Objective:To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on behavioral and psychological symptoms and quality of life in patients with mild to moderate Alzheimer disease (AD).Methods:Forty mild and moderate patients who met the diagnostic criteria of AD in the tenth edition of the International Classification of Diseases from May 2017 to December 2018 in the Seventh People′s Hospital of Wenzhou City were selected and divided into the control group (20 cases) and the rTMS group (20 cases) according to random number list. The control group was treated with basic treatment while the rTMS group was treated with rTMS on the basis of the basic treatment. The scores of AD assessment scale-cognitive section (ADAS-cog), mini mental state examination (MMSE), neuropsychiatric inventory (NPI), activity daily living (ADL), and quality of life in AD (QOL-AD) were observed and compared between the two groups before and after treatment.Results:There were no significant differences in ADAS-cog, MMSE, NPI, ADL, and QOL-AD scores between the rTMS group and the control group before treatment ( P>0.05). After treatment, the MMSE, ADL, and QOL-AD scores of the rTMS group were significantly higher than those of the control group: (22.80 ± 3.83) scores vs.(20.30 ± 5.49) scores, (63.05 ± 17.24) scores vs. (54.15 ± 9.20) scpres, (37.55 ± 7.94) scores vs. (31.00 ± 11.45) scores; the ADAS-cog and NPI scores were significantly lower: (18.45 ± 4.16) scores vs.(22.15 ± 5.01) scores, (57.2 ± 16.25) scores vs. (72.65 ± 39.37) scores, (27.15 ± 7.53) scores vs. (34.65 ± 14.91) scores, and there were significantly differences ( P<0.05). At the same time, the MMSE, ADL, and QOL-AD scores of the rTMS group were significantly higher than those before treatment, the ADAS-cog and NPI scores were significantly lower, and the difference was statistically significant ( P<0.05). Conclusions:rTMS can effectively improve the behavioral and psychological symptoms of patients with mild to moderate AD and significantly improve the quality of life.

Objective To examine the effects of participating in Balint group ( PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1 ∶ 2. Sub-jects of PBG received Balint group intervention for one year,while control group received natural observation. Maslach Burnout Inventory ( MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0. 05). After the intervention,PBG had statistically lower subscale scores in emotional exhaustion ((20. 1±8. 3) vs (22. 6±8. 7),t=1. 993,P=0. 048) and depersonalization (( 6. 8± 4. 9) vs ( 10. 8 ± 5. 2),t=5. 355,P<0. 001) than the control group, while had statistically higher score in personal accomplishment subscale ((38. 3±7. 5) vs (34. 6±7. 7),t=3. 311,P=0. 001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs.

Objective:To correlate creatine kinase (CK) and creatine kinase- isoenzyme MB (CK-MB) with different states of bipolar disorder in patients.Methods:A total of 206 patients with bipolar disorder who received treatment in The 7 th People's Hospital of Wenzhou, China between January 2018 and June 2019 were included in the patient group. A total of 369 healthy controls who concurrently received physical examination were included in the control group. CK and CK-MB levels were detected in all participants. The Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAMD)-7 scale, the Bech-Rafaelsen Melancholy Scale (BRMS), and modified version of the Overt Aggression Scale (MOAS) were used to evaluate the mental symptoms, depression, mania and aggression of patients. The CK and CK-MB levels were compared between patients with different states of bipolar disorder. Results:In the control group, CK and CK-MB levels in males were 112.5 (94.5, 156.5) U/L and 17.0 (15.0, 20.0) U/L, respectively, which were significantly higher than those in females [73.0 (61.0, 86.3) U/L, 15.0 (13.0, 18.0) U/L, Z = -9.732, -3.535, both P < 0.001). In the patient group, CK and CK-MB levels in males were 129.0 (80.0, 233.5) U/L, 12.0 (10.0, 17.0) U/L, respectively, which were significantly higher than those in females [73.0 (55.0, 94.0) U/L, 13.5 (11.0, 17.0) U/L, Z = -9.510, -4.746, both P < 0.001]. There was no significant difference in CK level in males between the control and patient groups ( Z = -1.003, P = 0.316), but significant difference in CK-MB level in males was observed between the two groups ( Z = -6.570, P < 0.001). There were significant differences in CK and CK-MB levels in females between the control and patient groups ( Z = -2.535, -9.707, P = 0.011, P < 0.001). In the patient group, CK level in the manic, depressive, and symptom-alleviated states was 132.0 (78.0, 297.0) U/L, 85.0 (56.0, 145.0) U/L, 128.0 (110.0, 165.0) U/L respectively in males, and it was 73.0 (49.0, 122.3) U/L, 51.0 (45.0, 67.0) U/L and 84.5 (61.0, 193.0) U/L, respectively in females. There was significant difference in CK level in males and females between different states of bipolar disorder ( χ2 = 9.019, 16.720, P = 0.011, P < 0.001). In males, CK level was correlated with the BPRS total score, BRMS total score, and MOAS total score in the manic state, as well as the BPRS total score in the symptom-alleviated state ( r = 0.282, 0.286, 0.236, 0.574). In females, CK level was correlated with the MOAS total score in the manic state ( r = 0.260). In males, CK-MB level was correlated with the BRMS total score in the manic and depressive states ( r = 0.186 and 0.496). In females, CK-MB level was correlated with the MOAS total score and the BRMS total score in the manic state ( r = 0.155, 0.572). Conclusion:CK and CK-MB levels are correlated with bipolar disorder in different states and they are of certain clinical significance and provide innovative insights into the diagnosis of bipolar disorder.

