The effectiveness of online group mindfulness-based cognitive therapy for outpatients with depression in China.

OBJECTIVES: With the development of online technology and the increase in real-world needs, conducting psychotherapy on online platforms has become a popular trend. The present study followed the schedule and content of Mindfulness-based Cognitive Therapy (MBCT), and only changed the treatment format (from offline to online) to investigate the effectiveness of online group MBCT for Chinese outpatients with depression. METHODS: The study used before-and-after controlled design, and included 88 depressed outpatients, of which 75 formally underwent a 10-week online group MBCT. The 24-item Hamilton Depression Scale (HAMD-24), Hamilton Anxiety Scale (HAMA), Self-Depression Rating Scale (SDS), Mindful Attention Awareness Scale (MAAS), and Self-Acceptance Questionnaire (SAQ) were administered to patients one week prior to treatment, the fifth week of treatment, and the tenth week of treatment. Repeated-measures data were processed using linear mixed-effects models. RESULTS: 75 patients (85.23 %) attended >4 sessions, 44 of whom were taking psychotropic medication during treatment. HAMD-24 and HAMA scores decreased significantly in both medicated and unmedicated patients (w10 < w1, p < 0.05). HAMD-24 and HAMA scores declined more rapidly in patients taking medication, with significant decreases in the fifth week (w5 < w1, p < 0.05). The remarkable effectiveness of treatment (HAMD-24 score reduction >50 %) was >30 %, but there were no significant changes in patients' SDS, MAAS, or SAQ scores. CONCLUSIONS: This study supports the effectiveness of online group MBCT for outpatients with depression and the adherence of depressed patients to participate in online group MBCT was high.

Chinese university students showed less disordered eating during the COVID-19 campus lockdown.

OBJECTIVE: The rapid spread of the Omicron variant of COVID-19 in China had resulted in campus lockdown in many universities since February 2022, profoundly affecting students' daily lives. Campus lockdown conditions differ considerably from home quarantine, so that the eating patterns of university students may be different. Thus, the current study aimed to: (1) investigate university students' eating patterns during campus lockdown; (2) identify factors associated with their disordered eating. METHOD: An online survey about recent life changes, disordered eating, stress, depression, and anxiety was carried out from April 8th to May 16th, 2022. A total of 2541 responses from 29 provinces/cities of China were received. RESULTS: 2213 participants were included in the main analysis, and other 86 participants were analyzed separately as a subgroup due to their diagnosis of eating disorder. Participants who were undergoing campus lockdown (the lockdown group) showed less disordered eating than those who had never been in campus lockdown (the never-lockdown group), as well as those who had experienced campus lockdown before (the once-lockdown group). However, they perceived more stress and felt more depressed. Being female, higher BMI, gaining weight, increasing exercise, spending more time on social media, higher level of depression and anxiety were all related to disordered eating in the lockdown group. CONCLUSIONS: Disordered eating among Chinese university students was less prevalent during campus lockdown due to the strict and regular diet. However, there is a potential risk of "revenge eating" after campus lockdown ends. Thus, there should be further tracking and related prevention. LEVEL OF EVIDENCE: IV, uncontrolled trials without any interventions.

Exploring Association Between Serotonin and Neurogenesis Related Genes in Obsessive-Compulsive Disorder in Chinese Han People: Promising Association Between DMRT2, miR-30a-5p, and Early-Onset Patients.

