“Zhong De Ban” (German–Chinese class): training in psychoanalytically oriented psychotherapy at the Shanghai Mental Health Center

German psychoanalysts have played a special role in the spread of psychoanalytically oriented psychotherapy in China. This article describes the history of the training programme anchored at the Shanghai Mental Health Center, its specific design, the cooperation with Chinese colleagues, and the importance of self-experience in groups. It reflects on the sociocultural background of the involvement of German psychoanalysts and the promotion of the project by German institutions. Conscious and unconscious aspects of group dynamics on both the German and Chinese sides are presented and discussed.

An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial

Background Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider–assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center’s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). Conclusions The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients’ limited use of the online platform. Trial Registration ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467

Prediction of steady-state plasma concentrations of olanzapine in Chinese Han in patients based on a retrospective population pharmacokinetic model

Purpose: To develop robust methods of establishing a population pharmacokinetics (Pop-PK) model of olanzapine, using existing hospital in-patient information, in order to predict the steady-state plasma concentration of olanzapine tablets in Chinese Han inpatients, thus providing guidance for individualized therapy for mental disorders.Methods: A retrospective study analyzing and predicting the steady-state plasma olanzapineconcentration was performed using nonlinear mixed-effect modeling (Phoenix® NLME8). The effects of ten potential covariates, including age, gender, Body Mass Index, fasting lipid, family history, alcohol and smoking status in 107 Chinese Han patients with steady-state plasma olanzapine concentration were collected from the hospital information system (HIS) in Wuhan Mental Health Center from Feb 2017 to Jul 2019.Results: The final model was validated using bootstrap and visual predictive check (VPC) and was found to fit the one-compartment mixed error model. Smoking status was found to be the only factor affecting olanzapine tablets clearance. The standard Pop-PK parameters apparent volume of distribution (VL/F) and clearance (CL/F) were 223 L and 12.4 Lꞏh-1, respectively.Conclusion: The Pop-PK model for olanzapine established with the data from HIS is effective inpredicting the plasma olanzapine tablets concentration of individual Chinese in-patients. This Pop-PK model approach can now be adapted to optimize other antipsychotic drugs.

Tidlig avklaring – et møte mellom mennesker. Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern.

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team, a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center. Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed. Keywords: community mental health center (CMHC), health service development, intake assessment, general mental health

Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team (EAT), a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center (CMHC). Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed.

Bullying, Present Romantic Relationship and Depression as Predictive Factors of Non-Suicidal Self-Injury in Adolescent Psychiatric Patients

Background: Non-suicidal self-injury (NSSI), as a major public health issue of high complexity, multifactorial causes and great socioeconomic and family impact, affects China now especially after COVID-19. The aim of this study was to explore the clinical and psychological characteristic in adolescent psychiatric patients with or without NSSI.Methods: Adolescent psychiatric patients were recruited from psychiatric outpatient and inpatient unit in Guangdong mental Health Center between October and December 2020. NSSI was evaluated by the modified version of Adolescents Self-Harm Scale. Childhood trauma was assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Peer bullying experience was evaluated by The Revised Olweus Bully/Victim Questionnaire（BVQ-R). Depression was assessed by the Montgomery–Asberg Depression Rating Scale (MADRS). Clinical data were collected from electronic medical record system.Results: The sample included 157 adolescent psychiatric patients (72.6% female), aged 13-18 years (M=15.39, SD=0.145). NSSI group experienced more peer bullying (t=4.08,P＜0.001), more likely to get into romantic relationship currently(χ2=5.38, P=0.02), more times of hospitalization (t=0.36, P<0.001), receiving more antipsychotic treatment (t=3.58, P<0.001), benzodiazepine treatment (t=3.46, P＜0.001), and mood-stabilizer treatment (χ2 =8.53, P<0.001). The significant predictor of NSSI for the last one year included being in romantic relationship currently (OR =4.27, 95% CI=[1.53,11.93]), outpatient (OR=0.38, 95%CI=[0.16,0.88]), BVQ-R total (OR=1.10, 95% CI=[1.02,1.18])，MARDS total (OR= 1.05, 95% CI=[1.01,1.09]), and benzodiazepine PDD/DDD (OR=5.79, 95% CI=[0.99,33.72]).Conclusions: Adolescent psychiatric patients with NSSI have significantly higher incidences of life event such as peer bulling, childhood trauma experience, and they were more likely to get into a romantic relationship. Meanwhile, patients with NSSI had significantly severe level of depression, being more on benzodiazepine and mood-stabilizer use. This provides a valuable basis for our clinical treatment of adolescent mental patients with NSSI.

