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Challenges and strategies in depression research

Sichuan Mental Health.2023;36(5):385-387. doi:10.11886/scjsws20231008003

Depression constitutes the most common mental disorder with high prevalence rate， and is the leading contributor to the global burden of disease. Many factors are found to influence the development of depression， whereas either reliable biomarkers for the early diagnosis or diagnostic criteria for subtype classification currently exist for depression. Therefore， this paper gives a detailed discussion on the current status and existing challenges of depression research in the context of brain imaging， psychoneuroimmunology and electroencephalography， thus providing a new perspective for research directions and future strategies related to depression.

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Effects of acute-phase monotherapy and combination therapy on quality of life in patients with depressive disorders

Xiaodan REN ; Qi TIAN ; Jia ZHOU ; Yanping REN ; Le XIAO

Sichuan Mental Health.2023;36(5):388-395. doi:10.11886/scjsws20230308002

BackgroundThe treatment of patients with depressive disorders is short of targeted outcome assessment. As a secondary outcome that is guided by patient values， quality of life is thus of relatively high evaluative value. In China， there exists a lack of large sample prospective cohort studies evaluating the effect of different treatment protocols on quality of life in patients with acute depressive disorder. ObjectiveTo explore the effects of monotherapy and combination therapy on the quality of life of patients with depressive disorder in acute phase， so as to provide references for optimizing the outcome of treatment for such patients. MethodsA prospective follow-up cohort study from August 24， 2020 to November 29， 2021 was conducted， including 1 330 patients from 22 hospitals across 18 cities in China. All these patients met the diagnostic criteria for depressive episodes， recurrent depressive disorder from the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Patients were divided into monotherapy group （n=969） and combination therapy group （n=361） according to the acute phase treatment protocol. At baseline， the end of the first half month as well as the 1^st， 2^nd， 3^rd， 6^th， 9^th and 12^th months of treatment， patients were assessed with Inventory of Depressive Symptomatology Self-report （IDS-SR30）， Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form （Q-LES-Q-SF）， Concise Health Risk Tracking Scale （CHRT） and Siehan Disability Scale （SDS）. Frequency， Intensity， and Burden of Side Effects Rating （FIBSER） was adopted for assessment at each visit time point of treatment. Spearman correlation analysis was adopted to examine the correlation of quality of life with suicide risk， adverse reactions and impaired social functioning among patients. ResultsAt the end of three months of treatment， the Q-LES-Q-SF score of monotherapy group was higher than that of combination therapy group， and the difference was statistically significant （Z=2.008， P<0.05）. The time effects of both treatment protocols possessed statistical significance （F=111.393， P<0.01）. At the end of three months of treatment， the Q-LES-Q-SF score was negatively correlated with CHRT and SDS scores， respectively， in both monotherapy group and combination treatment group （r=-0.660， -0.712， -0.634， -0.718， P<0.01）. ConclusionBoth monotherapy and combination therapy can facilitate the improvement of the life quality of patients with acute depressive disorder， but monotherapy may achieve better than the combination therapy in this aspect. ［Funded by The National Key Research and Development Program of China "Research on the Prevention and Control of Major Chronic Non-communicable Diseases" （number， 2017YFC1311101）］

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Clinical characteristics and influencing factors of onset age in inpatients with early- and late-onset obsessive-compulsive disorder inpatients

Ping ZHOU ; Chuyao WANG ; Minyao XIE ; Haocheng CHEN ; Shasha SONG ; Huan ZHANG ; Na LIU

