OBJECTIVE: To observe the clinical effect of Tiaoshen Guben holistic therapy of acupuncture and moxibustion (holistic treatment with acupuncture and moxibustion by adjusting the mind and consolidating the root) on comorbidity of depression and insomnia. METHODS: Twenty-four patients with comorbidity of depression and insomnia were included and treated with Tiaoshen Guben holistic therapy of acupuncture and moxibustion. Acupuncture was applied to Baihui (GV20), Guanyuan (CV4), bilateral Neiguan (PC6), etc. The refined moxibustion therapy was delivered at Zhongwan (CV12), Qihai (CV6), bilateral Yongquan (KI1), etc. Subcutaneous embedding therapy with thumb-tack needle was adopted at bilateral Xinshu (BL15), bilateral Pishu (BL20), etc. The intervention was operated once every other day, 3 treatments a week, and for 6 consecutive weeks. Before and after treatment completion, and in 1 month after treatment, Pittsburgh sleep quality index (PSQI) and Hamilton's depression scale (HAMD-17) were adopted to assess sleep quality and depression symptoms in the patients, respectively. Before and after treatment completion, using functional magnetic resonance imaging (fMRI), the functional connectivity (FC) of locus coeruleus (LC) in brain regions was evaluated; and the levels of serum norepinephrine (NE), cortisol (CORT), adrenocorticotropic hormone (ACTH) and corticotropin releasing hormone (CRH) were detected. RESULTS: Compared with the scores before treatment, PSQI and HAMD-17 scores after treatment completion and in 1 month after treatment were reduced (P<0.01); and strengthened FC was revealed between the right LC and the pars opercularis of the left inferior frontal gyrus, as well as the lateral occipital lobe region. After treatment completion, serum NE was elevated (P<0.01), the levels of CORT, ACTH and CRH were reduced (P<0.01). Before and after treatment completion, the difference in FC between the right LC and the pars opercularis of the left inferior frontal gyrus was negatively correlated with the differences in PSQI score (r = -0.484, P = 0.016) and HAMD-17 score (r = -0.233, P = 0.027). CONCLUSION Tiaoshen Guben holistic therapy of acupuncture and moxibustion can effectively alleviate depression symptoms and improve sleep quality in the patients with comorbidity of depression and insomnia, which is obtained probably through reducing the levels of serum CORT, ACTH and CRH, increasing serum NE, strengthening the FC of the right LC with the pars opercularis of the left inferior frontal gyrus and the lateral occipital lobe region.
Humans ; Moxibustion ; Sleep Initiation and Maintenance Disorders/therapy* ; Male ; Female ; Middle Aged ; Adult ; Acupuncture Therapy ; Depression/complications* ; Aged ; Young Adult ; Acupuncture Points ; Comorbidity

Objective:To explore the association of blood and urinary cadmium levels with lipid profile levels and dyslipidemia in Chinese adults aged 18 to 79 years.Methods:Based on the China National Human Biomonitoring (CNHBM) program, a cross-sectional survey was conducted from 2017 to 2018 using a multi-stage stratified random sampling method, including a total of 10 713 adults aged 18 to 79 years. Data was obtained through questionnaires, physical examinations, biological sample collection, and laboratory testing. Multiple linear mixed effect model (MLMM) and generalized linear mixed effect model (GLMM) were used to analyze the association of blood and creatinine-corrected urinary cadmium levels with lipid profile levels as well as dyslipidemia among adults.Results:The age of 10 713 participants was (47.23±0.24) years, with 5 372 males accounting for 61.3% of the national population. The weighted mean±standard error (SE) of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was (5.21±0.03), (1.86±0.03), (2.96±0.03), and (1.43±0.01) mmol/L, respectively. The prevalence rate of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, low HDL-C, and high LDL-C was 16.0%, 21.6%, 6.6%, 13.5%, and 10.0%, respectively. MLMM showed that, after adjusting for relevant confounders, log-transformed blood cadmium levels were positively associated with increased levels of TC, TG and LDL-C ( P<0.05). When blood cadmium levels were categorized into quartiles, compared to the lowest exposure group ( Q1), participants in the highest blood cadmium exposure group ( Q4) had increases of 0.19 (95% CI: 0.06, 0.32) mmol/L in TC and 0.25 (95% CI: 0.08, 0.43) mmol/L in TG. GLMM indicated that, after adjusting for confounders, higher blood cadmium exposure levels were associated with increased risks of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, and high LDL-C ( P<0.05). Further analysis by quartiles showed that, compared to the blood cadmium Q1 exposure group, the OR value (95% CI) for the Q4 group was 1.53 (1.12, 2.08) for hypercholesterolemia, 1.54 (1.09, 2.17) for hypertriglyceridemia, 2.24 (1.47, 3.40) for mixed hyperlipidemia, and 1.49 (1.07, 2.09) for high LDL-C. Conclusion:The cadmium internal exposure levels are associated with blood lipid profile levels as well as the incidence of dyslipidemia in Chinese adults aged 18 to 79.

