Objective:A nationwide multi-center and large sample survey was conducted to compare the validity of the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) questionnaire and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier (CUDOS-M) depression subscale in identifying mixed features in patients experiencing (hypo-) manic episodes.Methods:Using a convenience sampling method, 366 patients with bipolar disorder experiencing acute (hypo-) manic episodes who met the inclusion and exclusion criteria were recruited. The diagnosis of "with mixed features" was based on the DSM-5 criteria for mixed features. The predictive validity of the MINI-M questionnaire and the CUDOS-M depression subscale to screen mixed features was analyzed using the receiver operating characteristic (ROC) curve. Additionally, the difference in area under the ROC curve (AUC) between the two instruments was compared.Results:The AUC for the MINI-M questionnaire and the CUDOS-M depression subscale in screening mixed features were 0.79 (95 %CI=0.75-0.84) and 0.81 (95 %CI=0.77-0.86), respectively. There was no statistically significant difference in AUC between the two measurements ( Z=-1.19, P>0.05). Among patients with acute (hypo-) manic episodes, 45.9% (168/366) presented with mixed features according to the DSM-5 criteria, while the corresponding figures were 43.7% (160/366) using the MINI-M questionnaire (total score≥3) and 42.1% (154/366) using the CUDOS-M depression subscale (total score≥20). Screening results were comparable among the three measures. Conclusion:Mixed features are common among patients experiencing acute (hypo-) manic episodes. The MINI-M questionnaire and the CUDOS-M depression subscale demonstrate equivalent validity in identifying mixed features.

Objective:A nationwide multi-center and large sample survey was conducted to compare the validity of the Mini International Neuropsychiatric Interview (Hypo-) Manic Episode with Mixed Features-DSM-5 Module (MINI-M) questionnaire and the Clinically Useful Depression Outcome Scale Supplemented with Questions for the DSM-5 Mixed Features Specifier (CUDOS-M) depression subscale in identifying mixed features in patients experiencing (hypo-) manic episodes.Methods:Using a convenience sampling method, 366 patients with bipolar disorder experiencing acute (hypo-) manic episodes who met the inclusion and exclusion criteria were recruited. The diagnosis of "with mixed features" was based on the DSM-5 criteria for mixed features. The predictive validity of the MINI-M questionnaire and the CUDOS-M depression subscale to screen mixed features was analyzed using the receiver operating characteristic (ROC) curve. Additionally, the difference in area under the ROC curve (AUC) between the two instruments was compared.Results:The AUC for the MINI-M questionnaire and the CUDOS-M depression subscale in screening mixed features were 0.79 (95 %CI=0.75-0.84) and 0.81 (95 %CI=0.77-0.86), respectively. There was no statistically significant difference in AUC between the two measurements ( Z=-1.19, P>0.05). Among patients with acute (hypo-) manic episodes, 45.9% (168/366) presented with mixed features according to the DSM-5 criteria, while the corresponding figures were 43.7% (160/366) using the MINI-M questionnaire (total score≥3) and 42.1% (154/366) using the CUDOS-M depression subscale (total score≥20). Screening results were comparable among the three measures. Conclusion:Mixed features are common among patients experiencing acute (hypo-) manic episodes. The MINI-M questionnaire and the CUDOS-M depression subscale demonstrate equivalent validity in identifying mixed features.