Sichuan Mental Health.2023;36(5):396-401. doi:10.11886/scjsws20230727003

BackgroundThe obsessive-compulsive disorder （OCD） features complexity in etiological factors and high heterogeneity in clinical manifestations. OCD patients with different ages of onset vary in clinical symptoms and etiology. However， current studies on inpatients with early- and late-onset OCD are limited. ObjectiveTo explore the differences in clinical characteristics between early- and late-onset OCD inpatients as well as the factors affecting the onset age of OCD， so as to provide references for early screening and treatment of OCD patients. MethodsThis study was based on collected medical records of 540 patients with OCD who received inpatient treatments at the Affiliated Brain Hospital of Nanjing Medical University between March 2012 and March 2023. Patients with onset age above 18 were placed into early-onset group （n=310） and the others into late-onset group （n=230）. Then differences in demographic data and clinical symptoms between two groups of patients were compared. Binary logistic regression was used to analyze the factors that affect the onset age of OCD. ResultsObserving the demographic data， there were significant differences between the two groups in the results in gender， marital status， family history of mental illness， ratio of comorbidities with other mental illnesses， occupational composition， education level and types of obsessive-compulsive symptoms （χ²=22.302、170.556， 9.224， 13.624， 242.277， 59.791， 7.231， P<0.05 or 0.01）. Also， the results in ages of onset and hospitalization between two groups were significantly different （Z=-19.915， 16.831， P<0.01）. In terms of clinical symptoms， the early onset group had a higher proportion of symptoms including obsessive thinking （χ²=11.998， P<0.05）， ordering （χ²=7.731， P<0.05） and rituals （χ²=7.714， P<0.05）， while the proportion of obsessive checking （χ²=8.204， P<0.05） and washing （χ²=7.506， P<0.05） symptoms were relatively low. In terms of risk factors， there were several independent risk factors that influence the onset age of OCD inpatients， including comorbid neurodevelopmental disorder， comorbid affective disorder， family history of schizophrenia and family history of affective disorder （OR=19.587， 1.830， 3.065， 4.431， P<0.05）. Among them， comorbid neurodevelopmental disorder was the core influencing factor， and female gender was a protective factor for early-onset patients （OR=0.417， P<0.01）. ConclusionThere are differences in demographic data and clinical symptom characteristics between early- and late-onset OCD inpatients， and comorbid neurodevelopmental disorder plays as a core risk factor affecting the onset age of OCD inpatients. ［Funded by Jiangsu Province Key Research and Development Plan for Social Development Special Project（number， BE2021616）； Jiangsu Province Social Development General Project （number， BE2022678）； Key Project of Nanjing Medical Science and Technology Development Fund （number， ZKX20029）］

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Study on altered functional and effective connectivity of bilateral precuneus in drug-naïve first-episode patients with adolescent-onset schizophrenia

Hongchao YAO ; Junlin WU ; Hongwei LI ; Lihua ZHUO ; Guoping HUANG ; Ruohan FENG ; Ruishan LIU ; Lu WANG ; Zhenlin LI

Sichuan Mental Health.2023;36(5):402-408. doi:10.11886/scjsws20230828001

BackgroundCompared with adult-onset schizophrenia， patients with adolescent-onset schizophrenia experience a high genetic susceptibility， severe negative symptoms， high recurrence rate， poor prognosis and social function recovery. And clarifying the brain functional alterations in adolescent-onset schizophrenia is of great significance for further elucidating the pathogenesis of the disease and exploring personalized and precise treatment. ObjectiveTo investigate the altered functional and effective connectivity of bilateral precuneus in first-episode patients with adolescent-onset schizophrenia based on resting-state functional magnetic resonance imaging （rs-fMRI）， thus providing reliable imaging evidence in guiding the study on mechanism involved in adolescent-onset schizophrenia. MethodsTwenty-one drugnaïve first-episode patients with adolescent-onset schizophrenia who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） criteria for schizophrenia were enrolled， and another 21 psychiatrially healthy controls matched on age， educational background and gender were concurrently selected. The schizophrenic subjects were evaluated using the Psychotic Symptom Rating Scales （PSYRATS） and Positive and Negative Symptom Scale （PANSS）. All participants underwent rs-fMRI scans， and the whole-brain seed-based functional and effective connectivity analyses were conducted in bilateral cuneus region. Then the correlation between functional connectivity strength and clinical symptoms of patients was discussed. ResultsIn terms of functional connectivity， the functional connectivity of bilateral precuneus and left middle temporal gyrus was increased in patient group compared with healthy control group ［P<0.01， family-wise error （FWE） correction at cluster level， P<0.05］. In terms of effective connectivity， patient group responded to negative feedback with greater activation of seed region and left middle frontal gyrus than healthy control group. Correlation analysis within patient group denoted that the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus was positively correlated with the total PANSS score （r=0.450， P<0.05）. ConclusionThe resting-state functional and effective connectivity of bilateral precuneus is abnormally alerted in drugnaïve first-episode patients with adolescent-onset schizophrenia， and the decreased effective connectivity of bilateral precuneus and left middle frontal gyrus may be related to the development of clinical symptoms. ［Funded by National Key Research and Development Program of China （number， 2022YFC2009901， 2022YFC2009900）］

