The cognitive effects of adjunctive repetitive transcranial magnetic stimulation for late-onset depression: a randomized controlled trial with 4 week follow-up.

Objectives: Cognitive impairment is common and linked to poor outcomes in patients with late-onset depression (LOD). The cognitive effects of repetitive transcranial magnetic stimulation (rTMS) for LOD are not well understood. This study aimed to investigate the effects of rTMS on cognitive function in elderly patients with LOD. Methods: In total, 58 elderly patients (aged 60 to 75 years) with depression were enrolled and randomly assigned to an active rTMS group or a sham group. The participants received active or sham rTMS over the left dorsolateral prefrontal cortex for 4 weeks, 5 days a week, at a frequency of 10 Hz rTMS and 120% of the motor threshold (MT). Cognitive function was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) at baseline, the end of the 4 week treatment period, and at the 4 week follow-up. Results: The active rTMS group showed significant improvements in immediate memory and attention scores on the RBANS compared to the sham group. However, no significant differences were observed between the two groups in other cognitive domains assessed by the RBANS. No serious adverse events related to rTMS treatment were observed. Conclusion: Treatment with 120% MT rTMS was associated with improvement in cognitive defects related to the active phase of LOD. These findings suggest that rTMS could provide early improvements in cognitive function in clinical settings for elderly patients with LOD.Clinical trial registration: https://www.chictr.org.cn/showproj.html?proj=40698, identifier ChiCTR1900024445.

Relationship Between Alzheimer's Disease and Retinal Choroidal Thickness: A Cross-Sectional Study.

BACKGROUND: The choroid is involved directly or indirectly in many pathological conditions such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). OBJECTIVE: The objective of this study was to investigate the association between retinal choroidal properties and the pathology of AD by determining choroidal thickness, hippocampus volume, cognitive functions, and plasma BACE1 activity. METHODS: In this cross-sectional study, 37 patients with AD and 34 age-matched controls were included. Retinal choroidal thickness was measured via enhanced depth imaging optical coherence tomography. Hippocampal volume was measured via 3.0T MRI. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog). Plasma BACE1 activity was analyzed using a fluorescence substrate-based plasma assay, and regression model were to analyze the data. RESULTS: Retinal choroidal thickness was significantly thinner in the AD group than in the control group [(114.81±81.30) µm versus (233.79±38.29) µm, p < 0.05]. Multivariable regression analysis indicated that the ADAS-cog scores (ß=-0.772, p = 0.000) and age (ß=-0.176, p = 0.015) were independently associated with choroidal thickness. The logistic regression model revealed that the subfoveal choroidal thickness was a significant predictor for AD (OR = 0.984, 95% CI: 0.972-0.997). CONCLUSION: There was a general tendency of choroid thinning as the cognitive function declined. Although choroidal thickness was not a potential indicator for early stage AD, it was valuable in monitoring AD progression.

Efficacy of Group Reminiscence Therapy on Cognition, Depression, Neuropsychiatric Symptoms, and Activities of Daily Living for Patients With Alzheimer Disease.

The current study aimed to investigate the effects of group reminiscence therapy on cognitive function, depression, neuropsychiatric symptoms, and activities of daily living in patients with mild-to-moderate Alzheimer disease (AD). A single-blind randomized parallel-design controlled trial was conducted between May 1, 2017, and April 30, 2018. Ninety patients with mild-to-moderate AD recruited from Beijing Geriatric Hospital were randomly allocated into intervention (n = 45) and control groups (n = 45). In the intervention group, group-based reminiscence therapy was performed in two 30- to 45-minute sessions weekly for 12 weeks. Control participants received only conventional drug treatments and routine daily care. Alzheimer disease-related symptoms were evaluated using the Alzheimer's Disease Assessment Scale-Cognitive section, the Cornell Scale for Depression in Dementia (CSDD), the Neuropsychiatric Inventory, and the Barthel Index. Four time points were set for data collection: baseline (before treatment), 4 weeks (during treatment), 12 weeks (end of treatment), and 24 weeks (12 weeks posttreatment). χ2 Tests, independent t tests, repeated-measures analysis of variance, and Bonferroni tests were used for data analysis. Significant improvements in depressive and neuropsychiatric symptoms were found in the intervention group compared to the control group (P < .05). Mean CSDD scores in the intervention group were improved at all 3 time points compared to baseline and showed the greatest effect at 12 weeks (t = 2.076, P = .041) and 24 weeks follow-up (t = 3.834, P = .000) compared to controls. Group reminiscence therapy was effective for improving depressive symptoms and was beneficial for treating neuropsychiatric symptoms in patients with AD.

Effects of risperidone on glucose metabolism in Chinese patients with schizophrenia: a prospective study.

