·In this issue (June 2015)·
We are pleased to announce that the Shanghai Archives of Psychiatry has now been accepted for registration in PsycINFO, a database with 2.7 million records that provides systematic coverage of the psychological literature from the 1800s to the present.
This issue starts with a Commentary about the Special Article by Paul Bebbington in the last issue[1]which discussed a new model for conceptualizing psychosis based on findings in psychosocial epidemiology. Murray and colleagues[2]acknowledges the important contribuon that Bebbington’s integraon of cognive theory and community-based epidemiology of the social risk factors and non-psychotic symptoms associated with psychoc-like condions makes to our understanding of schizophrenia and related disorders, but they believe that a more complex model that includes the exciting new findings in genetics and molecular biology[3]is needed to move the fi eld forward. They use the findings of the sociodevelopmentalcognitive model to suggest an updated dopamine hypothesis, one in which dopamine dysfunction is a dynamic process that can be altered by social stressors like child abuse or by biological challenges like cannabis use.
The second Commentary by Button and Munafo[4]discusses the network meta-analysis of cognitive behavioral therapy (CBT) for generalized anxiety disorder by Zhu and colleagues[5]which reported the surprising fi nding that current meta-analyses of CBT in generalized anxiety disorder do not meet the rigorous requirements specified by the Cochran Collaboration GRADE criteria of study quality and, thus, cannot be considered robust findings. Button and Munafo suggest that inadequate placebo control and failure to blind participants, therapists, and evaluators in psychotherapy trials make it diffi cult to remove potenal bias and, thus, seriously reduces the robustness of the casual inferences that can be drawn from such trials. They suggest some options for reducing these biases in psychotherapy studies - including learning about the basic science of the underlying mechanism of acon of CBT, using measures of bias to adjust outcomes, and having multi-arm studies that assess each component of the intervenon. But it will never be possible for randomized controlled trials of psychotherapeutic interventions to fully meet the robust GRADE criteria.
The systematic review and meta-analysis in this issue by Jiang and colleagues[6]considers randomized controlled trials about the e ff ecveness of metacognive training (MCT) for schizophrenia, an exciting new adjunctive treatment for schizophrenia aimed at reducing positive symptoms, particularly delusions, by training patients to identify and alter the cognitive biases that underlie delusions and other psychotic symptoms.[7]They identified a total of 10 randomized controlled trials (RCTs), but these studies used di ff erent measures to assess outcomes so it was only possible to pool results for four studies that reported the posive symptom scale score of the Positive and Negative Syndrome Scale (PANSS) at the end of the intervenon and for four studies that reported the delusion subscale score of the Psychoc Symptom Rang Scales (PSYRATS) at the end of the intervenon. Overall, the results about the effectiveness of MCT were inconclusive; more randomized controlled trials that use standardized methods of assessing outcomes will be needed before deciding on whether or not to recommend MCT as a standard adjuncve treatment for schizophrenia.
The first Original Article by Chen and colleagues[8]adds to the growing literature about the ‘brain network disconnection model’ of schizophrenia,[9]which posits that abnormalities in the connectional architecture of the inter- and intra-hemispheric networks of the brain are responsible for the behavioral and cognitive abnormalities seen in schizophrenia. The study compared diffusion tensor imaging data from 24 male patients with paranoid schizophrenia during an acute phase of their illness with that of 24 healthy agematched male controls. Based on the constructed structural networks, they found longer mean characteriscs path lengths (CPLs) in the paent group than in the control group for all 18 inter- and intrahemispheric networks assessed, though only some of the results were statistically significant. These findings support the ‘connecvity hypothesis’ of schizophrenia, but larger studies with more broadly representative samples of paents are needed to con fi rm the results.
The case report by Saha and Jakhar[14]discusses a rare case from India in which a brain tumor (an oligodendroglioma) presented with a three-year history of chronic mania. The late onset of the condition (at 52 years of age); its progressive, non-reming course; and its non-responsiveness to standard medication eventually precipitated a MRI exam that idenfi ed the tumor. Surgical removal resulted in full resolution of the manic symptoms with some mild residual cognive deficits. In many low- and middle-income countries brain imaging studies are often either not available or very expensive, so clinicians need to use clinical acumen to identify the characteristics that distinguish organic versus funcon eology of psychiatric symptoms.
The Research Methods paper by Fan and colleagues[15]discusses the development of an instrument for assessing the severity of acute and chronic symptoms of ketamine abuse, an increasingly popular drug of abuse in China. They administered a preliminary 35-item checklist to 187 inpatients with ketamine dependence and used exploratory and confirmatory factor analysis of the results to generate a final 22-item scale that considered 4 groups of symptoms: social withdrawal, sleep disturbances, psychotic-like symptoms, and euphoria. Further work is needed to determine whether or not this new scale will be useful in monitoring the treatment of individuals with ketamine abuse or dependence.
