Prior research has demonstrated significant deficits in sensory attenuation in patients with schizophrenia， which is a phenomenon that pertains to their inability to adequately modulate the intensity of sensory feedback associated with self-initiated voluntary actions. Sensory attenuation， a fundamental aspect of the sense of agency， is crucial for individuals to accurately perceive their own actions and effectively adapt to the external environment. Investigation on this phenomenon sheds light on the intricate mechanisms underlying sensory information processing deficits in patients with schizophrenia. This paper comprehensively examines the intricate relationship between abnormal sensory attenuation and the early identification of schizophrenia， delves into the underlying mechanisms that give rise to these abnormalities， and explores intervention strategies specifically designed to address them. Ultimately， our aim is to offer novel perspectives and insights that can contribute to the advancement of diagnosis and treatment of schizophrenia. ［Funded by Regional Project of National Natural Science Foundation of China （number， 32160202）］

BackgroundPatients with depressive disorder commonly experience sleep disturbances. Previous studies have indicated that group exercise therapy is beneficial in alleviating depressive symptom among patients with depressive disorder. However， there is a lack of research on the impact of group exercise therapy on improving sleep quality in patients with depressive disorder. ObjectiveTo explore the impact of group exercise therapy on sleep quality in patients with acute mild-to-moderate depression during the acute phase， so as to provide references for clinically improving the sleep quality of patients with mild to moderate depressive disorder during the acute phase. MethodsFrom December 2018 to July 2021， patients with mild-to-moderate depressive disorder during the acute phase （n=40）， who met the diagnostic criteria for depressive disorder according to International Classification of Diseases， tenth edition （ICD-10） ，were recruited from the outpatient clinic of Beijing Anding Hospital， Capital Medical University. All participants underwent an 8-week moderate-intensity group exercise therapy program comprising three sessions per week， each lasting 60 minutes. Assessments were conducted at baseline and after 2， 4， 6 and 8 weeks of intervention using Visual Analogue Scale （VAS）， Hamilton Depression Scale-17 item （HAMD-17） and Pittsburgh Sleep Quality Index （PSQI）. The reduction scores at each time point relative to baseline treated as the dependent variables， time as the independent variable， baseline scores as covariates， with time as a fixed effect and baseline values as random effects. Data were analyzed using a linear mixed-effects model. ResultsThe PSQI scores of patients at baseline， 2， 4 ， 6 and 8 weeks after the intervention were （10.62±5.12）， （9.07±3.58）， （7.39±3.66）， （6.54±3.84） and （5.50±3.41）， respectively. The results of linear mixed effect model analysis showed that after 2， 4， 6 and 8 weeks of intervention， patients scored lower than baseline， with statistically significant differences observed in all cases （P<0.01）. The HAMD-17 sleep fcctor scores at baseline， 2， 4， 6 and 8 weeks were （2.25±1.56）， （2.06±1.49）， （1.36±1.27）， （1.22±1.46） and （0.97±1.34）， respectively. The results of linear mixed effects model analysis showed that the HAMD-17 sleep factor scores of 4， 6 and 8 weeks of intervention were lower than that of baseline， and the difference was statistically significant （P<0.05 or 0.01）. The VAS scores at baseline， 2， 4， 6 and 8 weeks after the intervention were （3.18±2.17）， （4.74±2.22）， （6.01±2.31）， （6.54±2.16） and （7.90±1.64）， respectively. The results of linear mixed effect model analysis showed that VAS scores of 2， 4， 6 and 8 weeks of intervention were higher than baseline，and the difference was statistically significant （P<0.01）. ConclusionGroup exercise therapy may improve sleep quality and alleviate depressive symptoms in patients with mild-to-moderate depressive disorder during the acute phase. ［Funded by National Key Research and Development Plan Project （number， 2016YFC1307200）； Beijing Municipal Hospital Scientific Research and Cultivation Plan Project （number， PX2024070）］

