Psychiatry in traditional Chinese medicine

Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines

This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust.

Key learning aims

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Traditional Chinese medicine in psychiatric practice in Singapore

Around three-quarters of the Singaporean population are of Chinese ethnic origin, and so traditional Chinese medicine is the most widely practised non-Western system of healthcare on the island.

German wine in an American bottle: the spread of modern psychiatry in China, 1898-1949

Modern psychiatry was first introduced to mainland China around 1900 by Western missionaries. By 1949 the field had developed gradually as a result of contact with Western psychiatry and especially its American practitioners. This paper analyses the role played by key individuals and events in this process in the years prior to 1949. It argues that modern psychiatry was introduced to China through a process of cultural adaptation in which the USA served as a bridge for German thought.

Posttraumatic Coping and Distress

The current body of knowledge related to trauma and posttraumatic stress disorder (PTSD) is primarily based on research conducted in Western nations. Thus, Western clinicians and researchers may know little about whether people from non-Western societies have similar reactions or symptom manifestations to specific traumatic events. Traditional Chinese health beliefs with their roots in Taoism, Confucianism, and Buddhism influence illness perception and affect coping behaviors of Chinese exposed to traumatic events. This article discusses compatible and incompatible aspects of the traditional Chinese health beliefs with Western beliefs about PTSD and examines how culture-based motivations may possibly impact emotional responses to traumatic events between American and Chinese cultures. This article also reviews the literature on the prevalence and applications of Western diagnostic criteria and measures of PTSD in contemporary Chinese populations and proposes suggestions for developing a culturally sensitive framework for clinical management of Chinese trauma survivors.

Experiences of Chinese migrants caring for family members with schizophrenia in Australia

Little is known about the experience of Chinese migrants to Australia who are caring for a person with schizophrenia. The research was exploratory in nature, providing information on the health, help-seeking behaviors, burden, and caring experiences of Chinese carers of people with schizophrenia in Melbourne. Ethnic Chinese carers of people with schizophrenia were recruited. Health care or social service professionals were also interviewed to understand the context of Chinese migrants in seeking help for mental health problems and caring for someone with psychiatric illness. Recommendations for Chinese migrants facing mental health problems and challenges for social work practice are described.

Schizophrenia literacy among Chinese in Shanghai, China: a comparison with Chinese-speaking Australians in Melbourne and Chinese in Hong Kong

OBJECTIVE

The study reported in this paper was aimed at developing understanding of schizophrenia-related knowledge and preferences surrounding professional help, medication, and treatment methods among Chinese living in Shanghai, China.

METHOD

A multi-stage cluster sampling method in which participants were taken from six of the 20 districts in Shanghai was adopted for this study. The 522 Shanghai Chinese participants were presented with a vignette describing an individual with schizophrenia before being asked questions designed to assess both their understanding of schizophrenia and their preferences surrounding professional help, medication, and treatment methods. A comparative approach was adopted to identify similarities and differences between our findings and those of two previous studies on the mental health literacy of Chinese living in Melbourne, Australia and Hong Kong, respectively.

RESULTS

A lower percentage of Shanghai Chinese than Hong Kong Chinese and Australian Chinese could correctly identify the condition described in the vignette as a case of acute schizophrenia. Although a far lower percentage of Shanghai Chinese endorsed the use of counselling professionals, a much higher percentage of the same group endorsed Chinese medical doctors and herbal medication. A lower percentage of Shanghai Chinese endorsed 'lifestyle changes' as a strategy for dealing with schizophrenia than did Chinese subjects living in Australia and Hong Kong. On the other hand, a higher percentage of Shanghai residents endorsed psychiatric treatment and the traditional Chinese practices of 'eating nutritious food/taking supplements' than among the other two groups of Chinese.

CONCLUSIONS

This study highlights the need for educating Chinese in Shanghai to improve their schizophrenia literacy. The contents of the education programmes will need to take into consideration the socially and culturally driven beliefs that may have been influencing the knowledge and preferences of Shanghai Chinese concerning professional help, medication, and treatment methods for people suffering from schizophrenia.

