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OBJECTIVE: Vitamin D is thought to be deficient in patients with bipolar disorder. The purpose of this study is to use latent profile analysis to identify the patterns of vitamin D levels in patients with episodes of bipolar depression, and to examine the relationship among these latent profiles and demographic and clinical characteristics. METHODS: A total of 149 patients diagnosed with bipolar depression were selected in Guangzhou, China. Depression was evaluated by Zung Self-Rating Depression Scale. Serum 25-hydroxyvitamin D levels tested at baseline and after two weeks of psychiatric treatment were included in the latent profile analysis to identify subgroups. P-trend analysis was used to assess the association between subgroups and depression improvement. Multinomial logistic regression analysis was used to assess the influencing factors of subgroups. RESULTS: A three-profiles solution was found to demonstrate the best fit [low-level profile (32.9%), medium-level profile (51.0%), and high-level profile (16.1%)]. There was a significant nonlinear relationship between depression improvement and vitamin D high-level profile, compared to medium-level profile (P for trend <0.05). In multinomial logistic regression analysis, baseline and post-treatment SDS scores, admission season, age, and body mass index significantly affect the profile membership. CONCLUSIONS: This study found that individuals with high levels of vitamin D showed a significant improvement in depression severity. However, those with low levels of vitamin D remained deficient, indicating a need for targeted vitamin D supplementation. Our findings may provide valuable insights for designing tailored vitamin D supplement interventions to address vitamin D deficiency in bipolar depression.
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INTRODUCTION: Several studies have demonstrated that patients with major depressive disorder (MDD) commonly show reductions in heart rate variability (HRV) parameters. Thus, interventions for the improvement of low HRV may be advantageous in treating MDD. This systematic review and meta-analysis aimed to explore the improvement effects of current clinical treatments on low HRV in patients with MDD. METHODS: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, EMBASE, PsycINFO, and CNKI databases were searched for relevant literature. Interventional studies of patients with confirmed MDD, which included baseline and post-intervention data and at least one HRV parameter as an outcome indicator, were included for meta-analysis. RESULTS: Twenty-one studies were included in the review. Several studies affirmed the role of psychotherapy in improving low HRV in patients with MDD showing a significant increase in high-frequency and low-frequency power after psychotherapy in the meta-analysis. However, both pharmacotherapy studies and physiotherapy studies included in the meta-analysis showed significant heterogeneity. LIMITATIONS: The main limitation of this study was the relatively small samples for the meta-analysis, and more high-quality randomized controlled trials in this field are wanted. CONCLUSIONS: Psychotherapy was effective for improving low HRV in patients with MDD. However, the effect of pharmacotherapy or physical therapy on low HRV in MDD remains unclear. Regarding research methods, it is necessary to formulate and standardize operational guidelines for future HRV measurements.
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Trastorno Depresivo Mayor , Humanos , Frecuencia Cardíaca/fisiología , Psicoterapia/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
STUDY OBJECTIVES: Based on a cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we aimed to evaluate the relationship between sleep duration and the incidence of cognitive impairment among older Chinese adults. METHODS: We conducted a prospective analysis based on 3692 participants from the CLHLS at baseline (in 2011), and as a 3-year follow-up (till 2014), 531 participants (14.4%) had cognitive impairment, which was defined as a Mini-Mental State Examination score <24. Sleep duration was classified into three groups: short (≤5 hours/day), normal (>5 but <10 hours), and long (≥10 hours/day). A logistic regression model was used to examine the association between baseline sleep duration and cognitive impairment after adjusting for sociodemographic data, living habits, and health conditions. RESULTS: Five hundred sixty-two participants (15.2%) were in the short-duration group, and 608 participants (16.5%) were in the long-duration group. After adjusting for multiple potential confounders, compared with normal sleep duration, long sleep duration was associated with the incidence of cognitive impairment (OR = 1.309, 95% CI: 1.019-1.683), especially among men (OR = 1.527, 95% CI: 1.041-2.240) and those having a primary and above education level (OR = 1.559, 95% CI: 1.029-2.361). No significant association was observed between short sleep duration and cognitive impairment (OR = 0.860, 95% CI: 0.646-1.145). CONCLUSIONS: Excessive sleep may increase the risk of cognitive impairment in older individuals. It may be a suggestive sign of early neurodegeneration and may be a useful clinical tool to identify those at a higher risk of progressing to cognitive impairment.
