Transitory restless arms syndrome in a patient with antipsychotics and antidepressants: a case report.

BACKGROUND: Restless arms syndrome (RAS) is characterized by uncomfortable aching or burning sensations in the arms. RAS is regarded as an upper limb variant of restless legs syndrome (RLS). The lack of specific diagnostic criteria makes it difficult to recognize the RAS. Therefore, RAS is usually neglected in clinical practice. Moreover, when a patient was diagnosed with RAS, the adjustment of medications was the first choice for doctors, which may make the patient's condition unstable. CASE PRESENTATION: A 33-year-old woman was diagnosed with schizophrenia and major depressive disorder. Starting with 0.6 g/d amisulpride, 0.1 g/d quetiapine, 75 mg/d venlafaxine sustained-release tablets, the patient reported symptoms of RAS (itching arms) on the fourth day since the latest hospitalization. After ruling out other factors, her RAS was suspected to be induced by antidepressants or antipsychotics. Without medication adjustment, RAS spontaneously remitted. CONCLUSIONS: This case suggests that psychiatrists should pay attention to RAS when using antipsychotics and/or antidepressants. Moreover, RAS may be transitory. When a patient manifests RAS, observation may be one choice instead of an immediate medication adjustment.

Mediating effects of self-efficacy, coping, burnout, and social support between job stress and mental health among young Chinese nurses.

AIMS: To examine the mediating effects of self-efficacy, coping, burnout, and social support in the link between job stress and depression and anxiety among young Chinese nurses. DESIGN: A cross-sectional survey was used. METHODS: Full-time young nurses (N = 1,029) who worked in nine tertiary grade A hospitals in Chengdu China were recruited from December 2016-March 2017. Structural equation modelling was applied to analyse the mediating effects. RESULTS: Job stress had a direct positive effect on anxiety (ß = 0.054) and it also exerted indirect positive effects on depression (ß = 0.337) and anxiety (ß = 0.325) through mediating factors. Emotional exhaustion and social support were the main mediating variables, accounting for 72.0% of the variation in anxiety and nearly 43.4% in depression. CONCLUSION: Emotional exhaustion and social support may have significant mediating effects in the link between job stress and depression and anxiety. Strategies including deceasing emotional exhaustion, enhancing social support in work environment, and reducing job stressors would be useful to prevent depression and anxiety among young nurses. IMPACT: What problems did the study address? Depression and anxiety have great impact on professional performance of nurses and even patient safety. Factors such as coping, burnout, etc., may have different mediating effects in the paths from job stress to depression and anxiety. What were the main findings? Job stress had direct and indirect positive effects on anxiety and it only had indirect positive effect on depression. Emotional exhaustion and social support were the main mediating variables in the link between job stress and depression and anxiety. Where and on whom will the research have impact? Nursing managers should be more cognizant of the impact of job stress on the development of depression and anxiety. The significant mediating effect of emotional exhaustion and social support in the link between job stress and depression and anxiety should be emphasized by nursing administrators and effective targeted measures need to be adopted.

Social support and clinical improvement in COVID-19 positive patients in China.

OBJECTIVES: To explore the relationship between psychosocial support related factors and the mental health of COVID-19 positive patients. METHODS: This exploratory study of 35 COVID-19 positive patients were enrolled between February 1 to March 1, 2020. Sleep quality, depression, anxiety, and social support were measured and social support related data of participants were collected. Psychological intervention was administered and patients were followed two weeks post intervention. Linear regression was performed to explore the relationship between psychosocial risk factors and improvement of psychological symptoms. FINDINGS: Thirty-two individuals exhibited sleep, depressive and anxiety symptoms which improved post support intervention. At baseline, symptoms were associated with gender, severity of pneumonia, social support. Better social support at follow-up and improvement from COVID-19 predicted improvement in their psychological symptoms. DISCUSSION: This initial evidence from China may stress the importance of administering psychosocial intervention during the treatment of COVID-19 for better patient outcomes in other countries.

[Determinants of Drinking Relapse after Treatments in Patients with Alcohol Dependence in Sichuan Province].

OBJECTIVE: To identify factors that influent drinking relapse after treatments in patients with alcohol dependence in Sichuan province. METHODS: Data were collected in 10 cities of Sichuan province from September 2014 to June 2015,involving 599 patients who received treatments for alcohol dependence. A questionnaire survey was administered on these patients one year after discharge through face to face interviews,collecting data in relation to their demographic characteristics,drinking over the past year,smoking,mood and level of stress. Ordinal polytomous logistic regression analyses were performed to determine the association of these factors with drinking relapse. RESULTS: All of the 599 patients started drinking again after treatments: 18 having low-risk drinking,92 having hazardous drinking,103 having harmful drinking,and 386 having alcohol dependence. Younger patients [odds ratio (OR)=0.978,P=0.009],those who experienced less positive events (OR=0.978,P<0.001) or more negative events (OR=1.014,P=0.003),and those with depression (OR=1.121,P=0.001) were more likely to resume a higher level of alcohol drinking than their counterparts. CONCLUSION: High relapse with alcohol dependence is evident. So does hazardous and harmful drinking. Negative life events and depression are risk factors of drinking relapse,while older age and positive life events are protective factors.

