Internet addiction and residual depressive symptoms among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic: a network analysis perspective.

To assess the inter-relationships between residual depressive symptoms (RDS) and Internet addiction (IA) using network analysis among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic. RDS and IA were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Internet Addiction Test (IAT), respectively. Central symptoms and bridge symptoms in the network model were examined. A total of 1,454 adolescents met the study criteria and were included in the analyses. The prevalence of IA was 31.2% (95% CI: 28.8%-33.6%). In the network analysis, the nodes IAT15 ("Preoccupation with the Internet"), PHQ2 ("Sad mood"), and PHQ1 ("Anhedonia") were the most central symptoms in the IA-RDS network model. Bridge symptoms included IAT10 ("Sooth disturbing about your Internet use"), PHQ9 ("Suicide ideation"), and IAT3 ("Prefer the excitement online to the time with others"). Additionally, PHQ2 ("Sad mood") was the main node linking "Anhedonia" to other IA clusters. Internet addiction was common among clinically stable adolescents with major psychiatric disorders during the COVID-19 pandemic. Core and bridge symptoms identified in this study could be prioritized as targets for the prevention and treatment of IA in this population.

Suicide ideation and anhedonia among clinically stable adolescents with the recurrent depressive disorder during the COVID-19 pandemic: A network perspective.

BACKGROUND: Anhedonia is a suicide risk factor among adolescent patients with recurrent depressive disorder (depression hereafter). This study examined associations between suicidal ideation (SI) and residual depressive symptoms (RSD), including anhedonia, among clinically stable adolescents with depression. METHOD: A network analysis was performed to examine the association between RDS and SI among adolescents with depression. Node-specific predictive betweenness was computed to examine short paths between anhedonia and SI. Additionally, a Network Comparison Test (NCT) was conducted to examine gender differences in derived network model characteristics. RESULTS: The network analysis identified close associations of PHQ9 ("Suicide ideation") with PHQ1 ("Anhedonia") as well as some other RDS including PHQ6 ("Guilt"), PHQ2 ("Sad mood") and PHQ8 ("Motor disturbances"). Additionally, PHQ2 ("Sad mood") and PHQ4 ("Fatigue") were the main bridge nodes linking anhedonia and SI. Comparisons of network models did not find significant differences in network global strength or edge weights. LIMITATION: Causal relations between anhedonia and SI could not be determined due to the cross-sectional study design. CONCLUSIONS: SI was directly related to Anhedonia in addition to Guilt, Sad mood and Motor disturbances. Sad mood and Fatigue were the main bridge nodes linking Anhedonia and SI. To reduce the risk of SI among clinically stable adolescents with depression during the COVID-19 pandemic, specific RDS including Anhedonia, Guilt, Sad mood, Motor disturbances and Fatigue should be targeted in interventions.

Structure of Hypomanic Symptoms in Adolescents With Bipolar Disorders: A Network Approach.

Background: Bipolar disorders (BD) are severe mental illnesses that are often misdiagnosed or under-diagnosed. The self-report 33-item Hypomania Checklist (HCL-33) and the 33-item Hypomania Checklist - external assessment (HCL-33-EA) are well-validated scales for BD symptom detection. This study compared the network structure, central symptoms, and network stability of hypomanic symptoms measured by the HCL-33 vs. the HCL-33-EA. Methods: This cross-sectional study was conducted from January to December 2019. Adolescents (aged between 12 and 18 years) with BD were recruited from the outpatient department of Child Psychiatry, First Affiliated Hospital of Zhengzhou University. All participants were asked to complete the HCL-33, and their caregivers completed the HCL-33-EA. Network analyses were conducted. Results: A total of 215 adolescents with BD and their family caregivers were recruited. Node HCL17 ("talk more," node strength = 4.044) was the most central symptom in the HCL-33 network, followed by node HCL2 ("more energetic," node strength = 3.822), and HCL18 ("think faster," node strength = 3.801). For the HCL-33-EA network model, node HCL27 ("more optimistic," node strength = 3.867) was the most central node, followed by node HCL18 ("think faster," node strength = 3.077), and HCL17 ("talk more," node strength = 2.998). In the network comparison test, there was no significant difference at the levels of network structure (M = 0.946, P = 0.931), global strength (S: 5.174, P = 0.274), or each specific edge (all P's > 0.05 after Holm-Bonferroni corrections) between HCL-33 and HCL-33-EA items. Network stabilities for both models were acceptable. Conclusion: The nodes "talk more" and "think faster" acted as central symptoms in BD symptom network models based on the HCL-33 and HCL-33-EA. Although the most prominent central symptom differed between the two models ("talk more" in HCL-33 vs. "more optimistic" in HCL-33-EA model), networks based on each measure were highly similar and underscored similarities in BD symptom relations perceived by adolescents and their caregivers. This research provides foundations for future studies with larger sample sizes toward improving the accuracy and robustness of observed network structures.

Cyberbully victimization and its association with residual depressive symptoms among clinically stable adolescents with psychiatric disorders during the COVID-19 pandemic: A perspective from network analysis.

