Zhan-Jiang Li

Prevalence and sociodemographic correlates of depression in an elderly population living with family members in Beijing, China

BACKGROUND To date, there has been no large-scale survey of geriatric depression (GD) involving both rural and urban areas in China using standardized assessment tools and diagnostic criteria. This study aimed to determine the 12-month and lifetime prevalence rates of GD and sociodemographic correlates in urban and rural regions of Beijing, China.MethodA total of 1601 elderly patients (aged 60 years) were randomly selected and interviewed in Beijing using the Composite International Diagnostic Interview (CIDI 1.0). Basic sociodemographic and clinical data were also collected during the interviews. RESULTS The overall 12-month prevalence of GD was 4.33%, and the 12-month prevalence rates for men and women were 2.65% and 5.83% respectively. The overall lifetime prevalence of GD was 7.83%, and lifetime prevalence rates for men and women were 4.65% and 10.66% respectively. Female sex, lower educational level, monthly income, rural abode, and the presence of one or more major medical conditions were associated with increased risk of GD. Of the GD subjects interviewed, 25.2% were receiving some type of treatment, with only 4.7% preferring to seek treatment from mental health professionals. CONCLUSIONS Although still relatively low by international standards, there is an increasing trend in the prevalence of GD in China. The low percentage of subjects treated for GD is a major public health concern that should be addressed urgently.

Altered resting state functional connectivity patterns of the anterior prefrontal cortex in obsessive-compulsive disorder.

In this study, we explored different spontaneous functional connectivity patterns between the anterior prefrontal cortex and other brain regions in nonmedicated patients with obsessive-compulsive disorder in a resting state, and examined the relationship between the abnormal spontaneous functional connectivity patterns of the anterior prefrontal cortex and clinical symptoms in patients with obsessive-compulsive disorder. Twenty nonmedicated patients with obsessive-compulsive disorder and 20 sex-matched and age-matched healthy individuals underwent resting state functional MRI scanning. Compared with the healthy controls, significantly increased positive functional connectivity with the right anterior prefrontal cortex was observed in the right insula and the middle cingulate cortex in patients with obsessive-compulsive disorder. Our findings suggest that abnormal intrinsic or spontaneous functional connectivity in the cognitive control system in a resting state may underlie the pathophysiology of obsessive-compulsive disorder.

Abnormal topological organization in white matter structural networks revealed by diffusion tensor tractography in unmedicated patients with obsessive-compulsive disorder.

BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder defined by recurrent thoughts, intrusive and distressing impulses, or images and ritualistic behaviors. Although focal diverse regional abnormalities white matter integrity in specific brain regions have been widely studied in populations with OCD, alterations in the structural connectivities among them remain poorly understood. OBJECTIVE The aim was to investigate the abnormalities in the topological efficiency of the white matter networks and the correlation between the network metrics and Yale-Brown Obsessive-Compulsive Scale scores in unmedicated OCD patients, using diffusion tensor tractography and graph theoretical approaches. METHODS This study used diffusion tensor imaging and deterministic tractography to map the white matter structural networks in 26 OCD patients and 39 age- and gender-matched healthy controls; and then applied graph theoretical methods to investigate abnormalities in the global and regional properties of the white matter network in these patients. RESULTS The patients and control participants both showed small-world organization of the white matter networks. However, the OCD patients exhibited significant abnormal global topology, including decreases in global efficiency (t = -2.32, p = 0.02) and increases in shortest path length, Lp (t = 2.30, p = 0.02), the normalized weighted shortest path length, λ (t = 2.08, p=0.04), and the normalized clustering coefficient, γ (t = 2.26, p = 0.03), of their white matter structural networks compared with healthy controls. Further, the OCD patients showed a reduction in nodal efficiency predominately in the frontal regions, the parietal regions and caudate nucleus. The normalized weighted shortest path length of the network metrics was significantly negatively correlated with obsessive subscale of the Yale-Brown Obsessive-Compulsive Scale (r = -0.57, p = 0.0058). CONCLUSIONS These findings demonstrate the abnormal topological efficiency in the white matter networks in OCD patients.