Obsessive-compulsive disorder (OCD) is a deliberating disorder with complex genetic and environmental etiologies. Hypotheses about OCD mainly include dysregulated neurotransmitters, especially serotonin, and disturbed neurodevelopment. Single nucleotide polymorphism (SNP) association studies regarding OCD are often met with inconsistent results. However, stratification by age of onset may sometimes help to limit the heterogenicity of OCD patients. Therefore, we conducted a stratified SNP association study enrolling 636 patients and 612 healthy controls. Patients were stratified by age of onset as early-onset (EO-OCD) and late-onset (LO-OCD). Blood extracted from the patients was used to genotype 18 loci, including serotonin system genes, Slitrk1, Slitrk5, and DMRT2 and related miRNA genes. Logistic regression was used to compare allele and genotype frequencies of variants. A general linear model was used to evaluate the association between variants and trait anxiety. In our study, rs3824419 in DMRT2 was associated with EO-OCD, G allele was the risk allele. Rs2222722 in miR-30a-5p was associated with EO-OCD, with the C allele being the risk allele. Rs1000952 in HTR3D was found associated with trait anxiety in OCD patients. The significance disappeared after FDR correction. Our results supported neurodevelopment-related genes, DMRT2 and miR-30a-5p, to be related to EO-OCD. However, we cannot prove serotonin genes to be directly associated with EO-OCD. While an association between HTR3D and trait anxiety was discovered, comparisons based on biological or clinical traits may be helpful in future studies. As our detective powers were limited, more large-scale studies will be needed to confirm our conclusion.

Changing patterns and influencing factors of involuntary admissions following the implementation of China's mental health law: A 4-year longitudinal investigation.

Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China's first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.

Non-suicidal self-injury in Shanghai inner bound middle school students.

BACKGROUND: Non-suicidal self-injury (NSSI) behaviour is very common among adolescents. Its prevalence and behavioural characteristics may vary according to regional and cultural differences. Investigation of NSSI locations and diagnosis of adolescents with NSSI are relatively lacking in China. AIMS: The study objective was to determine the prevalence and features of NSSI among middle school students in Shanghai. METHODS: The participants were from grade 6 to 8 selected from three junior schools in Jing'an District. Consenting students completed the Ottawa Self-Injury Inventory to determine the prevalence and characteristics of NSSI. Those who indicated NSSI within the past month were administered the Mini-International Neuropsychiatric Interview for Children and Adolescents to assess for emotional disorders. RESULT: The result shows 510 participants (21.7%; mean age 13.51 (0.97) years old; 56.7% female) reported at least one instance of NSSI during the previous 12 months. NSSI was significantly more common in girls than boys (24.9% vs 18.5%; χ2=14.03, p=0.00). Commonly reported reasons for NSSI were for internal and external emotion regulation (87.9%, 82.3%) and social influence (57.8%). Anxiety disorders were the most common (28.9%) disorder associated with NSSI. CONCLUSION: The rate of NSSI of middle school students in Shanghai inner bound is similar to those reported in North American and European youth. It is essential that school mental health professionals are aware of how to manage NSSI within the school setting.

The classification of eating disorders in China: A categorical model or a dimensional model.

OBJECTIVE: According to the ICD-10 and DSM-5, eating disorders (EDs) are classified using a categorical model that assumes the subtypes are qualitatively different from one another. However, it is still intensely debated that a dimensional model is more suitable. The aim of this study is to examine whether EDs have a categorical or dimensional latent structure using a sample of Chinese ED patients. METHOD: The sample included 322 patients, diagnosed with an ED from 2010 to 2017 in the Shanghai Mental Health Center, and comparison participants (N = 850), recruited from undergraduate students in one university in Shanghai. Participants were evaluated with the Eating Disorder Inventory-2 (EDI-2) questionnaire and another questionnaire developed by the researchers. Three taxometric procedures (MAXimum EIGenvalue [MAXEIG], latent-mode factor analysis [L-Mode], and Mean Above Minus Below A Cut [MAMBAC]) were applied, respectively, to analyze the patients' clinical symptoms data. RESULTS: Patients were divided into three groups according to their clinical diagnosis. The plots of the three taxometric analysis procedures supported the categorical construct in anorexia nervosa, binge-eating/purging group, and bulimia nervosa group. The Comparison Curve Fit Indices of the MAXEIG, L-Mode, and MAMBAC procedures were 0.694, 0.709, 0.704 in the AN-BP group and 0.727, 0.67, 0.62 in the BN group, respectively, which also support the categorical construct. DISCUSSION: The results support two distinct classes of ED subtypes among Chinese sample. Further work on applying hybrid model in analysis has been discussed.