BackgroundCombination of antipsychotic drugs and modified electroconvulsive therapy （MECT） is currently a commonly used method for treating schizophrenia， but its efficacy varies among different patient groups. ObjectiveTo explore the therapeutic effects of MECT on schizophrenia patients living in different urban versus rural environments， so as to provide references for the selection of treatment plans based on patients' residence. MethodsA total of 587 patients hospitalized at Luzhou Mental Health Center， Zigong Mental Health Center and Yibin Fourth People's Hospital from May 2018 to August 2022， who met the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） ，were included in the study. Patients were divided into two groups： medication-only group （n=106） and MECT combined with medication group （n=481）. In MECT combined with medication group， 24 rural patients residing in urban areas were excluded， leaving the remaining patients divided into urban group （n=103） and rural group （n=354） based on their place of residence. Positive and Negative Syndrome Scale （PANSS） was used to assess the severity of symptoms. Clinical efficacy was evaluated using PANSS score reduction rate， and covariance analysis was used to compare the therapeutic effects of different patients. ResultsThe differences of reduction rate of PANSS total score， positive symptom scale score and negative symptom scale score as well as treatment effectiveness rate between MECT combined with medication group and medication-only group were statistically significant （F=11.149， 12.111， 31.725， χ²=14.010， P<0.01）. Statistically significant differences were also observed in reduction rate of PANSS total score and positive symptom subscale score as well as treatment effectiveness rate between urban and rural patients in MECT combined with medication group （F=3.946， 4.523， χ²=4.033， P<0.05）. ConclusionThe efficacy of MECT combined with medication may be superior to medication alone in the treatment of schizophrenia， and the combined therapy may be more effective in urban patients than that in rural patients， with potentially more pronounced improvements in positive symptoms.

BackgroundThe depressive episode is one of the most prevalent mental illnesses worldwide. Relaxation therapy as a psychotherapy for depressive disorder has shown itself to be a viable tool， yet the existing research on relaxation therapy combined with sertraline in the treatment of depressive episodes in children and adolescents is severely limited. ObjectiveTo discuss the effect of relaxation therapy combined with sertraline on the new-onset depressive episodes in children and adolescents， and to provide references for the treatment of depressive episodes in children and adolescents. MethodsFrom January 1， 2019 to December 31， 2020， a sample of 422 children and adolescents with depressive episodes attending the Child Mental Health Department of Sichuan Mental Health Center and fulfilling the International Classification of Diseases， tenth edition （ICD-10） diagnostic criteria were enrolled， and they were classified into study group （n=208） and control group （n=214） using random number table method. All participants were offered sertraline， based on this， study group was assigned to relaxation therapy for 25~30 min per day， five days per week for a period of two weeks. Hamilton Depression Scale 24-item （HAMD-24） and Hamilton Anxiety Scale （HAMA） were applied at the enrollment， the end of 2 weeks of treatment and the end of the 2^nd week after discharge. ResultsA total of 369 patients completed the study， including 185 in study group and 184 in control group. Analysis on HAMD-24 scores revealed a significant time effect， group effect and time×group interaction effect （F=813.279， 17.625， 8 994.905， P<0.01）. Significant time effect， group effect， and time×group interaction effect were noted on HAMA scores （F=635.041， 10.716， 13 945.986， P<0.01）. A reduction in HAMD-24 and HAMA scores was reported in study group at end of 2 weeks of treatment and end of the 2^nd week after discharge compared with baseline （t=0.924， 0.359， P<0.01）. At the end of the 2^nd week after discharge， study group scored lower on HAMD-24 and HAMA compared to control group （t=0.210， 0.720， P<0.05）. At the end of 2 weeks of treatment， study group resulted in greater improvements in depressive symptoms and anxiety symptoms than those of control group （95.14% vs. 66.30%， 89.18% vs. 71.74%， χ²=78.942， 22.526， P<0.05）. The overall efficacy rate yielded no statistical difference between two groups at end of the 2^nd week after discharge （P>0.05）， and no statistical difference was found in the adverse reactions between the two groups （P>0.05）. ConclusionCompared with sertraline alone， its combination with relaxation therapy may achieve a better short-term efficacy in the treatment of depressive episode in children and adolescents. ［Funded by Sichuan Medical Scientific Research Project （number， S18020）］

