Newly self-administered two-step tool for screening cognitive function in an ageing Chinese population: an exploratory cross-sectional study.

Background: Early screening of cognitive function is critical to dementia treatment and care. However, traditional tests require face-to-face administration and are often limited by implementation costs and biases. Aims: This study aimed to assess whether the Thoven Cognitive Self-Assessment (TCSA), a novel, innovative two-step touchscreen-based cognition assessment tool, could identify early cognitive impairment due to dementia in older adults. Methods: The TCSA was administered to 61 healthy controls (HCs), 46 participants with mild cognitive impairment (MCI) and 44 participants diagnosed with dementia recruited from Shanghai. Two outcome measures were generated from the TCSA test: the TCSAprimary task score and the TCSAsecondary task score. Results: The total average scores in the control group for the TCSAprimary task and TCSAsecondary task were significantly higher than those in the MCI and dementia groups (TCSAprimary task: HCs vs MCI group vs dementia group, 8.58±1.76 vs 5.40±2.67 vs 2.74±2.11, F=75.40, p<0.001; TCSAsecondary task: HCs vs MCI group vs dementia group, 23.02±3.31 vs 17.95±4.93 vs 11.93±5.50, F=76.46, p<0.001). Moreover, receiver operating characteristic analysis showed that a score below 7.5 for the TCSAprimary task and a score below 22.5 for the TCSAsecondary task were indicators of MCI. Conclusions: The TCSA appears to be efficacious for the detection of cognitive impairment in older adults. It demonstrates the potential for large-scale cognition screening in community service settings.

Study of differences between patients with schizophrenia and healthy people in semantic processing.

Semantic processing is important in language comprehension and production, and context can facilitate understanding and accelerate processing speed by pre-activating semantically related words. There are many studies suggesting that patients with schizophrenia have inferior language ability. This study was aimed to examine the differences between patients with schizophrenia and healthy people in semantic processing with Chinese classifier-noun pairs rating tasks. Participants were required to finish rating tasks to judge acceptability of classifier-noun pairs. Also, the Positive and Negative Syndrome Scale (PANSS) was conducted in the schizophrenia group. According to results of variance analysis, schizophrenic patients' accuracy of judgment on the acceptability of classifier-noun pairs differed from the control group (F = 4.13, p < .05), and the contextual effect of classifier constraint could be observed in healthy people (F(1, 31) = 5.38, p < .05) but not in patients with schizophrenia (F(1, 25) = 3.55, p = .07), indicating that they failed to use the contextual information to facilitate language comprehension as healthy people. Stepwise linear regression analysis found that hostility, poor impulse control and suspiciousness/persecution and preoccupation in the PANSS may have contributed to the reduced sensitivity in the rating in patients (t = -2.38-3.80, p < .05).

Divergent responses of ecosystem water-use efficiency to extreme seasonal droughts in Southwest China.

The recurrent drought extremes have resulted in deleterious impacts on ecological security. Despite that many attempts have been made to explore ecosystem responses to different severities of droughts, a deep understanding of how ecosystem water-use efficiency (WUE) responds to extreme seasonal droughts is critical for predicting the trends under future climate change, especially in the ecologically-fragile karst ecosystem across Southwest China. This study systematically examined the spatio-temporal variations of ecosystem WUE over the karst and non-karst areas, as well as their divergent responses to different seasonal droughts. Our findings revealed the apparent increase in drought frequency, duration, and severity in Southwest China during the past four decades. Meanwhile, spring and summer drought events were the prevailing drought types. Compared with the non-karst area, multi-year mean WUE in the karst area was relatively lower, whereas the area exhibiting significant increase in WUE (p < 0.01) accounted for 39.3% and 22.3%, respectively. However, the effects of drought on ecosystem WUE varied in different seasons with more severe consequence in the karst ecosystem. During the early stage of autumn-spring drought in 2009/2010, ecosystem WUE was apparently larger than the baseline condition with the difference turning to be negative anomalies during the peak period, whereas the effect of summer drought in 2011 led to negative anomalies nearly throughout the duration. Further analysis revealed that the anomalies in evapotranspiration acted a prominent role in altering WUE at the onset of both droughts, while ecosystem WUE was mainly determined by the sensitivity of gross primary production during the later stage. All analyses are beneficial for expecting the coupling relationship between global carbon and water cycles to future climate change, particularly as droughts are projected to increase in terms of frequency and severity.

