Adjunctive Electroconvulsive Therapy for Schizophrenia: A Meta-analysis of Randomized Rater-Masked Controlled Trials [RETRACTED]

OBJECTIVE

The aim of the study was to examine published randomized controlled trials (RCTs) for the efficacy and safety of adjunctive electroconvulsive therapy (ECT) when combined with antipsychotics (APs) versus AP therapy for schizophrenia and related disorders during the acute phase.

METHODS

Two evaluators independently selected studies, extracted data, and conducted quality assessment and data synthesis. Standardized and weighted mean differences (SMD/WMD), risk ratio (RR) ±95% confidence intervals (CIs), number needed to treat (NNT), and number needed to harm (NNH) were calculated.

RESULTS

Twenty-two RCTs (n = 1365, age = 36.9 years, male = 53%), including double-blind (8 RCTs) and rater-masked (14 RCTs) designs, were identified and analyzed. Adjunctive ECT was superior to AP therapy regarding (1) symptomatic improvement at last-observation endpoint (standardized mean difference, -0.67; P < 0.00001; I = 79%); (2) study-defined response (RR = 1.81, I = 0%, P < 0.00001, NNT = 4) and remission (RR = 2.05, I = 0%, P = 0.0004, NNT = 13); and (3) positive, negative, and general psychopathology subscores (weighted mean difference, -4.01 to -1.79; P = 0.005-0.0001). Results were similar in all preplanned subgroup analyses including Chinese (11 RCTs) versus non-Chinese (7 RCTs) origin, those with a Jadad score 3 or higher (12 RCTs) versus lower than 3 (6 RCTs), and those with clozapine (5 RCTs) versus those with non-clozapine treatments (13 RCTs). Compared with AP therapy, adjunctive ECT AP was significantly associated with more headache (RR = 2.72, P = 0.04, NNH = 5) and memory impairment (RR = 14.24, P = 0.01, NNH = 7).

CONCLUSIONS

Adjunctive ECT seems to be an effective and safe option for schizophrenia and related disorders during acute phases but was associated with transient memory impairment and headaches.

Physical restraint for psychiatric patients and its associations with clinical characteristics and the National Mental Health Law in China

Physical restraint (PR) for patients is an ongoing controversial topic in psychiatry. This study examined the percentage of PR and its associations with clinical characteristics and the implementation of the National Mental Health Law (NMHL) in China. The study consecutively assessed a sample of 1364 psychiatric inpatients. Socio-demographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Psychopathology and insight were measured using standardized instruments. The percentage of PR was 27.2% in the whole sample with 30.7% and 22.4% occurring respectively before and after the NMHL implementation (p=0.001). In multiple logistic regression analysis PR was positively associated with unemployment, lower income, aggression in the past month, being admitted before the NMHL implementation and poorer insight. The percentage of PR in Chinese psychiatric patients is associated with various clinical factors and appeared to decrease after the implementation of the NMHL. Focused and individualized care for patients who are unemployed, have low income, recent aggression and poor insight would be necessary at early stages of admission.

Intensity and Types of Physical Exercise in Relation to Dementia Risk Reduction in Community-Living Older Adults

OBJECTIVE

To systematically examine the amount and type of physical exercise that might reduce the future risk of dementia in community-living older people.

DESIGN

Six-year observational study.

SETTING

All the Elderly Health Centers (EHCs) of the Department of Health in Hong Kong.

PARTICIPANTS

A total of 15,589 community-living Chinese aged 65 years and older with no history of stroke, clinical dementia, or Parkinson disease when they completed health assessment at the EHCs in the first 6 months of 2005.

MEASUREMENTS

Self-reported habitual physical exercise patterns, including the frequency, duration, and type of exercise, at baseline and Year 3 were analyzed. The study outcome was incident dementia in 6 years. Dementia was defined by presence of clinical dementia in accordance with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems or Clinical Dementia Rating of 1 to 3.

