BackgroundAggressive behavior in schizophrenic patients could result in legal disputes and public safety concerns. In patients with illness episodes of different numbers， there may exist differences in the association between levels of novel inflammatory indicators and aggressivity. ObjectiveTo investigate the differences in the correlation between levels of novel inflammatory indicators and aggressivity in patients with first-episode and recurrent schizophrenia， in order to search for inflammatory biomarkers to assess aggression level in schizophrenic patients. MethodsA total of 168 schizophrenic patients were selected as subjects， who were hospitalized for acute disease onset in Chaohu Hospital of Anhui Medical University from October 2022 to April 2024 as well as met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）. Patients were divided into first-episode group （n=58） and recurrent group （n=110）. Meanwhile， 110 healthy controls from community who matched in age and gender with the patient group were recruited. All patients were evaluated with Modified Overt Aggression Scale （MOAS） and Positive and Negative Syndrome Scale （PANSS）. All subjects went through examination of the levels of novel inflammatory indicators， including neutrophil/lymphocyte ratio （NLR）， monocyte/lymphocyte ratio （MLR）， platelet/lymphocyte ratio （PLR）， neutrophil/high-density lipoprotein ratio （NHR）， monocyte/high-density lipoprotein ratio （MHR） and platelet/high-density lipoprotein ratio （PHR）. Spearman correlation analysis was adopted to investigate the correlation between levels of novel inflammatory indicators and the total score of MOAS in patients with first-episode and recurrent schizophrenia. ResultsThe levels of NLR， MLR， PLR， NHR， MHR and PHR in first-episode group were higher than those in control group （adjusted P<0.01）. The levels of NLR， MLR， NHR， MHR and PHR in recurrent group were higher than those in control group （adjusted P<0.01）. No significant difference was observed in the comparison in the levels of six novel inflammatory indicators between first-episode group and recurrent group （adjusted P>0.05）. Spearman correlation analysis showed， the MOAS total score of recurrent group was positively correlated with the levels of NLR， MLR and PLR （r=0.234， 0.192， 0.243， P<0.05）. There was no statistical significance in the correlation between MOAS total score and levels of six novel inflammatory indicators in first-episode group （P>0.05）. ConclusionAmong patients with first-episode and recurrent schizophrenia， the correlation between levels of novel inflammatory indicators and aggressivity could differ. NLR， MLR and PLR might be the biomarkers for assessing aggression level in recurrent schizophrenic patients. ［Funded by Anhui Provincial Natural Science Foundation （number， 2108085MH275）］

Abstract Depressive disorder can cause damage to the social function of adolescents and bring heavy burden to the family and society. Dietary behavior is closely related to mental health , and depressive disorder can increase the risk of poor dietary behavior. At the same time , adolescence is a critical period for eating disorders , and patients with adolescent depression are more likely to have a series of bad eating behaviors . The combination of poor eating behaviors can negatively affect the treatment of the disease and the future development of the adolescent. This arti- cle aims to review the current status and potential mechanisms of unhealthy eating behaviors in adolescents with de- pression , in order to provide a theoretical basis for future prevention and early intervention .

Objective: To explore the characteristic of obesity in adolescents with major depressive disorder and its relationship with inflammatory cytokines. Methods : One hundred and forty adolescents with major depressive disorder were enrolled. According to the classification standard of body mass index(BMI) for adolescents in China, the patients were classified into underweight group, normal group, overweight group and obese group. The center for epidemiologic studies depression scale(CES-D) was used to evaluate symptoms of depression in patients, and ultrasensitive multiplex electrochemiluminescence detection technology was used to measure the levels of plasma inflammatory cytokines including interleukin(IL)-6,IL-17A,IL-1β,IL-6,IL-8 and tumour necrosis factor(TNF)-α. One-way ANOVA or Kruskal-WallisHtest and chi-square test were used for comparison between groups. Binary Logistic regression was used to analyze the influencing factors of obesity in adolescent patients with major depressive disorder. Results : Among the 140 adolescent patients with major depressive disorder, wasting were 9.3%(13/140), overweight were 17.9%(25/140) and obesity were 6.4%(9/140) respectively. There were statistically significant differences in gender(χ2=8.301,P<0.05) and inflammatory cytokines IL-6(H=16.217,P<0.01), IL-8(H=10.926,P<0.05) and TNF-α(H=7.879,P<0.05) among the four groups. Analysis of covariance showed that the difference in levels of the inflammatory cytokine IL-6(F=4.486,P<0.01) remained statistically significant after controlling for age, gender and antidepressant use. The results of multiple comparisons showed that compared with the wasting group, the plasma IL-6(Z=-3.843,PBonferroni calibrate<0.01) were higher in the obese group; compared with the normal group, the obesity rate of males was higher than that of females(χ2=8.812,PBonferroni calibrate<0.01), and the level of IL-6 in the obese group(Z=-3.023,PBonferroni calibrate<0.05) was higher. Binary Logistic regression analysis showed that plasma IL-6(OR=2.500,P<0.01) and gender(OR=11.292,P<0.01) were independent influencing factors for obesity in patients with adolescent depressive disorders. Conclusion There are gender differences in obesity rates in adolescents with depressive disorders, and obesity is associated with elevated levels of inflammatory cytokines.

