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China's service system for community residents with severe mental disorders:achievements,challenges and prospects

Sichuan Mental Health.2024;37(3):193-197. doi:10.11886/scjsws20240428003

With the implementation of the 'Mental Health Law of the People's Republic of China' and relevant policies,governments at all levels have devoted more resources to community-based rehabilitation services for patients with mental disorders,making the mental health services more accessible and professional to the majority of patients with mental disorders.Monumental achievements have been made in community-based rehabilitation services for patients with severe mental disorders,while challenges have always existed in the China's community mental health service system for patients with severe mental disorders.Therefore,this article elaborated the achievements,challenges and prospects of China's community mental health service system for patients with severe mental disorders,aiming to provide references for future work and further improve the quality and accessibility of community mental health service for patients with mental disorders.

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Identification of genetic loci that overlap between major depressive disorder and insomnia using the conditional false discovery rate analysis

Wenchao SONG ; Lijun CHU ; Jing MA

Sichuan Mental Health.2024;37(3):198-204. doi:10.11886/scjsws20231113004

Background Major depressive disorder and insomnia often coexist,and the two may share a mechanism of pathogenesis and be affected by common underlying genes with strong pleiotropic effects.Previous genome-wide association studies(GWAS)mainly focused on single-gene morphological characters analysis,which impose limitations on showing possible pleiotropic effects.Objective To identify genetic loci related to insomnia and major depressive disorder,and to examine whether there are common genetic factors underlying both insomnia and depression.Methods The GWAS data for major depressive disorder originates from the Psychiatric Genomics Consortium(PGC),which comprises a total of 246363 depressive cases and 561190 controls.The insomnia GWAS data was downloaded from Sleep Disorder Knowledge Portal,involving 1331010 participants.Then the conditional false discovery rate(cFDR)and conjunction cFDR(ccFDR)were utilized to identify the genetic loci associated with major depressive disorder and insomnia,and pathway enrichment analysis was performed to examine the biological functions of these loci.Results A significant pleiotropic effect was detected between major depressive disorder and insomnia.By leveraging pleiotropic enrichment,21 susceptibility loci(17 novel loci)for major depressive disorder and 38 susceptibility loci(28 novel loci)for insomnia were identified with the threshold of cFDR<0.01.A total of 16 pleiotropic loci(15 novel loci)related to both major depressive disorder and insomnia were identified with the threshold of ccFDR<0.05.pathway enrichment analysis indicated that the susceptibility loci were mainly enriched in synaptic transmission pathway,such as postsynaptic density(GO:0014069,P=4.91E-04,FDR=4.84E-03),asymmetric synapse(GO:0032279,P=5.09E-04,FDR=4.84E-03),and regulation of postsynaptic membrane neurotransmitter receptor levels(GO:0099072,P=5.11E-04,FDR=1.69E-02).Conclusion A significant pleiotropic enrichment is found between major depressive disorder and insomnia,and the comorbidity mechanism is related to synaptic transmission.

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Correlation between functional connectivity of the precuneus and early efficacy to antidepressant treatment in patients of major depressive disorder

Hongqi XIAO ; Minlan YUAN ; Hongru ZHU ; Yuan CAO ; Changjian QIU

Sichuan Mental Health.2024;37(3):205-211. doi:10.11886/scjsws20231219001

Background The activity in precuneus within default mode network has been reported to be associated with antidepressant response,whereas the relationship between the functional network of precuneus and early response to antidepressant medications remains unclear.Objective To investigate the relationship between precuneus functional connectivity(FC)and early efficacy of antidepressant treatment in patients with major depressive disorder,so as to find a neurobiomarker to predict the early efficacy of antidepressants.Methods A consecutive sample of 47 patients with major depressive disorder who attended the Mental Health Center,West China Hospital of Sichuan University from July 2017 to February 2019 and fulfilled the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)were recruited.Baseline resting-state functional magnetic resonance imaging scan findings and clinical assessments were recorded in participants.All patients treated with antidepressants for two weeks.Improvement was defined as 20%or greater reduction in baseline 16-item Quick Inventory of Depressive Symptoms Self-Report Scale(QIDS-SR16)by treatment exit,and patients were then classified into early improved group(n=27)and non-improved group(n=20).FC values of precuneus and whole brain were calculated using bilateral precuneus as seed region,and baseline precuneus FC values were compared between two groups.Pearson correlation analysis was utilized to explore the correlation between FC values in brain regions with statistically significant differences and QIDS-SR16 total scores and reduction rates.Results FC values between the left precuneus and left precentral gyrus and between the right precuneus and right fusiform gyrus in early improved group were both higher than those in non-improved group(GRF correction,P<0.01).The FC valves between the left precuneus and the left precentral gyrus and between the right precuneus and the right fusiform gyrus were positively correlated with QIDS-SR16 reduction rate(r=0.475,0.297,P<0.05).Conclusion Weakened FC between the left precuneus and left precentral gyrus and between the right precuneus and right fusiform gyrus are related to poor early efficacy to antidepressant treatment,and FC of precuneus may be a potential predictor of early response to antidepressants.