Regional homogeneity of spontaneous brain activity in adult patients with obsessive–compulsive disorder before and after cognitive behavioural therapy

BACKGROUND Cognitive behavioural therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). Several neuroimaging studies have explored alterations of brain function in OCD patients as they performed tasks after CBT. However, the effects of CBT on the neural activityin OCD during rest remain unknown. Therefore, we investigated changes in regional homogeneity (ReHo) in OCD patients before and after CBT. METHODS Twenty-two OCD patients and 22 well-matched healthy controls participated in the resting-state functional magnetic resonance imaging scans. We compared differences in ReHo between the OCD and control groups before treatment and investigated the changes of ReHo in 17 OCD patients who responded to CBT. RESULTS Compared to healthy controls, OCD patients exhibited higher ReHo in the right orbitofrontal cortex (OFC), bilateral middle frontal cortex, right precuneus, left cerebellum, and vermis, as well as lower ReHo in the bilateral caudate, right calcarine, right posterior cingulate cortex, and right middle temporal cortex. Along with the clinical improvement in OCD patients after CBT, we found decreased ReHo in the right OFC, bilateral middle frontal cortex, left cerebellum and vermis, and increased ReHo in the left caudate. Improvement of OCD symptoms was significantly correlated with the changed ReHo in the right OFC and left cerebellum. CONCLUSIONS Although these findings are preliminary and need to be replicated in larger samples, they indicate the presence of abnormal spontaneous brain activity of the prefrontal-striatal-cerebellar circuit in OCD patients, and provide evidence that CBT can selectively modulate the spontaneous brain activity of this circuit in OCD patients.

Obsessive-compulsive symptoms in a normative Chinese sample of youth: Prevalence, symptom dimensions, and factor structure of the Leyton Obsessional Inventory—Child Version

BACKGROUND Chinese adolescents face life stresses from multiple sources, with higher levels of stress predictive of adolescent mental health outcomes, including in the area of obsessive-compulsive disorders (OCD). Valid assessment of OCD among this age group is therefore a critical need in China. This study aims to standardise the Chinese version of the Leyton short version scale for adolescents of secondary schools in order to assess this condition. METHODS Stratified randomly selected adolescents were selected from four high schools located in Beijing, China. The Chinese version of the Leyton scale was administered to 3221 secondary school students aged between 12 and 18 years. A high response rate was achieved, with 3185 adolescents responding to the survey (98.5 percent). Exploratory factor analysis (EFA) extracted four factors from the scale: compulsive thoughts, concerns of cleanliness, lucky number, repetitiveness and repeated checking. The four-factor structures were confirmed using Confirmatory Factor Analysis (CFA). RESULTS Overall the four-factor structure had a good model fit and high levels of reliability for each individual dimension and reasonable content validity. Invariance analyses in unconstrained, factor loading, and error variance models demonstrated that the Leyton scale is invariant in relation to the presence or absence OCD, age and gender. Discriminant validity analysis demonstrated that the four-factor structure scale also had excellent ability to differentiate between OCD and non-OCD students, male and female students, and age groups. LIMITATIONS The dataset was a non-clinical sample of high school students, rather than a sample of individuals with OCD. Future research may examine symptom structure in clinical populations to assess whether this structure fits into both clinical and community population. CONCLUSIONS The structure derived from the Leyton short version scale in a non-clinical secondary school sample of adolescents, suggests that a four-factor solution can be utilised as a screening tool to assess adolescents׳ psychopathological symptoms in the area of OCD in mainland Chinese non-clinical secondary school students.

Brief cognitive-behavioural therapy for patients in the community with schizophrenia: Randomised controlled trial in Beijing, China

BackgroundBrief cognitive-behavioural therapy (CBT) is an emerging treatment for schizophrenia in community settings; however, further trials are needed, especially in non-Western countries.AimsTo test the effects of brief CBT for Chinese patients with schizophrenia in the community (trial registration: ChiCTR-TRC-13003709).MethodA total of 220 patients with schizophrenia from four districts of Beijing were randomly assigned to either brief CBT plus treatment as usual (TAU) or TAU alone. Patients were assessed at baseline, post-treatment and at 6- and 12-month follow-ups by raters masked to group allocation.ResultsAt the post-treatment assessment and the 12-month follow-up, patients who received brief CBT showed greater improvement in overall symptoms, general psychopathology, insight and social functioning. In total, 37.3% of those in the brief CBT plus TAU group experienced a clinically significant response, compared with only 19.1% of those in the TAU alone group (P = 0.003).ConclusionsBrief CBT has a positive effect on Chinese patients with schizophrenia in the community.

Psychotherapy Services in China: Current Provisions and Future Development

The current paper provides an overview of the history and development of mental health services with special emphasis on psychotherapy in China. Recent epidemiological surveys have revealed high prevalence rates of mental disorders that translate into a huge demand for mental health care. The Chinese government responds to such demand by increasing the number and types of mental health professionals in delivering mental health interventions, one of which is cognitive behavioural therapy (CBT). Due to unique Chinese cultural values, CBT needs to be adapted to these values so as to enhance its acceptability by Chinese people. Furthermore, training and supervision of Chinese therapists require some cultural adaptation in therapist’s training and supervision skills. This paper concludes by providing some specific recommendations on improving the quality and accessibility of CBT in China.

Attentional bias modulation by reappraisal in patients with generalized anxiety disorder: an event-related potential study

Affective states influence subsequent attention allocation. We evaluated emotional negativity bias modulation by reappraisal in patients with generalized anxiety disorder (GAD) relative to normal controls. Event-related potential (ERP) recordings were obtained, and changes in P200 and P300 amplitudes in response to negative or neutral words were noted after decreasing negative emotion or establishing a neutral condition. We found that in GAD patients only, the mean P200 amplitude after negative word presentation was much higher than after the presentation of neutral words. In normal controls, after downregulation of negative emotion, the mean P300 amplitude in response to negative words was much lower than after neutral words, and this was significant in both the left and right regions. In GAD patients, the negative bias remained prominent and was not affected by reappraisal at the early stage. Reappraisal was observed to have a lateralized effect at the late stage.

Effects of cognitive behavioral therapy on white matter fibers of patients with obsessive-compulsive disorder as assessed by diffusion tensor imaging: study protocol for a parallel group, controlled trial

Background: Short-duration cognitive behavioral therapy is an effective method for the treatment of obsessive-compulsive disorder. It alters the functions of multiple brain regions or tissues, and improves symptoms. Imaging studies show changes in the microstructure of white matter fiber bundles of patients with obsessive-compulsive disorder. Methods/Design: We will conduct a single-blind, parallel, controlled trial in the Beijing Anding Hospital, Capital Medical University, China. A cohort of 60 patients with obsessive-compulsive disorder will undergo 12 weeks of cognitive behavioral therapy. An additional 60 healthy controls will comprise the control group. All participants will be evaluated before and after 12 weeks of treatment. The primary outcome will be fractional anisotropy values in the frontal-striatal-thalamic circuits assessed by diffusion tensor imaging. The secondary outcomes will be Yale-Brown Obsessive-Compulsive Scale, Hamilton Depression Rating Scale, and Hamilton Anxiety Scale scores. Discussion: This trial will assess the changes in white matter fibers of patients with obsessive-compulsive disorder after treatment with cognitive behavioral therapy using diffusion tensor imaging. This will hopefully reveal the neural mechanisms underlying the treatment of obsessive-compulsive disorder by cognitive behavioral therapy. It will also provide objective clinical evidence of its effectiveness, and for the development of individual treatment strategies. Trial registration: This trial was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) (ChiCTR-IOR-14005436) on 29 October 2014. Ethics: The study protocol was approved by the Ethics Committee of Beijing Anding Hospital of Capital Medical University of China on 17 June 2013, approval number (2013)Keyan(7). Informed consent: Written informed consent will be provided by participants and their guardians.

The effects of cognitive behavioral therapy on resting-state functional brain network in drug-naive patients with obsessive-compulsive disorder

Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD), the treatment mechanisms remain poorly understood. This study aimed to investigate the effects of CBT on changes in the intrinsic whole‐brain functional network of OCD patients.