This issue starts with a review of advances in genetic studies about substance abuse in China by Sun and colleagues.^[1] The growing prominence of this problem has been recently highlighted with the publication of the 2010 Global Burden of Disease results for China,^[2] which reported that the use of tobacco, alcohol and illicit drugs were the 3^rd, 7^th, and 12^th most important causes of ill-health in the country, respectively. Other studies^[3,4] have shown that the demographic pattern of smoking and alcohol use in China is quite different from that reported in most other countries: in China the age of initiation of regular use is older and the prevalence of use in females is much lower. Understanding the relative contributions of genetic, environmental and cultural factors to understanding these observed cross-national patterns of substance abuse would make a substantial contribution to our understanding of these conditions and, thus, improve our ability to develop effective interventions. This review on genetic studies by Sun describes the current state of the art in China, showing where findings from China parallel those from other countries and, more importantly, the areas where unique findings from China have contributed to the international corpus of knowledge about these important conditions.

The systematic review and meta-analysis by Qian and colleagues^[5] focuses on a topic that has received relatively little attention in the Chinese literature – eating disorders. The authors conducted an exhaustive search of the international and Chinese literature to identify community-based studies about the prevalence of eating disorders. Only 15 studies were of sufficient quality to be included in the analysis; none of them were conducted in China and only one was conducted in Asia (South Korea). The reported prevalence varied widely from study to study, possibly because different studies included different conditions under the ‘eating disorder’ rubric (which variously included anorexia nervosa, bulimia nervosa, binge eating disorder and other or atypical eating disorders) or because of the use of different operational criteria for the specific conditions over time. The overall conclusions, which can only be considered suggestive, were that eating disorders are relatively common, more common in women than in men, increasing over time, and more prevalent in Western than in Asian countries. Clearly, more high-quality epidemiological work that uses standardized diagnostic criteria is needed, particularly in low- and middle-income countries.

The first original research article in the issue by Wang and colleagues^[6] discusses a survey that aims to assess mental health literacy in a representative sample of 1953 adults living in Shanghai.This study is the Shanghai-component of a national effort by the Ministry of Health^[7] to annually monitor awareness of mental health issues among community members. Given the very low rates of care-seeking among persons with current mental disorders in the country,^[4]monitoring mental health literacy was an important component of China’s new mental health law^[8] (which came into effect on 1 May 2013). These surveys are considered an essential first step to decreasing the stigma associated with mental illnesses and, thus, changing attitudes about seeking help for these types of problems. Ideally, these annual surveys can be used to assess the effectiveness of the mental health promotion campaigns that are envisioned in the law. In the Shanghai survey, respondents correctly answered 72% of the 20 questions related to mental health knowledge, but the identification of specific disorders described in five vignettes was poor, ranging from a low of 19% for schizophrenia with predominantly negative symptoms to a high of 42% for mania. However, detailed factor analysis of the Shanghai results indicated that the constructs covered by the measures used by the Ministry of Health to assess mental health literacy are not clearly defined; and the lack of rigorous assessment of the reliability and validity of the instruments is concerning. More qualitative and quantitative research is needed to revise the scales before they can reliably monitor changes in mental health literacy over time.

The second original research article by Jiang and colleagues^[9] discusses the characteristics and treatment-seeking of children with the most common pediatric mental disorder in China – Attention-Deficit/Hyperactivity Disorder (ADHD). Over a 12-year period children with ADHD accounted for about one-third of all new patients seen at Shanghai’s largest child and adolescent counseling clinic situated at the Shanghai Mental Health Center, but this proportion has been dropping over time as other diagnoses become more prominent. As is true in other countries, about 80% of the ADHD patients are male and the vast majority of them are treated with central nervous system stimulants, though the adjunctive use of behavior treatments has increased in recent years. Despite a tendency to earlier identification, most children with ADHD are ill for at least 2 years before their first diagnosis and treatment. Increased efforts to educate parents and teachers in China about this important condition and to decrease the stigma associated with receiving treatment for the condition are needed to speed up the recognition and treatment of children with ADHD.

