Abstract:Approximately one-third of patients with depressive develop to treatment-resistant depression （TRD） since they do not respond to existing antidepressants. TRD is a chronic depressive state with a long course of illness， which is highly resistant to current treatment regimens and has poor prognosis， putting a heavy burden on the patient's family and society. This review summarizes the current treatment options for TRD， reviews and analyses the evidence for the use of ketamine in TRD，focusing on clinical routes of administration， dose， and duration of efficacy. Furthermore， ethical factors were added to the safety discussion of ketamine， hoping to provide a reference for the clinical treatment of TRD and the standard use of ketamine.

Abstract:Objective To investigate the epidemiological status of cognitive impairment in elderly patients with hypertension in Shanghai community， and analyze the influencing factors. Methods A total of 1 192 elderly people over 65 years old were selected from 6 community neighborhood committees of Huajing Town， Xuhui District， Shanghai by random cluster sampling. The prevalence of cognitive impairment in the elderly was assessed by 8-item Ascertain Dementia （AD-8） screening questionnaire. The prevalence of hypertension in the elderly was obtained by face-to-face interview. The correlation between different lifestyles and cognitive impairment in elderly patients with hypertension was analyzed by multivariate regression analysis. Results A total of 565 patients with hypertension and 185 patients with cognitive impairment were detected. Among the 565 elderly patients with hypertension， 103 had cognitive impairment. The prevalence of cognitive impairment in elderly patients with hypertension was 18.2%， which was significantly higher than that in non-hypertensive patients ［13.1%（82/527）， χ2 =6.016， P=0.014］. The protective factors of cognitive impairment in elderly patients with hypertension were enjoying exercise （OR=0.56， 95%CI=0.34-0.93， P=0.025） and often participating in community activities for the elderly （OR=0.48， 95%CI=0.24-0.93， P=0.045）. Less than 7 hours of sleep per day （OR=2.13， 95%CI=1.30-3.48， P=0.003） was a risk factor for cognitive impairment in elderly patients with hypertension. Conclusions Regular exercise， participating in community activities and sleep time deficiency were the influential factors of cognitive impairment in elderly patients with hypertension.Promoting healthy lifestyle in the elderly patients with hypertension is an important measure to prevent development of cognitive impairment.

Abstract:Objective To investigate the efficacy and its relevant influence factors of paroxetine combined with mirtazapine in the treatment of patients with depression without response in early stage. Methods A multicenter， block randomized， double-blind， double-dummy， controlled trial was designed. A total of 525 patients with depression were selected from five general hospitals and psychiatric hospitals in China. Participants received paroxetine during a 2-weeks open-label phase， with 475 cases completed. A total of 204 patients who showed non-response in early stage （Hamilton Rating Scale score reduction rate ＜ 20%） were divided into paroxetine group （n=68）， mirtazapine group （n=68）， and paroxetine combined with mirtazapine group （n=68） according to the ratio of 1∶1∶1 by block randomization method. After 6 weeks of treatment， the curative effect was evaluated by the reduction rate of Hamilton Depression Scale at the time of randomization and before and after treatment. The treatment was effective if the reduction rate was more than 50%. The patients were divided into effective group and ineffective group according to the results. Univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of efficacy. Results Univariate analysis showed that there was no significant correlation between each variable and antidepressant efficacy. Multivariate logistic regression analysis showed that age ≤ 37 years old （OR=4.694， 95%CI=1.061-20.779， P＜0.05） and combination treatment of paroxetine and mirtazapine （OR=2.836， 95%CI=1.035-7.770， P＜0.05） were independent efficacy factors after controlling for the confounding factors. Conclusions The efficacy of paroxetine combined with mirtazapine in patients with acute depression is superior to monotherapy. Age under 37 years old is an independent risk factor of efficacy.

