To standardize clinical treatment decisions and improve the comprehensive diagnosis and treatment of bipolar disorder in China, the Psychiatric Branch of the Chinese Medical Association initiated the Guidelines for the Prevention and Treatment of Bipolar disorder in China (2025 edition). This protocol summary describes the background and purpose of the guideline, the formulation method, working group members, division of responsibilities, guideline registration, conflicts of interest, collection and selection of clinical issues, the evidence-based foundation of the guideline, writing and external review, as well as publishing, dissemination, and other aspects.

To standardize clinical treatment decisions and improve the comprehensive diagnosis and treatment of bipolar disorder in China, the Psychiatric Branch of the Chinese Medical Association initiated the Guidelines for the Prevention and Treatment of Bipolar disorder in China (2025 edition). This protocol summary describes the background and purpose of the guideline, the formulation method, working group members, division of responsibilities, guideline registration, conflicts of interest, collection and selection of clinical issues, the evidence-based foundation of the guideline, writing and external review, as well as publishing, dissemination, and other aspects.

Objective:To find out the occurrence of anxiety and depressive symptoms, and the major risk factors, and the participation rate, as well as the experience of medical personnel who are involved in the intervention.Methods:Since January 2018, a pilot intervention had been carried out on pregnant women registered in the antenatal clinic. The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms, and risk factors were screened too. Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel. A qualitative interview was conducted on the intervention providers.Results:A total of 9 488 pregnant women were included, and the positive rate of moderate anxiety symptoms was 3.0%, the positive rate of severe anxiety symptoms was 1.4%; the positive rate of moderate depression symptoms was 18.1%, and the positive rate of severe depressive symptoms was 5.2%; the comorbidity rate of anxiety and depression symptoms was 3.4%. The first three risk factors for pregnant women with anxiety symptoms were: once had premenstrual stress symptom, excessive fear of fetal growth, previous abnormal maternal history; the first three risk factors for pregnant women with depressive symptoms: once had premenstrual stress symptom, previous abnormal maternal history, this pregnancy was cherished; the first three risk factors for pregnant women with moderate and above anxiety combined with depression were: once had premenstrual stress symptom, excessive fear of fetal growth, and fear the delivery process is not successful. Among the psychological moderate risk pregnant women, 19.1% participated in the midwife joint counselor clinic, and 1.7% participated in the obstetrician joint psychological specialist nurse clinic, 2.2% of the pregnant women with high risk participated in the psychological multidisciplinary consultation, and 1.7% referred to the psychiatric department. From the interviews, providers believed that it was necessary to further strengthen the ability of psychological intervention capacity, and the psychological screening tools needed to be improved, and the problems sought by pregnant women involved in physical, psychological and social aspects, and the influence of pregnant women's treatment compliance included multiple factors.Conclusions:The psychological health care service during pregnancy was feasible, but the screening scales needed further examination. The mental health care ability of obstetric medical staff needed to be strengthened, and the compliance of pregnant women with mental health services needed to be improved.

Amisulpride,a kind of the second generation antipsychotics,was marketed in China in 2010.A series of clinical research and experience before and after listed,especially the data based on Chinese population,provided evidence for the generalization and application of amisulpride.In order to optimize the clinical application of amisulpride,and improve the prognosis of patients,Expert Advice on the Practical Use of Amisulpride in the Treatment of Schizophrenia is presented here.This advice is based on the recent evidence and clinical experience,for guiding the clinical medication of amisulpride.