Objective:To explore the association of blood and urinary cadmium levels with lipid profile levels and dyslipidemia in Chinese adults aged 18 to 79 years.Methods:Based on the China National Human Biomonitoring (CNHBM) program, a cross-sectional survey was conducted from 2017 to 2018 using a multi-stage stratified random sampling method, including a total of 10 713 adults aged 18 to 79 years. Data was obtained through questionnaires, physical examinations, biological sample collection, and laboratory testing. Multiple linear mixed effect model (MLMM) and generalized linear mixed effect model (GLMM) were used to analyze the association of blood and creatinine-corrected urinary cadmium levels with lipid profile levels as well as dyslipidemia among adults.Results:The age of 10 713 participants was (47.23±0.24) years, with 5 372 males accounting for 61.3% of the national population. The weighted mean±standard error (SE) of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) was (5.21±0.03), (1.86±0.03), (2.96±0.03), and (1.43±0.01) mmol/L, respectively. The prevalence rate of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, low HDL-C, and high LDL-C was 16.0%, 21.6%, 6.6%, 13.5%, and 10.0%, respectively. MLMM showed that, after adjusting for relevant confounders, log-transformed blood cadmium levels were positively associated with increased levels of TC, TG and LDL-C ( P<0.05). When blood cadmium levels were categorized into quartiles, compared to the lowest exposure group ( Q1), participants in the highest blood cadmium exposure group ( Q4) had increases of 0.19 (95% CI: 0.06, 0.32) mmol/L in TC and 0.25 (95% CI: 0.08, 0.43) mmol/L in TG. GLMM indicated that, after adjusting for confounders, higher blood cadmium exposure levels were associated with increased risks of hypercholesterolemia, hypertriglyceridemia, mixed hyperlipidemia, and high LDL-C ( P<0.05). Further analysis by quartiles showed that, compared to the blood cadmium Q1 exposure group, the OR value (95% CI) for the Q4 group was 1.53 (1.12, 2.08) for hypercholesterolemia, 1.54 (1.09, 2.17) for hypertriglyceridemia, 2.24 (1.47, 3.40) for mixed hyperlipidemia, and 1.49 (1.07, 2.09) for high LDL-C. Conclusion:The cadmium internal exposure levels are associated with blood lipid profile levels as well as the incidence of dyslipidemia in Chinese adults aged 18 to 79.

