Abstract:Medically unexplained symptoms（ MUS） is a common medical phenomenon in general hospitals， which constitutes a serious financial burden on individuals and society. The pathologic mechanism of MUS is not yet clear， and there are obvious differences in the definition and diagnostic criteria. Since MUS is involved in both biological medical and psychiatry， it must be a multi-factorial problem. Finally， it is very important to establish the definition and operable diagnostic criteria for the clinical diagnosis and treatment of MUS.

Abstract:Objective To investigate the role of serum inflammatory factors， matrix metallo proteinase （MMP）-9 and soluble CD40 ligand（ sCD40L）， in the pathogenesis and the progression of leukoaraiosis（ LA）. Methods A total of 78 cases of LA patients（ LA group） and 50 cases of healthy physical examination patients （control group） were selected. LA group was divided into 3 grades according to the Fazekas score： 28 cases in mild group， 28 in moderate group and 22 in severe group. The levels of serum MMP-9 and sCD40L were measured by enzyme-linked immunosorbent assay（ ELIAS）， and the cognitive function was evaluated by the Montreal Cognitive Assessment（ MoCA） scale. Results The level of serum MMP-9 and sCD40L of LA group was higher than that of the control group， and the difference was statistically significant（ P＜ 0.05）. With the progression of the disease， the level of serum MMP-9 in LA patients increased gradually， and the difference among different grades was statistically significant（ P＜0.05）. However， there was no significant difference in serum sCD40L among different grades（ P＞ 0.05）. The Pearson correlation analysis showed that the level of serum MMP- 9 was positively correlated with the severity of LA（ r=0.497，P=0.004）， and negatively correlated with MoCA score（ r=-0.398，P=0.030）. There was no significant correlation between the level of serum sCD40L and the severity of LA， the MoCA score（ P＞0.05）. Logistic regression analysis showed that MMP-9 was an independent risk factor for cognitive dysfunction in LA patients（ OR=2.336，P=0.014）. Conclusions Serum MMP-9 and sCD40L are involved in the pathogenesis of LA， and MMP-9 can be used as an indicator to evaluate the severity of LA， which is related to cognitive function.

Abstract:Objective To explore the curative effects of Yuyin Qianyang Decoction on Parkinson syndrome caused by antipsychotics and its influence on the quality of life. Methods A randomized double blind case control study was designed. A total of 120 antipsychotic induced Parkinson syndrome patients were randomly divided into study group（ n=60） and control group（ n=60）. Patients of the two groups were given Yuyin Qianyang Decoction combine with trihexyphenidyl placebo and trihexyphenidyl combined with Yuyin Qianyang Decoction placebo respectively. All the patients were treated for 12 weeks. Abnormal Involuntary Movement Scale（ AIMS） and Mos 36-item Short Form Health Survey（ SF-36） were applied to evaluate patients' curative effects and quality of life before treatment and 4， 8 and 12 weeks after treatment. Results There was no statistical difference in curative effects of antipsychotic induced Parkinson syndrome between the study group and control group（ F=0.186，P＞ 0.05）. However， there were significant differences among different time points （F=70.180， P＜0.05）， and the interaction among different time points and groups was not significant（ F=0.939， P＞ 0.05）. After treatment， the SF-36 score of the study group increased significantly in physical function， role of physical， bodily pain， vitality， social function， role of emotion， mental health， physical component summary and mental component summary（ P ＜ 0.05）. Before treatment， there was no statistical difference in SF-36 between the two groups. After treatment， the scores of study group were significantly higher than those of the control group in role physical， role emotional， mental health， reported health transition， physical component summary and mental component summary（ P＜ 0.05）. Conclusions The Qianyang Decoction showed almost the same effect as trihexyphenidyl in treating antipsychotic induced Parkinson syndrome， but it can improve the quality of life of the patients.

Abstract:Objective To analyze the effects of case management on the social support and family burden of direct caregivers of patients with schizophrenia in the community. Methods A total of 40 direct caregivers of patients with schizophrenia who met the research criteria in Nanlang Town Zhongshan City where the case management service were provided were selected into case management group. According to the economic and demographic matching principle， another 40 direct caregivers of patients with schizophrenia in Minzhong Town Zhongshan City where basic management service were provided were randomly selected into control group. The patients and their families in the case management group received community case management， while the patients and their families in the control group was provided national standard basic management services. The two groups were followed up for one year. The Social Support Rating Scale（ SSRS） and Family Burden Scale（ FBS） were applied at the time of admission and the second year. The difference of the social support and disease burden of the two groups were compared. Results The added value of the case management group was better than that of the basic management group in objective support， subjective support， support utilization and SSRS total points（ t=5.84，5.02，7.41，10.89，respectively； P＜0.01）. The subtraction score of the case management group was better than that of the basic management group in the family financial burden， household daily activities， family relationships， family members' mental health and FBS total points（ t=-4.86， -2.73，-3.16，-3.80，-4.37， respectively； P ＜ 0.01）. Conclusions Case management can better promote social support for family members of schizophrenic patients and reduce family burden relative to basic management.