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Disfunción Cognitiva , Anciano , China/epidemiología , Disfunción Cognitiva/diagnóstico , Estudios de Cohortes , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , SueñoRESUMEN
INTRODUCTION: The Brief Index of Sexual Functioning for Women (BISF-W) is proved to be a useful instrument to assess female sexual function, but the validation information of its Chinese version is still unavailable. It has not been used to assess female sexual function among Han Chinese women with recurrent depression. AIM: This study aims to validate the Chinese version of BISF-W (C-BISF-W) with a new scoring algorithm and evaluate the impact of recurrent depression on sexual function among Han Chinese women. METHODS: Three groups of subjects, 63 unmedicated patients with recurrent depression, 50 medicated remitted patients with recurrent depression, and 92 healthy controls were enrolled in this study. Sexual function was assessed with C-BISF-W. A new scoring algorithm was developed to provide an overall composite score (G) and seven dimension scores: desire (D1), arousal (D2), frequency of sexual activity (D3), orgasm (D4), sexual interaction (D5), relationship dissatisfaction (D6), and problems affecting sexual function (D7). MAIN OUTCOME MEASURES: Psychometric analyses were conducted. RESULTS: Four factors whose Eigenvalues were higher than 1 were extracted, explaining 61.426% of the total variance. Compared with healthy age-matched control, unmedicated cases scored significantly lower in G, D1, D2, D3, D4 and D5, whereas these were higher in D6 and D7. No significant difference was found in the scores of G, D1, D2, D3, D4, and D5 between remitted cases and control, but the former scored higher in D6 and D7 than the latter. In comparison with unmedicated cases, medicated remitted cases got a higher score in G, D1, D2, and D5. For the healthy control, sexual function (G) was negatively correlated with age. CONCLUSIONS: With the new scoring algorithm, C-BISF-W is proved to be a validated instrument to assess female sexual function. The impact of recurrent depression on female sexual function is negatively profound and extensive.
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Trastorno Depresivo Mayor/complicaciones , Autoinforme/normas , Conducta Sexual/psicología , Disfunciones Sexuales Psicológicas/complicaciones , Disfunciones Sexuales Psicológicas/psicología , Adulto , Algoritmos , Antidepresivos/uso terapéutico , Trastorno Depresivo Mayor/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Psicometría , Recurrencia , Disfunciones Sexuales Psicológicas/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: The Mood Disorder Questionnaire (MDQ) is a well-recognized screening tool for bipolar disorder, but its Chinese version needs further validation. This study aims to measure the accuracy of the Chinese version of the MDQ as a screening instrument for bipolar disorder (BPD) in a group of patients with a current major depressive episode. METHODS: 142 consecutive patients with an initial DSM-IV-TR diagnosis of a major depressive episode were screened for BPD using the Chinese translation of the MDQ and followed up for one year. The final diagnosis, determined by a special committee consisting of three trained senior psychiatrists, was used as a 'gold standard' and ROC was plotted to evaluate the performance of the MDQ. The optimal cut-off was chosen by maximizing the Younden's index. RESULTS: Of the 142 patients, 122 (85.9%) finished the one year follow-up. On the basis of a semi-structured clinical interview 48.4% (59/122) received a diagnosis of unipolar depression (UPD), 36.9% (45/122) BPDII and 14.8% (18/122) BPDI. At the end of the one year follow-up,9 moved from UPD to BPD, 2 from BPDII to UPD, 1 from BPDII to BPDI, the overall rate of initial misdiagnosis was 16.4%. MDQ showed a good accuracy for BPD: the optimal cut-off was 4, with a sensitivity of 0.72 and a specificity of 0.73. When BPDII and BPDI were calculated independently, the optimal cut-off for BPDII was 4, with a sensitivity of 0.70 and a specificity of 0.73; while the optimal cut-off for BPDI was 5, with a sensitivity of 0.67 and a specificity of 0.86. CONCLUSIONS: Our results show that the Chinese version of MDQ is a valid tool for screening BPD in a group of patients with current depressive episode on the Chinese mainland.
