Yiru Fang

Publications (61) View all

• Article: Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China.

  Yu-Tao Xiang, Ling Zhang, Gang Wang, Chen Hu, Gabor S Ungvari, Faith B Dickerson, Amy M Kilbourne, Tian-Mei Si, Yi-Ru Fang, Zheng Lu, [......], Kelly Yc Lai, Edwin Hm Lee, Jian Hu, Zhi-Yu Chen, Yi Huang, Jing Sun, Xiao-Ping Wang, Hui-Chun Li, Jin-Bei Zhang, Helen Fk Chiu
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  ABSTRACT: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to compare demographic and clinical features between patients with MDD and those with BD, but being misdiagnosed as MDD, in China. A total of 1487 patients diagnosed with MDD were consecutively evaluated in 13 psychiatric hospitals or psychiatric units of general hospitals nationwide in China. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini-International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses, and identify patients with MDD and those with BD, but being misdiagnosed with MDD. The proportions of BD (all types), bipolar I disorder (BD-I), and bipolar II disorder (BD-II) misdiagnosed as MDD in clinical practice were 20.8%, 7.9%, and 12.8%, respectively. Multiple logistic regression analyses revealed that compared to MDD patients, BD-I was characterized by more atypical depressive features (increased appetite, increased sleep, and weight gain) [odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.2-3.2], more psychotic symptoms (OR = 2.1, 95% CI: 1.3-3.5), more lifetime depressive episodes (OR = 1.1, 95% CI: 1.1-1.2), and earlier age of onset (OR = 0.97, 95% CI: 0.9-0.99); BD-II was characterized by more psychotic symptoms (OR = 2.1, 95% CI: 1.4-3.1) and earlier age of onset (OR = 0.96, 95% CI: 0.9-0.97). In addition, compared to BD-II patients, BD-I patients were characterized by more frequent depressive episodes per year (OR = 3.1, 95% CI: 1.5-6.6). Depressive episodes in the context of BD-I and BD-II, among those who were misclassified as MDD, present some different clinical features compared to MDD. This finding should be taken into account in guiding diagnostic practices in China.
  Bipolar Disorders 03/2013; 15(2):199-205. · 5.29 Impact Factor
• Article: Crosstalk between 5-HT2cR and PTEN signaling pathway in atypical antipsychotic-induced metabolic syndrome and cognitive dysfunction.

  Jun Cai, Zhenghui Yi, Weihong Lu, Yiru Fang, Chen Zhang
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  ABSTRACT: Accumulating evidence indicates that chronic treatment with atypical antipsychotics (AAPs) leads to metabolic syndrome (MetS) and cognitive dysfunction. It has been found that patients receiving antipsychotic treatment with MetS have significantly worse cognitive function when compared to those without the MetS, suggesting an intrinsic relationship between MetS and cognitive dysfunction. Thus, investigating the reasons for the side effects induced by AAPs is an important step in the effort to understand the patholophysiology of this condition. The 5-HT2c receptor (5-HT2cR) antagonist properties of AAPs are likely to contribute to AAP-induced MetS. There is crosstalk between phosphatase and tensin homolog deleted on chromosome 10 (PTEN) and 5-HT2cR. PTEN negatively regulates the activity of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway, which plays an important role in obesity-induced insulin resistance in peripheral tissue. In the central nervous system, PI3K/AKT signaling modulates synaptic plasticity, a mechanism underlying learning and memory processes. This suggests that PI3K/AKT signaling contributes to both metabolic and cognitive activities. Since PTEN negatively regulates PI3K/AKT signaling and has crosstalk with 5-HT2cR, we hypothesized that the 5-HT2cR antagonism of AAPs may disrupt its crosstalk with PTEN and then trigger the PI3K/AKT signaling, and AAP-induced MetS and cognitive impairments may occur via this analogous signaling pathway.
  Medical Hypotheses 01/2013; · 1.39 Impact Factor
• Article: Prescribing patterns of antidepressants, antipsychotics and mood stabilizers in bipolar patients misdiagnosed with major depressive disorder in China.