Acupuncture for posttraumatic stress disorder: conceptual, clinical, and biological data support further research

Posttraumatic stress disorder (PTSD) is common, debilitating, and has highly heterogeneous clinical and biological features. With the exception of one published preliminary clinical trial, rationale in support of the efficacy of acupuncture, a modality of Chinese medicine (CM), for PTSD has not been well described. This is a focused review of conceptual and clinical features of PTSD shared by modern western medicine (MWM) and CM, and of biological mechanisms of acupuncture that parallel known PTSD pathology. MWM and CM both recognize individual developmental variables and interactions between external conditions and internal responses in the genesis of PTSD. There is one published and one unpublished clinical trial that preliminarily support the efficacy of acupuncture for PTSD. Although there have been no mechanistic studies of acupuncture in human PTSD, extant research shows that acupuncture has biological effects that are relevant to PTSD pathology. Conceptual, clinical, and biological data support possible efficacy of acupuncture for PTSD. However, further definitive research about simultaneous clinical and biological effects is needed to support the use of acupuncture for PTSD in health care systems.

Depression literacy among older Chinese immigrants in Canada: a comparison with a population-based survey

BACKGROUND

Investigations of mental health literacy are important because the recognition of a mental health problem is the first step in seeking appropriate mental health care. Lack of recognition is a significant barrier to accessing mental health resources. Older Chinese immigrants are at increased risk for depression; however, there is no research investigating their depression literacy, including their beliefs about treatment, etiology, and prognosis.

METHODS

This study investigated depression literacy among 53 older Chinese immigrants in Canada (aged 55-87 years) and compared their literacy to Canadian-born participants of the same age who were part of a larger population-based survey. Depression literacy was assessed through interviews using a case vignette and included the following indices: rates of correct identification of depression; perceived efficacy of various people, professions and treatments; and perceptions of etiology and prognosis.

RESULTS

In the Chinese sample, 11.3% correctly identified depression in the case vignette. In contrast, 74.0% of participants in the population-based survey correctly identified depression. Differences in the perceptions of helpful people and interventions, etiology, and prognosis were also noted between the samples. Both samples strongly endorsed physical activity as helpful in the treatment of depression.

CONCLUSIONS

In light of these results, it is clear that older Chinese immigrants would benefit from information regarding the symptoms, etiology, and treatment of depression, and that this information may begin to address the serious underutilization of mental health services among this group. Our discussion highlights practice implications and promising interventions.

Knowledge and preferences regarding schizophrenia among Chinese-speaking Australians in Melbourne, Australia

OBJECTIVE

The aim of this study was to better understand the knowledge of schizophrenia, preferences regarding professional help, medication and treatment methods among Australians of a Chinese-speaking background.

METHODS

A cluster convenience sampling method was adopted in which subjects were taken from the four main areas in cosmopolitan Melbourne where most Chinese people live. A total of 200 Chinese-speaking Australians participated in the study. They were presented with a vignette describing an individual with schizophrenia and were then asked questions to assess their understanding of schizophrenia and their preferences regarding professional help, medication and treatment methods. A comparative approach was used to compare our findings with those of a previous study on the mental health literacy of Australian and Japanese adults.

RESULTS

Compared with the Australian and Japanese samples, a much lower percentage of Chinese-speaking Australians (15.5%) was able to identify the vignette as a case of schizophrenia/psychosis. A higher percentage of the Chinese-speaking Australians believed that professionals, and particularly counselling professionals, could be helpful for the person in the vignette. A higher percentage of the Chinese-speaking Australian and Japanese samples believed that close family members could be helpful, and expressed more uncertainty about the usefulness or harmfulness of certain medications than the Australian sample. A higher percentage of the Chinese-speaking Australians than the Australian and Japanese samples endorsed inpatient treatment for the person in the vignette. About 22, 17, 19 and 28% of the Chinese-speaking Australian participants, respectively, rated 'traditional Chinese medical doctors', 'Chinese herbal medications', 'taking Chinese nutritional foods/supplements' and 'qiqong' as helpful. Many perceived 'changing fungshui' and 'traditional Chinese prayer' to be harmful.

CONCLUSIONS

Campaigns to increase the schizophrenia literacy of Chinese-speaking Australians are needed and must take into consideration the aforementioned socially and culturally driven beliefs so that culturally relevant education programmes can be developed.

Mental health first aid training for the Chinese community in Melbourne, Australia: effects on knowledge about and attitudes toward people with mental illness

Background

The aim of this study was to investigate in members of the Chinese community in Melbourne the impact of Mental Health First Aid (MHFA) training on knowledge about mental disorders and on attitudes to people with mental illness. The hypotheses were that at the end of the training participants would have increased knowledge of mental disorders and related treatments, and decreased negative attitudes towards people with mental disorders.