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Trastorno Bipolar/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Adulto , China , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Psicometría , Sensibilidad y Especificidad , Encuestas y CuestionariosRESUMEN
`The single-nucleotide polymorphism rs1344706 located in the ZNF804A zinc finger protein 804A gene is a well-established genome-wide significant variant for schizophrenia. The aim of this study was to investigate the potential association between this ZNF804A polymorphism and treatment response to atypical antipsychotic. Seventy-one first-episode inpatients with schizophrenia receiving olanzapine, aripiprazole, or quetiapine monotherapy were enrolled. Symptom response to treatment was assessed using the Positive and Negative Syndrome Scale (PANSS) on admission and reassessed after 4 weeks of treatment. Single-nucleotide polymorphism rs1344706 was genotyped by direct sequencing. There was substantial difference in treatment response among patients with 3 different genotypes regarding total PANSS score and positive subscore (for total PANSS score, F = 4.608, df = 2, P = .013; for positive subscore, F = 4.183, df = 2, P = .019). Compared with G homozygotes, T carriers showed significantly less improvement in total PANSS score as well as positive subscore (for total PANSS score, F = 8.724, df = 1, P = .004; for positive subscore, F = 9.392, df = 1, P = .005). Our results suggest that ZNF80A rs1344706 polymorphism may play a role in treatment response to atypical antipsychotic, although replication is required to confirm this finding.
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Antipsicóticos/uso terapéutico , Factores de Transcripción de Tipo Kruppel/genética , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/genética , Adolescente , Adulto , Alelos , Pueblo Asiatico/genética , Femenino , Frecuencia de los Genes , Estudios de Asociación Genética , Genotipo , Humanos , Masculino , Polimorfismo de Nucleótido SimpleRESUMEN
Background: To explore the relationship between serum levels of inflammatory markers and symptomatic severity of bipolar disorder (BD). Materials and methods: A cross-sectional study was conducted on 126 BD patients with current depressive episode (BDD), 102 BD patients with current mixed or (hypo)manic episode (BDM) and 94 healthy controls (HC). All participants were drug-naïve and had no current active physical illness associated with inflammatory response or history of substance abuse. Fasting serum levels of CRP, leptin (LEP), adiponectin (ADP), visfatin (VIS), TNF-α, IL-2, IL-6, IL-10, IL-17), and monocyte chemoattractant protein-1 (MCP-1) were measured with enzyme-linked immunosorbent assay (ELISA). Symptomatic severity of BD was assessed with HAMD-17 and YMRS. Generalized linear model was used to determine the association between the serum levels of inflammatory markers and symptomatic severity of BD. Results: The serum levels of IL-6, IL-10 and IL-17, and the IL-6/IL-10 ratio were significantly lower in mild BDD than in HC. In moderate BDD, the serum levels of MCP, IL-6 and IL-17 were significantly lower than in HC. In severe BDD, the serum level of ADP, MCP-1, IL-10 and IL-17and the IL-17/IL-10 ratio were significantly lower than in HC. The serum levels of TNF-α and the IL-6/IL-10 ratio were significantly higher in mild BDM than in HC. In moderate BDM, the serum level of VIS, IL-2, and IL-17 were significantly higher than in HC, but the IL-6/IL-10 ratio was significantly lower than in control. In severe BDM, the serum levels of IL-6 and IL-17 and the ratios of IL-6/IL-10 and IL-17/IL-10 were significantly lower than in HC, but the neutrophil/lymphocyte ratio was significantly higher than in HC. Conclusion: In BDD, immune-inhibition is persistently predominant, while in mild-to-moderate BDM, immune system is activated but inhibited in severe BDM. The dynamic change of serum inflammatory markers suggests that alteration of peripheral inflammatory markers in BD is state-dependent instead of trait-marked.