Association of the HTR2C-759C/T polymorphism and antipsychotic-induced weight gain: a meta-analysis.

BACKGROUND: Antipsychotic-induced weight gain (AIWG) is a crucial factor for the medication cessation of patients with schizophrenia. Multiple studies have shown that the functional polymorphism -759 C/T (rs3813929) in the HTR2C promoter region could possibly be correlated with AIWG. AIM: To evaluate the genetic association of the HTR2C-759C/T polymorphism and AIWG in patients with schizophrenia with antipsychotic drugs (APDs) administration. METHODS: Eligible studies were identified by searching the following databases: PubMed, Embase, Web of Science, China Nation Knowledge Infrastructure (CNKI), VIP, Wanfang Data, Chinese Biomedical Literature Database (CBM) and the Airiti Library. The quality of studies was evaluated based on the Newcastle-Ottawa Scale. The pooled OR and 95% CI were calculated for the dominant (CT/TT/T vs CC/C) mode, and subgroup analyses were performed based on ethnicity, antipsychotic medication and gender; all statistical analyses were performed using the statistical software STATA V.12.0. RESULT: A total of 17 studies with 3170 patients with schizophrenia were included in our meta-analysis. The result of the meta-analysis has shown that the association between the -759 C/T polymorphism and AIWG is statistically significant (OR 0.34, 95% CI: 0.20 to 0.57, z=4.11, p<0.001). The subgroup analyses revealed significant correlations between the -759 C/T polymorphism and AIWG in the Caucasian population (OR 0.33, 95% CI: 0.14 to 0.77, z=2.55, p=0.011), the Asian population (OR 0.31, 95% CI: 0.18 to 0.52, z=4.46, p<0.001), the patients with APDs administration (CT/TT/T vs CC/C: OR 0.63, 95% CI: 0.40 to 1.00, z=1.97, p=0.049) and the patients with atypical antipsychotic drug administration (CT/TT/T vs CC/C: OR 0.21, 95% CI: 0.09 to 0.47, z=3.83, p<0.001). The sensitivity analysis showed that the results were stable. Begg's test (after correction z=1.07, p=0.287) and Egger's test (t=-2.41, p=0.029) show that the included articles have no significant publication bias. CONCLUSION: There is a significant genetic association between HTR2C-759C/T and AIWG, and patients with T allele are less likely to have AIWG.

Nitrate sources and biogeochemical processes in karst underground rivers impacted by different anthropogenic input characteristics.

Nitrate is one of the most common pollution sources in groundwater, particularly in highly vulnerable karst aquifers. The potential for nitrification and denitrification within karst aquifers varies in different settings depending on the extent of anthropogenic inputs, so that accurate identification of nitrate sources can be difficult. Geochemical data and dual nitrate isotopes were measured in this study, incorporating a Bayesian isotopic mixing model, and used to identify nitrate sources, nitrification and denitrification, and quantitatively determine nitrate sources under different extents of anthropogenic inputs in three karst catchments within Chongqing Municipality, SW China: Laolongdong (an urbanized area), Qingmuguan (a suburban village), and Shuifang Spring (a protected natural area). At the Laolongdong catchment, the groundwater was in a reducing condition and enriched in δ15NNO3 (averaging 18.9 ± 6.9‰) and δ18ONO3 (averaging 8.5 ± 4.6‰). Manure and sewage waste were the main contributing nitrate sources. A slope of 1.8: 1 of the dual isotopes suggested a denitrification process occurring in anaerobic conduit flow. Within the Qingmuguan catchment, groundwater had average δ15NNO3 and δ18ONO3 values of 9.7 ± 3.5‰, and 1.9 ± 3.4‰, respectively. The data showed evidence for nitrification, and the contribution of soil organic nitrogen was 52.1%, followed by a contribution of 44.8% from manure and wastewater. At the Shuifang Spring catchment, the mean δ15NNO3 and δ18ONO3 values in groundwater were 8.8 ± 2.9‰, 2.3 ± 4.6‰, respectively. Nitrification was the dominant process and most of the nitrate was derived from soil organic nitrogen. This study suggests that karst underground rivers overlain by urban land use undergo denitrification, while the suburban and relatively pristine karst aquifers are dominated by nitrification, allowing development of a conceptual model for nitrate sources and transformations in karst aquifers from the categories of land use (i.e., urban, suburban, and pristine areas). MAIN FINDING: Anthropogenic activities can change biogeochemical nitrogen dynamics of vulnerable karst aquifers, such that the groundwater overlain by an urban settlement has undergone denitrification, while suburban and pristine areas have been dominated by nitrification.