RESULTS

Both the cognitively stable and incident groups reported exercising a median of 7 days per week and 45 minutes per day at baseline and Year 3. The former practiced aerobic and mind-body exercises more at baseline and Year 3, whereas the latter practiced stretching and toning exercises more. The odds ratio for dementia remained significant for aerobic (0.81; 95% confidence interval 0.68-0.95; P = .01) and mind-body exercises (0.76; 0.63-0.92; P = .004) after excluding participants who developed dementia within 3 years after baseline and adjusting for important potential confounders, such as age, gender, educational level, and physical and psychiatric comorbidities.

CONCLUSION

Although physical exercise is widely promoted as a nonpharmacological intervention for dementia prevention, not all types of exercise appear to be useful in reducing risk of dementia in older people. Our findings suggest that daily participation in aerobic and mind-body but not stretching and toning exercises might protect community-living older adults from developing dementia.

Adjunctive huperzine A for cognitive deficits in schizophrenia: a systematic review and meta-analysis

OBJECTIVE

The aim of this study was to examine the efficacy of huperzine A (HupA), an isolate of Huperzine serrata, in the treatment of cognitive deficits in schizophrenia spectrum disorders.

METHODS

PubMed, PsycINFO, Embase, Cochrane Library, Cochrane Controlled Trials Register, WanFang, Chinese Biomedical, and China Journal Net databases were searched from inception to 15 July 2015 for randomized controlled trials (RCTs) in English or Chinese of HupA augmentation of antipsychotic drug therapy versus placebo or ongoing antipsychotic treatment.

RESULTS

Twelve RCTs (n = 1117) lasting 11.7 ± 6.0 weeks met inclusion criteria. All had been conducted in China. HupA outperformed comparators on the following outcome measures: the Wechsler Memory Scale-Revised including memory quotient (weighted mean difference (WMD: 10.59; 95% confidence interval (CI): 5.65, 15.53; p < 0.0001); Wechsler Adult Intelligence Scale-Revised including verbal intelligence quotient (IQ), performance IQ, and full IQ (WMD: 3.97 to 5.66; 95%CI: 0.20, 8.58; p = 0.01 to 0.00001); Wisconsin Card Sorting Test including response administer and non-perseverative errors (WMD: -12.79 to -12.29; 95%CI: -23.70, -0.88; p = 0.03 to 0.003). In studies using the Positive and Negative Syndrome Scale (n = 7)/Brief Psychiatric Rating Scale (n = 1), the differences in total score were significant (standard mean difference: -0.77; 95%CI: -1.27, -0.27; p = 0.002). All-cause discontinuation (risk ratio: 0.67; 95%CI: 0.36, 1.24; p = 0.20) and adverse events were similar between groups.

CONCLUSIONS

This review suggests that adjunctive HupA is an effective choice for improving cognitive function for patients with schizophrenia spectrum disorders. More well-designed RCTs are needed to further confirm HupA's efficacy. Copyright © 2016 John Wiley & Sons, Ltd.

Smoking in male patients with schizophrenia in China: A meta-analysis

BACKGROUND

The aim of this study was to examine the prevalence of current smoking in male patients with schizophrenia in China.

METHOD

A systematic literature search was conducted from database inception until June 20, 2015 without language restrictions in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and WanFang Database. Studies fulfilling the following criteria were included: (a) data available in male schizophrenia patients and (b) data available on current smoking status. Statistical analyses were performed with the Comprehensive Meta-Analysis program.

RESULTS

A total of 23 studies met eligibility criteria for the meta-analysis. The pooled prevalence of current smoking was 59.1% (95% Confidence interval [CI]: 53.3-64.7%). Current smoking was significantly more frequent in inpatients than in outpatients (61.3% vs. 48.2%, Q=7.5, P=0.006), and higher in chronic compared to first-episode patients (74.5% vs. 45.1%, Q=32.3, P=0.0001). Furthermore, using a median split, patients aged 38.2 years or older smoked more often than those aged below 38.2 years (65.8% vs. 52.3%, Q=6.4, P=0.01). There were no significant associations between prevalence of current smoking and definitions of smoking, study publication year, sample size and illness duration.

CONCLUSIONS

The pooled prevalence of current smoking of male patients with schizophrenia in China is lower compared to Western and other Asian countries. Possible relationships between lower prevalence of current smoking and psychopathology in patients with schizophrenia require further investigation.

