·In this issue (August 2015)·

This issue starts with a Commentary by Lam[1]about the Special Article by Paul Bebbington published in a previous issue.[2]Bebbington’s article discussed a new model for conceptualizing psychosis based on findings in psychosocial epidemiology; Lam agrees that this new integrated approach raises the exciting possibility of new methods for prevenng the onset of psychosis or ameliorang the course of psychoc disorders, but she cautions much more research will be needed before these potenal bene fi ts can be realized.

The meta-analysis by WZ Wang and colleagues[3]reports on the adjunctive use of electroconvulsive therapy (ECT) in the management of treatmentrefractory paents with schizophrenia. Concerns about potential adverse effect of ECT in Western countries has restricted the use of ECT both in the treatment of severe depression and in the treatment of treatmentresistant schizophrenia, so it is not surprising that 18 of the 22 randomized controlled trials about the use of ECT in schizophrenia identified after an extensive search of both the English-language and Chineselanguage literature were conducted in China. The meta-analysis found that combined treatment with ECT and antipsychotic medication had a significantly better outcome than treatment with antipsychotic medication alone. The proportion of participants experiencing headache or cognive impairment during the treatment was higher in the combined treatment group, but the overall level of functioning at the end of the trial was better in the combined treatment group. The results support the adjuncve use of ECT in treatment-refractory schizophrenia, but the incomplete methodological information provided by most of the included studies from China leaves unanswered questions about the validity of the results, so betterdesigned studies will be needed to confirm these fi ndings.

The first original research article by Zhang and colleagues[4]is about the use of a Japanese-based cognitive therapy – Naikan therapy – as an adjunctive treatment during the recovery phase of schizophrenia. This is a randomized controlled trial (RCT) among 235 inpatients with schizophrenia whose acute symptoms had resolved. Both groups received standard medications and inpatient rehabilitation training; the intervenon group was also trained in a cognive selfre fl econ process (Naikan therapy) and engaged in this method for 20 2-hour sessions over a 4-week period. All patients were subsequently discharged and followedup 1 year later. Both at the end of the 4-week treatment period and one year after the finish of treatment the severity of symptoms was significantly less and the social funconing was signi fi cantly beer in the Naikan group than in the control group. The relapse rate over the 1-year follow-up in the Naikan group was half of that in the control group (10.6% v. 20.5%).Given the relatively large sample, the randomized design, and the one-year post-intervention follow-up, this is an impressive fi nding that deserves to be replicated and, if replicable, widely promoted as an adjuncve treatment in the management of chronic schizophrenia.

The second original research article by ZY Wang and colleagues[5]is the drug pre-registration study in China for generic duloxetine, currently one of the most popular antidepressants in the country. It is a large (n=299), multi-center, double-blind, 8-week RCT that compared generic duloxetine to paroxetine in the treatment of major depressive disorder (MDD). Based on an intention-to-treat (ITT) analysis, there were substantial reductions in the severity of depressive symptoms (assessed using the Hamilton Depression rating scale) in both groups over the 8 weeks of treatment, but no signi fi cant di ff erences in the magnitude or rate of improvement between the two groups. The prevalence of mild-to-moderate adverse e ff ects were relavely common (57% in the duloxene group and 55% in the paroxene group), but they were severe enough to require discontinuing the treatment in only six paents in each group. The authors conclude that generic duloxene is e ff ecve and safe in the acute treatment of MDD.

The third original research article by SL Wang and colleagues[6]provides information relevant to the ongoing debate about the potential value of a positive family history of a ff ecve disorder in predicng the effi cacy of different types of antidepressant medication.[7-9]The authors enrolled 77 paents with depression (based on the Internaonal Classi fi caon of Diseases [ICD-10] criteria), assessed the status of all fi rst-degree relaves to classify 37 of the paents into a ‘posive family history’ group and 40 onto a ‘no family history’ group, and then treated them all with standard doses of duloxetine for 12 weeks. There were several di ff erences between paents with and without a positive family history: those with a positive family history had an earlier age of onset, a longer duration of illness, a higher level of psychic anxiety, and more prominent anhedonia. However, there was no significant difference in the magnitude or rate of improvement of depressive symptoms over the 12 weeks of treatment between paents with and without a positive family history. Treatment met the pre-determined criteria for effectiveness in 76% of paents with a posive family history and 78% of those without a family history. Thus the results do not support hypotheses about the differential effectiveness of medicaon based on family history of a ff ecve disorder.

The Forum pieces by Peng and Jiang[10]and Shi[11]discuss the concurrent occurrence of bipolar andobsessive-compulsive symptoms, a condition that has received increasing attention as more nosologists, researchers, and clinicians consider the etiology and management of comorbid psychiatric condions.[12]Several lines of research indicate that individuals with comorbid bipolar disorder (BD) and obsessive compulsive disorder (OCD) are di ff erent from those with BD in the absence of OCD. There is connuing controversy about whether the concurrent occurrence of these two conditions should be considered a) independent comorbid conditions, b) a relatively severe subtype of BD, or c) a unique condition etiologically distinct from both BD and OCD. The available studies are primarily crossseconal studies with small samples, so they are unable to definitively resolve this issue. Treatment of this comorbid condion can be complicated because using selective serotonin reuptake inhibitors (SSRIs) to treat the OCD may increase the risk of precipitating manic symptoms. This is one of several examples of common comorbid psychiatric disorders (e.g., depression and anxiety) that weaken confidence in the distinctness of the conditions defined in current diagnostic systems. Whether or not the long-prophesied biologic-genetic revoluon in diagnosc nosology will eventually resolve these issues remains to be seen.

