Xylarkarynone A and B:Two Bioactive Eremophilane Sesquiterpenes from Xylaria sp. HHY-2.

A new compound xylarkarynone A (1), a first reported natural product compound xylarkarynone B (2) and eight known compounds (3-10) were isolated from Xylaria sp. HHY-2. Their structures were elucidated by spectroscopic methods, DP4+ probability analyses and electronic circular dichroism (ECD) calculations. The bioactivities of isolated compounds were assayed. Compound 1 exhibited obvious activity against A549 cells with an IC50 value of 6.12 ± 0.28 µM. Additionally, compound 1 showed moderate antifungal activities against Plectosphaerella cucumerina and Aspergillus niger with minimum inhibitory concentrations (MICs) of both 16 µg/mL, which was at the same grade with positive control nystatin. Most compounds exhibited varying degrees of inhibitory activity against P. cucumerina, indicating that Xylaria sp. has potential as inhibitors against P. cucumerina.

Effects of rosiglitazone on quality of life and prognosis of patients with early stage glottic laryngeal carcinoma.

Early-stage glottic laryngeal carcinoma refers to Tis-T2 lesions without cervical lymph nodes involvement and distant metastasis. Rosiglitazone facilitates expression of anti-inflammatory substances in the body, protecting immune system and improving patient's treatment efficacy and prognosis. We aimed to clarify the influence of rosiglitazone on prognosis of early-stage glottic laryngeal carcinoma. The control group received low-temperature plasma radiofrequency ablation and the observation group additionally received rosiglitazone; 4 mg, 2 times/day for 6 months. After treatment, the observation group showed reduction in the fundamental frequency perturbation and amplitude perturbation and increase in the harmonic-to-noise ratio relative to the control group. Total effective rate was 80.31% and 77.14% for observation and control groups, respectively (P > 0.05). Peripheral blood immune makers were higher in the observation group. The incidence rates of adverse reactions were lower in the observation group. The median survival time was 33 months in control group and 47 months in observation group (P < 0.05). The five-year survival rate was 77.14% in the observation group and 54.29% in the control group (P < 0.05). Rosiglitazone can prolong the survival of early-stage glottic laryngeal carcinoma patients, improving immune function and reducing adverse reactions during treatment.

Genome-wide association exploratory studies in individuals with ultra-high risk for schizophrenia in Chinese Han nationality in two years follow-up: A subpopulation study.

BACKGROUND: Although ultra-high risk for schizophrenia (UHR) is related to both genetic and environment factors, the precise pathogenesis is still unknow. To date, few studies have explored the Genome-Wide Association Studies (GWAS) in UHR or HR individuals especially in Han population in China. METHODS: In this study, a GWAS analysis for 36 participants with UHR and 43 with HR were performed, and all deletion variations in 22q11 region were also compared. RESULTS: Sixteen individuals with UHR (44.4%) and none with HR converted into schizophrenia in follow-up after two years. Six loci including neurexin-1(NRXN1) (rs1045881), dopamine D1 receptor (DRD1) (rs686, rs4532), chitinase-3-like protein 1 (CHI3L1) (rs4950928), velocardiofacial syndrome (ARVCF) (rs165815), dopamine D2 receptor (DRD2) (rs1076560) were identified higher expression with significant difference in individuals converted into schizophrenia after two years. The Family with Sequence Similarity 230 Member H (FAM230H) gene in the 22q11 region were also found high expression in UHR group. CONCLUSIONS: Further expansion of sample size and validation studies are needed to explore the pathogenesis of these risk loci in UHR conversion into schizophrenia in the future.

Prevalence and Patterns of Insomnia Symptoms Among People Aged 65 and Above in Guangdong Province, China.