Suicidal ideation in Chinese patients with chronic obstructive pulmonary disease: a controlled study

BACKGROUND

No study has been published on the prevalence of suicidal behaviour in older Chinese patients with chronic obstructive pulmonary disease (COPD). This study examined the 1-year prevalence of suicidal ideation in older Chinese COPD patients and explored its demographic and clinical correlates.

METHODS

A consecutive sample of 143 COPD patients and 211 matched control subjects were recruited and interviewed using structured, standardized instruments.

RESULTS

The 1-year prevalence of suicidal ideation in COPD patients and controls were 15.4% and 10.9%, respectively. In multivariate analyses, suicidal ideation was significantly associated with the severity of depressive symptoms in COPD patients.

CONCLUSION

Suicidal ideation was not higher in COPD patients than in controls.

The Prevalence of Insomnia, Its Demographic Correlates, and Treatment in Nurses Working in Chinese Psychiatric and General Hospitals

PURPOSE

To determine the prevalence of insomnia and its socio-demographic correlates in Chinese nurses.

DESIGN AND METHODS

Up to 799 nurses were examined. Demographic data, total sleep time (TST), and insomnia were collected.

FINDINGS

The mean expected and actual TST were 8.3 ± 1.5 and 6.1 ± 1.1 hr, respectively. The prevalence of at least one type of reported sleep disturbance was 69.7%; the rates of difficulty initiating sleep, difficulty maintaining sleep, and early morning awakening were 54.6%, 54.7%, and 55.9%, respectively.

PRACTICE IMPLICATIONS

There is a large discrepancy of actual and expected sleep duration, and insomnia is common among nurses in China.

Depression after minor stroke: the association with disability and quality of life--a 1-year follow-up study

OBJECTIVE

Minor stroke is characterized by mild neurological functional impairment and relatively good outcome. Little is known about the association between post-stroke depression (PSD) and outcomes of minor stroke. The aim of this study was to investigate the association between PSD and disability and quality of life (QoL) at 1 year after minor ischemic stroke.

METHODS

Patients with first-ever minor ischemic stroke (n = 747) were followed up at 14 ± 2 days, 3 months, 6 months, and 1 year after stroke. Depressive symptoms were assessed at each follow-up. Patients diagnosed with depression at 14 ± 2 days formed the early-onset PSD group; those who were diagnosed with depression at any subsequent follow-ups for the first time constituted the late-onset PSD group. The outcomes of minor stroke including disability (modified Rankin score ≥ 2) and QoL (Short Form-36 Health Survey) were assessed at the 1-year follow-up.

RESULTS

A total of 198 (26.5%) patients were diagnosed with PSD over the 1-year follow-up; 136 and 62 patients were allocated to the early-onset PSD group and late-onset PSD group, respectively. Both early-onset and late-onset PSD were independently associated with disability and poor physical and mental health at 1 year after stroke. Recovery from depression (n = 112) within 1 year decreased the adverse impacts of PSD on functional outcome and QoL.

CONCLUSIONS

Post-stroke depression was independently associated with disability and poor QoL at 1 year after first-ever minor ischemic stroke. Recovery from PSD decreased but did not eliminate the adverse impacts of PSD on outcomes of minor stroke.

Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Free radicals may be involved in the pathogenesis of tardive dyskinesia (TD). We conducted this meta-analysis to systematically examine the efficacy of extract of Ginkgo biloba (EGb), a potent antioxidant possessing free radical-scavenging properties, as a treatment for TD in schizophrenia using randomized controlled trial (RCT) data.

METHOD

Drawn from English and Chinese databases, 3 RCTs of EGb augmentation of antipsychotics (APs) vs. AP plus placebo or AP monotherapy were identified. 2 evaluators extracted data. The primary outcome measure was the severity of TD symptoms assessed by the Abnormal Involuntary Movement Scale (AIMS). Weighted mean difference (WMD) and risk ratio (RR) ±95% confidence intervals (CI) were calculated. Statistical analyses were performed using Review Manager (version 5.1.7.0) and STATA (version 12.0).