Evaluation of TSEB turbulent fluxes using different methods for the retrieval of soil and canopy component temperatures from UAV thermal and multispectral imagery.

The thermal-based Two-Source Energy Balance (TSEB) model partitions the evapotranspiration (ET) and energy fluxes from vegetation and soil components providing the capability for estimating soil evaporation (E) and canopy transpiration (T). However, it is crucial for ET partitioning to retrieve reliable estimates of canopy and soil temperatures and net radiation, as the latter determines the available energy for water and heat exchange from soil and canopy sources. These two factors become especially relevant in row crops with wide spacing and strongly clumped vegetation such as vineyards and orchards. To better understand these effects, very high spatial resolution remote-sensing data from an unmanned aerial vehicle were collected over vineyards in California, as part of the Grape Remote sensing and Atmospheric Profile and Evapotranspiration eXperiment and used in four different TSEB approaches to estimate the component soil and canopy temperatures, and ET partitioning between soil and canopy. Two approaches rely on the use of composite T rad, and assume initially that the canopy transpires at the Priestley-Taylor potential rate. The other two algorithms are based on the contextual relationship between optical and thermal imagery partition T rad into soil and canopy component temperatures, which are then used to drive the TSEB without requiring a priori assumptions regarding initial canopy transpiration rate. The results showed that a simple contextual algorithm based on the inverse relationship of a vegetation index and T rad to derive soil and canopy temperatures yielded the closest agreement with flux tower measurements. The utility in very high-resolution remote-sensing data for estimating ET and E and T partitioning at the canopy level is also discussed.

Effects of omega-3 fatty acids on metabolic syndrome in patients with schizophrenia: a 12-week randomized placebo-controlled trial.

RATIONALE: Individuals with schizophrenia are at increased risk of developing metabolic syndrome (MetS) due to their lifestyle and antipsychotic treatment. Our previous study showed that patients with both schizophrenia and MetS present an increased expression and production of tumor necrosis factor-alpha (TNF-alpha). Omega-3 fatty acids have a documented role in suppressing TNF-alpha; therefore, we hypothesized that they may be of value in relieving inflammation and improving metabolic disturbance in patients with both schizophrenia and MetS. OBJECTIVES: This study employed a randomized placebo-controlled trial to investigate the effects of omega-3 fatty acids on MetS in patients with schizophrenia. METHODS: We recruited 80 patients with both schizophrenia and MetS who received long-term olanzapine monotherapy. The patients were randomly assigned to the OMG-3 group (n = 40) or the placebo group (n = 40). RESULTS: Patients with both schizophrenia and MetS had significantly higher levels of TNF-alpha than the control subjects (Z = - 4.37, P < 0.01). There was a significant correlation between omega-3 fatty acid treatment and reduced triglyceride (TG) levels (Fgroup × time = 13.42; df = 1, 66; P < 0.01) when the patients completed this study. Along with metabolic improvement, omega-3 fatty acids decreased TNF-alpha levels after 12 weeks of treatment (Fgroup × time = 6.71; df = 1, 66; P = 0.012). We also found that the extent of TNF-alpha decrease was significantly correlated with that of TG decrease (r = 0.38, P = 0.001). CONCLUSIONS: Our findings provide suggestive evidence that omega-3 fatty acids have beneficial effects on TG metabolism in patients with both schizophrenia and MetS that parallel decreased inflammation levels.

