Trends in the prescribing of psychotropic medications for inpatient children and adolescents, 2000-2010: a study from China.

The objective of this study was to investigate the patterns in prescribing of psychotropic drugs for children and adolescents within the psychiatric department of a general hospital in China. Medical records of 878 patients (0-18 years old) were reviewed in 2000, 2005 and 2010. Patient characteristics, total psychotropic drug use and the proportionate use of each drug class (antipsychotics, antidepressants, mood stabilizers and anxiolytic-hypnotic drugs) were analysed. The results indicated that there was a 19.2% increase in the overall use of psychotropic drugs during the study period. The use of selective serotonin reuptake inhibitors increased from 24.8 to 45%, whereas that of tricyclic antidepressants decreased from 17.7 to 0.5%. The use of second-generation antipsychotics increased from 56 to 80%. In contrast, the use of first-generation antipsychotic decreased from 26.2 to 6.5%. The use of valproate also increased significantly from 2.1 to 16.4%. In patients diagnosed with schizophrenia, the use of selective serotonin reuptake inhibitors increased from 1.2 to 18.9% and that of valproate increased from 0 to 12.6%. The increasing trends in psychotropic drug use necessitate addition research to confirm their safety and efficacy in this specific population.

Abnormal spontaneous brain activity in medication-naïve ADHD children: a resting state fMRI study.

Abnormal baseline brain functional connectivity in attention-deficit/hyperactivity disorder (ADHD) has been revealed in a number of studies by using resting-state functional MRI (rfMRI). The aim of this study was to investigate the spontaneous frontal activities in medication-naïve ADHD boys using the rfMRI derived index, amplitude of low-frequency fluctuation (ALFF). In total 17 ADHD boys and 17 matched controls were recruited to undergo rfMRI scan on a 3.0T MRI system. For each subject, six oblique slices covering the frontal areas were acquired with a rapid sampling rate (TR=400ms). Functional images were processed in AFNI for calculation of ALFF and then group comparison was performed using voxel-based t-test. With a corrected threshold of p<0.05 determined by AlphaSim, we found that in comparison with controls, ADHD patients demonstrated higher ALFF values in the left superior frontal gyrus and sensorimotor cortex (SMC), and lower ALFF values in the bilateral anterior, middle cingulate and the right middle frontal gyrus (MFG). Significant correlations were found between patients' WSCT measures and the peak ALFF located in the right MFG (r=0.69, p=0.02), and the left SMC (r=0.65, p=0.03). Our results revealed abnormal frontal activities at resting state associated with underlying physiopathology of ADHD, and suggested the ALFF analysis to be a potential approach in further exploration of this disorder.

[Microstructural abnormalities of basal ganglia and thalamus in children with first-episode Tourette's syndrome: a diffusion tensor imaging study].

OBJECTIVE: To investigate the microstructural integrity of basal ganglia and thalamus in children with first episode drug-naive Tourette's syndrome (TS) by diffusion tensor imaging (DTI). METHODS: Ten right handed patients with TS (mean age = 8.1 +/- 2.7 years old, 7 males and 3 females) and 10 age and gender-matched healthy control subjects (mean age = 9.5 +/- 1.6 years old, 9 males and 1 female) were recruited. All of the participants had normal findings on conventional MRI. DTI was performed using a 3.0T MR scanner by employing a spin echo single-shot EPI sequence with 15 diffusion encoding directions. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) maps were generated from each participant's DTI images using DTIStudio software. Bilateral regions of interest (ROI) for the caudate nucleus, putamen,globus pallidus and thalamus were manually traced through ROIEditor software on averaged DWI maps. The differences on DT-MRI variables (ADC, FA) between the two groups were compared using the SPSS13.0 software. Significance level was set at 0.05. RESULTS: Significant decrease in FA values in left globus pallidus and bilateral thalamus, and increase in ADC values in the bilateral caudate nucleus, bilateral putamen and bilateral thalamus were found in the children with TS compared with the normal controls. CONCLUSION: The results support the hypothesis of abnormalities in basal ganglia and thalamus in the pathophysiology of TS.

[Epidemiological investigation on major depressive disorder in the most heavily damaged areas from Wenchuan earthquake in 2008].