RESULTS

The 3 RCTs (n=299) from China, of 12 weeks duration, involved schizophrenia patients with TD of 55.9±13.4 years old. EGb (240 mg/day) outperformed the control group in reducing the severity of TD and clinical symptoms as measured by the AIMS (trials=3, n=299, WMD: -2.30 (95%CI: - 3.04, -1.55), P<0.00001) and the adverse drug reactions as assessed by the Treatment Emergent Symptom Scale (TESS) (trials=2, n=142, WMD: -2.38 (95%CI: -4.01, -0.74), P=0.004). Both the Positive and Negative Syndrome Scale (PANSS) total score (trials=2, n=239, P=0.87) and all-cause discontinuation (trials=3, n=299, P=0.21) were similar between the EGb and control group.

CONCLUSION

This meta-analysis suggests that adjunctive EGb appeared to be an effective and safe option for improving TD in the treatment of schizophrenia patients. However, better RCTs are needed to demonstrate its efficacy and safety especially on cognitive function in TD.

TRIAL REGISTRATION

PROSPERO

CRD42015024930.

Prevalence of aggression in hospitalized patients with schizophrenia in China: A meta-analysis

INTRODUCTION

Aggression is a major concern in psychiatric inpatient care. Variations in study designs, settings, populations and data collection methods render comparisons of the prevalence of aggressive behavior in high-risk settings difficult. We proposed to estimate the pooled prevalence of aggression among inpatients with schizophrenia in China.

METHODS

Reports on aggressive behaviour involving physical contact or risks of interpersonal violence, in schizophrenia in Chinese general psychiatric wards were retrieved by using computer-assisted searches and manual searches of the reference lists of the relevant literature. Statistical analyses were conducted using the Comprehensive Meta-Analysis V2 software. Potential sources of heterogeneity were analyzed with Cochrane's Q analysis.

RESULTS

The search yielded 19 eligible studies involving a total of 3,941 schizophrenia patients. The prevalence of aggressive behavior in psychiatric wards ranged between 15.3% and 53.2%. The pooled prevalence of aggression was 35.4% (95% CI: 29.7%, 41.4%). The most commonly reported significant risk factors for aggression were positive psychotic symptoms: hostility or suspiciousness, 78.9% (15 studies); delusions, 63.2% (12 studies); disorganized behavior, 26.3% (5 studies); and auditory hallucinations, 10.5% (2 studies); together with: past history of aggression, 42.1% (8 studies); and involuntary admission, 10.5% (2 studies).

CONCLUSIONS

Aggressive behaviour is common in Chinese inpatients with schizophrenia. The prevalence figures indicate the need to identify reliable clinical and illness predictors for aggression in inpatient psychiatric wards and to test investigations aimed at reducing aggressive episodes and their adverse outcomes.

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern

OBJECTIVE

Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia.

METHODS

The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed.

RESULTS

A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults.

CONCLUSION

Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.

Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care

PURPOSE

Sexual dysfunction in schizophrenia patients is common. In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. Illness- or treatment-related sexual dysfunction in this patient population has been never studied. This study describes the prevalence and correlates of sexual dysfunction and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China.

METHOD

A total of 607 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. Patients' socio-demographic and clinical characteristics including sexual function and QOL were recorded using a standardized protocol and data collection.

RESULTS

Sexual dysfunction was present in 69.9% of all patients; 60.7% in males and 80.6% in females. Multiple logistic regression analysis revealed that female gender, being single, older age and use of first-generation antipsychotics were independently and significantly associated with more sexual dysfunction accounting for 23.5% of its variance (P<0.001). Unexpectedly, sexual dysfunction was not associated with lower QOL.

CONCLUSIONS

High rate of sexual dysfunction was reported in the majority of patients with schizophrenia treated in primary care in China. Given its negative impact on social adjustment, QOL and treatment adherence, efforts should be made to address sexual dysfunction in this patient population.

Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study

BACKGROUND

While oral antidepressants reach efficacy after weeks, single-dose intravenous (i.v.) ketamine has rapid, yet time-limited antidepressant effects. We aimed to determine the efficacy and safety of single-dose i.v. ketamine augmentation of escitalopram in major depressive disorder (MDD).

