Abstract:Objective To investigate the influence factors of olanzapine dose-adjusted plasma concentration in patients with schizophrenia. Methods A total of 544 schizophrenic impatients treated with olanzapine in Beijing Huilongguan Hospital from February to September 2020 were selected. Plasma concentrations of olanzapine were tested by high performance liquid chromatography-tandem mass spectrometry. The general information of patients was extracted from the medical record system， and the effects of age， gender， weight， combined medication and liver and kidney function on the dose-adjusted plasma concentration of olanzapine were analyzed statistically. Results The olanzapine dose-corrected plasma concentration of elderly group was significantly higher than that of young group［ （4.31±1.74） vs（ 5.11±1.88）ng（/ ml·mg·d）， t=4.263， P＜ 0.05］. The dose corrected plasma concentration of olanzapine in female patients was significantly higher than that in male patients［ （5.43±1.89） vs（ 4.02±1.57）ng（/ ml·mg·d）， t=9.148，P＜0.05］. The dose corrected plasma concentration of olanzapine in obese group was significantly lower than that in non-obese group［ （4.13±1.79） vs（ 4.55±1.80）ng（/ ml·mg·d）， t=2.095，P ＜ 0.05］. The olanzapine dose-corrected plasma concentrations corresponding to patients with olanzapine alone， olanzapine combined with risperidone， olanzapine combined with sodium valproate， and olanzapine combined with clozapine were（ 4.72±1.77）， （4.91±1.91），（ 3.52±1.06） and（ 4.39±2.23） ng（/ ml·mg·d） respectively. The differences among the four groups were statistically significant（ F=3.762， P=0.012）. Further pairwise comparison showed that the dose corrected plasma concentration of olanzapine was significantly lower in the combined valproate group than in the olanzapine group alone（ P＜0.05）. There was no significant effect of liver and kidney dysfunction on dose corrected plasma concentration of olanzapine（ P＞0.05）. Conclusions Age， gender， weight and combination of medication of schizophrenic patients all have effects on the dose-adjusted plasma concentration of olanzapine. When using olanzapine for treatment， clinicians should consider the combined effect of all factors and make a reasonable administration plan.

Abstract:Objective To explore the effects of left prefrontal dorsolateral cortex（ L-DLPFC） transcranial magnetic stimulation（ rTMS） with intermittent theta burst stimulation（ iTBS） paradigm and traditional rTMS on the negative symptoms and cognitive function of patients with schizophrenia. Methods A total of 80 cases were selected from 1 183 schizophrenics of Harbin Baiyupao Psychiatric Hospital from September 2018 to March 2020 as objects of study. The 80 schizophrenia patients were randomly divided into iTBS group（ 40 cases） and rTMS group（ 40 cases） by random number table. Patients in the iTBS group was given a combination of iTBS and drug therapy， while patients in the rTMS group received a combination of rTMS and drug therapy. The L-DLPFC stimulation was selected as the stimulation site，5 times per week，for 4 weeks of treatment， a total of 20 times. Before and after treatment， Positive and Negative Symptom Scale（ PANSS） was used to assess negative symptoms of schizophrenic patients， and Wisconsin Card Sorting Test（ WCST） was applied to evaluate the cognitive function of patients with schizophrenia. Results After the treatment， PANSS the negative scale score ［iTBS：（ 29.81±4.02） vs（ 26.22±3.88），t=10.540； rTMS：（ 30.91±5.53） vs（ 27.35±4.99）， t=9.786］， total score［ iTBS：（ 78.14±7.59） vs（ 73.65±5.43）， t=6.219； rTMS：（ 78.88±10.00） vs（ 75.21±9.14）， t=9.297］， lack of response score［ iTBS：（ 15.70±1.71） vs（ 14.76±1.75）， t=3.641； rTMS：（ 15.56±2.44） vs（ 14.12±2.03）， t=7.792］， thinking disorder score［ iTBS：（ 7.68±1.53） vs（ 7.32±1.18）， t=2.837； rTMS：（ 7.85±1.84） vs （7.21±1.72）， t=4.875］ and WCST scores of RF［ iTBS： 128.00（ 50.50， 128.00） vs 106.00（ 42.00， 128.00）， Z=-4.92；rTMS： 128.00（ 98.25， 128） vs 106.50（ 36.75， 128.00），Z=-4.86］， NRPE［ iTBS： 87.00（ 62.50， 95.00） vs 74.00（ 42.00， 91.00）， Z=-4.55； rTMS： 89.50（ 80.75， 96.50） vs 68.00（ 53.00， 82.75），Z=-4.33］ in iTBS group and rTMS group were significantly lower than those before the treatment（ P＜0.05）. WCST scores of RC［ iTBS： 40.00（ 33.50， 57.50） vs 59.00（ 53.50， 79.50）， Z=-4.92； rTMS： 39.50（ 32.75， 46.00） vs 58.00 （46.79， 75.50）， t=-4.86］ and RFP［ iTBS： 0.09（ 0.05， 0.23） vs 0.18（ 0.14， 0.34）， Z=-5.30； rTMS： 0.08（ 0.05， 0.16） vs 0.19（ 0.15， 0.24）， Z=-5.09］ were significantly higher than those before the treatment（ P＜0.05）. After treatment， there were no statistical differences in scores or score difference of PANSS and WCST between iTBS group and rTMS group（ P ＞ 0.05）. Conclusions When the total number of stimuli is fixed， both iTBS and rTMS can improve the negative symptoms and cognitive function of schizophrenia， and the therapeutic effect is equivalent， but the time of iTBS paradigm is less.