Abstract:Objective To study the curative effect of the self-designed rehabilitation therapy on Parkinson disease and its effects on magnetic resonance spectroscopy（ MRS） in patients. Methods A total of 78 patients with Parkinson disease who were admitted in our hospital from January 2015 to December 2016 were selected as the research objects and randomly divided into control group and study group. The patients in the control group were treated with simple drug treatment. While on the basis of the control group， the study group adopted the self-designed rehabilitation therapy. After a course of treatment， the curative effect of the two groups were evaluated with Unified Parkinson's Disease Rating Scale（ UPDRS） for exercise and non-motor symptoms， Berg Balance Scale（ BBS） for balance abilities， Activities of Daily Living（ ADL） for the ability of living， Minimental State Examination（ MMSE） for mental status， Hamilton Depression Scale（ HAMD） for depression status and Parkinson Disease Sleep Scale（ PDSS） for the quality of sleep. At the same time， the changes of four serum enzymes were monitored before and after the treatment in the two groups. The proton magnetic resonance spectroscopy（ 1H-MRS） was applied to check the changes of substantia nigra metabolism， and the correlation between 1H-MRS and Parkinson patients' exercise and non-motor symptoms. Results After the treatment， the scores of UPDRS， BBS， ADL， MMSE， HAMD and PDSS were all improved in both groups（ P ＜ 0.05）.After treatment， the 1H-MRS indicators， including NAA/Cr and Cho/Cr， were improved（ P ＜ 0.05）， and the expression levels of SOD， GSH-PX， CAT， MDA were improved as well（ P＜0.05）. All the indicators mentioned above of the study group were superior to the control group（ P＜0.05）. In addition， NAA/Cr and Cho/Cr were negatively correlated with UPDRS（ |r|≥0.7， P＜0.05）. Conclusions The rehabilitation therapy can improve the curative effect in patients with Parkinson disease， improve the serum enzyme expression levels， patients' activities of daily living， sleep quality， intelligent mental state. It also increase the value of NAA/Cr and Cho/Cr in substantia nigra（ 1H-MRS index）， which is worthy of popularization and further research.

Abstract:Objective To explore the emotional response and electroencephalogram α power to happy， sad and horror music in deteriorated schizophrenia patients. Methods A total of 66 deteriorated schizophrenia patients and 30 healthy controls were recruited. The electroencephalogram（ EEG） was collected in three music fragments of happy， sad and horror. The subjective happiness score and EEG α power were compared between the two groups. Results Deteriorated schizophrenia patients showed lower pleasure levels to the happy music than healthy controls， and lower fear levels to horror music. There was no statistical difference in the feeling to sad music between the two groups. Deteriorated schizophrenia patients exhibited significantly stronger electroencephalogram α power in bilateral frontal and temporal lobes. The comparison of the left and right brain showed that the α power of the right posterior temporal lobe was higher than that of the left side. Conclusions Deteriorated schizophrenia patients suffer from music induced emotional disorders： anhedonia and lack of horror. The abnormal α power of bilateral frontal lobes， temporal lobes and right posterior temporal lobe of the brain is enhance， which may be the biological basis of it.

Abstract:Objective To explore the factors affecting quality of life of the migraine patients， and help to optimize the management of the migraine patients. Methods A total of 138 migraine patients in the outpatient clinic of Central Hospital of Panzhihua were recruited and investigated with Migraine Specific Quality of Life Questionnaire 2.1（ MSQ 2.1）， recording age， gender， frequency（ number of headache attacking in a month）， degree of headache， body mass index（ BMI）， the score of Generalized Anxiety Disorder-7 scale（ GAD-7）， the score of Patient Health Questionnaire 9-item Depression Scale（ PHQ-9）， the score of Athens Insomnia Scale （AIS）， and whether they had substance abuse or precursor headache. Univariate analysis was first applied， and then multivariate linear regression analysis was carried out with the related factors as independent variables and MSQ 2.1 score as dependent variable. Results Univariate analysis showed that MSQ 2.1 score was associated with whether substance abuse， degree of headache， BMI， frequency， PHQ-9 score， GAD-7 score and AIS score（ P＜0.05）. Multiple factor analysis showed that PHQ-9 score， GAD-7 score and AIS score did not enter the regression equation（ P ＜ 0.05）. MSQ 2.1 score was negatively correlated with whether substance abuse， degree of headache， BMI and frequency（ P ＜ 0.05）. Conclusions The abuse of painkillers in migraine patients induce heavier headache， more frequent attacks and higher BMI， which makes the quality of life worse in patients.