METHOD

Thirty outpatients with severe MDD (17-item Hamilton Rating Scale for Depression total score ⩾ 24) were randomized to 4 weeks double-blind treatment with escitalopram 10 mg/day+single-dose i.v. ketamine (0.5 mg/kg over 40 min) or escitalopram 10 mg/day + placebo (0.9% i.v. saline). Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR). Suicidal ideation was evaluated with the QIDS-SR item 12. Adverse psychopathological effects were measured with the Brief Psychiatric Rating Scale (BPRS)-positive symptoms, Young Mania Rating Scale (YMRS) and Clinician Administered Dissociative States Scale (CADSS). Patients were assessed at baseline, 1, 2, 4, 24 and 72 h and 7, 14, 21 and 28 days. Time to response (⩾ 50% MADRS score reduction) was the primary outcome.

RESULTS

By 4 weeks, more escitalopram + ketamine-treated than escitalopram + placebo-treated patients responded (92.3% v. 57.1%, p = 0.04) and remitted (76.9% v. 14.3%, p = 0.001), with significantly shorter time to response [hazard ratio (HR) 0.04, 95% confidence interval (CI) 0.01-0.22, p < 0.001] and remission (HR 0.11, 95% CI 0.02-0.63, p = 0.01). Compared to escitalopram + placebo, escitalopram + ketamine was associated with significantly lower MADRS scores from 2 h to 2 weeks [(peak = 3 days-2 weeks; effect size (ES) = 1.08-1.18)], QIDS-SR scores from 2 h to 2 weeks (maximum ES = 1.27), and QIDS-SR suicidality from 2 to 72 h (maximum ES = 2.24). Only YMRS scores increased significantly with ketamine augmentation (1 and 2 h), without significant BPRS or CADSS elevation.

CONCLUSIONS

Single-dose i.v. ketamine augmentation of escitalopram was safe and effective in severe MDD, holding promise for speeding up early oral antidepressant efficacy.

Current cigarette smoking in Chinese female patients with schizophrenia: A meta-analysis

The study objective was to perform a meta-analysis of the prevalence of current smoking in Chinese female patients with schizophrenia. A systematic literature search was conducted and studies fulfilling the following criteria were included: female schizophrenia patients; reporting current smoking rate computed from samples. Eight studies were included. The pooled current smoking prevalence was 4.3% (95% Confidence interval [CI]: 3.2-5.6%). The finding showed that smoking rate of female patients with schizophrenia in China was lower compared to their Western and other Asian counterparts.

The 33-item Hypomania Checklist (HCL-33): A new self-completed screening instrument for bipolar disorder

BACKGROUND

Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD). This study tested the psychometric properties and the accuracy of the Chinese version of the 33-item Hypomania Checklist (HCL-33) to identify BD in Chinese clinical settings.

METHODS

A total of 350 depressed patients were consecutively interviewed in a major psychiatric hospital in China. The patients' socio-demographic and clinical characteristics were recorded using standardized protocol and data collection procedures. The HCL-33 was completed by patients to detect symptoms characteristic of mania and hypomania. DSM-IV diagnoses were established using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

The HCL-33 showed high internal consistency with two-factorial dimensions. The optimal cut-off point on the HCL-33 to differentiate BD from MDD was 15, while cut-off points of 14 and 13 differentiated BD-I and BD-II from MDD, respectively. The maximum sensitivity was 0.62, 0.67 and 0.72 for differentiating BD, BD-I and BD-II from MDD, respectively.

CONCLUSIONS

The HCL-33 is a useful tool for screening for BD in Chinese depressed patients. The routine clinical use of the HCL-33 as a screening instrument for BD in Chinese patients is recommended.

Aripiprazole for Tourette's syndrome: a systematic review and meta-analysis

OBJECTIVE

To review the efficacy and safety of aripiprazole (ARI) for Tourette's syndrome (TS).

METHODS

This review included randomized controlled trials (RCTs) of children and adolescents (6-18 years) with TS comparing ARI monotherapy with another monotherapies in relation to clinical improvement and adverse events.