Case report of anti-N-methyl-D-aspartate receptor encephalitis in a middle-aged woman with a long history of major depressive disorder.

BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease involving antibodies against the NR1 subunits of NMDARs. The disease shows variable clinical presentation, and involves new-onset acute psychotic symptoms, making it difficult to differentiate from major depressive disorder with psychotic symptoms. Potential associations between this autoimmune disorder and onset or progression of major depressive disorder remains unclear. CASE PRESENTATION: We present a rare case of a patient who had both major depressive disorder and anti-NMDAR encephalitis and in whom the encephalitis initially went undetected. The patient had been suffering from depressive disorder for more than 6 years without any treatment, when she was hospitalized for new-onset psychotic symptoms. She was initially diagnosed only with major depressive disorder with psychotic symptoms, but antipsychotics did not alleviate symptoms and the patient's psychiatric course began to fluctuate rapidly. Anti-NR1 IgG autoantibodies were detected in cerebrospinal fluid, and the combination of immunotherapy and antipsychotics proved more effective than antipsychotics alone. The patient was then also diagnosed with anti-NMDAR encephalitis. CONCLUSIONS: Our case suggests that clinicians should consider anti-NMDAR encephalitis when a patient with depressive disorder shows sudden fluctuations in psychiatric symptoms. It also highlights the need for research into possible relationships between anti-NMDAR encephalitis and major depressive disorder.

Association of testosterone levels and heroin usage characteristics in male heroin users.

BACKGROUND: Previous studies have shown that heroin abuse can alter the gonadal functions. Few studies examined the association between testosterone levels and heroin use in the existing literature. We aimed to determine the association between gonadal hormones and heroin usage characteristics over 12 weeks of abstinence in heroin users. METHODS: We collected data on patient demographics and heroin use patterns for 65 men aged 18 to 45 and for 29 age-matched healthy controls. Serum levels of total testosterone, estradiol, and prolactin were assessed at 5 time points. RESULTS: Testosterone levels gradually increased and prolactin levels decreased in heroin users in this study. In heroin users, a significant positive correlation was observed between the way of using drug and the testosterone levels, the way of using drug and the estradiol levels, between the duration of heroin dependence and the testosterone levels, between the duration of heroin dependence and the estradiol levels on D0, and between relapse time and testosterone levels on D84. CONCLUSIONS: Our data reveal testosterone might promote injection drug use and repeated relapse in male heroin users.

Focusing on quality of life in the family caregivers of patients with schizophrenia from the perspective of family functioning: A cross-sectional study.

ABSTRACT: The study aimed to explore the association between family functioning and quality of life (QOL) in family caregivers of patients with schizophrenia.Totally 121 family caregivers were surveyed in the cross-sectional study by the self-administration questionnaires about sociodemographic characteristics, family functioning and QOL. Family functioning was evaluated in terms of the family assessment device and the Family Adaptability and Cohesion Evaluation Scale II China Version. QOL was evaluated in terms of TSDHE short-form 12-item health survey, version 2. Multiple regression models were built to explore the association between QOL and family functioning.A regression analysis showed that poorer physical health of family caregivers was significantly associated with the lower educational level of caregivers, the closer kinship with patients and the multiple episodes schizophrenia. The other regression analysis showed that better family adaptability and affective responsiveness were significantly associated with the better mental health of family caregivers.Family functioning is associated with mental health rather than the physical health of family caregivers. Psychoeducational intervention could focus on family caregivers with a lower educational level and closer kinship, and those who look after patients with multiple episodes schizophrenia. Further family intervention could focus on family adaptability and affective expression in family caregivers of patients with schizophrenia.

A real-world study on clinical predictors of relapse after hospitalized detoxification in a Chinese cohort with alcohol dependence.

BACKGROUND: The relapse rate of alcohol dependence (AD) after detoxification is high, but few studies have investigated the clinical predictors of relapse after hospitalized detoxification in real-world clinical practice, especially among Chinese patients. METHODS: This longitudinal cohort study followed up 122 AD patients who were discharged from January 1, 2016 to January 30, 2018 from their most recent hospitalization for detoxification. These patients were interviewed by telephone from May 20, 2017, to June 30, 2018, at least 6 months after discharge. During the interview, the relapse were assessed by using a revised Chinese version of the Alcohol Use Disorder Identification Test. Candidate predictors, such as therapeutic modalities during hospitalization and at discharge, medical history data related to alcohol use, and demographic information, were obtained from the medical records in the hospital information system. RESULTS: During the 6-24 months (with a median of 9 months) follow-up period, the relapse rate was 53.3%. Individuals with a college education level and those who had not been treated with the brief comprehensive cognitive-motivational-behavioural intervention (CCMBI) were more likely than their counterparts to relapse after hospitalized detoxification, and their adjusted HRs (95% CIs) were 1.85 (1.09, 3.16) and 2.00 (1.16, 3.46), respectively. The CCMBI use predicted a reduction in the relapse rate by approximately one-fifth. CONCLUSION: Undergoing the CCMBI during detoxification hospitalization and having less than a college-level education could predict a reduced risk of AD relapse. These findings provide useful information both for further clinical research and for real-world practice.