·In This Issue·

·In This Issue·

The current issue starts with a seminar on genome-wide association studies(GWAS)in schizophrenia by Professors Cui and Jiang［1］.We highlight this field because of the active interest and participation of Chinese researchers in the booming field of the genetics of mental disorders.The long-term potential of these approaches for understanding the diseases psychiatrists are concerned about is great. However，after decades of vigorous research it remains unclear how long it will be before these approaches can make important contributions to the diagnosis，prevention and treatment of psychiatric disorders.

The first research article［2］considers two common subtypes of mild cognitive impairment(MCI)：amnestic MCI(aMCI)which often progresses to Alzhiemer’s disease，and MCI that results from small vessel disease(sv-MCI)which often progresses to vascular dementia.As treatments for the different types of dementia improve and become more specific，discriminating different types of MCI will become increasingly important，but there are not，as yet，any easy methods for doing this in routine clinical practice.This study compares the characteristics of 50 individuals with aMCI，69 individuals with sv-MCI，and 49 normal control subjects.The findings support prior research showing greater memory impairment in aMCI subjects than in sv-MCI subjects.The most important results is that the Auditory Verbal Learning Test，a relatively simple test that assesses immediate recall，delayed recall and delayed recognition，is quite useful in distinguishing these two types of MCI.

The second article［3］reports on a study of micro RNA-206(miRNA-206)，previously identified as a promising potential biomarker of bipolar mania，in 36 bipolar patients experiencing an acute manic episode.The study compares miRNA-206 levels in peripheral blood between patients and controls and follows miRNA levels in the patient group over eight weeks of treatment.The authors find no significant differences between patients or controls and no significant correlations between miRNA-206 activity and the clinical severity of manic symptoms. Thus the results fail to confirm previous reports，but the power of the study was relatively low(22%)so larger studies are needed to confirm this negative result.

The third research article［4］considers bone density changes in 28 drug-naive patients in the first episode of schizophrenia during the first year of treatment with risperidone.The use of age matched controls and drug-naive patients and the high level of compliance to the original medication for the full year(71%)allow the authors to avoid many of the confounding factors that cloud the results of other studies about the relationship of antipsychotic medication and bone density.They report that the decline in bone mineral density was much more rapid in the second six months of treatment than in the first six months of treatment.So clinicians and researchers must make sure that they monitor bone density for longer than six months before determining the effect of antipsychotic medications on bone density.Their main result is quite sobering：among the 20 young adult patients who completed the one year of treatment with risperidone，8 (40%)met WHO criteria for bone mass loss and 1 (5%)met WHO criteria for osteoporosis.Clearly，this problem is not being given the level of attention it deserves.

The fourth research article［5］provides further information about the relationship of brain derived neurotrophic factor(BDNF)and abnormal activity of superoxide dismutase(SOD)(which metabolizes free radicals)in patients with schizophrenia.It is the first study we know of that compares these relationships between first-episode，drug naive patients and chronic patients so it provides a new perspective to this complex issue.The study assesses blood concentrations of SOD and BDNF in 78 firstepisode patients，67 chronic patients and 50 normal controls and evaluates symptom severity in the patient groups using the Positive and Negative Syndrome Scale.The authors find that SOD activity is highest in chronic patients，intermediate in first-episode patients and lowest in controls while the levels of BDNF are lowest in chronic patients，intermediate in first-episode patients and highest in controls.They did not，however，confirm their hypothesis about an inverse relationship between BDNF levels and SOD activity levels.In the first-episode group symptom severity is negatively correlated with SOD activity and positively correlated with BDNF levels but in chronic patients these relationships no longer exist.These findings confirm prior work about the role of free radicals，SOD activity and BDNF as biological markers in schizophrenia. The differences found between first-episode and chronic patients underline the complexity of these relationships and the need for continued research in this area.

The last research article［6］compares the effectiveness，adverse reactions and costs associated with using quetiapine versus clozapine as adjunctive treatments for inpatients with acute mania whoare treated with lithium as the primary medication. 64 female patients with acute mania are randomly assigned to the two groups and assessed at baseline and 1，2，4 and 6 weeks after starting treatment using the Beck Rafaelson’s Mania Rating Scale (BRMS)and the Treatment Emergent Symptom Scale.The authors report that the effectiveness of the two methods are quite similar.The frequency of occurrence of adverse reactions was much higher in the clozapine group but the overall severity of adverse effects，though higher in the clozapine group at the early phase of treatment，was similar at the end of the 6-week treatment period.Given that clozapine is produced generically in China the treatment cost of quetiapine was 23-fold that of clozapine，but the overall cost of the six weeks of treatment was similar in the two groups，primarily because clozapine use was associated with much greater use of auxiliary medications.One other important finding from the study was that most remissions(defined as a 50%decrease in the baseline BRMS score)occurred between 4 weeks and 6 weeks after starting treatment;thus clinicians and researchers should not make decisions about the effectiveness of an adjunctive drug regimen in mania until it has been continued for at least six weeks.