The case report by Sachdeva and colleagues[13]also considers a comorbid condition, in this case, comorbid schizophrenia and obsessive compulsive disorder. The report presents the case of a paent with a 4-year history of food refusal with severe, disabling obsessive-compulsive symptoms who was initially treated by local non-psychiatric clinicians by tubefeeding and subsequently tube-fed by family members for 4 years prior to his first arrival at a psychiatric clinic. Despite the primary presentation of obsessive compulsive symptoms and food refusal, it subsequently became clear that there was underlying delusions of contamination and substantial formal thought disorder, so the inial diagnosis of obsessive compulsive disorder was subsequently changed to schizophrenia. Treatment with antipsychotic medication combined with behavioral management of the eang behavior (and counselling with family members who were reluctant to stop the tube-feeding because they believed the patient would starve) led to significant improvement in his symptoms, though he remained disabled by his schizophrenia. This case highlights the importance of clarifying the underlying etiology of food refusal, one of several relatively common symptoms that can be the presenng symptom for a variety of psychiatric and medical condions.

The Biostatistics in Psychiatry article in this issue by Liu[14]provides an introduction to the analysis of longitudinal data sets, a problem that has confounded psychiatric researchers for decades. In psychiatric research this usually involves multiple observations of the same group of individuals at a limited number of time points with equally or unequally spaced intervals. Traditionally researchers used ‘multivariate data structures’ (with rows representing individuals and columns represenng results at di ff erentmes) to analyze such data, but there are several problems with arranging the data in this way (e.g.,me intervals may vary between subjects, and some predictor covariates like economic status or location of residence may vary over time). More recently analysts prefer to use‘univariate data structures’ (with each row represenng ame at which the outcome is assessed) because this allowsme to be explicitly speci fi ed as a predictor of the trajectory of individuals. To avoid the oen substanal biases that can arise in the analysis of longitudinal data, psychiatric researchers need to familiarize themselves with these newer, more advanced stascal methods.

[Shanghai Arch Psychiatry. 2015;27(4): 200-202. doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.215102]

1. Lam LCW. Challenges to the uniqueness of psychotic experience in psychosis: insights on research methodology and intervention. Shanghai Arch Psychiatry. 2015; 27(4): 203-205. doi:http://dx.doi.org/10.11919/ j.issn.1002-0829.215068

2. Bebbington P. Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. Shanghai Arch Psychiatry. 2015; 27(2): 70-81. doi:http://dx.doi.org/10.11919/ j.issn.1002-0829.215027

3. Wang WZ, Pu CC, Jiang JL, Cao QY, Wang JJ, Zhao M, et al. Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis. Shanghai Arch Psychiatry. 2015; 27(4): 206-219. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215093

4. Zhang H, Li CH, Zhao LY, Zhan GL. Single-blind, randomized controlled trial of effectiveness of Naikan therapy as an adjunctive treatment for schizophrenia over a oneyear follow-up period. Shanghai Arch Psychiatry. 2015; 27(4): 220-227. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215055

5. Wang ZY, Xu XF, Tan QR, Li KQ, Ma C, XieSP et al. Treatment of major depressive disorders with generic duloxetine and paroxene: a mul-centered, double-blind, double-dummy, randomized controlled trial. Shanghai Arch Psychiatry. 2015; 27(4): 228-236. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215064

6. Wang SL, Qian MC, Zhong H, Song GH, Lu MJ, Feng R, et al. Comparison of the e ff ecveness of duloxene in depressed patients with and without a family history of affective disorders in fi rst-degree relaves. Shanghai Arch Psychiatry. 2015; 27(4): 237-245. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215080

7. Sugawara H, Sakamoto K, Harada T, Ishigooka J. Predictors of efficacy in lithium augmentaon for treatment-resistant depression. J Affect Disord. 2010; 125(1-3): 165-168. doi: hp://dx.doi.org/10.1016/j.jad. 2009.12.025

8. Morishita S, Kinoshita T. Predictors of response to sertraline in patients with major depression. Hum Psychopharmacol. 2008; 23: 647-651. doi:hp://dx.doi.org/10.1002/hup.969

9. Duggan C, Sham P, Minne C, Lee A, Murray R. Family history as a predictor of poor long-term outcome in depression. Br J Psychiatry. 1998; 173: 527-530

10. Peng DH, Jiang KD. Comorbid bipolar disorder and obsessive-compulsive disorder. Shanghai Arch Psychiatry. 2015; 27(4): 246-248. doi:http://dx.doi.org/10.11919/ j.issn.1002-0829.215009

11. Shi SX. Obsessive compulsive symptoms in bipolar disorder patients: a comorbid disorder or a subtype of bipolar disorder? Shanghai Arch Psychiatry. 2015; 27(4): 249-251 doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.215091

12. Krishnan KR. Psychiatric and medical comorbidies of bipolar disorder. Psychosom Med. 2005; 67(1): 1–8

13. Sachdeva A, Chandra M, Saxena A, Beniwal RP, Kandpal M, Kumar A. Case report of comorbid schizophrenia and obesessive-compulsive disorder in a paent who was tubefed for four years by family members because of a refusal to eat. Arch Psychiatry. 2015; 27(4): 252-255. doi: hp://dx.doi. org/10.11919/j.issn.1002-0829.215013

·Errata·

There is an error in the print version of the arcle:

Zhou Y, Zhou RS, Li WJ, Lin YQ, Yao J, Chen J, et al. Controlled trial of the e ff ecveness of community rehabilitaon

In the fi rst sentence of the fi rst paragraph of secon 4.1 (Main fi ndings),

The online version of the arcle is correct.