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Efficacy of rTMS and CBT-I on patients with chronic insomnia disorder:a randomized controlled study

Yani LIU ; Xiaojie SUI ; Yinxia BAI ; Dongsheng LYU ; Ping YAO

Sichuan Mental Health.2024;37(3):212-218. doi:10.11886/scjsws20240105001

Background To date,pharmacologic therapy is considered the standard first-line treatment for insomnia disorder,but there are still some concerns over the adverse reactions.Repetitive transcranial magnetic stimulation(rTMS)and cognitive behavioral therapy for insomnia(CBT-I)as an alternative to pharmacologic therapy have the advantages of fewer side effects and better patient tolerance in the treatment of chronic insomnia disorder.Objective To explore the clinical efficacy of rTMS and CBT-I on chronic insomnia disorder,so as to provide a novel therapeutic option for the treatment of chronic insomnia disorder.Methods A total of 50 patients with chronic insomnia disorder attending the outpatient clinic of Inner Mongolia Autonomous Region Mental Health Center or community hospital from September 21,2020 to December 16,2021 and fulfilling the International Classification of Sleep Disorders,third edition(ICSD-3)diagnostic criteria were enrolled.Additionally,16 age-and sex-matched healthy controls recruited from the community were set as control group.Patients were randomly divided into rTMS group and CBT-I group,25 cases in each group,and received rTMS or CBT-I intervention for 6 weeks respectively.At enrollment and completion of intervention,patients were subjected to Polysomnography(PSG),Pittsburgh Sleep Quality Index(PSQI),Insomnia Severity Index(ISI)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS).All participants underwent resting-state functional magnetic resonance imaging(rs-fMRI)scans,and amplitude of low-frequency fluctuation(ALFF)was calculated.The brain regions with statistically different ALFF values between patient group and control group were chosen as regions of interest(ROIs),and whole-brain seed-based functional connectivity analyses were conducted.Results After a 6-week intervention in the two groups,the main effect of time was significant for PSQI(F=41.160,P<0.05),ISI(F=69.615,P<0.05)and RBANS immediate memory(F=47.923,P<0.05),language(F=12.090,P<0.05)and delayed memory indices(F=28.193,P<0.05).A significant main effect of time for total sleep time(F=8.995,P<0.05),a significant main effect of time for sleep efficiency(F=12.414,P<0.05),a significant main effect of group for sleep efficiency(F=4.342,P<0.05)and a significant main effect of time for N1%(F=7.806,P<0.05)were observed.Sleep efficacy in CBT-I group improved significantly from pre-to post-test(t=-2.785,P<0.05).Patients in rTMS group showed increased functional connectivity between the orbital superior frontal gyrus and other regions including left lentiform nucleus putamen(t=4.991,P<0.05),right median cingulate and paracingulate gyri(t=4.471,P<0.05)and right postcentral gyrus(t=4.922,P<0.05),and increased functional connectivity between the orbital superior frontal gyrus and left middle frontal gyrus was found in CBT-I group(t=6.586,P<0.05).Conclusion rTMS and CBT-I may help alleviate insomnia and improve cognitive function of patients with chronic insomnia disorder.

