Qing-E Zhang

Interhemispheric Functional Connectivity and Its Relationships with Clinical Characteristics in Major Depressive Disorder: A Resting State fMRI Study

Background Abnormalities in large-scale, structural and functional brain connectivity have been increasingly reported in patients with major depressive disorder (MDD). However, MDD-related alterations in functional interaction between the cerebral hemispheres are still not well understood. Resting state fMRI, which reveals spontaneous neural fluctuations in blood oxygen level dependent signals, provides a means to detect interhemispheric functional coherence. We examined the resting state functional connectivity (RSFC) between the two hemispheres and its relationships with clinical characteristics in MDD patients using a recently proposed measurement named “voxel-mirrored homotopic connectivity (VMHC)”. Methodology/Principal Findings We compared the interhemispheric RSFC, computed using the VMHC approach, of seventeen first-episode drug-naive patients with MDD and seventeen healthy controls. Compared to the controls, MDD patients showed significant VMHC decreases in the medial orbitofrontal gyrus, parahippocampal gyrus, fusiform gyrus, and occipital regions including the middle occipital gyrus and cuneus. In MDD patients, a negative correlation was found between VMHC of the fusiform gyrus and illness duration. Moreover, there were several regions whose VMHC showed significant negative correlations with the severity of cognitive disturbance, including the prefrontal regions, such as middle and inferior frontal gyri, and two regions in the cereballar crus. Conclusions/Significance These findings suggest that the functional coordination between homotopic brain regions is impaired in MDD patients, thereby providing new evidence supporting the interhemispheric connectivity deficits of MDD. The significant correlations between the VMHC and clinical characteristics in MDD patients suggest potential clinical implication of VMHC measures for MDD. Interhemispheric RSFC may serve as a useful screening method for evaluating MDD where neural connectivity is implicated in the pathophysiology.

Psychometric properties of the Chinese versions of the Quick Inventory of Depressive Symptomatology - Clinician Rating (C-QIDS-C) and Self-Report (C-QIDS-SR)

BACKGROUND Developing accurate and time-efficient tools to measure depressive symptoms is important for research and clinical practice. This study aimed to test the psychometric properties of the Chinese version of the 16-item Quick Inventory of Depressive Symptomatology - Clinician Rating (C-QIDS-C) and Self-Report (C-QIDS-SR). METHODS This study included 998 patients with major depressive disorder (MDD) established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed using the Hamilton Rating Scale for Depression (HAMD), C-QIDS-C and C-QIDS-SR at baseline and 6 weeks later. RESULTS Internal consistency (Cronbachs alpha) ranged from 0.73 to 0.82 for C-QIDS-C and C-QIDS-SR at both the baseline and exit. The involvement and energy domains at baseline, and sad mood, concentration/decision making, self outlook, involvement and agitation/retardation domains at exit had the highest item-total correlations across the two C-QIDS scales. The C-QIDS-C and C-QIDS-SR total scores were highly correlated with the HAMD total score at both baseline (r=0.61, p<0.01 and r=0.54, p<0.01, respectively) and exit (r=0.75, p<0.01 and r=0.72, p<0.01, respectively). The C-QIDS-C, C-QIDS-SR and HAMD were equally sensitive to change of depressive symptoms, suggesting high concurrent validity. The C-QIDS-C and C-QIDS-SR showed uni-dimensional measurement properties in exploratory factor analyses at both baseline and exit. CONCLUSIONS The C-QIDS-C and C-QIDS-SR have excellent psychometric properties and are sensitive measurement of symptom severity in MDD.