Cortical surface area reduction in identification of subjects at high risk for post-traumatic stress disorder: A pilot study.

OBJECTIVE: Victims of motor vehicle accidents often develop post-traumatic stress disorder, which causes significant social function loss. For the difficulty in treating post-traumatic stress disorder, identification of subjects at high risk for post-traumatic stress disorder is essential for providing possible intervention. This paper aims to examine the cortical structural traits related to susceptibility to post-traumatic stress disorder. METHODS: To address this issue, we performed structural magnetic resonance imaging study in motor vehicle accident victims within 48 hours from the accidents. A total of 70 victims, available for both clinical and magnetic resonance imaging data, enrolled in our study. Upon completion of 6-month follow-up, 29 of them developed post-traumatic stress disorder, while 41 of them didn't. At baseline, voxelwise comparisons of cortical thickness, cortical area and cortical volume were conducted between post-traumatic stress disorder group and trauma control group. RESULTS: As expected, several reduced cortical volume within frontal-temporal loop were observed in post-traumatic stress disorder. For cortical thickness, no between-group differences were observed. There were three clusters in left hemisphere and one cluster in right hemisphere showing decreased cortical area in post-traumatic stress disorder patients, compared with trauma controls. Peak voxels of the three clusters in left hemisphere were separately located in superior parietal cortex, insula and rostral anterior cingulate cortex. CONCLUSION: The finding of reduced surface area of left insula and left rostral anterior cingulate cortex suggests that shrinked surface area in motor vehicle accident victims could act as potential biomarker of subjects at high risk for post-traumatic stress disorder.

A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice.

OBJECTIVE: This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs. METHOD: A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview. RESULTS: 685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China. CONCLUSIONS: Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.

Progressive decline of cognition during the conversion from prodrome to psychosis with a characteristic pattern of the theory of mind compensated by neurocognition.

The association between neurocognition and the theory of mind (ToM) abilities during the progression of psychosis is unclear. This study included 83 individuals with attenuated psychosis syndrome (APS), from which 26 converted to psychosis (converters) after a follow up period of 18months. Comprehensive cognitive tests (including MATRICS Consensus Cognitive Battery, Faux-Pas Task, and Reading-Mind-in-Eyes Tasks) were administered at baseline. A structural equation modeling (SEM) analysis was conducted to estimate the effects of neurocognition on the ToM functioning in both APS and healthy controls (HC) datasets. At baseline, the converters and non-converters groups differed significantly on several domains of cognitive performance. The SEM analysis demonstrated that the path from neurocognition to ToM was statistically significant in the APS dataset (p<0.001). However, in the HC dataset, the result of the same analysis was not significant (p=0.117). Positive correlations between neurocognition and ToM were observed, and the most obvious correlations were found in the converters group compared with the non-converters group (p=0.064) and compared with the HC group (p=0.002). The correlation between ToM abilities and neurocognition may be increased during the progression of the condition, especially for individuals who convert to psychosis after a short period.

Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis.

OBJECTIVE: The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. METHOD: The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. RESULTS: Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. CONCLUSION: A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.

Psychometric Properties of the Chinese Version of the Eating Attitudes Test in Young Female Patients with Eating Disorders in Mainland China.

