Abstract:Modified electroconvulsive therapy （MECT） is the most effective treatment for rapid relief of depressive symptoms. However， the use of MECT is impeded by adverse effects， especially the cognitive function impairments. Combining animal and clinical studies of MECT， this paper discusses the neurogenic mechanism of MECT efficacy and cognitive side effects.

Abstract:Objective To explore the relationship between selenium and childhood autism spectrum disorder. Methods PubMed， Embase， Cochrane Library， Web of Science， VIP， Wanfang Data， CNKI， and CBM were searched to collect studies of the relationship between Se and childhood autism from the establishment of the databases up to Octuoer 2021. Newcastle-Ottawa scale （NOS） was used to evaluate the quality of methodology. RevMan 5.3 and Stata 16 softwares were used to conduct a Meta-analysis of the extracted data. Results Totally 1 225 literatures were retrieved by computer， and including 20 case-control studies involving 2 119 subjects. The level of selenium from serum， nail and urine in the autism group were much lower than those in the control group ［SMDserum=-1.08， 95%CI（-1.61， -0.54）， P＜ 0.01； SMDnails=-1.28， 95%CI（-2.41， -0.14）， P=0.03； SMDurine=-0.24， 95%CI（-0.46， -0.03）， P=0.03］， and the differences were statistically significant. The level of selenium from hair， red cell and plasma in the autism group were not significantly different from those of the control group ［SMDhair=0.46，95%CI （-0.49， 1.40）， P=0.34； SMDred cell=-0.39， 95%CI （-1.76， 0.98）， P=0.58； SMDplasma=-0.09， 95%CI （-1.39， 1.20）， P=0.89］. Conclusions Selenium levels in serum， urine and nails are associated with autism spectrum disorders in children. Therefore， helping children develop good eating habits has a certain reference significance for the prevention of autism spectrum disorders.

Abstract:Objective To explore the correlation between sleep quality and anxiety and depression symptoms in patients with anxiety disorder and depression disorder. Methods From August 2020 to August 2021， a total of 70 inpatients with generalized anxiety disorder， panic disorder and depression in Shenzhou Kangning Hospital were recruited， including 33 cases in depression group and 37 cases in anxiety group. The scores of Hamilton Anxiety Scale （HAMA）， Hamilton Depression Scale （HAMD）， Pittsburgh sleep quality index （PSQI） and Polysomnography data between the two groups were compared and analyzed. Results Among all the enrolled patients in this study， 57.1%（40/70） had PSQI ＞15， and 54.3%（38/70） had sleep efficiency lower than 80%， 48.5%（16/33） had sleep efficiency lower than 80% in the depression group， and 59.5%（22/37） had sleep efficiency lower than 80% in the anxiety group. There were significant differences in HAMD， HAMA， stage N3 sleep and the duration of slow wave sleep （SWS） between depression group and anxiety group （P＜ 0.05）. The HAMD score is positively correlated with PSQI （r=0.416， P＜ 0.05）， and negatively correlated with minimum oxygen saturation （r=-0.416， P＜ 0.05） in depression group. HAMA was positively correlated with PSQI， Stage W and wake time after sleep onset （WASO）（r=0.388-0.476， P ＜ 0.05）， and negatively correlated with rapid eye movement （REM） duration， microarousal index REM and sleep efficiency （r=-0.488- -0.429， P＜ 0.05）. In anxiety group， HAMA was positively correlated with PSQI （r=0.521， P＜0.01）， negatively correlated with sleep period time （SPT） （r=-0.519， P＜ 0.01）. HAMD was positively correlated with PSQI （r=0.424， P＜ 0.01）， and negatively correlated with microarousal index REM and microarousal index non-rapid eye movement （NREM） （r=-0.476- -0.449， P ＜ 0.01）. Conclusions Some patients with depression disorder and anxiety disorder have lower sleep efficiency， and the sleep quality of patients with anxiety disorder and depression disorder is correlated with depression and anxiety symptoms.