Methods

Respondents were 108 participants of three MHFA training workshops for the Chinese community in Melbourne conducted by a qualified MHFA trainer. Participants completed the research questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test). The questionnaires assessed participants' ability to recognize a mental disorder (depression and schizophrenia) described in the vignettes, knowledge about the professional help and treatment, and negative attitudes towards people with mental illness.

Results

Between pre- and post-test there was significant improvement in the recognition of mental disorders, beliefs about treatment became more concordant with health professionals, and negative attitudes reduced.

Conclusion

The MHFA training course for general members of the Chinese community in Melbourne produced significant positive change in the level of mental health literacy and reductions in stigmatizing attitudes. The evidence from this study, together with the accumulated evidence of the benefits of MHFA training in the general Australian community, suggests that this approach should be scaled up to a level where it can have an impact on the whole of the Chinese community in Australia.

Depression literacy among Australians of Chinese-speaking background in Melbourne, Australia

BACKGROUND

This study investigated the knowledge of depression and preference for professional help, medications and treatment methods among Australians of Chinese-speaking background, and the perceptions of this population of the causes of mental illness.

METHODS

Adopting a cluster convenience sampling method, the study recruited 200 Chinese-speaking subjects from four major areas in metropolitan Melbourne where many Chinese live. The respondents were presented with a vignette describing an individual with depression and then asked questions to assess their understanding of depression and preference for professional help, medications and treatment methods. A comparative approach was used to compare the findings with those of a previous study of the mental health literacy of Australian and Japanese adults.

RESULTS

Compared to the Australian and Japanese samples, a much lower percentage of Chinese-speaking Australians (14%) could correctly identify major depression described in the vignette, and a higher percentage believed that counseling professionals could be helpful. Higher percentages of those who believed that close family members could be helpful were found in the Chinese-speaking Australian and Japanese samples, and these two groups also expressed more uncertainty about the usefulness or harmfulness of certain medications compared to the Australian sample. Higher percentages of respondents in both the Chinese-speaking Australian and the Australian sample considered "lifestyle changes" to be helpful compared to the Japanese sample. In the Chinese-speaking sample, 30%, 17.4%, 33% and 27% of the respondents rated "traditional Chinese medicine doctors," "Chinese herbal medications," "taking Chinese nutritional foods/supplements" and "qiqong" as helpful. Many perceived "changing fungshui" and "traditional Chinese worship" to be harmful. Regarding the perception of causes of mental illness, items related to psychosocial perspectives including "life stress" and "interpersonal conflict" were rated highly by the respondents, whereas traditional beliefs including "punishment for misdeeds conducted by ancestors" and "demon possession" had the lowest ratings.

CONCLUSIONS

Campaigns to increase the mental health literacy of Chinese-speaking Australians are needed. The above-mentioned socially and culturally driven beliefs need to be taken into consideration in the development of culturally relevant education programs.

Beliefs in traditional Chinese medicine efficacy among Chinese Americans: implications for mental health service utilization

We examined how community attitudes towards traditional Chinese conceptions of health and Western dichotomization of illness might affect perceptions of traditional Chinese medicine (TCM) efficacy in order to identify factors underlying psychiatric service underutilization among Chinese-Americans. We administered an experimental vignette to assess perceived illness, severity, and beliefs of TCM efficacy for physical and psychiatric disorders among 90 Chinese-Americans ascertained through a national telephone survey. Perceived illness severity was unrelated to assessment of TCM effectiveness. However, psychiatric conditions tended to be viewed as distinct from physical disorders, and TCM use was endorsed as less effective for psychiatric illnesses when compared with physical illnesses. Furthermore, differences in perceived TCM efficacy appeared to be magnified among US-born respondents, with US-born respondents endorsing lower efficacy for psychiatric disorders than foreign-born respondents. These findings suggest that TCM use for psychiatric disorders may decrease with Westernization, but might delay access to psychiatric services among first-generation immigrants.

