1.The Australian Life Saving Drugs Program and its implications for medical assistance system for the rare diseases in China
Yiru GUAN ; Wei XIANG ; Fang ZHANG
Chinese Journal of Health Policy 2015;(8):51-55
Objective:To introduce the Australian Life Saving Drugs Program ( LSDP) and provide references for medical assistance system for the rare diseases in China. Methods:The main content and characteristics of LSDP were analyzed and compared with the Chinese status quo valuation. Results:Through the orphan drug designation and cost-effectiveness evaluation, eligible drugs are included in LSDP and funded to the rare disease patients. LSDP stip-ulated the strict funding criteria and conditions, established the Guidelines and Disease Advisory Committees, and processed the post-market reviews program in order to guarantee the medication requirements of the patients. Conclu-sions:The Australian experience is worth learning and China should implement a country-led management system for the rare disease and orphan drugs, and explore a medical assisstance system in line with the Chinese national condi-tion based on the catastrophic medical insurances.
2.Advances in neuroimaging studies on executive impairment of patients with euthymic bipolar disorder
Tao YANG ; Guoqing ZHAO ; Yiru FANG ; Jun CHEN
Journal of Shanghai Jiaotong University(Medical Science) 2017;37(8):1156-1160
Bipolar disorder (BD) is a chronic mental illness with high recurrence rate and disability. As one of the core symptoms, cognitive impairment may occurs at every stage of the disease. Evidence from the neuroimaging studies revealed that the abnormal brain volumes, the blood flow and oxygen saturation of key brain areas are related to executive impairment in patients with bipolar disorder. This article reviews current structural and functional neuroimaging studies about the executive impairment of patients with euthymic bipolar disorder and research progresses.
3.The efficacy of cognitive-behavioral education and self-management on the recurrent or deterioration of depression
Zuowei WANG ; Yaguang WANG ; Fang FANG ; Zhiping LU ; Ping WANG ; Yiru FANG
Chinese Journal of Behavioral Medicine and Brain Science 2012;(12):1095-1097
Objective To evaluate the efficacy of antidepressants plus cognitive-behavioral education and self-management preventing the recurrent or deterioration of depression.Methods Outpatients with non-episode depression,Hamilton Rating Scales of Depression 17 items (HAMD17 ≥3),entered openly intervention group (n =30) and control group (n =30),and were followed up one year.Patients in intervention group received intervention,including treatment as usual,group education of cognitive behavior,self-help group attendance and self-management of depressive mood.Patients in control group only received treatment as usual.The primary outcome was time to recurrent or deterioration of depression.Kaplan-Meier methodology was used to evaluate differences of survival curves between two different groups.Results There were significant differences for risk of recurrent or deterioration (x2 =5.70,P < 0.05) and one-year rate of recurrent or deterioration (intervention group 27% (8/30),control group 53% (16/30),x2 =4.44,P < 0.05) between two groups,but not for average time of recurrent or deterioration (intervention group (4.75 ± 2.49) months,control group (6.63 ± 3.10) months,t =-1.48,P >0.05).There were no significant differences for risk of drop-out (x2 =1.66,P > 0.05),one-year rate of drop-out (intervention group 13% (4/30),control group 23% (7/30),x2 =1.00,P > 0.05) and average time of drop-out (intervention group (7.25 ± 3.78) months,control group (4.00 ± 2.58) months,t =1.71,P > 0.05) between two groups.Conclusion Antidepressants plus cognitive-behavioral education and self-management can effectively prevent the recurrent or deterioration of depression.
4.Association study of dopamine D1 receptor gene and cognitive function of first-episode schizophrenic patients
Chen ZHANG ; Zezhi LI ; Zhiguo WU ; Jun CHEN ; Daihui PENG ; Yiru FANG ; Shunying YU
Chinese Journal of Behavioral Medicine and Brain Science 2011;20(3):224-226
Objective To investigate the relationship between cognitive function of first-episode schizophrenic patients and dopamine D1 receptor gene. Methods A total of 112 first-episode schizophrenic patients and 60 healthy controls were evaluated with Wechsler adult intelligence scale ( WAIS-R), Wechsler memory scale (WMS) and Wisconsin card sort test (WCST) ,and genotyped one polymorphism (rs4532) within DRD1 gene using TaqMan SNP genotyping assay. Results There were no significant differences on the frequencies of the genotypes and alleles of rs4532 polymorphism between patients with schizophrenia and normal controls ( x2 =2.90, P=0.35; x2 = 0.01, P= 0. 93 ). There were significant differences in all index of WCST between two groups (P <0.01 ). Patients with rs4532G allele had worse WCST performance than those without G allele ((60.9 ± 13.2)%vs (44.9 ±21.3)%, t=4.79, P=0.00002). Conclusion Rs4532 polymorphism of DRD1 gene may be associated with executive function impairment in schizophrenic patients.