Abstract:Objective A small sample exploratory study was carried out to verify the effectiveness and safety of vagal nerve stimulation （VNS） intervention in patients with treatment-resistant depression （TRD）. Methods From February 2018 to December 2020， five TRD patients who met the inclusion and exclusion criteria were screened and included in the outpatient department of Beijing Anding Hospital for VNS. The efficacy and safety were evaluated at 2 weeks after operation （startup commissioning parameters） and 1， 6 and 12 months after startup. The depressive symptoms of patients were evaluated by 17 item Hamilton Depression Scale to evaluate the curative effect， and the complications and adverse reactions were observed. Results The symptoms of 5 patients began to improve about 1 month after operation. 6 months after the start of treatment， 4 patients achieved effective treatment （HAMD-17 reduction rate ≥ 50%）， and 2 patients achieved clinical remission （HAMD-17 ≤ 7）. None of the 5 patients had surgery related or material related complications. Hoarseness， shortness of breath and foreign body sensation in the throat were transient. Conclusions This study preliminarily explored the effect of VNS in the treatment of TRD in the domestic population. Four patients achieved effective treatment 6 months after the start of treatment， and there were no serious adverse events.

Abstract:Objective To compare the differences of immune and stress related factors between bipolar depression and unipolar depression， and to further explore potential peripheral blood biomarkers of these two kinds of depressions. Methods The inpatients of Beijing Anding Hospital Affiliated to Capital Medical University from January to December 2018 were selected as the research objects. 933 patients with monophasic depression and 546 patients with bipolar depression were included in this study. Demographic data and biochemical indicators were compared between the two groups. The biochemical indicators included C-reactive protein （CRP）， complement 3 （C3）， complement 4 （C4）， immunoglobulin M （IgM）， immunoglobulin G （IgG）， immunoglobulin A （IgA）， adrenocorticotropic hormone （ACTH） and cortisol. Logistic regression analysis was used to control the confounding factors and clarify the correlation between the two types of depression and various biological indexes. Receiver operating characteristic （ROC） curve was used to analyze the predictive value of the above demographic and biological indexes related to bipolar depression. Results Bipolar depression and unipolar depression were different in the terms of C3 （Z=3.41， P=0.001）， IgG （Z=-2.04， P=0.041）， IgA （Z= -4.30， P＜ 0.001） and ACTH （Z=2.03， P=0.042）， with statistical significance （P＜ 0.05）. Logistic regression analysis showed that age （OR=0.98， 95%CI=0.97-0.98）， gender （OR=0.62， 95%CI=0.49-0.78）， C3 （OR=3.45， 95%CI=1.90-6.27） and IgA （OR=0.80， 95%CI=0.71-0.91） were associated with bipolar depression. ROC analysis showed that C3， IgA and age alone had poor accuracy in the classification of bipolar depression and monophasic depression， and the area under the curve （AUC） was 0.55-0.63. After logistic regression modeling， the AUC of predicting bipolar depression was 0.66 （P＜ 0.05）， the sensitivity was 65%， and the specificity was 63%. Conclusions Younger age， higher levels of C3， and lower levels of IgA are related factors of bipolar depression. Compared with a single biological index， the combined diagnostic model including C3， IgA， gender and age is more effective in distinguishing monophasic depression from bipolar depression.