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Objective: This study focused on mood regulations and their association with sociodemographic status, exercise pattern, and physical conditions of adults and older adults in China who did not undergo interventions. Method: Data were based on the 2016 to 2018 Guangdong National Physique Monitoring data, in which 5242 participants aged 20-69 years were recruited. Multiple statistical analysis methods, such as descriptive and logistic regression analyses, were used to study each exercise motivation and its association with influencing factors, including sociodemographic characteristics, exercise measurements, and physical conditions. An exercise index for mental health was also used to investigate the number and types of people who were more likely to meet the index. Results: We observed that 44.9% (2355/5242) of participants did not engage in physical exercise in this study. Only older participants (40 to 69 years old) and those with an average level of education (high school/technical secondary school) showed a significant association with exercising for mood regulation. Few people met the index that is good for mental health (16.64% [872/5242] met index 1, and 2.84% (149/5242) met index 2), and higher education showed a significant association with a reduction in the mental health burden and the prevention of depression. Conclusion: This study found that motivating people to be more active and educating them on the potential mental health benefits of exercise could help them to exercise more.
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Ejercicio Físico , Salud Mental , Adulto , Afecto , Anciano , Pueblo Asiatico , China/epidemiología , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVE: The present study aimed to evaluate the efficacy and safety of aripiprazole once-monthly (AOM) compared to oral aripiprazole in treating acute schizophrenia. METHODS: This randomized, double-blind, non-inferiority study recruited patients from 15 trial sites across China from May 2017 to April 2019. Patients with an acute psychotic episode received AOM at 400 mg or oral aripiprazole at 10-20 mg for 12 weeks. The primary and secondary efficacy endpoints were the difference in scores from baseline to week 10, as assessed on the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impressions-Severity (CGI-S) scores, respectively. RESULTS: A total of 436 patients were randomized. Among them, 159/218 (72.9%) and 165/218 (75.7%) in the AOM and oral aripiprazole groups completed 10 weeks of treatment, respectively. The least-squares (LS) mean changes from baseline to endpoint (week 10) in PANSS were - 33.6 for the AOM group and - 34.8 in the oral aripiprazole group, respectively, with a difference of - 1.2 (95% CI: - 4.1, 1.7). The non-inferiority margin of AOM to oral aripiprazole was - 4.1, which was above the lower limit of the pre-defined margin. The altered CGI-S score was - 2.2 and - 2.3 in the AOM and oral aripiprazole groups, respectively. The incidence of treatment-emergent adverse events (TEAEs) was similar in both groups. The rate of discontinuation due to TEAEs was 2.3% and 3.2% in the AOM and oral aripiprazole groups, respectively. CONCLUSIONS: This study confirmed the efficacy and safety of AOM for the treatment of Chinese patients with acute schizophrenia. The non-inferiority of AOM to oral aripiprazole was established, with comparable efficacy and tolerability. These findings suggested that AOM could be used as a treatment option for patients experiencing an acute episode of schizophrenia. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03172871.