BackgroundPatients demonstrating depressive disorder with psychotic symptoms often have increased risk of death and poor prognosis. A large amount of research has explored the factors influencing psychotic symptoms in adult patients with depressive disorder， but few has focused on adolescent patients. ObjectiveTo explore the influencing factors of psychotic symptoms in adolescent patients with depressive disorder， so as to provide references for early screening and intervention in clinic. MethodsA total of 96 adolescent patients who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） for depressive disorder and were seen in the psychiatry departments of Chaohu Hospital of Anhui Medical University and The Fourth People's Hospital of Hefei from September 2022 to January 2023 were included. Another 56 healthy individuals from the health examination center of Chaohu Hospital of Anhui Medical University were concurrently recruited as control group. Patients were assigned into psychotic group （n=32） and non-psychotic group （n=64） according to the presence or absence of psychotic symptoms. Hamilton Depression Scale-24 item （HAMD-24）， Positive and Negative Syndrome Scale （PANSS）， Positive and Negative Suicide Ideation （PANSI） and Childhood Trauma Questionnaire-Short Form （CTQ-SF） were used for evaluation. Plasma brain-derived neurotrophic factor （BDNF） concentration was obtained using Meso Scale Discovery electrochemiluminescence assay. Pearson and Spearman correlation analysis were adopted to determine the correlation of PANSS positive symptom subscale score with plasma BDNF concentration and clinical characteristics of adolescent depression patients with psychotic symptoms. Binary Logistic regression analysis was used to identify the factors influencing the presence of psychotic symptoms in adolescent patients with depressive disorder， and multiple linear regression analysis was utilized to screen the factors affecting the severity of psychotic symptoms. ResultsThe plasma BDNF concentration of adolescent patients with depressive disorder was lower than that of control group （t=-3.080， P<0.01）.The plasma BDNF concentration of psychotic group was lower than that of non-psychotic group （t=2.418， P<0.05）， while the body mass index （BMI） PANSI scores， CTQ-SF scores and HAMD-24 total scores were all higher than those of non-psychotic group （t=-2.024， -2.530， -2.187， -4.977， P<0.05 or 0.01）. Correlation analysis showed that PANSS positive symptom subscale scores were negatively correlated with anxiety/somatization factor score and weight factor score in HAMD-24 of psychotic group （r=-0.438， -0.498， P<0.05 or 0.01）. Binary Logistic regression showed that BMI， plasma BDNF concentration， HAMD-24 total scores and cognitive dysfunction factor score were the influencing factors of psychotic symptoms in adolescent patients with depressive disorder. Multiple linear regression analysis demonstrated that weight factor scores （β=-0.349， P<0.05） and anxiety/somatization factor score （β=-0.433， P<0.05） in HAMD-24 were the factors influencing the severity of psychotic symptoms. ConclusionHigh BMI， low plasma BDNF concentration， severe depressive symptoms and cognitive dysfunction may be the risk factors of psychotic symptoms in adolescent patients with depressive disorder， furthermore， BMI and anxiety symptoms are found to be associated with the severity of psychotic symptoms. ［Funded by Scientific Research Fund Project of Anhui Institute of Translational Medicine （number， 2022zhyx-B01）； Central Finance Supported Provincial Key Clinical Specialty Construction Project of Anhui Province in 2019］

BackgroundSuicide ideation in adolescent inpatients with depression is a multi-factorial problem， and perceived stress is considered to be closely related to suicide ideation， while its mediating role in suicide ideation among adolescent inpatients with depression remains unclear. ObjectiveTo explore the mediating effect of psychological capital on the relationship between perceived stress and suicide ideation among adolescent inpatients with depression， so as to provide references for preventing the onset of suicide ideation in adolescent inpatients with depression. MethodsA sample of 585 adolescent patients who were hospitalized in Beijing Huilongguan Hospital from June 2021 to March 2023 and fulfilling the International Classification of Diseases， 10th edition （ICD-10） diagnostic criteria for depression were enrolled. All patients were evaluated using self-designed questionnaire， Chinese Perceived Stress Scale （CPSS）， Positive Psychological Capital Questionnaire （PPQ） and Beck Scale for Suicide Ideation-Chinese Version （BSI-CV）. Pearson correlation was used to assess the correlation among the scores of the above scales. Bootstrap method was employed to verify the mediating effect of psychological capital on the relationship between perceived stress and suicide ideation. ResultsCPSS score in adolescent inpatients with depression was positively correlated with BSI-CV score （r=0.375， P<0.01）， and CPSS score and BSI-CV score were negatively correlated with PPQ score （r=-0.481， -0.436， P<0.01）. Psychological capital played a significant yet a partial role in mediating the link between perceived stress and suicide ideation， with an indirect mediating effect value of 0.160 （95% CI： 0.178~0.373）， accounting for 30.42% of the total effect. ConclusionThe perceived stress of adolescent inpatients with depression can affect the onset of suicide ideation both directly and indirectly through psychological capital.

