Beijing HuiLongGuan Hospital

BackgroundMajor depressive disorder (MDD) in adolescents represents a significant global public health challenge. Moreover, metacognitive dysfunction plays a critical role in its onset, progression, and prognosis, but research on the metacognitive characteristics of Chinese adolescents with MDD remains highly limited.MethodsThe study was conducted from January 2024 to January 2025 and employed a cross-sectional design with convenience sampling. The participants included 202 adolescents who were diagnosed with MDD, with a mean age of 15 years. All the subjects completed a self-administered general information questionnaire to collect demographic information. The Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Adverse Childhood Experience Questionnaire-Revised (ACE), Rumination Response Scale Chinese Version (RRS), and Metacognitive Questionnaire-30 (MCQ) were utilized to evaluate the psychological well-being of adolescents diagnosed with MDD.ResultsMultiple linear regression analyses demonstrated the potential of the RRS total score, reflective pondering and household dysfunction as predictors of metacognitive deficits in adolescents diagnosed with MDD, with statistical significance at p < 0.05. Furthermore, the total ACE scores of adolescents diagnosed with MDD were significantly positively correlated with the MCQ (β = 0.189, p < 0.001) and RRS (β = 0.380, p < 0.001) scores. Additionally, the total RRS score was positively correlated with the MCQ score (β = 0.675, p < 0.001). Mediation analyses demonstrated that rumination mediated the association between adverse childhood experiences and metacognitive deficits, with a mediating effect value of 1.136 and a 95% confidence interval of [0.639, 1.635], explaining 57.32% of the total effect.ConclusionRumination mediates the relationship between adverse childhood experiences and metacognitive deficits in adolescents with MDD. Rumination, reflective pondering and household dysfunction in adolescents with MDD can predict metacognitive dysfunction to varying degrees. Our study highlights that interventions targeting rumination may be particularly effective in mitigating the negative impact of ACEs on metacognitive functioning in adolescents with MDD.

Purpose Depression is one of the leading causes of avoidable suffering worldwide, and over 50% of patients do not respond to their first antidepressant treatment, which underscores the need for more effective alternatives. This clinical predicament urgently requires an effective solution. The core objective of this study is to clarify the clinical efficacy and application value of the triple reuptake inhibitor toludesvenlafaxine in patients with poor response to the first antidepressant therapy, providing a new basis for treatment options for this refractory group. Methods This multicenter study included 61 patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-V ) criteria for depression. All patients still had a Montgomery Depression Rating Scale (MADRS) score of ≥24 after 4 weeks of treatment with an adequate single initial antidepressant, and were clearly classified as an ineffective or partially effective initial antidepressant treatment. Patients were switched to toludesvenlafaxine for an 8-week treatment period. The primary outcome measure was the change in MADRS score from baseline to 8 weeks. The secondary outcome measures included the changes in the scores of the Hamilton Anxiety Scale (HAMA), the Dimensional Anhedonia Rating Scale (DARS), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), and the Clinical Global Impression of Severity Scale (CGI-S) from baseline to 8 weeks. Results For such patients that did not respond to the first treatment, significant and rapid efficacy was demonstrated after switching to toludesvenlafaxine. At 8 weeks of treatment, the average MADRS score of the patients decreased by 15.5 points compared with the baseline (95% CI, −17.7 to −13.3; p &amp;lt; 0.0001; Cohen’s d = 2.35). Forty-three percent of them met the clinical remission, and 67% achieved a clinical response. More clinically significant is that the therapeutic effect emerged at an early stage—2 weeks (95% CI, −9.4 to −6.4; p &amp;lt; 0.0001; Cohen’s d = 1.52) and 4 weeks (95% CI, −13.3 to −9.8; p &amp;lt; 0.0001; Cohen’s d = 2.11). After 2 weeks of treatment, there were statistically significant differences in the HAMA, Q-LES-Q-SF, and CGI-S scores at each time point compared with the baseline. The improvement in the DARS score was statistically significant from 4 weeks. In terms of safety, the most common adverse reactions were palpitations, constipation, nausea, vomiting, hypoesthesia, and dizziness, which are mostly mild to moderate and controllable. In particular, the drug significantly improved sexual dysfunction (95% CI, −4.3 to −0.7; p = 0.0071), which is crucial for improving treatment compliance. Conclusion This study confirmed that toludesvenlafaxine not only has significant clinical efficacy (including early onset, high remission, and response) for patients with depression who did not respond to the first antidepressant treatment, but also has good safety and can improve sexual dysfunction that affects compliance. This result highlights the significant position of toludesvenlafaxine in addressing the key clinical challenge of first treatment failure, providing a highly valuable new option for the subsequent treatment of such patients.