Objective:This study explores the diagnostic efficiency of a modified semi-structured clinical interview (MSCI) based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) for bipolar disorder (BD) by comparing MSCI with a traditionally structured interview and a self-reported diagnostic scale.Methods:MSCI, Structured Clinical Interview for DSM Axis Ⅰ Disorders-Patient Edition (SCID-Ⅰ/P), and 32-item hypomania checklist (HCL-32) were simultaneously administered in 445 outpatients with major depressive disorder ( n=100) or BD ( n=345). All patients were followed up for at least half a year and at least three times to confirm the diagnosis based on the clinical data, follow-up evaluation, and treatment efficacy. The sensitivity and specificity of the three diagnostic strategies were compared using the chi-square test. Results:The sensitivity of MSCI was significantly higher than that of SCID-Ⅰ/P (0.67 vs. 0.32, χ 2=82.10, P<0.001) but was similar to that of HCL-32 (0.67 vs. 0.70, χ 2=2.22, P=0.136). MSCI presented significantly lower specificity than SCID-Ⅰ/P (0.96 vs.1.0, χ 2=4.08, P=0.043) but significantly higher specificity than HCL-32 (0.96 vs.0.67, χ 2=27.89, P<0.001). For the diagnosis of bipolar Ⅰ disorder, no significant difference was found between the sensitivity of MSCI (1.0) and SCID-Ⅰ/P (0.73) (χ 2=3.47, P=0.062) and between the sensitivity of MSCI and HCL-32 (0.73) (χ 2=3.47, P=0.062). For bipolar Ⅱ disorder, the sensitivity of MSCI (0.90) was significantly higher than that of SCID-Ⅰ/P (0.41) (χ 2=92.49, P<0.001) and that of HCL-32 (0.66) (χ 2=22.51, P<0.001). For BD with mixed features, the sensitivity of MSCI (0.37) was significantly higher than that of SCID-Ⅰ/P (0.19) (χ 2=10.85, P<0.001) but lower than that of HCL-32 (0.80) (χ 2=49.40, P<0.001). For other specified bipolar and related disorders, the sensitivity of MSCI (0.41) did not significantly differ from that of SCID-Ⅰ/P (0.18) (χ 2=2.73, P=0.100) but was significantly lower than that of HCL-32 (0.70) (χ 2=4.53, P=0.033). Conclusion:Compared to SCID-Ⅰ/P and HCL-32, MSCI has better diagnostic efficiency for BD.

Objective:This study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.Methods:Based on the Phase Ⅰ (2012) and Phase Ⅱ (2021) databases of National Bipolar Mania Pathway Survey (BIPAS), patients with bipolar disorder were included. General demographic data, clinical characteristics, symptomatic phenotypes, and mixed characteristics were retrieved. The detection rates and symptomatic performances of patients with or without mixed states in Phase Ⅰ and Ⅱ were compared using the chi-square test.Results:For patients with mixed states, the detection rate during Phase Ⅱ (2021) using DSM-5 (18.79%, 199/1 059) criteria was significantly higher than that during Phase Ⅰ (2012) using ICD-10 (6.78%, 199/2 934; χ 2=125.05, P<0.001). Whether using ICD-10 or DSM-5 criteria, patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations. Conclusion:The DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states. The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.

Objective:This study explores the diagnostic efficiency of a modified semi-structured clinical interview (MSCI) based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) for bipolar disorder (BD) by comparing MSCI with a traditionally structured interview and a self-reported diagnostic scale.Methods:MSCI, Structured Clinical Interview for DSM Axis Ⅰ Disorders-Patient Edition (SCID-Ⅰ/P), and 32-item hypomania checklist (HCL-32) were simultaneously administered in 445 outpatients with major depressive disorder ( n=100) or BD ( n=345). All patients were followed up for at least half a year and at least three times to confirm the diagnosis based on the clinical data, follow-up evaluation, and treatment efficacy. The sensitivity and specificity of the three diagnostic strategies were compared using the chi-square test. Results:The sensitivity of MSCI was significantly higher than that of SCID-Ⅰ/P (0.67 vs. 0.32, χ 2=82.10, P<0.001) but was similar to that of HCL-32 (0.67 vs. 0.70, χ 2=2.22, P=0.136). MSCI presented significantly lower specificity than SCID-Ⅰ/P (0.96 vs.1.0, χ 2=4.08, P=0.043) but significantly higher specificity than HCL-32 (0.96 vs.0.67, χ 2=27.89, P<0.001). For the diagnosis of bipolar Ⅰ disorder, no significant difference was found between the sensitivity of MSCI (1.0) and SCID-Ⅰ/P (0.73) (χ 2=3.47, P=0.062) and between the sensitivity of MSCI and HCL-32 (0.73) (χ 2=3.47, P=0.062). For bipolar Ⅱ disorder, the sensitivity of MSCI (0.90) was significantly higher than that of SCID-Ⅰ/P (0.41) (χ 2=92.49, P<0.001) and that of HCL-32 (0.66) (χ 2=22.51, P<0.001). For BD with mixed features, the sensitivity of MSCI (0.37) was significantly higher than that of SCID-Ⅰ/P (0.19) (χ 2=10.85, P<0.001) but lower than that of HCL-32 (0.80) (χ 2=49.40, P<0.001). For other specified bipolar and related disorders, the sensitivity of MSCI (0.41) did not significantly differ from that of SCID-Ⅰ/P (0.18) (χ 2=2.73, P=0.100) but was significantly lower than that of HCL-32 (0.70) (χ 2=4.53, P=0.033). Conclusion:Compared to SCID-Ⅰ/P and HCL-32, MSCI has better diagnostic efficiency for BD.