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Efficacy of brief cognitive behavioral therapy on improving quality of life improvement in patients with schizophrenia

Qian SUN ; Xiaojie YANG ; Yun MA ; Zhihua GUO ; Zhanjiang LI

Sichuan Mental Health.2024;37(3):219-225. doi:10.11886/scjsws20240202003

Background The course of schizophrenia is prolonged,and patients have impaired social function and significantly reduced quality of life.Drug therapy combined with psychological therapy is particularly important for improving the quality of life of patients.Brief cognitive behavioral therapy(BCBT)has been widely applied in clinical practice,but current research on BCBT focuses more on improving patients' symptoms and lacks relevant reports on improving quality of life.Objective To evaluate the efficacy and influencing factors of BCBT combined with conventional treatment on improving the quality of life in patients with schizophrenia.Methods A total of 210 patients who met the diagnostic criteria for schizophrenia in the International Classification of Diseases(10th edition)(ICD-10)and were followed up at the outpatient department of Beijing Anding Hospital Capital Medical University from August 2011 to December 2016 were selected.Using a random number table method,patients were divided into study group and control group,with 105 cases in each group.Both groups received routine treatment,and the research group received a total of 8 BCBT sessions for 12 weeks on this basis.At the baseline period and 12 weeks of treatment,26 weeks of follow-up and 52 weeks of follow-up,Positive and Negative Syndrome Scale(PANSS),Personal and Social Performance Scale(PSP)and World Health Organization Quality of Life Brief(WHOQOL-BREF)were used for evaluation.Results The results of repeated measures analysis of variance showed that the time point effect and interaction effect of PANSS total score were statistically significant(F=118.783,8.083,P<0.01).The time point effect,inter group effect and interaction effect of PSP total score were statistically significant(F=94.358,4.048,5.490,P<0.05 or 0.01).The time point effect,inter group effect and interaction effect of the total score of WHOQOL-BREF were all statistically significant(F=12.330,4.168,4.142,P<0.05 or 0.01)Binary Logistic regression analysis showed that the study group(OR=1.861,95%CI:1.004～3.448)and young age(OR=1.044,95%CI:1.001～1.088)were protective factors for improving quality of life of patients,while high PANSS baseline score(OR=0.972,95%CI:0.945～0.999)was a risk factor for improving quality of life of patients.Conclusion The combination of BCBT and conventional treatment has an earlier onset of improvement in the quality of life of patients with schizophrenia,and long-term efficacy is superior to conventional treatment.

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Efficacy of aripiprazole combined with olanzapine for hospitalized male patients with schizophrenia and its effect on metabolic syndrome

Shunhua LIU ; Xiaofeng YUAN ; Xueting YE ; Yuliang ZHANG ; Li ZHAO ; Kunyuan ZHOU

Sichuan Mental Health.2024;37(3):226-231. doi:10.11886/scjsws20230916001

Background Schizophrenia and the use of antipsychotic medications are identified to be the likely contributors to the development of metabolic syndrome(MS)and cardiovascular disease,and jeopardize the prognosis of schizophrenia.Therefore,effectively preventing or reducing the risk of developing MS in patients with schizophrenia is critical.Objective To explore the efficacy of aripiprazole combined with olanzapine for male schizophrenia patients and its effect on MS,so as to provide a certain reference for the selection of antipsychotic drugs for schizophrenia patients.Methods Male patients(n=80)who were hospitalized in The Third People's Hospital of Meizhou from February to June 2023 and fulfilling the International Classification of Diseases,tenth edition(ICD-10)diagnostic criteria for the schizophrenia were enrolled,and grouped using random number table method,each with 40 cases.Study group was treated with aripiprazole combined with olanzapine,while control group was given aripiprazole monotherapy.The treatment lasted for 6 continuous weeks in both groups.At the baseline,Positive and Negative Symptom Scale(PANSS)score,MS-related indices[fasting plasma glucose(FPG),hemoglobin A1c(HbA1c),body mass index(BMI),waist-to-hip ratio(WHR),lipid profile],S100 calcium-binding protein B(S100B)and high sensitivity C-reactive protein(hs-CRP)were recorded.Then the PANSS scores at the end of the 2nd,4th and 6th week of treatment,the Clinical Global Impression(CGI)scores at the end of the 2nd and 6th week of treatment,as well as the MS-related indices,S100B,hs-CRP,Treatment Emergent Symptom Scale(TESS)score and Rating Scale for Extrapyramidal Side Effects(RSESE)score at the end of the 6th week of treatment were recorded in all participants.Results Analysis on PANSS score revealed a significant group effect,time effect and group×time interaction effect(F=18.092,634.780,2.917,P<0.05 or 0.01).Analysis on CGI score revealed a significant group effect and time effect(F=20.492,99.190,P<0.01).At the end of the 6th week of treatment,study group detected lower serum concentrations of HbA1c and triglyceride(TG)compared with control group(t=-3.495,-3.293,P<0.05).The post-treatment hs-CRP level was lower in study group than that in control group(t=-3.916,P<0.05).Study group scored lower on TESS compared with control group(t=-4.684,P<0.01).Conclusion Aripiprazole combined with olanzapine can effectively alleviate psychotic states in male schizophrenia patients,and the combination therapy yields less impact on MS-related indices than olanzapine monotherapy.

