An Epidemiologic Survey and Violent Behavior Analysis of Antisocial Personality Disorder in Young Men in Chengdu.

OBJECTIVES: To investigate the epidemiological characteristics of antisocial personality disorder (ASPD) in young men in Chengdu and explore the characteristics and risks of violence. METHODS: Stratified random sampling was used to conduct a self-assessment questionnaire survey in 4 108 males aged from 18 to 34 in Chengdu, including general demographic characteristics, structured clinical interview for the diagnostic and statistical manual of mental disorders-Ⅳ axis Ⅱ disorders (SCID-Ⅱ) personality disorder screen questionnaire, violence questionnaire, psychosis screening questionnaire (PSQ), Alcohol Use Disorders Identification Test (AUDIT) and drug use. χ2 test, univariate and multivariate logistic regression were used for analysis and odds ratio (OR) was calculated. RESULTS: The positive rate of ASPD was 5.91%, which was associated with young age, unmarried, unemployment state, low educational level, violent behavior, psychotic symptoms, alcohol and drug use (P<0.05). Young men with ASPD also had a risk (P<0.05) of violence (OR was 8.51), multiple violence (OR was 16.57), injury (OR was 6.68), intentional violence (OR was 11.41), etc., the risk decreased after controlling for psychotic symptoms and substance abuse, but was still statistically significant. CONCLUSIONS: The risk of violence, severe violence and intentional violence in young men in Chengdu is high, and psychotic symptoms and substance abuse increase the risk of ASPD violence and relate characteristics.

Prevalence of depressive symptoms and its correlates among medical students in China: a national survey in 33 universities.

We conducted a national survey among medical students in China to estimate the prevalence of depressive symptoms and explore associated risk factors based on an established questionnaire composed of demographic information, life events in the past four weeks before survey, and the validated Chinese version of the 21-item Beck's Depression Inventory (BDI). The mean age of enrolled 9010 students was 20.7 (standard deviation: 1.6) years. BDI scores indicated that 19.9% had depressive symptoms based on the cut-off score of 14. Socioeconomic factors and student characteristics such as male sex, low monthly income per capita, father's poor education background, and higher year of study were associated with higher prevalence of depressive symptoms among medical students. Students who studied in comprehensive universities were more likely to have depressive symptoms compared with those from medical universities. Habitual smoking and alcohol drinking, sleep deprivation, and hospitalization or medication for one week or more in the last four weeks also predisposed students to higher risk of depressive symptoms. Our results indicate that depressive symptoms are becoming a highly prevalent health problem among Chinese medical students. Primary and secondary prevention should be prioritized to tackle this issue based on potential risk factors.

Voxel-wise meta-analyses of brain blood flow and local synchrony abnormalities in medication-free patients with major depressive disorder.

BACKGROUND: Published meta-analyses of resting-state regional cerebral blood flow (rCBF) studies of major depressive disorder (MDD) have included patients receiving antidepressants, which might affect brain activity and thus bias the results. To our knowledge, no meta-analysis has investigated regional homogeneity changes in medication-free patients with MDD. Moreover, an association between regional homogeneity and rCBF has been demonstrated in some brain regions in healthy controls. We sought to explore to what extent resting-state rCBF and regional homogeneity changes co-occur in the depressed brain without the potential confound of medication. METHODS: Using the effect-size signed differential mapping method, we conducted 2 meta-analyses of rCBF and regional homogeneity studies of medication-free patients with MDD. RESULTS: Our systematic search identified 14 rCBF studies and 9 regional homogeneity studies. We identified conjoint decreases in resting-state rCBF and regional homogeneity in the insula and superior temporal gyrus in medication-free patients with MDD compared with controls. Other changes included altered resting-state rCBF in the precuneus and in the frontal-limbic-thalamic-striatal neural circuit as well as altered regional homogeneity in the uncus and parahippocampal gyrus. Meta-regression revealed that the percentage of female patients with MDD was negatively associated with resting-state rCBF in the right anterior cingulate cortex and that the age of patients with MDD was negatively associated with rCBF in the left insula and with regional homogeneity in the left uncus. LIMITATIONS: The analysis techniques, patient characteristics and clinical variables of the included studies were heterogeneous. CONCLUSION: The conjoint alterations of rCBF and regional homogeneity in the insula and superior temporal gyrus may be core neuropathological changes in medication-free patients with MDD and serve as a specific region of interest for further studies on MDD.