The study aimed to investigate the reliability and validity of the Chinese version of the eating attitudes test (EAT-26) among female adolescents and young adults in Mainland China. This scale was administered to 396 female eating disorder patients and 406 noneating disorder healthy controls, in addition 35 healthy controls completed a retest after a 4-week intervals. Tests for reliability, convergent validity and receiver operating characteristic analysis were performed to detect the psychometric properties. The EAT-26 demonstrated good internal consistency (Cronbach's alpha = 0.822-0.922), test-retest reliability (interclass correlation coefficient = 0.817) and convergent validity(r = 0.450-0.750). The receiver operating characteristic analysis showed that the cut-off 14 for anorexia nervosa and 15 for bulimia nervosa represented good compromises with approximate sensitivity (0.66-0.68) and specificity (0.85-0.86). Our findings provided evidence that the Chinese version of the EAT-26 was a psychometrically reliable and valid self-rating instrument for identifying people suffering from an eating disorder in Mainland China. A clinical cut-off range between 14 and 15 could be used, but caution should be exercised because of the low sensitivity of the tool. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Peripheral SLC6A4 Gene Expression in Obsessive-Compulsive Disorder in the Han Chinese Population.

BACKGROUND: Serotonergic system dysfunction has been implicated in obsessive-compulsive disorder (OCD). This study examined peripheral SLC6A4 gene expression in OCD patients and healthy controls to explore the relationship between SLC6A4 and OCD. METHODS: Participants included 50 first episode OCD patients and 60 age and gender-matched healthy controls. Relative SLC6A4 gene expression were examined by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) in peripheral leukocytes of all the subjects. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to assess the severity and subtype of OCD. RESULTS: SLC6A4 gene expression, normalized by glyceraldehyde-3-phosphate dehydrogenase (GAPDH), were not significantly different between the OCD patients and healthy controls(z=-0.79, p=0.428). Male OCD patients showed a tendency of low gene expression of SLC6A4 in peripheral blood (z=-1.66, p=0.096). We did not find a significant correlation between SLC6A4 expression and the severity and subtype of OCD. CONCLUSION: There is no correlation between SLC6A4 expression levels and the severity and subtype of OCD, but male OCD patients showed a tendency of low gene expression of SLC6A4 in peripheral blood. These results suggest that gene expression of SLC6A4 in peripheral blood may not be a useful biomarker of OCD in the Han Chinese population.

The Latent Class Structure of Chinese Patients with Eating Disorders in Shanghai.

BACKGROUND: Eating disorder is culture related, and the clinical symptoms are different between eastern and western patients. So the validity of feeding and eating disorders in the upcoming ICD-11 guide for Chinese patients is unclear. AIMS: To explore the latent class structure of Chinese patients with eating disorder and the cross-cultural validity of the eating disorder section of the new ICD-11 guide in China. METHODS: A total of 379 patients with eating disorders at Shanghai Mental Health Center were evaluated using the EDI questionnaire and a questionnaire developed by researchers from 2010 to 2016. SPSS 20.0 was used to enter data and analyze demographic data, and Latent GOLD was employed to conduct latent profile analysis. RESULTS: According to the results of latent profile analysis, patients with eating disorder were divided into five classes: low-weight fasting class (23.1%), non-fat-phobic binge/purge class (21.54%), low-fat-phobic binge class (19.27%), fat-phobic binge class (19.27%), and non-fat-phobic low-weight class (16.76%). Among the clinical symptoms extracted, there were significant differences in Body Mass Index (BMI), binge eating behavior, self-induced vomiting, laxative use and fat-phobic opinion; while there was no significant difference in restrictive food intake. CONCLUSIONS: Based on the clinical symptoms, there are five latent classes in Chinese patients with eating disorder, which is in accordance with the diagnostic categories of feeding and eating disorder in ICD-11. However, further work is needed in improving the fat-phobic opinion of patients with eating disorder and clarifying the BMI standard of thinness in the Chinese population.

Divergent Structural Responses to Pharmacological Interventions in Orbitofronto-Striato-Thalamic and Premotor Circuits in Obsessive-Compulsive Disorder.