OBJECTIVE: To assess the prevalence, demographic characteristics, risk factors and protective factors on major depression disorder (MDD) among the affected people in the epicenter, 7 months after the 2008-earthquake in Wenchuan, China. METHODS: Stratified multistage cluster randomization was conducted to choose 14 503 subjects aged 15 years or over in the city of Dujiangyan, Beichuan county and Qingchuan county, Sichuan province. We used the general health questionnaire (GHQ-12) as the screening instrument, and the structured clinical interview for DSM-IV-TR axis I disorder-patient edition (SCID-I/P) as the tool for diagnosis. RESULTS: There were 180 persons diagnosed as MDD with other 13 asymptomatic ones. The point prevalence of MDD was 1.27% and the lifetime prevalence was 1.36%. Risk factors were including:being female (OR = 1.56, 95%CI: 1.136 ∼ 2.143, P < 0.05), co-morbidity with somatic diseases (OR = 4.02, 95%CI: 2.75 - 5.90, P < 0.05), wounded in the earthquake (OR = 3.29, 95%CI: 1.92 - 5.65, P < 0.05), property loss up to 10 000 - 20 000 Yuan (OR = 2.09, 95%CI: 1.18 - 3.69, P < 0.05), property loss up to > 20 000 Yuan (OR = 2.54, 95% CI: 1.38 - 4.68, P < 0.05), death or missing of family members (OR = 3.79, 95%CI: 2.08 - 6.89, P < 0.05) and in middle-age (OR = 2.31, 95%CI: 1.38 - 3.86, P < 0.05) etc. Having had a job seemed to be a protective factor (OR = 0.60, 95%CI: 0.43 - 0.83, P < 0.05). CONCLUSION: Major depressive disorder appeared to be a common psychiatric disease in these quake-stricken areas, that causing serious problems. Sustained follow-up and care provided to the affected people in these areas were of extreme importance.

[Quality of life of children with attention deficit hyperactivity disorders].

OBJECTIVE: To assess the quality of life of children with attention deficit hyperactivity disorders (ADHD). METHODS: The PedsQL 4.0 generic core scales (Chinese Version) were administered to 73 ADHD children and 98 gender and age-matched healthy children. The parents of the children completed the Conners Parent Symptom Questionnaire. RESULTS: A total of 169 out of 171 recruited families completed the questionnaires, with a response rate of 98.8%. The ADHD children had significantly lower scores (72.7 +/- 13.0) of PedsQL 4.0 than that of the healthy children (83.7 +/- 12.0, t = -49.3, P = 0.000). The Parent Proxy-Report total score of the ADHD children (70.0 +/- 12.4) was also lower than the normal controls (82.4 +/- 11.2, t = -57.7, P = 0.000). The psychosocial health functioning of ADHD children (Children Self-Report 68.6 +/- 14.5, Parent Proxy-Report 64.9 +/- 15.4) was consistently poorer than the Physical Functioning (Children Self-Report 81.2 +/- 14.0, Parent Proxy- Report 81.7 +/- 15.6) (P = 0.000). The ADHD children had significantly higher scores in Conners Parent Symptom Questionnaire (44.54 +/- 17.89) than the normal controls (16.09 +/- 9.23, t = 100.08, P = 0.000). The PedsQL 4.0 scores were negatively correlated with school functioning scores, learning problems, hyperactivity index and the total scores of Conners Parent Symptom Questionnaire (r = -0.650, -0.630, and -0.599 respectively, P = 0.000). CONCLUSION: ADHD children suffer from poor quality of life and learning difficulties.

[A cross-sectional investigation on eating disorders in 1486 female students from universities, senior high schools and junior high schools in Chengdu].