BackgroundPatients demonstrating depressive disorder with psychotic symptoms often have increased risk of death and poor prognosis. A large amount of research has explored the factors influencing psychotic symptoms in adult patients with depressive disorder， but few has focused on adolescent patients. ObjectiveTo explore the influencing factors of psychotic symptoms in adolescent patients with depressive disorder， so as to provide references for early screening and intervention in clinic. MethodsA total of 96 adolescent patients who met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） for depressive disorder and were seen in the psychiatry departments of Chaohu Hospital of Anhui Medical University and The Fourth People's Hospital of Hefei from September 2022 to January 2023 were included. Another 56 healthy individuals from the health examination center of Chaohu Hospital of Anhui Medical University were concurrently recruited as control group. Patients were assigned into psychotic group （n=32） and non-psychotic group （n=64） according to the presence or absence of psychotic symptoms. Hamilton Depression Scale-24 item （HAMD-24）， Positive and Negative Syndrome Scale （PANSS）， Positive and Negative Suicide Ideation （PANSI） and Childhood Trauma Questionnaire-Short Form （CTQ-SF） were used for evaluation. Plasma brain-derived neurotrophic factor （BDNF） concentration was obtained using Meso Scale Discovery electrochemiluminescence assay. Pearson and Spearman correlation analysis were adopted to determine the correlation of PANSS positive symptom subscale score with plasma BDNF concentration and clinical characteristics of adolescent depression patients with psychotic symptoms. Binary Logistic regression analysis was used to identify the factors influencing the presence of psychotic symptoms in adolescent patients with depressive disorder， and multiple linear regression analysis was utilized to screen the factors affecting the severity of psychotic symptoms. ResultsThe plasma BDNF concentration of adolescent patients with depressive disorder was lower than that of control group （t=-3.080， P<0.01）.The plasma BDNF concentration of psychotic group was lower than that of non-psychotic group （t=2.418， P<0.05）， while the body mass index （BMI） PANSI scores， CTQ-SF scores and HAMD-24 total scores were all higher than those of non-psychotic group （t=-2.024， -2.530， -2.187， -4.977， P<0.05 or 0.01）. Correlation analysis showed that PANSS positive symptom subscale scores were negatively correlated with anxiety/somatization factor score and weight factor score in HAMD-24 of psychotic group （r=-0.438， -0.498， P<0.05 or 0.01）. Binary Logistic regression showed that BMI， plasma BDNF concentration， HAMD-24 total scores and cognitive dysfunction factor score were the influencing factors of psychotic symptoms in adolescent patients with depressive disorder. Multiple linear regression analysis demonstrated that weight factor scores （β=-0.349， P<0.05） and anxiety/somatization factor score （β=-0.433， P<0.05） in HAMD-24 were the factors influencing the severity of psychotic symptoms. ConclusionHigh BMI， low plasma BDNF concentration， severe depressive symptoms and cognitive dysfunction may be the risk factors of psychotic symptoms in adolescent patients with depressive disorder， furthermore， BMI and anxiety symptoms are found to be associated with the severity of psychotic symptoms. ［Funded by Scientific Research Fund Project of Anhui Institute of Translational Medicine （number， 2022zhyx-B01）； Central Finance Supported Provincial Key Clinical Specialty Construction Project of Anhui Province in 2019］

Substance use disorder is a complex health condition characterized by excessive dependence and abuse of psychoactive substances.Current treatments are few and generally ineffective,and new treatment methods are urgently needed.In recent years,ketamine has been found to be effective in the treatment of substance use disorders in controlling relapse rates and reducing withdrawal reactions in clinical studies.Basic research has shown that ketamine has a therapeutic effect by altering neuroplasticity and modulating neurofunctional networks.However,the use of ketamine may lead to side effects such as increased blood pressure and psychiatric symptoms,and potential addiction.But current clinical studies are optimistic about its safety.As a fast-acting drug with a novel mechanism of action,ketamine needs to be studied in depth to explore its benefits and risks,thereby providing a safe and effective new method for the treatment of substance use disorders.