Mediating role of anxiety and impulsivity in the association between child maltreatment and lifetime non-suicidal self-injury with and without suicidal self-injury.

BACKGROUND: Child maltreatment can increase the risk of lifetime non-suicidal self-injury (NSSI) and suicidal self-injury (SSI), but there is limited knowledge regarding the differences of potentially psychological mechanisms between NSSI with and without SSI. METHODS: Participants, 3918 community-based Chinese young men aged 18-34 years in Chengdu, were included in this study. We investigated the association between depression, anxiety, psychosis, child maltreatment, adulthood traumatic events, impulsivity, alcohol dependence, drug abuse, and lifetime of NSSI among participants with and without SSI. Parallel mediation analysis was utilized to explore the mediators for the relation between child maltreatment and NSSI. RESULTS: The prevalence of lifetime NSSI was 6.1 % (95 % CI: 5.4 %-6.9 %) among young men. Anxiety and impulsivity partially mediated the effect of child maltreatment on NSSI either with (indirect effect: 51.2 %) or without SSI (indirect effect: 34.3 %). Depression was independently and significantly associated with only NSSI but not with NSSI+SSI. Alcohol dependence and psychosis were independently and significantly associated with NSSI+SSI and mediated the effect of child maltreatment on NSSI+SSI. LIMITATIONS: The cross-sectional survey data limits the robustness of the proof to the causal relationships. CONCLUSIONS: Anxiety and impulsivity are associated with NSSI either with or without SSI and partially mediate the effect of child maltreatment on NSSI. Depression is associated with only NSSI, while alcohol dependence and psychosis are only associated with NSSI+SSI. It could be crucial to improve treatment and recovery of alcohol dependence and psychosis for preventing young men engaged in NSSI from attempting SSI.

[Characteristics of recidivism in patients with mental disorders: 156 cases analysis].

OBJECTIVE: To analyze the characteristics of recidivism in patients with mental disorders, including criminology, clinic and guardianship, in order to provide references for preventing recidivism. METHODS: Using the self-designed questionnaire, 156 psychotic patients who had repeated crimes were appraised by West China Forensic Science Center of Sichuan University from 2007 to 2011 and the data were collected and analyzed. RESULTS: In the majority of these cases, patients were male, 26-45 years old, junior high school or below diploma, unmarried, and farmers or jobless. Each patient broke law 3.26 times on average. The main crimes were intentional injury (34.6%) and murder (15.7%). Within 5 years after diagnosis with mental disorder, 56.4% of the patients committed first crime. Within 1 year after the first time breaking the law, 55.8% of them repeated crimes. The diagnoses of schizophrenia (63.5%) were in the majority. The assessment results were mostly irresponsibility (61.5%). Among the patients, 44.9% of them didn't receive treatment while 34.6% of them were out of supervision. After the first crime, 66.1% of them didn't receive criminal prosecution while only 7.1% of them went through the appraisement of forensic psychiatry. CONCLUSION: Most of the patients had low education and low income. Meanwhile, low outpatient rate and pool supervision occurred in this special crowd. A good system for care and treatment of these mental patients should be built to prevent them from recidivism.

[Statistical prediction methods in violence risk assessment and its application].

It is an urgent global problem how to improve the violence risk assessment. As a necessary part of risk assessment, statistical methods have remarkable impacts and effects. In this study, the predicted methods in violence risk assessment from the point of statistics are reviewed. The application of Logistic regression as the sample of multivariate statistical model, decision tree model as the sample of data mining technique, and neural networks model as the sample of artificial intelligence technology are all reviewed. This study provides data in order to contribute the further research of violence risk assessment.

