ObjectiveTo observe the efficacy and safety of sertraline combined with low-dose olanzapine in the treatment of depression and anxiety comorbidity and its effect on sleep quality， so as to provide references for the related clinical treatment. MethodsA total of 121 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode and generalized anxiety disorder in The Third People's Hospital of Tianshui and the Sanatorium for Mental Illness of Veterans in Tianshui from October 2019 to August 2020 were enrolled， and they were divided into two groups according to the random number table method. Study group （n=61） received sertraline combined with low-dose olanzapine， while control group （n=60） received sertraline only. Then the disease severity degree， sleep quality and adverse reactions were assessed using Hamilton Depression Scale - 17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pittsburgh Sleep Quality Index （PSQI） and Treatment Emergent Symptom Scale （TESS） at the baseline， 1^st， 2^nd， 4^th， 6^th and 8^th weekend， respectively. ResultsPost-treatment HAMD-17， HAMA and PSQI scores in both groups were lower than those before treatment （P<0.05）. At each time point after treatment， HAMD-17， HAMA and PSQI scores of study group were lower than those of control group， with statistical significance （P<0.05）. ConclusionSertraline alone and its combination with low-dose olanzapine are both effective in the treatment of depression and anxiety comorbidity， while the combination therapy achieves better efficacy and higher safety in alleviating anxiety and insomnia symptoms.

ObjectiveTo investigate the application value of narrative medical model in communication with cancer patients with low education level. MethodsRetrospective analysis was performed on 80 cancer patients with low education level who were hospitalized in West China Hospital of Sichuan University from March 2019 to April 2020. They were randomly divided into control group （n=40） and observation group （n=40）. The control group received conventional nursing intervention， while the observation group received narrative medical nursing mode intervention. Both groups received intervention for 6 months. The Self-rating Anxiety Scale （SAS）， Self-rating Depression Scale （SDS）， Morisky Medication Adherence Scale （MMAS-8）， Social Support Rating Scale （SSRS） and self-designed knowledge of the disease and cognition questionnaire were used for evaluation before and after intervention. ResultsAfter intervention， the SAS and SDS scores of observation group were lower than those of control group （t=7.493， 8.314， P<0.01）. After intervention， medication compliance of observation group was higher than that of control group （χ²=4.012， P=0.045）. SSRS subscale score and total score were higher than those in control group （t=2.198， 7.548， 2.664， 4.248， P<0.05 or 0.01）. After intervention， the mastery rate of knowledge about the disease and the excellent and good rate of cognitive behavior in observation group were higher than those in control group （χ²=4.588， 5.541， P<0.05）. ConclusionThe narrative medical model is of certain application value in communication with cancer patients with low education level. It can better improve the patients’ negative emotions， social support， and knowledge and cognition of the disease.

ObjectiveTo evaluate the efficacy and safety of 7 atypical antipsychotics combined with selective serotonin reuptake inhibitors（SSRIs） in the treatment of refractory obsessive-compulsive disorder by network Meta-analysis. MethodsRandomized controlled trials （RCTs） about atypical antipsychotics and SSRIs in the treatment of refractory obsessive-compulsive disorder were searched in CNKI， Wanfang Data， VIP， CBM， PubMed， Embase and Cochrane Library databases from inception to June 2020. Based on inclusion and exclusion criteria， the literature screening， date extraction and assessing risk of bias were performed by two researchers independently. Then all statistical analyses were performed using Stata 15.0 software. ResultsA total of 36 RCTs covering 7 atypical antipsychotics and 2 362 patients were included. Network Meta-analysis showed that the surface under the cumulative ranking （SUCAR） of total response rate was the largest in Olanzapine + SSRIs， followed by Paliperidone + SSRIs， Amisulpride + SSRIs， Risperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Aripiprazole + SSRIs， SSRIs， and Placebo + SSRIs in turn. In terms of Hamilton Anxiety Scale （HAMA） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by Aripiprazole + SSRIs， Quetiapine + SSRIs， Risperidone + SSRIs， and SSRIs in turn. In terms of Treatment Emergent Symptom Scale （TESS） score， the SUCAR was the largest in Amisulpride + SSRIs， followed by SSRIs， Paliperidone + SSRIs， Quetiapine + SSRIs， Ziprasidone + SSRIs， Risperidone + SSRIs， Aripiprazole + SSRIs， and Placebo + SSRIs in turn. ConclusionCompared with single application of SSRIs， its combination with atypical antipsychotics achieves better efficacy and higher safety in treating refractory obsessive-compulsive disorder， with Olanzapine+SSRIs being the most effective and Amisulpride+SSRIs the safest.