BackgroundThe issue of depression among adolescents is becoming increasingly serious， seriously endangering their healthy development. The issue of sleep disturbances in adolescents with depressive disorder is gradually receiving attention， but there is currently a lack of research on the relationship between sleep quality and suicide risk in this patient population. ObjectiveTo explore the relationship between suicide risk and sleep quality in adolescents with depressive disorders， and analyze the influencing factors of suicide risk， so as to provide references for clinical intervention. MethodsA total of 101 adolescents patients who met the diagnostic criteria for depressive disorder in the International Classification of Diseases， 10th edition （ICD-10） and were hospitalized at Hefei Fourth People's Hospital from June 2020 to February 2023 were selected. The patients were evaluated using the Nurses' Global Assessment of Suicide Risk （NGASR） and Pittsburgh Sleep Quality Index （PSQI）. According to the NGASR score， patients were divided into severe suicide risk group （n=35） and non-severe suicide risk group （n=66）. Pearson correlation analysis was used to examine the correlation between sleep quality and suicide risk in adolescents with depression. Multiple Logistic regression was used to analyze the influencing factors of severe suicide risk in adolescent patients with depression. ResultsStatistically significant differences were found between the two groups in terms of academic pressure， peer relationship and family relationship （t=3.942， 4.378， 6.748， P<0.05）. Moreover， there was a statistically significant difference in PSQI score between two groups （t=7.398， P<0.05）. There was also a statistically significant difference in sleep quality between the two groups （χ²=4.986， P<0.05）. Pearson correlation analysis showed a positive correlation between total PSQI score and NGASR score （r=0.698， P<0.05）. Severe depression （OR=1.628， 95% CI： 1.079~2.457）， high academic pressure （OR=1.118， 95% CI： 1.018~1.228） and poor sleep quality （OR=1.158， 95% CI： 1.033~1.297） were identified as risk factors of severe suicide risk， while good relationships with classmates （OR=0.908， 95% CI： 0.826~0.998） and family （OR=0.904， 95% CI： 0.823~0.993） were protective factors. ConclusionSleep quality in adolescents with depression is negatively correlated with suicide risk and poor sleep quality may be a risk factor for severe suicide risk.

BackgroundDepression as a major mental health condition is commonly found in junior high school students. Peer attachment， emotional resilience and childhood abuse have been found to be associated with depressive symptoms， and it has been hypothesized that peer attachment and emotional resilience may play a chained effecting path in the relationship between childhood abuse and depressive symptoms in junior high school students. ObjectiveTo explore the relationship between childhood abuse and depressive symptom in junior high school students， analyze the effecting path of peer attachment and emotional resilience， thus to provide references for improving the mental health of junior high school students. MethodsFrom May to July 2022， a cluster sampling technique was utilized to recruit 1 781 junior high school students from a junior high school in Anhui province. Childhood Trauma Questionnaire Short Form （CTQ-SF）， Revised version of Inventory of Parent and Peer Attachment （IPPA-R）， Adolescent' Emotional Resilience Questionnaire （AERQ） and Center for Epidemiological Studies Depression Scale （CES-D） were used as the measurement tools. Pearson correlation coefficient was calculated to assess the correlation among above scales. Process4.2 and Bootstrapping method were employed to verify the effecting path of peer attachment and emotional resilience in the relationship between childhood abuse and depressive symptoms. ResultsCTQ-SF score was negatively correlated with IPPA-R peer attachment subscale score and AERQ score （r=-0.527， -0.495， P<0.01） and positively correlated with CES-D score （r=0.669， P<0.01） in junior high school students. IPPA-R peer attachment subscale score was positively correlated with AERQ score （r=0.556， P<0.01） and negatively correlated with CES-D score （r=-0.599， P<0.01） in junior high school students. AERQ score was negatively correlated with CES-D score （r=-0.698， P<0.01） in junior high school students. Childhood abuse in junior high school students was shown to be a positive predictor of depressive symptoms （β=0.675， P<0.01） and a negative predictor of peer attachment （β=-0.824， P<0.01） and emotional resilience （β=-0.305， P<0.01）. Peer attachment and emotional resilience were independent effecting path between childhood abuse and depressive symptoms， with indirect effect size of 0.093 （95% CI： 0.066~0.122） and 0.108 （95% CI： 0.084~0.133）， respectively. Peer attachment and emotional resilience affected as a chain effecting path between childhood abuse and depressive symptoms， with indirect effect size of 0.087 （95% CI： 0.071~0.105）， accounting for 12.89% of the total effect. ConclusionChildhood abuse in junior high school students can affect the presence of depressive symptom both directly and indirectly through either separate or chained effecting path of peer attachment and emotional resilience. ［Funded by 2020 Provincial General Scientific Research Project of West Anhui Health Vocational College （number， KJ2020B006）； 2024 Provincial University Natural and Humanities Sciences Research Project of West Anhui Health Vocational College （number， 2024AH053467）］