Brain-derived neurotrophic factor as a biomarker for cognitive recovery in acute schizophrenia: 12-week results from a prospective longitudinal study.

RATIONALE: It is generally accepted that impaired cognitive function is a core feature of schizophrenia. There is evidence for the role of brain-derived neurotrophic factor (BDNF) in cognitive function. Olanzapine was reported to yield cognitive improvement in patients with schizophrenia. OBJECTIVES: In this study, we performed a prospective, open-label, 12-week observation trial to investigate whether peripheral BDNF may represent a potential biomarker for the effect of cognitive improvement induced by olanzapine in patients with schizophrenia. METHODS: In total, 95 patients with acute schizophrenia were enrolled in the study. We also recruited 72 healthy individuals for a control group. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate symptom severity and treatment response. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Plasma BDNF levels were measured with an enzyme-linked immunosorbent assay. RESULTS: Of the 95 patients consented into the study, 68 completed the 12-week follow up. Our results showed that schizophrenia patients with acute exacerbation had significantly poorer performance than that of the controls (Ps < 0.01). A significantly decreased plasma level of BDNF in patients was observed compared with the controls (F = 7.77, P = 0.006). A significant improvement in each PANSS subscore and total score was observed when the patients completed this study (Ps < 0.01). Additionally, 12-week olanzapine treatment exhibited significant improvements in RBANS immediate memory, attention, and total scores (P = 0.018, 0.001, and 0.007, respectively). Along with the clinical improvement, plasma BDNF levels after 12-week olanzapine monotherapy (4.67 ± 1.74 ng/ml) were also significantly increased compared with those at baseline (3.38 ± 2.11 ng/ml) (P < 0.01). Spearman's correlation analysis showed that the increase in plasma levels of BDNF is significantly correlated with the change in the RBANS total scores (r = 0.28, P = 0.02) but not with the change in the PANSS total scores (r = - 0.18, P = 0.13). There is a significant correlation of BDNF increase with the change of RBANS attention subscore (r = 0.27, P = 0.028). CONCLUSIONS: Our findings suggest that olanzapine improves psychiatric symptoms and cognitive dysfunction, particularly attention and immediate memory, in patients with acute schizophrenia, in parallel with increased plasma BDNF levels. Plasma BDNF levels may be a potential biomarker for cognitive recovery in acute schizophrenia.

Interaction between BDNF and TNF-α genes in schizophrenia.

OBJECTIVE: Our recent work reported that tumor necrosis factor-α (TNF-α) is negatively correlated with brain-derived neurotrophic factor (BDNF) in patients with schizophrenia. A previous study has shown that TNF-α could regulate the extracellular secretion of BDNF. Therefore, we hypothesized that the TNF-α gene (TNF-α) may interact with the BDNF gene (BDNF) to influence schizophrenia risk. METHODS: We recruited 694 patients with schizophrenia from three mental hospitals in Eastern China and 725 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was employed to evaluate symptom severity. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was performed to assess cognitive function. The SNPs rs6265 in BDNF and rs1799964 in TNF-α were genotyped. RESULTS: There were no significant differences in allele and genotype frequencies in either rs6265 or rs1799964 between the case and control groups. A significant association of rs6265 AA + AG × rs1799964 CC + CT with schizophrenia was observed (OR = 1.14, 95%CI: 1.02-1.27; P = .02). There were significant differences in the RBANS attention and total scores between the patients with rs6265A and rs1799964C alleles and those without these two alleles (P = .03 and P = .03 after Bonferroni correction, respectively). CONCLUSION: Our findings provided preliminary evidence that the interaction of BDNF and TNF-α may confer susceptibility to schizophrenia and cognitive dysfunction.

Genetic association analysis of microRNA137 and its target complex 1 with schizophrenia in Han Chinese.