Affective personality as cognitive-emotional presymptom profiles regulatory for self-reported health predispositions

Three studies that examined the links between affective personality, as constructed from responses to the Positive Affect (PA) and Negative Affect (NA) Scale (PANAS), and individuals' self-report of self-esteem, intrinsic motivation and Beck's Depression Inventory (BDI) depression in high school students and persons in working occupations are described. Self-report estimations of several other neuropsychiatric and psychosocial variables including, the Uppsala Sleep Inventory (USI), the Hospital Anxiety and Depression (HAD) test, Dispositional optimism, Locus of control, the Subjective Stress Experience test (SSE) and the Stress-Energy (SE) test, were also derived. Marked effects due to affective personality type upon somatic and psychological stress, anxiety and depression, self-esteem, internal and external locus of control, optimism, stress and energy, intrinsic motivation, external regulation, identified regulation, major sleep problems, problems falling asleep, and psychophysiological problems were observed; levels of self-esteem, self-motivation and BDI-depression all produced substantial effects on health and well-being. Regression analyses indicated PA was predicted by dispositional optimism (thrice), energy (thrice), and intrinsic motivation, and counter predicted by depression (twice) and stress (twice); and NA by anxiety (twice), stress (twice), psychological stress, identified regulation, BDI depression and psychophysiological problems, and counter predicted by internal locus of control and self-esteem. BDI-depression was predicted by negative affect, major sleep problems and psychophysiological problems (Study III), self-esteem by dispositional optimism and energy, and counter predicted by anxiety, depression and stress (Study I), and intrinsic motivation by dispositional optimism, energy, PA and self-esteem (Study II). These convergent findings are interpreted from a perspective of the cognitive-emotional expressions underlying behavioural or presymptomatic profiles presenting predispositions for health or ill health.

Acupuncture for posttraumatic stress disorder: a randomized controlled pilot trial

The purpose of the study was to evaluate the potential efficacy and acceptability of accupuncture for posttraumatic stress disorder (PTSD). People diagnosed with PTSD were randomized to either an empirically developed accupuncture treatment (ACU), a group cognitive-behavioral therapy (CBT), or a wait-list control (WLC). The primary outcome measure was self-reported PTSD symptoms at baseline, end treatment, and 3-month follow-up. Repeated measures MANOVA was used to detect predicted Group X Time effects in both intent-to-treat (ITT) and treatment completion models. Compared with the WLC condition in the ITT model, accupuncture provided large treatment effects for PTSD (F [1, 46] = 12.60; p < 0.01; Cohen's d = 1.29), similar in magnitude to group CBT (F [1, 47] = 12.45; p < 0.01; d = 1.42) (ACU vs. CBT, d = 0.29). Symptom reductions at end treatment were maintained at 3-month follow-up for both interventions. Accupuncture may be an efficacious and acceptable nonexposure treatment option for PTSD. Larger trials with additional controls and methods are warranted to replicate and extend these findings.

Developing a Traditional Chinese Medicine Diagnostic Structure for Post-Traumatic Stress Disorder

BACKGROUND

Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.

METHODS

Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.

RESULTS

The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation-Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire-and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.

CONCLUSIONS

The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.

Sleep disturbances and their management in patients with brain injury

OBJECTIVES

Sleep disturbances in people with brain injuries, although quite common, remain a problematic management issue for caregivers. This article will review the architecture of sleep, the assessment of insomnia, and discussion of common medications that may exacerbate the problem. Nonpharmacological management techniques, including stimulus control, sleep restriction, and relaxation therapy, will also be discussed.

MAIN OUTCOME MEASURES

An intensive analysis of pharmacological agents used in treatment, including descriptions of the positive and negative effects of the various classes of drugs (e.g., sedative/hypnotics, antihistamines, dopamine agonists, and stimulants) will be provided.

CONCLUSIONS

These discussions will hopefully assist in the decision-making processes of caregivers managing this unique group of persons with sleep difficulties.

Depression, sleep physiology, and antidepressant drugs

This review summarizes current findings regarding effects of antidepressant compounds on sleep architecture and interprets their clinical relevance. Effects of the major classes of antidepressant drugs on sleep properties are presented, with the antidepressant compounds organized into categories based primarily on their putative mechanism of action. The majority of antidepressant compounds, across several different categories, exhibit robust suppression of REM sleep. Others, such as bupropion and nefazodone, lack REM suppressant effects. Such findings support the idea that critical neurochemical mechanisms involved in the regulation of discrete sleep stages can be elucidated by means of polysomnographic investigations utilizing pharmacologically targeted agents. Clinicians have appreciated the importance of antidepressant drug effects on sleep when considering therapeutic options for patients. While such decisions in the past were based on empirical observations, an increasing amount of information regarding specific effects of different antidepressant drugs on sleep continuity and sleep architecture is available. Thus, clinicians may choose to consider profiles of sleep effects for different antidepressant drugs in the initial selection of an antidepressant compound.

Epilepsy in Chinese culture

This article reviewed the meaning and development of epilepsy in Chinese culture. The theories of Yin and Yang and the five elements, fundamentals of traditional Chinese medicine, were introduced, which form the context of understanding of the etiology, classification, and treatment of epilepsy in traditional Chinese medicine.

The effects of paroxetine and nefazodone on sleep: a placebo controlled trial

We studied the effect of acute (1 day) and subacute (16 days) administration of the new antidepressant, nefazodone (400 mg daily), and the selective serotonin re-uptake inhibitor (SSRI), paroxetine (30 mg daily), on the sleep polysomnogram of 37 healthy volunteers using a random allocation, double-blind, placebo-controlled design. Compared to placebo, paroxetine lowered rapid eye movement (REM) sleep and increased REM latency. In addition, paroxetine increased awakenings and reduced Actual Sleep Time and Sleep Efficiency. In contrast, nefazodone did not alter REM sleep and had little effect on measures of sleep continuity. We conclude that in contrast to typical SSRIs, nefazodone administration has little effect on sleep architecture in healthy volunteers.

Nightcap: laboratory and home-based evaluation of a portable sleep monitor

In this paper, we describe the first field tests of a home-based sleep monitoring system, the Nightcap, which uses eyelid and body movement sensors to discriminate wake, NREM, and REM sleep automatically. Ten normal young adults were studied in the sleep laboratory and at home to allow comparison of Nightcap-derived measures with those obtained by traditional polysomnography. The agreement between the two techniques was 87% based on 1-min epochs--93% for NREM, 80% for REM, and 72% for wake. When the values for sleep latency, REM latency, wake time, NREM time, and REM time calculated from polysomnograph records were compared with the values calculated from Nightcap data, no significant differences were seen. In cases of extremely poor sleep, objective sleep efficiency estimates correlated well with subjective reports, suggesting that the Nightcap is sensitive to clinically relevant changes in the quality of sleep. This new device should prove useful to researchers wishing to study the psychophysiology and pathophysiology of sleep in more naturalistic and cost-effective paradigms than possible in the traditional sleep laboratory.

Changes in sleep polygraphic variables and clinical state in depressed patients during treatment with citalopram

Drug-induced improvement of depression may be mediated by changes in sleep physiology. The aim of this study was to relate changes in sleep polygraphic variables to clinical state during treatment with citalopram, a highly specific serotonin uptake inhibitor. Sixteen patients took part. The study was single-blind and uncontrolled. A 1-week wash-out period was followed by 1 week of placebo administration, a medication period of 5 weeks, and a 1-week placebo period. For the entire group a significant decrease of rapid eye movement sleep (REMS) and a significant lengthening of REMS latency were observed initially as well as at the end of treatment. No changes in sleep continuity were found, but non-REMS stage 2 (percentage) was significantly increased. On the basis of clinical change, as expressed by the scores of the Hamilton Rating Scale for Depression, at the end of the citalopram treatment the patient group was split in two halves: eight less and eight more improved patients. The groups did not differ with respect to any sleep polygraphic variable.

Psychiatric stigma in non-Western societies

Factors bearing on social stigma in persons with a psychiatric illness are the subject of this review of the literature. The review concentrates on material pertaining to non-Western societies. This is a topic that has not received much systematic attention. The cultural meanings associated with psychiatric illness are examined. Emphasis is given to societies ordinarily studied by anthropologists and social historians of non-Western medicine. Stigma is variable in the more elementary societies. It is present in India and especially China, and studies suggest the social stigma is less prevalent in Islamic societies. It is important to distinguish between how psychiatric illness is handled in community settings as versus in the system and tradition of medicine.

China's importation of Western psychiatry: cultural relatively and mental disorders

As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought. This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of 'mental illness'. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. The goal of this paper is to show that these categorical assumptions are still premature, and that examining the meaning of current 'rates of mental illness' in China specifically raises more questions than it answers. Hopefully, this discussion will stimulate a renewed interest in ethnographic methods that would uncover locally-based understandings and thereby create the basis for a more sophisticated epidemiological comparison.