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Efficacy of group play therapy on cognitive function and negative symptoms in hospitalized female patients with schizophrenia

Manman YUE ; Rui MA ; Yuanxiong WU ; Rui WANG ; Yanhai WU ; Jinling WU ; Shu CUI

Sichuan Mental Health.2024;37(3):232-236. doi:10.11886/scjsws20230804003

Background Schizophrenia patients are often accompanied by negative symptoms and severe cognitive impairment,but effective interventions intended to alleviate such condition are currently limited.Existing researches on group play therapy for schizophrenia is still in its initial stages,and such therapy has the potential to contribute to symptoms improvement.Objective To explore the efficacy of group play therapy on improving cognitive function and negative symptoms in hospitalized female patients with schizophrenia,so as to provide references for clinical intervention in such group.Methods This study involved 40 female patients with schizophrenia who received inpatient treatment at the Third People's Hospital of Fuyang from April 2022 to May 2023 as well as met the diagnostic criteria of the International Classification of Diseases,tenth edition(ICD-10).They were divided into study group(n=20)and control group(n=20)according to the random number table method.Both groups received routine treatment,and the study group received 10 sessions of group play therapy for 5 weeks on the basis.At baseline,Scale for Assessment of Positive Symptoms(SAPS),Scale for Assessment of Negative Symptoms(SANS),Self-rating Depression Scale(SDS),Nurses' Observation Scale for Inpatient Evaluation(NOSIE),and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)were used for assessment.Post-therapy evaluation was conducted by using SAPS,SANS and RBANS.Patients' baseline SAPS scores,SANS scores,RBANS total scores,and various factor scores of RBANS were used as covariates,and covariance analysis was adopted to compare the scores of each scale between the two groups after treatment.Results A total of 39 patients went through the whole study.Results of covariance analysis showed that the SANS score of study group was lower than that of control group,while several scores of RBANS(including total score,immediate memory factor score,speech function factor score and attention factor score)were all higher than those in control group.Significant difference was observed between two groups in scores of both scales above(F=13.408,10.331,4.932,9.967,10.010,P<0.05 or 0.01).Conclusion Group play therapy may help improve negative symptoms and cognitive function in hospitalized female patients with schizophrenia.

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Relationship between mindful parenting,parenting stress and adolescents'aggressive behaviors:based on actor-partner interdependence model

Si CHEN ; Weiqi MU ; Mingjie ZHOU ; Xucheng GUO

Sichuan Mental Health.2024;37(3):237-242. doi:10.11886/scjsws20240227003

Background Mindful parenting is related to the physical and mental health of adolescents,but only few empirical studies have been conducted on the mindful parenting and none has addressed on the impact and actor-partner effects of mindful parenting on adolescents' aggressive behaviors via parenting stress.Objective To explore the impact and actor-partner effects of mindful parenting on adolescents' aggressive behaviors via parenting stress,so as to provide references for improvements in family education and interventions on behavioral problems in adolescents.Methods A sample of 907 subjects(including family members and students)from three classes in each of five grades from grade 5 in elementary school to grade 9 in junior high school in Mianyang,Sichuan Province were selected from September 8 to 15,2023.Parents were assessed with Mindfulness In Parenting Questionnaire(MIPQ)and Parenting Stress Index-Short Form(PSI-SF),and students were required to fulfill aggressive behavior scale of Youth Self-Report(YSR).Pearson correlation analysis was utilized to examine the correlation among the above scales.The actor-partner interdependence model was used to analyze the impact of mindful parenting on their own and their spouses' parenting stress,as well as the impact on adolescents' aggressive behaviors via parenting stress.Results A total of 472 families completed the effective questionnaires.Both father and mother's mindful parenting exhibited an actor effect on adolescents' aggressive behaviors via their own parenting stress,with the effect size of-0.018(P=0.002)and-0.026(P=0.012).The partner effect sizes of father's mindful parenting and mother's mindful parenting on adolescents' aggressive behaviors via their spouse's parenting stress were-0.006(P=0.026)and-0.007(P=0.012),respectively.Conclusion Mindful parenting has been proven to have specific indirect impact on adolescents' aggressive behaviors through their own and their spouse's parenting stress,and the actor effect and partner effect are found both significant.