Abstract:Objective To explore the effect of transcranial direct current stimulation（ tDCS） on spatial working memory in schizophrenic patients with tardive dyskinesia（ TD）. Methods A total of 38 schizophrenic patients with TD from Suzhou Guangji Hospital， Suzhou Social Welfare Home， Nanchong Physical and Mental Hospital， and Taicang Third People's Hospital were randomly divided into trail group（ 21 cases） and control group（ 17 cases）. Both groups received conventional medication therapy. The trail group received tDCS with a current of 2 mA at the left dorsolateral prefrontal cortex and the contralateral supraorbital margin. The control group was treated with sham tDCS for 3 weeks. The patients were followed up at baseline， after the 15th treatment and 2 weeks after treatment. The Spatial Working Memory（ SWM） module of the Cambridge Neuropsychological Test Automatic Battery（ CANTAB） was used to evaluate the cognition of the patients in both groups. Results After 15 treatments， the total number of errors［ 31.00（ 28.50，49.00）］， the average first response time（ 4 boxes）［ 3 289.500（ 1 871.750，5 018.000）ms］， the average first response time（ 6 boxes）［2 862.500（ 2 128.500，4 672.250）ms］， the average first response time（ 8 boxes）［ 3 328.500（ 2 611.250， 5 120.750）ms］， has no statistically significant difference compared with those of the control group（ P＞0.05）. The strategy score of SWM index analysis in the experimental group［ 19.00（ 17.00，20.00）］ was lower than that in the control group［ 21.00（19.50，23.00）］. The difference was statistically significant（ P＜0.05）. In the followup after 2 weeks， there was no statistically significant difference in SWM between the two groups（ P＞ 0.05）. Conclusions There may be immediate improvement effect of tDCS on the ability of schizophrenic patients to use strategies.

Abstract:Objective To study the correlation between self-esteem and social self-esteem of the caregivers of patients with violent schizophrenia. Methods From January 2014 to December 2016， a total of 966 guardians of schizophrenics in Chongqing Mental Health Center were included， of which 487 violent schizophrenics guardians were assigned to the study group， 479 non violent schizophrenia guardians were assigned to the control group. All the subjects were evaluated by self-esteem scale（ SES） and Texas Social Behavior Inventory（ TSBI）. Results The total score of SES in the study group（ 22.48±4.07） was significantly higher than that in the control group（ 21.48±4.13）， and the difference was statistically significant（ t=3.787， P ＜ 0.05）. The total score of TSBI in the study group（ 45.01±5.72） was lower than that in the control group （46.02±6.14）， and the difference was statistically significant（ t=2.649， P ＜ 0.05）. Pearson analysis showed that SES score was positively correlated with TSBI score（ r=0.125， P ＜ 0.01）. Conclusions The guardians of violent schizophrenics had higher self-esteem and lower social self-esteem than the guardians of non violent schizophrenics. Guardian self-esteem is positively correlated with social self-esteem.

