Yifeng Xu

Assessment of a six-week computer-based remediation program for social cognition in chronic schizophrenia.

Background Programs to remediate cognitive deficits have shown promising results in schizophrenia, but remediation of social cognition deficits is less well understood. Social cognitive deficits may cause more disability than the widely recognized neurocognitive deficits, suggesting that this is an area worthy of further investigation. Aim Implement and evaluate a brief computerized cognitive remediation program designed to improve memory, attention, and facial affect recognition (FAR) in outpatients with chronic schizophrenia. Methods Baseline assessments of FAR and of clinical, cognitive, and psychosocial functioning were completed on 20 males with schizophrenia enrolled in an outpatient rehabilitation program at the Shanghai Mental Health Center (the intervention group) and on 20 males with schizophrenia recruited from among regular outpatients at the Center (the control group). Both groups received treatment as usual, but the intervention group also completed an average of 12.7 sessions of a computer-based remediation program for neurocognitive, social, and FAR functioning over a 6-week period. The baseline measures were repeated in both groups at the end of the 6-week trial. Results There were no statistically significant differences in the changes in clinical symptoms (assessed by the Positive and Negative Syndrome Scale, PANSS) or cognitive measures (assessed using the Hong Kong List Learning Test and the Letter-Number Sequencing Task) between the intervention and control groups over the 6-week trial, but there were modest improvements on the PANSS for the intervention group between baseline and after the intervention. There was a significantly greater improvement in the social functioning measure (the Personal and Social Performance scale, PSP) in the intervention group than in the control group. The pre-post change in the total facial recognition score in the intervention group was statistically significant (paired t-test=-2.60, p=0.018), and there was a statistical trend of a greater improvement in facial recognition in the intervention group than in the control group (F(1,37)=2.93; p=0.092). Conclusion Integration of FAR training with a short, computer-administrated cognitive remediation program may improve recognition of facial emotions by individuals with schizophrenia, and, thus, improve their social functioning. But more work on developing the FAR training modules and on testing them in larger, more diverse samples will be needed before this can be recommended as a standard part of cognitive remediation programs.

Comparison of Chinese and international psychiatrists' views on classification of mental disorders

This study aimed to explore the views and attitudes of Chinese psychiatrists on mental disorders classification, and to compare their similarities and differences with those of the international mental health professionals.

The rights of psychiatric patients in China : A survey of medical staff and consumers' attitudes toward patient participation in clinical trials

To explore and compare attitudes of consumers (patients and their family members) and medical staff toward clinical trials related to mental health in China, we developed two questionnaires for medical staff and patients and their family members. Approximately 66.2% of medical staff who had no research experience believed that patients could be persuaded to participate in clinical trials, but the percentage of consumers who believed so was just 12.5%. Both groups agreed that written informed consent was required; however, more medical staff than patients agreed that such consent could be provided by patients or their guardian (88.4% vs. 71.4%). Only 9.5% of medical staff thought that patient treatment would be compromised by refusal to participate; the proportion of consumers who thought the same was 29.4%. Great differences exist between medical staff and consumers attitudes and beliefs regarding clinical trials. Medical staff were more likely to have a favorable attitude toward their patients participating in clinical trials and considered that informed consent could be provided by guardians rather than the patient.

An Evaluation of the Shanghai Mental Health Service Schizophrenia Rehabilitation Program

This study aimed to evaluate the effectiveness of a rehabilitation program for people with schizophrenia in Shanghai, China. Thirty-five people with schizophrenia participated in an eight-module program that focused on a range of psychosocial skills, while 38 others received treatment as usual in the community. Participants were assessed at baseline and subsequently at 4-week intervals over 12 weeks using the Positive and Negative Syndrome Scale, Clinical Global Impression Scale, Drug Attitude Inventory, and Personal and Social Performance Scale. The rehabilitation program participants demonstrated significantly better improvement over the course of the program than did the control participants on all measures. The rehabilitation program is effective in addressing psychosocial deficits evident in many people who have schizophrenia, and it should be implemented more widely.

Dysfunction of cognition patterns measured by MATRICS Consensus Cognitive Battery (MCCB) among first episode schizophrenia patients and their biological parents

Background Schizophrenia is characterized by abnormal perception, thinking, emotions, and behaviors. Cognitive dysfunction is acknowledged as one of the most pivotal symptoms in schizophrenia. In addition to positive or negative symptoms, which had been proposed by Gallhofer in the early 1970s, schizophrenia patients suffered from cognitive impairments as well. Many studies show that there is genetic susceptibility in the first grading kinship of patients with schizophrenia. Patients with schizophrenia have cognitive impairment not only in the acute phase but also in the stable phase. Studies also show that the healthy first-grading relatives of patients with schizophrenia suffer from cognitive defects. However, there is still a lack of studies about the cognitive features of biological parents of those with schizophrenia. In this study, we speculate the biological parents of schizophrenia patients have specific cognitive dysfunction. And we explore the patterns of cognition among both schizophrenia patients and their biological parents using the Chinese version of MATRICS Consensus Cognitive Battery (MCCB). Aims Cognitive features of patients with schizophrenia might be affected by the cognition mode of patients’ biological parents. The dysfunctional cognitive patterns need to be characterized among the patients with schizophrenia and their parents. Methods We applied the MATRICS Consensus Cognitive Battery (MCCB, a novel measurement tool) to evaluate the cognitive function of 29 first-episode patients with schizophrenia (meeting ICD-10 diagnostic criteria for schizophrenia, aged between 17-45 years old), 58 cases of biological parents of schizophrenia patients (aged between 40-70 years old) and 46 healthy controls (aged between 40-70 years old). Furthermore, we explored the relationship between the cognitive dysfunction in patients with schizophrenia and their biological parents. All data were analyzed using SPSS18.0 statistical software. Results 1) Male patients with schizophrenia had obvious cognitive defects in six domains of cognitive function as measured by the MCCB (all except the social cognition domain) compared to their male parents. Female patients showed lower ability on both working memory and problem reasoning than their female parents. 2) The significant differences of both working memory and reasoning problems also existed between the patients’ fathers and matched healthy controls. 3) Patients’ mothers didn’t show any significant difference on the problem reasoning domain compared with healthy controls. However, the visual learning domain appeared abnormal in patients’ mothers compared with healthy controls. Conclusion There are six dimensions of cognitive impairments in both first-episode schizophrenia patients and their biological parents. Compared with healthy controls, patients’ biological parents have conspicuous dysfunction in domains of working memory, problem reasoning and visual learning as well. Further study is needed to explore the underlying mechanisms of similar cognitive dysfunction between first-episode schizophrenia patients and their biological parents.

The use of the SDQ with Chinese adolescents in the clinical context

This study investigated the psychometric properties of the Strengths and Difficulties Questionnaire when it was applied to a sample of 443 outpatients in China. Included in the sample were 88 adolescents diagnosed with depression, 96 with schizophrenia, 98 with generalized anxiety, 70 with OCD, and 91 with ADHD. Each patient and one of their parents completed the SDQ at intake. Confirmatory Factor Analyses provided limited support for the proposed five factor structure of the scale over other models. Internal reliabilities of the subscales for both self and parent report were weak, and inter-rater agreement between self- and parent-report was moderate. The specificity and sensitivity for the Total Difficulties scores were weak. Overall, these findings suggest that the use of the SDQ in clinical samples in China may be limited.

Evaluations of treatment efficacy of depression from perspective of both patients' symptoms and general sense of mental health and wellbeing: a large scale, multi-centered, longitudinal study in China

Relying on the absence, presence of level of symptomatology may not provide an adequate indication of the effects of treatment for depression, nor sufficient information for the development of treatment plans that meet patients needs. Using a prospective, multi-centered, and observational design, the present study surveyed a large sample of outpatients with depression in China (n=9855). The 17-item Hamilton Rating Scale for Depression (HRSD-17) and the Remission Evaluation and Mood Inventory Tool (REMIT) were administered at baseline, two weeks later and 4 weeks, to assess patients self-reported symptoms and general sense of mental health and wellbeing. Of 9855 outpatients, 91.3% were diagnosed as experiencing moderate to severe depression. The patients reported significant improvement over time on both depressive symptoms and general sense after 4-week treatment. The effect sizes of change in general sense were lower than those in symptoms at both two week and four week follow-up. Treatment effects on both general sense and depressive symptomatology were associated with demographic and clinical factors. The findings indicate that a focus on both general sense of mental health and wellbeing in addition to depressive symptomatology will provide clinicians, researchers and patients themselves with a broader perspective of the status of patients.

Sleep problems among clinically depressed adults in China

Abstract Background: The aim of the study was to explore which variables predict poor sleep among clinically depressed Chinese adults. Methods: In total, 100 participants were recruited from Shanghai Mental Health Centre. The dependent variables were number of hours spent sleeping as well as the quality of sleep and number of times the participants woke during the night. The independent variables were gender, age, length of depression and severity of depression. The use of antipsychotic medication was controlled for in all analyses. Results: The results demonstrated that depression severity was the most important predictor of sleep quality and night waking. Gender and age were also found to be predictors of sleep problems. Conclusions: The findings demonstrated that depressed Chinese patients experienced similar relationships between sleep disturbance and depression to Westerners. Future studies should include other measures of sleep quality as well as variables consistently found to be associated with both depression and sleep difficulty, such as the use of addictive substances and psychosocial factors.

Does practice make perfect? Results from a Chinese feasibility study of cognitive remediation in schizophrenia

Patients with schizophrenia often receive little by way of non-pharmacological interventions. Despite this, promising outcomes in programmes targeting cognitive deficits have been reported, suggesting that this is an area worthy of further investigation. The aim of the study was to implement and evaluate a brief computerised cognitive remediation programme designed to improve memory and attention in a male Chinese sample with chronic schizophrenia. Pre-testing was completed on a number of clinical and cognitive measures for intervention (nu2009=u200914) and treatment as usual (nu2009=u200917) participants. The intervention group then completed six weeks ( x no. of sessionsu2009=u200912.78) of the computer-based cognitive remediation programme. Post-test measures for both groups were then collected again. Following the six week intervention, we found, contrary to our expectations, the intervention group improved on several of the clinical variables. The intervention group also performed better than the control group on the post-test measure of attention, but not verbal memory. These findings suggest that it is feasible to improve some aspects of cognitive abilities with a simple computerised training programme for people with serious mental illness.

Social support and clinical depression in China

It has been recognised for many years that in Western contexts social support is associated with depression. However, relatively few studies have investigated this association in non‐Western countries, and few, if any, in a clinical population. The present study aimed to establish how the perceived quality of social support provided by their spouse, their family and their friends to people in China who have a clinical diagnosis of depression is associated with aspects of their illness.