Recent genome-wide association studies (GWAS) have identified a strong association signal of microRNA137 host gene (MIR137) with schizophrenia. MIR137 dysfunction results in downregulation of presynaptic target gene complexin 1 (CPLX1) and impairs synaptic plasticity in the hippocampus. In this study, we aimed to investigate whether the variants of MIR137 and CPLX1 confer susceptibility to schizophrenia in Han Chinese. This study employed 736 patients with schizophrenia patients and 751 well-matched healthy subjects for genetic analysis, and genotyped 12 SNPs within MIR137 and CPLX1. SZDB database was used to performed brain eQTL analysis. There were no significant differences of CPLX1 expression in hippocampus, prefrontal cortex or stratum between the schizophrenia patients and control subjects. No significant differences were observed in allele and genotype frequencies in studied SNPs between the case and control groups. Gene interaction analysis showed that MIR137 SNP rs1625579 did not affect schizophrenia susceptibility in interaction with the CPLX1 polymorphic variants. Our findings do not support MIR137 and CPLX1 conferring susceptibility to schizophrenia in Han Chinese.

Genome-wide significant, replicated and functional risk variants for Alzheimer's disease.

Genome-wide association studies (GWASs) have reported numerous associations between risk variants and Alzheimer's disease (AD). However, these associations do not necessarily indicate a causal relationship. If the risk variants can be demonstrated to be biologically functional, the possibility of a causal relationship would be increased. In this article, we reviewed all of the published GWASs to extract the genome-wide significant (p < 5×10-8) and replicated associations between risk variants and AD or AD-biomarkers. The regulatory effects of these risk variants on the expression of a novel class of non-coding RNAs (piRNAs) and protein-coding RNAs (mRNAs), the alteration of proteins caused by these variants, the associations between AD and these variants in our own sample, the expression of piRNAs, mRNAs and proteins in human brains targeted by these variants, the expression correlations between the risk genes and APOE, the pathways and networks that the risk genes belonged to, and the possible long non-coding RNAs (LncRNAs) that might regulate the risk genes were analyzed, to investigate the potential biological functions of the risk variants and explore the potential mechanisms underlying the SNP-AD associations. We found replicated and significant associations for AD or AD-biomarkers, surprisingly, only at 17 SNPs located in 11 genes/snRNAs/LncRNAs in eight genomic regions. Most of these 17 SNPs enriched some AD-related pathways or networks, and were potentially functional in regulating piRNAs and mRNAs; some SNPs were associated with AD in our sample, and some SNPs altered protein structures. Most of the protein-coding genes regulated by the risk SNPs were expressed in human brain and correlated with APOE expression. We conclude that these variants were most robust risk markers for AD, and their contributions to AD risk was likely to be causal. As expected, APOE and the lipoprotein metabolism pathway possess the highest weight among these contributions.

A Study of the Characteristics of Alexithymia and Emotion Regulation in Patients with Depression.

BACKGROUND: Even though patients with depression often show significant alexithymia, the underlying mechanism of their alexithymia remains unclear. Furthermore, few experimental studies have explored their ability to regulate emotions. OBJECTIVE: To explore the characteristics of alexithymia in patients with depression, and the relationship of depressive symptoms, alexithymia and emotion regulation. METHODS: A total of 36 patients with depression and 31 healthy controls were enrolled. HAMD-24 and HAMA were used to evaluate depressive and anxious symptoms. Toronto Alexithymia Scale (TAS) was employed to assess alexithymia. A computer experiment was used to evaluate emotion regulation. RESULTS: 66.67% of the patients with depression were considered as having alexithymia, but the rate in the control group was only 3.23%. The rates showed a significant difference (χ2=28.661, p<0.001). The score of TAS was higher in patients with depression than healthy controls (t=7.378, p<0.001). In a computerized emotional regulation experiment, under watch-neutral conditions, the emotion experience ratings of patients with depression were higher than those of controls (t=2.080, p=0.043); while under watch-negative, negative-reappraisal and negative-suppression conditions, the ratings of patients with depression showed no difference from those of the controls. The scores of TAS were correlated with the HAMD-24 scores and the HAMA scores significantly in patients with depression. However, the ratings on the emotional regulation experiment had no correlation with the HAMD-24 scores, the HAMA scores or the TAS scores. CONCLUSION: The incidence of alexithymia is higher in patients with depression than the general population. The depressive symptoms may have interplay with alexithymia in patients with depression. Emotion regulation ability may be an independent trait and have nothing to do with the depressive state.

