality of life have a positive significant impact on insight in patients with schizophrenia. Younger age, higher BPRS scores have a negative significant impact on insight in patients with schizophrenia. The node ITAQ 8 (strength=1.17) was the most central node within the ITAQ network, while node ITAQ 3 was the least central node (strength=0.69). The edge ITAQ 1-ITAQ 2 was the thickest and most saturated edge in network model. CONCLUSIONS: Considering patterns and correlation of insight, it is necessary to ensure adherence to medications and engagement with mental health services for patients with schizophrenia, which could also improve their quality of life. Taking medication actively is more central to identify ITAQ and might be the potential targets for future interventions.

Oscillation of Electronic-Band-Gap Size Induced by Crystalline Symmetry Change in Ultrathin PbTe Films.

For the semiconductors of atomic length scales, even one atom layer difference could modify crystal symmetry and lead to a significant change in electronic structure, which is essential for modern electronics. However, the experimental exploration of such effect has not been achieved due to challenges in sample fabrication and characterization with atomic-scale precision. Here, we report the discovery of crystal symmetry alternation induced band-gap oscillation in atomically thin PbTe films by scanning tunneling microscopy. As the thickness of PbTe films is reduced from an 18- to 2-atomic layer, the band-gap size not only expands from 0.19 eV to 1.06 eV by 5.6 fold, but also exhibits an even-odd-layer oscillation, which is attributed to the alternating crystal symmetries between P4/mmm and P4/nmm. Our work sheds new light on electronic structure engineering of semiconductors at atomic scale for next-generation nanoelectronics.

Violent behavior and the network properties of psychopathological symptoms and real-life functioning in patients with schizophrenia.

Objective: To assess the interplay among psychopathological symptoms and real-life functioning, and to further detect their influence with violent behavior in patient with schizophrenia. Methods: A sample of 1,664 patients with post-violence assessments and their propensity score-matched controls without violence from a disease registration report system of community mental health service in Guangdong, China, were studied by network analysis. Ising-Model was used to estimate networks of psychopathological symptoms and real-life functioning. Then, we tested whether network properties indicated the patterns of interaction were different between cases and controls, and calculated centrality indices of each node to identify the central nodes. Sensitivity analysis was conducted to examine the difference of interaction patterns between pre-violence and post-violence assessments in violence cases. Results: Some nodes in the same domain were highly positive interrelations, while psychopathological symptoms were negatively related to real-life functioning in all networks. Many symptom-symptom connections and symptom-functioning connections were disconnected after the violence. The network density decreased from 23.53% to 12.42% without statistical significance (p = 0.338). The network structure, the global network strength, and the global clustering coefficient decreased significantly after the violence (p < 0.001, p = 0.019, and p = 0.045, respectively). Real-life functioning had a higher node strength. The strength of sleeping, lack of spontaneity and flow of conversation, and preoccupation were decreased in post-violence network of patients. Conclusion: The decreasing connectivity may indicate an increased risk of violence and early warning for detecting violence. Interventions and improving health state based on nodes with high strength might prevent violence in schizophrenia patients.

Influencing factors of multiple adverse outcomes among schizophrenia patients using count regression models: a cross-sectional study.

BACKGROUND: Schizophrenia patients have increased risks of adverse outcomes, including violent crime, aggressiveness, and suicide. However, studies of different adverse outcomes in schizophrenia patients are limited and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models. METHODS: This study included schizophrenia patients who had at least one follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes were included: a) aggressiveness with police dispatch or violent crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. The incidence density of these adverse outcomes was investigated using the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models, accordingly. The best model was chosen based on goodness-of-fit tests. We further analyzed associations between the number of occurrences of adverse outcomes and sociodemographic, clinical factors with the best model. RESULTS: A total of 130,474 schizophrenia patients were enrolled. Adverse outcomes rates were reported to be less than 1% for schizophrenia patients in 2020, in Guangdong. The NB model performed the best in terms of goodness-of-fit and interpretation when fitting for the number of occurrences of aggressiveness without police dispatch, whereas the ZINB models performed better for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher education and employment were protective factors for aggressive and violent behaviors. Disease onset aged ≥ 18 years served as a significant risk factor for aggressiveness without police dispatch, and self-harm or suicide attempts. Family history of mental diseases was a risk factor for self-harm or suicide attempts individually. CONCLUSIONS: NB and ZINB models were selected for fitting the number of occurrences of adverse outcomes among schizophrenia patients in our studies. Influencing factors for the incidence density of adverse outcomes included both those shared across different types and those individual to specific types. Therefore, comprehensive and customized tools in risk assessment and intervention might be necessary.