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Psychological abuse and neglect in relation to mobile phone addiction in junior high school students:path analysis of self-esteem and interpersonal alienation

Linhua LI ; Lilan CHEN

Sichuan Mental Health.2024;37(3):243-248. doi:10.11886/scjsws20230717001

Background Mobile phone addiction has attracted widespread attention in society,and psychological abuse and neglect is an important factor in predicting mobile phone addiction,whereas limited research has been done to evaluate its impact on mobile phone addiction.Objective To explore the correlation of psychological abuse and neglect with mobile phone addiction,and to test the pathway of self-esteem and interpersonal alienation,so as to provide references for preventing and curbing mobile phone addiction in junior high school students.Methods In May 2022,a cluster sampling was utilized to select 800 students in two middle schools in a county of Hainan Province,and all students were assessed using Child Psychological Abuse and Neglect Scale(CPANS),Mobile Phone Addiction Index(MPAI),Rosenberg Self-esteem Scale(SES)and Interpersonal Alienation Scale of Adolescent StudentsAlienation Scale.Pearson correlation analysis was adopted to determine the correlation among the above-mentioned scales,and Process Macro 3.5 for SPSS was used to test the mediation effect.Results CPANS score was negatively correlated with SES score(r=-0.278,P<0.01),and positively correlated with Interpersonal Alienation Scale score and MPAI score(r=0.471,0.372,P<0.01).SES score was negatively correlated with Interpersonal Alienation Scale score and MPAI score(r=-0.438,-0.196,P<0.01).Interpersonal Alienation Scale score was positively correlated with MPAI score(r=0.392,P<0.01).Interpersonal alienation(indirect effect value was 0.104)played a mediation role in the relationship between psychological abuse and neglect and mobile phone addiction.Self-esteem and interpersonal alienation exhibited a chained mediation effect on the relationship between psychological abuse and neglect and mobile phone addiction(indirect effect value was 0.026),accounting for 6.99%of the total effect.Conclusion Psychological abuse and neglect can not only directly predict mobile phone addiction,but also can indirectly affect mobile phone addiction through separate mediation of interpersonal alienation or chained mediation of self-esteem and interpersonal alienation.

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Effect of fear of disease progression on sleep quality in patients with type 2 diabetes mellitus:the pathway of executive function

Na ZHANG ; Wenkai ZHENG ; Ling LI ; Mengge BAI ; Chunni HENG

Sichuan Mental Health.2024;37(3):249-254. doi:10.11886/scjsws20230823001

Background Type 2 diabetes mellitus is one of the most prevalent diseases,which imposes a heavy burden on patients' families and the society.Sleep disorders are recognized as risk factors for the development of diabetes,which may affect the onset and development of diabetes through neuro-endocrino-metabolic pathways,so identifying the factors responsible for the sleep quality of diabetic patients is of great importance in improving their sleep quality.Objective To investigate the relationship among fear of disease progression,executive function and sleep quality in patients with type 2 diabetes mellitus,so as to provide references for improvement of sleep quality in patients with type 2 diabetes mellitus.Methods A sample of 197 patients with type 2 diabetes mellitus who were admitted to the Endocrinology Department of the Second Affiliated Hospital of the Air Force Military Medical University from January to May 2023 and met the criteria defined in the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China(2020 edition)were consecutively selected.All subjects were assessed using Fear of Progression Questionnaire-Short Form(FoP-Q-SF),Behavior Rating Inventory of Executive Function-Adult version(BRIEF-A)and Pittsburgh Sleep Quality Index(PSQI).Then the Process macro for SPSS(Model 4)and Bootstrap technique were applied to examine the mediating effect of executive function on the relationship between fear of disease progression and sleep quality in patients with type 2 diabetes mellitus.Results ①75 patients(38.07%)with type 2 diabetes mellitus were found to have sleep problems.②PSQI score in patients with type 2 diabetes mellitus was positively correlated with FoP-Q-SF score and BRIEF-A score(r=0.159,0.287,P<0.01).③Executive function mediated the relationship between fear of disease progression and sleep quality,the indirect value was 0.076(95%CI:0.022～0.146),accounting for 39.58%of the total effect.Conclusion Sleep disorders are common in patients with type 2 diabetes mellitus,and executive function may play a medicating role in the relationship between fear of disease progression and sleep quality.

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