Abstract:Objective To explore the moderation effect of prosocial behavior between life events and depression in adolescents， in order to provide clinical implication for the prevention and treatment of depression among adolescents. Methods From September 2018 to March 2019， 5 491 young students from 6 junior high schools and 3 high schools were selected by stratified cluster sampling method according to the proportion of students and the types of school in a district of Shanghai in the beginning of this year. A self-designed questionnaire on general information， Kutcher Adolescent Depression Scale-11， Adolescent Self-Rating Life Events Check List and Prosocial Behavior Subscale of Strengths and Difficulties Questionnaire were adopted in the test. Moderating effect of prosocial behavior were analyzed by hierarchical regression. Results Correlation analysis indicated that the score of life events was positively correlated with the score of depression （r=0.290， P ＜ 0.05）， and negatively correlated with the score of prosocial behavior （r=-0.183， P ＜ 0.05）. The score of prosocial behavior was negatively correlated with the score of depression （r=-0.475， P ＜ 0.05）. Hierarchical linear regression analysis indicated that the moderating effect of prosocial behavior was statistically significant （β=-0.060， P ＜ 0.05）. At low prosocial behavior， the positive predictive effect of life events on depression is strong （β=0.260， P＜0.01）. At high prosocial behavior， the positive predictive effect of life events on depression was weak （β=0.140， P＜ 0.01）. Conclusions Prosocial behavior could modertae the relationship of life events and depression. With the increase level of prosocial behavior， the effect of life events on depression decrease.

Abstract:Depression is also known as depressive disorder， and the incidence is increasing year by year. The mechanism hypothesis mainly includes monoamine neurotransmitter hypothesis， monoamine receptor hypothesis， neuroendocrine hypothesis and brain-derived neurotrophic factor hypothesis. Nowadays， most depression models can simulate the behavior characteristics of patients with depression and the changes of neurotransmitters in the brain. In recent years， it has been found that the impact of gut microbiota on human body span the nervous， endocrine， immune and other systems and are related to the incidence of depression. The discovery of the relationship between depression and gut microbiota is helpful to provide a new way for the treatment of depression. In this paper， animal models of depression and related studies of gut microbiota are reviewed.

Abstract:The treatment of major depressive disorder（MDD）comorbid with chronic pain has always been a central issue in clinical practice. Scientists have explored its etiology and pathogenesis and found that the complex interaction between pro-inflammatory factors and anti-inflammatory factors is considered to be the key to the occurrence， development and prognosis of MDD comorbid with chronic pain. This review summarizes the mechanism of inflammatory factors in MDD with chronic pain， and prospects the development direction of drug treatment in this kind of disease in the future.

Abstract:In recent years， electroconvulsive therapy， one of the important means of the treatment of depression， not only significantly improve symptoms， but also affect the cognitive function of patients to some extent. This paper discusses the potential mechanisms of cognitive dysfunction after electroconvulsive therapy based on the results of animal studies and clinical studies.

Abstract:Clinically， more than half of patients with depressive disorder have somatic pain， and inflammatory mediators play an important role in the common pathophysiological process of them. Peripheral cytokines can also produce other inflammatory mediators that can pass through the blood-brain barrier after being stimulated， thus inducing the occurrence of central inflammation. This article mainly describes the research progress of inflammatory cytokines related to depressive disorder with somatic pain.

Abstract:Objective To explore the current situation and influencing factors of agoraphobia after incerebral hemorrhage operation. Methods A cross-sectional study was carried out on the patients with intracerebral hemorrhage who were admitted to the Department of Neurological Comprehensive Ward of a 3A hospital in Sichuan Province from June 2018 to December 2019. The general condition questionnaire， Modified Rankin Scale （mRS）， Visual Analogue Scale （VAS）， Tampa Scale of Kinesiophobia （TSK）， Social Support Rating Scale （SSRS） and Hospital Anxiety and Depression Scale （HADS） were used to investigate the patients who met the inclusion criteria， and to analyze the influencing factors of agoraphobia after cerebral hemorrhage operation. Results The incidence of dyskinesia was 35.7% （68/192）， and the average score of TSK was （38.98±9.65）. There were 68 cases in the Kinesiophobia group （TSK ＞ 37 points） and 124 cases in the non-Kinesiophobia group （TSK ≤ 37 points）. The difference in educational level between the two groups was statistically significant （χ2 =30.03，P＜ 0.05）. The scores of pain （4.55±0.73）， anxiety （11.31±1.6）， depression （12.1±2.07）， degree of disability （2.24±1.14） were higher than those in non-Kinesiophobia group［ （2.04±0.82）， （8.96±1.62），（8.21±1.54）， （1.06±0.92）］， respectively， and the differences were statistically significant （t=21.128，9.661， 14.707，14.354，P ＜ 0.05）. The score of SSRS in Kinesiophobia group （27.88±4.04） was lower than that in non-Kinesiophobia group （35.15±2.96）， and the difference was statistically significant （t=10.233，P ＜ 0.05）. Univariate analysis and correlation analysis showed that education level， pain score， anxiety score， depression score， SSRS and disability degree were statistically significantly associated with the occurrence of kinesiophobia （P ＜ 0.05）. The multivariate regression analysis showed that VAS （t=7.875， P ＜ 0.001）， anxiety score （t=4.190， P＜ 0.001）， depression score （t=3.917， P＜ 0.001）， SSRS （t=-2.469， P=0.014） and disability degree （t=6.052， P＜ 0.001） were the risk factors for the development of kinesiophobia. Conclusions The incidence of kinesiophobia is higher in patients with intracerebral hemorrhage after operation. The degree of pain， anxiety and depression， social support and disability are the influencing factors of kinesiophobia

