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Insomnia disorder is a common clinical mental disorder.Currently, clinical subtyping of insomnia disorder relies primarily on symptomatic descriptions, lacking objective measures and subtyping-based treatment approaches. In recent years, increasing attention has been drawn to sleep electroencephalography (EEG) as a valuable tool for observing abnormal sleep architecture and continuity of insomnia disorder. Sleep EEG analysis holds the potential to elucidate the underlying biological mechanisms of insomnia disorder, facilitating data-driven subtyping and enhancing personalized therapeutic strategies.Five types of sleep EEG subtypes of insomnia disorder were systematically searched and summarized: classifications derived from objective sleep duration, power spectral characteristics, cyclic alternating pattern, spindle and microarousal.EEG characteristics of each subtype and clinical outcomes are discussed.This review aims to provide evidence-based insights for clinical subtyping and personalized treatment of insomnia disorder.
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ObjectiveTo explore the barriers and facilitators of the adherence of formal practice after mindfulness-based cognitive therapy (MBCT) in psychological counseling outpatients. MethodsOne-on-one interview was conducted in 15 psychological counseling outpatients who attended MBCT at Shanghai Mental Health Center and had been out of treatment 5 months or more. Data was analyzed using thematic analysis. ResultsPoor mood, weak willpower, limited time and space, lack of companionship and supervision, and discomfort with the recording were the five factors that prevented the patients from sticking to their practice. Personality trait, trust, benefit, need for self-care, time/space arrangement, fellow practitioners, therapists, and ease and convenience of practice were the eight factors that promoted the patients to practice. ConclusionThe COM-B model helps therapists and individuals with practice needs to understand the mechanism of formal practice facilitators at a holistic level. Therapists and individuals with practice needs should be concerned about possible barriers on the adherence of formal practice.
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Body image flexibility (BIF) is the specific type of psychological flexibility in the research field of body image, which reflects the ability to experience negative body image and related events in an open and acceptive way, and take actions consistent with one's values. Body image is actually not stable. If negative body image could not be adjusted effectively in time, it would develop into body image disturbance (BID), which is one of the core symptoms and psychopathological mechanisms of eating disorder (ED) and body dysmorphic disorder (BDD). BIF is one of the important factors in this development path, gaining more and more attention as a protective factor for body image. So far, most studies focus on eating disorder patients and related sub-clinical populations. Body image-acceptance and action questionnaire is the most widely used measurement. BIF is related to some sample characteristics, such as gender, age and body size.Cultural context also has an impact on it.Positive and negative body image and eating disorder pathological characteristics are also strongly associated with BIF. As to the intervention, the application of mindfulness, acceptance and compassion in treatment may improve BIF. Future studies need to improve the research methods and designs, and pay attention to other samples. More specific interventions need to be developed, of which the therapeutic mechanisms also need to be explored.
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Objective To explore the characteristics of alexithymia and interoception in patients with panic disorder(PD) and its relationship. Methods Thirty-seven patients with PD and 45 healthy con-trols who met the diagnostic criteria of DSM-Ⅳ were selected. Toronto Alexithymia Scale ( TAS) and state-trait anxiety inventory ( STAI) were used to assess the characteristics of alexithymia and anxiety symptoms respectively. The heartbeat perception levels were tested by the Mental Tracking Paradigm. Results The de-tection rate of alexithymia in patients with panic disorder was 37. 83% (14/37),but the rate in the normal control group was only 4. 44%(2/45),and the difference was statistically significant (χ2=14. 42,P<0. 05). The total score of TAS (55. 11±10. 99),factor Ⅰ (20. 62±6. 78) and factor Ⅱ (14. 68±3. 70) in the PD group were higher than those in the control group (42. 93± 9. 25,12. 82± 4. 99,11. 42±3. 04; F=20. 72, 31. 08,15. 31,P<0. 01). The levels of the heartbeat perception were higher in the PD group than that in the control group (0. 75±0. 15,0. 58±0. 19;t=4. 13,P<0. 05). In PD group,the score of STAI were positively correlated with TAS total score and factor Ⅰ and Ⅱ scores( r=0. 57,0. 61,0. 47;r=0. 54,0. 62,0. 39,P<0. 05). There was no significant correlation between the scores of STAI and the level of interoception. The mediating effect of interoception level on alexithymia and state anxiety was not significant while the mediating effect on alexithymia and trait anxiety was also not significant. Conclusions The alexithymia detection rate and interoception sensitivity in patients with panic disorder were higher than those of healthy people. There may be interaction between alexithymia and anxiety symptoms. Interoception may be a clinical feature of panic disorder.
