BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

BackgroundChildhood and adolescence are critical stages in psychological development. During the public health emergencies， children and adolescents exhibit weaker psychological coping ability， making them more vulnerable to mental health issues. ObjectiveTo investigate trends in the distribution of hospitalized children and adolescents patients at mental health centers of a general hospital during public health emergencies， so as to provide references for future research and intervention for adolescent under similar contexts. MethodsA retrospective cohort study was conducted on 6 613 children and adolescent patients hospitalized and discharged from the Mental Health Center of West China Hospital， Sichuan University， from January 1， 2018 to December 31， 2022. Patients were included if their primary diagnosis was schizophrenia， schizotypal disorder and delusional disorder， depressive disorder， bipolar disorder， anxiety disorder or post-traumatic stress disorder in International Classification of Diseases， tenth edition （ICD-10）. Patients were divided into two groups based on their admission period： pre-COVID-19 pandemic period （from January 1， 2018 to December 31， 2019） and during the COVID-19 pandemic （from January 1， 2020 to December 31， 2022）. Trends in diagnostic distributions were analyzed using the trend chi-square test. ResultsSignificant differences were observed between pre-pandemic and pandemic periods in age， length of hospital stay and sex（t=10.743， 4.082， χ²=29.092， P<0.01）. During the COVID-19 pandemic， the proportions of depressive disorder， bipolar disorder and anxiety disorder among hospitalized children and adolescents patients increased （χ²_trend=11.058， 67.333， 17.276， P<0.01）， while the proportions of schizophrenia， schizotypal disorder and delusional disorder decreased （χ²_trend=219.924， P<0.01）. Among patients aged 6~14 years， the proportion of bipolar disorder increased （χ²_trend=18.207， P<0.01）. Among patients aged 15~19 years， the proportion of bipolar disorder and anxiety disorder also increased （χ²_trend=57.339， 19.011， P<0.01）. In male patients， the proportions of depressive disorder and bipolar disorder increased （χ²_trend=21.729， 11.380， P<0.01）， while in female patients， the proportion of bipolar disorder and anxiety disorder increased （χ²_trend=54.830， 14.377， P<0.01）. ConclusionCompared with the pre-pandemic period， during the COVID-19 pandemic， among hospitalized children and adolescents patients， there are more female patients than male patients， with a tendency for patients to be younger and have shorter lengths of hospital stay. The proportions of depressive disorder， bipolar disorder and anxiety disorder have all increased.

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.

BackgroundFunctional near-infrared spectroscopy （fNIRS） is a new generation of imaging tool that can be used to assist the diagnosis of psychiatric disorders. However， whether the patterns of prefrontal cortex activation observed by fNIRS are specific for different psychiatric disorders remains to be explored. ObjectiveTo investigate the characteristics of prefrontal cortex activation in patients with depression， anxiety disorder， bipolar disorder and schizophrenia in verbal fluency task （VFT） using fNIRS. MethodsFrom September to December 2021， 39 patients with schizophrenia， 205 patients with depressive disorder， 212 patients with anxiety disorder and 77 patients with bipolar disorder meeting the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited in the outpatient and inpatient department of West China Hospital， Sichuan University. fNIRS was used to monitor the prefrontal cortex hemodynamic changes of patients under VFT， and the clinical symptoms of patients were assessed by Symptom Checklist 90 （SCL-90） and Hypomania Checklist-32 items（HCL-32）. Differences in mean oxyhemoglobin （HbO₂） concentration and the initial slope from 2 to 7 second during VFT were compared among patients with different diseases， and the correlation between mean HbO₂ concentration/initial slope and clinical symptoms was analyzed by partial correlation analysis. ResultsThe concentration of HbO₂ in channel 4 （Z=2.828， P=0.028） and channel 6 （Z=2.912， P=0.022） in patients with depression were significantly higher than those in patients with schizophrenia. Patients with anxiety had significantly higher changes in mean HbO₂ concentration in channel 4 （Z=3.154， P=0.010）， channel 5 （Z=3.021， P=0.015）， channel 6 （Z=2.980， P=0.017） and of all channels （Z=2.881， P=0.024） than those of schizophrenia patients. There was a statistically significant difference in the initial slope of channel 3 between patients with depressive disorder and those with bipolar disorder （Z=2.691， P=0.039）. Among patients with bipolar disorder， the anger-hostility scores of SCL-90 were negatively correlated with the mean HbO₂ concentration changes in channel 4 （r=-0.505， P=0.004）， channel 6 （r=-0.390， P=0.004）， channel 15 （r=-0.546， P=0.002）， channel 16 （r=-0.550， P=0.002） and the mean HbO₂ concentration changes of all channels （r=-0.491， P=0.006）. ConclusionPatients with schizophrenia had lower activation in frontopolar and orbitofrontal region than patients with depression and anxiety disorder， and the initial slope of the right frontopolar， inferior frontal and orbitofrontal region in patients with depression is higher than patients with bipolar disorder. In addition， patients with bipolar disorder had less activation in the frontopolar and orbitofrontal lobe， the insular cover of Broca's area and the upper outer frontal cortex， and were more irritable and hostile. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， ZYJC21083）］

