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BACKGROUND: With the modification of DSM-5 mixed features specifier, a brief scale to screen mixed features in patients with mood disorders is needed in clinical practice. This study aimed to explore the psychometric properties of the Chinese version of the Clinically Useful Depression Outcome Scale supplemented with DSM-5 Mixed subtype (CUDOS-M-C) for the Chinese patients with mood disorders. METHODS: Overall, 300 patients with major depressive episode were recruited. All participants were assessed using CUDOS-M-C, Young Mania Rating Scale, Hamilton Anxiety Scale and Montgomery-Asberg Depression Rating Scale. The receiver operating characteristic (ROC) curve analysis was used to calculate the optimal cut-off values of CUDOS-M-C score. The reliability and validity of CUDOS-M-C were examined using Cronbach's alpha, intraclass correlation coefficient (ICC) and principal component analysis (PCA). RESULTS: The results of PCA indicated two-factor structure as the best solution for CUDOS-M-C, which explained 54.82% of cumulative variance. The Cronbach's alpha was 0.892 and the ICC was 0.853. The area under the ROC curve of the CUDOS-M-C for participants with mixed depression was 0.927 (p<0.001) and the suitable cut-off value was 8, with a sensitivity of 91.6% and specificity of 79.9%. LIMITATIONS: Most of the patients were recruited from eastern China and further research with larger sample is warranted. And this study did not perform confirmatory factor analysis to identify the generalization of factor structure of CUDOS-M-C. Besides, the study performed the test-retest reliability of CUDOS-M-C and further analysis is needed to ascertain the patient's post-treatment changes. CONCLUSION: The CUDOS-M-C demonstrated to have satisfactory psychometric properties as a self-report scale, and could be applied to screen patients with mixed depression in clinical practice.

Brain systems that promote maintenance of homeostasis in the face of stress have significant adaptive value. A growing body of work across species demonstrates a critical role for the amygdala in promoting homeostasis by regulating physiological and behavioral responses to stress. This review focuses on an emerging body of evidence that has begun to delineate the contribution of specific long-range amygdala circuits in mediating the effects of stress. After summarizing the major anatomical features of the amygdala and its connectivity to other limbic structures, we discuss recent findings from rodents showing how stress causes structural and functional remodeling of amygdala neuronal outputs to defined cortical and subcortical target regions. We also consider some of the environmental and genetic factors that have been found to moderate how the amygdala responds to stress and relate the emerging preclinical literature to the current understanding of the pathophysiology and treatment of stress-related neuropsychiatric disorders. Future effort to translate these findings to clinics may help to develop valuable tools for prevention, diagnosis, and treatment of these diseases.

Atmospheric nitrogen (N) deposition, climatic variables and anthropogenic management affect grassland-ecosystem stability by driving changes in plant community and loss of plant diversity. Determination of their influences on plant composition and diversity is essential for predicting ecosystem response to future global changes and for making policies of sustainable grassland management. We evaluated the relative contributions of atmospheric N deposition, climatic variables and grassland management to plant diversity and N accumulation by temporally monitoring the changes in plant community and N status in a temperate grassland ecosystem. Ambient low-level N deposition combined with long-term grassland enclosure led to increases in above-ground biomass and abundance of grasses and sedges, and decreases in those of forbs. The dominant species of perennial forbs and grasses also displayed divergence in their biomass and abundance over time. Nitrogen deposition made greater contributions to the divergent changes in perennial forbs and grasses. However, air temperature and precipitation fluctuations mainly contributed to the annual fluctuations in annual and biennial species. Long-term enclosure aggravated the cumulative effects of soil inorganic N on plant-diversity loss while mowing had opposite effects on the N accumulation. Synthesis and applications. Ambient low-level N deposition can drive loss of plant diversity due to N accumulation in grassland ecosystem under long-time enclosure. Therefore, appropriate grassland management, such as rationally grazing and/or mowing, may be effective practices in terms of maintenance of plant biodiversity under the scenario of enhanced atmospheric N deposition.