Objective:This study investigates the difference in the detection rate and symptomatology between ICD-10 and DSM-5 diagnostic criteria for bipolar disorder with mixed states.Methods:Based on the Phase Ⅰ (2012) and Phase Ⅱ (2021) databases of National Bipolar Mania Pathway Survey (BIPAS), patients with bipolar disorder were included. General demographic data, clinical characteristics, symptomatic phenotypes, and mixed characteristics were retrieved. The detection rates and symptomatic performances of patients with or without mixed states in Phase Ⅰ and Ⅱ were compared using the chi-square test.Results:For patients with mixed states, the detection rate during Phase Ⅱ (2021) using DSM-5 (18.79%, 199/1 059) criteria was significantly higher than that during Phase Ⅰ (2012) using ICD-10 (6.78%, 199/2 934; χ 2=125.05, P<0.001). Whether using ICD-10 or DSM-5 criteria, patients with mixed states had a significantly higher frequency of multiple symptomatic manifestations. Conclusion:The DSM-5 diagnostic criteria generate a high detection rate for bipolar disorder with mixed states. The clinical phenotypes of bipolar disorder with mixed states vary significantly using different diagnostic tools.

Objective To explore the association of methyl-CpG-binding protein2 (MeCP2) polymorphisms with female schizophrenia in Chinese Han population.Methods By using the technology based on microarray Chip,gene polymorphism analysis of 4 locus located in the gene MeCP2 was performed in 126 schizophrenia patients fulfilled with DSM-Ⅳ-TR criteria for schizophrenia and in 144 healthy controls.Chi square test was used to compare the inter-group differences of genotypic and allelic distribution.Haplotype case-control association analysis based on linkage disequilibrium was conducted using SNP stats online software after the data was screened.The significance of results was corrected by permutation test.Results To the point of Locus rs1616369 which located in Gene MeCP2,the distribution of the genotype G/A between two groups(24.8％ vs 34.3％) reached significance (P＜0.05) ; rs3027933,genotype G/C(25.6％ vs 34.8％),P＜0.05 ; rs17435,genotype T/A(25.6％ vs 35.5％),P ＜ 0.05 ; rs2239464,genotype C/A (58.5％ vs 71.8％),P＜ 0.05.The distribution prevalence of Haplotype GCCA was 0.1581 in case group,and 0.2389 in control group,reached significant difference(P＜0.05).Conclusion As to female MeCP2 gene,the genotype on the four locations might associate with the onset of schizophrenia,MeCP2 might be susceptibility gene of female schizophrenia.The Haplotype GCCA maybe the protective factor.