The effects of total sleep deprivation and subsequent treatment with clomipramine on depressive symptoms and sleep electroencephalography in patients with a major depressive disorder

In the present study patients with a major depressive disorder were first subjected to total sleep deprivation (TSD) and then treated with clomipramine. Sleep electroencephalography (EEG) was registered prior to and after TSD, during the 2 initial nights of antidepressive treatment and after 19 days. A negative correlation between response to TSD and clomipramine was found. TSD did not differentially influence the sleep EEG (responders vs nonresponders): responders tended, however, to show a more classical depressive sleep pattern prior to TSD. Clomipramine profoundly suppressed rapid eye movement (REM) sleep; the amount of initial REM sleep reduction, however, did not correlate significantly with therapy response after 3 weeks of treatment.

Attitudes towards psychoses and psychotic patients in Beijing

The issue of public health education regarding mental illnesses has been relatively low profile in the People's Republic of China. A questionnaire study was carried out on 3,028 lay members of the Beijing population to ascertain their knowledge of opinions concerning and attitudes towards the mentally ill. Very few subjects had systematic knowledge about mental illness and nearly half had no acquired knowledge at all. On the whole they were sympathetic towards the mentally ill and towards provision of high quality mental health care. Despite this sympathy a small proportion still attributed mental illness either to 'ghosts', 'retribution for ancestors' evil deeds' or 'bad thoughts'. Superstitious ideas were clearly related to low educational attainment. The attitudes of family members of psychotic patients were explored in greater detail.

Adolescent mental health in China

Adolescent Mental Health in China is the responsibility of the wider society and is supported by social, educational and health care resources. With limited facilities, China emphasizes community mental health care, with prevention and health promotion as priorities. Mental health is considered in the context of an orderly socialist society with stable family life supported by the state. Society is currently influenced by a mixture of Communist ideology, ancient tradition and newer Western approaches. Difficulties in reconciling these factors are affecting the attitudes and behaviour of China's youth.

Psychiatry in the People's Republic of China

In the spring of 1985, a party of psychiatrists from Great Britain and Ireland visited four major Chinese cities--Beijing (Peking), Shanghai, Nanjing (Nanking) and Guangzhou (Canton), as a study tour of the Royal College of Psychiatrists, under the auspices of the Chinese Medical Association. A number of psychiatric hospitals were visited and there was opportunity for many discussions with psychiatrists and other professional staff. This paper records some impressions of the psychiatric services and practices that were observed, together with material obtained in discussions. It is hoped that it will update and complement previous reports by Western visitors to China, and thus increase understanding of mental health in China.

Sleep stage transitions and tonic REM in depression

The hypothesis that greater perturbations of EEG-sleep architecture and continuity would occur in clinical depression contingent upon epsilon stage shifts was tested. Duration of successive REM cycles was also evaluated in 16 young adult (17-25 years) nonpsychotic unipolar patients with primary depression and eight age-matched normal controls for 8 hr during 1-3 consecutive EEG recording nights (epsilon N = 55). Two subgroups of eight patients were identified whose polysomnograms contained greater than 100 versus less than 100 epsilon sleep stage transitions. As predicted, sleep was shallow and fragmented to a significantly larger extent in depressives with: greater than 100 stage shifts versus, less than 100 transitions, compared with controls. This was reflected by significantly longer delays in falling asleep, more intermittent wakefulness transitions into stage 1, increased epsilon stage shifts, and more transitional stage 1 sleep. The depressed patients with less than 100 stage shifts (versus greater than 100 transitions relative to the controls) accumulated significantly less total sleep (7.0 vs greater than or equal to 7.6 hr), REM time; exhibited fewer REM episodes, and a slower REM cycle. Compared with controls both patient constituencies accumulated less REM time, showed a propensity for shallow NREM sleep reflected by significantly decreased stage 4, and more frequent transition into stage 1. REM time significantly increased progressively during sleep through the fourth cycle in both controls and depressives. The initial REM cycle was significantly longer among patients (N = 16), and the fourth proved to be shorter compared with controls. The longer first REM cycle in primary depression is construed to represent a disinhibition of neural processes that would normally either attenuate or delay this phenomenon. Accordingly, the possibility is raised that REM sleep disinhibition potentiates the mood disturbances and neurovegetative symptoms of endogenous/primary depression.