A retrospective study of pituitary-thyroid interaction in patients with first-episode of bipolar disorder type I in Mania State.

ABSTRACT: Bipolar disorder (BD)-mania is related to the dysfunction of anterior pituitary gland, but the pituitary-thyroid interaction on the acute stage of BD has been controversial. In order to rule out the effects of drugs, we aimed to determine the upstream interaction of first-episode of BD type I in mania state, and tried to find the relationship between thyroid-stimulating-hormone (TSH) and Prolactin (PRL)This study included 70 real-world patients diagnosed with first-episode BD-mania recuited and 70 healthy controls (HC) matched for age and sex from 2016 to 2017 in the same district of Shanghai. We compared the levels of thyroid hormones and prolactin between the two groups, and linear regression and curve estimation were used for the correlation analysis of TSH and PRLThere were differences in triiodothyronine (TT3), total thyroxin (TT4), and free thyroxine (FT4) concentrations between the groups (P's < .05). After being grouped by sex, higher PRL in the male and female BD-mania subgroup were observed compared to each isosexual HC [(P's < .01, Cohen's d = 0.82/1.08, 95%CI (0.33, 1.31)/(0.58, 1.58)]. Higher FT4 in the male BD-mania group was observed compared to the HC males [(P's  < .01, Cohen's d = 0.90, 95%CI (0.41, 1.39)] while the female BD-mania group showed lower TT3 and TT4 compared to the HC females [(P's  < .01, Cohen's d = 0.93/0.88, 95%CI (0.43, 1.42)/(0.39, 1.37)]. In the female BD-mania group, correlation analysis established an inverse relationship between PRL and TSH (r2 = 0.25, F = 11.11, P < .01).The findings demonstrate that sex impacts the concentration of hormones secreted by the anterior pituitary of patients with first-episode BD-mania. The increased PRL may be a putative mechanism that underlies the onset in female patients with a moderate inverse relationship between TSH and PRL. Thyroid hormones and prolactin levels may be developed as potential markers for identifying BD-manic.

Prolonged grief disorder in Chinese Shidu parents who have lost their only child.

Background: China has the largest population of '"loss-of-only-child' parents, that are also known as Shidu parents in Chinese society; however, little is known about their unresolved grief. Objective: This is the first study to examine the grief symptoms, prevalence, comorbidity and potential predictors of prolonged grief disorder (PGD) in such parents, taking into consideration that the new PGD diagnostic criteria ICD-11 will soon be implemented in China. Methods: 149 Shidu parents completed assessments of PGD (PG-13), PTSD (PCL-C), depression (CES-D) and general psychiatric morbidity (GHQ-12) via in-person interviews. Results: Of the 149 Shidu parents, 22.2% met the PGD criteria, with a mean of 7.59 years post-loss, and 62.4% experienced daily longing or yearning. Regression analysis indicated that fewer years since loss, subjective perception of poor economic situation, female gender and more hospital visits were prominent risk factors for the development of PGD. Older age of the parents at the time of child loss was also associated with PGD. Parents with PGD had higher comorbidity of PTSD or depression compared with those without PGD. Conclusions: There is a high prevalence of PGD and a high rate of comorbidity between PGD and PTSD or depression in Shidu parents in China, which highlights the need of timely developing effective assessments and interventions to prevent PGD in this population, particularly in female, recently bereaved, low-income and aged parents who lost their only child.

Antecedentes: China tiene la población más grande de padres que han perdido a su hijo único, conocidos como los padres shidu en la sociedad china; sin embargo, se conoce poco respecto a su duelo no resuelto.Objetivo: Este es el primer estudio en evaluar los síntomas de duelo, y la prevalencia, comorbilidades y predictores potenciales del trastorno de duelo prolongado (TDP) en este tipo de padres, tomando en consideración que los nuevos criterios diagnósticos para el TDP de la CIE-11 se implementarán pronto en China.Métodos: 149 padres Shidu completaron evaluaciones para TDP (PG-13), TEPT (PCL-C), depresión (CES-D) y morbilidad psiquiátrica general (GHQ-12) mediante entrevistas en persona.Resultados: De los 149 padres shidu, 22,2% cumplieron los criterios para TDP, con un promedio de 7,59 años pospérdida, y 62,4% experimentaron nostalgia y anhelo. Los análisis de regresión indicaron que menos años luego de la pérdida, una percepción subjetiva de una pobre situación económica, el sexo femenino, y un mayor número de consultas en hospitales eran factores de riesgo prominentes para el desarrollo de TDP. Una mayor edad de los padres al momento de la pérdida del niño también se asoció con TDP. Los padres con TDP tenían mayor comorbilidad de TEPT o depresión comparados con aquellos que no tenían TDP.Conclusiones: Existe una alta prevalencia del TDP y una alta tasa de comorbilidad entre el TDP, el TEPT o la depresión en padres Shidu en China, lo cual resalta la necesidad de desarrollar a tiempo evaluaciones e intervenciones efectivas para prevenir el TDP en esta población, en particular en mujeres, en deudos recientes, en aquellos con bajos ingresos, y en padres de edad avanzada que perdieron a su hijo único.

Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study.

BACKGROUND: The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions. METHOD: Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD. RESULT: The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD. CONCLUSION: With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.

An investigation of physical and mental health consequences among Chinese parents who lost their only child.

BACKGROUND: The term "loss-of-only-child family" means that the only child in a family passed away or is disabled due to an accident or other events. The parents who cannot conceive or do not adopt another child, are known as Shidu parents in China. This study compares the physical and mental health of Shidu parents with those parents who have not experienced such loss. METHODS: The target group is comprised of parents being Shidu for more than 1 year (N = 95) and the control group is comprised of parents with a living child (N = 97) from the same area as the Shidu parents. Socio-demographic information and physical health outcomes were collected by the adapted questionnaires. PCL-C (PTSD Checklist-Civilian Version), CES-D (Center for Epidemiological Studies Depression Scale) and GHQ-12 (General Health Questionnaire) were applied to evaluate the parents' physical and mental status. RESULTS: Shidu parents have a higher risk of developing PTSD and depression, and suffer more severe psychiatric disorders compared to parents with a living child. The rate of PTSD in the Shidu group was up to 32.6% and the scores of PCL-C are much higher than the control group. The physical status of Shidu parents were much worse than that of the control group, characterized by higher morbidity of chronic diseases and more hospital visits. CONCLUSIONS: Shidu parents have more severe mental health problems and a higher rate of chronic diseases than parents who have a living child. Loss of the only child is the most traumatic event for the parents, which is a serious and unique problem in Chinese society that deserves attention. More studies and support are desired to improve the physical and mental health of Shidu parents.

Factors associated with one year retention to methadone maintenance treatment program among patients with heroin dependence in China.

OBJECTIVE: The aim of this study was to evaluate the risk factors associated with dropout from Methadone Maintenance Treatment (MMT) clinics within a 1 year follow-up cohort study in China. METHODS: A data analysis is to explore the adherence of MMT during one year from three hundred and twenty patients with heroin dependence at five clinics (3 in Shanghai, 2 in Kunming) in China. All participants were from the part of China-United States cooperation project entitled "Research about improving the compliance and efficacy of methadone maintenance treatment in China". Our data analysis includes the patients' attendance in the 6 months clinical study and the data in another 6 months afterward. The data of patients at baseline were collected with the Addiction Severity Index (ASI) which is a semi-structured questionnaire covering socio-demographic characteristics and drug use history. The one year attendance after recruitment at the clinics and daily dose were abstracted from the MMT clinic register system. The Cox proportional hazards model were used to explore the risk factor of dropout, defined as seven consecutive days without methadone. RESULTS: By the end of 1 year of treatment 86 patients still remained in MMT without dropout (87% in Shanghai and 13% patients in Kunming). Over the entire 1-year period the median days of remaining in the program were 84 days (in Shanghai and Kunming were 317 days and 22 days).The factors associated with retention included age (HR=0.98, 95%C.I.:0.96-0.99, P=0.0062) and ASI alcohol scores (HR=5.72, 95%C.I.:1.49-21.92, P=0.0109) at baseline. CONCLUSION: One year retention of newly recruited patients with heroin dependence was related to age and ASI alcohol scores at baseline. The adherence is poorer for the patients who are young and having more serious alcohol problems.

Identification of the N-acylsphingosine amidohydrolase 1 gene (ASAH1) for susceptibility to schizophrenia in a Han Chinese population.

OBJECTIVES: To study the involvement of the N-acylsphingosine amidohydrolase 1 gene (ASAH1) in the susceptibility to schizophrenia in the Han Chinese population. METHODS: We performed cDNA microarray analysis to exam the gene expression profile in six schizophrenic patients and six healthy controls. We evaluated the ASAH1 expression levels in 30 subjects with chronic schizophrenia and 30 healthy controls by using real-time polymerase chain reaction (PCR). A total of 254 unrelated probands with schizophrenia and their biological parents were also genotyped at three single nucleotide polymorphisms (SNPs: rs3753118, rs3753116, and rs7830490) of the ASAH1 gene for association analysis. RESULTS: In the microarray analysis, the ASAH1 gene was down-regulated in all schizophrenic patients compared with healthy controls. In real-time PCR, the ASAH1 expression levels for schizophrenic patients with positive family history were significantly decreased (P = 0.020). In the association analyses, two SNPs (rs7830490 and rs3753118) and one haplotype (rs7830490 (A)-rs3753116 (G)) of ASAH1 showed significant evidence of nominal associations with schizophrenia (P = 0.026; P = 0.046; P = 0.007, respectively). The haplotype remained statistically significant (empirical P = 0.045) after correction for multiple testing. CONCLUSIONS: This study supports that the ASAH1 gene may be a potential candidate gene for schizophrenia in Han Chinese subjects.