To assess the reliability and validity of Patient Health Questionnaire-9 (PHQ-9) for patients with major depressive disorder (MDD) and to assess the feasibility of its use in psychiatric hospitals in ...China.
One hundred nine outpatients or inpatients with MDD who qualified the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria completed PHQ-9 and Hamilton Depression Scale (HAMD-17). Two weeks after the initial evaluation, 54 randomly selected patients underwent repeat assessment using PHQ-9. For validity analysis, the construct validity and criterion validity were assessed. The internal concordance coefficient and the test-retest correlation coefficients were used for reliability analysis. The correlation between total score and scores for each item and the correlation between scores for various items were evaluated using Pearson correlation coefficient.
Principal components factor analysis showed good construct validity of the PHQ-9. PHQ-9 total score showed a positive correlation with HAMD-17 total score (r = 0.610, P < 0.001). With HAMD as the standard, PHQ-9 depression scores of 7, 15, and 21 points were used as cut-offs for mild, moderate, and severe depression, respectively. Consistency assessment was conducted between the depression severity as assessed by PHQ-9 and HAMD (Kappa = 0.229, P < 0.001). Intraclass correlation coefficient between PHQ-9 total score and HAMD total score was 0.594 (95% confidence interval, 0.456-0.704, P < 0.001). The Cronbach's α coefficient of PHQ-9 was 0.892. Correlation coefficients between each item score and the total score ranged from 0.567-0.789 (P < 0.01); the correlation coefficient between various item scores ranged from 0.233-0.747. The test-retest correlation coefficient for total score was 0.737.
PHQ-9 showed good reliability and validity, and high adaptability for patients with MDD in psychiatric hospital. It is a simple, rapid, effective, and reliable tool for screening and evaluation of the severity of depression.
The Measurement and Treatment Research to Improve Cognition Schizophrenia Consensus Cognitive Battery (MCCB) has also been proposed for use in clinical trials to assess cognitive deficits in patients ...with bipolar disorder (BD). The aim of this study was to evaluate cognitive function assessed by the MCCB in BD.
A literature search of the PubMed, Embase, PsycINFO, SCI, Cochrane Library databases and the Cochrane Controlled Trials Register was conducted. Case reports, reviews and meta-analyses were excluded and a systematic review of the remaining studies of cognitive function in BD was carried out. The cognitive outcome measure was the MCCB, including 7 domains and overall cognition. A random-effects model was applied.
Eighty eight studies were initially identified. Seven clinical studies comprising a total of 487 patients and 570 healthy controls (HC) were included in the meta-analysis. Patients with BD performed worse than HC in overall cognition and processing speed with a large effect size of >0.8; with a medium effect size (0.5-0.8) in attention, working memory, verbal learning and visual learning; and with a small effect size (0.2-0.5) in reasoning and problem solving and social cognition.
Patients with BD performed worse than HC in overall cognition and all cognitive domains of the MCCB. Cognitive deficits in domains of processing speed and working memory are prominent in patients with BD. Our findings suggest that MCCB can be usefully applied in BD.
Abstract Background Theoretical and empirical evidence indicates the critical role of the default mode network (DMN) in the pathophysiology of the bipolar disorder (BD). This study aims to identify ...the specific brain regions of the DMN that is impaired in patients with BD. Methods A total of 56 patients with BD and 71 healthy controls (HC) underwent resting-state functional magnetic resonance imaging. Three commonly used functional indices, i.e., fractional amplitude of low-frequency fluctuation (fALFF), regional homogeneity (ReHo), and degree centrality (DC), were utilized to identify the brain region showing abnormal spontaneous brain activity in patients with BD. Then, this region served as the seed region for resting-state functional connectivity (rsFC) analysis. Results Compared to the HC group, the BD group showed reduced fALFF, ReHo, and DC values in the left precuneus. Moreover, patients exhibited decreased rsFCs within the left precuneus and between the left precuneus and the medial prefrontal cortex. Additionally, there was diminished negative connectivity between the left precuneus and the left putamen, extending to the left insula (putamen/insula). The abnormalities in DMN functional connectivity were confirmed through various analysis strategies. Conclusions Our findings provide convergent evidence for the abnormalities in the DMN, particularly located in the left precuneus. Decreased functional connectivity within the DMN and the reduced anticorrelation between the DMN and the salience network are found in patients with BD. These findings suggest that the DMN is a key aspect for understanding the neural basis of BD, and the altered functional patterns of DMN may be a potential candidate biomarker for diagnosis of BD.
Bipolar disorder (BD) is a complex mental illness characterized by different mood states, including depression, mania/hypomania, and euthymia. This study aimed to comprehensively evaluate dynamic ...changes in intrinsic brain activity by using dynamic fractional amplitude of low-frequency fluctuations (dfALFF) and dynamic degree centrality (dDC) in patients with BD euthymia or depression and healthy individuals.
