Abstract:With the aging of the population， late-life depression has become an important disease affecting the physical and mental health of the elderly，which should be paid more attention to. The diagnosis of late-life depression is not clear， and its pathogenesis， clinical manifestation， treatment and outcome are very different from other types of depression. In recent years， the related literature on the treatment of late-life depression is increasing， but the conclusions are inconsistent. Therefore， based on the above problems， we will elaborate the relevant literature on the treatment of late-life depression， in order to provide ideas and reference for clinical work and future research.

Abstract:Objective To study and discuss the correlation between enlarged perivascular space （EPVS） and the severity of cerebral edema （CED） in patients with acute ischemic cerebral infarction. Methods The clinical data of patients with acute cerebral infarction who visited the Affiliated Hospital of Xuzhou Medical University within 24 hours after onset from August 2015 to October 2020 were retrospectively investigated. The degree of CED and EPVS grade of stroke were evaluated by cranial imaging data after admission. The patients were divided into two groups with or without CED， and the correlation between EPVS and cerebral edema was studied. The degree of cerebral edema was further divided into three groups： CED1， 2 and 3. EPVS was divided into three groups： mild， moderate and severe. The factors affecting the severity of CED and the relationship between them were analyzed. Results A total of 342 patients with acute cerebral infarction were included， 216 male patients and 126 female patients， with an average age of （66.47±12.10） years. The proportion of atrial fibrillation， National Institutes of Health Stroke Scale （NIHSS） score， white matter hyperintensity， and EPVS in the group with edema were significantly higher than those in the group without edema， and the differences were statistically significant （P＜ 0.05）. Multivariate logistic regression analysis indicated that NIHSS score and moderate to severe EPVS were positively correlated with the occurrence of edema （β=0.067， P=0.013； β=0.916， P=0.003）， that is， the risk of edema was increased （OR=1.069，2.500）， which was an independent risk factor. The results of univariate and multivariate logistics regression analysis grouped according to different degrees of edema in patients showed that the degree of EPVS was an independent risk factor leading to moderate and severe edema （P＜ 0.05）. EPVS was positively correlated with edema， and the risk of edema increased with the severity of EPVS （CED1 OR=4.692， P=0.015； OR=5.100， P=0.026； CED2 OR=9.432， P=0.008； OR=13.099， P=0.009）. Conclusions EPVS is an independent risk factor for cerebral edema， and EPVS may be an imaging predictive marker of cerebral edema in patients with acute cerebral infarction.

Abstract:Objective To evaluate the predictive validity of the Chinese version of the schizophrenia early signs scale （ESS-C）. Methods A total of 70 patients with schizophrenia discharged from 6 mental health centers in Hongkou， Baoshan， Jiading， Songjiang， Changning and Xuhui districs of Shanghai from March to June 2018 were recruited. All patients were assessed by ESS-C and Positive and Negative Symptom Scale （PANSS） every 2 weeks until disease recurrence or follow-up for 6 months. The ESS-C scale scores of the recurrence group and the non-recurrence group were compared， and the predictive validity of the ESS-C was evaluated by constructing the curve of receiver operating characteristic （ROC）. Results Compared with the non-recurrence group， the scores of all dimensions and total scores of ESS-C in the last evaluation in the relapse group were higher， and the differences were statistically significant （P＜ 0.05）. The scale discriminative performance was good. The area under the ROC curve was 0.886， 95%CI valued from 0.803 to 0.970. The sensitivity， specificity， positive predictive value and negative predictive value were 78.6%， 89.3%， 64.7% and 94.3%， respectively， with 21.5 points as the optimal cut-off value for recurrence. Conclusions The ESS-C has good predictive accuracy and is a simple and reliable tool for evaluating the relapse of schizophrenia in the community.

Abstract:Objective To explore the changes of clinical symptoms and working memory in patients with depression before and after treatment in the acute phase and their correlation. Methods Patients with depression， who were admitted to the outpatient clinic of Beijing Anding Hospital affiliated to Capital Medical University from July 2017 to December 2019， were recruited， given 10-20 mg/d Escitalopram oxalate treatment per day， and followed up for 12 weeks. At baseline and the end of the 12th week， self-ordered pointing task （SOPT） and delayed recall task were used to evaluate working memory， and the HAMD-17 scale was used to evaluate clinical symptoms. Chi-square test， Wilcoxon rank sum test and Spearman correlation analysis were used to compare the changes of each index and the correlation between them. Results A total of 139 patients with depression were recruited， among which 73 patients completed 12 weeks follow-up. Anxiety symptoms are related to working memory accuracy under K2 load conditions （r=-0.171，P ＜ 0.05） and are related to working memory capacity （r=-0.89，P＜ 0.05）. At the end of the 12th week， 43 patients （58.9%） had a complete remission. There was a statistically significant difference in the decrease of HAMD-17 score between the remission group ［16.00 （12.00，19.00）］ and the non-remission group ［8.00 （4.00，11.00）］ （P＜ 0.05）. There was statistically significant difference in the depressive symptoms ［7.00（6.00，9.00） vs 5.00（3.00，5.00）］， anxiety symptoms［4.00（3.00，6.00） vs 2.00 （1.00，4.00）］， insomnia symptoms ［1.00（0，3.00） vs 1.00（0，2.00）］， and somatic symptoms ［2.00（1.00，3.00） vs 1.00 （0，3.00）］ between remission group and non-remission group （all P＜0.05）. After 12 weeks of follow-up， The total score of HAMD-17 and the change value of each dimension had no correlation with the change value of each dimension of working memory （P＞ 0.05）. Conclusions Anxiety symptoms of patients with depression are related to working memory. There is no correlation between clinical symptoms and working memory changes before and after treatment in the acute phase.