Metabolic adverse effects of olanzapine on cognitive dysfunction: A possible relationship between BDNF and TNF-alpha.

OBJECTIVE: There is accumulating evidence indicating that long-term treatment with second-generation antipsychotics (SGAs) results in metabolic syndrome (MetS) and cognitive impairment. This evidence suggests an intrinsic link between antipsychotic-induced MetS and cognitive dysfunction in schizophrenia patients. Olanzapine is a commonly prescribed SGA with a significantly higher MetS risk than that of most antipsychotics. In this study, we hypothesized that olanzapine-induced MetS may exacerbate cognitive dysfunction in patients with schizophrenia. METHODS: A sample of 216 schizophrenia patients receiving long-term olanzapine monotherapy were divided into two groups, MetS and non-MetS, based on the diagnostic criteria of the National Cholesterol Education Program's Adult Treatment Panel III. We also recruited 72 healthy individuals for a control group. Cognitive function was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Plasma brain-derived neurotrophic factor (BDNF) and tumor necrosis factor-alpha (TNF-alpha) were measured by an enzyme-linked immunosorbent assay for 108 patients and 47 controls. RESULTS: Among the 216 schizophrenia patients receiving olanzapine monotherapy, MetS was found in 95/216 (44%). Patients with MetS had more negative symptoms, higher total scores in PANSS (Ps<0.05) and lower immediate memory, attention, delayed memory and total scores in RBANS (Ps<0.01). Stepwise multivariate linear regression analysis revealed that increased glucose was the independent risk factor for cognitive dysfunction (t=-2.57, P=0.01). Patients with MetS had significantly lower BDNF (F=6.49, P=0.012) and higher TNF-alpha (F=5.08, P=0.026) levels than those without MetS. There was a negative correlation between the BDNF and TNF-alpha levels in the patients (r=-0.196, P=0.042). CONCLUSION: Our findings provide evidence suggesting that the metabolic adverse effects of olanzapine may aggravate cognitive dysfunction in patients with schizophrenia through an interaction between BDNF and TNF-alpha.

Effectiveness of Antipsychotic Drugs for 24-Month Maintenance Treatment in First-Episode Schizophrenia: Evidence From a Community-Based "Real-World" Study.

OBJECTIVE: Maintenance treatment of schizophrenia with antipsychotic medications has become a standard for the prevention of psychotic relapse. However, little is known about the effectiveness of antipsychotic drugs for maintenance treatment in "real-world" populations with schizophrenia. We carried out a prospective study to assess the effectiveness of the most frequently prescribed antipsychotic drugs in the maintenance treatment of schizophrenia from 2 community settings. METHODS: This study was conducted from October 2011 to December 2014. All participants were diagnosed with schizophrenia according to DSM-IV, were treated with an antipsychotic monotherapy, and were registered in a case management program with monthly monitoring for 24 months. The primary outcome measure, Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales were used to evaluate symptom severity and treatment response. The Personal and Social Performance scale (PSP) was used to evaluate the patients' social functioning. The Medication Adherence Rating Scale (MARS) was used to assess medication adherence behavior. On the basis of antipsychotic used at baseline, patients were clustered into 7 groups: aripiprazole (n = 21), clozapine (n = 84), chlorpromazine (n = 61), olanzapine (n = 34), perphenazine (n = 21), quetiapine (n = 27), and risperidone (n = 99). RESULTS: Of the 347 patients enrolled in the study, 312 completed the 24-month follow-up. There were no significant differences among the treatment groups in the PANSS total and subscale scores or the CGI-S and CGI-I scores over 24 months (all P values > .05). There were also no significant differences in interactions between PSP scores and antipsychotic drugs (P = .17). The remission rates increased as the follow-time lapsed in all groups, but no significant difference was observed in remission rates at each time point among the 7 groups (P values > .05). At the endpoint, MARS total scores were over 6, but did not significantly differ among the studied drugs (P = .24). CONCLUSIONS: These findings suggest that antipsychotic drugs can achieve equivalent effectiveness in maintenance treatment of first-episode schizophrenia through a well-organized case management program and family participation.