Objective: This survey investigated the prevalence, distribution, and correlative factors of insomnia symptoms among people aged 65 and above in Guangdong Province, China. Methods: The Guangdong Mental Health Survey was conducted on the elderly in all 21 cities of Guangdong Province from September to December 2021. Multistage stratified cluster sampling was adopted, and 16 377 adult residents were interviewed face-to-face, from which 4001 elderly participants aged 65 and above were included for this study. Complex weighted adjustment methods were applied to weight the data. Multinomial logistic regression was applied to test the independent associations of clinical insomnia symptoms (CIS) and subthreshold insomnia symptoms (SIS) with the factors. Results: The pooled estimate of insomnia symptoms was 13.44% [95% confidence interval (CI): 12.2 %-14.7%]. The 1-month weighted prevalence of SIS and CIS were 11.15% (95% CI: 10.05%-12.37%) and 2.28% (95%CI: 1.77%-2.94%), respectively. Multinomial logistic regression analysis revealed that urban residence, irregular diet, low body mass index, chronic disease, napping 3-4/week, early changes in dementia, symptoms of subthreshold depression, subthreshold generalized anxiety, and generalized anxiety disorder were positively associated with SIS. Additionally, living in urban areas, having chronic diseases, symptoms of subthreshold depression, major depressive disorder, subthreshold generalized anxiety, generalized anxiety disorder were positively associated with CIS. Conclusion: Insomnia symptoms, including CIS and SIS, were prevalent among the elderly in Guangdong Province. Given the high burden of CIS and SIS, policymakers and healthcare professionals must explore and treat the related factors accordingly.

The Role of Depression and Anxiety in the Relationship Between Arthritis and Cognitive Impairment in Chinese Older Adults.

BACKGROUND: Mental disorders and cognitive impairment are common in older patients with arthritis. While it is recognized that mental conditions may play a role in the connection between arthritis and cognitive impairment, the precise underlying relationship remains uncertain. METHODS: The data was derived from the baseline survey of the Guangdong Mental Health Survey in South China, involving a sample of 3,764 citizens aged 65 and older. An array of aspects were explored, including socio-demographics, lifestyle behaviors, self-reported chronic conditions, depression, anxiety, and cognitive impairment. Logistic regression analyses examined the association between arthritis and cognitive impairment after adjustment for potential confounders. Serial mediation models were used to examine whether depression or anxiety played a mediating role in the arthritis-cognitive impairment linkage. RESULTS: The prevalence rates of cognitive impairment and arthritis of the older adults were 28.9% and 12.1%, respectively. Compared to those without arthritis, participants with arthritis were at a higher risk of cognitive impairment (OR = 1.322, 95%CI: 1.022-1.709) after adjustment for socio-demographics, lifestyle behaviors, and mental health conditions. Serial mediation analyses indicated that depressive and anxiety symptoms co-played a serial mediating role in the association between arthritis and cognitive impairment (B1 = 0.025, 95%CI: 0.005-0.052; B2 = 0.050, 95%CI: 0.021-0.086). CONCLUSIONS: Arthritis may heighten cognitive impairment risk in Chinese older adults, and the relationship was potentially mediated by depressive and anxiety symptoms. Future interventions should be considered, integrating mental health assessments into arthritis care frameworks and being alert to possible cognitive impairment.

Frequency and associated factors of accommodation and non-strabismic binocular vision dysfunction among medical university students.

AIM: To investigate the frequency and associated factors of accommodation and non-strabismic binocular vision dysfunction among medical university students. METHODS: Totally 158 student volunteers underwent routine vision examination in the optometry clinic of Guangxi Medical University. Their data were used to identify the different types of accommodation and non-strabismic binocular vision dysfunction and to determine their frequency. Correlation analysis and logistic regression were used to examine the factors associated with these abnormalities. RESULTS: The results showed that 36.71% of the subjects had accommodation and non-strabismic binocular vision issues, with 8.86% being attributed to accommodation dysfunction and 27.85% to binocular abnormalities. Convergence insufficiency (CI) was the most common abnormality, accounting for 13.29%. Those with these abnormalities experienced higher levels of eyestrain (χ2=69.518, P<0.001). The linear correlations were observed between the difference of binocular spherical equivalent (SE) and the index of horizontal esotropia at a distance (r=0.231, P=0.004) and the asthenopia survey scale (ASS) score (r=0.346, P<0.001). Furthermore, the right eye's SE was inversely correlated with the convergence of positive and negative fusion images at close range (r=-0.321, P<0.001), the convergence of negative fusion images at close range (r=-0.294, P<0.001), the vergence facility (VF; r=-0.234, P=0.003), and the set of negative fusion images at far range (r=-0.237, P=0.003). Logistic regression analysis indicated that gender, age, and the difference in right and binocular SE did not influence the emergence of these abnormalities. CONCLUSION: Binocular vision abnormalities are more prevalent than accommodation dysfunction, with CI being the most frequent type. Greater binocular refractive disparity leads to more severe eyestrain symptoms.

Gene Polymorphisms and Expression of NRG1, DAOA, and DISC1 Genes in a Chinese Han Population with an Ultra-High Risk for Psychosis.