Abstract:Objective To explore the role of plasma inflammatory related factors in predicting the antidepressant efficacy of escitalopram in patients with depression in the early stage of treatment. Methods A total of 85 patients with major depressive disorder （MDD）， who were treated in the outpatient department of Beijing Anding Hospital Affiliatedd to Capital Medical University from January 2016 to December 2018， were treated with escitalopram for 12 weeks. According to the treatment response， the patients were divided into responders and non-responders. The liquid phase suspension chip technology was used to detect the levels of 21 inflammatory-related factors in the plasma at baseline and 2 week after treatment， and the changes from baseline to week 2 between responders and non-responders were compared. Results After 12 weeks of treatment with escitalopram， there were 62 patients （72.94%） in the respond group and 23 patients （27.06%） in the non-respond group. The 2-week change value of plasma granulocyte-macrophage colony stimulating factor （GM-CSF） （P=0.078）， interferon gamma （IFNγ） （P=0.053）， interleukin 17 （IL-17） （P=0.030）， interferon gamma inducible protein （IP-10） （P=0.046）， monocyte chemokine 1β （MCP-1β） （P=0.080） and tumor necrosis factor （TNFα） （P=0.087） were different between responders and non-responders （P＜ 0.1）. The logistic regression model which combinations of age， gender， BMI and the six factors above from baseline to 2 weeks can reflect the efficacy of escitalopram （AUC=0.702； sensitivity， 0.500； specificity， 0.814）. Conclusions The early changes of inflammation-related factors can predict the antidepressant effect of escitalopram in acute phase， but it still needs to be verified by large-scale independent samples.

Abstract:Objective To evaluate the accuracy of the Self-Rating Depression Scale and Beck Depression Inventory in diagnosing depression and distinguishing the severity of depression. Methods From August 2018 to August 2020， a total of 200 voluntary patients with mood and sleep problems in Chongqing Mental Health Center were enrolled. The diagnosis of depression and the severity of depression were assessed according to the ICD-10 entry criteria， and the Self-Rating Depression Scale and Beck Depression Inventory were evaluated at the same time. The accuracy of the two depression scales was evaluated by area under ROC curve. Results There was a significant correlation between the Self-Rating Depression Scale and Beck Depression Inventory （r=0.848， P ＜ 0.001）. The area under the ROC curve for diagnosing depression and distinguishing the severity of depression were similar and there was no statistical difference between the two scales （P ＞ 0.1）. With the aggravation of depression， the area under ROC curve gradually increased （0.754/0.761-0.904/0.911）， and Youden index gradually increased （0.498/0.403-0.768/0.751）. The positive likelihood ratio increased gradually （2.71/2.14-9.63/10.1）， and the positive predictive value increased gradually but was not ideal （17.2%/17.8%）. Conclusions The accuracy of the Self-Rating Depression Scale and the Beck Depression Inventory in diagnosing depression and distinguishing the severity of depression is similar， and the more severe the depression is， the more accurate the evaluation of the two scales will be. The two scales have specific purposes and specific populations， so they cannot be used arbitrarily.

Abstract:Cognitive impairment is a symptomatic area of many mental disorders. Cognitive impairment in patients with depression is an important cause of occupational and functional disability. Multiple interacting neurobiological mechanisms （such as neuroinflammation） are related to cognitive deficits in depression. This paper summarizes a variety of biological mechanisms related to cognitive function of depression， including brain mechanism， neurotransmitter system， neuroendocrine system， inflammatory response and neurotrophic factors， and analyzes the research progress of biological mechanism of patients with depression complicated with cognitive impairment. At present， there is still a lack of in-depth exploration of cognitive impairment of depression in China and abroad. The future direction is to integrate the nervous system， endocrine system and immune system and further explore the biological mechanism of cognitive impairment of depression.