Abstract:Schizophrenia is a serious mental disease with unknown etiology. A large number of studies have shown that computerized cognitive remediation therapy（ CCRT） has a significant curative effect on the rehabilitation of schizophrenia patients. This review summarizes the efficacy of cognitive function， clinical symptoms and social function of patients with schizophrenia based on CCRT， so as to elaborate the advantages of CCRT， and point out the current limitations and future development direction of this method， providing reference for the follow-up research and the treatment of schizophrenia.

Abstract:Ultra-high-risk of schizophrenia（ Ultra-high-risk， UHR） refers to people in the prodromal stage of schizophrenia. Since early identification and intervention of UHR can improve clinical efficacy， delay or even prevent the transition of UHR， the related research has become the hot spot. Understanding the psychosocial factors and cognitive function characteristics of UHR can provide ideas for early identification and intervention of UHR. Therefore， this article intends to review the psychosocial and cognitive function characteristics and intervention of the ultra-high-risk population of schizophrenia， in order to provide references for the early intervention of UHR and related scholars.

Abstract:Objective To establish a new risk score model for the diagnosis of posterior circulation ischemia（ PCI） related vertigo， and to determine the optimal cut-off values and validate their diagnostic value in PCI-related vertigo in the elderly. Methods This study was conducted in two steps. Firstly， a risk score model was developed using multifactorial logistic regression analysis according to regression coefficient values in 380 PCI-related vertigo patients and 380 control patients matched according to age and sex. It was then validated in 149 PCI-related vertigo patients and 328 control subjects. Receiver operating characteristic（ ROC） curve was applied to analyze the diagnostic efficacy of the score model， ABCD2 and Essen scoring systems to PCI related vertigo. Results Multivariate logistic regression analysis showed that 13 factors including 4 kinds of medical history（ hypertension， diabetes， ischemic stroke and hyperlipidemia）， 6 kinds of symptoms（ diplopia， dysarthria， choking on water， impaired hearing， unilateral limb weakness， and tinnitus） and 3 kinds of physical signs（ limb sensory loss， limb ataxia and gait ataxia） were the influencing factors of PCI related vertigo（ P＜0.05）， and included in the final diagnostic risk model， with score ranging from -6 to 32. The higher the score was， the more likely the diagnosis was. Based on the PCI risk score， patients were divided into 3 subgroups： low-risk （-5 to 0 points， risk is less than 18.4%）， intermediate-risk（ 1 to 10 points）， and high-risk（ ≥11 points， risk is greater than 80.2%）. According to Youden index， the optimal cut-off point of PCI scoring system was 4 points， with a sensitivity of 92.2% and a specificity of 58.7%. The area under the ROC curve of PCI scoring system was 0.846（ 95%CI：0.794 to 0.898）， which was significantly higher than that of ABCD2［ 0.752（ 95%CI：0.668 to 0.836）］ and Essen scoring system［ 0.659（ 95%CI：0.569 to 0.748）］（ P values of Delong test were 0.009 and 0.001， respectively）. Conclusions The PCI scoring system was superior to the ABCD2 and Essen scoring systems in diagnosing PCI-related vertigo. A score of 4 is the diagnostic threshold for this scoring system， but elderly patients with a PCI risk score above 0 should undergo further investigation.