Status of mandatory treatment of mentally ill offenders without criminal responsibility in China: Information from 5,262 mandatory treatment judgments.

Background: To avoid public health risks, all governments ensure monitoring and treatment of mentally ill persons if they offend and assess their level of criminal responsibility. The Criminal Procedure Law of the People's Republic of China (2013) instituted special procedures. However, there are few articles in English which explain the implementation of mandatory treatment procedures in China. Methods: We collected 5,262 qualified documents from 2013 to 2021 from the China Judgments Documents Online. We analyzed social demographic characteristics, trial-related information as well as the mandatory treatment-related content, to investigate the mandatory treatment of China's mentally ill offenders without criminal responsibility, from 2013 to 2021. Simple descriptive statistics and chi-square tests were used to compare differences among several types of documents. Results: There was an overall change trend of the number of documents: increasing year by year from 2013 to 2019 after the implementation of the new law, but with sharp decrease in 2020 and 2021 during covid-19 pandemic. From 2013 to 2021, a total of 3,854 people had applications made for mandatory treatment, of whom 3,747 (97.2%) were given mandatory treatment, 107 (2.8%) had applications rejected. "Schizophrenia and other psychotic disorders" was the most common diagnosis in both groups and all offenders receiving mandatory treatment (3,747, 100.0%) were considered to have no criminal responsibility. A total of 1,294 patients had applications made for relief of mandatory treatment, of whom 827 (63.9%) were subsequently approved for relief, 467 (36.1%) were rejected. A total of 118 patients had applications for relief two or more times, and 56 (47.5%) were finally relieved. Conclusion: Our study presents the Chinese model of a criminal mandatory treatment system to the international community which has been in operation since the implementation of the new law. Legislatory changes and covid-19 pandemic can have effect on the number of mandatory treatment cases. Patients, their close relatives and mandatory treatment institutions have the right to apply for relief from mandatory treatment, but the final decision in China is taken by the court.

[Reliability of the Violence Risk Scale of Chinese version].

OBJECTIVE: To introduce and revise the Violence Risk Scale (VRS) for assessing violence risk and risk change, and to examine the reliability of Violence Risk Scale of Chinese version(VRS-C). METHODS: The original English version of the VRS was translated into Chinese according to established translation procedures. To examine the scorer reliability the 14 cases assessed by 3 assessors separately. One hundred and twenty-five patients with mental disorders from 3 different institutions in Sichuan province (Refined Control Ward in Ankang Hospital, Department of Forensic Psychiatry, Institute of Forensic Science and Mental Health Center of West China Hospital) were collected to examine the reliability of VRS-C. RESULTS: The results showed moderately good scale reliability of the VRS-C, with 0.80 of ICC for scorer reliability. All items have significant consistence with Cronbach's alpha coefficient as 0.921, split-half reliability as 0.906 and item total correlation as 0.246-0.849. CONCLUSION: The reliability of the VRS-C version is acceptable.

[Application of modified overt aggression scales on risk behavior assessment of patients with mental illness].

OBJECTIVE: To explore the value of Modified Overt Aggression Scales (MOAS) in assessing risk behavior of patients with mental illness. METHODS: Four hundred and ninety patients, who were from three mental health institutions (Refined Control Ward in Ankang Hospital, Mental Health Center of West China Hospital, Relief Ward in De Kang Hospital) belong to public security, health and civil system respectively, were evaluated with MOAS. RESULTS: Three hundred and thirteen patients did not have dangerous behavior, but 177 patients did (99 aggression, 78 violence). The descending order of risk behavior in patients with mental illness were Refined Control Ward in Ankang Hospital, Mental Health Center of West China Hospital, Relief Ward in De Kang Hospital. Physical and total aggression scores were higher in Refined Control Ward in Ankang Hospital than that in other two hospitals (P < 0.05). Autoaggression score in Mental Health Center of West China Hospital was higher than that in other two hospitals (P < 0.05). Physical and total aggression scores in male were higher than that in female (P < 0.05). Autoaggression score in female was higher than that in male (P < 0.05). Score of every single item and total score were higher in violent and aggressive group than that in non dangerous behavior group (P < 0.05). Physical and total aggression scores in violent group were higher than that in aggressive group (P < 0.05). CONCLUSION: The proportion, type and degree of risk behaviors in three mental health institutions are different and the type of risk behavior has gender difference.