BACKGROUND: While most of the second generation antipsychotic agents are associated with abnormal glucose metabolism, previous studies have shown that risperidone has relatively little effect upon blood glucose levels. This study aimed to explore the effect of risperidone on the glucose-regulating mechanism of patients with schizophrenia by using the oral glucose tolerance test (OGTT), measuring insulin and C-peptide levels. METHODS: Thirty inpatients with schizophrenia taking risperidone were studied. All the patients were given a simplified OGTT at baseline and six weeks after treatment. Plasma glucose, insulin, and C-peptide concentrations were measured at fasting, then 1 and 2h after OGTT respectively. Other data, including demographic characteristics and plasma drug concentrations, were also recorded. RESULTS: (1) There was no significant increase in the proportion of patients demonstrating abnormal plasma glucose levels compared with baseline (p=1.000, McNemar test); (2) risperidone was associated with elevated insulin concentrations (p=0.013), C-peptide levels (p=0.020), insulin/glucose ratio (p=0.020) and BMI (p<0.01); (3) no sex differences in glucose-related measures were observed. CONCLUSION: Risperidone treatment may be associated with alterations in glucose-regulating mechanisms in patients with schizophrenia.

Escitalopram in major depressive disorder: a multicenter, randomized, double-blind, fixed-dose, parallel trial in a Chinese population.

Escitalopram, the S-enantiomer of citalopram and the most selective of the selective serotonin reuptake inhibitor (SSRI) has been shown to be efficacious in the treatment of major depression in white populations. Our aim in this study was to investigate the efficacy and tolerability of escitalopram in Chinese patients with moderate to severe major depression. Patients who met DSM-IV criteria for a major depressive episode were enrolled in this multicenter, randomized, double-blind, fixed-dose comparison trial. Patients were given escitalopram 10 mg/day or fluoxetine 20 mg/day for 8 weeks. All patients were assessed with the 17-item Hamilton Depression Rating Scale (HAM-D-17) and the Montgomery-Asberg Depression Rating Scale (MADRS). Tolerability was assessed on the basis of adverse effects (measured with a locally developed checklist), regular biochemical tests, and electrocardiograph (ECG) assessments. Two hundred forty patients were enrolled and randomized to escitalopram (123 patients) or fluoxetine (117 patients). The HAM-D-17 total scores of both groups decreased significantly from baseline, but there was no significant difference at week 8 between the two groups (15.8 for escitalopram and 14.7 for fluoxetine; P >.05). There were no significant differences in response rates at all visits after treatment based on either HAM-D-17 or MADRS. A post hoc analysis indicated that escitalopram was superior to fluoxetine on two items of the HAM-D-17: "depressed mood" (P =.023) and "work and interest" (P =.024). The adverse events reported in the escitalopram and fluoxetine groups were comparable, and most were mild to moderate. Both drugs showed good compliance profiles. Escitalopram 10 mg/day is at least as efficacious as fluoxetine 20 mg/day and well tolerated in Chinese patients with major depression, with possible superiority in some core symptoms such as "depressed mood" and "work and interest."

Gender differences in 542 Chinese inpatients with schizophrenia.

OBJECTIVE: To investigate gender differences in the onset and other clinical features of Han Chinese inpatients with schizophrenia. METHODS: Five-hundred-and-forty-two Han Chinese inpatients with DSM-IV schizophrenia were assessed with the Positive and Negative Symptoms Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Function scale (GAF) and locally-developed standardized data collection forms. Comparisons were made between male and female patients. RESULTS: This is the largest study of gender differences in schizophrenia to be conducted in a Chinese population. In our sample, we found that schizophrenia onset occurred at a significantly earlier age in male patients compared to female patients and that late-onset schizophrenia (as defined by onset> or =45 years) was significantly more common in female patients. The paranoid subtype of schizophrenia was less common in male patients, males received higher daily doses of antipsychotics and demonstrated a different pattern of antipsychotic usage, being less likely to be treated with SGAs. Further, cigarette smoking was more common in male patients and male patients were more likely to be single or never married. By contrast, female patients showed a different pattern of ongoing symptoms and severity, being more likely to have persistent positive symptoms, more severe positive and affective symptoms, and a greater number of suicide attempts whereas male patients were more likely to show severe deterioration over time. CONCLUSIONS: There are notable gender differences in the age at onset, treatment and a range of other clinical features in Han Chinese patients with schizophrenia. Such differences were largely consistent with those reported in Western studies. These gender differences need to be considered in the assessment and management of Chinese patients with schizophrenia.

Help-seeking behaviors of Chinese patients with schizophrenia admitted to a psychiatric hospital.

PURPOSE: To investigate the help-seeking behaviors and related factors of Chinese psychiatric inpatients with schizophrenia. METHOD: Two hundred and two patients with schizophrenia (ICD-10) were enrolled in this study. A locally-developed, semi-structured questionnaire was used to collect data, including data on illness and help-seeking histories from patients, informants, and medical records. RESULTS: Among 202 inpatients, 120 patients (59.4%) had sought help from at least one type of non-psychiatric facility (NPF), and 82 patients (40.6%) went to a psychiatric hospital directly. Among the NPFs they contacted, 66 patients (32.7%) tried traditional Chinese medicine (TCM) from licensed practitioners (including acupuncturists), 64 (31.7%) chose general hospitals (including 9 who went to emergency departments), and 52 (25.7%) sought help from qigong (breathing exercise) masters or other folk healing methods. The reasons for seeking treatment from NPFs varied; the most common ones included feeling shameful or stigmatized about going to psychiatric hospitals, inaccessibility to or unavailability of psychiatric hospitals, and fear of being incarcerated or receiving electric shock treatment. CONCLUSION: A substantial proportion of psychiatric inpatients in China seek help from non-psychiatric facilities and/or folk healing methods. Feeling shameful or stigmatized, inaccessibility to and/or unavailability of psychiatric services are among the most common barriers to seeking psychiatric treatment. Patients who sought psychiatric help directly are likely to be female, with a chronic onset of illness, a mixed syndrome of positive and negative symptoms, or a better economic status.

Cigarette smoking in Chinese male inpatients with schizophrenia: a cross-sectional analysis.

Given the high rates of cigarette smoking in schizophrenia in many published studies from around the world, we studied the relationship between smoking status and clinical characteristics in male Chinese schizophrenic inpatients. Two hundred seventy-nine schizophrenic inpatients were assessed using clinical data forms to ascertain historical, demographic and treatment variables and collateral information was also collected from case records and interviews with patients and family members. Current smokers (N=112) were compared with non-smokers (N=167) on clinical variables by independent sample t-tests and chi(2) tests, with adjustment for confounding variables using ANCOVA and binary logistic regression analysis. Compared to non-smokers, current smokers were significantly more likely to be divorced, have lower educational attainment, a more episodic course, have a greater number of previous psychotic relapses and more likely to be treated with clozapine. There was no correlation, however, between smoking consumption and schizophrenic psychopathology. Accordingly, cigarette smoking may be associated with certain clinical features in schizophrenic patients, and should be carefully screened for when making treatment and rehabilitation plans.

Antipsychotic drug use in 503 Chinese inpatients with schizophrenia.

Objective. To determine current patterns of antipsychotic medication use and metabolic complications among hospitalized Chinese patients with schizophrenia. Method. A total of 503 inpatients who met ICD-10 diagnostic criteria for schizophrenia were enrolled. Demographic features and records of current treatment (medication, dose, duration of treatment) were collected through cross-sectional chart review along with biophysical parameters (body mass index and laboratory findings). Results. (1) Most patients (457/503, 90.9%) were found to receive antipsychotic monotherapy; (2) clozapine was the most common medication used (152/507, 30.2%); (3) the subset of patients treated within the course of a first episode psychosis, or with less than 5 years of illness, were more likely to be treated with second-generation antipsychotics (SGAs) than with conventional antipsychotic medications or clozapine; (4) patients treated with clozapine or conventional antipsychotics were more likely to manifest metabolism-related physical conditions than those receiving SGAs. Conclusion. Conventional antipsychotics and clozapine constitute the current mainstream of schizophrenia treatment in China where a lower percentage of patients receive SGAs other than clozapine than in developed countries. The high incidence of treatment-related metabolic complications in this population suggests that these issues are under-appreciated based on current patterns of medication use.

Attitudes, knowledge, and perceptions of Chinese doctors toward drug abuse.

We assessed the attitudes, knowledge, and perceptions of Chinese doctors who worked with drug abusers to provide direction for planned drug and alcohol education and training. A 34-item questionnaire was developed; 523 copies were distributed and 446 (84.5%) validated copies were collected. Half of the respondents (50.0%) had no formal training before they started treating drug abusers. Among them, only 16.6% were psychiatrists. Less than half of the respondents agreed that drug abuse (addiction) is a brain disorder. Male and female doctors and doctors from different facilities tended to have different opinions on reasons for relapse, efficacy of treatments, and awareness of treatment modalities, among others. Doctors from involuntary facilities were more likely to disagree with the idea that drug addiction is a brain disorder and favored compulsory treatment. Doctors involved in drug abuse treatment in China are not well prepared or experienced in drug abuse treatment and have negative attitudes toward drug abuse and abusers.