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Antipsicóticos , Esquizofrenia , Antipsicóticos/efectos adversos , Aripiprazol/efectos adversos , Preparaciones de Acción Retardada , Método Doble Ciego , Humanos , Esquizofrenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
OBJECTIVES: To survey anxiety and depression symptoms to COVID-19 outbreak in the public, medical staff and patients during the initial phase of the pandemic. DESIGN: Cross-sectional online survey administered through WeChat Mini Program using Chinese versions of Zung Self-rating Depression Scale and Zung Self-rating Anxiety Scale. SETTING: Guangzhou, China. PARTICIPANTS: 47 378 public, 1512 medical staff and 125 patients with COVID-19. RESULTS: Higher rates of depression (47.8%) and anxiety symptoms (48.7%) were shown by patients who were screened positive compared with those of the public (35.6%, 25.7%) or medical staff (15.4%, 13.3%). The professional identity of a nurse, conditions of 'with an infected family member' and 'working at the frontline' were risk factors to depression or anxiety symptoms for the medical staff. Younger age, lower educational level, female and not having adequate masks were the risk factors for the public. CONCLUSION: The COVID-19 outbreak increased people's depression or anxiety emotion responses, which varied extensively among the patients, public and medical staff.
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Ansiedad , COVID-19 , Depresión , Cuerpo Médico/psicología , Pandemias , Ansiedad/epidemiología , COVID-19/psicología , China/epidemiología , Estudios Transversales , Depresión/epidemiología , Femenino , Humanos , Prevalencia , Encuestas y CuestionariosRESUMEN
AIMS: To evaluate the prevalence of metabolic syndrome (MetS) and its correlates in patients with bipolar disorder (BD) during acute-phase treatment in southern China. METHODS: This study included 148 BD patients presenting with acute mood symptoms and 65 healthy controls at entry. Sociodemographic characteristics were noted for all participants. For patients, lifestyle information (alcohol, smoking, and exercise habits) and clinical characteristics were also collected. Patients were followed up for 6 months after the commencement of pharmacological treatment. Using the Chinese Medical Association Diabetes Branch criteria, MetS prevalence rates were calculated at entry and recalculated for patients at months 1, 3, and 6. RESULTS: At baseline, MetS was presented in 11.5% of the patients; overweight, 34.5%; low high-density lipoprotein cholesterol, 15.5%; hypertriglyceridemia, 29.1%; hypertension, 14.9%; and hyperglycemia, 5.4%. Compared with controls, the patients had a significantly higher prevalence of MetS and all its components except for hyperglycemia (P < 0.05). In the regression analysis, history of hypertension, presence of diabetes, and alcohol drinking were associated with MetS. During the follow-up period, rates of MetS and overweight increased gradually and stably, hypertriglyceridemia and low high-density lipoprotein cholesterol increased significantly in the first month and then remained stable, and hypertension and hyperglycemia remained stable all the time. CONCLUSIONS: These data show that MetS is highly prevalent in Chinese BD patients. Weight gain and dyslipidemia result from a short period of treatment. Early interventions for weight gain and dyslipidemia are warranted.
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Trastorno Bipolar/complicaciones , Síndrome Metabólico/epidemiología , Adulto , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/epidemiología , China/epidemiología , Progresión de la Enfermedad , Dislipidemias/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hiperglucemia/epidemiología , Hipertensión/epidemiología , Masculino , Síndrome Metabólico/complicaciones , Sobrepeso , Prevalencia , Factores de RiesgoRESUMEN
AIM: Duration of untreated psychosis (DUP) is associated with outcome and functioning. It is expected that scientists will find factors that modulate DUP, but thus far, research on this topic has shown inconsistent results. Furthermore, similar studies in China are insufficient. This study aims to explore social and clinical factors for DUP in South China and to learn the influence that family plays on DUP through their awareness of psychosis. METHODS: Participants included 216 patients with first episode schizophrenia spectrum disorder. The Nottingham Onset Schedule was used to assess DUP. The relationship between DUP and social and clinical characteristics were then analysed by correlation analysis, survival analysis and Cox regression analysis. The awareness of the patient's family for the cause of psychosis, the reason for treatment and the cause for delay of treatment were investigated using a questionnaire. RESULTS: The median DUP was 64.5 days. Insidious onset and being unemployed were found to be risk factors for a long DUP. The family attributed the main cause of psychosis to stress. The main cause for the delay of treatment was because families misjudged the patients' disease. More family members of long DUP patients compared to short DUP patients thought the causes were due to ideological problems or puberty, rather than to mental health. CONCLUSION: The results of this study indicated that some social or clinical characteristics influence DUP. The family's awareness plays an important role when seeking help. To reduce DUP, the public needs more knowledge of mental illness.