Abstract:Depressive disorder is one of the most common co-diseases of epilepsy. At present， the research in this field is in the ascendant， but the degree of clinical attention still needs to be improved. Patients with epilepsy have not been fully identified and diagnosed， and the quality of life declines. Studies have shown that epilepsy and depression have a common pathogenesis， including neurotransmitter regulation mechanism， neuro-immune regulation mechanism， brain network related mechanism and genetic related mechanism. This article reviews the research progress on the related mechanism of epilepsy comorbid depression

Abstract:Objective To explore the relationship between the symptom severity of attention deficit hyperactivity disorder （ADHD） and obesity in school-age children. Methods A total of 60 school-age children with ADHD who were admitted to Qingdao Mental Health Center and met DSM-5 diagnostic criteria were selected as subjects. The self-made basic demographic characteristics questionnaire and Conners Parental Symptom Questionnaire were used to evaluate and calculate the body mass index （BMI）. According to the BMI， the children were divided into obese group and non-obese group. The scale scores and obesity degree of the two groups were compared， and the relationship between the severity of ADHD symptoms and obesity degree was analyzed. Results The total score of Conners Parental Symptom Questionnaire in obese group was significantly higher than that in non-obese group ［（73.46±6.75） vs （58.02±5.70）， t=9.317， P ＜ 0.05］， among which the score of conduct problem ［（15.00±0.98） vs （13.03±1.78）， t=4.943， P ＜ 0.05］， impulse-hyperactivity ［（10.25±1.51） vs （9.25±1.42）， t=2.996， P＜ 0.05］， and hyperactivity index ［（23.17±2.50）］ vs （20.30±2.80）， t=4.947， P＜ 0.05］ were significantly higher than those of the non-obese group. The correlation test was made between the Percentile of BMI and each factor score of Conners Parental Symptom Questionnaire and the results showed a positive correlation （r=0.559， 0.404， all P＜ 0.05）. Binary Logistic regression analysis showed that conduct disorder （OR=3.371， 95%CI： 1.389-8.181） and anxiety （OR=1.325， 95%CI： 0.947- 1.853） were independent risk factors for obesity （all P＜ 0.05）. Conclusions The severity of ADHD symptoms is correlated with obesity in school-age children， and the severity of ADHD symptoms may affect the weight of children.

Abstract:Objective To investigate the clinical and imaging features of sporadic Creutzfeldt-Jakob disease （sCJD） and to follow up the survival period， in order to guide the clinical early detection of the disease. Methods A retrospective analysis of 9 patients with sCJD admitted to the Department of Neurology， Peking University Third Hospital from January 2002 to December 2020 was carried out. Results The onset age of the 9 patients was （62±10） years. The most common symptoms were akinetic mutismin 7 cases （7/9）， myoclonic seizures 6 cases （6/9）， slow to response 5 cases （5/9）， ataxia 4 cases （4/9）， mental behavior disorder and confusion 3 cases （3/9）， and walking instability 3 cases （3/9）. The first symptoms were mainly sluggish reaction， mental behavior abnormal and confusion. There are six cases（6/9）with cortical ribboning sign on diffusion weighted imaging，positive cerebral spinal fluid 14-3-3 protein 4 cases （4/9）， basal ganglion abnormal high signal 3 case （3/9）， and electroencephalogram three-phase wave 1 case （1/9）. The median survival time was 4 months. In the 24-months follow-up， 2 patients （2/9） survived. Conclusions In this study， the majority of patients with sCJD are middle-aged and elderly， and the first symptom is not specific. The occurrence of magnetic resonance diffusion-weight imaging "cortical ribboning sign" and basal ganglion abnormal high signal is frequent. The median survival time was short.

Abstract:Apathy is characterized by loss of motivation. It is a major disease that seriously endangers physical and mental health. Recent investigations have exhibited the high prevalence of apathy， which severely impacted daily work and life of patients with cerebral vessel disease. The specific process and mechanism of apathy are still unclear and the treatment of apathy is ineffective， so apathy of cerebral vessel disease has gradually become a hotspot. This article reviews the method of evaluation， progress and treatment of apathy in patients with cerebral vessel disease， in order to understand and intervene the symptoms of apathy better.

Abstract:Alzheimer disease （AD） is a neurodegenerative disease， which is the most common type of dementia. At present， the pathogenesis of AD is still unclear， and it is difficult to develop new drugs. For many years， the strategy of "one molecule， one targe" has been used to treat AD， but the effect is not ideal. In other diseases such as cancer， AIDS and tuberculosis， multi-target drug combination therapy has shown good clinical benefits， while the drug combination therapy for AD is still in its initial stage. Thus， in this paper， the research progress is summarized from the mechanism of action.

Abstract:The high incidence of cerebral small vessel disease （CSVD） not only increases the burden on society and families， but also reduces the patient's own quality of life， and its severity is no less than that of macrovascular stroke. The occurrence of CSVD is caused by many pathogenetic mechanisms jointly， which has not yet been fully elucidated. are still to be fully elucidated. CSVD is considered to be the most common cause of cognitive impairment， and there are many common risk factors between the two