Objective: This study examined the prevalence of cyberbullying and its relationship with residual depressive symptoms in this patient population during the COVID-19 outbreak using network analysis. Methods: This was a multicenter, cross-sectional study. Adolescent patients attending maintenance treatment at outpatient departments of three major psychiatric hospitals were included. Experience of cyberbullying was measured with a standard question, while the severity of Internet addiction and depressive symptoms were measured using the Internet Addiction Test and the Patient Health Questionnaire-9, respectively. The network structure of depression and cyberbully were characterized and indices of "Expected Influence" was used to identify symptoms central to the network. To identify particular symptoms that were directly associated with cyberbully, the flow function was used. Results: Altogether 1,265 patients completed the assessments. The overall prevalence of cyberbullying was 92.3% (95% confidence interval (CI): 90.8-93.7%). Multiple logistic regression analysis revealed that male gender (p = 0.04, OR = 1.72, 95%CI: 1.04-2.85) was significantly associated with higher risk of cyberbullying, while a relapse of illness during the COVID-19 pandemic was significantly associated with a lower risk of cyberbullying (p = 0.03, OR = 0.50, 95%CI: 0.27-0.93). In the network of depression and cyberbully, "Sad mood," "Anhedonia" and "Energy" were the most central (influential) symptoms. Furthermore, "Suicidal ideation" had the strongest negative association with cyberbully followed by "Guilt". Conclusion: During the COVID-19 pandemic, the experience of cyberbullying was highly prevalent among clinically stable adolescent psychiatric patients, particularly male patients. This finding should raise awareness of this issue emphasizing the need for regular screening and interventions for adolescent patients. Central symptoms (e.g., "Sad mood," "Anhedonia" and "Energy") identified in this study should be targeted in interventions and preventive measures.

Prevalence of Internet Addiction Disorder and Its Correlates Among Clinically Stable Adolescents With Psychiatric Disorders in China During the COVID-19 Outbreak.

Background: Since the Coronavirus disease 2019 (COVID-19) pandemic emerged, Internet usage has increased among adolescents. Due to this trend, the prevalence of Internet addiction disorder (IAD) may have increased within this group. This study examined the prevalence of IAD and its correlates among clinically stable adolescents with psychiatric disorders in China during the COVID-19 outbreak. Method: A multi-center, cross-sectional study was carried out between April 29 and June 9, 2020 in three major tertiary mental health centers in China. IAD and depressive symptoms were assessed using the Internet Addiction Test (IAT) and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Results: A total of 1,454 adolescent psychiatric patients were included in final analyses. The prevalence of IAD was 31.2% (95% CI: 28.8-33.6%) during the COVID-19 pandemic. A multiple logistic regression analysis revealed that poor relationships with parents (P < 0.001, OR = 2.34, 95%CI: 1.49-3.68) and elevated total PHQ-9 scores (P < 0.001, OR = 1.19, 95%CI: 1.16-1.21) were significantly associated with higher risk for IAD while longer daily physical exercise durations (P = 0.04, OR = 0.67, 95%CI: 0.46-0.98) and rural residence (P = 0.003, OR = 0.62, 95%CI: 0.46-0.85) were significant correlates of lower risk for IAD. Conclusions: IAD was common among adolescent patients with clinically stable psychiatric disorders during the COVID-19 pandemic; regular physical exercise, healthy relationships with parents and fewer symptoms of depression were associated with lower risk within this population.

Design, Synthesis, and Biological Evaluation of Novel 3-Aminomethylindole Derivatives as Potential Multifunctional Anti-Inflammatory and Neurotrophic Agents.

The development of multifunctional molecules that are able to simultaneously interact with several pathological components has been considered as a solution to treat the complex pathologies of neurodegenerative diseases. Herein, a series of aminomethylindole derivatives were synthesized, and evaluation of their application for antineuroinflammation and promoting neurite outgrowth was disclosed. Our initial screening showed that most of the compounds potently inhibited lipopolysaccharide (LPS)-stimulated production of NO in microglial cells and potentiated the action of NGF to promote neurite outgrowth of PC12 cells. Interestingly, with outstanding NO/TNF-α production inhibition and neurite outgrowth-promoting activities, compounds 8c and 8g were capable of rescuing cells after injury by H2O2. Their antineuroinflammatory effects were associated with the downregulation of the LPS-induced expression of the inflammatory mediators inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Western blotting and immunofluorescence assay results indicated that the mechanism of their antineuroinflammatory actions involved suppression of the MAPK/NF-κB signal pathways. Further studies revealed that another important reason for the high comprehensive antineuroinflammatory activity was the anti-COX-2 capabilities of the compounds. All these results suggest that the potential biochemical multifunctional profiles of the aminomethylindole derivatives provide a new sight for the treatment of neurodegenerative diseases.

Validation of the 33-item Hypomania Checklist (HCL-33) in screening adolescents with bipolar disorder.