The prevalence rate of tic disorder in Chinese children and adolescents is relatively high, and tic disorder is often co-occurring with psychiatric disorders such as attention deficit and hyperactive disorder and obsessive compulsive disorder.The cognitive impairments of tic disorder patients with different clinical types, course of disease and comorbidities are different, but all affect the learning and life quality of patients.Exploration of the cognitive function characteristics of tic disorder patients is conducive to further understanding of the disease and its etiological mechanism, and has guiding significance for clinical recognition, diagnosis and treatment.

Morita therapy has been bom for more than 100 years.Inpatient Morita therapy is highly oper-able and easy to master.It can improve many refractory neuroses through four-stage treatment.But more neuroses are treated in outpatient clinics,and Morita therapy cannot be used in hospitalized patients.Therefore,the formula-tion of expert opinions on outpatient operations is particularly important.This paper is based on domestic and for-eign references,and after many discussions by domestic Morita therapy experts,and then drew up the first version of the expert opinions on operation of outpatient Morita therapy.Meanwhile the operation rule of Morita therapy in three stages of outpatient treatment was formulated:in the etiological analysis stage,under the theoretical guidance of Morita therapy,analyze the pathogenic factors,to improve treatment compliance and reduce resistance;during the operating stage,guide patients to engage in constructive and meaningful actions,realizing the achievement of letting nature take its course principle;in the cultivating character and enriching life stage,pay attention to positive infor-mation,expanding the scope and content of actions,improving the ability to adapt to complex life,and preventing recurrence caused by insufficient abilities.It will lay a foundation for the promotion of Morita therapy in domestic outpatient clinics,so that more patients with neurosis and other psychological diseases could receive characteristic Morita therapy treatment in outpatient clinics.

Objective:To explore the correlation between attempted suicide and childhood trauma as well as inflammatory cytokines levels in adolescents with depressive disorder.Methods:From January to December 2021, a total of 164 adolescents with depressive disorder were included and categorized into attempted suicide group ( n=108) and non-attempted suicide group ( n=56) according to whether they accompanied attempted suicide or not. The Chinese version of the suicide module of MINI 5.0, the childhood trauma questionnaire(CTQ), and the center for epidemiological studies depression scale (CES-D) were used to assess suicidal behavior, childhood trauma and depressive symptoms, while the plasma inflammatory cytokines levels were measured by electrochemiluminescence technology. The data were statistically analyzed by SPSS 23.0 software. Logistic regression was applied to analyze the independent influencing factors of attempted suicide and the predictive value of each independent risk factor for attempted suicide was assessed by receiver operating characteristic curve(ROC) curves. Results:The prevalence of attempted suicide was 65.9%(108/164) in adolescents with depressive disorder.The univariate analyses showed that the total CTQ score ((55.19±12.44), (45.50±12.11)) ( t=-4.771, P<0.001), CES-D total score ((40.75±10.26), (32.98±13.39)) ( t=-4.131, P<0.001), IL-6 level(1.87 (1.32, 2.69) pg/mL, 1.56 (1.05, 1.87) pg/mL)( Z=-3.102, P=0.002), IL-10 level (0.53 (0.38, 0.83) pg/mL, 0.47 (0.31, 0.69) pg/mL) ( Z=-2.100, P=0.036) and IL-17A level (2.20 (1.52, 3.65) pg/mL, 1.67 (1.25, 2.97) pg/mL) ( Z=-2.254, P=0.024) in plasma of patients in the attempted suicide group were significantly higher than those in non-attempted suicide group. Logistic stepwise regression analyses showed that CTQ total score, IL-6, IL-10, and IL-17A were risk factors for attempted suicide in adolescents with depressive disorder.The ROC showed that the total score of CTQ combined with IL-6 (AUC=0.782, 95% CI=0.709-0.855, P<0.001), the total score of CTQ combined with IL-10 (AUC=0.765, 95% CI=0.688-0.841, P<0.001), and the total score of CTQ combined with IL-17A (AUC=0.762, 95% CI=0.684-0.840, P<0.001) had a larger area under the curve, indicating better recognition and prediction ability for attempted suicide, with high sensitivity and specificity. Conclusion:The incidence of attempted suicide in adolescents with depressive disorder is high, and which is closely related to childhood trauma and the levels of inflammatory cytokines.