Objective:To investigate the effects of modified electroconvulsive therapy(MECT)in combina-tion with medication and medication alone on relapse and cognitive functioning in patients with major depressive disorder(MDD).Methods:Totally 324 patients meeting the diagnostic criteria ofthe DSM-5 for MDD were select-ed and divided into combined MECT group(n=117)and non-combined MECT group(n=207).At baseline and 5 years of follow-up,both groups completed the General Information Questionnaire,Montreal Cognitive Assessment(MoCA),and Hamilton Depression Scale(HAMD)to analyze associations between cognitive functioning and mul-tiple variables.Results:At baseline,there were no significant differences between the two groups on general infor-mation,MoCA,and HAMD scores(Ps＞0.05).After 5 years of follow-up,the relapse rate was lower in the com-bined MECT group than in the un-combined MECT group[(37.6％vs.72.0％),P＜0.001].MECT was a protec-tive factor against recurrence of MDD[RR(95％CI)=0.52(0.40-0.66)],and the MoCA scores were lower in the combined MECT group than in the un-combined MECT group[(20.9±3.5)vs.(23.6±4.2),β=-1.93,P＜0.001].Conclusion:Combined MECT is a protective factor against MDD recurrence.Its effects on the cognitive functioning of MDD patients may have long-term effects.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Objective:To explore the effects of anhedonia, childhood abuse, and depression on suicidal ideation, and the mediating role of anhedonia in adolescents.Methods:A total of 7 431 middle school students were invited to participate in the study. Suicidal ideation, depression, childhood abuse, and anhedonia were assessed by the Positive and Negative Suicide Ideation Scale (PANSI), Self-Rating Depression Scale (SDS), Childhood Trauma Questionnaire (CTQ) and Temporal Experience of Pleasure Scale (TEPS); according to the score of suicidal ideation, a total score of 36 was used as the cut-off score, all students were divided into the group with suicidal ideation ( n=1 265) and the group without suicidal ideation ( n=6 166). Difference test was performed using independent sample t-test and χ 2 test; Correlation analysis was performed by Pearson correlation; The process macro program compiled by Hayes was used to conduct the regulated mediation model analysis; The mediation effect values and 95%bootstrap confidence intervals of depressive symptoms between childhood maltreatment and suicidal ideation were analyzed by the bootstrap method; Simple slope analysis was utilized to examine the interaction effects for depression and anhedonia. Results:The detection rate of adolescent suicidal ideation was 17.02% (1 265/7 431);Childhood abuse significantly positively predicted depression ( β=0.56, P<0.001); depression significantly positively predicted suicidal ideation ( β=0.59, P<0.001); depression and anhedonia interaction significantly predicted suicidal ideation ( β=-0.05, P<0.001); simple slope analysis indicates that low anhedonia depression predicted suicidal ideation ( β=0.51, P<0.001) than the high anhedonia group ( β=0.47, P<0.001). Conclusion:Depression partially mediates the effects of childhood abuse on suicidal ideation, and anhedonia modulates the effects of childhood abuse on suicidal ideation. As the level of anhedonia gradually increases, the predictive effect of depression on suicidal ideation gradually decreases.

Objective:To explore the influence of maternal attachment and alexithymia on risk of non-suicidal self-injury in adolescents.Methods:Fifty-seven outpatients and inpatients from Anhui Mental Health Center with non-suicidal self-injury (NSSI) and their mothers were involved as the case group, and fifty-three age-, gender-, and education-matched adolescents and their mothers as the normal controls.They were assessed with the experience in close relationship inventory(ECR), the 20-item Toronto alexithymia scale (TAS-20) and the adolescents self-harm scale.SPSS 22.0 software was used for correlation analysis and Logistic regression analysis.Results:There were significant differences in attachment avoidance ((3.7±0.6), (3.0±0.6)), attachment anxiety ((4.0±0.7), (3.1±0.9)), difficulty identifying feelings ((2.9±0.7), (2.3±0.7)), difficulty describing feelings((3.0±0.6), (2.4±0.5)) and alexithymia ((57.2±8.3), (49.5±9.5))between the two mother groups ( t=6.53, 5.79, 4.01, 5.50, 4.56, all P<0.05). NSSI of adolescents was positively correlated with the scores of attachment anxiety, attachment avoidance, alexithymia, difficulty identifying feelings, difficulty describing feelings( r=0.487, 0.532, 0.401, 0.360, 0.468, all P<0.05). Logistic regression analysis showed that unsafe maternal attachment( B=2.57, OR=3.07, 95% CI=1.01-169.54, P=0.024)and the higher alexithymia level( B=1.95, OR=2.14, 95% CI=1.29-3.58, P=0.003)could lead to higher risk of NSSI in adolescents. Conclusion:Unsafe maternal attachment and the higher alexithymia level may be the risk factors for adolescents with NSSI.

Objective To explore relationship of psychotic symptoms with childhood abuse and psy-chological resilience in patients with depression. Methods According to whether the psychotic symptoms ex-ist,160 patients with depression were divided into psychotic major depression (PMD group,n=80) and non-psychotic major depression (NMD group,n=80). All patients were assessed with general information ques-tionnaire,the childhood trauma questionnaire(CTQ) and the Conner-Davidson resilience scale( CD-RISC). Using logistic regression analysis to explore the influencing factors of psychiatric symptoms in depressive pa-tients. Results There were significant differences in the emotional abuse (( 17. 80 ± 2. 78), ( 10. 14 ± 1. 46)),the physical abuse ((16. 98±3. 21),(8. 31±1. 24)),the sexual abuse ((8. 74±1. 87),(7. 85± 1. 71)),the emotional neglect (( 21. 46 ± 1. 95), ( 15. 71 ± 2. 12)) and total score of childhood abuse ((81. 98±9. 88),(54. 10±4. 36)) between the two group (F=68. 88,70. 91,2. 91,45. 93,77. 28,all P<0. 01). There were significant differences in the resilience (F=4. 47,P<0. 01),the power ( F=5. 59,P<0. 01),the optimism (F=2. 35,P=0. 033) and total score of psychological resilience ( F=7. 23,P<0. 01) between the two group. Logistic regression analysis showed that attack in early age( B=2. 57,P=0. 024,OR (95%CI)=13. 07(1. 01-169. 54)) was a risk factor for psychotic symptoms in patients with depression. No experience of childhood abuse (B=-1. 95,P=0. 003,OR( 95% CI)= 0. 14(0. 04-0. 52)),the higher psy-chological resilience level(B=-2. 54,P<0. 01,OR(95%CI)=0. 08(0. 02-0. 27)),mild to moderate depres-sion (B=-1. 33,P=0. 013,OR(95%CI)=0. 27(0. 09-0. 76))were protective factors of psychotic symptoms in patients with depression. Conclusion Psychological resilience may be the protective factor for psychotic symptoms in patients with depression while childhood abuse may be a risk factor.