[Prepulse inhibition of startle reflex in schizophrenics and healthy adults].

OBJECTIVE: To evaluate the characteristics of sensory gating inhibition and variation of schizophrenia with both prepulse inhibition (PPI) and P50. METHODS: The PPI of startle reflex and P50 were tested by an event-related potential (ERP) recorder in 82 first episode schizophrenics (FES) recruited from September 2007 to February 2014 at Shanghai Mental Health Hospital and 78 healthy controls (NC) from hospital staffs and local residents for the same period. All patients fulfilled the evaluation of PPI with strong stimulus alone and strong + weak stimulus paradigm, P50 with conditioning (S1)-testing (S2) paradigm. The psychotic symptoms were assessed with Positive and Negative Syndrome Scale (PANSS). RESULTS: (1) Compared with control group, schizophrenia group had increased P(L) (NC: (89 ± 14) ms, FES: (97 ± 17) ms, P < 0.05) and PPL, decreased amplitude (NC: (92 ± 21) ms, (24 ± 14) µV, FSZ: (96 ± 20) ms, (41 ± 29) µV, P < 0.05, 0.01), lower PPI inhibition ratio (NC: (67 ± 32)%, FSZ: (41 ± 37)%, P < 0.05). (2) Compared with NC group, there were increased S2 amplitude [NC: (3 ± 2) µV vs FES: (5 ± 3) µV, P < 0.05] and ratio of S2/S1 amplitude [(43 ± 22) % vs (82 ± 41)%, P < 0.05] in schizophrenia group. And P50 inhibition decreased significantly. CONCLUSION: Schizophrenics have both PPI and P50 impairments. And a combination of PPI inhibition ratio and S2/S1 (P50) may be a better electrocerebrophysiological index for schizophrenia.

[Three-year follow up of event-related potentials PPI, P50 and Color map of N400 during the rehabilitation of first episode schizophrenia patients].

OBJECTIVE: To investigate the relationship between the variations of event-related potentials (ERP) and clinical symptoms and treatment in first episode schizophrenia patients. METHODS: The ERP (P50, color map of N400 and prepulse inhibition of the startle reflex (PPI) ) were tested in 85 first episode schizophrenia (FES) patients and 78 normal controls (NC), and followed-up at 1, 2 and 3 years after treatment in FES. Positive and negative symptom scale (PANSS) was used to evaluate the psychotic symptoms of patients. RESULTS: (1) Compared with NC, FES showed decreased PPI% (41% ± 37% vs 68% ± 42%, P < 0.001), increased P50 S2/S1(87 ± 41 vs 51 ± 47, P < 0.001), prolonged N400 latency and decreased N400 amplitudes (P < 0.05 - 0.01 ). ( 2) Significant correlations were found between variations of color map of N400 latencies and general scores of PANSS (r = 0.321, P = 0.042), N400 amplitude and positive symptom scores (r = -0.437, P = 0.008) and total scores of PANSS (r = -0.392, P = 0.023), but the variations of PPI and P50 latencies and amplitudes did not show significant correlation with the positive symptom scores and total scores of PANSS. (3) The color map of N400 latencies and amplitudes in FES group showed significant difference (P < 0.05) but the major indexes of PPI and P50 did not show significant difference (P > 0.05) among the 1, 2 and 3 years' follow-up after treatment. CONCLUSION: This follow-up study suggests that the variations of PPI and P50 is probably a trait marker of FES, and the variations of color map of N400 might be a status marker of FES.

Effects of sleep deprivation on polysomnography and executive function in patients with depression.