ObjectiveTo analyze the status of depression with somatization symptoms among college students during the pandemic of COVID-19， and to screen the influencing factors. MethodsFrom 12 to 19 March 2020， all the 2019 freshmen in Communication University of China， Nanjing completed a web-based survey， in which all the students were assessed by Psychological Questionnaires for Emergent Events of Public Health （PQEEPH）， somatization subscale of Symptom Checklist 90 （SCL-90）， Self-rating Depression Scale （SDS） and self-designed general demographic questionnaire， then the collected data were processed by univariate and multivariate Logistic regression. ResultsA total of 3 406 valid questionnaires were collected， with an effective recovery rate of 93.0%. The detection rate of depression symptoms and depression with somatization symptoms were 55.7% （1 898/3 406） and 4.9% （93/1 898）， respectively. Logistic regression analysis showed that single parent family （OR=2.977， P<0.01）， score of neurasthia dimension in PQEEPH （OR=3.693， P<0.01）， score of obsessive-anxiety dimension in PQEEPH （OR=6.794， P=0.001）， depression of moderate degree （OR=1.788， P=0.065）， and depression of severe degree （OR=4.462， P=0.003） were risk factors for depression with somatization symptoms of college students during the COVID-19 pandemic. ConclusionDuring the COVID-19 pandemic， a certain proportion of college students suffer from depression with somatization symptoms， furthermore， obsessive-anxiety， neurasthenia， moderate-to-severe depression and single parent family are the risk factors of depression with somatization symptoms among college students.

ObjectiveTo understand the characteristics of high-risk inmates’ impulsivity and to explore the influencing factors of impulsivity， so as to provide a theoretical basis for identifying the high-risk factors and making effective intervention. MethodsA total of 588 male inmates in Nanjing were selected as the research subjects. They were divided into four groups according to their violent crime reasons， high impulsiveness， borderline personality and antisocial personality. The detailed criminal records of inmates， general demographic data questionnaire， self-made substance use questionnaire， Barratt Impulsiveness Scale （BIS-11） and Childhood Trauma Questionaire-Short Form （CTQ-SF） were used to investigate， and multiple stepwise regression analysis was conducted to analysis the influencing factors of impulsivity of high-risk inmates. Results① There were statistically significant differences in age， marital status and drug use history among the four groups （F=4.890、13.945、26.137， P<0.01）. ② There were statistically significant differences in BIS-11 and CTQ-SF scores among the four groups （F=81.196， 16.208， P<0.01）. ③ Drug use history （β=1.832， P<0.05）， affective neglect （β=0.278， P<0.01） and affective abuse （β=0.307， P<0.01） had positive predictive effects on impulsivity of all high-risk inmates. Affective neglect （β=0.482， P<0.01） had a positive predictive effect on impulsivity of violent criminals. ConclusionDrug use history， affective neglect and emotional abuse were the risk factors for high impulsivity in male high-risk inmates.

ObjectiveTo explore the psychosocial factors affecting pregnancy reactions of primipara， so as to alleviate pregnancy reactions in early pregnancy stage. MethodsBasic information scale， Symptom Checklist 90 （SCL-90）， Pregnancy Pressure Scale （PPS） and Pregnancy-unique Quantification of Emesis and Nausea （PUQE） were used to assess the primiparas in a hospital from April to June 2020， thereafter， multiple linear regression was used to screen the main psychosocial factors affecting pregnancy reaction. ResultsA total of 100 pregnant women completed the survey， and the scores of PUQE， PPS and SCL-90 were （4.39±1.14）， （10.89±6.94） and （112.75±22.27）， respectively. Analysis showed that the pregnancy reactions were mild in 93 cases （93%）， moderate in 6 cases （6%） and severe in 1 case （1%）. One-way ANOVA results showed that there was no significant difference in PUQE score among primipara of different age， working status， education levels and average annual family incomes （F=0.57， 0.07， 0.89， 0.51， P>0.05）. Multifactorial regression analysis showed that pregnancy stress， SCL-90 score， obsessive-compulsive symptoms， depression levels， hostility， paranoia and others had statistical significance （P<0.05 or 0.01）. ConclusionThe main psychosocial factors influencing pregnancy reaction are the pregnancy stress and psychosomatic symptoms including obsessive-compulsive symptoms， depression levels， paranoia， hostility， sleep status， diet and others.