Abstract:Objective To explore the effect of venlafaxine combined with agomelatine on the efficacy of senile depression and the effect of serum brain-derived neurotrophic factor （BDNF）. Methods A total of 104 elderly patients with depression admitted to Guanyuan Mental Health Center from October 2019 to November 2020 were selected as the research objects， and they were divided into study group （52 cases） and control group （52 cases） by a random number table. The control group was treated with agomelatine combined with placebo， and the study group was treated with venlafaxine combined with agomelatine. The scores of Hamilton Depression Scale （HAMD）， clinical efficacy， BDNF， S100β and cognitive function were compared between the two groups before and after treatment. The drug safety of the two groups were recorded. Results The HAMD scores of the control group after 4 weeks of treatment and after 12 weeks of treatment were （15.58±3.01） points and （11.37±2.13） points respectively， and the study group were （12.11±2.34） points and （9.23±1.57） points respectively， which were all lower than those before treatment （P＜ 0.05）. HAMD scores of the two groups after 12 weeks of treatment were lower than those after 4 weeks of treatment （P＜ 0.05）. HAMD scores of the study group after 4 weeks and after 12 weeks of treatment were lower than those of the control group （P＜ 0.05）. The total effective rate of the study group （92.31%，48/52） was higher than that of the control group （76.92%，40/52） （P ＜ 0.05）. The S100β of the control group after 4 weeks of treatment and after 12 weeks of treatment were （1.81±0.32） μg/L and （1.41±0.25） μg/L， study group were （1.52±0.28） μg/L and （1.19±0.18） μg/L， which were lower than those before treatment （P ＜ 0.05）. S100β after 12 weeks of treatment in two groups was lower than that after 4 weeks of treatment （P ＜ 0.05）. The BDNF of the control group after 4 weeks of treatment and after 12 weeks of treatment were （29.18±5.46） μg/L and （43.52±8.24） μg/L， and the study group were （33.43±6.17） μg/L and （47.49±7.83） μg/L， which were higher than those before treatment （P ＜ 0.05）. BDNF after 12 weeks of treatment in both groups was higher than that after 4 weeks of treatment （P ＜ 0.05）. The S100β of the study group after 4 weeks of treatment and 12 weeks of treatment were lower than that of the control group （P ＜ 0.05）， and BDNF was higher than that of the control group （P ＜ 0.05）. The score of the Repetitive Neuropsychological State Test （RBANS） after 12 weeks of treatment in the control group was （78.28±10.23） points， the study group was （82.09 ±11.76） points， which were both higher than those before treatment and 4 weeks after treatment （P ＜ 0.05）. The RBANS score of the study group after 12 weeks of treatment was higher than that of the control group （P ＜ 0.05）. There was no significant difference in the incidence of total adverse drug reactions between the two groups （P ＞ 0.05）. Conclusions Venlafaxine combined with agomelatine can significantly reduce the score of depression symptoms in elderly depression patients， enhance the efficacy， improve neurological function and cognitive function， and has good safety.

Abstract:Selective serotonin reuptake inhibitor （SSRIs） is currently the first-line clinical treatment for depression and anxiety disorders. Prescription data show that the use of SSRIs antidepressants in men of reproductive age is increasing. However， people pay more attention to the safety of perinatal use of SSRIs in women， ignoring the impact on semen quality and fertility in male patients. The available evidence from both basic and clinical studies suggests that long-term use of SSRIs in men of reproductive age can have adverse effects on semen parameters and fertility. Now， a systematic review of relevant studies is presented to provide a basis for guiding clinical use.

Abstract:There is the largest micro ecological environment in the gut， which plays an important role in maintaining human health. Recent studies have shown that the diversity of gut microbiota plays an important role in the occurrence of depression and other mental diseases. However， the role of intestinal flora in the treatment of depression remains to be elucidated. At present， selective serotonin reuptake inhibitors （SSRIs） are commonly used as the first-line drugs in the treatment of depression. Many animal and clinical studies have shown that SSRIs can change the distribution of intestinal flora， and this change may be related to the mechanism of antidepressant effect of SSRIs. This article reviews the effects of SSRIs antidepressants on intestinal flora and its mechanism， to provide new ideas for clinical treatment.