Frequency-dependent changes in amplitude of low-frequency oscillations in depression: A resting-state fMRI study

OBJECTIVE We conducted this fMRI study to examine whether the alterations in amplitudes of low-frequency oscillation (LFO) of major depressive disorder (MDD) patients were frequency dependent. MATERIALS AND METHODS The LFO amplitudes (as indexed by amplitude of low-frequency fluctuation [ALFF] and fractional ALFF [fALFF]) within 4 narrowly-defined frequency bands (slow-5: 0.01-0.027Hz, slow-4: 0.027-0.073Hz, slow-3: 0.073-0.198Hz, and slow-2: 0.198-0.25Hz) were computed using resting-state fMRI data of 35 MDD patients and 32 healthy subjects. Repeated-measures analysis of variance (ANOVA) was performed on ALFF and fALFF both within the low frequency bands of slow-4 and slow-5 and within all of the four bands. RESULTS We observed significant main effects of group and frequency on ALFF and fALFF in widely distributed brain regions. Importantly, significant group and frequency interaction effects were observed in the ventromedial prefrontal cortex, inferior frontal gyrus, precentral gyrus, in a left-sided fashion, the bilateral posterior cingulate and precuneus, during ANOVA both within slow-4 and slow-5 bands and within all the frequency bands. CONCLUSIONS The results suggest that the alterations of LFO amplitudes in specific brain regions in MDD patients could be more sensitively detected in the slow-5 rather than the slow-4 bands. The findings may provide guidance for the frequency choice of future resting-state fMRI studies of MDD.

Comparison of risperidone oral solution and intramuscular haloperidol with the latter shifting to oral therapy for the treatment of acute agitation in patients with schizophrenia.

This randomized, parallel-group, open study investigated the efficacy and safety of risperidone oral solution (RIS-OS) in combination with clonazepam and intramuscular haloperidol for the treatment of acute agitation in patients with schizophrenia, and the study explored the possibility of decreasing the efficacy of an acute 6-week treatment by switching intramuscular haloperidol injection to RIS-OS. Two hundred and five agitation-exhibiting schizophrenic inpatients at six hospitals were originally included in the study. The 47-day trial consisted of 5 days (session I) of receiving either oral treatment (RIS-OS plus clonazepam) or intramuscular treatment (intramuscular haloperidol) and a 42-day (session II) period of either withdrawing from clonazepam or shifting from intramuscular haloperidol to a RIS-OS period. The primary efficacy outcome was measured as the change in the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) in session I and the change in the PANSS in session II. Safety was assessed by the frequency of the adverse events. Mean PANSS-EC improvement was significant after 5 days of treatment in both groups (P>0.05) and was similar between the two treatment groups (P<0.01). Most patients’ PANSS-EC scores improved or remained stable during the drawback/shift treatment period. Efficacy was not significantly different between the two treatment groups after the 6-week treatment (P>0.05). However, combination treatment exhibited greater efficacy, and adverse events, especially extrapyramidal symptoms, were lower with the oral treatment than with the intramuscular treatment in session I. These results show that RIS-OS in combination with clonazepam is an effective treatment, comparable with intramuscular haloperidol, and is well-tolerated for acute agitation in patients with schizophrenia.

Prospective memory deficits in patients with depression: A meta-analysis

BACKGROUND Prospective memory (PM) can be impaired in patients with psychiatric disorders including depression. This meta-analysis systematically examined PM in patients with depression. METHODS The meta-analysis was conducted according to the guidelines from Strengthening the Reporting of Observational studies in Epidemiology (STROBE). Case-control studies on PM in patients with depression were included. Standardized mean differences (SMDs) and 95% confidence interval (CI) were calculated using random effect models. RESULTS Ten case-control studies (n = 596) comparing patients with depression (n = 299) with healthy controls (n = 297) were included in the analyses. Compared with healthy controls, patients with depression had significant impairment in event-based PM (EBPM) [8 trials, n = 436; SMD: -0.87 (95%CI: -1.43, -0.31), P = 0.002; I2 = 87%]. Significance was observed after removing two outlier trials [SMD: -0.44 (95%CI: -0.69, -0.20), P = 0.0004; I2 = 23%] and also in 8 out of the 13 subgroup analyses. Similarly, time-based PM (TBPM) was significantly impaired in patients with depression [4 trials, n = 239; SMD: -0.89 (95%CI: -1.46, -0.31), P = 0.003; I2 = 78%] when compared with healthy controls. CONCLUSIONS This meta-analysis showed that both TBPM and EBPM appeared to be impaired in patients with depression.

N-acetylcysteine for major mental disorders: a systematic review and meta-analysis of randomized controlled trials

This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the efficacy and safety of adjunctive N‐acetylcysteine (NAC), an antioxidant drug, in treating major depressive disorder (MDD), bipolar disorder, and schizophrenia.