This issue also includes three reviews.The review by Cao and Geng［7］summarizes the current status of research on schizoaffective disorder，a condition that is one of the most commonly diagnosed psychotic conditions in western countries but is rarely diagnosed in China.The review by Zheng，Wang and Li［8］summarizes the state of the literature on high-risk syndromes for psychosis，a topic that is of considerable interest because of the DSM-5 proposal for a new diagnostic entity labeled‘Attenuated Psychosis Syndrome’.The third review by Feng and Zhao［9］provides an update on research about the effectiveness of psychoanalytic psychotherapy. Despite the increasing influence of biological psychiatry and biological approaches to treatment of the mentally ill in China，over the last 20 years China has also seen a rapid increase in the popularity of psychoanalytic psychotherapy.Traditional outpatient psychiatric services in large psychiatric hospitals in China have primarily focused on psychotic disorders and，more recently，on affective disorders so there is a void in the treatment of anxiety disorders.This void is being filled by a new cadre of psychologists，many of who have limited training that does not include supervision of clinical cases.Psychoanalytic training，with its strong emphasis on clinical supervision，is trying to bridge this gap;it is one of few areas in China where there is substantial overlap between psychiatry and the nascent field of clinical psychology.

The Forum in this issue focuses on an issue of particular interest to child psychiatrists：the advantages and disadvantages of drug holidays in the treatment of attention deficit and hyperactivity disorder(ADHD).The current state of the debate is summarized by Professors Du and Wang from China［10］and by Professor Szabo from South Africa［11］.Concerns about reduced efficacy and more severe adverse effects(i.e.，inhibited growth，disrupted sleep)with continuous treatment of ADHD using stimulants has led many clinicians and concerned parents to advocate intermittent drug holidays.Others have suggested that children with ADHD are at greater risk for injury and have significantly reduced functioning during drug holidays. Many studies have been conducted with intermittent short(e.g.，over weekends)and long(e.g.，during summer holidays)cessation of stimulant medications in children with ADHD，but the quality of the data is not yet sufficient to merit a definitive conclusion.In the absence of clear proof of greater benefits than disadvantages of drug holidays both the Chinese and South African commentators recommend against the use of drug holidays.In cases where the clinical response is inadequate or adverse effects are problematic its recommended that clinicians consider changing the medication or changing the dosage of the current medication rather than converting continuous treatment to intermittent treatment by the introduction of drug holidays.

1. Cui DH，Jiang KD.Research in schizophrenia using Genomewide Association Study(GWAS)methodology.Shanghai Arch Psychiatry，2011，23(5)：261-264.

2. Hu ZJ，Wang JH，Lang Y，Jia JP，Han Y.Comparison of the neuropsychological characteristics of two subtypes of Mild Cognitive Impairment.Shanghai Arch Psychiatry，2011，23 (5)：265-271.

3. Wang ZW，Li ZZ，Wang LX，Wu ZG，Yuan CM，Hong W，et al.Changes in the level of microRNA-206 gene expression in patients with Type I Bipolar Disorder before and after treatment and comparison with a control population.Shanghai Arch Psychiatry，2011，23(5)：272-277.

4. Li XY，Chen H，Chen XL，Xu FZ，Xiang BP.Case-control study of changes in bone mineral density in drug-naïve patients in the first-episode of schizophrenia during the first year of treatment with risperidone.Shanghai Arch Psychiatry，2011，23 (5)：278-283.

5. Chen DC，Yang KB，Wang N，Nie Y，Xiu MH，Li YL，et al. Differences in the levels of superoxide dismutase and brainderived neurotrophic factor in first-episode schizophrenia，chronic schizophrenia and normal control subjects.Shanghai Arch Psychiatry，2011，23(5)：284-290.

6. Tang XW，Wu H，Chen Q.Randomized controlled trail comparing quetiapine with lithium and clozapine with lithium in the treatment of female patients with mania.Shanghai Arch Psychiatry，2011，23(5)：291-298.

7. Cao JW，Geng WX.Current research on Schizoaffective Disorder.Shanghai Arch Psychiatry，2011，23(5)：299-302.

8. Zheng LN，Wang JJ，Li CB.Progress in research about high-risk syndromes for psychosis.Shanghai Arch Psychiatry，2011，23 (5)：303-306.

9. Feng Q，Zhao XD.Therapeutic effect of psychodynamic psychotherapy：A review.Shanghai Arch Psychiatry，2011，23(5)：307-311.

10. Du YS，Wang MJ.Are drug holidays in the treatment of Attention Deficit/Hyperactivity Disorder(ADHD)justified？Shanghai Arch Psychiatry，2011，23(5)：312-314.

11. Szabo CP.Drug holidays and Attention Deficit/Hyperactivity Disorder.Shanghai Arch Psychiatry，2011，23(5)：315.