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Association of the brain-derived neurotrophic factor gene polymorphisms and clinical symptoms in patients with schizophrenia

Jiali LUO ; Jie ZHANG ; Jing WAN ; Jinming YU ; Junjiao PING

Sichuan Mental Health.2023;36(5):409-415. doi:10.11886/scjsws20230220002

BackgroundIn relation to neurodevelopmental hypothesis in the etiology of schizophrenia， brain-derived neurotrophic factor （BDNF） as a neurotrophin occupies a relatively dominant position in neuronal development and is a potential biomarker for schizophrenia， and previous studies have suggested that its serum concentration and genetic polymorphisms play a vital role in the pathogenesis of schizophrenia， but this remains controversial. ObjectiveTo analyze the difference in BDNF serum concentration between schizophrenic patients and healthy controls， and to explore the correlation of three BDNF single nucleotide polymorphism （SNPs） including rs11030101， rs2030324 and rs6265 with BDNF serum concentration and clinical symptoms in patients with schizophrenia， thus providing references for the clinical treatment of schizophrenia. MethodsA case-control study was conducted on 55 patients with schizophrenia who attended the Zhongshan Third People's Hospital from January 2019 to December 2020 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and 31 healthy controls concurrently recruited from the hospital or general population. Positive and Negative Symptom Scale （PANSS） was utilized to evaluate the psychiatric symptoms of patients with schizophrenia. BDNF serum concentration in all participants was measured using enzyme-linked immunosorbent assay （ELISA）， and the genotype distributions of three BDNF SNPs （rs11030101， rs2030324， rs6265） were investigated by polymerase chain reaction sequence-based typing method. ResultsBDNF serum concentration in patient group was lower than that in control group， with statistical difference （t=-3.804， P<0.01）. In terms of clinical symptoms， PANSS total score， excitement/hostility domain score， and depression/anxiety domain score demonstrated statistical difference among patients with different genotypes at SNP rs11030101 （t=2.022， Z=-2.696， -2.467， P<0.05 or 0.01）. No statistical difference was noted in BDNF serum concentration in patients with different genotypes at three BDNF SNPs （Z=1.483， F=2.584， 0.417， P>0.05）. ConclusionPatients with schizophrenia are found to have low BDNF serum concentration， and the three BDNF SNPs （rs11030101， rs2030324， rs6265） are not associated with BDNF serum concentration， whereas the BDNF rs11030101 polymorphism may contribute to the manifestation of clinical symptoms of excitement/hostility and depression/anxiety in patients with schizophrenia. Furthermore， BDNF serum concentration seems to be more dependent on clinical diagnosis effect rather than genetic polymorphism. ［Funded by Guangdong Province Medical Science and Technology Research Fund Project （number， A2021205）； Zhongshan Medical Research Program （number， 2022J221）］

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Cognitive function of patients with comorbid borderline personality disorder and bipolar disorder