[Criminological characteristics of female violent criminal suspects].

OBJECTIVE: To study criminological characteristics of female violent criminal suspects who accepted forensic psychiatry assessment. METHODS: Information of the suspects involved in judicial appraisal between 2000 and 2009 were collected and analyzed according to our self-made scale. RESULTS: The age of 259 suspects were between 16 and 81 years old. There were 205 (79.2%) suspects who were younger than 45 years old. There were 225 (86.9%) suspects who were married. There were 14 different appraisal results: schizophrenia 47.1%, without psychosis 15.4%, depression 10.4% and others 27.1%. Irresponsibility involved with 59.5%, partial responsibility 18.5% and full responsibility 22.0%. Murder were 85.7%, arson 10.4%, inflicted injury 1.9% and robbery 1.9%. A total of 191 cases resulted in death, accounting for 82.3% of all cases. In 34.9% of all cases, the victims were male spouse of the suspects. Main weapons used in the crime were cutters and other working related tools (36.3%). There were 66.8% of all cases were with pathological motivation, 29.7% with reality motivation and 3.5% cases were with unknown motivation. CONCLUSION: Female violent suspects in our cases often suffered from various kinds of mental diseases. Their motivations were pathological primarily. Most cases were intentional killing with family members as victim mainly. Major weapons used were daily working related tools.

[Evaluation on social function in cases involving sexual assault of patients with mental retardation].

OBJECTIVE: To explore social function in assessment of self-defense capability of patients with mental retardation against sexual assault. METHODS: The data of 125 sexual assault victims with mental retardation were collected according to our forensic psychiatry assessment criteria. Mental retardation was rated with WAIS-RC, GAF, and the rating scale of the intelligence disability. RESULTS: There were significant differences in occupation, marital status, education, knowledge about sex, and history of pregnancy among the patients with different levels of self-defense capability. The kappa values of the rating scale score of the intelligence disability, GAF, and IQ were 0.710, 0.661, and 0.494; the kappa values of that and self-defense capability were 0.538, 0.472, and 0.316 respectively. CONCLUSION: The level of social function is very important in the assessment of self-defense capability in patients with mental retardation.

[Analysis of intelligence in criminals with no psychosis diagnosed with forensic psychiatry].

OBJECTIVE: To study the intelligence of criminals with no psychosis diagnosed with forensic psychiatry. METHODS: The intelligence test results in 88 criminal cases with no psychosis and in 89 criminal cases with schizophrenia were compared. RESULTS: There were no significant statistical differences between two groups with respect to their sex, age, education, occupation, marital status, and criminal type. The average intelligence quotient (IQ) of no psychosis group was significantly higher than that of the schizophrenic group, but was significantly lower than the normal. There was no significant statistical difference between the subgroups claiming as either suffering or denying psychosis. CONCLUSION: There is a mild impairment in the intelligence in no psychosis group.

[Prevalence and risk factors of social anxiety disorder in high schools and universities in Chengdu].

OBJECTIVE: To explore the prevalence and risk factors of social anxiety disorder (SAD) in high schools and universities in Chengdu. METHODS: 2279 students in Chengdu sampled by optimum distributing delaminating grouping method were interviewed one-to-one by the trained psychiatrists according to SCID. Both the cooperated SAD patients (n=156) and the normal counterparts (NC, n=156) in the 2279 students completed Egma Minnen av Bardndosnauppforstran (EMBU), State-Trait Anxiety Inventory (STAI-Form Y), Fear of Negative Evaluation Scale (FNE) and Defense Style Questionnaire (DSQ). RESULTS: There were 179 SAD patients, 88 female ones and 91 male ones, in the 2279 students of the high schools and universities in Chengdu. Statistical analysis reveals that the SAD patients differ from the NC in seven aspects, i.e. growing circumstances (P = 0.049), family economical status(P = 0.000), family history of psychiatric disorder, scales of EMBU,STAI, FNE and DSQ. CONCLUSION: The total prevalence of SAD in the students of high schools and universities in Chengdu was 8.15%, the female prevalence 8.35%, and the male prevalence 7.62%. The possible risk factors were: growing up in the countryside, low family economic state, parental rearing pattern being deficient in emotional warmth, understanding, trust and encouragement but excessive in refuse, denial and overprotection, having anxiety trait, feeling fear of negative evaluation, more likely to use neurotic and immature defense mechanism while less likely to use mature defense mechanism, having positive family mental disorder history.