Non-suicidal self-injury(NSSI)is a behavior that occurs most often in adolescents.Previous studies showed that this behavior has the addictive related characteristics.Interestingly,the addictive nature of NSSI behavior can be assessed using Ottawa selfinjury inventory(OSI),the higher addiction score indicates the more serious NSSI behavior.From the psychological mechanism,different models show that the addictive feature of NSSI behavior may be related to the behavioral reinforcement mechanism and the interaction mechanism of emotion,cognition,and behavior of susceptible individuals.From the neurobiological mechanisms,opioid and dopamine may mediate the addiction characteristics of NSSI,and the brain reward circuit originated in the midbrain system may play a key role.From the perspective of treatment,current psychotherapy may have advantages in alleviating NSSI behavior,while therapeutic drugs and non-invasive neural regulation of substance use disorders may improve NSSI behavior via alleviating behavioral addiction.In conclusion,NSSI may be an addictive disorder,which needs further verification in the future studies.

OBJECTIVE: We hypothesize that the amplitude of low-frequency fluctuations (ALFF) is involved in the altered regional baseline brain function in social anxiety disorder (SAD). The aim of the study was to analyze the altered baseline brain activity in drug-naive adult patients with SAD. METHODS: We investigated spontaneous and baseline brain activities by obtaining the resting-state functional magnetic resonance imaging data of 20 drug-naive adult SAD patients and 19 healthy controls. Voxels were used to analyze the ALFF values using one- and two-sample t-tests. A post-hoc correlation of clinical symptoms was also performed. RESULTS: Our findings show decreased ALFF in the bilateral insula, left medial superior frontal gyrus, left precuneus, left middle temporal gyrus, right middle temporal pole, and left fusiform gyrus of the SAD group. The SAD patients exhibited significantly increased ALFF in the right inferior temporal gyrus, right middle temporal gyrus, bilateral middle occipital gyrus, orbital superior frontal gyrus, right fusiform gyrus, right medial superior frontal gyrus, and left parahippocampal gyrus. Moreover, the Liebowitz Social Anxiety Scale results for the SAD patients were positively correlated with the mean Z values of the right middle occipital and right inferior occipital but showed a negative correlation with the mean Z values of the right superior temporal gyrus and right medial superior frontal gyrus. CONCLUSION: These results of the altered regional baseline brain function in SAD suggest that the regions with abnormal spontaneous activities are involved in the underlying pathophysiology of SAD patients.
Adult* ; Anxiety ; Anxiety Disorders* ; Brain* ; Humans ; Magnetic Resonance Imaging* ; Orbit ; Parahippocampal Gyrus

Objective To review recent neuroimaging studies of aggressive/violent behaviors in schizophrenia and related the neural circuits of aggressive behaviors,tocusing on structure magnetic resonance imaging (MRI) method,published from 2000 to 2014.Methods A systematic literature search was conducted using articles from PsycINFO,Embase,Pubmed and Cnki pnblished between 2000 and 2014,we usedaggressive, violent, schizophrenia, structure M RI as the key words,to explore the relationship between schizophrenia of aggressive/violent behaviors and the related neural circuits.Results Of the 18 studies included in the analysis,mostly were case-control studies,two were written in Chinese.The neuroimaging literature on aggression in schizophrenia revealed the related grey matter volume of brain areas which contained the frontal lobe,temporal lobe,amygdala,hippocampus,cerebelum and caudate nucleus.Conclusion Findings from the current reviews suggest that the occurrence of violent/aggressive behaviors of schizophrenia were related with serval neural circuits as the frontal-temporal cognitive circuit,Papez circuit,cerebellum advaneed cognitive circuit and caudate nucleus-reward seeking cireuits.However,the precise violent/aggressive neural mechanism has vet to be studied further.