Objective To explore brain glucose metabolism changes in positron emission tomography (PET) studies in depression patients with systematic review and meta-analysis.Methods Standard search strategy for the Cochrane Review Group was performed in PubMed,EMBase,and Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,VIP and CBMDisc databases.The papers were published from Jan 1,1982 to Apr 8,2014.Search key words included depression,depressive,PET,position emission tomography,FDG and 18 F-Fluorodeoxyglucose.Hand searching and truncation were also used to avoid missing references.Psychiatric journals and fluoro-deoxyglucose related articles were manual searched from 2013 October to April 2014.SDM (signed differential mapping) software was used for voxelbased meta-analysis (P ≤ 0.005,extent threshold ＞ 10).MNI coordinates were calculated to Talairach coordinates in all of the included studies.Brain parameter mapping was reconstructed by SDM software.Then Pooled Meta-analysis was performed.Results Ten studies met the inclusion criteria,including 188 depressed patients and 169 healthy controls.There was no significant heterogeneity between the ten studies (P ＞ 0.05).SDM analysis showed depressive patients had decreased brain metabolism in right inferior frontal gyrus (orbital part and opercular part),right gyrus rectus,right dorsolateral superior frontal gyrus,right median cingulate/paracingulate gyri,left superior temporal gyrus and left middle frontal gyrus (orbital part) and increased brain metabolism in bilateral thalamus,right angular gyrus and left precentral gyrus.Conclusions These results suggest that depressive patients had brain function abnormalities with decreased activity in fronto-temporal-limbic system and increased activity in thalamus.

Objective To explore brain glucose metabolism changes in positron emission tomography (PET) studies in depression patients with systematic review and meta-analysis.Methods Standard search strategy for the Cochrane Review Group was performed in PubMed,EMBase,and Web of Science,PsycINFO,Cochrane Library,CNKI,Wanfang,VIP and CBMDisc databases.The papers were published from Jan 1,1982 to Apr 8,2014.Search key words included depression,depressive,PET,position emission tomography,FDG and 18 F-Fluorodeoxyglucose.Hand searching and truncation were also used to avoid missing references.Psychiatric journals and fluoro-deoxyglucose related articles were manual searched from 2013 October to April 2014.SDM (signed differential mapping) software was used for voxelbased meta-analysis (P ≤ 0.005,extent threshold ＞ 10).MNI coordinates were calculated to Talairach coordinates in all of the included studies.Brain parameter mapping was reconstructed by SDM software.Then Pooled Meta-analysis was performed.Results Ten studies met the inclusion criteria,including 188 depressed patients and 169 healthy controls.There was no significant heterogeneity between the ten studies (P ＞ 0.05).SDM analysis showed depressive patients had decreased brain metabolism in right inferior frontal gyrus (orbital part and opercular part),right gyrus rectus,right dorsolateral superior frontal gyrus,right median cingulate/paracingulate gyri,left superior temporal gyrus and left middle frontal gyrus (orbital part) and increased brain metabolism in bilateral thalamus,right angular gyrus and left precentral gyrus.Conclusions These results suggest that depressive patients had brain function abnormalities with decreased activity in fronto-temporal-limbic system and increased activity in thalamus.

ObjectiveTo explore gamma resonance signals in acute medication-free schizophrenics,and the effects of antipsychotics on gamma activity.MethodsSchizophrenia patients( n=56) and normal controls ( n =18 ) underwent auditory steady-state event-related potential testing and were evaluated of their psychopathic syndromes with the positive and negative syndrome scale (PANSS) before and after 8 weeks of medication with oral chlorpromazine or clozapine.Click trains varying in rate of stimulation 40 Hz were presented; EEG-evoked power and intertrial phase synchronization were obtained in response to stimulation frequency.ResultsSchizophrenic patients showed reduced evoked power( Fz:( 5.08 ± 1.48) μV2 vs (6.91 ± 1.64) μV2 ; Cz:(4.70 ± 2.03 ) μV2 vs ( 6.93 ± 1.43 ) μV2 ; P ＜ 0.01 ) and a tendency of reduction in phase synchronization ( Fz:0.14 ± 0.04 vs 0.13 ± 0.04,P =0.051 ; Cz:0.18 ± 0.06 vs 0.17 ± 0.06,P =0.056) in response to 40 Hz stimulation.However significant correlations were not observed between oscillatory responses and clinical parameters in schizophrenic patients.There were no significant differences of gamma power and ITC in patients before and after chlorpromazine or clozapine administered.ConclusionSchizophrenia patients have deficits in the power and coherent of gamma oscillations,and can not be normalized by medication with antipsychotics.