The Biostatistics article by Chen[16]discusses an increasingly important component of research - metaanalysis. The volume of psychiatric research available has increased dramatically over the last couple of decades so pooling prior results of previous studies is an essential prelude to any new study. If conducted well, meta-analysis can indicate what works, what doesn’t work, and - most importantly - where additional research is needed. The arcle provides a brief overview of the fi xed-e ff ects and random-e ff ects models of metaanalysis and provides an example of how to conduct these analyses using the open-access soware package‘R’ based on a previously published dataset.
Finally, we sadly report the passing of one of our distinguished international board members. Professor Wayne Katon, from the University of Washington in Seattle, was one of the most prominent advocates for bringing psychiatric practice into general medicine. As the editor-in-chief of General Hospital Psychiatry for several decades he championed the training of general physicians in the assessment and management of mental disorders and spearheaded their role in the provision of community-based mental health services. His in fl uence is evident in general pracce clinics around the United States and elsewhere where mental health services are now considered an integral part of the package of clinical services, something that was not the case three decades ago. Professor Katon was also a friend of the Shanghai Archives of Psychiatry, providing important intellectual support in our effort to create a bridge between psychiatric practice in China and elsewhere. He will be sorely missed by his colleagues, his students, and his paents.
[Shanghai Arch Psychiatry. 2015; 27(3): 136-138. doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.215069]
1. 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
2. Murray RM, Dieli L, La Cascia C, La Barbera D. Bridging the gap between research into biological and psychosocial models of psychosis. Shanghai Arch Psychiatry. 2015; 27(3): 139-143. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215067
3. Howes OD, Murray RM. Schizophrenia: an integrated sociodevelopmental-cognitive model. Lancet. 2014; 383(9929): 1677-1687
5. Zhu Z, Zhang L, Jiang J, Li W, Cao X, Zhou Z, et al. Comparison of psychological placebo and waing list control condions in the assessment of cognitive behavioral therapy for the treatment of generalized anxiety disorder: a meta-analysis. Shanghai Arch Psychiatry. 2014; 26(6): 319-331. doi: hp:// dx.doi.org/10.11919/j.issn.1002-0829.214173
6. Jiang JL, Zhang L, Zhu ZP, Li W, Li CB. Metacognitive training for schizophrenia: a systematic review. Shanghai Arch Psychiatry. 2015; 27(3): 149-157. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.215065
7. Moritz S, Woodward TS. Metacognitive training in schizophrenia: from basic research to knowledge translaon and intervention. Curr Opin Psychiatry. 2007; 20(6): 619-625. doi: hp://dx.doi.org/10.1097/YCO.0b013e3282f0b8ed
8. Chen JH, Yao ZJ, Qin JL, Yan R, Hua LL, Lu Q. Abnormal inter- and intra-hemispheric integration in male paranoid schizophrenia: a graph-theoretical analysis. Shanghai Arch Psychiatry. 2015; 27(3): 158-166. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.215036
9. Fitzsimmons J, Kubicki M, Shenton ME. Review of funconal and anatomical brain connecvity fi ndings in schizophrenia. Curr Opin Psychiatry. 2013; 26(2): 172-187. doi: http:// dx.doi.org/10.1097/YCO.0b013e32835d9e6a
10. Zhou Y, Zhou RS, Li WJ, Lin YQ, Yao J, Chen J, et al. Controlled trial of the effectiveness of community rehabilitation for patients with schizophrenia in Shanghai, China. Shanghai Arch Psychiatry. 2015; 27(3): 167-174. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.215026
11. Chen JL, Chen JD, Li SC, Liu J, Ouyang GH, Luo WX, et al. Comparisons of family environment between homeless and non-homeless individuals with schizophrenia. Shanghai Arch Psychiatry. 2015; 27(3): 175-182. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.214162
12. Phillips MR. [Family Environment Scale - Chinese Version (FES-CV)]. In: Wang XD, Wang XL, Ma H, editors. [Handbook of Mental Health Rang Scales (updated version)]. Beijing: Chinese Mental Health magazine; 1999. p. 134-142. Chinese
13. Chen HH, Phillips MR, Cheng H, Chen QQ, Chen XD, Fralick D, et al. Mental health law of the People’s Republic of China (English translation with annotations). Shanghai Arch Psychiatry. 2012; 24(6): 305-321.doi: http://dx.doi. org/10.3969/j.issn.1002-0829.2012.06.001
14. Saha R, Jakhar K. Oligodendroglioma presenng as chronic mania. Shanghai Arch Psychiatry. 2015; 27(3): 183-185. doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.215039
15. Fan N, Xu K, NingYP, Wang DP, KeXY, Ding Y, et al. Development of a checklist of short-term and long-term psychological symptoms associated with ketamine use. Shanghai Arch Psychiatry. 2015; 27(3): 186-194. doi: hp:// dx.doi.org/10.11919/j.issn.1002-0829.214158
16. Chen DG. Meta-analysis for psychiatric research using free soware R. Shanghai Arch Psychiatry. 2015; 27(3): 195-199. doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.215063