Objective to evaluate the validation of atypical depression among Chinese outpatients with depressive episodes and explore the role of atypical depressive symptoms in distinguishing bipolar depression from unipolar depression.Methods Structural clinical interviews with self-compiled questionnaires were performed on 276 outpatients with current depressive episode,then comparison of clinical characteristics including age of onset,gender proportion,seasonality,comorbidity of anxiety disorder,bipolar property,psychotic features,number of depressive episodes,and maximum duration of depressive episode were conducted between atypical (defined by DSM-Ⅳ-TR) and nonatypical depression.then the rate of atypical depressive symptoms were compared between unipolar depression and bipolar depression.Results The proportion of atypical depression among all the participants was 23.9％.Compared to nonatypical depression,psychotic features were more likely seen in atypical depression (20.0％ vs 9.1％,P＜0.05),but no difference was found in other clinical features between atypical and nonatypical depression.Except mood reactivity,atypical symptoms including oversleeping(45.5％ vs 26.0％),overeating (22.7％ vs 15.4％),weight gain(24.1％ vs 14.6％),leaden paralysis (56.6％ vs 47.2％),interpersonal rejection sensitivity(66.7％ vs 34.2％) were more likely to occur in bipolar depression than in unipolar depression,the difference was statistically significant for oversleeping and interpersonal rejection sensitivity (P ＜ 0.05).Patients with mood reactivity differed little from those without mood reactivity in other clinical features.No association was found between mood reactivity,leaden paralysis and other criteria symptoms of atypical depression.Conclusion-Atypical depression might be a useful concept,but its diagnostic criteria needs further validation among Chinese population.

Objective To test the efficacy of cognitive behavioral self help therapy for chronic insomnia (CBTI-SH) patients with hypnotic long-term use.Methods A total of 60 adults with chronic insomnia and common comorbidities were recruited.Participants were randomly assigned to either intervention group (IG,n =30) if they had used hypnotics more than 6 months,or control group(CG,n =30) if they had never used hypnotics in the past 6 months.All the patients were given CBTI-SH for 4 weeks.The primary outcome was self-report symptom,based on sleep diaries (including Sleep Latency(SL),Wake after Sleep Onset(WASO),Total Sleep Time(TST),Time In Bed(TIB),Sleep Efficiency(SE) which were evaluated on baseline and at the end of the 2nd,4th week treatment.Continuous variables were evaluated by repeated-measures multivariate analyses of variance (MANOVA).At the conclusion of treatment,each participant was asked how many days per week they enacted each of 6 core elements of the CBT regimen.Linear regression models were examined to determine net predictors of CBTI-SH adherence.Results The MANOVA showed a significant treatment group × time interaction,as well as time main effects for SE,TIB and WASO(P＜0.05).The patients in CG made better improvements than those in IG on SE,TIB and WASO((0.19 ±0.08) vs(0.09 ±0.09),(92.48 ± 32.64) vs (78.06 ±60.05),(103.08 ±64.82) vs (64.92 ±56.36),respectively) (P ＜ 0.05).Effect size were 1.14,0.85 and 0.62 respectively.Self-ratings of treatment adherence showed patients in the IG reported less adherence to standard rise time and TIB prescription than those in CG.(P ＜ 0.05).According to the linear regression models,both age and the comorbidity of chronic somatic diseases explained net associations with CBTI-SH adherence (P ＜ 0.05).Conclusion Chronic insomnia patients with hypnotic long-term use show less sleep improvement and less adherence to CBTI-SH compared with those who don' t use these medicines.Both age and the comorbidity of chronic somatic diseases explain net associations with CBTI-SH adherence.

ObjectiveTo explore the personality traits of Han Chinese women with recurrent depression.MethodsAssessed by the Big Five Inventory (BFI),a comparison research was conducted between 118 Han Chinese women with recurrent depression and 65 sex,race and culture background matched health controls.Results Han Chinese women with recurrent depression scored lower in extraversion,conscientiousness and openness ( 17.93± 5.43,30.24 ± 5.94,30.03 ± 7.33 ) than matched controls ( 20.72 ± 3.79,31.94 ± 3.84,32.75 ± 5.32 ),while scored higher in neuroticism (21.38 ± 3.91) than the later one ( 27.57 ± 6.19 ).A binary logistic regression model,with group (case vs.control) as dependent variable and extroversion,conscientiousness,openness and neuroticism as independent variables,was built to assess each personality dimension's independent impact on recurrent depression.It came out to be that only extraversion ( OR =0.881,95％ CI =0.083-0.966,P=0.007) and neuroticism ( OR =1.225,95％ CI =1.134-1.323,P ＜ 0.01 ) were statistically significantly associated with recurrent depression ( P＜ 0.05 ).ConclusionIn the big five personality model,extraversion and neuroticism might act as independent personality traits to impact Han Chinese women with recurrent depression in a positive and negative way respectively.