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Objective To explore the functional connectivity (FC) of the fronto-striatal circuitry in patients with bulimia nervosa (BN) based on the resting-state fMRI and its correlation with the inhibitory function.Methods 27 medication-naive female patients with BN and 27 age-and education-matched female healthy control subjects were included in the study.All the subjects performed a stop signal task (SST) and underwent the resting-state fMRI scan,separately.The FC between striatal subregions and the frontal cortex was analyzed.Results Compared with healthy controls,FC between the right ventral rostral putamen (VRP) and the right supplementary motor areas (SMA) decreased (MNI coordinate:x =3,y =-15,z =51,K =27) in patients with BN.And the FC was also decreased between the right VRP and premotor area(PM) (MNI coordinate:x =27,y =0,z =57,K =44).FC between bilateral dorsal caudal putamen (DCP) (MNI coordinate:x=21,y=-6,z=48,K=43) and the right PM(MNI coordinate:x=21,y=-12,z=57,K=24) was decreased in patients with BN (P<0.05,Alphasim corrected,voxel P<0.005,clusters ≥ 20 voxels).FC between the right VRP and right SMA was negatively correlated with the stop signal reaction time (SSRT) in patients with BN (r=-0.595,P=0.004).The FC between right DCP and right PM was positively correlated with the impulsivity regulation subscale scores of the Eating Disorder Inventory-Ⅱ in patients with BN(r=0.483,P=0.023).Conclusion There is disrupted FC between the striatum and motor cortex in medication-naive female patients with BN based on resting-state fMRI,which may be related to impaired inhibitory control in patients with BN.
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Objective To investigate the eye-movement features of smooth pursuit in subjects at clinical high risk for psychosis.Methods sixty subjects at clinical high risk for psychosis and sixty healthy controls were recruited.The smooth pursuit tasks were assessed in both horizontal (0.4 Hz) and Lissajous (0.2 or 0.4 Hz) condition.The Wechsler Memory Scale-third edition and spatial span subtest were used to assess working memory.The difference of the smooth pursuit performance between the two groups and the relationship between smooth pursuit and working memory were analyzed.Results Subjects at clinical high risk for psychosis showed significantly lower Horizontal components for pursuit gain [Lissajous 0.2 Hz task (0.82±0.12) vs.(0.89±0.09),Lissajous 0.4 Hz task (0.78±0.13) vs.(0.84±0.14)],lower vertical components for pursuit gain [Lissajous 0.2 Hz task (0.80±0.14) vs.(0.86±0.12),Lissajous 0.4 Hz task (0.71±0.15)vs.(0.77±0.16)] and higher mean positional error [Lissajous 0.2 Hz task (37.00±19.10) vs.(30.45± 16.18),Lissajous 0.4 Hz task (44.18±19.70) vs.(37.61±16.26)] compared to healthy controls (P<0.05).There was a significant correlation between pursuit gain and performance on Spatial Span (Horizontal components:r=0.361,P=0.005;vertical components:r=0.327,P=0.01 1) in the Subjects at clinical high risk for psychosis.Conclusions Subjects at clinical high risk for psychosis showed deficits in smooth pursuit,and the deficits were related to the working memory.
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Objective:To evaluate the validity and reliability of the Chinese version of the Eating Disorder Examination Questionnaire 6.0 (EDE-Q 6.0) in female patients with eating disorders.Methods:A total of 239 patients with eating disorder and 142 healthy controls who were recruited consented to participate in the study and completed Chinese EDE-Q 6.0.Confirmatory factor analysis was used in patients to compare the original 4-factor model,1-factor model and 3-factor model.The criterion validity was tested with the Eating Disorder Inventory (EDI).Mann-Whitney U analysis was used to compare the differences of EDE-Q 6.0 scores on the two samples to test the empirical validity,and ROC analysis was used to determine the cut-off value.The internal consistency of the scale was tested in two samples.Among all participants,89 patients and 31 healthy controls were retested 1 month later.Results:The original 4-factor model fit better than the other two.The EDE-Q 6.0 total score and the EDI total score had a high consistency in the total sample,patients and controls,respectively (ICC =0.88,0.87,0.73).Patients had higher scores on the EDE-Q 6.0 than controls (Ps <0.01).The mean area under the curve (AUC) of EDE-Q 6.0 was 0.91,the optimal cut-off point of EDE-Q 6.0 was total score ≥ 1.27,sensitivity and specificity were 79.4% and 88.2% respectively.The Cronbach α coefficients were 0.95,0.91,and 0.88 for the total sample,patients and controls respectively.The test-retest reliabilities were 0.73 for the total scale,0.58,0.68,0.69 and 0.71 for the 4 factors.Conclusion:The Chinese version of the Eating Disorder Examination Questionnaire 6.0 have good psychometric properties and diagnosis accuracy,and it could be used to assess the severity of clinical symptoms.