Objective To evaluate the clinical value of whole-brain diffusion tensor imaging(DTI) in diagnosing patients with social anxiety disorder(SAD) using an automated method based on support vector machine(SVM) classification.Methods Whole brain DTI data were collected from 19 patients with SAD and 19 age-,gender-and education-matched healthy control(HC) subjects.Fractional anisotropy(FA) of whole brain was obtained by input all tensor images into Diffusion Toolkit software.Based upon the characteristics of brain FA,the pattern recognition of brain image data(PROBID) toolbox on the grounds of SVM algorithm was employed to classify the subjects,evaluate the diagnostic value of whole-brain FA data based SVM in diagnosing SAD patients and verify the robustness of the diagnostic results using permutation test with the threshold at P≤0.001.The weight vector score of each voxel was calculated according to the ratio between this voxel and whole brain in FA differences of the two groups.The white matter regions identified by setting the threshold to the top 30％ of the weight vector scores with at least 10 contiguous voxels were demonstrated by MRIcro software.Results Diagnostic accuracy of whole-brain FA based SVM in diagnosing SAD was 92.11％ (35/38) in which the specificity was 94.44％ (17/18),the sensitivity was 90.00％(18/20),the positive likelihood ratio was 17.01,the negative likelihood ratio was 0.11 and the diagnostic index was 184.22％.Permutation test suggested that the diagnostic results were significantly reliable.White matter regions showing major contributions favoring SAD over HC were located in the genu and splenium of the corpus callosum,the left uncinate fasciculus,the left inferior longitudinal fasciculus,the left inferior fronto-occipital fasciculus,bilateral frontal gyri and the left occipital lobe.Whereas,white matter in bilateral anterior cingula,the left middle cerebellar peduncle and the left inferior parietal lobule showed more contributions to diagnose HC than to diagnose SAD.Conclusions As whole brain FA data based on SVM showing a high accuracy in diagnosing SAD,brain DTI characteristics have the potential to be the specific indicators in the diagnosis of SAD.SVM might be used as a tool to verify the reliability of white matter abnormalities and provide regions of interest in DTI study of neurological and psychiatric diseases.

Objective To investigate the therapeutic effect of stereotactic surgical treatment and postoperative cognitive functions in patients with treat-resistant obsessive compulsive disorder(TRO). Methods Twelve patients with TRO receiving MRI stereotactic bilateral anterior capsulotomy was retrospectively studied. The evaluation was conducted using the Yale-Brown obsessive compulsive rating scale (Y-BOCS),Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC),Wechsler Memory Scale-Revised in China(WMS-R), Modified Version of Wisconsin Card Sorting Tests (M-WCST) before and 6 months after the operation. Results The scores of Y-BOCS was 5.00(1.00,12.25) and 25.00 (20.25,32.00) after and before surgery, respectively. The scores of Y-BOCS were significantly lower after surgery than before (P<0.05). Most of cognitive function tests were not significantly different in TRO between pre-operation and 6 month post-operation (P>0.05).There were significant improvements in several cognitive tests after surgery including im-mediately logical memory 20.00(12.50,24.00),delayed logical memory16.50(11.50,21.75),immediately visual reproduc- tion 12.00(11.00,14.00),delayed visual reproduction11.00(8.50,14.00) and block design test scores 36.50(29.75,46.75), immediately logical memory14.00(13.00,18.75),delayed logical memory 14.50 (8.75,17.00),immediately visual reproduc-tion 11.00(6.50,11.75),delayed visual reproduction 8.50(6.25,10.00) and block design test scores 30.50(21.00,41.50) (P<0.05). Conclusions MRI-guided bilateral anterior internal capsulotomy is effective and safe treatment for patients with TRO and can improve their cognitive function.

To investigate the prevalence of mental health problems in male violent offenders of Hunan and Sichuan Provinces; and to compare the types and severity of problems between the violent and nonviolent offenders.Methods:Ninety-one violent juvenile offenders and 64 nonviolent juvenile offenders in the juvenile detention centers of Hunan,and 81 violent juvenile offenders in the juvenile detention centers of Sichuan; 39 high school students from a middle school of Hunan Province and 49 from a middle school of Sichuan Province were investigated using the Investigation Screening Inventory for Child Mental Disorder and the Kiddy Schedule for Affective Diseases and Schizophrenia (K-SADS-PL),and classified according to the Diagnostic and Statistical Manual of Mental Disorders.Results:In the Hunan violent group,86.6％ met the criterion of conduct disorder (CD),17.6％ of substance abuse,9.9％ of substance dependence,while in the Hunan nonviolent group,75.0％ met the criterion of CD,and 11.7％ of substance abuse; these were all significantly higher than those of the control group (P＜0.05).In the Sichuan violent group,17.3％ met the criterion of attention deficit/hyperactivity disorder (ADHD),18.5％ of oppositional defiant disorder (ODD),69.1％of CD,and 22.2％ of substance abuse; these were all significantly higher than those of the Sichuan control group.Moreover,63.7％ of Hunan-violent,55.6％ of Sichuan-violent,and 45.0％ of Hunannonviolent offenders had a previous offence records.Conclusion:Mental and behavioral disorders among delinquent youth is becoming a serious problem,and there is an urgent need to develop and implement effective assessment and treatment approaches for juvenile offenders with the aim of reducing offence and recidivism in this population.