Abstract:Objective To evaluate the clinical value of P300 and total cerebral small vessel disease （CSVD） score in detecting the degree of cognitive impairment in patients with CSVD， and to explore their matching degree with cognitive function screening scale. Methods A total of 72 patients diagnosed with CSVD in the Department of Neurology of Lianyungang Oriental Hospital from October 2018 to June 2020 were included， and 34 normal physical examinees matched by age and gender were included as the control group. Mini-mental State Examination （MMSE）， Montreal Cognitive Assessment （MoCA）， P300 and total CSVD scores were examined within one week for all the subjects included. According to the cognitive function screening scale （MMSE， MoCA）， CSVD patients were divided into cognitive impairment group and non-cognitive impairment group. The relationship between MMSE and MoCA scores， and P300 latency， P300 amplitude， and total CSVD score among the three groups was analyzed. Results The latency of P300 recorded at the central point （CZ） in cognitive impairment group and non-cognitive impairment group was longer than that in control group （P＜0.001）.The latency of P300 recorded in cognitive impairment group was longer than that in non-cognitive impairment group［（397.471±35.911） ms vs. （342.584±14.502） ms，P ＜ 0.001］. The total CSVD score of cognitive impairment group and non-cognitive impairment group was higher than that of control group （P＜ 0.001）， and the total CSVD score of cognitive impairment group was higher than that of non-cognitive impairment group （P＜ 0.001）. Correlation analysis results showed that MMSE and MoCA scores have strong negative correlations with P300 latency （r=-0.768，P＜ 0.001；r=-0.824，P＜ 0.001） and total CSVD score （r=-0.816，P＜ 0.001； r=-0.896， P ＜ 0.001）. When the CZ of P300 latency was 348.4 ms， the sensitivity and specificity of CSVD were 94.3% and 83.1%， respectively. When the total CSVD score was 2， the sensitivity and specificity of CSVD were 82.9% and 97.2%， respectively. Conclusions P300 latency and total CSVD score may be the indicator of cognitive impairment in patients with CSVD for the early stage， and can reflect cognitive function more objectively than MMSE and MoCA.

Abstract:Objective To investigate the current situation and influencing factors of non-suicidal self-injury （NSSI） among nursing freshmen in a western college. Methods From November to December in 2020， 1 521 freshmen majoring in nursing in a western university were selected to conduct a questionnaire survey to analyze the NSSI detection rate， behavior characteristics and influencing factors of nursing freshmen. Results Among the 1 521 nursing freshmen， 1 467 valid questionnaires were collected， among which 332 cases had NSSI behavior， and the detection rate was 22.6%. The average age of students with NSSI behavior was （19.12±0.98） years old. Logistic regression analysis showed that male （OR=1.913， 95%CI：1.318-2.775）， with anxiety symptoms （OR=3.895， 95%CI：2.464-6.157）， with passive suicidal ideation （OR=4.661， 95%CI： 3.434-6.328） were positively correlated with NSSI behavior. Conclusions The incidence of NSSI in nursing freshmen in a western university is relatively high. Male， freshmen with anxiety and passive suicidal ideation are prone to NSSI behaviors. It is suggested to prevent and intervene the NSSI behavior of freshmen in nursing school from gender， emotion and specialty