RESULTS

Six RCTs with a total of 528 subjects (ARI treatment group: n = 253; control group: n = 275) met the inclusion criteria. These included two RCTs (n = 255) that compared ARI monotherapy with tiapride (TIA). Tic symptoms control assessed by Yale Global Tic Severity Scale (Standard Mean Difference (SMD) = -0.38 (Confidence Interval (CI) = -1.32 to 0.56); I(2) = 90%, P = 0.42) revealed no significant differences between the two groups. Extrapyramidal symptoms were significantly different when ARI (1.5%) was compared with haloperidol (HAL) (43.5%). No significant group differences were found in the rates of nausea/vomiting, dizziness, and dry mouth between ARI and TIA (RR = 0.57 to 1.00 (95%CI = 0.14-4.20); I(2) = 0% to 69%, P = 0.35 to 1.00).

CONCLUSION

This review found that ARI has similar efficacy to TIA and HAL for TS, while extrapyramidal symptoms were significantly less with ARI than with HAL. ARI can be considered as an alternative treatment option for TS.

Smoking and its associations with sociodemographic and clinical characteristics and quality of life in patients with schizophrenia treated in primary care in China

OBJECTIVE

Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated smoking rates in this population. This study investigated the rate of smoking and its associations with sociodemographic and clinical characteristics and quality of life (QOL) in patients with schizophrenia treated in primary care in China.

METHODS

This was a cross-sectional, community-based survey. A total of 621 schizophrenia patients were recruited from 22 primary care services in Guangzhou, China, in 2013. Patients' sociodemographic and clinical characteristics, smoking status, and QOL were recorded.

RESULTS

The frequency of current smoking was 23.8% in the whole sample; 41.5% for men and 2.5% for women. Multiple logistic regression analysis revealed that male gender, married status, alcohol use, older age at onset, fewer major medical conditions, lower education level and more hospitalizations were independently associated with current smoking.

CONCLUSION

The frequency of smoking in Chinese schizophrenia patients treated by primary care physicians is lower than most figures reported from Western and Chinese psychiatric settings.

Self-Reported and Interviewer-Rated Oral Health in Patients With Schizophrenia, Bipolar Disorder, and Major Depressive Disorder

PURPOSE

To compare self-reported (SR) and interviewer-rated (IR) oral health between schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) patients.

DESIGN AND METHODS

356 patients with SZ, BP, or MDD underwent assessments of psychopathology, side effects, SR, and IR oral health status.

FINDINGS

118 patients (33.1%) reported poor oral health; the corresponding proportion was 36.4% in BP, 34.8% in SZ, and 25.5% in MD (p = .21). SR and IR oral health correlated only modestly (r = 0.17-0.36) in each group.

PRACTICE IMPLICATIONS

Psychiatric patients need to be assessed for both SR and IR oral health.

Clozapine in schizophrenia and its association with treatment satisfaction and quality of life: Findings of the three national surveys on use of psychotropic medications in China (2002-2012)

OBJECTIVE

We examined the time trends and correlates of clozapine use in schizophrenia patients in China.

METHOD

A total of 14,013 patients with schizophrenia treated in 45 psychiatric hospitals/centers nationwide were interviewed in 2002, 2006 and 2012. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects, satisfaction with treatment and quality of life (QOL) were recorded in a standardized fashion.

RESULTS

Clozapine was used in 32.9% of the whole sample; with corresponding figures of 39.7%, 32.5% and 26.4% in 2002, 2006 and 2012 (p<0.001). Families of clozapine users had lower satisfaction with treatment than those of the non-clozapine group, without significant differences with respect to patients' treatment satisfaction and mental or physical QOL. In multiple logistic regression analyses, compared to the non-clozapine group, patients on clozapine had an earlier age of onset, longer illness duration, more global illness severity and drug-induced central nervous system, gastrointestinal and other side effects, lower antipsychotic doses, less delusions and hallucinations, more negative symptoms, were more likely male, inpatients, to have a family history of psychiatric disorders, receive treatments in regional centers and receive antipsychotic polypharmacy, but less likely to have health insurance and receive first-generation antipsychotics and benzodiazepines (R(2)=0.498, p<0.001).