Abstract:Objective To observe the clinical effect of high frequency repetitive transcranial magnetic stimulation（ rTMS） on shoulder-hand syndrome after stroke. Methods A total of 60 patients with shoulder hand syndrome after stroke admitted to Department of Rehabilitation in Huaian Rehabilitation Hospital from June 2019 to October 2020 were divided into control group（ 30 cases） and treatment group（ 30 cases） by random number table method. Both groups received routine analgesic treatment and conventional rehabilitation treatment. On the basis of conventional treatment， the control group was given the pseudo rTMS treatment， and the treatment group was given 5 Hz rTMS treatment. The treatment was conducted 6 days a week for 2 weeks. During the treatment， 1 case fell off from the control group and 2 fell off from the treatment group. Visual analogue scale（ VAS） was used to evaluate the degree of pain. Fugl-Meyer Assessment-Upper Extremity（ FAM-UE） was used to evaluate the upper limb motor function. Drainage method was used to evaluate the swelling degree of affected forearm. Pittsburgh Sleep Quality Index（ PSQI） was used to evaluate the sleep state. Results After 2 weeks of treatment， the pain were relieved in both groups， and the difference was statistically significant（ P＜ 0.05）. The pain improvement degree of the treatment group was better than that of the control group， and the difference was statistically significant［ VAS=（4.85±0.86） in the control group and（ 4.30±1.10） in the treatment group， P ＜ 0.05］. The motor function of affected limb was improved in both groups after treatment， and the differences were statistically significant（ P＜0.05）. The improvement degree of the treatment group was better than that of the control group［ FMA-UE=（31.00±4.00） in the control group， FMA-UE=（35.89±4.74） in the treatment group， P ＜ 0.05］. The degree of swelling of affected limbs in the two groups was significantly lower than that before treatment， and the differences were statistically significant（ P ＜ 0.05）. The degree of swelling reduction in the treatment group was better than that in the control group［ （52.85±12.48） ml in the control group，（ 47.70±11.17） ml in the treatment group， P＜0.05］. The sleep quality of the two groups was significantly improved after treatment， and the differences were statistically significant（ P ＜ 0.05）. There was no statistical significance in the difference of sleep quality between the two groups［ PSQI=（7.70±2.00） in the control group and（ 7.37±2.26） in the control group， P＞ 0.05］. Conclusions High frequency rTMS can significantly improve the degree of pain and clinical symptoms in patients with shoulder-hand syndrome after stroke， however two weeks of high frequency rTMS treatment can not significantly improve sleep quality compared with conventional treatment.

Abstract:Objective To explore the incidence and influencing factors of prenatal depression in pregnant women with different parities of pregnancy. Methods A total of 336 pregnant women in the third trimester of pregnancy were selected from the obstetric clinic of Taihe Hospital of Traditional Chinese Medicine in Fuyang from May to October 2020， including 210 first pregnant women and 126 second pregnant women. The general demographic data were assessed with the self-made general information scale. The antenatal depression was assessed with the Edinburgh Postnatal Depression Scale（ EPDS）. Sleep and anxiety were assessed with Pittsburgh Sleep Quality Index（ PSQI） and Self-rating Anxiety Scale（ SAS）. Results The incidence rate of antenatal depression in pregnant women was 31.55%（ 106/336）， and the incidence rate of antenatal depression was higher in first pregnancy than in second pregnancy［ 36.19%（ 76/210） vs 23.81%（ 30/126）， χ2=5.590， P=0.018］. Antenatal anxiety（ OR=5.611，95%CI=2.318-13.582，P＜0.001） and sleep disorders（ OR=1.995， 95%CI=1.019-3.908，P=0.044） were risk factors of antenatal depression in first pregnant women， and prenatal education（ OR=0.267，95%CI=0.137-0.519，P ＜ 0.001） was a protective factor of antenatal depression in first pregnant women； antenatal anxiety（ OR=5.467，95%CI=1.284-23.288，P=0.022） and junior high school education or below（ OR=4.396， 95%CI=1.060-18.223，P=0.041） were risk factors of antenatal depression in second pregnant women. Working during pregnancy（ OR=0.340，95%CI=0.132-0.87，P=0.026） was a protective factor of antenatal depression in second pregnant women. Conclusions The incidence rate of antenatal depression is higher in the third trimester， and the incidence rate of antenatal depression is higher in the first pregnancy than in the second. Sleep disorder， antenatal anxiety and prenatal education were the influencing factors of antenatal depression in the first pregnancy. Antenatal anxiety， education and work status were the influencing factors of antenatal depression in the second pregnancy. The intervention and prevention of antenatal depression in different parity should focus on different risk factors.