Chaomin WANG ; Bo XIN ; Na LI ; Kun ZHANG ; Hua XUE ; Jincheng WANG ; Cuixia AN

Sichuan Mental Health.2023;36(5):416-421. doi:10.11886/scjsws20230426002

BackgroundThe comorbidity rate of bipolar disorder and borderline personality disorder （BPD） is high， and the cognitive impairment of comorbidity patients is more serious. ObjectiveTo explore the difference of cognitive function between bipolar disorder patients with BPD or not， so as to provide references for clinical diagnosis and treatment. MethodsUsing simple random sampling， 60 patients with bipolar disorder comorbidity BPD treated in the First Hospital of Hebei Medical University from April 2021 to April 2022 were selected as the research group， including 33 patients with bipolar depression and 27 patients with bipolar mania. At the same time， 60 patients with bipolar disorder were randomly selected as the control group， including 35 patients with bipolar depression and 25 patients with bipolar mania. The cognitive function of patients was evaluated by the Chinese version of Repeatable Battery for the Assessment of Neuropsychological Status （RBANS） and the Stroop Color Word Test. ResultsThe immediate memory， visual span， speech function and total score of RBANS in the comorbid group were lower than those in the non-comorbid group， and the differences were statistically significant （t=-2.356， -2.138， -3.306， -2.729， P<0.05 or 0.01）. The single word time， single color time， double word time and double color time in Stroop Color Word Test in comorbid group were longer than those in non-comorbid group， and the differences were statistically significant （t=4.808， 3.341， 5.249， 5.167， P<0.01）. The immediate memory， visual span， speech function and total score in RBANS of bipolar depression patients with comorbid BPD were lower than those of bipolar depression patients without comorbid BPD （t=-2.446， -2.407， -2.231， -2.078， P<0.05）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those of non-comorbid BPD patients （t=-3.652， 3.035， 4.406， 5.016， P<0.01）. The speech function and total score of RBANS in bipolar manic patients in comorbid group were higher than those in non-comorbid group （t=-2.777， -2.347， P<0.05 or 0.01）， and the time of single word， single color， double word and double color in Stroop Color Word Test were longer than those in non-comorbid group （t=3.600， 2.658， 2.943， 4.337， P<0.05 or 0.01）. ConclusionThe cognitive impairment of bipolar disorder patients comorbid with BPD is more severe than that of patients without comorbid with BPD. ［Funded by Medical Science Research Project of Hebei Province in 2022 （number， 20221407）］

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Effect of home-based early intensive behavioral intervention using VB-MAPP on verbal ability in children with autism spectrum disorder

Xueping CHEN ; Qingying ZHANG ; Yi WU ; Hongwu WANG ; Wenwang RAO ; Duo LI ; Yan OU ; Shaoyuan SU ; Guimin LIU

Sichuan Mental Health.2023;36(5):422-427. doi:10.11886/scjsws20221229004

BackgroundHome-based intervention occupies a prominent place in the treatment of autism spectrum disorder （ASD） in children， whereas previous studies on the effect of home-based early intensive behavioral intervention on verbal ability of children with ASD are somewhat inadequate. ObjectiveTo study the effects of intensive family behavioral of intervention based on Verbal Behavior Milestones Assessment and Placement Program （VB-MAPP） on the language ability of children with ASD， so as to provide references for the development of family intervention strategies for children with ASD. MethodsChildren aged 2 to 3 years old who attended the Children's Rehabilitation Department of the Second Affiliated Hospital of Shantou University Medical College from September 2020 to December 2021 and met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for ASD were selected as the study objects. A non-randomized concurrent control trial was conducted to compare a study group （n=24） receiving home-based early intensive behavioral intervention using VB-MAPP with a control group （n=14） receiving training from other special institutions or early childhood education institutions. The intervention lasted for 6 months in both groups. Before and after the intervention， the VB-MAPP milestone assessment was performed in the two groups， and the VB-MAPP milestone score， mand， trac and listener responds were selected as the study indicators. Then the intervention effect was compared between two groups， and the multiple linear regression was performed to screen the related influencing factors. ResultsAfter intervention， the total milestone assessment score， mand， tact and listener responds scores of study group were higher than those of control group， with statistical difference （Z=-4.339~-2.195， P<0.05 or 0.01）. Multiple linear regression analysis denoted that the average weekly hours of home-based intervention in the first three months had certain effect on listener responds （β=1.029， P<0.05）. ConclusionApplication of home-based early intensive behavior intervention using VB-MAPP may contribute to the improvement of verbal abilities such as mand， tact and listener responds in children with ASD. ［Funded by 2020 Guangdong Provincial Science and Technology Innovation Strategy Special Fund （number， 20200601）］