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Objective To compare the difference of early trauma experience between early-onset and late-onset obsessive-compulsive disorder(OCD),and the kinds of early trauma in the cause of OCD. Methods Three hundred and twenty-six patients with obsessive-compulsive disorder and 480 healthy con-trols were enrolled. Early Trauma Inventory-Short Form ( ETI-SF) was applied to assess the early trauma ex-perience,compare the difference of early trauma experience between early-onset ( n=138) and late-onset ( n=188) OCD,and the kinds of early trauma in the cause of OCD. Results There were significant differences in the early trauma experience between obsessive-compulsive disorder group and control group((3.90±3.61) vs (1.88±2.61), P<0.01).Scores of physical((1.12±1.38) vs (0.71±1.23), P=0.001),emotional((1.58± 1.71) vs (0.42±1.01), P<0.01),and sexual abuse((0.27±0.59) vs (0.09±0.36), P=0.001),and a gener-al traumatic experience((0.94±1.17) vs (0.66±1.09), P<0.01) were significant difference between patients and controls. Except sexual abuse((0.30±0.66) vs (0.24±0.67), P=0.42),there were significant differ-ences in the early trauma between early-onset and late-onset OCD((5.12±3.58) vs (3.01±3.38), P<0.01), especially emotional abuse((2.18±1.76) vs (1.12±1.53), P<0.01).247(75.8%) OCD patients and 79(57. 9%) healthy controls experienced early trauma(χ2=21.48, P<0.01). Experiencing one kind of early trau-ma,the prevalence of OCD was 39.1%,two kind was 61.0%,three kind of early trauma was 65.8%,and ex-periencing four or more kind of early trauma,the prevalence of OCD was up to 84.4%. Conclusion OCD patients have much more early trauma,especially early-onset OCD. Experiencing more kind of early trauma, and the prevalence of OCD higher may associated with the development of obsessive-compulsive disorder. It is important to consider the role of childhood trauma in the prevention and treatment of OCD.
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Objective To investigate the relationship between the characteristics of psychological defense style and clinical symptoms of eating attitude in patients with anorexia nervosa patients. Methods Totally 92 ca?ses ( 46 cases of restricting type,46 cases of binge?eating/purging type,48 cases of early onset before 16 years old, 44 cases of late onset after 16 years old) meeting the Diagnostic and Statistical Manual of Mental Disorders,Forth Edition ( DSM?4) for anorexia nervosa (AN) were collected.92 gender?marriage?and education?matched normal cases in a psychiatric hospital were selected as the healthy control group(HC) .All were assessed with defensive style questionnaire(DSQ) and eating attitude test?26(EAT?26).DSQ and EAT?26 were compared between AN and HC,between early onset of AN( before 16 old years) and late onset of AN( after 16 old years) ,and between AN?R and AN?P.Then correlation study was done for the AN. Results Compared with HC,AN showed higher scores in the immature defense,neurotic defense ((4.49±1.13)vs (3.55±0.93),(4.33±0.76)vs (3.88±0.69), P0.05) . Conclusion AN patients tend to use more immature defense and neurotic de?fense compared with HC,and AN?P patients use more immature defense compared with AN?R. Immature defense and neurotic defense are related to the eating attitude,and the immature defense is related the duration.
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Objective To explore the feature of functional connectivity of default mode network (DMN) and salience network (SN) in unmedicated schizophrenia patients during a resting state by functional magnetic resonance imaging (fM-RI). Methods The SPM8 and DPARSFA softwares combined with independent component analysis (ICA) were used to in-vestigate functional connectivity (FC) of the DMN and SN in 27 unmedicated patients with schizophrenia and 27 age-and gender-matched healthy controls. Results Concerning the DMN, patients with schizophrenia showed decreased FC in right inferior frontal gyrus , right precuneus(unadjusted P<0.05)and increased FC in right middle cingulate gyrus, left middle frontal gyrus(unadjusted P<0.05). With regard to the SN, patients showed reduced connectivity in left inferior frontal gyrus, right inferior frontal gyrus, left anterior cingulate, left postcentral gyrus(unadjusted P<0.05)and increased connectivity in left superior temporal gyrus(unadjusted P<0.05). Correlation analyses showed that the increased FC of left superior temporal gyrus significantly correlated with PANSS-positive symptoms(r=0.568,P=0.002)and decreased FC of right precuneus significantly negatively correlated with delusion symptom(r=-0.458,P=0.016). Conclusion This study provides evidence for resting state functional abnormalities of DMN and SN in unmedicated schizophrenia patients. These aberrant function connectivities in some brain regions of the two networks could be a source of abnormal introspectively-oriented mental actives.