  Yu-Tao Xiang, Chen Hu, Gang Wang, Qi-Wen Zheng, Yi-Ru Fang, Gabor S Ungvari, Amy M Kilbourne, Kelly Y C Lai, Tian-Mei Si, Da-Fang Chen, Zheng Lu, Hai-Chen Yang, Jian Hu, Zhi-Yu Chen, Yi Huang, Jing Sun, Xiao-Ping Wang, Hui-Chun Li, Jin-Bei Zhang, Helen F K Chiu
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  ABSTRACT: OBJECTIVE: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to examine prescribing patterns of antidepressants, antipsychotics and mood stabilizers in BD patients misdiagnosed with MDD in China. METHODS: A total of 1487 patients originally diagnosed with MDD were consecutively screened for diagnostic revision in 13 psychiatric hospitals or psychiatric units of general hospitals in China nationwide. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses. Data on psychotropic prescriptions were collected by a review of medical records. RESULTS: Three hundred and nine of the 1487 patients (20.8%) fulfilled DSM-IV criteria for BD; 118 (7.9%) for BD-I and 191 (12.8%) for BD-II on the MINI. Of the BD patients (n = 309), 227 (73.5%) received any use of antidepressants, 73 (23.6%) antipsychotics and 33 (10.7%) mood stabilizers. In multiple logistic regression analyses, compared with those with MDD, patients with BD-I were more likely to receive antidepressants (OR 1.7, 95% CI 1.1-2.8, p = 0.02), antipsychotics (OR 1.6, 95% CI 1.04-2.5, p = 0.04) and mood stabilizers (OR 3.9, 95% CI 2.1-7.2, p < 0.001), whereas patients with BD-II were more likely to receive mood stabilizers (OR 2.4, 95% CI 1.3-4.4, p = 0.003). There was no difference in the use of antidepressants (OR 1.1, 95% CI 0.8-1.5, p = 0.7) and antipsychotics (OR 1.3, 95% CI 0.9-1.9, p = 0.2) between BD-II and MDD. In addition, there was no difference between BD-I and BD-II in any use of antidepressants, antipsychotics and mood stabilizers. CONCLUSIONS: The prescription of antidepressants for BD patients misdiagnosed with MDD is very common, and only a very small proportion of patients received guideline-concordant treatment. Considering the potentially hazardous effects of inappropriate pharmacotherapy in this population, continuing education and training addressing the correct diagnosis of BD and rational use of psychotropic medications are needed in China. Copyright © 2012 John Wiley & Sons, Ltd.
  Human Psychopharmacology Clinical and Experimental 10/2012; · 2.48 Impact Factor
• Article: Abnormal functional connectivity with mood regulating circuit in unmedicated individual with major depression: a resting-state functional magnetic resonance study.

  Dai-Hui Peng, Ting Shen, Jie Zhang, Jia Huang, Jun Liu, Shu-Yong Liu, Kai-da Jiang, Yi-Feng Xu, Yi-Ru Fang
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  ABSTRACT: Reports on mood regulating circuit (MRC) indicated different activities between depressed patients and healthy controls. The functional networks based on MRC have not been described in major depression disorder (MDD). Both the anterior cingulate cortex (ACC) and thalamus are all the key regions of MRC. This study was to investigate the two functional networks related to ACC and thalamus in MDD. Sixteen patients with MDD on first episode which never got any medication and sixteen matched health controls were scanned by 3.0 T functional magnetic resonance imaging (fMRI) during resting-state. The pregenual anterior cingulate cortex (pgACC) was used as seed region to construct the functional network by cortex section. The thalamus was used as seed region to construct the functional network by limbic section. Paired-t tests between-groups were performed for the seed-target correlations based on the individual fisher z-transformed correlation maps by SPM2. Depressed subjects exhibited significantly great functional connectivity (FC) between pgACC and the parahippocampus gyrus in one cluster (size 923) including left parahippocampus gyrus (-21, -49, 7), left parietal lobe (-3, -46, 52) and left frontal lobe (-27, -46, 28). The one cluster (size 962) of increased FC on thalamus network overlapped the precuneus near to right parietal lobe (9, -52, 46) and right cingulate gyrus (15, -43, 43) in health controls. Abnormal functional networks exist in earlier manifestation of MDD related to MRC by both cortex and limbic sections. The increased functional connectivity of pgACC and decreased functional connectivity of thalamus is mainly involved in bias mood processing and cognition.
  Chinese medical journal 10/2012; 125(20):3701-6. · 0.86 Impact Factor
• Article: [A comparative study of N400 in generalized anxiety disorder versus obsessive compulsive disorder patients].

  Chen Zhang, Xing-Shi Chen, Qing-Sheng Ren, Zheng-Hui Yi, Chong Chen, Yi-Ru Fang
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  ABSTRACT: To explore the features of events-related potentials (ERP) component N400 in generalized anxiety disorder (GAD) versus obsessive compulsive disorder (OCD) patients and understand the cognitive pattern and processing characteristic for Chinese characters. ERP component N400 was recorded by Guangzhou Runjie WJ-1 ERP apparatus. And 41 GAD patients, 69 OCD patients and 58 normal controls (NC) were tested by the Chinese idioms ending with matching (congruent) or mismatching (incongruent) words. (1) Latencies: Significant differences were found of N400 latencies in ending words with the same pronunciation but different forms and meanings (NC: (377 ± 40) ms, OCD: (395 ± 43) ms, GAD: (396 ± 43) ms, congruent; NC: (415 ± 32) ms, OCD: (429 ± 35) ms, GAD: (430 ± 36) ms, incongruent), ending words with the same meaning but different pronunciations and forms (NC: (411 ± 32) ms, OCD: (424 ± 40) ms, GAD: (433 ± 39) ms, incongruent), ending words with different pronunciations, forms and meanings (NC: (399 ± 47) ms, OCD: (427 ± 53) ms, GAD: (434 ± 42) ms, congruent; NC: (442 ± 36) ms, OCD: (465 ± 35) ms, GAD: (474 ± 35) ms, incongruent) (P < 0.05 - 0.01). Compared with NC, the N400 latencies were prolonged in GAD and OCD patients. Compared with OCD patients, the GAD patients also showed prolonged N400 latencies in ending words with different pronunciations, forms and meanings (incongruent situation). (2) Significant differences were found of N400 amplitudes in ending words with the same pronunciation but different forms and meanings (NC: (9 ± 5) µV, OCD: (6 ± 5) µV, GAD: (6 ± 5) µV, congruent; NC: (11 ± 6) µV, OCD: (5 ± 4) µV, GAD: (6 ± 4) µV, incongruent), ending words with similar forms but different pronunciations and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (7 ± 5) µV, congruent; NC: (14 ± 6) µV, OCD: (6 ± 5) µV, GAD: (9 ± 7) µV, incongruent), ending words with different pronunciations, forms and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (5 ± 3) µV, congruent; NC: (14 ± 6) µV, OCD: (9 ± 7) µV, GAD: (9 ± 7) µV, incongruent) (P < 0.05 - 0.01). Compared with NC, N400 amplitudes decreased in GAD and OCD patients respectively. Compared with OCD patients, the GAD patients also showed elevated N400 amplitudes in ending words with similar forms but different pronunciations and meanings (congruent). The cognitive and emotional problems in GAD and OCD may be measured by N400 elicited by Chinese idioms. Notable N400 priming effects can be found in Chinese idioms.
  Zhonghua yi xue za zhi 09/2012; 92(35):2468-72.