Objective To explore the characteristics of attachment and the effects of childhood trauma,emotional autonomy and parental rearing style of anxiety disorders.Methods 38 outpatients and hospital patients in Anhui Mental Health Center with anxiety were recruited as the study group,and 39 age-,gender-,and educationmatched adult college students or medical staff were screened as the control group.The study group and control group were assessed with adult attachment questionnaire3.1 (AAQ3.1),parental bonding instrument (PBI),childhood trauma questionnaire 28item short form (CTQ-SF) and emotional autonomy scale (EAS).Results ①Higher levels of insecure adult attachment (84.2％) were reported in the anxiety disorders group compared with the normal controls(10.3％),and the attachment type of two groups had statistical significance(x2 =42.28,P＜0.01).② The attachment of anxiety disorders,emotional autonomy,childhood trauma and the way of parenting was related to different degree.Attachment,childhood trauma and parenting were significantly increased in the anxiety disorders group compared with the normal controls(P＜0.05).The mother attachment factors were significantly correlated with individualized (r=0.405,P＜0.405),mother love (r=0.358,P＜0.358),mother control (r=0.467,P＜0.467),father control (r=0.460,P＜0.01),emotional abuse (r=0.473,P＜0.473) and sexual abuse (r=0.494,P＜0.01).The father attachment factors were significantly correlated with individualized (r=0.520,P＜0.01),emotional abuse (r=0.339,P＜0.339) and sexual abuse (r=0.378,P＜0.05).And individualized,mother love,parental control,emotional and physical abuse could be employed to predict attachment factor.Conclusion The attachment pattern is insecure in the anxiety disorders.Emotional autonomy,childhood trauma and parenting have a significant influence on attachment patterns of anxiety disorders.

ObjectiveTo explore the relationship among the aggressive behavior,hostile attribution bias and childhood trauma in schizophrenic patients.Methods 135 schizophrenic patients were tested with Modified Overt Aggression Scale (MOAS),the Chinese-version of the Ambiguous Intentions Hostility Questionnaire (AIHQ-C) and Childhood Trauma Questionnaire (CTQ).According to the score of the MOAS,the patients were divided into the aggressive group ( n =58 ) and the non-aggressive group ( n =77 ).The hostile attribution bias and the childhood trauma were compared between the two groups,and correlation and hierarchical regression analysis were used to investigate the relationships of the variables.ResultsCompared with the non-aggressive patients,the aggressive patients had significantly higher AIHQ-C total hostility bias score (6.27 ± 1.20 vs 5.90 ± 0.97,P ＜0.05 ),total blame bias score (8.04 ± 1.97 vs 6.91 ± 2.10,P ＜ 0.01 ) and total aggression bias score ( 6.17 ±1.02 vs 5.59 ± 1.04,P ＜ 0.01 ).Correlation analysis showed that the MOAS score,AIHQ scores and the total score of CTQ were significantly positively correlated with each other ( r =0.171 ～ 0.350,P ＜ 0.05 ～0.01 ).Regression analysis indicated the hostile attribution bias directly predicted the aggressive behavior( β =0.342,P ＜0.05) and completely mediated the relationship between the childhood trauma and the aggressive behavior.ConclusionThe aggressive behavior in schizophrenic patients is associated with the experience of childhood trauma and the attribution style.The childhood trauma indirectly influences the aggressive behavior by the mediating of the hostile attribution bias.