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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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ObjectiveTo develop the interacting learning mode in simulative situation on sex and health courses for college students and evaluate the effect of it.MethodsThe core curriculum for general education of sex and health was open to all the students in Shanghai Jiao Tong University from Feb.2010 to Jun.2011.The courses imported simulative-situation-learning method.At the end of the semester,the feedbaick and the suggestion of the students were collected and sorted.ResultsAll groups from the course involved the simulative situation seriously,which included homosexuality of college students,undesired pregnancy and contraception knowledge,etc.According to the feedback of the courses,most of the students acceptted this kind of teaching method.ConclusionInteracting learning in simulative situation can obviously increase the interest and enthusiasm of students.Meanwhile,the new courses not only improve students' understanding of knowledge,but also improve their communication skills and team work ability.
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Objective To improve the teaching quality of Sex and Reproductive Health for college students.Methods From February 2008 to June 2010,the general elective course of SeX and reproductive health were offered for students from all the majors in Shanghai Jiao Tong University.The lessons were conducted in the form of lectures,group discussions,role-plays and debates.The self-designed questionnaires were respectively given out after the first class and at the end of the last class in order to have an understanding of the rate of the relevant knowledge known by the students and their suggestions.Results The rate of the relevant knowledge known by the students significantly increased.Some suggestions about the educational reform were received through questionnaire and educational feedback.Conclusion The reproductive health service is needed for college students.Group discussions and role-plays are ideal methods for interactive teaching.
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Objective To investigate the association between early trauma experiences and obsessivecompulsive disorder (OCD). Methods One hundred and eighty-five patients who met with OCD diagnosis of DSM-Ⅳ and one hundred and thirty-two healthy controls were recruited. Early trauma experience of all participants was assessed with Early Trauma Inventory-Short Form (ETI-SF) ,and severity of symptoms of OCD patients was evaluated with Yale-Brown Obsessive-Compulsive Severity Scale (Y-BOCS). Results When compared with controls, OCD group showed significantly higher in ETI-SF total score (3.55 ± 3.29 vs 1.51 ± 1.98, P < 0. 01 ) and had greater in general trauma (0.89 ± 1.10 vs 0. 43 ±0.77, P<0.01 ) ,physical abuse (0.98 ± 1.31 vs 0.65 ±1.04, P=0. 016),emotional abuse(1.43 ±1.61 vs 0.38 ±0.89, P<0. 01),and sexual abuse(0.24 ±0.59 vs 0.06 ±0.30, P<0. 01 ). Female OCD patients reported more sexual abuse than male patients(0.33 ±0.69 vs0. 16 ± 0.45, P = 0.049) . There was a negative correlation between onset age of obsessive symptoms and early trauma experiences(P < 0. 01 ), except sexual abuse experiences (P = 0. 10). Conclusion OCD patients have much more childhood traumas, and the more trauma experiences are,the earlier onset of OCD is, which may associated with the development of obsessive-compulsive disorder.
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Objective To study the relationship between personality and defense mechanism of obsessivecompulsive disorder (OCD) patients.Methods Thirty-four OCD patients were tested with Swedish University Scales of Personality(SSP) and defensive style questionnaire( DSQ), and the result was compared with that of thirty-one normal controls.Results The SSP scores of STA,PsTA,SS,E,TI and M of OCD patients were significantly higher than that of normal controls (t = 2.06 ~ 5.10, P < 0.05 ).Comparing with normal controls, OCD patients tended to use immature and intermediate mechanism such as projection, passive aggression, unconscious emerge, phantasy, withdrawl and reaction formation, but less used mature mechanism such as sublimation, suppression and humor (t = -2.27 ~ 6.73, P< 0.05 ).All subscales of SSP in OCD patients, excluding SD and D, had positive correlation with total score of immature mechanism (r = 0.375 ~ 0.719, P < 0.05 ).The OCD patients' SSP scores of STA had positive correlation with mature mechanism (r = 0.378, P < 0.05 ).The OCD patients' STA, PsTA, I, AS, E, M,VTA and PhTA score of SSP had positive correlation with intermediate mechanism (r= 0.381 ~0.548, P< 0.05 ).All subscales of SSP in OCD patients, excluding SD, had positive correlation with total score of concealment (r =0.342 ~ 0.530, P < 0.05 ).Conclusion OCD patients have the neurotic and aggressive features of personality;and the personalities of OCD patients have significant correlation with defense mechanism.