Objective To compare the results of Danielson procedure with and without prosthetic valve ring in treating Ebstein anomaly and to define the effect of prosthetic valve ring on the procedure.Methods From January 2006 to December 2009,31 cases of Ebstein anomaly over 10 years old were classified as type A or type B according the Carpentier＇s classification scheme.Patients were treated by Danielson procedure or Danielson procedure plus prosthetic valve ring at Anzhen hospital.They were retrospectively classified as Danielson procedure group (group A,n =19) and Danielson procedure plus prosthetic valve ring group (group B,n =12 ).Results There was 1 early in-hospital death due to lung infection and hypoxemia in group A,and no early death in group B ( Fisher exact test,P =0.51 ).The mean follow-up time was ( 23.0 ± 18.5 ) months (5 -41 months).The cumulative follow-up time was 59.42 patient-years.There was one late death in group A due to the redo tricuspid valve plastic procedure because of severe tricuspid regurgitation,and no late death in group B.With echocardiography inspection,11 patients had mild and 7 had moderate to severe tricuspid regurgitation in group A,and only 2 mild tricuspid regurgitation in group B.The tricuspid valve competence after surgery in group B was better than in group A ( Fisher exact test,P=0.024).The 6-minute walk distance test (6MWD) in group B was significantly better than in group A(415 ±41 )m vs ( 382 ± 46 ) m( t test,P =0.047 ).The New York heart functional class in group B was statistically better than in Group A ( P =0.024).Conclusion Although there was no significant difference in the early and late mortality rate between the two groups after surgery,Danielson procedure plus prosthetic valve ring was better than pure Danielson procedure in prevention of late tricuspid regurgitation recurrence,heart function and 6MWD test during follow-up.

To investigate clinical features of somatization disorder. Methods Seventy-nine paeeeeee with somatization disorder (SD), diagnosed based on the Chinese Classification and Diagnostic Criteria of Mental Disorders, version 3 ( CCMD-3 ) during September 2006 to August 2008, were selected and assessed by serf-edited somatic symptom list ( SSSL), symptom checklist-90 ( SCL-90 ), Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD). Results Sixty-two symptoms in two to six systems were involved in SDs, with a mean and standard deviation of 12.4 ± 6.6 symptoms in 4.2 ± 0.9 systems. The skin, nervous system, gastrointestinal system, respiratory and circulatory systems were the most involved in those symptoms. Depression, anxiety and hostile mood, number and total score of somatic symptoms all correlated positively with the total scores of HAMA and scores of somatic anxiety and mental anxiety (P < 0.01 ), but not with the total score of HAMD (P > 0.05 ). Conclusions Multiple systems were involved in SD, usually with complicated symptoms including depression and anxiety, which was prone to inappropriate medical diagnoses. Number and severity of somatic symptoms positively correlated with severity of anxious symptoms.

Objective The study is designed to evaluate the difference in identification for depression and clinical effectiveness of its treatment between psychiatrists and non-psychiatric Dhysieians at out-patient departments of general hospitals and to analyze its related factors.Methods Totally,680 patients who visited psychiatric clinics in nine general hospitals of Shanghai at first time were screened by psychiatrists using Composite International Diagnostic Interview(CIDI)for depression and the screening resuhs were compared to the diagnosis made by non-psychiatric physicians as goal-keepers there.Altogether 297 patients with depression were recruited and assessed using Hamilton Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA).A self-made questionnaire for basic information was used to assess the ability for identification of depression in non-psychiatric physicians of general hospitals.Results Psychiatrists identified depression correctly in 337 of 680 patients who visited psychiatric clinics in general hospitals at their first visit,but non-psychiatric physicians only identified 216 patients,with statistically significant difference(χ2=30.73,P=0.000).A consistent agreement on depression diagnosis between the findings by psychiatrists and by CIDI was reached with Kappa of 0.774,but Kappa for that between the findings by non-psychiatric physicians and CIDI was 0.439.Effectiveness of treatment for depression by psychiatrists was better than that by non-psychiatric physicians,with higher total score and scores for each item of HAMD four,eight and 12 weeks after treatment,respectively(P＜0.05 or P＜0.01).Length of professional work of non-psychiatric physicians and annual time for professional training in management of mental disorders associated with their ability of identification for depression(P＜0.05).Conclusion Ability of non-psychiatric physicians to identify alQd cope with depression in the psychiatric department of general hospitals was insufficient,suggesting that more importance should be attached to the management of service quality at psychiatric department of general hospitals.