Abstract:Objective To explore the effect of cognitive behavioral therapy（ CBT） combined with medication on adolescent patients with generalized anxiety disorder（ GAD）. Methods A total of 68 adolescent patients with GAD aged 13-22 years were divided into CBT combined with medication group（ combined group） and medication group by random number table method， and were given 8 weeks medication treatment. Patients in the combined group were also given CBT once a week. Hamilton Anxiety Scale（ HAMA-14） and student- Life Stress Inventory（ SLSI） were used to evaluate the efficacy of both groups at baseline and the 4th and 8th week of treatment. Results 32 cases in the combined group and 24 cases in the medication group completed the study. At baseline， there was no statistically significant difference in age， sex， being the only child and years of education between the two groups（ P＞0.05）. After 4 weeks of treatment， HAMA-14 and SLSI score in combined group were lower than those in medication group（ t=-2.348，P=0.023；t=-3.014，P=0.003）. After 8 weeks of treatment， there were statistically significant differences in HAMA-14 score and SLSI score between the two groups（ t=-2.597，P=0.012；t=-3.639，P=0.001）. After 8 weeks of treatment， compared within each group， the HAMA-14 and SLSI scores of the combined group and the medication group were gradually decreased， and the differences were statistically significant（ HAMA-14： F=74.961，P＜0.05；F=37.614，P＜0.05； SLSI： F=28.818，P＜ 0.05；F=30.137，P＜ 0.05）. Conclusions CBT combined group and medication group can effectively relieve the anxiety symptoms of adolescent patients with GAD and improve the student life stress symptoms. The effect of CBT combined intervention is better than that of medication treatment alone.

Abstract:"Unit personnel" and "intra-industry social personnel" are two groups that cannot be ignored in the standardized training of resident doctors. Based on the teaching practice of neurology resident training base in Xuanwu Hospital of Capital Medical University， this paper discusses how to carry out targeted teaching and training for the above two groups of people from the aspects of clinical basic skills training， multi-mode teaching， performance appraisal， and the establishment of tutorial system.

Abstract:Depressive disorder， which mainly manifested as significant and constant down in spirits， is a global disease that seriously endangers physical and mental health. Currently， the mechanism of commonly used antidepressants is mainly based on the monoamine hypothesis， but some patients have poor therapeutic effect because of drug resistance. Therefore， further exploration of new pathogenesis of depressive disorder is expected to be used to guide clinical diagnosis and treatment in the future. Mitophagy is one of the main method to clear damaged mitochondria， which is related to the pathogenesis of many diseases. In recent years， some studies have shown that mitophagy may play a role in the occurrence and development of depressive disorder， but the specific process and mechanism are still unclear. This article reviews the status of mitophagy in the process of depressive disorder.

Abstract:Studies have found that the risk of mild behavioral impairment（ MBI） developing into dementia in the future is extremely high and can be regarded as the early stage of dementia. Exploring the clinical evaluation methods of MBI can help clinicians identify MBI earlier and delay the occurrence and development of dementia. This paper gives an overview of clinical evaluation methods of MBI and the advantages and disadvantages between every method， in order to attract the attention of clinicians and provide a more standardized， comprehensive and reasonable evaluation plan for clinical work.

Abstract:DNA methylation is one of the main modification modes in epigenetics. 5-hydroxymethylcytosine （5hmC）， as a product of DNA demethylation， has become a new epigenetic marker. Due to the high distribution of 5hmC in the central nervous system and the constant changes in the process of neurodevelopment， it is very important for normal neurodevelopment and neurological function. Recent studies have found that 5hmC imbalance caused by aging or environmental stress may play an important role in the occurrence and development of diseases. Therefore， this article reviews the role of 5hmC in neurodevelopment and neurodegenerative diseases in recent years.

Abstract: