Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Posttraumatic stress disorder (PTSD) is a kind of mental disorder associated with traumatic experiences. The core symptoms of PTSD include intrusions, avoidance of trauma reminders, negative alterations in cognitions and mood and alterations in arousal. Cognitive processing therapy (CPT) may reduce PTSD symptoms by changing the connectivity of cerebellum, central executive network, and default mode network through the core therapeutic steps of preventing avoidance, releasing true emotion, and recognizing and challenging "stuck points". At present, a large number of empirical studies abroad have certified the significant efficacy of CPT, but it has not been widely promoted in China. Therefore, this article intends to summarize the clinical application of CPT in different populations and its possible therapeutic mechanism, in order to provide evidence-based medical evidence for the localization and clinical application in China.

Major depressive disorder (MDD), is characterized by high incidence rate, high suicide rate, and high disability rate, however, the underlying pathogenesis of MDD is still unclear. Based on the diathesis-stress model of depression, epigenetic mechanisms strongly explain the integration of genes and environment in the development of depression. However, depression has a high degree of clinical heterogeneity, with individuals of different ages presenting different symptoms and epigenetic changes. As a dynamic molecular marker that varies with age and environmental experience, epigenetics helps to elucidate the unique and complex disease pathogenesis of depression at different ages. Therefore, this paper aims to review relevant epigenetic studies of depression at different ages of onset to explore its potential age-specific association mechanism, in order to provide a theoretical basis for the formulation of accurate intervention measures for patients with MDD at different ages.

Major depressive disorder (MDD), is characterized by high incidence rate, high suicide rate, and high disability rate, however, the underlying pathogenesis of MDD is still unclear. Based on the diathesis-stress model of depression, epigenetic mechanisms strongly explain the integration of genes and environment in the development of depression. However, depression has a high degree of clinical heterogeneity, with individuals of different ages presenting different symptoms and epigenetic changes. As a dynamic molecular marker that varies with age and environmental experience, epigenetics helps to elucidate the unique and complex disease pathogenesis of depression at different ages. Therefore, this paper aims to review relevant epigenetic studies of depression at different ages of onset to explore its potential age-specific association mechanism, in order to provide a theoretical basis for the formulation of accurate intervention measures for patients with MDD at different ages.

Objective:To investigate the effect of virtual reality (VR) attention training on cognitive function in patients with depressive episode.Methods:64 patients diagnosed as major depressive disorder and bipolar disorder depressive episodes according to the DSM-5 criteria were recruited. They were randomized into virtual reality training (VRT) group ( n=23), computerized cognitive remediation therapy (CCRT) group ( n=21) and blank control group ( n=20). Prior to the intervention, seven cognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB)-B version in all patients, via information processing speed (IPS), attention/alertness (ATT), working memory, word learning, visual learning (VL), reasoning and problem solving, and social cognition. VRT group and CCRT group were trained for four weeks at a frequency of five days a week, and half an hour for each day training. Blank control group did not receive any treatment related to attention training. After the training, three groups were assessed by the MCCB-A. The differences of the cognitive functions among three groups were explored by the repeated analysis of ANOVA and paired sample ttest. Results:(1) Before the intervention, there were no differences in all cognitive functions (all P>0.05) among three groups. (2) After four-week interventions, the cognition of IPS, ATT and VL in VRT group (56.74±9.68, 56.48±10.22, 57.83±4.16), CCRT group (48.90±9.77, 49.48±9.51, 55.95±5.52) and the blank control group (50.35±7.93, 47.55±7.80, 47.95±9.90) had significant groups×time interactions ( F=14.06, 12.88, 9.39, all P<0.01); simple effect analysis showed that IPS and ATT scores in VRT group were higher than both CCRT group and the blank control group (all P<0.05), while the VL scores in VRT group and CCRT group were both higher than the blank control group (all P<0.01).(3) Cognitive functions in VRT group significantly improved in IPS, ATT, VL and overall domains compared with the baseline ( t=-9.33, -6.00, -5.13, -6.26, all P<0.01). Conclusion:VR attention training may be more beneficial than CCRT attention training to improve the attention among depressive patients.