The third original research article by Zhu and colleagues^[10] describes a randomized controlled trial that was conducted as part of the approval process required by the State Food and Drug Administration of China prior to the clinical use of generic memantine hydrochloride manufactured in China in the treatment of moderate to severe Alzheimer’s Disease (AD). The prevalence of AD in China has been increasing dramatically, partly due to the rapid aging of the population,^[11]so this is a major public health problem that has not, as yet, been effectively addressed. In the absence of an effective treatment for AD, efforts have been focused on slowing the progressive decline in cognitive functioning that typically occurs in individuals with the condition. Memantine is one promising agent that has been shown to be effective in large studies conducted in several countries, including China. However, this medication needs to be used continuously to be effective so it can be quite costly for families and for national health insurance systems. The use of a generic form of the medication would reduce the cost by over 50%, so this is an important development in the treatment of the condition for low- and middle-income countries trying to reduce overall health expenditures. The current study compares the efficacy and safety of locally manufactured generic memantine to that of imported proprietary memantine in a 16-week, double-blind, randomized controlled trial among individuals with moderate to severe AD. As expected, there were no significant differences between the two groups. Further study is needed to confirm the long-term efficacy and safety of the generic form of memantine, and cost-effectiveness studies are needed to demonstrate the extent to which using this generic medication will reduce the financial burden of families caring for elders with AD and the health care costs of governments dealing with rapidly aging populations.

The Forum by Wang and Xu ^[12] discusses the use of Transcranial Magnetic Stimulation (rTMS) as a treatment for medication-resistant auditory hallucinations in schizophrenia. There have been several meta-analyses about this issue that generally support the safety and effectiveness of rTMS for the management of auditory hallucinations in schizophrenia, but the sample sizes of the studies included in these meta-analyses are typically quite small. Moreover, as the techniques for administering sham rTMS—the most common comparison group in the reported RCTs – have improved over time, the pooled effect sizes for rTMS have tended to get smaller. More work is needed before rTMS can be recommended as a standard adjunctive treatment for medication-resistant auditory hallucinations. First, larger-sample RCTs are needed to confirm its effectiveness, and then comparison studies will be needed to determine the appropriate intensity, location, and duration of the rTMS treatments.

The case report ^[13] about a case of recurrent neuroleptic malignant syndrome is a reminder to all clinicians who use antipsychotic medications. This life threatening condition, that often mimics a rapidly developing severe infection, can occur at any dose of any antipsychotic medication. The risk is greater in individuals receiving multiple antipsychotic medications and in older individuals in whom the medications and their active metabolites may accumulate due to hepatic or renal abnormalities that delay the normal breakdown of these compounds. Given the increasing use of antipsychotic medications by non-psychiatric physicians (particularly for nursing home residents), focused training is needed to ensure that they remain vigilant about the risk of neuroleptic malignant syndrome.

Finally the biostatistics in psychiatry paper ^[14] discusses power analysis and sample size, a bread-and-butter issue for all researchers. Lu and colleagues describe the difference between hypothesis testing and power analysis, discuss the advantages of longitudinal versus cross-sectional studies, and provide a series of examples to illustrate the statistical issues that need to be considered when designing a study or assessing the validity of the results of a completed study.

References

1.	Sun Y, MengSQ, Li J, Shi J, Lu L. Advances in genetic studies of substance abuse in China. Shanghai Archives of Psychiatry 2013; 25(4): 199-211.
2.	Yang G, Wang Y, ZengYX, GaoGF, Liang XF, Zhao MG, et al. Rapid health transition in China. 1990-2010: findings from the Global Burden of Disease Study. Lancet 2013; 381: 1987-2015.
3.	Li Q, Hsia J, Yang G. Prevalence of smoking in China in 2010. NEJM 2011;364(25):2469-2470.
4.	Phillips MR, Zhang JX, Shi QC, Song ZQ, Ding ZJ, Pang ST, et al. Prevalence, associated disability and treatment of mental disorders in four provinces in China, 2001-2005: an epidemiological survey. Lancet 2009, 373:2041-2053.
5.	Qian J, Hu Q, Wan YM, Li T, Wu MD, RenZQ, Yu DA. Prevalence of eating disorders in the general population: a systematic review. Shanghai Archives of Psychiatry 2013; 25(4): 212-223.
6.	Wang JY, He YL, Jiang Q, Cai J, Wang WL, ZengQZ, et al. Mental health literacy among residents in Shanghai. Shanghai Archives of Psychiatry 2013; 25(4): 224-235.
7.	Chinese Ministry of Health. Survey evaluation protocol of mental health work from the General Office of the Ministry of Health (MOHCDC[2010] Number 24).Beijing: Ministry of Health. Available from: http://www.gov.cn/gzdt/2010-03/08/content_1550552.htm. (accessed August 1, 2013) (in Chinese)
8.	Chen HH, Phillips MR, Cheng H, Chen QQ, Chen XD, Fralick D, et al. Mental health law of the People’s Republic of China (English translation with annotations). Shanghai Archives of Psychiatry 2012; 24 (6): 305-321.
9.	Jiang LX, Li Y, Zhang XY, Jiang WQ, Yang CY, Hao N, et al. Twelve-year retrospective analysis of outpatients with Attention-Deficit/Hyperactivity Disorder in Shanghai. Shanghai Archives of Psychiatry 2013; 25(4): 236-242.
10.	Zhu MJ, Xiao SF, Li GJ, Li X, Tang MN, Yang SM, et al. Effectiveness and safety of generic memantine hydrochloride manufactured in China in the treatment of moderate to severe Alzheimer’s disease: a multi-center, double-blind randomized controlled trial. Shanghai Archives of Psychiatry 2013; 25(4): 244-253.
11.	Jia J, Wang F, Zhou A, Jia X, Li F, Tang M, et al. The prevalence of dementia in urban and rural areas of China. Alzheimers Dement 2013. doi: 10.1016/j.jalz.2013.01.012. [Epub ahead of print] (Accessed 20 August 2013)
12.	Wang JJ, XuYF. Should repetitive Transcranial Magnetic Stimulation (rTMS) be considered an effective adjunctive treatment for auditory hallucinations in patients with schizophrenia?Shanghai Archives of Psychiatry 2013; 25(4): 254-255.
13.	OuyangZX, Chu Li. A case of recurrent neuroleptic malignant syndrome. Shanghai Archives of Psychiatry 2013; 25(4): 256-258.
14.	Lu NJ, Han Y, Chen T, Gunzler DD, Xia YL, Lin J, et al. Power analysis for cross-sectional and longitudinal study designs. Shanghai Archives of Psychiatry 2013; 25(4): 259-262.