Objective:To evaluate the reliability and validity of Chinese version of Glasgow antipsychotics side-effect scale (GASS).Methods:Totally 200 patients diagnosed as schizophrenia following the criteria of DSM-IV were enrolled in the study.Cronbach’s α was used to investigate the internal consistency of GASS.Exploring factor analysis was used to examine the construct validity.Pearson correlation analysis between GASS and TESS and CGI sub-scale of side effect were conducted to evaluate the criterion validity.Based on clinical criteria, the sensitivity and specificity and ROC curve was calculated so as to establish the cut-off point of the scale and test discrimination validity.Results:For reliability, Cronbach’s α ws 0.926, indicating that GASS had a good internal consistency.Four main factors were extracted by exploratory factor analysis which were extrapyramidal side effect factor, genitourinary side effect factor, anticholinergic side effect factor, over sedation and cardiovascular side effect factor.For validity, exploring analysis demonstrated that nineteen item of the scale has relatively higher factor load on the principal factor (0.531-0.972), suggesting that the scale had a good construct validity.The total score of the GASS was positively correlated with that of TESS and CGI subscale of side effects( r=0.90, P<0.05; r=0.87, P<0.05). The cut-off point of experimental validity of GASS for mild antipsychotics side effects was determined as ≥1.With this cut-off point, GASS had both high sensitivity (96.3%) and high specificity (70.7%), area under curve (AUC) were 0.78.The cut-off point of GASS for moderate antipsychotics side effects was determined as ≥20, with the sensitivity and specificity of GASS were 86.3% and 84.7%, AUC were 0.92.When the cut-off point of GASS for severe antipsychotics side effects was determined as ≥41, GASS had both high sensitivity (92.1 %) and high specificity (96.3 %), AUC were 0.96. Conclusion:GASS has good reliability and validity and can reflect the side effects of antipsychotics, and it can be adopted as a useful instrument to evaluate the severity of side effects of antipsychotics.

Objective:To evaluate the validity and reliability of the Chinese version of the Lubeck Alcohol Withdrawal Risk Scale(C-LARS).Methods:Referring to previous literature and clinical expert opinions using the Delphi method,a C-LARS was established through translation and back-translation.Principal component analysis was used to evaluate the structural validity of C-LARS,and the maximum variance method was used to calculate factors and factor loadings to evaluate the structural validity of C-LARS.The severity of alcohol withdrawal syn-drome in patients was evaluated using the the Alcohol Withdrawal Scale(AWS),and the criterion validity of C-LARS was evaluated by calculating the correlation coefficient between AWS and C-LARS.Results:The internal correlation coefficient(ICC)of the evaluation factors was 0.972,and the total Cronbach α coefficient was 0.938.Factor analysis and ROC analysis showed that a C-LARS score of ≥ 3 could predict the occurrence of mild alcohol withdrawal syndrome,with sensitivity and specificity of 0.945 and 0.899,respectively.The C-LARS scores of ≥ 5 could predict the occurrence of moderate alcohol withdrawal syndrome,with sensitivity and specificity of 0.910 and 0.905,respectively.The C-LARS scores of≥7 could predict the occurrence of severe alcohol with-drawal syndrome within 12 hours,the sensitivity and specificity were 0.990 and 0.877,respectively.Conclusion:The C-LARS has good validity and reliability,which could be used as a tool to assess the incidence and severity of alcohol withdrawal syndrome within 12 hours after visit.