Cariprazine in Therapy of Delusions with a Therapeutic Resistance due to Traumatic Brain Injury Randomized, Double-Blind Placebo-Controlled Study

Objective: We studied cariprazine in therapy of delusions with a therapeutic resistance due to traumatic brain injury randomized, double-blind placebo-controlled study manner. Methods: to traumatic brain injury hundred patients (100 all men) whom we studied were under observation in Mental Health Center of the Ministry of Health of the Republic of Azerbaijan from January 2020 to June 2021. The method of randomization was given by lottery. Each patient was randomized to receive either in agreement of the instruction cariprazine (50 patients) over 5 day in dose 6 mg one times per os in morning after meet for 6 weeks or matched placebo (50 patients) in a double-blind manner. A structured clinical interview, for DSM-5Axis I Disorder, Patient Edition, was used to diagnose according to DSM-5 major or mild neurocognitive disorder due to traumatic brain injury. Result: All patients (50) treated with cariprazine treated participants responded by 6 weeks, versus two of the 50 placebo-treated participants (p<0.001). The most common and problematic side effect in the cariprazine group was not. Conclusion: The authors believe this to be the first double-blind placebo-controlled randomization study to test the efficacy of a cariprazine in the management of in therapy of delusions with a therapeutic resistance due to traumatic brain injury randomized, double-blind placebo-controlled study manner. They need to be replicated in a larger study group.

Comorbidity and Treatment in Older Psychiatric In-patients—A Retrospective Study in a Chinese Psychiatric Hospital

Background: Comorbid somatic diseases increase the death risk and affect the condition, treatment, and prognosis of older psychiatric patients. We investigated the comorbidity and drug treatment in older patients with psychosis.Methods: This retrospective study used data from 3,115 older psychiatric in-patients hospitalized at the Shanghai Mental Health Center Affiliated to Shanghai Jiaotong University School of Medicine, China discharged from 2005 to 2015. Descriptive analyses of patients' age, sex, treatment drugs, diagnoses (based on ICD-10), and time trend were performed.Results: Patients' median age was 56 (range, 50-98) years; 1,824 (58.6%) were female. The top five first-level diagnoses were schizophrenia (F20) (n = 1,818, 58.3%), depressive episode (F32) (n = 457, 14.6%), bipolar affective disorder (F31) (n = 151, 4.8%), manic episode (F30), (n = 143, 4.6%), and vascular dementia (F01) (n = 136, 4.4%). Mental (99.9%), central nervous system (85.2%), digestive system (83.5%), cardiovascular system (72.5%), and anti-infective (59.6%) drugs had the highest prescription rates. The combined use of antidepressants, anti-anxiety, anti-arrhythmic, hormones and endocrine system drugs were significantly higher in female than in male patients, while mood stabilizers and genitourinary system drugs significantly more frequent in men. With increasing age, the F20-F29 patients decreased, while F00-F09 patients increased, with the corresponding changes to prescription in those patients. In comparison to that in 2005-2010, the combined prescriptions for genitourinary and cardiovascular drugs increased between 2011 and 2015, and F00-F09 and F40-F48 older patients doubled, accordingly anti-Alzheimer's disease drugs and antidepressants more than doubled. F30-F39 patients increased by 49.1%, and anti-anxiety drugs, mood stabilizers, etc. increased by ≥50%; F20-F29 older patients decreased by 26.7%, while antipsychotics only increased by 4.4%.Conclusions: This study found the combined drug treatment of somatic diseases, particularly for central nervous, digestive, cardiovascular, respiratory and genitourinary drugs were extremely common among older psychiatric in-patients in China. With increasing age, the F20-F29 patients decreased, while F00-F09 patients increased; the antipsychotics prescriptions decreased, and almost all comorbidity drugs increased. Compared with that in 2005-2010, the older patients with all diagnosis except F20-F29 increased in 2011-2015, and the prescriptions for psychotropic, genitourinary, and cardiovascular drugs increased.