背景: 世界各地关于进食障碍的流行病学研究得到的患病率数据不尽一致，目前尚缺乏系统综述研 究以明确这些差别的原因所在。
目的: 运用Meta 分析的方法汇总不同地区普通人群进食障碍的患病率数据，以确定与患病率相关的 因素。
方法: 系统检索PubMed/Medline、PsycINFO、ISI web of knowledge、Ovid、中国知识资源总库，中国 科技期刊数据库，万方数据，中国生物医学文献服务系统的数据库，收集关于进食障碍患病率的文献， 按照预先制定的纳入及排除标准筛选相关研究。采用R-2.15.2 软件进行统计分析。
结果: 共检索到9315 篇不重复的文献（约四分之一为中文文献），其中仅15 项研究符合纳入标准， 累计调查72 961 人。纳入的15 项中无国内研究，仅一项来自于亚洲国家（韩国）。估计的进食障 碍的终生患病率为1.01%（95%CI，0.54 ～ 1.89%），12 个月患病率为0.37%（95%CI，0.22 ～ 0.63%）， 4 周患病率为0.21%（95%CI，0.15 ～ 0.28%）。神经性厌食、神经性贪食、暴食性障碍的终生患病率 分别为0.21%（95%CI，0.11 ～ 0.38%）、0.81%（95%CI，0.59 ～ 1.09%）、2.22%（95%CI，1.78 ～ 2.76%）。 女性进食障碍终生患病率与男性之比为4.2。欧洲国家进食障碍的终生患病率约为韩国研究报告数 据的6.1 倍。随着时间推移，总的进食障碍患病率有所升高，但无统计学意义，但神经性厌食症的 患病率有统计学意义的升高。
结论: 普通人群中进食障碍较为常见，女性比男性多，西方国家比亚洲国家多。可能由于进食障碍的 诊断标准有了变动，近年来报道的患病率有增高趋势。研究局限性包括可获得的流行病学资料非常 有限，不同研究中进食障碍包括的类别有所不同以及缺少中低收入国家（包括中国）中合适的流行 病学研究。