5.Default-mode network connectivity in depression:A resting-state fMRI study
Junjuan ZHU ; Daihui PENG ; Jianqi LI ; Min ZHANG ; Zhenghui YI ; Kaida JIANG ; Yiru FANG
Chinese Journal of Nervous and Mental Diseases 2014;(8):454-458
Objective To explore the role of default mode network (DMN) in the pathophysiology of depression and the correlations between the functional connectivity (FC) of DMN and the clinical characteristics of depression through the resting-state fMRI scan in depressed patients. Methods Sixteen medication-na?ve patients with major depressive disorder and 15 healthy controls were recruited and underwent the resting-state MRI scan. Hamiliton depression rating scale (HAMD) was used to evaluate patients’symptom. The FC of DMN and its correlations with clinical features of pa-tients were analyzed. Results Compared with healthy controls, the FC within DMN in depressed patients is disturbed. There were negative correlations between the left mPFC-left hippocampus FC and HAMD total scores (r=-0.569, P=0.021) and subscale scores for sluggishness (r=-0.498, P=0.050). The left mPFC-right hippocampus FC in patients was negatively correlated with HAMD scores (r=-0.508, P=0.045). There were negative correlations between FC in the hippo-campus and HAMD subscale scores for cognitive impairment (r=-0.509, P=0.044). Conclusions The results suggest that there is abnormal FC within DMN in drug-na?ve patients with depression during resting state and some abnormal altera-tions of FC may be correlated with the clinical characteristics in depression.
6.The study on the expression of the p-CREB in a rat model of chronic mild stress.WANG Lingxiao, PENG
Lingxiao WANG ; Jianhua HUANG ; Chen ZHANG ; Jia HUANG ; Yuping TANG ; Shunyin YU ; Kaida JIANG ; Yiru FANG
Chinese Journal of Nervous and Mental Diseases 2014;(1):26-30
Objective To better understand the role of CREB signaling pathway in chronic mild stress (CMS), we investigated the alteration of CREB and p-CREB in CMS rats with and without fluoxetine hydrochloride. Methods Fifty adult male Sprague-Dawley rats were randomly divided into three groups:CMS group (26), fluoxtine group (12) and con-trol group (12). The rats in CMS group and fluoxtine group received 8 weeks of chronic mild stress. Rats in fluoxtine group were administered daily injections of fluoxetine 10mg/kg I.P. Sucrose preference tests and open-field test were car-ried out after the 8th week. Based on endpoint sucrose-intake, animals were further divided into 4 groups:CMS sensitive group, CMS resilient group, fluoxtine group and control group. Western blot was used to detect the expression levels of CREB and p-CREB in the hippocampus and prefrontal cortex. Results The sucrose consumption was significantly de-creased in CMS resilience group compared to sensitive group, control group and fluoxetine-intervention group (all P<0.05). Similarly, the numbers in total arm entries, percentage of entries into open arms and time spent in open arms was significantly lower in CMS resilience group compared to control group(all P<0.05), but not different compared to CMS sensitive group(all P<0.05). The p-CREB in the hippocampus was significantly lower in CMS sensitive rat compared to CMS resilience group, control group and fluoxetine-intervention group(all P<0.05), but CREB was not dfferent among the four groups(all P<0.05). Conclusions The elevated phosphorylation of CREB in the hippocampus and prefrontal cortex of resilience CMS rats may contribute to the mood alteration induced by stress.
7.Pharmacoeconomic comparisons of venlafaxine and mirtazapine in patients with treatment-resistant major depression
Yaguang WANG ; Zuowei WANG ; Chengmei YUAN ; Jun CHEN ; Zhiguo WU ; Yiru FANG
Chinese Journal of Behavioral Medicine and Brain Science 2014;23(4):327-330
Objective To compare the cost-effectiveness and cost-utility of venlafaxine and mirtazapine in patients with treatment-resistant major depression (TRD).Methods One hundred and five patients with TRD were enrolled in this study and grouped into venlafaxine treatment (n=50) and mirtazapine treatment (n=55) based on the double-blind randomization scheme generated by computer.The treatment costs of antidepressants during 8 weeks were calculated,the rates of clinical response and remission were taken as treatment effectiveness,and the quality-adjusted life years (QALYs) as treatment utility.The descriptive analysis and nonparametric test were used to compare the cost-effectiveness and cost-utility of different groups.Results During 8 weeks,the treatment cost of antidepressant was ¥ 1 396.44 for venlafaxine and ¥ 1 206.90 mirtazapine,and the difference between two groups was ¥ 189.54.The cost-effectiveness ratios between venlafaxine and mirtazapine were very close (differed ¥ 0.06 for remission rate and ¥ 1.08 for response rate respectively).There was no significant difference for cost-utility ratios between two groups (physical functioning Z=-0.15,P>0.05 ; mental health Z=-0.54,P>0.05).Conclusion Both cost-effectiveness and cost-utility of venlafaxine in patients with TRD are close between venlafaxine and mirtazapine.
8.Analyses of vitamin D2/D3 levels in moderately and severely depressive patients
Yao HU ; Xudong MAO ; Xiaohua LIU ; Haiying CHEN ; Yi QU ; Yiru FANG ; Shenxun SHI ; Yan WU
Journal of Shanghai Jiaotong University(Medical Science) 2017;37(3):359-362
Objective · To detect the vitamin D2 and D3 levels in the patients with moderate and severe depression. Methods · Eighty-five patientswho met the criteria for major depressive disorder were recruited (53 patients with moderate depression, 32 patients with severe depression). Fifty agematchedhealthy volunteers were recruited as controls. Serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels were detected by using liquidchromatography-tandem mass spectrometry (LC-MS/MS). The risk factors which might influence the severity of depression were screened by Logisticregression analysis. Results · The serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in the case group was lower than those in the controlgroup (P=0.012, P=0.000, P=0.000). The patients with moderate depression presented significantly lower serum 25 (OH) D3 and total 25 (OH) D2/D3 levelsthan the controls did (P=0.000), although no significant difference in serum 25 (OH) D2 levels was found between these two groups. As well, the serum 25 (OH) D2, 25 (OH) D3 and total 25 (OH) D2/D3 levels in patients with severe depression were significantly lower than those in patients with moderate depression and controls (P<0.05). The body mass index of severe depression group was much higher than that of moderate depression group and control group (P=0.002). Both overweight/obesity and the concentration of vitamin D may be the major influencing factors of depression severity (P=0.034, P=0.011). Conclusion · Vitamin D2 and D3 deficiency in depressive patients, particularly in those patients with severe depression, was shown in the present study. In addition, overweight/obesity as well as the concentration of vitamin D may exert the significant influence on the severity of depression. Vitamin D supplementation and weight control may be needed to be considered in making therapeutic strategies of major depressive disorder.
9.Four-year follow-up study of changes in prescriptions of antidepressants for inpatients with psychosis
Jun CHEN ; Zucheng WANG ; Min WANG ; Yong WANG ; Zhiguo WU ; Jia HUANG ; Zezhi LI ; Yousong SU ; Yiru FANG
Journal of Shanghai Jiaotong University(Medical Science) 2009;29(10):1205-1209
Objective To investigate the changes in the prescriptions of antidepressants for inpatients with psychosis from 2005 to 2008. Methods The prescriptions of antidepressants for all the inpatients with psychosis in Shanghai Mental Health Center were investigated by one day survey on each June 1st from 2005 to 2008. The most common diseases treated with antidepressants, the most commonly used antidepressants, the average dosage of antidepressants and the combination use of antidepressants were analysed. Results The most common diseases treated with antidepressants were affective disorder, schizophrenia and neurosis. The prescription rate of tricyclic antidepressants declined year by year, and that of selective serotonin reuptake inhibitors (SSRIs) fluctuated moderately, while that of antidepressants of newer generation with the other transmitter mechanisms such as venlafaxine, mitrazapine and trazodone increased gradually. Single antidepressant prescription was common, while the combination use of antidepressants accounted for a small portion. Combination use of antidepressants with one psychotropics (antipsychotics, mood stabilizer, sedative hypnotics) was common, while with two were less frequently occurred. Conclusion Prescriptions of antidepressants for patients with psychosis hospitalized in Shanghai Mental Health Center from 2005 to 2008 are relatively safe and reasonable. Antidepressants of newer generation have been widely used in clinics, and SSRIs have been serving as the major antidepressants.
10.Reliability and validity of Chinese version of the neuropsychiatric inventory
Tao WANG ; Shifu XIAO ; Yiru FANG ; Xia LI ; Guanjun LI ; Minjie ZHU ; Jindi ZHOU ; Lili SHEN ; Haihong WANG ; Shixing QIAN
Chinese Journal of Behavioral Medicine and Brain Science 2010;19(5):469-471
Objective To assess the reliability and validity of the Chinese version of the neuropsychiatric inventory (CNPI). Methods The CNPI was administered to 219 caregivers of patients with Alzheimer's disease (AD). Each caregiver was retested 4 weeks after initial testing. Results The Cronbach a coefficient of the total symptom scale was 0.69. The Cronbach α coefficient of the total caregiver distress subscale was 0.72. The Cronbach α coefficient of the entire inventory was 0. 82. The test-retest coefficients ranged from 0.66 to 0.98 (P < 0.01). Principal axis factoring analysis of the symptom subscale yielded a five-factor solution which contributed to 67.0% of the cumulative variance. Factor 1, which included aberrant motor behavior, hallucinations, delusion and irritability had the most significant contribution to the cumulative variance. Principal axis factoring analysis of the caregiver distress subscale also yielded a five-factor solution which contributed to 70.2% of the cumulative variance. Factor 1, which included depression, delusion, sleep/night behavior, aberrant motor behavior, and irritability had the most significant contribution to the cumulative variance. Conclusion This Chinese version of NPI is a reliable and valid tool for measuring neuropsychiatric disturbances in patients with AD.