The resting-state functional magnetic resonance imaging data were analyzed from 37 euthymic and 28 depressed patients with BD, as well as 85 healthy individuals. Using the sliding-window method, the dfALFF and dDC were calculated for each participant. These values were compared between the 3 groups using one-way analysis of variance (ANOVA). Additional analyses were conducted using different window lengths, step width, and window type to ensure the reliability of the results.
The euthymic group showed significantly lower dfALFF and dDC values of the left and right cerebellum posterior lobe compared with the depressed and control groups (cluster level P
< 0.05), while the latter two groups were comparable. Brain regions showing significant group differences in the dfALFF analysis overlapped with those with significant differences in the dDC analysis. These results were consistent across different window lengths, step width, and window type.
These findings suggested that patients with euthymic BD exhibit less flexibility of temporal functional activities in the cerebellum posterior lobes compared to either depressed patients or healthy individuals. These results could contribute to the development of neuropathological models of BD, ultimately leading to improved diagnosis and treatment of this complex illness.
Abstract
Background
This is a cross-sectional study comparing the degree of subjective quality of life (QOL) impairment and its predictive factors in first-episode schizophrenia (FES) and individuals ...at clinical high-risk (CHR) for psychosis.
Methods
Seventy-seven FES, 59 CHR, and 64 healthy controls (HC) were included. The QOL of all participants was assessed using the World Health Organization Quality of Life (WHOQOL)-Brief Form (BREF). Psychiatric symptoms of individuals with FES were assessed with the Positive and Negative Syndrome Scale (PANSS), five factors were further identified through factor analysis; for individuals with CHR and HC, the Scale of Prodromal Symptoms (SOPS) was used.
Results
The total and four sub-domain scores of the WHOQOL-BREF in the FES and CHR groups were lower than those of the HC group. The overall and psychological health scores in the CHR group were lowest. In the FES group, after applying Bonferroni’s correction, there is a negative correlation between the total QOL scores and anxiety/depressive symptom scores (
r
= –0.34,
P
= 0.003). The stepwise multiple regression analysis showed that the QOL of both FES and CHR group were negatively affected by anxiety/depressive symptoms and unemployment (
P
< 0.05).
Conclusions
Compared with FES, CHR individuals are more dissatisfied with their QOL. Although diagnostic assessment of FES and CHR relies heavily on positive symptoms, the QOL is more affected by anxiety/depressive symptoms and social functioning.
Aim
Neurophysiological markers of schizophrenia may help identify individuals who are at an increased risk of developing psychosis. As an operational measure of sensorimotor gating, pre‐pulse ...inhibition (PPI) deficit has been investigated in clinical high‐risk (CHR) individuals. In this study, we performed a systematic review and meta‐analysis of studies that investigated PPI in CHR individuals.
Methods
Relevant studies published as of July 2019 were retrieved from the PubMed, Cochrane, Embase, PscyINFO, EBSCO and Chinese databases. PPI was evaluated by calculating the standard mean differences (SMDs) between CHR individuals and healthy controls (HC) in meta‐analysis. Quality of studies was assessed using the Newcastle‐Ottawa Scale. I2 index was used to assess heterogeneity and Egger's test was used to assess publication bias.
Results
Eight studies were found to be eligible. The meta‐analysis included five studies with a combined study population of 184 CHR subjects and 161 HC. CHR individuals showed lower PPI levels compared to HC in 120 ms inter‐stimulus interval or stimulus onset asynchrony paradigm (P = .491, SMD = −0.62). No significant heterogeneity was observed in 120 ms PPI paradigm (χ2 = 3.41, P = .491, I2 = 0.0%).
Conclusion
CHR individuals had lower PPI level compared to HC in 120 ms paradigm, which were relatively stable and significant. The results indicate the presence of information processing and inhibitory problems prior to the development of full‐blown psychosis. PPI may be clinically used as an objective indicator to supplement the understanding of CHR individuals.
Background
Prepulse inhibition (PPI) is a measure of sensorimotor gating used to identify deficits in early‐stage information processing and inhibitory function defects. Many studies support the ...presence of PPI deficits in schizophrenia patients. However, very few studies have explored PPI levels among first‐degree relatives (FDR) of schizophrenia patients, and the results have been inconsistent. This review article explored PPI levels in FDR of schizophrenia patients.
Methods
We performed a systematic literature review using the PubMed, Cochrane, Embase, EBSCO and Chinese databases from inception to January 2020. A series of related factors (eg, PPI paradigm, heritability and sample characteristics) and outcomes were summarized from the literature that met the inclusion criteria. The Newcastle‐Ottawa Scale was used to assess the quality of the included studies.
Results
A total of eight studies were eligible for systematic review after screening. A meta‐analysis of the selected studies was not conducted due to the limitations of quantity and paradigm heterogeneity. A majority of the studies' subjects were siblings of schizophrenia patients and different paradigms were applied. Most of the included studies reported no difference in PPI values between FDR of schizophrenia patients and healthy controls.
Conclusion
Contrary to traditional certainty that unaffected FDR of schizophrenia patients have PPI defects, our review found no sufficient evidence supporting that the PPI level in FDR of schizophrenia patients was lower than in healthy controls. A prospective cohort study focusing on different outcomes such as developing schizophrenia is required to explore PPI levels in FDR of schizophrenia patients.
Aim
The extent and specifics regarding cognitive dysfunction in patients with bipolar disorder (BD) or major depressive disorder (MDD) and their unaffected first‐degree relatives (FDR) have not been ...addressed in any single study. The present study compared the cognitive function of patients with BD or MDD, their FDR, and healthy control (HC) individuals.
Methods
The study population comprised adults (aged 18–55 years) with BD, adults with MDD, FDR (children or siblings of patients with BD or MDD), and HC (n = 105, 109, 85, and 95, respectively). The Repeatable Battery for the Assessment of Neuropsychological Status was used to assess neurocognitive functions, with five domains and 12 tests. A Wechsler Adult Intelligence Scale brief form was applied to evaluate IQ. Status of mood was assessed using the Young Mania Rating Scale and the Hamilton Depression Scale.
Results
The mixed model indicated significant variation among the four groups in cognitive function. Cognitive impairments, compared to HC, progressively greater from least to most were found in: FDR, MDD, and BD (F = 32.74, P < 0.001). Years of education correlated with cognitive performance (F = 17.04, P < 0.001), as did IQ (F = 240.63, P < 0.001). The total score for the Hamilton Rating Scale for Depression negatively correlated with cognitive function (F = 5.78, P = 0.017).
Conclusion
Among the study groups, patients with BD had the most severe deficits, followed by MDD patients and FDR. Cognitive deficits could not be associated with a specific psychiatric disorder, but differences in degree were noted.
Prepulse inhibition (PPI) is a measurement method for the sensory gating process, which helps the brain adapt to complex environments. PPI may be reduced in patients with bipolar disorder (BD). This ...study investigated PPI deficits in BD and pooled the effect size of PPI in patients with BD.
We conducted a literature search on PPI in patients with BD from inception to July 27, 2019 in PubMed, Embase, Cochrane Library databases, and Chinese databases. No age, sex, and language restriction were set. The calculation formula was PPI = 100 - 100*((prepulse - pulse amplitude) / pulse amplitude). The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies.
Ten eligible papers were identified, of which five studies including a total of 141 euthymic patients and 132 healthy controls (HC) were included in the meta-analysis. Compared with HC, euthymic patients with BD had significantly lower PPI at the 60 ms interstimulus interval (ISI) between pulse and prepulse (P = 0.476, I
= 0.0%, SMD = - 0.32, 95% CI = - 0.54 - -0.10). Sensitivity analysis shows no significant change in the combined effect value after removing any single study. There was no publication bias using the Egger's test at 60 ms (P = 0.606). The meta-analysis of PPI at the 60 ms ISI could have significant clinical heterogeneity in mood episode state, as well as lack of data on BD I or II subtypes.
Euthymic patients with BD show PPI deficits at the 60 ms, suggesting a deficit in the early sensory gate underlying PPI. The PPI inhibition rate at a 60 ms interval is a stable index. More research is needed in the future to confirm this outcome, and to delve deeper into the mechanisms behind deficits.
Hyperprolactinemia is a common antipsychotic-induced adverse event in psychiatric patients, and the quality of clinical studies investigating the best treatments has varied. Thus, to better summarize ...the clinical evidence, we performed an umbrella review of overlapping systematic reviews and meta-analyses for the treatment of antipsychotic-induced hyperprolactinemia.
The PubMed, Cochrane Library, PsycINFO, Scopus and EMBASE were searched, and reviews and meta-analyses meeting our inclusion criteria were selected. Relevant data were extracted, and an umbrella review was conducted of all included meta-analyses. The quality of included meta-analyses was assessed by using PRISMA scores and AMSTAR 2 quality evaluation. Finally, the clinical evidence for appropriate treatments was summarized and discussed.
Five meta-analyses published between 2013 and 2020 met the requirements for inclusion in this umbrella review. The PRISMA scores of the included meta-analyses ranged from 19.5-26. AMSTAR 2 quality evaluation showed that 2 of the 5 included meta-analyses were of low quality and 3 were of very low quality. The included meta-analyses provide clinical evidence that adding aripiprazole or a dopamine agonist can effectively and safely improve antipsychotic-induced hyperprolactinemia. Two meta-analyses also showed that adjunctive metformin can reduce serum prolactin level, but more clinical trials are needed to confirm this finding.
Adjunctive dopamine agonists have been proven to be effective and safe for the treatment of antipsychotic-induced hyperprolactinemia. Among the researched treatments, adding aripiprazole may be the most appropriate.
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