Regional years of life lost, years lived with disability, and disability-adjusted life-years for severe mental disorders in Guangdong Province, China: a real-world longitudinal study.

BACKGROUND: To understand the magnitude and spatial-temporal distribution of the regional burden attributable to severe mental disorders is of great essential and high policy relevance. The study aimed to address the burden of severe mental disorders by evaluating the years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) in Guangdong, China. METHODS: We undertook a longitudinal study based on a multicenter database established by the Health Commission of Guangdong, involving a total of 21 prefectures and four economic regions in the Guangdong province. A total of 520,731 medical records from patients with severe mental disorders were collected for 2010-2020. Data were analyzed via an integrated evaluation framework by synthesizing prevalence estimates, epidemiological adjustment as well as comorbidity assessment to develop internally consistent estimates of DALY. DALY changes during 2010-2020 were decomposed by population growth and aging and further grouped by Socio-demographic Index (SDI). DALYs were projected to 2030 by the weighted median annualized rate of change in 2010-2020. RESULTS: In 2010-2020, the average DALYs for severe mental disorders reached 798,474 (95% uncertainty interval [UI]: 536,280-1,270,465) person-years (52.2% for males, and 47.8% for females). Severe mental disorders led to a great amount of disease burden, especially in Guangzhou, Shenzhen, and Foshan cities. Schizophrenia and mental retardation with mental disorders were the two leading sources of the burden ascribed to severe mental disorders. Population growth and aging could be accountable for the increasing burden of severe mental disorders. Economic regions with higher SDI carried a greater burden but had lower annualized rates of change in DALYs. The overall burden of severe mental disorders is projected to rise modestly over the next decade. CONCLUSIONS: The findings urge prioritization of initiatives focused on public mental health, prevention strategies, health resources reallocation, and active involvement of authorities to effectively address the anticipated needs.

Disease risk analysis for schizophrenia patients by an automatic AHP framework.

BACKGROUND: Based on more than 15 million follow-up records of 404,426 patients from Guangdong Mental Health Center over the past 10 years, this study aims to propose a disease risk analysis and prediction model to support chronic disease management and clinical research for schizophrenia patients. METHODS: Based on a mental health information and intelligent data processing platform, we design an automatic AHP framework called AutoAHP to analyze and predict the disease risks of schizophrenia patients. Through automatic extraction, transformation and integration of follow-up data in the real world such as demography, treatment, and the disease course, a chronic database of patient status is established. In combination with age-period-cohort, logistic regression and Cox models, we apply the AutoAHP to assess disease risk and implement risk prediction in practice. RESULTS: A list of essential factors for risk prediction are identified, including annual changes in mental health policy, public support, regional difference, patient gender, compliance, and social function. After the verification of 1,222,038 complete disease course and treatment records of 256,050 patients, the AutoAHP framework achieves a precision of 0.923, a recall of 0.924, and a F1 of 0.923. The model is demonstrated to be superior to general models and has better performance in risk prediction. CONCLUSIONS: Aiming at the risk assessment of patients with schizophrenia which is influenced by factors, such as time, region and complication, the AutoAHP framework is able to be applied as a model in combination with logistic regression and Cox models to support clinical analysis of disease risk related factors and assist decision-making in chronic disease management.

Quantum Oscillations in Ferromagnetic (Sb, V)2 Te3 Topological Insulator Thin Films.