背景: 近期中华人民共和国精神卫生法的实施是了解中国社区居民精神卫生知识知晓度基线数据的契机。
目的: 了解上海市居民精神卫生知识和态度。
方法: 来自上海市所有的19个区县1953名15岁及以上的常住居民完成了《精神卫生与心理保健知识问卷》及《案例》部分的调查。知识问卷满分20分，得分越高，表明对相关知识的了解程度越高。案例部分包括5个案例的描述，在每个案例后提出9个相关问题以评估受访者对这些精神障碍的知识和态度。
结果: 精神卫生与心理保健知识问卷20个条目的正确回答率为26%～98%，平均72%。该问卷20个条目的内部一致性（α）为0.69，如果不纳入其中关于精神卫生健康促进的4个条目，α值则降至0.59。对一半的调查数据进行探索性因子分析，确定精神卫生与心理保健知识问卷20个条目的五因子模型，但用另一半数据进行验证性因子分析表明上述模型仅部分有效。案例相关知识调查发现，受访者对以下精神障碍的正确识别率分别为：躁狂症42%，抑郁症35%，阳性症状为主的精神分裂症30%，阴性症状为主的精神分裂症18%，焦虑症21%。工作压力太大（37.3%）、思想上的问题（30.0%）和受了打击（24.4%）被视为精神疾病的3个主要原因。找人做心理咨询（34.2%）和看精神科医生（33.3%）是建议求助的方法中2种最主要的方式。受教育程度愈高、愈年轻者对精神卫生知识的知晓率就愈高，对常见精神疾病的识别率也愈高。
结论: 调查发现上海市居民对精神卫生与心理保健知识的知晓度有所提高。由于尚未充分评估精神卫生与心理保健知识问卷及案例部分问卷的信度和效度，所以本研究结果只能视为预初性的。需要进一步的工作，如首先从质和量两方面着手修订这些工具，才能将其用于评估精神卫生促进运动的有效性。

背景: 注意缺陷多动障碍（Attention Deficit/Hyperactivity Disorder, ADHD）是中国精神科门诊儿童患者中最常见的诊断，最高比例约占所有患儿的50%。
目的: 了解中国精神科儿童门诊ADHD 患儿特征和治疗情况的变迁。
方法: 随机抽取2000 年至2011 年间在上海市精神卫生中心儿少心理咨询门诊初诊患儿的病历，每年抽取250 份。在所抽取的3000 例患儿中，998 例（33%）诊断为ADHD。
结果: 约80% 的ADHD 患儿为男性，大多数在7 岁之前患病。确诊患儿初诊时平均（标准差）年龄为10.0（2.6）岁，初诊时平均病程为2.9（1.2）年，近年趋势为初诊年龄变小，初诊时病程变短。约20% 的患儿为非上海户籍，约11% 合并其他精神疾病诊断（主要是抑郁症和抽动障碍），近年来上述比例呈上升趋势。576 例（58%）有复诊记录的患儿中，77% 接受中枢兴奋剂，但是，行为治疗（单用或合并药物）的比例近年来明显增加。
结论: ADHD 仍然是中国精神科门诊儿童患者中最常见的诊断，但由于非专科治疗服务的扩大以及其他疾病诊断的增加，门诊ADHD 患儿的比例在下降。令人欣慰的是ADHD 呈现早诊断和早治疗的趋势以及非药物干预的应用有所增加。尽管如此，多数ADHD 患儿确诊前至少已有2 年病程，因此需要进一步研究来确定更好的方法以便更早地识别和治疗这一障碍。

背景: 盐酸美金刚是目前用于治疗阿尔茨海默病（Alzheimer's disease, AD）唯一的N - 甲基- D - 天门冬 氨酸（N-methyl-D-aspartic acid receptor，NMDA）受体拮抗剂。
目的: 以进口盐酸美金刚（Ebixa）为对照，评价国产美金刚片治疗中度至重度AD 的有效性及安全性。
方法: 采用随机、双盲双模拟、平行对照、多中心研究方法，将229 例中、重度AD 患者分为研究 组（国产美金刚片）和对照组（进口美金刚片），治疗16 周。所有的患者在基线时以及入组后第 4、8、12、16 周接受评估。主要疗效指标为阿尔茨海默病评定量表认知分量表（Alzheimer's Disease Assessment Scale-Cognition, ADAS-Cog）评分，次要疗效指标为简易智能状态检查量表（Mini-Mental Statue Examination, MMSE）、日常生活能力量表（Activities of Daily Living, ADL）和临床疗效总评量表 （Clinical Global Impression, CGI）的评分。
结果: 研究组纳入安全性数据集（Safety Set，SS）、全分析数据集（Full Analysis Set，FAS）和完成方 案数据集（Per Protocol Set, PPS）分析的病例数分别为112、109 和103 例，对照组分别为111、107 和101 例。两组ADAS-Cog 总分和ADL 总分在治疗4 周、8 周、12 周、16 周末与基线相比均有所下降（p ＜ 0.001），两组MMSE 总分在治疗4 周、8 周、12 周、16 周末与基线相比均有所增加（p ＜ 0.001）。 各观察时点的ADAS-Cog 评分、ADL 评分和病情改善程度（CGI 评分）两组之间的比较无统计学差异。 研究组和对照组不良事件发生率分别为20.5% 和27.0%，差异无统计学意义（χ2=1.30，p=0.255）。