CONCLUSIONS

Clozapine was used in one-third of schizophrenia patients in China, with decreasing frequency since 2002. Patients prescribed clozapine had multiple markers of greater global illness severity/chronicity and decreased satisfaction with treatment by the families, but similar QOL and less delusions and hallucinations than patients not prescribed clozapine.

Measurement-Based Care Versus Standard Care for Major Depression: A Randomized Controlled Trial With Blind Raters

OBJECTIVE

The authors compared measurement-based care with standard treatment in major depression.

METHODS

Outpatients with moderate to severe major depression were consecutively randomized to 24 weeks of either measurement-based care (guideline- and rating scale-based decisions; N=61), or standard treatment (clinicians' choice decisions; N=59). Pharmacotherapy was restricted to paroxetine (20-60 mg/day) or mirtazapine (15-45 mg/day) in both groups. Depressive symptoms were measured with the Hamilton Depression Rating Scale (HAM-D) and the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR). Time to response (a decrease of at least 50% in HAM-D score) and remission (a HAM-D score of 7 or less) were the primary endpoints. Outcomes were evaluated by raters blind to study protocol and treatment.

RESULTS

Significantly more patients in the measurement-based care group than in the standard treatment group achieved response (86.9% compared with 62.7%) and remission (73.8% compared with 28.8%). Similarly, time to response and remission were significantly shorter with measurement-based care (for response, 5.6 weeks compared with 11.6 weeks, and for remission, 10.2 weeks compared with 19.2 weeks). HAM-D scores decreased significantly in both groups, but the reduction was significantly larger for the measurement-based care group (-17.8 compared with -13.6). The measurement-based care group had significantly more treatment adjustments (44 compared with 23) and higher antidepressant dosages from week 2 to week 24. Rates of study discontinuation, adverse effects, and concomitant medications did not differ between groups.

CONCLUSIONS

The results demonstrate the feasibility and effectiveness of measurement-based care for outpatients with moderate to severe major depression, suggesting that this approach can be incorporated in the clinical care of patients with major depression.

Prevalence and correlates of major depressive disorder among rural-to-urban migrant workers in Shenzhen, China

BACKGROUND

In China, rural-to-urban migrant workers (MWs) are a large and vulnerable population that may be at high risk for depression, but previous studies focused on depressive symptoms of MWs and no study has investigated the epidemiology of major depressive disorder (MDD). The objective of this study was to determine the prevalence and correlates of one-month and lifetime MDD among MWs in Shenzhen, China, and mental health services utilization of MWs with lifetime MDD.

METHODS

A total of 3031 MWs were recruited from 10 manufacturing factories and interviewed with the Chinese version of the Mini International Neuropsychiatric Interview.

RESULTS

The one-month and lifetime prevalence rates of MDD were 1.39% (95% CI: 0.97%, 1.80%) and 5.08% (95% CI: 4.30%, 5.86%), respectively. No significant gender and age-group differences were found in these rates. The risk factors for lifetime MDD included lower education, worse living condition, poorer self-perceived physical health, migration before adulthood, infrequently calling family members, and having done lots of jobs. Only 3.25% of the respondents with lifetime MDD had sought professional help prior to the interview.

LIMITATIONS

The MW sample was selected from manufacturing factories, we should be cautious in generalizing our findings to MWs of other industries.

CONCLUSIONS

Compared with the Chinese general population, MWs may have a similar prevalence of MDD, but the rate of lifetime mental health services use of MWs with lifetime MDD is extremely low. MDD is a major public health concern for this population. There is an urgent need to improve mental health services for MWs.

Frequency and Correlates of Distant Visual Impairment in Patients with Schizophrenia, Bipolar Disorder, and Major Depressive Disorder

OBJECTIVE

Distant visual impairment in the severely mentally ill is under-researched. This study aimed to assess the frequency and correlates of distant visual impairment in a cohort of Chinese psychiatric patients, including its effect on their quality of life.

