Electroconvulsive therapy for agitation in schizophrenia: Meta-analysis of randomized controlled trials

Background: Agitation poses a significant challenge in the treatment of schizophrenia. Electroconvulsive therapy (ECT) is a fast, effective and safe treatment for a variety of psychiatric disorders, but no meta-analysis of ECT treatment for agitation in schizophrenia has yet been reported. Aims: To systematically evaluate the efficacy and safety of ECT alone or ECT-antipsychotics (APs) combination for agitation in schizophrenia. Methods: Systematic literature search of randomized controlled trials (RCTs) was performed. Two independent evaluators selected studies, extracted data about outcomes and safety with available data, conducted quality assessment and data synthesis. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to judge the level of the overall evidence of main outcomes. Results: Seven RCTs from China, including ECT alone (4 RCTs with 5 treatment arms, n=240) and ECT-APs combination (3 RCTs, n=240), were identified. Participants in the studies were on average 34.3(4.5) years of age and lasted an average of 4.3(3.1) weeks of treatment duration. All 7 RCTs were non-blinded, and were rated as low quality based on Jadad scale. Meta-analysis of the pooled sample found no significant difference in the improvement of the agitation sub-score of the Positive and Negative Syndrome Scale (PANSS) when ECT alone (weighted mean difference=-0.90, (95% confidence interval (CI): -2.91, 1.11), p=0.38) or ECT-APs combination (WMD=-1.34, (95%CI: -4.07, 1.39), p=0.33) compared with APs monotherapy. However, ECT alone was superior to APs monotherapy regarding PANSS total score (WMD=-7.13, I2=0%, p=0.004) and its excitement sub-score (WMD=-1.97, pI2=0%, p=0.004) and its excitement sub-score at 7 and 14 days (WMD=-1.97 to -1.92, p=0.002 to 0.0001) after ECT. The ECT-APs combination was superior to APs monotherapy with respect to the PANSS total score at treatment endpoint (WMD=-10.40, p=0.03) and 7 days (WMD=-5.01, p=0.02). Headache ( number-needed-to-harm (NNH)=3, 95%CI=2-4) was more frequent in the ECT alone group compared to AP monotherapy. According to the GRADE approach, the evidence levels of main outcomes were rated as ‘‘very low’’ (37.5%) and “low” (50%). Conclusion: Pooling of the data based on 7 RCTs from China found no advantage of ECT alone or ECT-APs combination in the treatment of agitation related outcomes in schizophrenia patients. However, ECT alone or ECT-APs combination were associated with significant reduction in the PANSS total score. High-quality RCTs are needed to confirm the current interpretations. Review registration number: CRD4201400668

Sleep duration and patterns in Chinese older adults: A comprehensive meta-analysis

This meta-analysis examined the mean sleep duration and patterns in Chinese older adult population. A literature search was systematically conducted covering major English (PubMed, Embase and PsycINFO) and Chinese (Chinese National Knowledge Infrastructure (CNKI), WanFang and SinoMed) databases. Data in studies with the mean and standard deviation of sleep duration and/or the proportion of short and long sleep durations in Chinese older adults were extracted and pooled using random-effects models. Subgroup analyses were conducted according to gender, region, area, survey time and sample size. A total of 36 studies with 150,616 subjects were included for analyses. The pooled mean sleep duration of 21 studies with available data was 6.82 hours/day (95% CI: 6.59–7.05 hours/day). The estimated proportions of sleep duration \u3c5 hours/day, \u3c6 hours/day, \u3c7 hours/day were 18.8% (95% CI: 1.7%–35.9%), 26.7% (95% CI: 19.7%–33.7%) and 42.3% (95% CI: 34.8%–49.8%), respectively. The pooled proportions for long sleepers were 22.6% (95% CI: 13.9%–31.4%) (\u3e8 hours/day) and 17.6% (95% CI: 12.4%–22.9%) (\u3e9 hours/day). Given the adverse effects of unhealthy sleep patterns, health professionals should pay more attention to sleep patterns in this population in China

Duration of untreated bipolar disorder: A multicenter study

Little is known about the demographic and clinical differences between short and long duration of untreated bipolar disorder (DUB) in Chinese patients. This study examined the demographic and clinical features of short (≤2 years) and long DUB (\u3e2 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) was examined in 7 psychiatric hospitals and general hospital psychiatric units across China. Patients’ demographic and clinical characteristics were collected using a standardized protocol and data collection procedure. The mean DUB was 3.2 ± 6.0 years; long DUB accounted for 31.0% of the sample. Multivariate analyses revealed that longer duration of illness, diagnosis of BD type II, and earlier misdiagnosis of BD for major depressive disorder or schizophrenia were independently associated with long DUB. The mean DUB in Chinese BD patients was shorter than the reported figures from Western countries. The long-term impact of DUB on the outcome of BD is warranted

Prevalence of smoking in patients with bipolar disorder, major depressive disorder and schizophrenia and their relationships with quality of life

Few studies have compared the prevalence of smoking between patients with bipolar disorder, major depressive disorder (MDD) and schizophrenia. This study examined the prevalence of smoking and its relationships with demographic and clinical characteristics, and quality of life (QOL) in patients with these psychiatric disorders. A total of 1,102 inpatients were consecutively screened. Psychopathology and QOL were measured with standardized instruments. The prevalence of current smoking in the whole sample was 16.7%; 17.5% in bipolar disorder, 10.6% in MDD and 18.5% in schizophrenia. The rates of smoking in bipolar disorder (p = 0.004, OR = 2.5, 95%CI: 1.3–4.7) and schizophrenia (p = 0.03, OR = 2.0, 95%CI: 1.06–3.8) were significantly higher than in MDD, while no difference was found between bipolar disorder and schizophrenia. Smokers had a higher mental QOL than non-smokers (p = 0.007) in MDD, but no difference was found in the other two groups. Male gender, living alone, higher personal income, older age of onset, health insurance coverage, and first episode was significantly associated with smoking in one or more diagnostic groups. Smoking appears more common in bipolar disorder and schizophrenia than in MDD in China. The figures in all disorders were lower than that reported in most of other countries

Psychotic-like experiences and associated socio-demographic factorsamong adolescents in China

Objective Adolescents with persistent psychotic-like experiences (PLEs) may be at high risk for later development of psychoses. Exploring early age risk factors for PLEs may provide useful information for prevention of mental disorders and improvement of mental health. Method A total of 5427 adolescents (aged between 10 and 16) participated in a cross-sectional survey, with social and demographic information collected. The Positive Subscale of Community Assessment of Psychic Experiences (CAPE) was used to measure PLEs, and the CAPE Depressive and Negative Subscales were used to examine depressive and negative experiences. The Trauma History Questionnaire (child version) was used to assess experiences of previous traumatic events. Results In our study, 95.7% of the adolescents reported more than one episode of PLEs, while 17.2% reported “nearly always” having PLEs. High positive correlations were shown both between frequency scores among experiences of three dimensions (PLEs, depressive and negative experiences), and between frequency and distress scores. Factors associated with a higher risk for more frequent and distressing PLEs include: urban setting, family history of psychiatric illnesses, and higher impact from previous traumatic events at present. Conclusions Episodes of PLEs are common in Chinese adolescents, however only a small proportion have persistent PLEs, with worsening distress as the frequency increased. PLEs shared similar environmental and genetic risk factors not only with the clinical phenotypes, which is consistent with the continuity model of PLEs, but also with depressive and negative experiences, which may imply etiologic relation between different dimensions of psychosis at the subclinical leve

Psychotic-like experiences and correlation with childhood trauma and other socio-demographic factors: A cross-sectional survey in adolescence and early adulthood in China

Psychotic-like experiences (PLEs) in adolescence are found to be risk factors for later mental disorders. Previous research has also found that childhood trauma has a positive correlation with mental health problems. However, few studies have focused on the relationship between them, especially in adolescence and early adulthood. A total of 9122 students (age between 10 and 23.3) were surveyed and assessed with the positive and depressive subscales of the Community Assessment of Psychic Experiences and the Trauma History Questionnaire. A total of 20.7% students experienced frequent PLEs, 17.5% had frequent delusional experiences, and 7.6% had frequent hallucinatory experiences. Only a small portion of this sample experienced frequent PLEs, associated with more types of PLEs, more distress, and more depressive experiences. Several socio-demographic factors were associated with frequent PLEs in this sample, which could be further examined in future prevention studies. Students with frequent PLEs experienced significantly higher impact from trauma events, both at the time of the events and in the present, indicating a possible reciprocal effect between childhood trauma and PLEs. The impact of childhood trauma played an important role in the relationship between childhood trauma and PLEs

Long‐Term Benzodiazepine Use in Patients With Major Depressive Disorder in C hina

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108099/1/ppc12035.pd