BACKGROUND: Adolescents with bipolar disorder (BD) are often misdiagnosed with major depressive disorder (MDD), which delays the introduction of appropriate treatment resulting in adverse outcomes. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to distinguish BD from MDD in adolescents. METHOD: A total of 248 participants (171 MDD and 77 BD patients) were recruited from a university-affiliated hospital in China. Depression was measured with the Hamilton Depression Rating Scale. All participants completed the assessment with the HCL-33. RESULTS: A two-factor structure was found for the HCL-33, which explained 30.2% of the total variance. The internal consistency and split half reliability of the total scale were acceptable. The optimal cut-off value of 18 generated sensitivity of 0.52 and specificity of 0.73 for distinguishing BD from MDD. CONCLUSION: The HCL-33 seems to be a useful screening instrument to distinguish BD from depressed adolescents. However, considering certain less than robust psychometric properties, the HCL-33 needs to be modified and further refined for adolescent patients.

Psychometric Properties of the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) in Depressed Adolescents.

Background: Accurate and reliable self-report measurement tools examining depressive symptoms are scant in child psychiatry. This study assessed the psychometric properties of the Chinese Version of the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR) in depressed adolescents in China. Methods: Adolescents with major depressive episodes or bipolar depressive episodes were assessed using the C-QIDS-SR. The structure validity of the C-QIDS-SR was estimated using principal component analysis with varimax rotation. Results: A total of 246 depressed adolescents were included in the study. Cronbach's alpha was 0.77. The correlation coefficient between the baseline and endpoint assessments was 0.49 (p < 0.001), whereas, the correlation coefficient between the C-QIDS-SR and the Hamilton Rating Scale for Depression-17 items (HAMD-17) was 0.63 (p < 0.001). Principal component analysis with varimax rotation demonstrated the unidimensional structure of the C-QIDS-SR. Conclusion: The C-QIDS-SR is a reliable and valid instrument with acceptable psychometric properties to measure depressive symptoms in adolescents.

Gillies and Dunedin: The birthplace of modern plastic surgery.

Dunedin is a small city located in the southeastern part of the South Island of New Zealand, an enclave found in the Southern Hemisphere halfway around the World. How possibly would anyone consider such a remote place to be the birthplace of modern plastic surgery? Yet here was born both Sir Harold Delf Gillies, the "father of modern plastic surgery." and his first cousin once removed, Sir Archibold Hector McIndoe. Author Rainsford Mowlem, born in Auckland, was a contemporary of McIndoe at the University of Otago Medical School in Dunedin, from which they both graduated. Along with Kilner, Gillies, McIndoe, and Mowlem were known during the intervening years after the first World War as the "Big Four" full-time plastic surgeons in England. Henry Percy Pickerill was not born in New Zealand, but was the first dean and Director of the University of Otago Dental School when it opened. At Queen's Hospital in Sidcup he headed the New Zealand section, where he too was under the guidance of Gillies. After that war he returned to Dunedin, where for better or worse influenced there the future development of plastic surgery. Thus, the birthplace of the lives or careers of those 4 pioneers of plastic surgery-Gillies, Pickerill, McIndoe, Mowlem-was Dunedin. Perhaps were it not for the fate of the Great World Wars it may have never been, but it was.

Solution of the Onsager model for the structure of rigid rods confined on a spherical surface.

We consider a free energy, within the framework of the Onsager approximation, for a spatially and orientationally inhomogeneous distribution of hard rods confined on a spherical surface. These rods interact with each other though the excluded-volume interaction, forming a textured nematic structure on the spherical surface at high surface coverage. Our numerical solution to the model shows that the splay state, where on average rods line up in parallel to the longitudes on the spherical surface, is the only stable state. Other types of textures that have recently been suggested were also tested and all yield higher free energy than that of a ground splay state. We also provide a study of the disorder-splay transition, which is shown to have first-order characteristics.

Onsager model for the structure of rigid rods confined on a spherical surface.

Recent studies have suggested that a monolayer of self-avoiding hard rods confined on a spherical surface may display a distribution texture corresponding to splay, tennis-ball, rectangle, or cut-and-rotate splay symmetries. We investigate the system on the basis of a generalized Onsager model which includes both excluded-volume and entropic effects. The numerical solution indicates that the splay state, where on average rods line up in parallel to the longitudinal lines on the spherical surface, is the only stable state.

Dependence of the disorder-lamellar stability boundary of a melt of asymmetric wormlike AB diblock copolymers on the chain rigidity.

We study the disorder-order transition boundary of wormlile AB diblock copolymers on the basis of the wormlike chain formalism aided by a self-consistent mean-field treatment. We examine the influence of the persistency on the phase diagram and properties of the phase transition as a function of the volume fraction, Flory-Huggins parameter, and relative chain rigidity, covering a broad regime spanning from the Gaussian chain to rigid rodlike chain. On the one hand, we demonstrate that the results from a Gaussian-weight-based theory can be recovered in the long-chain limit and, on the other hand, we display that significant revisions to the phase diagram, due to the persistency effects, exist for shorter chains. A split-step numerical algorithm is designed for the computational task.