BACKGROUND: Sleep deprivation (SD) has been used in treatment of depression disorder, and could effectively improve the patients' depressive symptoms.The aim of the study was to explore the effects of SD on electroencephalographic (EEG) and executive function changes in patients with depression. METHODS: Eighteen depression patients (DPs) and 21 healthy controls (HCs) were enrolled in the present study. The whole night polysomnography (PSG) was recorded by Neurofax-1518K (Nihon Kohden, Japan) system before and after 36 hours of SD. The level of subjects' depression state was assessed by Visual Analogue Scale (VAS), and the executive function was assessed by Wisconsin Card Sorting Test (WCST). RESULTS: Significantly decreased sleep latency (SL; before SD: (31.8 ± 11.1) minutes, after SD: (8.8 ± 5.2) minutes, P < 0.01) and REM sleep latency (RL; before SD: (79.8 ± 13.5) minutes, after SD: (62.9 ± 10.2) minutes, P < 0.01) were found after SD PSG in depression patients. Decreased Stage 1 (S1; before SD: (11.7 ± 2.9)%, after SD: (7.3 ± 1.1)%, P < 0.01) and Stage 2 (S2, before SD: (53.8 ± 15.5)%, after SD: (42.3 ± 14.7)%, P < 0.05) of non-rapid eye movement (NREM) sleep, and increased Stage 3 (S3, before SD: (11.8 ± 5.5)%, after SD: (23.6 ± 5.8)%, P < 0.01) and Stage 4 (S4, before SD: (8.8 ± 3.3)%, after SD: (27.4 ± 4.8)%, P < 0.01) NREM sleep were also found. After SD, the depression level in patients decreased from 6.7 ± 2.1 to 2.9 ± 0.7 (P < 0.01). In WCST, the patients showed significantly decreased Response errors (Re, before SD: 22.3 ± 2.4, after SD: 18.3 ± 2.7, P < 0.01) and Response preservative errors (Rpe, before SD: 11.6 ± 3.6, after SD: 9.3 ± 2.9, P < 0.05). Depression patients' RE (t = 2.17, P < 0.05) and Rpe (t = 2.96, P < 0.01) also decreased significantly compared to healthy controls. CONCLUSION: SD can improve depression symptom and executive function in depression patients.

Two-year prospective case-controlled study of a case management program for community-dwelling individuals with schizophrenia.

BACKGROUND: A community-based rehabilitation program is an essential element of the comprehensive treatment of individuals with schizophrenia. OBJECTIVE: Assess the long-term effects of a community-based case management program for providing rehabilitations services to individuals with schizophrenia. METHODS: A total of 730 community-residing participants who met ICD-10 diagnostic criteriafor schizophrenia were enrolled, 380 in the case management group and 350 in the control group from two districts in Shanghai. Case management involved monthly training visits with patients and their co-resident family members that focused on encouraging medication adherence. Participants were assessed every three months for 24 months with the Camberwell Assessment of Need (CAN), Positive and Negative Syndrome Scale (PANSS), WHO-Disability Assessment Scale (WHO-DAS), and the Quality of Life Scale (QOLS). Level of discomfort due to side-effects was also assessed every three months. Individuals who discontinued their antipsychotic medication without physician approval for one month or longer at any time during follow-up were classified as 'self-determined medication discontinuation'. RESULTS: Compared to the treatment as usual group (i.e., follow-up management every 3 months), by the end of the two-year follow-up those who participated in the case management program had significantly lower rates of medication discontinuation, significantly less severe negative symptoms, lower relapse rates and lower rehospitalization rates. Other factors that had an independent effect on discontinuation of medication included educational level (those with more education had higher discontinuation rates), lack of family supervision of medication, higher dosages of medication, and greater medication-related discomfort. CONCLUSIONS: Case management is a feasible and effective long-term method for improving the rehabilitation outcomes of community residents with schizophrenia. Our results highlight the need to involve family members in the management of patients' medication, to use the minimum effective dosage of medication, and to aggressively manage all side-effects.