Abstract:Objective To understand the prevalence and the characteristics of its course of subthreshold anxiety. Methods Databases including Cochrane Library， PubMed， Embase， Web of Science CNKI and WangFang database were included. The retrieval time was from inception to June 2nd，2020. All related literature was retrieved for meta analysis. Results A total of 18 studies with 131 027 participants were included. The piont， year and lifetime prevalence rate of subthreshold anxiety was 3.8%、4.8% and 7.2% respectively. The results about the course of subthreshold anxiety showed that 10.5% had progressed to anxiety disorder， 29% had persistent subthreshold anxiety and 57.3%-80.8% had symptom relief during follow-up. Subgroup analysis showed female are at higher risk than male in time， year， and lifetime prevalence （RR： 1.8-2.3， 1.9， 1.2-1.6 respectively）， but the prevalence obtained by different sampling methods are not significantly different （P＞ 0.05）. On the other hand， the time point prevalence rates of different countries and different diagnostic tools （ICD/DSM） showed statistical differences （prevalence rate： 2.0%-6.1%， 3.0%-5.2% respectively）， and the lifetime prevalence rates of different countries， different diagnostic tools （ICD/DSM） and different research types （cross-sectional/cohort studies） showed statistical differences （prevalence rate： 0.6%- 10.3%， 10.3%-18.9%， 1.9%-10.3% respectively）. Conclusions The prevalence of subthreshold anxiety is low and affected by many factors， but its course development is diverse.

Abstract:Objective To evaluated the efficacy and acceptability of antidepressants for the treatment of panic disorder. Methods We searched Medline， Embase， CBM， CNKI in both English and Chinese databases， for the head-to-head randomized controlled trial of antidepressant treatment for panic disorder. Quality assessment and bias evaluation were conducted with the Cochrane Collaboration's RevMan 5.1.0 software. The network Meta-analysis were conducted with the Stata 14.2 software. Results A total of 25 trials met the inclusion criteria， involving 10 medications： mirtazapine， paroxetine， clomipramine， citalopram， fluoxetine， venlafaxine， escitalopram， sertraline， reboxetine， amfebutamone. The result of analysis showed that the drugs with good effectiveness were escitalopram， fluoxetine， venlafaxine and paroxetine， but there were no statistical significance in pairwise comparison of drugs （P＞ 0.05）. The more prominent antidepressants for the effect of score reduction were fluoxetine， mirtazapine， escitalopram， amfebutamone. Compared with clomipramine， fluoxetine ［MD=4.27 （1.12，7.43）］， escitalopram ［MD=3.84 （1.49，6.19）］， mirtazapine ［MD=3.42 （0.83，6.01）］， paroxetine ［MD=2.81 （0.82，4.80）］ and venlafaxine ［MD=2.06 （0.11，4.02）］ had obvious advantages in the effect of score reduction， which could reduce the score of Hamilton Anxiety Rating Scale （HAMA） significantly. There were no statistical significance in other pairwise comparisons of these drugs （P＞ 0.05）. The drug with good tolerance was paroxetine， followed by venlafaxine and escitalopram， but there was no significant difference in pairwise comparison of these drugs （P＞ 0.05）. Conclusions As the first-line drugs for the treatment of panic disorder， paroxetine， venlafaxine and escitalopram are effective drugs with both efficacy and safety.

Abstract:Anti-N-methyl-D-aspartate （NMDA） receptor encephalitis is one of the most common paraneoplastic encephalitis. Its main clinical manifestations are mental and behavioral abnormalities， disturbance of consciousness， seizures and central hypoventilation. Anti-NMDA receptor encephalitis is more common in female， with a male-to-female ratio of about 1︰4， and about 20%-59% of the patients have related tumors. There are many related tumors that induce anti-NMDA receptor encephalitis and one of the most common is ovarian teratoma. In this paper， the epidemiology， types， pathogenesis and identification of tumors associated with anti-NMDA receptor encephalitis are reviewed.

Abstract:Diabetic peripheral neuropathy and cognitive impairment， as the neurological complications of diabetes， often occur in diabetic individuals at the same time， and seriously affect the quality of life of diabetic patients. The two manifested as diabetic peripheral and central nervous system diseases respectively. The traditional view is that the two are independent diseases. At present， more and more evidences show that there is a significant correlation between diabetic peripheral neuropathy and cognitive impairment. The pathophysiological mechanisms of the two have many things in common， and the two have many common biological markers. This article reviews the clinical manifestations and electrophysiological manifestations， pathophysiological mechanisms， pathological changes， and biological markers of peripheral nerve and cognitive impairment in diabetic patients to further illustrate the relationship between the two.

Abstract: