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Hsinsung Yuan,1,2Xiao Zhu,1 Qiang Luo,3,4 Alice Halim,5 Michael Halim,5 Hao Yao,5 Yiyun Cai,1,6 Shenxun Shi1,6 1Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Psychiatry Department of Nanjing Brain Hospital, Nanjing, People’s Republic of China; 3Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, People’s Republic of China; 4Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Ministry of Education), Fudan University, Shanghai, People’s Republic of China; 5Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China; 6Shanghai Mental Health Center, Shanghai, People’s Republic of China Purpose: Early improvement in major depressive disorder is defined as a reduction of ≥20% in the 17-item Hamilton Depression Rating Scale (HAM-D-17) score at the second week after initiation of treatment, predicting long-term treatment response. However, there remains no effective strategy for switching medications when a patient fails to reach early improvement at the second week. This study focused on the predictive value of early symptom changes in each item of the HAM-D-17 scale for treatment response to selective serotonin reuptake inhibitor (SSRI) monotherapy and to provide a reference for switching antidepressants to enhance early treatment efficacy. Patients and methods: Our study was an observational, real-world study that enrolled 90 treatment-naïve patients experiencing their first episode of major depressive disorder in the outpatient department of Huashan Hospital. Patients who did not achieve the threshold of early improvement in the second week after starting treatment were switched to alternative SSRI monotherapy. Patient follow-up occurred at 2, 4, 8, and 12weeks after the initiation of treatment. We analyzed the relationship between the change in each symptom on the HAM-D-17 scale and treatment efficacy. Results: Early improvement predicted the treatment response at 12weeks (χ2=19.249, P999.999); treatment-emergent headache and tremor were associated with treatment efficacy (t=-9.521,P

The occurrence of complications during the gestation period is higher among pregnant women with a history of complications than among pregnant women without previous complications. High-risk pregnancy can cause negative emotional symptoms such as anxiety and depression in pregnant women. Current research on anxiety and depression symptoms in pregnant women is sparse.To examine the incidence of anxiety and depression symptoms in pregnant women with a history of previous complications or high risk pregnancy and related risk factors.Women with a history of previous complications in pregnancy or current 'high risk' pregnancy (e.g. test tube fertilization, etc.) were classified as 'high risk'. 197 of these 'high risk' women who were in their second trimester (16 to 20 weeks) underwent a monthly comprehensive assessment using the Hospital Anxiety and Depression Scale (HAD) in the last 4 months of the gestation period. The Edinburgh Postnatal Depression Scale (EPDS) was used for assessment and risk factor investigation 3 to 7 days, 42 days, and 3 months after childbirth.The mean (sd) HAD anxiety score among 'high-risk'women at the time of enrollment was 3.69 (2.76) and depression score was 3.42 (2.53). Significant anxiety symptoms and depression symptoms were found in 14 cases (7.18 %) and 10 cases (5.13%), respectively. Multivariate analysis showed a correlation between anxiety symptoms and history of miscarriage (OR: 8.162, 95%CI: 1.213 to 54.914)and testing positive for hepatitis (OR: 8.912, 95%CI: 1.052 to 75.498). Depressive symptoms were correlated with glucose positive urine (OR: 30.529, 95%CI: 1.312 to 710.610) and history of hemorrhaging (OR: 7.122, 95%CI: 1.015 to 49.984). General factors associated with anxiety and depression symptoms include patients' health status in the recent 3 months, concerns about fetal health, quality of marital relationship, and relationship with in-laws.Anxiety and depression symptoms are commonly seen in pregnant women with a history of previous complications or current 'high risk' pregnancy. Patients' recent health status, relationship with in-laws, marital quality and concerns about fetal health are associated with anxiety and depression symptoms during pregnancy.高危孕妇与普通孕妇相比在妊娠期会出现更多的并发症，高危因素作为一种应激因素更易诱发孕妇产生焦虑、抑郁等负面情绪症状。目前国内外对高危孕妇焦虑、抑郁症状的研究相对较少。.调查产科高危妊娠孕妇焦虑、抑郁症状发生率及其相关危险因素。.对197 例孕中期（16-20 周）的高危孕妇在妊娠最后4 月每月进行综合性医院焦虑/ 抑郁量表（HAD）评估和风险因素调查。产后3-7 天、42 天及3 月进行爱丁堡产后抑郁量表（EPDS）评估和风险因素调查。.入组时高危孕妇HAD 焦虑均分：3.69(2.76)，抑郁均分：3.42 (2.53)。焦虑症状14 例(7.18%)，抑郁症状10 例(5.13%)。多因素分析显示，怀孕有无保胎（OR：8.162, 95%CI：1.213-54.914）和乙肝阳性（OR：8.912, 95%CI：1.052-75.498）与焦虑症状相关。尿糖阳性（OR： 30.529, 95%CI：1.312-710.610）和既往出血史（OR：7.122, 95%CI：1.015-49.984）与抑郁症状相关。孕期影响高危孕妇焦虑、抑郁症状的因素有：近3 月孕妇健康状况、担心胎儿健康、夫妻关系、婆媳关系等。.高危妊娠孕妇焦虑、抑郁症状较常见。近3 月孕妇健康状况、婆媳关系、夫妻关系、担心胎儿健康是高危孕妇孕期焦虑、抑郁症状的风险因素。.

Summary Over the last decade increasing attention has been focused on individuals that simultaneously meet the criteria of two or more mental disorders. One of these comorbid conditions, comorbid bipolar disorder and obsessive compulsive disorder, is relatively common among patients with a primary diagnosis of bipolar disorder. But there is little research about the diagnosis and treatment of this comorbid condition, particularly in China. The available studies are primarily cross-sectional studies with small samples, so they are of limited use in understanding the etiology and course of this combined condition. A review of the limited literature suggests that this is a relatively severe, refractory subtype of bipolar disorder that only occasionally merits being considered a comorbid disorder. Larger prospective studies are needed to clarify the etiology, prognosis, and appropriate treatment for this comorbid condition.

To assess the perfusion changes in brains of patients with varying levels of generalized anxiety disorder (GAD).A total of 38 GAD outpatients of Department of Psychiatry at our hospital from February to August, 2014 and 10 healthy controls received a 99mTC-ECD SPECT/CT scan with scenium analysis. Differences between brain perfusion and anxiety levels were analyzed by SPSS 16. 0 with one-way ANOVA, Pearson's Chi-square, t test and Spearman's correlation.They were grouped according to the levels of anxiety severity, i. e. mild (n = 11) , moderate (n = 16) and severe (n = 11). They had significantly lower blood flow in right superior frontal medial gyrus, right precuneus, right putamen, bilateral paracentral lobule and bilateral supplementary motor area (t = -2.19, -2.14, -2.22, -2.34, -2.08, -3.26, -2.72, P0.05). Individuals had significantly greater blood flow in mild group than those of control group in right olfactory (t = 2.09 P = 0.05). Individuals of moderate group had significantly lower blood flow than those of control group in left superior frontal gyrus medial orbital, right superior frontal gyrus medial orbital and left supplementary motor area, but greater in right olfactory (t = -2.16, -2.24, -2.49, 2.17, P = 0.04, 0.04, 0.02, 0.04). Individuals had lower blood flow in severe group than those of control group in left frontal lobe, right putamen, left paracentral lobule, right paracentral lobule, left precuneus, right precuneus, left parietal lobe, left precentral, right precentral, right postcentral, left rolandic operculum, left supplementary motor area, right supplementary motor area and left central region (t = -2.32, -2.11, -3.16, -2.61, -2.39, -2.18, -2.32, -2.67, -2.14, -2.11, -2.25, -4.38, -3.54, -2.38, P = 0.03, 0.05, 0.01, 0.02, 0.03, 0.04, 0.03, 0.02, 0.05, 0.05, 0.04, 0.00, 0.00, 0.03). Statistical differences existed in right middle frontal gyms orbital part (mild: 0.96 ± 0.07, moderate: 1.03 ± 0.06, severe: 0.98 ± 0.08, P = 0.04) and left paracentral (mild: 0.91 ± 0.07, moderate: 093 ± 004 severe: 0.87 ± 0.07, P = 0.02). There was a tendency of negative correlation between perfusion in right middle cingulate and paracingulate gyri, left precuneus, right precuneus and left thalamus and anxiety scores by Spearman's correlation analysis (r = -0.28, -0.28, -0.27, -0.29, P = 0.09, 0.09, 0.10, 0.07).Scenium software provides quantitative measurements for diagnosis of GAD in different anxiety levels. Also larger samples are required for confirming the results in further studies.

Background Studies of mental disorders using single photon emission computed tomography (SPECT) have been done for many years in China. Many results have been obtained. We review these findings and introduce them to the outside world. Methods SPECT papers available on the Chinese Biomedical Bibliographic Database, focusing on depression, schizophrenia, Alzheimer’s disease (AD), vascular dementia (VD), anxiety disorder, and obsessive compulsive disorder (OCD) in China, were reviewed and the results were compared with those obtained outside China. Results We found that regional cerebral blood flow (rCBF) was abnormal in mental disorders, but the specificity of the abnormality is not yet consistent. Lower perfusion of rCBF could be seen in frontal, temporal, and parietal lobes of patients with depression, AD, schizophrenia, and VD. It seems that abnormality of the frontal lobe is more common in depression and schizophrenia, but temporal lobe abnormalities are more common in AD and VD. The perfusion of rCBF in the parietal lobe seems to be related to aging. Abnormalities in the occipital lobe and basal ganglia seem to be more associated with vascular problems. Thalamic dysfunction was mainly correlated with VD, and that of the cingulate largely with depression and schizophrenia. Hippocampal abnormalities were associated with AD. There were few reports on changes in anxiety disorders and other mental problems. Conclusion There is no specific biological marker of SPECT for individual mental disorders. Further study is needed to provide more specific information on the pathophysiology of mental disorders. It seems that brain abnormalities are similar in Chinese and non Chinese psychiatric patients.