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Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adolescente , Adulto , Concienciación , China , Familia/psicología , Femenino , Humanos , Masculino , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Análisis de Regresión , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Abnormalities in white matter (WM) have previously been reported in patients with obsessive-compulsive disorder (OCD). However, there was some inconsistency in the results obtained for altered regions of WM. The aim of this study was to investigate fractional anisotropy (FA) in the WM of the whole brain in patients with OCD by using diffusion tensor imaging (DTI). METHODS: In total, 28 unmedicated patients with OCD and 28 healthy volunteers underwent DTI scan. A voxel-based analysis was used to compare FA values in WM of the two groups at a voxel threshold of P<0.005 with an extent threshold of k>72 voxels (P<0.05; Alphasim correction). Subsequently, correlation analysis was conducted in order to find the correlation between the mean FA values in significantly altered brain regions and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores of the OCD patients. RESULTS: Compared with healthy volunteers, the OCD patients had lower FA value in the left lingual gyrus, right midbrain, and right precuneus. There were no regions with significantly higher FA values in OCD patients compared with healthy volunteers. The mean FA values in the above regions (left lingual, r=0.019, P=0.923; right midbrain, r=-0.208, P=0.289; and right precuneus, r=-0.273, P=0.161) had no significant correlation with the Y-BOCS scores of the OCD patients. CONCLUSION: The findings of this study suggest that alterations in WM of the left lingual gyrus, right midbrain, and right precuneus are associated with the pathophysiology mechanism of OCD, and these microstructural alterations do not correlate with symptom severity of OCD.
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Concurrence of psychosis and Dandy-Walker complex (DWC) has been reported in some medical literature. Here, we reported four patients with concurrent psychosis and DWC of all four subtypes. Some clinical features found were juvenile or young adult age onset, high frequency of family history of psychosis, atypical psychotic symptoms, and high prevalence of cognitive deficit and refractoriness to treatment, in line with the cases in previous reports. These findings might help further illuminate the role that the cerebellum plays in the etiology of schizophrenia or bipolar disorder.
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Comorbilidad , Síndrome de Dandy-Walker , Trastornos Psicóticos , Adolescente , Cerebelo/anomalías , Síndrome de Dandy-Walker/diagnóstico por imagen , Síndrome de Dandy-Walker/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Adulto JovenRESUMEN
BACKGROUND: A correct timely diagnosis of bipolar depression remains a big challenge for clinicians. This study aimed to develop a clinical characteristic based model to predict the diagnosis of bipolar disorder among patients with current major depressive episodes. METHODS: A prospective study was carried out on 344 patients with current major depressive episodes, with 268 completing 1-year follow-up. Data were collected through structured interviews. Univariate binary logistic regression was conducted to select potential predictive variables among 19 initial variables, and then multivariate binary logistic regression was performed to analyze the combination of risk factors and build a predictive model. Receiver operating characteristic (ROC) curve was plotted. RESULTS: Of 19 initial variables, 13 variables were preliminarily selected, and then forward stepwise exercise produced a final model consisting of 6 variables: age at first onset, maximum duration of depressive episodes, somatalgia, hypersomnia, diurnal variation of mood, irritability. The correct prediction rate of this model was 78% (95%CI: 75%-86%) and the area under the ROC curve was 0.85 (95%CI: 0.80-0.90). The cut-off point for age at first onset was 28.5 years old, while the cut-off point for maximum duration of depressive episode was 7.5 months. LIMITATIONS: The limitations of this study include small sample size, relatively short follow-up period and lack of treatment information. CONCLUSION: Our predictive models based on six clinical characteristics of major depressive episodes prove to be robust and can help differentiate bipolar depression from unipolar depression.