OBJECTIVE: To investigate the prevalence of eating disorders and its correlated factors in female students of universities, senior high schools and junior high schools. METHODS: A total of 1486 female students took part in the study. They were sampled by optimum distributing delaminating grouping method, representing the female students in 6 universities and 8 high schools in the 5 urban areas in Chengdu. Participants completed the Eating Disorder Inventory (EDI), Body Mass Index-based Silhouette Matching Test (BMI-SMT), Self-rating Depression Scale, Beck Anxiety Inventory and a self-administered questionnaire in the class time. We performed the t test and logistic regression to analysis the data. RESULTS: The estimated total prevalence of eating disorders in the female students was 3.32%. 17 years old (7.16%) was the easiest age to develop eating disorders while in senior high school (5.21%) showing the highest prevalence rate. There were differences between the eating disorders tendency group and none eating disorders tendency group in cognitive warp (P = 0.009) and expectation warp (P = 0.000) of BMI-SMT. The related factors of eating disorders were: concerning about the idol at media, non-harmonious parental relationships and being abused in childhood, body dissatisfaction factor of EDI, interoceptive awareness factor of EDI and anxiety. CONCLUSION: The total prevalence of female students' eating disorders in Chengdu was high and more attention should be paid to them on their mental health.

[Analysis on neuropsychological characteristics of subtypes of attention deficit hyperactivity disorder].

OBJECTIVE: To explore the neuropsychological characteristics of children with attention deficit hyperactivity disorder (ADHD). METHODS: Neuropsychological tests, including visual working memory, Stroop test, digits inverse reciting, vocabulary fluency, Wisconsin card sort test (WCST), and Temporal discounting were used to evaluate the capacity of response inhibition, phonological working memory, visual working memory executive function and delayed satisfying capacity of subjects. RESULTS: 1. The ADHD children spent longer time [ADHD-I (84(20), ADHD-C: 98 (31), normal: 70 (28)] to accomplish color naming and made more errors [ADHD-I: 3 (3), ADHD-C: 6 (19), normal: 2 (5)] than the normal control when the color was inconsistent with the word meaning in Stroop test (P < 0.01). 2. The scores of digits reciting [ADHD-I: 3 (3), ADHD-C: 3 (4), normal 4 (4)] inverse was lower in ADHD than in normal control (P < 0.01). 3. The representation of ADHD was poorer than normal control in visual working memory [ADHD-I: 21 (3), ADHD-C: 20 (5), Normal: 20 (3)], and in delayed visual memory [ADHD-I: 19 (5), ADHD-C: 19 (5), Normal: 20 (5)] (P < 0.01). 4. The scores of vocabulary fluency [ADHD-I: 1 (1), ADHD-C: 2 (1), normal: 0 (0)] was lower in ADHD than in normal control (P < 0.01). 5. In WCST, the ADHD children made more errors [ADHD-I :15 (17), ADHD-C: 15 (15), normal: 13 (13)] and less classification [ADHD-I: 5 (4), ADHD-C: 5 (4), normal: 5 (3)] than normal control (P < 0.01). 6. In Temporal discounting, the ADHD children showed significantly more impairments than normal control did (P < 0.01). 7. There was significant difference between the two subtype groups on some tests (P < 0.01). CONCLUSIONS: Obvious cognitive impairments were found in children with ADHD, involving poor response inhibition, impaired working memory, dysfunction of planning and set-shifting, and there was no significant difference between the two subtype groups.

[Study on the current situation and influential factors of anxiety sensitivity among middle school students in Chongqing].

OBJECTIVE: To explore the status and influencing factors on anxiety sensitivity among middle school students in Chongqing. METHODS: 58 classes from 12 schools were randomly selected in four administrative districts of Chongqing city. A total number of 2700 students was included for final analysis including 48.5% from junior high school and 51.5% from senior high school students with 49.2% boys and 50.8% girls. The Chinese version of the Anxiety Sensitivity Index-Revision, Adolescent Self-Rating Life Events Check List (ASLEC) and State-Trait Anxiety Inventory (STAI) were used. RESULTS: (1) There was no significant difference between grade groups (P = 0.49). (2) The level of girl's anxiety sensitivity was always higher than boy's (P < 0.001). (3) Data from multiple linear regression showed that the influential factors to the degree of anxiety sensitivity were: state of anxiety, trait anxiety, life events, sex, stress from learning, etc (standard coefficients of regression were 0.258, 0.163, 0.112, 0.093, 0.124, -0.096, 0.096). CONCLUSION: The major influential factors of anxiety sensitivity would include: sex, stress from learning, life events, interpersonal relationship, state of anxiety and trait anxiety.

[Study on the correlation between adolescents' emotional and behavioral problems and life events].