Monochromatic energy computed tomography image for active intestinal hemorrhage: a model investigation.

AIM: To investigate the value of computed tomography (CT) spectral imaging in the evaluation of intestinal hemorrhage. METHODS: Seven blood flow rates were simulated in vitro. Energy spectral CT and mixed-energy CT scans were performed for each rate (0.5, 0.4, 0.3, 0.2, 0.1, 0.05 and 0.025 mL/min). The detection rates and the contrast-to-noise ratios (CNRs) of the contrast agent extravasation regions were compared between the two scanning methods in the arterial phase (AP) and the portal venous phase (PVP). Comparisons of the CNR values between the PVP and the AP were made for each energy level and carried out using a completely random t test. A χ (2) test was used to compare the detection rates obtained from the two scanning methods. RESULTS: The total detection rates for energy spectral CT and mixed-energy CT in the AP were 88.57% (31/35) and 65.71% (23/35), respectively, and the difference was significant (χ (2) = 5.185, P = 0.023); the total detection rates in the PVP were 100.00% (35/35) and 91.4% (32/35), respectively, and the difference was not significant (χ (2) = 1.393, P = 0.238). In the AP, the CNR of the contrast agent extravasation regions was 3.58 ± 2.09 on the mixed-energy CT images, but the CNRs were 8.78 ± 7.21 and 8.83 ± 6.75 at 50 and 60 keV, respectively, on the single-energy CT images, which were significantly different (3.58 ± 2.09 vs 8.78 ± 7.21, P = 0.031; 3.58 ± 2.09 vs 8.83 ± 6.75, P = 0.029). In the PVP, the differences between the CNRs at 40, 50 and 60 keV different monochromatic energy levels and the polychromatic energy images were significant (19.35 ± 10.89 vs 11.68 ± 6.38, P = 0.010; 20.82 ± 11.26 vs 11.68 ± 6.38, P = 0.001; 20.63 ± 10.07 vs 11.68 ± 6.38, P = 0.001). The CNRs at the different energy levels in the AP and the PVP were significantly different (t = -2.415, -2.380, -2.575, -2.762, -2.945, -3.157, -3.996 and -3.189). CONCLUSION: Monochromatic energy imaging spectral CT is superior to polychromatic energy images for the detection of intestinal hemorrhage, and the detection was easier in the PVP compared with the AP.

Magnetization transfer imaging reveals the brain deficit in patients with treatment-refractory depression.

BACKGROUND: Studies on treatment resistant depression (TRD) using advanced magnetic resonance imaging techniques are very limited. METHODS: A group of 15 patients with clinically defined TRD and 15 matched healthy controls underwent magnetization transfer imaging (MTI) and T1-weighted (T1W) imaging. MTI data were processed and analyzed voxel-wised in SPM2. A voxel based morphometric (VBM) analysis was performed using T1W images. RESULTS: Reduced magnetization transfer ratio was observed in the TRD group relative to normal controls in the anterior cingulate, insula, caudate tail and amygdala-parahippocampal areas. All these regions were identified within the right hemisphere. VBM revealed no morphological abnormalities in the TRD group compared to the control group. Negative correlations were found between MRI and clinical measures in the inferior temporal gyrus. LIMITATIONS: The cross-sectional design and small sample size. CONCLUSIONS: The findings suggest that MTI is capable of identifying subtle brain abnormalities which underlie TRD and in general more sensitive than morphological measures.