Abstract:Objective To systematically evaluate antipsychotic-induced motor system adverse reactions in the treatment of psychiatric patients. Methods We searched PubMed， the Cochrane library， CBM， CNKI， VIP and Wan Fang database， collecting randomized controlled trials（ RCT） of various antipsychotic drugs compared with placebo or other psychotropic drugs in comparison to the treatment of psychotic disease. The search period was from the reservoir to November 2017. Evaluating the quality of the study according to Cochrane systematic reviews， Metaanalysis was performed for the results of homogeneous studies by The Cochrane Collaboration's software RevMan 5.3 and the heterogeneous data conducted a descriptive qualitative analysis. Results A total of 81 RCTs involving 21 810 patients were included in the analysis. Considering about the frequency of motor system adverse reactions， on the Parkinson syndrome， risperidone was more than quetiapine； on the extrapyramidal system（ EPS）， olanzapine and haloperidol caused more than aripiprazole， haloperidol caused more than ziprasidone， and ziprasidone caused more than placebo， but the placebo was more than aripiprazole； on the tremor， haloperidol was more than the aripiprazole， risperidone and ziprasidone， risperidone is more than quetiapine and the placebo was more than aripiprazole； haloperidol caused more rigidity than placebo； on the akathisia， haloperidol caused more than aripiprazole， olanzapine and risperidone， olanzapine was more than clozapine， ziprasidone was more than placebo and aripiprazole was lower than placebo. Conclusions The adverse effects of antipsychotics on the motor system are mainly Parkinson， EPS， tremor， rigidity and akathisia. The adverse events of motor system caused by aripiprazole are few， with less statistical significance than placebo. Haloperidol caused more motor-related adverse events， higher than most atypical antipsychotics， which indicates typical antipsychotics are more likely to cause motor side effects than atypical antipsychotics.

Abstract:Objective To estimate the application value of head-neck CT angiography（ CTA） and whole brain CT perfusion（ CTP） in patients with chronic cerebral ischemia by the correlation comparison study of head-neck CTA and brain CTP. Methods A total of 150 patients' CTA and CTP were analyzed for their correlations with the distribution of perfusion region， responsible blood vessels and perfusion abnormalities. Results The responsible vessels of 98.72% perfusion abnormal region were moderate vascular stenosis. With the aggravation of the degree of the stenosis of the responsible vessels， the proportion of abnormal region of perfusion was significantly increased. The degree of responsible vascular stenosis was moderately positively correlated with the staging of CTP in the pre-infarction stage. Conclusions Combined with the results of headneck CTA and whole brain CTP， the degree of chronic ischemia in patients with chronic cerebral ischemia can be comprehensively evaluated， which is more conductive to the selection of clinical treatment.

Abstract:Objective To explore the characteristics of comorbidity of chronic insomnia disorder（ CID） and restless legs syndrome（ RLS）. Methods A consecutive case series of CID were enrolled into the study. The patients' general information， etiological subtype， RLS symptoms investigation and RLS symptom severity scale were recorded. All patients were divided into CID with RLS group（ CID+RLS） and CID without RLS group（ CIDRLS）， and the distribution of etiological subtype was compared between two groups. Results 117 cases of CID were enrolled from 122 consecutive cases， the other 5 cases were eliminated because of unable cooperation. 50 cases（ 42.7%） comorbided two or more etiological subtypes. The incidences of insomnia due to mental disorders， insomnia due to medical disorders， psychological physiology insomnia were 50（ 42.7%） ，41（ 35.0%） and 32（ 27.4%） respectively. Insomnia due to other sleep disorder were 33（ 28.2%）， 30 cases of which（ 25.6%） were for RLS. Compared with the CID-RLS group， CID+RLS group had insomnia more due to medical disorders （40.0% vs 12.6%， P=0.001）， CID+RLS group had insomnia less due to poor sleep hygiene， physiologic insomnia， and unspecified（ 3.3% vs 18.4%， P=0.044； 0% vs 13.8%， P=0.032）. Conclusions In the Neurological outpatients， nearly half comorbid two or more kinds of subtypes. It is more common to have insomnia due to mental disorders， medical disorders and psychological physiology insomnia among CID outpatients. The subtypes of two groups are significantly different.