ObjectiveTo explore the effect of flipped classroom mode in the clinical probation teaching for undergraduate mental health students， so as to expand the new mode of clinical teaching in psychiatry department. MethodsA total of 85 undergraduate psychiatric students from Xinxiang Medical University in 2016 were selected. All participants were divided into experimental group （n=43） and control group （n=42） according to the random number table method. The flipped classroom clinical teaching mode was adopted to experimental group， and the traditional practice mode for control group. The probation lasted for 12 weeks. Theoretical knowledge of symptomology， psychiatric clinical skills （OSCE）， doctor-patient communication ability（SEGUE） and clinical thinking ability were assessed at the end of probation. ResultsAfter the probation， students in experimental group obtained higher scores in theoretical knowledge， clinical skills， doctor-patient communication ability and clinical thinking ability compared with control group. The differences were statistically significant ［（33.08±1.72） vs. （32.06±2.33）， （51.61±2.12） vs. （48.32±2.86）， （18.14±1.98） vs. （14.62±2.15）， （91.26±14.13） vs. （82.40±10.89）， t=2.307， 6.034， 3.230， 7.846， P<0.05 or 0.01］. ConclusionApplying the flipped classroom mode into the clinical probation teaching for mental health undergraduate students may help to improve students' theoretical knowledge level and clinical operation ability， faciliate doctor-patient communication， and have a positive impact on their clinical thinking ability.

The purpose of this paper is to present the diagnosis and treatment of idiopathic hypersomnia comorbidity tics disorder. The client is 15 years old， female， a senior student， with frequent blinking and a crooked mouth since childhood， diagnosed with tics disorder. She previously had consistently good academic performance. Since the COVID-19 epidemic in 2020， the client has been sleeping more， averaging 12 hours per day， accompanied by increased daytime sleep with fatigue after waking up， and a significant decline in her studies. She was diagnosed with idiopathic hypersomnia comorbidity persistent （chronic） movement or tic disorder. It was suggested that she adopt a method of comprehensive biopsychosocial intervention. Biotherapy with methylphenidate can improve her arousal， enhance attention and improve drowsiness， meanwhile， changes to tic symptoms must be monitored. Cognitive behavioral therapy was used to help the client correct cognitive biases， reshape cognitive structure， and establish confidence in rehabilitation. Mindfulness therapy was adopted to help the client adjust her emotions. In terms of social resources， the client was encouraged to explore resources actively， seek social support， and build therapeutic alliances. Through coordinating multiple resources， the client reduced symptoms of sleepiness and enhanced her adaptability to continue with her studies.

This paper reported a case of psychosomatic medicine-based comprehensive treatment for a patient with gynecological malignant tumor suffering severe left hip pain after surgery and radiotherapy， with the aim of demonstrating the pathophysiological classification of pain arising from pathological damage， and providing references for the clinical study and practice of the psychosomatic multi-dimensional treatment mode for clinical "organic pain". This case suggested that the onset of pain， even in the presence of pathological damage， also involved a combination of pathological damage， somatic manifestations of anxiety and individual cognitive biases.

The case report aims to raise the concern of clinicians about hiccups as an adverse reaction in olanzapine treatment. A 47-year-old male patient with epileptic mental disorder appeared symptoms of persistent hiccups on the fourth day of treatment with sodium valproate and carbamazepine jointing 10 mg/d olanzapine， and the symptoms disappeared two days after olanzapine withdrawal. The patient began to take olanzapine again， hiccups reappeared seven days after administration and relieved two days after withdrawal. During the whole treatment period， the dosage of sodium valproate and carbamazepine remained unchanged， indicating that the hiccups was induced by olanzapine. This case suggests that the possibility of hiccups should be considered in the clinical application of olanzapine.