METHODS

Adult psychiatric inpatients with schizophrenia, bipolar disorder, and major depressive disorder consecutively admitted to a psychiatric hospital in Beijing, China underwent assessments of psychopathology (Brief Psychiatric Rating Scale, 16-item Quick Inventory of Depressive Symptomatology [Self-Report]), quality of life (12-item Short-Form Medical Outcomes Study [SF-12], 25-item National Eye Institute Visual Function Questionnaire [NEI-VFQ25]), adverse effects (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale), and presenting (as opposed to uncorrected) distant visual acuity (Logarithm of the Minimum Angle of Resolution [LogMAR] chart with patients wearing spectacles, if they owned them). Distant visual impairment was defined as binocular distant visual acuity of a LogMAR score of ≥ 0.5 (< 6/18 Snellen acuity).

RESULTS

Among 356 patients who met the study criteria, the frequency of distant visual impairment was 12.6% (15.2% with schizophrenia, 11.9% with bipolar disorder, 8.8% with major depressive disorder). In multiple logistic regression analysis, distant visual impairment was significantly associated with ocular disease only (p = 0.002, odds ratio = 3.2, 95% confidence interval = 1.5-6.7). Controlling for the confounding effect of ocular disease, patients with distant visual impairment had a lower quality of life in the general vision domain of the NEI-VFQ25 (F[2, 353] = 9.5, p = 0.002) compared with those without. No differences in the physical and mental domains of the SF-12 and in other domains of the NEI-VFQ25 were noted in these 2 groups.

CONCLUSION

One-eighth of middle-aged severely mentally ill patients had distant visual impairment. Considering the impact of distant visual impairment on daily functioning, severely mentally ill patients need to be screened for impaired eyesight as part of their comprehensive health assessment.

Clozapine prescription and quality of life in Chinese patients with schizophrenia treated in primary care

OBJECTIVE

Clozapine is frequently used to treat schizophrenia in China. Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated the frequency of its use prescribed by primary care physicians. This study described the frequency, demographic and clinical characteristics of clozapine treatment and its impact on insight and quality of life (QOL) of patients with schizophrenia treated in primary care in China.

METHOD

A total of 623 patients with schizophrenia treated in 22 primary care services in Guangzhou, China in 2013 formed the study sample. Patients' socio-demographic and clinical characteristics including psychopathology, medication side effects and QOL were recorded using a standardized protocol and data collection.

RESULTS

The frequency of clozapine prescription was 35.6% with a mean daily dose of 127.7±88.2 mg. There were no significant differences between the patients with and without clozapine in either of the QOL domains after controlling the confounding factors. Multiple logistic regression analyses revealed that patients on clozapine had younger age of onset, more hospitalizations, more severe extrapyramidal side effects, but better insight and fewer prescriptions of first generation antipsychotics.

CONCLUSIONS

Clozapine use was found to be common and associated with better insight in patients with schizophrenia treated in primary care in China. Further examination of the rationale and appropriateness of clozapine in primary care in China is warranted.

Psychotic-like experiences and associated socio-demographic factors among adolescents in China

OBJECTIVE

Adolescents with persistent psychotic-like experiences (PLEs) may be at high risk for later development of psychoses. Exploring early age risk factors for PLEs may provide useful information for prevention of mental disorders and improvement of mental health.

METHOD

A total of 5427 adolescents (aged between 10 and 16) participated in a cross-sectional survey, with social and demographic information collected. The Positive Subscale of Community Assessment of Psychic Experiences (CAPE) was used to measure PLEs, and the CAPE Depressive and Negative Subscales were used to examine depressive and negative experiences. The Trauma History Questionnaire (child version) was used to assess experiences of previous traumatic events.

RESULTS

In our study, 95.7% of the adolescents reported more than one episode of PLEs, while 17.2% reported "nearly always" having PLEs. High positive correlations were shown both between frequency scores among experiences of three dimensions (PLEs, depressive and negative experiences), and between frequency and distress scores. Factors associated with a higher risk for more frequent and distressing PLEs include: urban setting, family history of psychiatric illnesses, and higher impact from previous traumatic events at present.

CONCLUSIONS

Episodes of PLEs are common in Chinese adolescents, however only a small proportion have persistent PLEs, with worsening distress as the frequency increased. PLEs shared similar environmental and genetic risk factors not only with the clinical phenotypes, which is consistent with the continuity model of PLEs, but also with depressive and negative experiences, which may imply etiologic relation between different dimensions of psychosis at the subclinical level.