BackgroundChildhood and adolescence are critical stages in psychological development. During the public health emergencies， children and adolescents exhibit weaker psychological coping ability， making them more vulnerable to mental health issues. ObjectiveTo investigate trends in the distribution of hospitalized children and adolescents patients at mental health centers of a general hospital during public health emergencies， so as to provide references for future research and intervention for adolescent under similar contexts. MethodsA retrospective cohort study was conducted on 6 613 children and adolescent patients hospitalized and discharged from the Mental Health Center of West China Hospital， Sichuan University， from January 1， 2018 to December 31， 2022. Patients were included if their primary diagnosis was schizophrenia， schizotypal disorder and delusional disorder， depressive disorder， bipolar disorder， anxiety disorder or post-traumatic stress disorder in International Classification of Diseases， tenth edition （ICD-10）. Patients were divided into two groups based on their admission period： pre-COVID-19 pandemic period （from January 1， 2018 to December 31， 2019） and during the COVID-19 pandemic （from January 1， 2020 to December 31， 2022）. Trends in diagnostic distributions were analyzed using the trend chi-square test. ResultsSignificant differences were observed between pre-pandemic and pandemic periods in age， length of hospital stay and sex（t=10.743， 4.082， χ²=29.092， P<0.01）. During the COVID-19 pandemic， the proportions of depressive disorder， bipolar disorder and anxiety disorder among hospitalized children and adolescents patients increased （χ²_trend=11.058， 67.333， 17.276， P<0.01）， while the proportions of schizophrenia， schizotypal disorder and delusional disorder decreased （χ²_trend=219.924， P<0.01）. Among patients aged 6~14 years， the proportion of bipolar disorder increased （χ²_trend=18.207， P<0.01）. Among patients aged 15~19 years， the proportion of bipolar disorder and anxiety disorder also increased （χ²_trend=57.339， 19.011， P<0.01）. In male patients， the proportions of depressive disorder and bipolar disorder increased （χ²_trend=21.729， 11.380， P<0.01）， while in female patients， the proportion of bipolar disorder and anxiety disorder increased （χ²_trend=54.830， 14.377， P<0.01）. ConclusionCompared with the pre-pandemic period， during the COVID-19 pandemic， among hospitalized children and adolescents patients， there are more female patients than male patients， with a tendency for patients to be younger and have shorter lengths of hospital stay. The proportions of depressive disorder， bipolar disorder and anxiety disorder have all increased.

BackgroundSibling relationships play a critical role in shaping anxiety symptoms in firstborn children. Anxiety symptoms often originate in early childhood and can persist into adolescence and adulthood. However， there is insufficient research on anxiety symptoms in preschool children， especially firstborn preschool children. ObjectiveTo explore the influencing factors of anxiety symptoms among firstborn preschool children， so as to provide references for the intervention of anxiety symptom for children in families with multiple children. MethodsFrom October to December 2021， a total of 8 449 children from 234 kindergartens in Longhua District of Shenzhen were included using a cluster sampling method. Sibling Inventory of Behavior （SIB） and Spence Preschool Anxiety Scale （SPAS） were used to investigate. Logistic regression analysis was used to identify influencing factors of anxiety symptoms in firstborn preschool children. ResultsA total of 8 419 （99.64%） valid questionnaires were collected. Anxiety symptoms were detected in 344（4.09%） firstborn preschool children. Statistically significant differences were observed between anxiety group and non-anxiety group in terms of household registration， monthly family income， maternal age， maternal education level， paternal education level， family living conditions and whether they are left-behind children （χ²/t=9.906， 33.490， 5.136， 13.485， 9.690， 17.332， 21.975， P<0.05 or 0.01）. Compared with non-anxiety group， children in the anxiety group scored higher on the SIB dimensions of rivalry， aggression and avoidance （t=165.322， 74.471， 286.419， P<0.01）， and lower on companionship， empathy and teaching （t=59.133， 42.417， 39.112， P<0.01）. Risk factors for anxiety symptoms in firstborn preschool children included left-behind children， as well as negative sibling relationships characterized by rivalry and avoidance （OR=1.195， 1.143， 1.260， P<0.05 or 0.01）. ConclusionFirstborn preschool children who are left-behind are more susceptible to anxiety symptoms. Negative sibling relationships， characterized by competition and avoidance， may also contribute to the emergence of anxiety symptoms in firstborn preschool children.