OBJECTIVE: To study the life events which are correlated with adolescent's emotion and behavior problems, and to provide evidence for clinicians and school staff to develop intervention for those problems. METHODS: Youth's Self Report (YSR) and Adolescent Self-Rating Life Events Check List (ASLEC) were used to assess adolescent's emotional and behavioral problems and life events by 'spot' study. The referred group consisted of 585 patients from 11 to 18 years old in a Mental Health Centre of West China Hospital of Sichuan University from July in 2002 to March in 2004. Level of IQ was above 5th grade of primary school among the study subjects who were willing to fill in the YSR and ASLEC. The non-referred group was selected in a 1280 students cluster-sample from the schools of Chengdu city, whose sex, age and father's career were matched with the referred group. Variance inflation factor (VIF) was used to verify that there was no collinearity to each other in the 6 factors of ASLEC: interpersonal relationship, learning pressure, being punished, losing good adaptation and other. Linear stepwise regression was adopted. RESULTS: The YSR scores in referred group were higher than those in non-referred group, and the referred group had more emotional and behavioral problems than the non-referred one. Partial correlations ranged from 0.124 to 0.418 in referred group, and from 0.104 to 0.388 in non-referred group. Unsatisfied interpersonal relationship, heavy learning pressure, having been punished and poor adaptation were likely to increase the risk of youth's emotional and behavioral problems. CONCLUSION: More attention should be paid to help adolescents in the following areas: solving intrapersonal affairs, relieving pressure from learning, avoiding punishment, and improving ability to fit themselves to their surroundings.

[An epidemiological study on mental problems in adolescents in Chengdu, China].

OBJECTIVE: To study the mental health problems in the adolescents aged 11-18 years in Chengdu, China. METHODS: Youth Self-Report (YSR) and the General Information Questionnaire were administered to 1802 students who were randomly selected from schools in Chengdu City. RESULTS: The overall rate of mental problems was 15.1% in the adolescents, 15.2% in boys and 14.9% in girls if 90th percentile of total scores and/or 98th percentile of syndromes scores were assigned as the cutpoint of norms. The overall rate of mental problems was 27.2% in the adolescents, 27.6% in boys and 26.8% in girls if 75th percentile of total scores and/or 98th percentile of syndromes scores were assigned as the cutpoint of norms. The rates of mental problems were not significantly different between boys and girls (chi-squared = 0.042, P = 0.838; chi-squared = 0.126, P = 0.723). Mental problems tended to be increasing with age (P = 0.000). There were 29 items that the percentiles were higher than 50% but 5 items were under 10% in all the 101 items of YSR. 3.1% of the adolescents often had suicidal intention, and 6.1% of the adolescents often thought of becoming opposite sex identity. CONCLUSION: The rates of mental problems in adolescents aged 11-18 years in Chengdu, Chana were 27.2% or 15.1% respectively,if 75th or 90th percentile of the total scores were assigned as the cutpoint of total scores. The mental problems in the adolescents tended to be increasing along with age.

[A cross-sectional study on suicide attempts in urban middle school students in Chengdu].

OBJECTIVE: To study the prevalence and associated factors of suicide attempt in middle school students. METHODS: Five middle schools in Chengdu were randomly sampled in the study. A total of 1393 students between the ages of 11 and 18 finished a self-administered questionnaire, Beck Depression Inventory (BDI), Adolescent Self-Rating Life Events Check List (ASLEC) and Egma Minnen av Bardodosnauppforstran (EMBU). Everyone who had suicide attempts was interviewed. Data were analysed by SPSS 8.0 (statistical package for the social science) program on computer. RESULTS: Thirty-six (2.6%) of the 1 393 students has the history of attempted suicide and the ratio of boys and girls was 1:2. Among the suicide attempters, 33.3% had recurrent events. The most common reason of suicide attempts in middle school stage was family conflicts (34.4%) with most common event as taking overdose tranquilizers or poisoning (50.0%). Risk factors of suicide attempt seemed to include hallucination, cigarette smoking, being bullied by peers, wanting to change sex, parents' remarriage, being female, father's refusal, being neglected in childhood and experiencing more events in the previous year. Protecting factor was found to have been family warmness. CONCLUSION: Suicide attempts were not uncommonly seen in middle school students. Clinicians and teaching staff should identify the risk factors and carry out intervention as early as possible.