Abstract:Objective To explore the chain mediating effect of social anxiety and regulatory emotional self-efficacy between perceived stress and mobile phone addiction in college students， so as to provide some basis for intervention of mobile phone dependence of college students. Methods A total of 1 000 college students from 3 universities in Heilongjiang Province were selected as subjects by convenience sampling method. The group test was carried out with the class as the unit by Chinese Perceived Stress Scale （CPSS）， the Interaction Anxiousness Scale （IAS）， the Regulatory Emotional Self-efficacy Scale （RES） and the Mobile Phone Addiction Tendency Scale （MPATS）. SPSS 23.0 and process v3.3 were used to test the mediating effect. Results A total of 1 000 questionnaires were sent out， and 963 valid data were recovered， with an effective recovery rate of 96.3%. The total score of CPSS was （38.58±7.10）， IAS （41.96±8.50）， ERS （43.60±6.67）， and MPATS （38.93±10.83）. Correlation analysis found that perceived stress， social anxiety， regulatory emotional self-efficacy and mobile phone dependence were significantly correlated with each other （P ＜ 0.01）. Chain mediating effect test found that perceived stress directly affected mobile phone dependence （P＜ 0.01）. At the same time， there are three indirect pathways： perceived stress affected mobile phone dependence through social anxiety and regulatory emotional self-efficacy （P ＜ 0.01）； secondly， partly through social anxiety； thirdly， partly through the mediating effect of regulatory emotional self-efficacy （P＜0.01）. Conclusions Social anxiety and regulatory emotional self-efficacy play a chain mediating role in the relationship between perceived stress and mobile phone dependence of college students. In the process of education， students' perceived stress and social anxiety can be alleviated， and their regulatory emotional self-efficacy can be improved， so as to reduce their dependence on mobile phones.

Abstract:Objective To investigate the expression and clinical significance of serum sphingosine-1- phosphate （S1P） in patients with hemorrhagic stroke. Methods A total of 124 patients with hemorrhagic stroke who underwent surgical treatment in our hospital from January 2016 to January 2019 were selected， including 28， 49， and 47 mild， moderate and severe cases respectively， with 88 cases of good prognosis and 36 cases of poor prognosis. A total of 86 healthy people collected by the physical examination center of this hospital during the same period were selected as controls. Enzyme-linked immunosorbent assay was used to detect the expression of S1P in serum. A logistic multivariate regression model was established to analyze the factors that affect the prognosis of patients. The value of S1P in predicting prognosis were analyzed by receiver operating characteristic （ROC） curve. Results The serum S1P concentration of patients with hemorrhagic stroke was （304.34±86.09） ng/ml， which was lower than that of healthy people ［（385.89±98.32）ng/ml， P＜0.05］. The serum S1P concentrations of patients with mild， moderate and severe hemorrhagic stroke were （331.03±100.23） ng/ml， （300.34±78.58） ng/ml， （287.70±66.89） ng/ml， respectively. The results of univariate analysis showed statistical differences between groups （F=24.012， P ＜ 0.05）. The serum S1P concentration decreased as the disease getting worse. Compared with patients with good prognosis， patients with poor prognosis had higher age， hematoma volume， and C-reactive protein levels， and lower S1P levels as well as lower GCS scores （P＜ 0.05）. The results of multivariate analysis showed that age （OR=1.897）， hematoma volume （OR=3.903）， GCS scores （OR=2.003）， C-reactive protein （OR=2.014）， serum neuron specific enolase （OR=4.231） and S1P （OR=0.896） were independent factors affecting the prognosis of patients with hemorrhagic stroke （P＜ 0.05）. The area under the ROC curve （AUC） of S1P predicting poor prognosis of patients with hemorrhagic stroke was 0.910 （95%CI： 0.821-0.968）， and the sensitivity and specificity were 82.35% and 90.12%， respectively. S1P predicted AUC higher than C-reactive protein （AUC=0.843）. Conclusions The expression level of serum S1P in patients with hemorrhagic stroke is reduced， which is related to the severity of the disease. SIP is helpful for early prediction of clinical prognosis.

Abstract:Anti-N-methyl-D-aspartate receptor （NMDAR） encephalitis is an autoimmune inflammation of the central nervous system （CNS） mediated by antibodies. Detectability of antibodies provides a new opportunity for us to further understand the autoimmune diseases of CNS. The disease is characterized by serious， complex and neuropsychiatric syndromes with many stages， but partially reversible. With early diagnosis and treatment， the prognosis of patients generally is good. This article mainly reviews the immunological progress of anti-NMDAR encephalitis， which is helpful for clinicians to further understand and investigate the mechanism of this disease.