An effective way of manipulating 2D surface states in magnetic topological insulators may open a new route for quantum technologies based on the quantum anomalous Hall effect. The doping-dependent evolution of the electronic band structure in the topological insulator Sb2- x Vx Te3 (0 ≤ x ≤ 0.102) thin films is studied by means of electrical transport. Sb2- x Vx Te3 thin films were prepared by molecular beam epitaxy, and Shubnikov-de Hass (SdH) oscillations are observed in both the longitudinal and transverse transport channels. Doping with the 3d element, vanadium, induces long-range ferromagnetic order with enhanced SdH oscillation amplitudes. The doping effect is systematically studied in various films depending on thickness and bottom gate voltage. The angle-dependence of the SdH oscillations reveals their 2D nature, linking them to topological surface states as their origin. Furthermore, it is shown that vanadium doping can efficiently modify the band structure. The tunability by doping and the coexistence of the surface states with ferromagnetism render Sb2- x Vx Te3 thin films a promising platform for energy band engineering. In this way, topological quantum states may be manipulated to crossover from quantum Hall effect to quantum anomalous Hall effect, which opens an alternative route for the design of quantum electronics and spintronics.

Relationship between sleep duration and sociodemographic characteristics, mental health and chronic diseases in individuals aged from 18 to 85 years old in Guangdong province in China: a population-based cross-sectional study.

BACKGROUND: Sleep is vital for maintaining individual's physical and mental health. Prior studies have reported close relationships between sleep duration and chronic diseases. However, in China, the prevalence of aberrant sleep duration and the associations between sleep duration and chronic conditions still merit studying in Guangdong province. This study aimed at examining the relationship between sleep duration and multiple dimensions of sociodemographic characteristics, mental health and chronic diseases in Guangdong province in China, with a large population-based data of individuals aged from 18 to 85 years old. METHODS: This study aimed at analyzing the sociodemographic and clinical characteristics of the population in Guangdong province. Multistage stratified cluster sampling was applied for this study. 13,768 participants from Guangdong province were interviewed with standardized assessment tools, including Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder (GAD-7). Basic socio-demographic information, mental health and chronic diseases information were collected. Self-reported sleep duration was classified as three types: short (< 7 h), normative (7-9 h) and long (≥9 h). RESULTS: The mean sleep duration was 6.75 ± 1.11 h. Short sleepers had a higher prevalence of chronic diseases, including anemia (6.2%, p = 0.024), gout (2.8%, p = 0.010), hyperlipidemia (3.9%, p = 0.003) and low back pain (5.6%, p = 0.020) than other types of sleeper. Multinomial logistic regression analysis revealed that short sleepers were more likely to have low income level, have depressive symptoms, be ex- or current drinkers and be overweight. Anemia, hyperlipidemia and low back pain were all risk factors for short sleep, while malignant tumor was risky for long sleep. CONCLUSIONS: Low income level, drinking status, being overweight, and chronic conditions may be associated with aberrant sleep duration in Guangdong province general population. Short sleepers have a higher risk of suffering from anemia, hyperlipidemia, and low back pain, while long sleepers are more likely to have malignant tumor. Health professionals should value the sleep patterns in general health care and attach importance to conduct further epidemiologic surveys to explore the relationship between sleep duration and health.

The psychosis analysis in real-world on a cohort of large-scale patients with schizophrenia.

BACKGROUND: With China experiencing unprecedented economic development and social change over the past three decades, Chinese policy makers and health care professionals have come to view mental health as an important outcome to monitor. Our study conducted an epidemiological study of psychosis in Guangdong province, with 20 million real-world follow-up records in the last decade. METHODS: Data was collected from Guangdong mental health information platform from 2010 to 2019, which had standardized disease registration and follow-up management for nearly 600,000 patients with six categories of mental diseases and 400,000 patients with schizophrenia. We conducted clinical staging for the disease course of the patients and divided the data with various factors into different stages of disease. Quantitative analysis was utilized to investigate the high relevant indicators to the disease. The results were projected on geography map for regional distribution analysis. RESULTS: The majority cases of mental disease incidence were between the age of 15 and 29, while the peak age for both male and female was between 20 to 24 years old. The disease course with the largest number of patients' cases was between 5 to 10 years. The therapeutic effect of patients gradually decreased with the development of disease course, while the risk increased with the disease course. The analysis of influencing factors showed that poor economic conditions incurred higher risk scores, and good medication adherence was effective in improving treatment outcomes. In addition, receiving good education contributed to the reduction of the risk of schizophrenia and the improvement of the efficiency of early treatment. Through the analysis of regional distribution of schizophrenia disease, developed economic conditions and favorable resource conditions could promote the reduction of disease risk, while in economically backward regions, it often accompanied with lower therapeutic effect and higher disease risk. CONCLUSIONS: Certain demographic factors had a relatively prominent impact on the therapeutic effect and risk of schizophrenia, such as high-quality medication adherence. Therapeutic effect and risk were highly correlated. Backward economic conditions often associated with poor efficacy and higher risk assessment, and the developed economy and better medical resource are beneficial for the treatment of psychotic.