Prior efforts to dissect etiological and pharmacological modulations in brain morphology in obsessive-compulsive disorder (OCD) are often undermined by methodological and sampling constraints, yielding conflicting conclusions and no reliable neuromarkers. Here we evaluated alteration of regional gray matter volume including effect size (Cohen's d value) in 95 drug-naïve patients (age range: 18-55) compared to 95 healthy subjects (age: 18-63), then examined pharmacological effects in 65 medicated (age: 18-57) and 73 medication-free patients (age: 18-61). Robustness of statistical outcomes and effect sizes was rigorously tested with Monte Carlo cross-validation. Relative to controls, both drug-naïve and medication-free patients exhibited comparable volumetric increases mainly in the left thalamus (d=0.90, 0.82, respectively), left ventral striatum (d=0.88, 0.67), bilateral medial orbitofrontal cortex (d=0.86, 0.71; 0.90, 0.73), and left inferior temporal gyrus (d=0.83, 0.66), and decreased volumes in left premotor/presupplementary motor areas (d=-0.83, -0.71). Interestingly, abnormalities in the thalamus and medial orbitofrontal cortex were present in medicated patients whereas entirely absent in premotor and ventral striatum. It suggests that pharmacotherapy elicited divergent responses in orbitofronto-striato-thalamic and premotor circuits, which warrants the design of longitudinal studies investigating the potential of these neuromarkers in stratified treatments of OCD.

Intrinsic functional connectivity alteration of dorsal and rostral anterior cingulate cortex in obsessive-compulsive disorder: A resting fMRI study.

Cortico-striato-thalamo-cortical (CSTC) circuit has been implicated in OCD pathophysiology by converging neuroimaging findings. The anterior cingulate cortex (ACC), as an important part within CSTC circuit, plays a critical role in OCD etiology. The ACC can be divided into dorsal and rostral parts anatomically, which are involved in cognitive process and emotional function, respectively. However, the diverse function of intrinsic signals from dorsal and rostral ACC regions remains unclear in OCD study. In this work, we applied resting-state functional magnetic resonance imaging (rs-fMRI) technology to investigate and differentiate the functional connectivity (FC) characteristics between dACC and rACC in unmedicated OCD patients. Also, the correlation between the altered FC and clinical symptom severity was analyzed. Decreased FC of rACC-DLPFC and increased FC between dACC and caudate were found. Moreover, the altered dACC-caudate FC was positively correlated with total Y-BOCS and compulsion score in OCD patients. Our findings implied the crossed function of dorsal and rostral circuits in the pathophysiologic mechanism of OCD. The dorsal cingulate-striatum functional pathway served as a potential biomarker for OCD symptomatology and merits further investigations.

Association of the 5-HT2A receptor gene promoter polymorphism-1438G/A with anorexia nervosa and psychopathological traits in the Chinese Han population: A preliminary study.

OBJECTIVE: The aim of the study was to explore the possible role of the 5-HT2A -1438G/A polymorphism in the susceptibility to anorexia nervosa (AN) in the Chinese Han population. METHODS: The -1438G/A polymorphism of 249 female AN patients, 228 matched healthy controls, and 198 trios was genotyped using SNaP shot assay. Psychopathological traits of eating-disordered behaviors in AN subjects were examined using the Chinese version of the Eating Disorder Examination Questionnaire. RESULTS: Neither the case-control analysis nor the transmission disequilibrium test revealed significant associations between the -1438G/A polymorphism and AN (P > .05). However, AA homozygote patients with AN had lower weight and shape concern scores of the EDE-Q6.0 than those of GA heterozygotes (P < .05). DISCUSSION: Our findings suggested that female AN patients with 5-HT2A -1438AA genotype may be characterized by less severe eating-disordered psychopathological traits in the Chinese Han population.

Resting-state functional connectivity changes within the default mode network and the salience network after antipsychotic treatment in early-phase schizophrenia.