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.

Demographic and clinical profile of patients with dementia receiving electroconvulsive therapy a case-control study

Purpose Little is known about the clinical characteristics of patients with dementia receiving electroconvulsive therapy (ECT) for the treatment of behavioral symptoms. This study examined the demographic and clinical profile of patients with dementia receiving ECT in China. Methods This was a retrospective, case-control study. The sample was composed of 23 patients with dementia treated with ECT and 71 sex- and age-matched controls treated for a period of 8 years (2007–2014) at the National Clinical Research Centre of Mental Disorders, China. Sociodemographic and clinical data were collected from the electronic chart management system. Results Multiple logistic regression analysis revealed that ECT was independently associated with high risk for suicide at admission. The recorded indications for ECT included both high risk for suicide and aggressive behavior. Most patients responded to ECT satisfactorily (56.5%) or partially (34.8%) with only mild-moderate transient memory impairment (30.4%). Conclusions Although this is a preliminary study limited by the retrospective design and small sample size, findings suggest that ECT is an effective and safe therapeutic intervention to reduce the risk for suicide and aggressive behavior in dementia.

Guidance on the conversion of the Chinese versions of the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR) and the Montgomery-Asberg Scale (C-MADRS) in Chinese patients with major depression

BACKGROUND The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) is a newly introduced screening tool, while the Montgomery-Asberg Scale (MADRS) is commonly used in research and clinical practice in China. Converting the total scores between the two instruments could facilitate the comparison of different studies. METHODS This study included 1164 patients with major depressive disorder (MDD). The diagnosis was established using the Mini International Neuropsychiatric Interview (MINI). The severity of depressive symptoms was assessed with the Chinese versions of MADRS (C-MADRS) and QIDS-SR (C-QIDS-SR) at baseline and 6 weeks later (exit point). Total scores of both scales were converted using Item Response Theory (IRT) analysis. RESULTS At baseline, the C-MADRS and C-QIDS-SR were not unifactorial, therefore the conversion between them could not be performed. At exit, the C-MADRS and C-QIDS-SR were unifactorial, meeting the unidimensionality assumption of the IRT approach. Depression severity thresholds for the QIDS-SR are suggested as 6-10 for mild, 11-15 for moderate, 16-20 for severe, 21+ for very severe depression and ≤ 5 for remission (www.ids-qids.org). Based on the results of this study, the corresponding C-MADRS thresholds are 9-17 for mild, 18-24 for moderate, 25-33 for severe, 34+ for very severe depression and ≤ 7 or 8 (7.5) for remission. CONCLUSIONS The conversion of C-QIDS-SR and C-MADRS total scores would help researchers understand findings across different studies using these scales.

Combination of Metformin and Lifestyle Intervention for Antipsychotic-Related Weight Gain: A Meta-Analysis of Randomized Controlled Trials

INTRODUCTION Weight gain is a common antipsychotic (AP)-related adverse drug reaction (ADR) that can increase the risk of cardiovascular diseases and premature mortality. This meta-analysis examined the efficacy and tolerability of combining metformin and lifestyle intervention for AP-related weight gain in schizophrenia. METHODS Randomized controlled trials (RCTs) with meta-analyzable data were searched and retrieved by 2 independent investigators. RevMan software (version 5.3) was used to synthesize data, and to calculate the standardized or weighted mean differences and risk ratio with their 95% confidence intervals. RESULTS Six RCTs (n=732) were included and meta-analyzed. The metformin and lifestyle combination (MLC) group had significant reduction in weight and body mass index compared with the metformin group, lifestyle group, and placebo group. There was less frequent weight gain of≥7% in the MLC group over placebo. No other group differences in ADRs, total psychopathology, and all-cause discontinuation were found. In terms of study quality, 5 RCTs were open-labelled, 1 RCT had low risk allocation concealment, and 3 RCTs specifically described randomization methods. CONCLUSION Combining metformin and lifestyle intervention shows significant effect in reducing AP-related weight gain. Higher quality and larger RCTs are needed to confirm these findings.Review registration: CRD42017059198.