Objective: Excessive daytime sleepiness (EDS) and insomnia symptoms are common in patients with major depressive disorder (MDD), which might lead to a poor prognosis and an increased risk of depression relapse. The current study aimed to investigate the prevalence, and sociodemographic and clinical correlates of EDS and insomnia symptoms among adolescents with MDD. Methods: The sample of this cross-sectional study included 297 adolescents (mean age=15.26 years; range=12–18 years; 218 females) with MDD recruited from three general and four psychiatric hospitals in five cities (Hefei, Bengbu, Fuyang, Suzhou, and Ma’anshan) in Anhui Province, China between January and August, 2021. EDS and insomnia symptoms, and clinical severity of depressive symptoms were assessed using Epworth sleepiness scale, Insomnia Severity Index, and Clinical Global Impression-Severity. Results: The prevalence of EDS and insomnia symptoms in adolescents with MDD was 39.7% and 38.0%, respectively. Binary logistic regression analyses showed that EDS symptoms were significantly associated with higher body mass index (odds ratio [OR]=1.097, 95% confidence interval [CI]=1.027–1.172), more severe depressive symptoms (OR=1.313, 95% CI=1.028–1.679), and selective serotonin reuptake inhibitors use (OR=2.078, 95% CI=1.199–3.601). And insomnia symptoms were positively associated with female sex (OR=1.955, 95% CI=1.052–3.633), suicide attempts (OR=1.765, 95% CI=1.037–3.005), more severe depressive symptoms (OR=2.031, 95% CI=1.523–2.709), and negatively associated with antipsychotics use (OR=0.433, 95% CI=0.196–0.952). Conclusion EDS and insomnia symptoms are common among adolescents with MDD. Considering their negative effects on the clinical prognosis, regular screening and clinical managements should be developed for this patient population.

Objective : The differences of cognitive impairment between children with attention deficit hyperactivity disorder (ADHD) and normal children were compared , the influencing factors of cognitive impairment of children with ADHD were analyzed . Methods : A total of 133 children with ADHD were selected as the ADHD group , and 117 normal children were recruited as the control group . The severity of the subjects ′ clinical symptoms was assessed using the Swanson , Nolan , & Pelham Rating Scale⁃Fourth Edition ( SNAP⁃IV) and the Weiss Functional Impairment Rating Scale . The degree of cognitive functional impairment of subjects was assessed using the MATRICS cognitive suite (MCBB) , and the executive function impairment of the subjects was assessed by the Behavior Rating Inventory of Executive Function ( BRIEF) . The differences in cognitive functional impairment of the two groups were compared . The children with ADHD were further divided into three groups according to their clinical phenotype and age , respectively , and the differences of cognitive impairment among the three groups were compared . The influencing factors of the degree of cognitive impairment in children with ADHD were analyzed by multiple linear regression . The improvement of methylphenidate sustained⁃release tablets on cognitive and executive functional impairment in children with ADHD was observed . Results : The scores of SNAP⁃IV , Weiss Functional Impairment Rating Scale , connection test and BRIEF of ADHD patients were significantly higher than those of normal controls (P < 0. 05) . The scores of symbol coding test and maze test of ADHD patients were significantly lower than those of normal controls (P < 0. 05) . The score of symbol encoding test in children with ADHD⁃HI was significantly higher than that in ADHD⁃I and ADHD⁃C groups (P < 0. 05) , and the total BRIEF score of ADHD⁃C was significantly higher than that in ADHD⁃I and ADHD⁃HI groups (P < 0. 05) . With the increase of age , the score of connection test of ADHD children gradually decreased , while the scores of symbol coding test and maze test gradually increased (P < 0. 05) . The results of multiple linear regression analysis showed that age was the influencing factor of ADHD children ′s score in the connection test , symbol coding test and maze test (P < 0. 05) ; the scores of SNAP⁃IV and Weiss Functional Impairment Rating Scale were the influencing factors of BRIEF score of ADHD children (P < 0. 05) . After methylphenidate treatment , the scores of connection testand BRIEF significantly decreased (P < 0. 001) , while the scores of symbol coding test and maze test significantly increased (P < 0. 001) . Conclusion The younger the age and the more serious the clinical symptoms related to ADHD suggest that the cognitive impairment of children with ADHD is more serious . After methylphenidate treatment , the degree of cognitive and executive impairment in children with ADHD are improved .