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Marked by the Third Plenary Session of the Eleventh Central Committee of the CPC, Shanghai health care started a journey of reform and opening up as with other sectors. This essay reviews various stages Shanghai health care experienced and the achievements for the last 30 years since reform and opening up, and analyzes the challenges Shanghai health care faces currently. On this basis, the essay summaries the experiences and lessons learned from Shanghai health care reform and development.
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Under the general requirements of China's national health reform, the basic framework of Shanghai's health reform was constructed at five different aspects the long term vision, goal, strategies, measures, supportive reform activities. The general thought of Shanghai's health reform can be concluded into two aspects: first, establishing a basic healthcare system of covering both urban and rural residents universally; second, enhancing the foundation of enabling sustainable health development.
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Objective To investigate the use of component N400 of the event-related potentials (ERPs) elicited by Chinese idioms ending with matching and nonmatching words to explore the cognitive patterns and processing mechanisms elicited by Chinese characters. Methods Sixty-two right-handed healthy adults (age 19-50 years) , were presented with Chinese idioms ending with words with the same pronunciation but different form and meaning, words with similar forms but different pronunciation and meaning, words with same meaning but different pronunciation and form, and words with different pronunciation, form and meaning. A Guangzhou Runjie WJ-1 instrument was used to record component N400 of the potentials evoked. Results N400 showed a midline distribution , and could be detected under electrodes Fz, Cz and Pz. Significant differences were found in N400 latencies and amplitudes between matching and nonmatching ending-words. Compared with idioms with matching ending-words, N400 latencies were prolonged and amplitudes increased in nonmatching cases. The observed changes in N400 latencies and amplitudes were related to stimulus types, and the longest latency and largest amplitude were e-licited by ending-words with different pronunciation, form and meaning. No gender difference in N400 latency or amplitude was observed. Conclusions Compared with Western phonetic words, Chinese ideographic words are more flexible stimuli for N400 research, offering 3 dimensions for change: pronunciation, form and meaning. The N400 features elicited by matching and nonmatching ending words in Chinese idioms are mainly determined by the meaning of the word.
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Schizophrenia is one of the most severe psychiatric disorders.Although the etiology is unknown,schizophrenia appears to be a polygenic disorder associated with environmental factors.There are evidences that intracellular signaling plays an important role in the pathogenesis of schizophrenia.Canonical Wnt pathway,which is closely related to the development and function maintenance of central nervous system,have drawn wide attention.Evidences for potential disturbances of Wnt signaling pathways in schizophrenia have accumulated,which are in favour of the hypothesis that Wnt signaling alterations may be important in the pathogenesis of schizophrenia.The research advances in the relationship between canonical Wnt signaling pathway and schizophrenia are reviewed in this paper.
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Objective To explore the traits of error-related negativity (ERN) in generalized anxiety disorder (GAD) patients. Methods Thirty GAD patients and thirty normal controls were enrolled in this study. Use the Hamilton Anxiety Scale and State-Trait Anxiety Inventory to assess the severity of symptoms. Error-related negativity was elicited by the modified Eriksen Flanker task, recorded by Brain Products' EEG/ERP recording system,and the EEG signals were analyzed off line by Brain Analyzer software. Results There were no significant differences between two groups at age, gender composition, handedness and education (P > 0.05 ), the scores of HAMA, SAI and TAI were significantly higher in GAD group than NC group( t = 8.225, P < 0.001; t = 4.093, P <0.001; t = 6.742, P < 0.001 ) ,there were no significant difference in behavioral reactions between two groups (P >0.05) except for non-response rate(GAD:(15.29 ± 18.18)% ,NC:(7.23 ±7.99)%; t=2.184, P=0.035).The ERN amplitudes of GAD group were larger than these of NC group( FCz: GAD: ( -8.76 ±5.74) μV,NC:( -6.91 ± 3.07 )μV, F = 6.924, P = 0.012), yet the ERN latency did not show any significant group difference.There were no significant correlations between HAMA scores and ERN amplitudes/latencies. Conclusion The increased amplitudes of ERN possibly reflect the abnormally activated internal error monitoring process in GAD patients.