Objective:To investigate the character and prevalence of cognitive impairment of patients with bipolar Ⅱ depression (BD-Ⅱ).Methods:124 patients diagnosed as bipolar Ⅱ depression according to the DSM-5 criteria and 124 demographically matched healthy subjects were recruited. Seven cognitive functions were assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery(MCCB) in all participants, including speed of processing (SOP), attention vigilance (AV), working memory (WM), verbal learning (VER), visual learning (VIS), reasoning problem solving (RPS), and social cognition (SC), and the composite. Analysis of covariance was used to test the differences in cognitive function. The number and percentage of cognitive domains impairment which was defined as the cognitive domains scored below standard values by 1, 1.5 and 2 standard deviation (SD) were explored.Results:(1) BD-Ⅱ patients were significantly impaired on seven MCCB domains and the composite scores compared with HC (all P<0.01). Correlation analysis showed that the scores of VER, RPS negatively correlated to the number of episodes ( r=-0.212, P=0.018; r=-0.183, P=0.042); (2) Most healthy control participants were not impaired on any 2 cognitive domains at 1.5 SD (79.84%,99/124) and 2 SD (92.74%,115/124) cut-offs, with the 2.42%-6.45% cognitive impairment at the 1.5 SD cut-off, and 0-4.84% at the 2 SD cut-off accordingly. (3) At the 1.5 SD cut-off, 33.06%,41/124 of the BD-Ⅱ patients were cognitively impaired in two or more domains, while at the 2.0 SD cut-off, 14.52%,18/124 of patients were cognitively impaired. Meanwhile, the incidence of impairment in various cognitive domains was 9.68%-24.19% and 3.23%-15.32%, of which the incidence rate of visual learning impairment was 12.90%, and the incidence rate of impairment in working memory and social cognition was 24.19%. Conclusions:Participants with BD-Ⅱ depression were generally impaired on a greater number of cognitive domains with a higher percentage than the healthy controls, especially on the cognitive domains of working memory, visual learning, and social cognition. And the domains of verbal learning and reasoning problem solving were negatively correlated with the number of episodes.

Objective:To investigate the effect of virtual reality (VR) attention training on cognitive function in patients with depressive episode.Methods:64 patients diagnosed as major depressive disorder and bipolar disorder depressive episodes according to the DSM-5 criteria were recruited. They were randomized into virtual reality training (VRT) group ( n=23), computerized cognitive remediation therapy (CCRT) group ( n=21) and blank control group ( n=20). Prior to the intervention, seven cognitive functions were assessed with the MATRICS Consensus Cognitive Battery (MCCB)-B version in all patients, via information processing speed (IPS), attention/alertness (ATT), working memory, word learning, visual learning (VL), reasoning and problem solving, and social cognition. VRT group and CCRT group were trained for four weeks at a frequency of five days a week, and half an hour for each day training. Blank control group did not receive any treatment related to attention training. After the training, three groups were assessed by the MCCB-A. The differences of the cognitive functions among three groups were explored by the repeated analysis of ANOVA and paired sample ttest. Results:(1) Before the intervention, there were no differences in all cognitive functions (all P>0.05) among three groups. (2) After four-week interventions, the cognition of IPS, ATT and VL in VRT group (56.74±9.68, 56.48±10.22, 57.83±4.16), CCRT group (48.90±9.77, 49.48±9.51, 55.95±5.52) and the blank control group (50.35±7.93, 47.55±7.80, 47.95±9.90) had significant groups×time interactions ( F=14.06, 12.88, 9.39, all P<0.01); simple effect analysis showed that IPS and ATT scores in VRT group were higher than both CCRT group and the blank control group (all P<0.05), while the VL scores in VRT group and CCRT group were both higher than the blank control group (all P<0.01).(3) Cognitive functions in VRT group significantly improved in IPS, ATT, VL and overall domains compared with the baseline ( t=-9.33, -6.00, -5.13, -6.26, all P<0.01). Conclusion:VR attention training may be more beneficial than CCRT attention training to improve the attention among depressive patients.

Objective:To investigate the character and prevalence of cognitive impairment of patients with bipolar Ⅱ depression (BD-Ⅱ).Methods:124 patients diagnosed as bipolar Ⅱ depression according to the DSM-5 criteria and 124 demographically matched healthy subjects were recruited. Seven cognitive functions were assessed with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery(MCCB) in all participants, including speed of processing (SOP), attention vigilance (AV), working memory (WM), verbal learning (VER), visual learning (VIS), reasoning problem solving (RPS), and social cognition (SC), and the composite. Analysis of covariance was used to test the differences in cognitive function. The number and percentage of cognitive domains impairment which was defined as the cognitive domains scored below standard values by 1, 1.5 and 2 standard deviation (SD) were explored.Results:(1) BD-Ⅱ patients were significantly impaired on seven MCCB domains and the composite scores compared with HC (all P<0.01). Correlation analysis showed that the scores of VER, RPS negatively correlated to the number of episodes ( r=-0.212, P=0.018; r=-0.183, P=0.042); (2) Most healthy control participants were not impaired on any 2 cognitive domains at 1.5 SD (79.84%,99/124) and 2 SD (92.74%,115/124) cut-offs, with the 2.42%-6.45% cognitive impairment at the 1.5 SD cut-off, and 0-4.84% at the 2 SD cut-off accordingly. (3) At the 1.5 SD cut-off, 33.06%,41/124 of the BD-Ⅱ patients were cognitively impaired in two or more domains, while at the 2.0 SD cut-off, 14.52%,18/124 of patients were cognitively impaired. Meanwhile, the incidence of impairment in various cognitive domains was 9.68%-24.19% and 3.23%-15.32%, of which the incidence rate of visual learning impairment was 12.90%, and the incidence rate of impairment in working memory and social cognition was 24.19%. Conclusions:Participants with BD-Ⅱ depression were generally impaired on a greater number of cognitive domains with a higher percentage than the healthy controls, especially on the cognitive domains of working memory, visual learning, and social cognition. And the domains of verbal learning and reasoning problem solving were negatively correlated with the number of episodes.