The authors have nothing to report.

BackgroundPatient safety culture (PSC) is a critical component of healthcare quality, particularly in psychiatric settings where unique risks exist. In China, research on PSC within mental health institutions remains underdeveloped, and the factors influencing it are poorly understood.MethodsThis cross-sectional study utilized the Chinese version of the Hospital Survey on Patient Safety Culture (HSOPSC) to assess PSC among 2,524 mental health nurses from multiple Level-2 and Level-3 psychiatric hospitals in China (2021–2023). We specifically examined the impact of hospital level on PSC perceptions. Multivariate regression models were employed to identify predictors of PSC composites.ResultsThe overall positive response rate (PPR) across the 12 PSC dimensions was 62.4%, indicating a moderate culture. Strengths were “Teamwork Within Units” (PPR = 83.3%) and “Organizational Learning” (PPR = 82.8%), while critical areas for improvement were “Nonpunitive Response to Error” (PPR = 46.6%) and “Staffing” (PPR = 43.3%). Regression analyses revealed that hospital level was a significant predictor of PSC outcomes, alongside years of experience and daily overtime hours (P < 0.05).ConclusionsThis pioneering national study reveals that the PSC landscape in Chinese psychiatric hospitals is characterized by specific strengths but also critical weaknesses, significantly influenced by hospital level. The findings compel a move away from one-size-fits-all approaches. We recommend stratified interventions: foundational support for Level-2 hospitals and advanced quality initiatives for Level-3 hospitals, with universal prioritization of addressing staffing shortages and fostering a nonpunitive “Just Culture”.

Background: Nonsuicidal self-injuries (NSSIs) are an important contributing factor to adolescent suicide, and various shared factors influence the risk of both NSSIs and suicide attempts (SAs). Both are important predictors of suicide and are part of a continuum of suicidal behaviors. Further exploration of the relationship between adolescent NSSI and SA may facilitate suicide prevention efforts. Methods: An online survey was conducted among 9,140 participants. Network analysis methods were used to explore expected influence (EI), bridge expected influence (BEI), edge weights, and differences between adolescents that have and have not attempted suicide (NSSI-SA and NSSI-NoSA, respectively). Results: Of the 9,140 participants, 7,030 completed the questionnaire, yielding a participation rate of 76.91%. Participants with at least one NSSI were retained, with 2,496 (35.50%) included in the network analysis. The strongest EI node for both networks was “emotion regulation strategies” (E = 1.389 and 1.393), and that for BEI was “personal distress” (Interpersonal Reactivity Index—personal distress; E = 0.497 and 0.492). Network comparisons revealed significant differences in NSSI 4 (“intentionally hitting walls, tables, and other hard objects”; E(Δ) = −0.384, P < 0.001), significant differences in BEI with regard to “perspective taking” (Interpersonal Reactivity Index—perspective taking; E(Δ) = −0.215, P < 0.001), and significant differences in edge weights between NSSI 4 and NSSI 5 (“intentionally hurting oneself by hitting with a fist, palm, or hard object”; E(Δr) = −0.173, P < 0.001). Conclusions: Our study suggests that interventions in the form of emotion regulation strategies can alleviate symptoms throughout the entire network. Attention should be paid to instances when NSSI 4 and NSSI 5 behaviors co-occur frequently.

Extensive research has documented altered emotion processing in binge drinkers. Genetic risks contribute to problem drinking; however, it remains unclear how genetic risks for alcohol misuse affect behavioral and brain responses to negative emotions. We curated data from the Human Connectome Project and identified 97 binge (69 men) and 379 demographically-matched non-binge (142 men) drinkers performing an emotion task during brain imaging. Alcohol use severity was quantified by the first principal component (PC1) identified of principal component analysis of 15 drinking measures. Polygenic risk scores (PRS) for alcohol dependence were computed for all subjects. With published routines and at a corrected threshold, we evaluated how brain responses to matching negative emotional faces vs. geometric shapes associated with PC1 and PRS in a linear regression, with age, sex, and race as covariates. Higher PC1 and PRS were both significantly correlated with greater symptom severity of somatic complaints in binge drinkers. Bingers relative to non-bingers showed stronger activation of a wide array of frontal, parietal and occipital regions and the insula in positive correlation with the PRS. These genetic risk markers featured more prominently in male than in female binge drinkers. In contrast, regional responses in the default mode network may represent sex-shared markers of the genetic risks. These findings suggest altered neurobiological processes of negative emotions in correlation with genetic risks for alcohol misuse in binge drinkers. Longitudinal studies are needed to show how dysfunctional negative emotion processing interlinks the genetic risks and problem drinking.