Abstract:Objective To explore the clinical features of children's head shotgun injury at long distance by pellet and its neurosurgical treatment. Methods The clinical data of 12 children with skull shotgun wounds by pellet at distance， who were consecutively admitted in our hospital from January 2000 to January 2017 were retrospectively analyzed. The differences between children's head shotgun injury and general firearm injury in adults were studied. The neurosurgical treatment of children's head shotgun injury at long distance by pellet was summarized. Results There were three cases of local debridement， seven cases of craniotomy， two cases of stereotactic surgery and one case of re-craniotomy for the metal foreign bodies. There were six cases of metal foreign body residues after operation， two cases of postoperative infection， one case of postoperative epilepsy and one case of permanent neurological dysfunction. Conclusions Children's head shotgun injury at distance seems to have a better outcome compared to adults gunshot wounds， with considerable postoperative longterm effects. A relatively conservative debridement is suggested for this kind of gunshot injury， so as to avoid aggravating neurological damage. There is no significant increase in the incidence of postoperative infection and epilepsy with the presence of residual metal in the cerebral.

Abstract:Anti-N-methyl-D-aspartate receptor encephalitis is a kind of autoimmune encephalitis of central nervous system. The clinical symptoms are complex. The clinical manifestations are characterized by mental and behavioral abnormalities， involuntary movements， seizures and disturbance of consciousness. The difference of mental disorder caused by anti N-methyl-D-aspartate receptor encephalitis and functional disease and the role and significance of electroencephalogram in its diagnosis are discussed in combination with two cases.

Abstract:Cerebral vasospasm is considered as the main cause of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Its pathogenesis is not clear yet， and its curative effect is not good. Recent studies have demonstrated that cerebral vasospasm following subarachnoid hemorrhage is influenced by many factors， including cerebral vascular dysfunction， oxidative stress， cortical depolarization， immune response， and so on. This is to review the possible pathogenesis and prevention and treatment of cerebral vasospasm after subarachnoid hemorrhage.

Abstract:Maladaptive daydreaming（ MD）， also called the excessive daydreaming or compulsive fantasy， is a fantasy activity described as a behavioral addiction for vivid fanciful imagery， which interferes human interaction and/or interferes with academic， interpersonal， or vocational functioning. Based on previous research， this paper synthesizes the current status of research on maladaptive daydreaming， including the concept， measurement， structured clinical interview， as well as the comorbidity on attention deficit hyperactivity disorder（ ADHD）， obsessive-compulsive disorder（ OCD） and other mental disorders in Diagnostic and Statistical Manual of Mental Disorders（ DSM-5）. This paper also introduces the antecedents， features， maintenance factors and results of MD. Future research should expand the sample to explore MD in the Chinese context， and further study the antecedents and comorbidity of MD， so as to develop treatment models and early intervention methods.

Abstract:Growth differentiation factor-15（ GDF-15） is a new divergent member of the transforming growth factor-β（ TGF-β） superfamily. Research on GDF-15 is currently focused on its anti-inflammatory， anticell proliferation， and inhibition of tumor growth. In the nervous system， researchers found that GDF-15 is a protective factor for nigral dopaminergic neurons， a new trophic factor for motor and sensory neurons， a predictor of cerebrovascular disease and brain damage. Recent studies have shown that GDF-15 also has the function of modulating the expression of neuronal ion channels and affecting the function of synaptic transmission. This review summarizes the biological characteristics of GDF-15 and its recent advances in neurological diseases.

Abstract:Obsessive-compulsive disorder（ OCD） is a refractory mental illness with complicated etiology. The application of imaging technology in mental illness is more extensive， and plays an increasingly important role in exploring the pathogenesis of OCD. Studies have found abnormal functional connectivity in the prefrontal cortex and subcortical structures of patients with OCD through functional magnetic resonance imaging（ fMRI）. OCD is a heterogeneous disease， therefore different neural circuits may mediate different obsessive compulsive symptoms. This paper is to analyze the research progress of OCD in recent years from the perspective of the pathogenesis of the brain， and to review he current research on the pathogenesis of OCD and its correlation with clinical symptoms.