Purpose: Although there is previous evidence supporting that ultra-high risk (UHR) for psychosis transformation is associated with NRG1, DAOA, and DISC1 genes, there have been no relevant studies in the Chinese population. The objective of the current study was to explore the gene polymorphism and expression of NRG1, DAOA, and DISC1 genes in a Han population with UHR for psychosis in China. Methods: Eighteen UHR individuals, 61 first-degree relatives of patients with schizophrenia (FDR), 55 first-episode psychosis individuals (FEP), and 61 healthy controls (HC) were enrolled in the study. The genotypes at four loci of the NRG1 gene, four loci of the DAOA gene, and two loci of the DISC1 gene were tested for all subjects, and mRNAs of NRG1 and DISC1 were examined and analyzed in a pairwise comparison among the four groups. Statistical analysis of genetics was performed using snpStats software. For the case-control association analysis, a single site association study, epistatic effect analysis, and haplotype analysis were used to explore the association of the above genes. Results: This study found that rs3918341 in the DAOA gene was associated with susceptibility to UHR by single site association analysis. Epistatic effect analysis results showed that the NRG1 gene interacted with the DAOA gene and DISC1 gene in the susceptibility to UHR. Haplotype association analysis showed that all haplotypes were not significantly associated with UHR. NRG1 mRNA was significantly downregulated in the UHR group compared with the HC group as well as the FEP group. Conclusion: Our preliminary results show that NRG1, DAOA, and DISC1 genes may play a role in psychosis onset, opening the way to the identification of prognostic biomarkers.

Guided isolation of secondary metabolites from Nectria sp. MHHJ-3 by molecular network strategy.

The fungus Nectria sp. MHHJ-3 was isolated from Illigera rhodantha. A molecular networking-guided the secondary metabolites investigation of Nectria sp. MHHJ-3 led to the isolation of ten metabolites (1-10), including two new naphthalenone derivatives, nectrianaphthalenones A (1) and B (2), and two new steroids, nectriasteroids A (3) and B (4). Their structures were elucidated by extensive spectroscopic analysis including the HRESIMS, 1D/2D NMR and electronic circular dichroism (ECD) spectra. A plausible biosynthetic pathway for 1-2 was proposed. Compounds 1 and 2 exhibited moderate acetylcholinesterase (AChE) inhibitory activities. Compounds 3 and 4 showed significant cytotoxic activity against selected tumor cells. Particularly, compound 3 exhibited the strongest activity against A549 cells with an IC50 value of 13.73 ± 0.03 µM, which was at the same grade with that of positive control cisplatin.

Patterns and correlates of insight among patients with schizophrenia in China：A network perspective.

OBJECTIVE: To explore the patterns and correlates of insight among patients with schizophrenia in a large Chinese population. METHOD: A multi-center cross-sectional study was conducted in Guangdong province, China. Patients with schizophrenia were included. Basic socio-demographic and clinical characteristics were collected in this study. Univariate analyses, multivariate logistic regression, and network analysis were conducted. RESULTS: A total of 6090 participants (58.8% were male, and 41.2% were female) met the study criteria and completed all the assessments. 63.5% (n = 3869) patients with schizophrenia had impaired insight. Fewer drug sides effect, higher psychological and environment domains scores in quality of life have a positive significant impact on insight in patients with schizophrenia. Younger age, higher BPRS scores have a negative significant impact on insight in patients with schizophrenia. The node ITAQ 8 (strength=1.17) was the most central node within the ITAQ network, while node ITAQ 3 was the least central node (strength=0.69). The edge ITAQ 1-ITAQ 2 was the thickest and most saturated edge in network model. CONCLUSIONS: Considering patterns and correlation of insight, it is necessary to ensure adherence to medications and engagement with mental health services for patients with schizophrenia, which could also improve their quality of life. Taking medication actively is more central to identify ITAQ and might be the potential targets for future interventions.

Validation of the developmental, dimensional and diagnostic interview -short version (3Di-sv) for diagnosis of autism spectrum disorder in Chinese children.

The purpose of this study was to evaluate the psychometric features of the Chinese version of the developmental dimensional diagnostic interview-short version (3Di-sv). A total sample of 138 children including 79 children with autism spectrum disorder (ASD) and 59 typically developing children completed the 3Di-sv interview. The Chinese version of the 3Di-sv has a good internal consistency (0.94). Test-retest analysis confirmed the instrument's time stability (0.89). The instrument's concurrent validity with the Autism Behavior Checklist (ABC), the Childhood Autism Rating Scale (CARS) and clinical diagnosis was verified; the correlation between total scores was 0.72, 0.82 and 0.90, respectively. The 3Di-sv significantly distinguished between autistic children and non-autistic children in every area of autism symptoms. Optimal cutoffs were derived using receiver operating characteristics curves. Using clinical diagnosis as criterion, overall sensitivity was 98 % and specificity was 90 %. The study determined that the Chinese version of 3Di-sv can well distinguish autistic children from typically developing children.

Identification of Critical Biomarkers and Mechanisms of Fructus Ligustri Lucidi on Vitiligo Using Integrated Bioinformatics Analysis.

Objective: Vitiligo is an autoimmune disease of the skin that targets pigment-producing melanocytes and results in patches of depigmentation that are visible as white spots. Recent research studies have yielded a strong mechanistic understanding of this disease. Fructus Ligustri Lucidi (FLL) has been used for premature graying of hair since ancient China and is currently used to treat vitiligo. However, the key biomarkers and mechanisms underlying FLL in vitiligo remain unclear. This study aimed to identify the potential biomarkers and mechanisms of FLL in vitiligo using network pharmacology analysis. Methods: The expression profiles of GSE65127 and GSE75819 were downloaded from the Gene Expression Omnibus database to identify differentially expressed genes (DEGs) between the vitiligo and healthy samples. Gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment of DEGs were performed using R analyses. We performed R to further understand the functions of the critical targets. Cytoscape tools have facilitated network topology analysis. Molecular docking was performed using Auto Dock Vina software. Results: The results showed that 13 DEGs were screened in vitiligo. Based on bioinformatics, network pharmacology and Western blot, we found that the critical targets of melanoma antigen recognized by 5,6-dihydroxyindole-2-carboxylic acid oxidase (TYRP1) may be related to the mechanism of action of FLL in the treatment of vitiligo. Conclusion: TYRP1, as a melanocyte molecular biomarker, may be closely related to the underlying mechanism of FLL in the treatment of vitiligo via the inhibition of melanocyte death.

Bridge connection between depression and anxiety symptoms and lifestyles in Chinese residents from a network perspective.

Background: Lifestyle habits are vital components of the culture of mental health treatment settings. We examined the bridge connection between depressive and anxiety symptoms and lifestyles from a network perspective using a population-based study. Methods: Face-to-face interviews were conducted with a provincially representative sample of 13,768 inhabitants from the Guangdong Sleep and Psychosomatic Health Survey based on standardized evaluation techniques. We identified the central symptoms by expected influence. The interconnection between depression and anxiety symptoms, as well as the bridge connectivity linking depression-anxiety symptoms and lifestyle factors, were assessed using the bridge centrality index. Network stability and sensibility analyses were performed using a case-dropping bootstrap procedure. Results: The core symptom that exhibited the highest expected influence was fatigue or little energy, followed by uncontrollable worry, trouble relaxing, and sad mood in the depression-anxiety symptoms network, while guilt was the most interconnected symptom and had the highest bridge strength. Surrounding nodes of each node explained an average variance of 57.63%. Additionally, suicidal thoughts were recognized as collective bridging symptoms connecting lifestyle variables in the network integrating depression-anxiety symptoms with lifestyle factors. Current tobacco and alcohol consumption were positively associated with suicidal thoughts and irritability. Habitual diet rhythm and physical exercise frequency were linked to suicidal thoughts, guilt, and poor appetite or overeating. Suicidal thoughts, irritability, and guilt indicated the greatest connectivity with lifestyle factors. All networks had high stability and accuracy. Conclusion: These highlighted core and bridge symptoms could serve as latent targets for the prevention and intervention of comorbid depression and anxiety. It might be crucial for clinical practitioners to design effective and targeted treatment and prevention strategies aiming at specific lifestyles and behaviors.

Depression, anxiety and insomnia in Chinese older adults and their family caregivers during the COVID-19 pandemic: an actor-partner interdependence model approach.

Aims: This study aimed to explore the dyadic effects of depression and anxiety on insomnia symptoms in Chinese older adults and their caregivers living in a community setting. Methods: Data were collected from 1,507 pairs of older adults and their caregivers who were in the Guangdong Mental Health Survey in China. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder module 7 (GAD-7), and Insomnia Severity Index (ISI) were used to measure depression, anxiety, and insomnia symptoms. Actor-Partner Interdependence Models (APIM) were used to determine whether anxiety or depression symptoms predicted individual or dyadic insomnia. Results: Older adults' and caregivers' depression and anxiety had significant positive correlations with their own and their caregivers' insomnia symptoms (all P < 0.001). Actor effects were found between depression and insomnia symptoms in both older adults and caregivers (B = 0.695, P < 0.001; B = 0.547, P < 0.001, respectively), with one significant partner effects (B = 0.080, P = 0.007). Actor effects were also found between anxiety and insomnia symptoms in both older adults and caregivers (B = 0.825, P < 0.001; B = 0.751, P < 0.001, respectively), with one significant partner effects (B = 0.097, P = 0.004). However, the caregivers' depression and anxiety were not associated with older adults' insomnia symptoms in the APIM analyses. Conclusions: Older adults and their caregivers had an interrelationship between psychological distress and insomnia. Consequently, healthcare providers might consider involving dyads when designing programs to reduce insomnia and improve psychological distress for family caregivers.

Meta-analysis of gender differences in transition prevalence among individuals at clinical high risk of psychosis.

Gender differences have been found in several areas of individuals at clinical-high risk for psychosis(CHR). Therefore the risk of transition to psychosis may differ between male and female CHR, but previous work has not systematically reviewed and analyzed gender differences in conversion rates.We performed a meta-analysis according to PRISMA guidelines including all studies that assessed CHR with reliable instruments and provided data on the transition from male CHR and female CHR to psychosis to understand the conversion rate conversion in male and female CHR. Seventy-nine article were identified.A total of 1250 out of 5770 in the male CHR individuals, and 832 out of 4468 in the female CHR individuals translated to psychotic disorders. Transition prevalence were 19.4%(95%CI:14.2-25.8%)at 1 year, 20.6% at 2 year (95%CI:17.1-24.8%),24.3% at 3 years (95%CI:21.5-27.4%),26.3% at 4 years or older (95%CI:20.9-32.5%) and 22.3% at all (95%CI:20.0-24.8%) in male CHR and 17.7% (95%CI:12.6-24.4%) at 1 years, 17.5% (95%CI:14.2-21.4%) at 2 year, 19.9%(95%CI:17.3-0.228%) at 3 years,and 0.267 (95%CI:22.1-31.9%) at 4 years or older follow-up,20.4% at all (95%CI:18.1-22.9%) in female CHR. There were differences between the two groups in the overall conversion, the 2-year, and the 3-year follow up transition prevalence, which were higher in men CHR than in female CHR. Future research characterizing male versus female CHR is needed with the expectation that interventions will be developed that are tailored to the respective gender, further reducing the rate of conversion to CHR.

Symptoms mediate the relationship between childhood trauma and non-suicidal self-injury: A hospital-based study of adolescents with mood disorder.

BACKGROUND: Childhood trauma has a significant impact on the development of adolescents, which may lead to interpersonal and psychological problems. Determining the incidence and consequences of childhood trauma in psychiatric clinical practice is of great significance. METHODS: A survey was conducted among adolescents with mood disorders. Childhood Trauma Questionnaire (CTQ), the Adolescent Non-Suicidal-Self-Injury Behavior Function Assessment Scale (ANBFAS) and a series of psychological scales were filled face to face. Path analysis was used to examine the causation structure of childhood trauma-related symptoms. RESULTS: A total of 117 participants (74.5%) had experienced at least one type of trauma. Interpersonal and psychological features of adolescent patients with childhood trauma were detailed in this study. The path analysis model showed that the relationships between childhood trauma and NSSI were mediated by depressive symptoms and thinking disorders, respectively, whereas depressive symptoms individually mediated the correlation between childhood trauma and sleep disturbances in adolescent patients with psychiatric disorders (χ2 /df = 1.23). CONCLUSION: For adolescent patients with childhood trauma, psychological counseling for interpersonal relationships should start with families and peers. It is important to treat their depressive symptoms and thinking disorders and alleviate NSSI behavior and sleep disorders.

Video game addiction in psychiatric adolescent population: A hospital-based study on the role of individualism from South China.

BACKGROUND: For decades, video game-related behaviors have been investigated in different psychologic research, much of whose attention has been paid to video game addiction (VGA), while the differences between VGA and social media addiction (SMA) should have deserved more attention. In addition to detecting common risk factors of VGA, one core question is whether social inclination (individualism or collectivism) matters. OBJECT: The objectives of this study were to clarify the prevalence of VGA and SMA,, identify the influencing factors of VGA, and clarify the relationships between VGA and adolescents' individualism-collectivism inclination. METHOD: The survey was conducted among 110 adolescent psychiatric patients. For each interviewee, psychological scales were filled face to face. Path analysis was used to examine the causation structure of the childhood trauma-related symptoms. RESULT: The prevalence of VGA was 40.9% (45 out of 110), and it was 41.8% for SMA (46 out of 110); childhood trauma, social media addiction, the individualistic inclination, and the rate of homosexuality were observed to be independent indicators for video game addiction (r2  = 0.46). CONCLUSION: Psychological counseling on patients' internet-related behaviors may focus on the individualistic personality and possible childhood trauma, which are two important risk factors of video game addiction. It is recommended to distinguish between video game addiction and social addiction in clinical practice.

Reflectance Confocal Microscopy and Dermoscopy For the Diagnosis and Treatment of Cutaneous Larva Migrans.

We describe a 39-year-old woman with a 1-month-old linear erythema diagnosed with cutaneous larva migrans by reflectance confocal microscopy (RCM). This case reveals that the great significance of diagnosing and treating cutaneous larva migrans (CLM) by RCM and dermoscopy, which might provide novel insights into dermatological clinical practice.

Prevalence and patterns of major depressive disorder and subthreshold depressive symptoms in south China.

BACKGROUND: Information on major depressive disorder (MDD) and subthreshold depressive symptoms (SDS) is rarely reported in south China. This study examines the prevalence rates and patterns of MDD and SDS of a large representative sample of adult residents in south China. METHODS: The Guangdong Mental Health Survey was conducted on adults (over 18 years) from September to December 2021. Multistage stratified cluster sampling was used and face-to-face interviews were done with a two-stage design by trained lay interviewers and psychiatrists. A total of 16,377 inhabitants were interviewed using standardized assessment tools. Data were weighted to adjust for differential probabilities of selection and differential response. RESULTS: The weighted prevalence rates of MDD and SDS were 2.5 % (95%CI: 2.2 %-2.9 %) and 14.7 % (95%CI: 14.0 %-15.5 %), respectively. Multinomial logistic regression analysis revealed that female, younger age, living in urban area, higher education, unmarried, irregular meal pattern, lack of physical exercise, chronic diseases, irregular napping pattern and short sleep were positively associated with SDS. Besides, female, younger age, unmarried, irregular meal pattern, lack of physical exercise, chronic diseases, short sleep and poor mental health were positively associated with MDD. LIMITATIONS: The cross-sectional nature of the study limited causal inferences. CONCLUSIONS: The prevalence of MDD in Guangdong province in 2021 is higher than in mainland China in 2013. Given the higher prevalence of SDS, and high burden of depression, it also offers valuable opportunities for policymakers and health-care professionals to explore the factors affecting mental health in Guangdong province, especially during the COVID-19 epidemic.

Two-year cohort-up study of clozapine prescription in Chinese patients with schizophrenia treated in rural primary care.

Few studies have examined the clozapine in cohort studies of Chinese patients with schizophrenia in rural primary care. The objective of this two-year cohort study was to describe the usage of clozapine and investigate and identify the demographic, clinical correlations and risk variables which affect the use of clozapine in patients with schizophrenia. A random cluster sampling technique was used, and participants were collected from China National Psychiatric Management System (CNPMS). The variables for clozapine use in individuals with schizophrenia who had undergone a two-year follow-up were determined using the generalized estimating equation (GEE). In this study, 742 patients with schizophrenia were invited, and 491 completed the two-year follow-up study. Being married, more years of education, more waist circumference, using mood stabilizer, using anticholinergic, higher ITAQ (Insight and Treatment Attitude Questionnaire) scores were more significantly related to the use of clozapine. Older age of onset, using second-generation antipsychotics (SGAs) except clozapine predicted a lower prevalence of using clozapine. The usage of clozapine was very common in patients with schizophrenia treated by primary care physicians, and was influenced by a variety of factors, including price of drugs, clinical factors, health regulations, and the characteristics of treatment environment. Further examination of the rationale and appropriateness of clozapine in primary care in China is necessary.