Standing Waves Induced by Valley-Mismatched Domains in Ferroelectric SnTe Monolayers.

Two-dimensional (2D) quasiparticle standing waves originate from the interference of coherent quantum states and are usually created by the scattering off edges, atomic steps, or adatoms that induce large potential barriers. We report standing waves close to the valence band maximum (E_{V}), confined by electrically neutral domain walls of newly discovered ferroelectric SnTe monolayers, as revealed by spatially resolved scanning tunneling spectroscopy. Ab initio calculations show that this novel confinement arises from the polarization lifted hole valley degeneracy and a ∼90° rotation of the Brillouin zones that render holes' momentum mismatched across neighboring domains. These results show a potential for polarization-tuned valleytronics in 2D ferroelectrics.

Enhanced Spontaneous Polarization in Ultrathin SnTe Films with Layered Antipolar Structure.

2D SnTe films with a thickness of as little as 2 atomic layers (ALs) have recently been shown to be ferroelectric with in-plane polarization. Remarkably, they exhibit transition temperatures (Tc ) much higher than that of bulk SnTe. Here, combining molecular beam epitaxy, variable temperature scanning tunneling microscopy, and ab initio calculations, the underlying mechanism of the Tc enhancement is unveiled, which relies on the formation of γ-SnTe, a van der Waals orthorhombic phase with antipolar inter-layer coupling in few-AL thick SnTe films. In this phase, 4n - 2 AL (n = 1, 2, 3…) thick films are found to possess finite in-plane polarization (space group Pmn21 ), while 4n AL thick films have zero total polarization (space group Pnma). Above 8 AL, the γ-SnTe phase becomes metastable, and can convert irreversibly to the bulk rock salt phase as the temperature is increased. This finding unambiguously bridges experiments on ultrathin SnTe films with predictions of robust ferroelectricity in GeS-type monochalcogenide monolayers. The observed high transition temperature, together with the strong spin-orbit coupling and van der Waals structure, underlines the potential of atomically thin γ-SnTe films for the development of novel spontaneous polarization-based devices.

Discovery of robust in-plane ferroelectricity in atomic-thick SnTe.

Stable ferroelectricity with high transition temperature in nanostructures is needed for miniaturizing ferroelectric devices. Here, we report the discovery of the stable in-plane spontaneous polarization in atomic-thick tin telluride (SnTe), down to a 1-unit cell (UC) limit. The ferroelectric transition temperature T(c) of 1-UC SnTe film is greatly enhanced from the bulk value of 98 kelvin and reaches as high as 270 kelvin. Moreover, 2- to 4-UC SnTe films show robust ferroelectricity at room temperature. The interplay between semiconducting properties and ferroelectricity in this two-dimensional material may enable a wide range of applications in nonvolatile high-density memories, nanosensors, and electronics.

[Chemical constituents from supercritical CO2 extraction of Schisandra chinensis].

OBJECTIVE: To study the chemical constituents from the supercritical CO2 extraction of Schisandra chinensis. METHODS: The compounds were separated and purified by conventional column chromatography and their structures were identified by spectroscopic methods. RESULTS: Nine compounds were isolated from the supercritical CO2 extraction of Schisandra chinensis, and their structures were identified as chrysophanol(1),schisandrin B(2), ß-sitosterol(3), schisandrin C(4),schisandrol A(5), angeloylgomisin H(6), daucosterol(7) 1, 5-dimethyl citrate (8), and shikimic acid (9). CONCLUSION: Compounds 1, 8 and 9 are isolated from Schisandra chinensis for the first time,and compound 1 as an anthraquinone is isolated from this genus for the first time.