OBJECTIVE: Abnormal resting-state functional connectivity (FC), particularly in the default mode network (DMN) and the salience network (SN), has been reported in schizophrenia, but little is known about the effects of antipsychotics on these networks. The purpose of this study was to examine the effects of atypical antipsychotics on DMN and SN and the relationship between these effects and symptom improvement in patients with schizophrenia. METHODS: This was a prospective study of 33 patients diagnosed with schizophrenia and treated with antipsychotics at Shanghai Mental Health Center. Thirty-three healthy controls matched for age and gender were recruited. All subjects underwent functional magnetic resonance imaging (fMRI). Healthy controls were scanned only once; patients were scanned before and after 6-8 weeks of treatment. RESULTS: In the DMN, the patients exhibited increased FC after treatment in the right superior temporal gyrus, right medial frontal gyrus, and left superior frontal gyrus and decreased FC in the right posterior cingulate/precuneus (P<0.005). In the SN, the patients exhibited decreased FC in the right cerebellum anterior lobe and left insula (P<0.005). The FC in the right posterior cingulate/precuneus in the DMN negatively correlated with the difference between the Clinical Global Impression (CGI) score pre/post-treatment (r=-0.564, P=0.023) and negative trends with the difference in the Positive and Negative Syndrome Scale (PANSS) total score pre/post-treatment (r=-0.475, P=0.063) and the difference in PANSS-positive symptom scores (r=-0.481, P=0.060). CONCLUSION: These findings suggest that atypical antipsychotics could regulate the FC of certain key brain regions within the DMN in early-phase schizophrenia, which might be related to symptom improvement. However, the effects of atypical antipsychotics on SN are less clear.

Correlation of social cognition and neurocognition on psychotic outcome: a naturalistic follow-up study of subjects with attenuated psychosis syndrome.

Neurocognitive decline has been observed in patients with psychosis as well as attenuated psychosis syndrome (APS). We tested the hypothesis that APS increases dependence on neurocognition during the interpretation of others' mental states and that a combination index of Theory of Mind (ToM) and neurocognition improves the predictive accuracy of psychosis conversion. A sample of 83 APS individuals and 90 healthy controls (HC) were assessed by comprehensive cognitive tests. The cohort also completed a one-year follow-up. In the APS group, ToM was associated with an apparent increase in neurocognition, but this trend was not evident in the HC group. Using the new index of combined neurocognition and ToM scores, the sensitivity for predicting psychosis-proneness was 75% and the specificity was 69%. Our data suggest that the correlations between ToM function and neurocognition in APS subjects were stronger than those in healthy controls. A composite index of neurocognition and ToM could improve the predictive validity of a future conversion to psychosis.

Co-morbidity of personality disorder in schizophrenia among psychiatric outpatients in China: data from epidemiologic survey in a clinical population.

BACKGROUND: The reported rates of personality disorder (PD) in subjects with schizophrenia (SZ) are quite varied across different countries, and less is known about the heterogeneity of PD among subjects with SZ. We examined the co-morbidity of PD among patients who are in the stable phase of SZ. METHOD: 850 subjects were randomly sampled from patients diagnosed with SZ in psychiatric and psycho-counseling clinics at Shanghai Mental Health Center. Co-morbidity of PDs was assessed through preliminary screening and patients were administered several modules of the SCID-II. Evidence of heterogeneity was evaluated by comparing patients diagnosed with SZ with those who presented with either affective disorder or neurosis (ADN). RESULTS: 204 outpatients (24.0 %) in the stable phase of SZ met criteria for at least one type of DSM-IV PD. There was a higher prevalence of Cluster-A (odd and eccentric PD) and C (anxious and panic PD) PDs in SZ (around 12.0 %). The most prevalent PD was the paranoid subtype (7.65 %). Subjects with SZ were significantly more likely to have schizotypal PD (4.4 % vs. 2.1 %, p = 0.003) and paranoid PD (7.6 % vs. 5.4 %, p = 0.034), but much less likely to have borderline, obsessive-compulsive, depressive, narcissistic and histrionic PD. CONCLUSIONS: These findings suggest that DSM-IV PD is common in patients with SZ than in the general population. Patterns of co-morbidity with PDs in SZ are different from ADN.