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Effects of assisted reproductive technology on physique and autistic behavior of children： a 3-year longitudinal follow-up study

Xinyu CHEN ; Chuanchuan CHEN ; Bei LUO ; Shuai QU ; Guoqiang WANG ; Kai ZHANG

Sichuan Mental Health.2023;36(5):428-432. doi:10.11886/scjsws20221026001

BackgroundAssisted reproductive technology is increasingly mature and widely used in clinic. As more and more newborns are born with assisted reproductive technology， the health problems of these newborns also need more attention. ObjectiveTo investigate the effects of assisted reproductive technology on newborn physique and autistic behavior， and to raise the attention of autistic behavior of assisted reproductive children. MethodsFrom the medical record information system， 588 assisted reproduction newborns （assisted reproduction group） born in the obstetrics department of Chaohu Hospital of Anhui Medical University from August 2018 to August 2019 were selected as the study objects. From the medical records information system， 600 newborns born naturally in the obstetrics department in the same period of time were selected as the control group. The basic information of all newborns was collected， including the mother's age and years of education， sex， gestational age， birth weight and birth length， and they were assessed by the Clancy Autism Behavior Scale （CABS） at 3 years of follow-up. ResultsThe educational years of mothers in assisted reproduction group were longer than those in control group ［（12.04±1.96） years vs. （11.34±2.90） years， t=-4.887， P<0.01］， gestational age and birth weight of assisted reproduction group were lower than those of control group ［（38.68±2.56） weeks vs. （39.53±2.91） weeks， t=5.315， P<0.01；（3 273.27±720.39） g vs. （3 158.29±701.74） g， t=2.792， P<0.05］. There was no significant difference in birth length between the two groups ［（49.97±5.94） cm vs. （50.07±6.08） cm， t=-0.287， P>0.05］. At the age of three， the weight and height of the assisted reproduction group were both lower than those of the control group ［（16.16±2.53）kg vs.（16.96±1.67）kg， t=6.393， P<0.01，（95.81±4.50）cm vs.（97.47±7.49）cm， t=4.626， P<0.01］. Respectively， 6 （1.00%） and 15 （2.55%） children with autism were detected in the control group and assisted reproduction group， and the difference was statistically significant （χ²=4.113， P<0.05）. ConclusionAssisted reproductive technology may affect the physical and neurological development of children. ［Funded by Outstanding Young Talents Support Program of Anhui Education Department （number， gxyqZD2022022）］

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Effect of fluoxetine combined with Shugan Jieyu capsule in the treatment of patients with depression and its impact on heart rate variability

Yuanyuan ZHAO ; Qian WU ; Bo LIU ; Fei GUO ; Cong LIU ; Yanli XIE ; Shichang YANG

