Zhenghui Yi

Comparisons of the Efficacy and Tolerability of Extended-Release Venlafaxine, Mirtazapine, and Paroxetine in Treatment-Resistant Depression A Double-Blind, Randomized Pilot Study in a Chinese Population

To compare the efficacy and tolerability of antidepressants switch with extended-release venlafaxine (venlafaxine-XR), mirtazapine, and paroxetine in Chinese patients with major depressive disorder who had 2 consecutive unsuccessful antidepressant trials. One hundred fifty adult patients with treatment-resistant depression according to their medical records and/or response to current treatments were randomly assigned to receive fixed-dosage treatment of venlafaxine-XR 225 mg/d (n = 50), mirtazapine 45 mg/d (n = 55), or paroxetine 20 mg/d (n = 45) for 8 weeks. The primary outcome was the remission rates that were defined as a score 7 or lower on the 17-item Hamilton Rating Scale for Depression (HRSD-17). Secondary outcomes included the remission rate defined by the Self-Rating Depression Scale of 50 or lower and the response rate defined by a 50% reduction or greater on the HRSD-17 total score, and the improvement of patients general health functions. The completion rates were 82% for venlafaxine-XR, 81.8% for mirtazapine, and 82.2% for paroxetine. Only one patient in paroxetine arm discontinued the study owing to an adverse event. The remission rates based on the HRSD-17 were 42.0% for venlafaxine-XR, 36.4% for mirtazapine, and 46.7% for paroxetine. There were no statistical significances between treatment arms in remission rates. Similarly, there were also no significant differences between groups in secondary outcome measure. Venlafaxine-XR, mirtazapine, and paroxetine were equally effective in the treatment of Chinese patients with major depressive disorder who failed at least 2 previous antidepressant treatments. Selecting any of these 3 antidepressants as a third-step antidepressant is a reasonable choice for this group of patients.

Lack of effect of brain derived neurotrophic factor (BDNF) Val66Met polymorphism on early onset schizophrenia in Chinese Han population.

Schizophrenia is a chronic psychiatric disorder with high heritability. Schizophrenic patients with early-age onset tend to have a greater genetic component and may be an attractive subpopulation for genetic studies. Brain-derived neurotrophic factor (BDNF) is considered a candidate gene for schizophrenia. A single nucleotide polymorphism (BDNF Val66Met) was reported to be associated with schizophrenia, although discrepancy remains. The aim of this study was to evaluate the association between BDNF Val66Met polymorphism and schizophrenia using an early onset sample in the Chinese Han population. Our sample consisted of 353 schizophrenic patients with onset before age 18 and 394 healthy controls. All subjects were of an ethnically homogenous Han Chinese origin. No significant differences of genotype or allele distribution were identified between the patients and controls. However, the Met allele was significantly associated with an earlier age of onset in male schizophrenic patients (Kaplan-Meier log-rank test P=0.005), but not in females (P=0.289). The BDNF Val66Met polymorphism has an important effect on the age of onset of schizophrenia in a gender-specific manner. This may represent a significant genetic clue for the etiology of schizophrenia and thus, further studies are required to uncover the exact role of BDNF in the development of schizophrenia.

A pilot study of the efficacy and safety of paroxetine augmented with risperidone, valproate, buspirone, trazodone, or thyroid hormone in adult Chinese patients with treatment-resistant major depression.

To compare the efficacy and safety of augmenting paroxetine with risperidone, buspirone, valproate, trazodone, or thyroid hormone in patients with treatment-resistant depression (TRD), 225 patients with retrospectively and/or prospectively identified stage II TRD were randomly assigned to receive an 8-week treatment of paroxetine 20 mg/d augmented with risperidone 2 mg/d (n = 45), sodium valproate 600 mg/d (n = 39), buspirone 30 mg/d (n = 46), trazodone 100 mg/d (n = 47), or thyroid hormone 80 mg/d (n = 48). The primary outcome was the remission rate defined as the 17-item Hamilton Rating Scale for Depression score of 7 or less at the end of study. Secondary outcomes included remission rate based on the Self-rating Depression Scale score of 50 or less at the end of study, response rate based on 17-item Hamilton Rating Scale for Depression total score of 50% improvement or greater from baseline, and the change in scores of Clinical Global Impression-Improvement scale, the Short Form 36 Health Survey, and the Life Satisfaction Rating Scale. The remission rates were 26.7% for risperidone, 48.7% for valproate, 32.6% for buspirone, 42.6% for trazodone, and 37.5% for thyroid hormone. There was no statistical significance among treatment arms in remission rates, secondary outcome measures, and adverse events. Risperidone, valproate, buspirone, trazodone, or thyroid hormone augmentation to paroxetine 20 mg/d was effective and well tolerated in Chinese patients with TRD. Large-sample studies are warranted to support or refute these findings.

Venlafaxine inhibits the upregulation of plasma tumor necrosis factor-alpha (TNF-α) in the Chinese patients with major depressive disorder: A prospective longitudinal study

Although tumor necrosis factor-alpha (TNF-α) has been recognized to be involved in the pathogenesis of major depressive disorder (MDD) for a long time, only few studies so far investigated the effects of antidepressant, venlafaxine on TNF-α and the results are inconsistent. Moreover, the association between plasma TNF-α levels and suicide accompanied with MDD is entirely unknown. To elucidate these relationships, in the present study, 64 first-episode drug-naïve MDD patients and 64 matched healthy controls were recruited. Total 61 MDD patients received 8-week venlafaxine treatment and they were divided into responders and non-responders according to the reduction rate of HRSD-17. Prior to venlafaxine treatment, both responders and non-responders shared a similar plasma TNF-α (p=0.33), which was significantly decreased following venlafaxine treatment (p<0.001, p=0.03, respectively). Compared to non-responders, the responder group had a greater reduction in TNF-α (p=0.01), which was associated with the greater reduction rate of HRSD-17 (B=1.02, p=0.01). In addition, the plasma TNF-α levels were equally higher in both suicidal and non-suicidal MDD patients (p=0.84) compared to the healthy controls on admission (p=0.001, p=0.03, respectively). Together, our data suggest that MDD per se rather than suicide is associated with the elevated plasma TNF-α, which can be inhibited with venlfaxine monotherapy. The extent of TNF-α reduction may be associated with the efficiency of venlafaxine.

No association between genetic variants of the LRRK2 gene and schizophrenia in Han Chinese

Mitochondrial dysfunction was widely reported in schizophrenia patients in recent studies. Leucine-rich repeat kinase 2 (LRRK2) is a mitochondrial protein, and mutations in the LRRK2 gene can induce mitochondrial dysfunction. LRRK2 mutations have been reported to be the most frequent genetic cause of Parkinsons disease (PD). We were interested in whether LRRK2 variants also play a role in schizophrenia. In this study, we genotyped 12 genetic variants (including 4 tag SNPs and 8 disease-associated variants) in the LRRK2 gene in a total of 2449 samples composed of two independent Han Chinese schizophrenia case-control cohorts (486 schizophrenia patients and 480 healthy controls from Hunan Province; 624 schizophrenia patients and 859 healthy controls from Shanghai). We compared the genotype, allele and haplotype frequencies of those SNPs between cases and controls. Statistical analyses revealed no association between LRRK2 variants/haplotypes and schizophrenia in these two schizophrenia case-control cohorts and the combined samples. Our results indicated that the LRRK2 variants are unlikely to be actively involved in schizophrenia in Han Chinese.

O-65 - Effect of brain-derived neurotrophic factor (BDNF) Val66Met polymorphism on early onset schizophrenia in chinese han population

Schizophrenia is a chronic psychiatry disorder with high heritability. Schizophrenic patients with early age at onset trend to have more genetic component and thus may be an attractive subpopulation for genetic studies. Brain-derived neurotrophimc factor (BDNF) is considered as candidate gene for schizophrenia. A single nucleotide polymorphism (BDNF Val66Met) was reported to be associated with schizophrenia, although discrepancy remains. The aim of this study was to evaluate the association between BDNF Val66Met polymorphism and schizophrenia using an early onset sample in Chinese Han population. Our sample consisted of 353 schizophrenic patients with onset before age 18 and 394 healthy age and sex matched controls. All subjects were ethnically homogenous Han Chinese origin. No significant differences of genotype or allele distribution were identified between the patients and controls. However, the Met allele was significantly associated with an earlier age at onset in male schizophrenic patients (Kaplan-Meier log-rank test Pxa0=xa00.005), but not in females (Pxa0=xa00.289). The BDNF Val66Met polymorphism has an important effect on the age at onset of schizophrenia in a gender-specific manner, and this may provided a significant genetic clue for the etiology of schizophrenia. Therefore, further studies are required to uncover the exact role of BDNF in the development of schizophrenia.

Validation of the Chinese Version of the Short TEMPS-A and its application in patients with mood disorders

BACKGROUNDnThe short version of Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego-Auto-questionnaire (TEMPS-A) is a useful instrument to measure affective temperaments. Aims of the present study are to validate the Chinese Version of the Short TEMPS-A, and to explore whether it could be useful to distinguish patients with mood disorders from healthy controls or differentiate patients with bipolar disorder (BPD) from those with major depressive disorder (MDD) in Chinese population.nnnMETHODSnA sample of 715 participants, including 387 patients with MDD, 143 with BPD and 185 healthy controls, was recruited. All participants completed The Chinese Version of the Short TEMPS-A. Standard psychometric tests of reliability and validation were performed. ANOVA, non-parameter test and Multiple Logistic Regression were used to test the association between TEMPS-A scores and mood disorders.nnnRESULTSnThe originally proposed five factors of the Chinese Version of the Short TEMPS-A were upheld. The Chronbach-Alpha coefficients of it varied from 0.70 to 0.89 and test-retest Spearman׳s Correlation Coefficients varied from 0.52 to 0.85. Significant differences were found across the three groups on all five TEMPS-A subscales (P<0.001). Multiple Logistic Regression showed that hyperthymic temperament distinguished patients with BPD from those with MDD (OR 1.28, 95% CI 1.14-1.45, P<0.001) after controlling for age, gender and the severity of depression.nnnLIMITATIONSnThe cross-sectional self-report design, unbalanced demographic characteristics and undifferentiated subtypes of bipolar disorders might limit the generalizability of the results.nnnCONCLUSIONnThe Chinese Version of the Short TEMPS-A shows good reliability and validity. It might be used as a screening tool in the general population to identify the vulnerability for developing a mood disorder and the potential risk for bipolar disorder among those who only have depressive symptoms.

O-64 - Blood-based gene expression profiles for classification of subsyndromal symptomatic depression and major depressive disorder

Objective The present study compared the expression profile and made the classification with the leukocytes by using whole-genome cRNA microarrays among patients with SSD, major depressive disorder (MDD) and healthy controls. Methods Gene expression profiling was conducted in peripheral blood leucocytes from drug-free first-episode subjects with SSD, MDD, and matched controls (8 subjects in each group) using global mRNA expression arrays. Support vector machines (SVMs) were utilized for training and testing on candidate signature expression profiles from signature selection step. Results We identified SSD and MDD gene signatures from blood-based gene expression profile and build a SSD- MDD disorder model with higher predictive power. Firstly, we identified 63 differentially expressed SSD signatures in contrast to control (Pxa0 Conclusion Blood cell-derived RNA may have significant value for performing diagnostic functions and identifying disease biomarkers in SSD and MDD. These 48 gene model could classify SSD, MDD, and healthy controls.

Common variants of the PINK1 and PARL genes do not confer genetic susceptibility to schizophrenia in Han Chinese

Schizophrenia is a prevalent psychiatric disorder with a complex etiology. Mitochondrial dysfunction has been frequently reported in schizophrenia. Phosphatase and tension homologue-induced kinase 1 (PINK1) and presenilin-associated rhomboid-like protease (PARL) are mitochondrial proteins, and genetic variants of these two genes may confer genetic susceptibility to schizophrenia by influencing mitochondrial function. In this study, we conducted a two-stage genetic association study to test this hypothesis. We genotyped 4 PINK1 and 5 PARL genetic variants and evaluated the potential association of the 9 SNPs with schizophrenia in two independent case–control cohorts of 2510 Han Chinese individuals. No positive association of common genetic variants of the PINK1 and PARL genes with schizophrenia was identified in our samples after Bonferroni correction. Re-analysis of the newly updated Psychiatric Genetics Consortium (PGC) data sets confirmed our negative result. Intriguingly, one PINK1 SNP (rs10916832), which showed a marginally significant association in only Hunan samples (Pxa0=xa00.032), is associated with the expression of a schizophrenia susceptible gene KIF17 according to the expression quantitative trait locus (eQTL) analysis. Our study indicated that common genetic variants of the PINK1 and PARL genes are unlikely to be involved in schizophrenia. Further studies are essential to characterize the role of the PINK1 and PARL genes in schizophrenia.

Down-regulation of PRKCB1 expression in Han Chinese patients with subsyndromal symptomatic depression

BACKGROUNDnSubsyndromal symptomatic depression (SSD) is a common disease with significant social dysfunction. However, SSD is still not well understood and the pathophysiology of it remains unclear.nnnMETHODSnWe classified 48 candidate genes for SSD according to our previous study into clusters and pathways using DAVID Bioinformatics Functional Annotation Tool. We further replicated the result by using real-time Quantitative PCR (qPCR) studies to examine the expression of identified genes (i.e., STAT5b, PKCB1, ABL1 and NRAS) in another group of Han Chinese patients with SSD (nxa0=xa050). We further validated the result by examining PRKCB1 expression collected from MDD patients (nxa0=xa020). To test whether a deficit in PRKCB1 expression leads to dysregulation in PRKCB1 dependent transcript networks, we tested mRNA expression levels for the remaining 44 genes out of 48 genes in SSD patients. Finally, the power of discovery was improved by incorporating information from Quantitative Trait (eQTL) analysis.nnnRESULTSnThe results showed that the PRCKB1 gene expression in peripheral blood mononuclear cells (PBMC) was 33.3% down-regulated in SSD patients (nxa0=xa048, txa0=xa03.202, pxa0=xa00.002), and a more dramatic (nxa0=xa017, 49%) down-regulation in MDD patients than control (nxa0=xa049, txa0=xa02.114, pxa0=xa00.001). We also identified 37 genes that displayed a strong correlation with PRKCB1 mRNA expression levels in SSD patients. The expression of PRKCB1 was regulated by multiple single nucleotide polymorphisms (SNPs) both at the transcript level and exon level.nnnCONCLUSIONSnIn conclusion, we first found a significant decrease of PRCKB1 mRNA expression in SSD, suggesting PRKCB1 might be the candidate gene and biomarker for SSD.