Sichuan Mental Health.2023;36(5):433-439. doi:10.11886/scjsws20230429001

BackgroundDepression is a kind of disease with relatively high suicide risk， which seriously affects the quality of life of patients and their families， and brings a great burden to society. Antidepressants in western medicine are effective， but the improvement of depressive symptoms is relatively limited by single use， and the combination of two antidepressants may increase the risk of adverse reactions in patients. The rational use of Chinese patent medicine and western medicine may play a complementary role， and the safety of Chinese patent medicine is high. ObjectiveTo explore the early clinical efficacy of fluoxetine combined with Shugan Jieyu capsule in the treatment of depression， and to compare the differences in efficacy， safety and influence on heart rate variability between fluoxetine combined with Shugan Jieyu capsule and fluoxetine alone， so as to provide references for clinical medication of depression patients. MethodsFrom December 2015 to June 2016， 64 patients who met the diagnostic criteria of depression in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） who were hospitalized in the Second Affiliated Hospital of Xinxiang Medical University were selected as the research objects， and were randomly divided into the combined medication group and the fluoxetine group with 32 patients in each group. Patients in both groups were treated with fluoxetine， while patients in the combined medication group were treated with Shugan Jieyu capsule on this basis. Patients in both groups were assessed with Hamilton Depression Scale-24 item （HAMD-24）， Hamilton Anxiety Scale （HAMA） and Heart Rate Variability （HRV） before treatment， and were assessed with HAMD-24 and Treatment Emergent Symptom Scale （TESS） at the end of the 2^nd， 4^th and 6^th week of treatment， and HRV was analyzed again at the end of the 6^th week of treatment. ResultsThe study ultimately included 60 patients with depression， with 30 cases in the combination therapy group and 30 cases in the fluoxetine group. At the end of the 2^nd， 4^th and 6^th week of treatment， the HAMD-24 score of the combined drug group was lower than that of the fluoxetine group （t=-2.677， -3.960， -4.432， P<0.05 or 0.01）. Compared with before treatment， the 24-hour mean standard deviation of normal RR intervals （SDNN）， normal low frequency （nLF） and normal high frequency （nHF） in the combined treatment group were higher at the end of the 6^th week （t=-73.970， -31.878， -38.721， P<0.01）， but significant lower in LF/HF （t=3.525， P<0.01）. At the end of the 6^th week of treatment， the total effective rate of the combined treatment group was higher than that of fluoxetine group， and the difference was statistically significant （86.67% vs. 70.00%， χ²=18.764， P<0.01）. At the 2^nd， 4^th and 6^th week of treatment， there was no significant difference in the number of adverse reactions between the two groups （P>0.05）. ConclusionCompared with fluoxetine alone， Shugan Jieyu capsule combined with fluoxetine may be better in clinical efficacy and improvement of heart rate variability in patients with depression， without increasing adverse reactions.

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CiteSpace-based visualization analysis of domestic and foreign research on somatic symptom disorder

Liuxi WANG ; Qinglin CHENG ; Fuzhi LIAN

Sichuan Mental Health.2023;36(5):440-446. doi:10.11886/scjsws20230220001

BackgroundThe etiology and pathogenesis of somatic symptom disorder are complicated， for which no effective treatment currently exists， posing a critical impact on their quality of life. ObjectiveTo analyze the current situation and development trend in domestic and foreign research on somatic symptom disorder from 2011 to 2021， and to better understand the research frontiers and hot spots in this field. MethodsOn 31 August 2022， literature on somatic symptom disorder published from January 1， 2011 to January 1， 2023 were searched in China National knowledge Infrastructure （CNKI）， Wanfang Data Knowledge Service Platform， Web of Science and PubMed， and a total of 15 035 articles were included， then the visualization analysis of the number of publications and keywords was conducted based on Microsoft Excel and CiteSpace software. ResultsIn the field of somatic symptoms disorder research from 2011 to 2021， the number of annual publications demonstrated an overall upward trend in foreign studies， and displayed a slow downward trend in domestic studies. The keyword co-occurrence network analysis revealed that the top five high-frequency keywords were "mental health" "depressive disorder" "depression" "anxiety" and "somatic symptom" in domestic studies， and were "symptom" "prevalence" "depression" "disorder" and "quality of life" in foreign studies. The burst analysis suggested that the burst terms in past five years were "somatic symptom" "syndrome" and "quality of life" in domestic studies， and were "major depressive disorder" and "outcome" in foreign studies. The clustering analysis yielded 8 clusters in domestic studies and 4 clusters in foreign studies， reflecting in the related disease， prevention and treatment protocols and epidemiological characteristics of somatic symptom disorder. ConclusionIn recent years， the publications and academic concerns regarding the research on somatic symptom disorder show an upward trend in foreign studies and are relatively inadequate in domestic studies， and both the domestic and foreign studies have been focused on the influencing factors of somatic symptom disorder. ［Funded by the Medical Health Science and Technology Project of Zhejiang Provincial （number， 2020PY064）； Medical Health Science and Technology Project of Hangzhou （number， 0020190783）］

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