Yiru Fang

• M.D., Ph.D.
• Professor (Full) at Shanghai Jiao Tong University School of Medicne

Background Little is known about the peripheral biochemicals between bipolar disorder at mixed episodes (BDM) and major depressive disorder with mixed features (MDM). This retrospective study was aimed to compare the peripheral biochemical parameters between patients with BDM and MDM. Methods This study included data from 269 BDM patients and 86 M...

Background There is a high prevalence of suicidal ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI) in bipolar disorder (BD). Understanding the nature of suicidality and NSSI in BD is an important way to inform optimal intervention for reducing suicide risk. We aimed to investigate the prevalence and correlates of SI, SA, an...

Background As the population in China rapidly ages, the prevalence of mild cognitive impairment (MCI) is increasing considerably. However, the causes of MCI vary. The continued lack of understanding of the various subtypes of MCI impedes the implementation of effective measures to reduce the risk of advancing to more severe cognitive diseases. Aim...

Background Differentiating bipolar disorder (BD) from unipolar depression (UD) is essential, as these conditions differ greatly in their progression and treatment approaches. Digital phenotyping, which involves using data from smartphones or other digital devices to assess mental health, has emerged as a promising tool for distinguishing between th...

BACKGROUND Differentiating bipolar disorder (BD) from unipolar depression (UD) is essential, as these conditions differ greatly in their progression and treatment approaches. Digital phenotyping, which involves using data from smartphones or other digital devices to assess mental health, has emerged as a promising tool for distinguishing between th...

Major depressive disorder (MDD) is a significant neurological disorder that imposes a substantial burden on society, characterized by its high recurrence rate and associated suicide risk. Clinical diagnosis, which relies on interviews with psychiatrists and questionnaires used as auxiliary diagnostic tools, lacks precision and objectivity in diagno...

Background In observational studies, frailty has been strongly associated with mental disorders. However, the mechanisms underlying the association between frailty and mental disorders remain unclear. Methods We conducted a two-sample Mendelian randomization (MR) study to assess the causal relationship between frailty, as measured by the frailty i...

Objective Measurement-based care (MBC) is an emerging, objective, and systematic evidence-based practice for monitoring symptom severity and treatment efficacy to assist clinicians in developing individualized treatment strategies for patients with major depressive disorder (MDD). This study aimed to identify the barriers and facilitators of enhanc...

Backgrounds Patients with major depressive disorder (MDD) have a high rate of metabolic syndrome (MetS), which could worsen disease progression. One of the most serious progressions in MDD is suicide attempts (SAs). Previous studies have found gender differences in MetS and SAs among MDD patients respectively. Therefore, we aimed to explore gender...

Introduction Cognitive dysfunction is believed to be among the core features of Bipolar Depression(BD-D). However, its evaluation and available treatments are limited. Here, we conducted a longitudinal follow-up clinical trial using the THINC-it tool to evaluate temporal sensitivity to change over time in cognitive function among patients with bipo...

Background The study aimed to explore the influence of gender on the prevalence of various somatic symptoms and their associations with suicidal ideation (SI) among patients with major depressive disorder (MDD). Methods We recruited 3,275 patients with MDD from the National Survey on Symptomatology of Depression (NSSD), among whom 1,745 patients h...

Purpose To validate the efficacy of enhanced measurement-based care against standard measurement-based care in patients with major depressive disorder. Patients and Methods In this pilot study of an ongoing multicenter cluster randomized controlled trails, 160 patients diagnosed with major depressive disorder were enrolled from 2 mental health cen...

Bipolar disorder is a mood illness that affects many people. It has a high recurrence frequency and will cause significant damage to the patient's social function. At present, the pathogenesis of BD is not clear. The National Center for Biotechnology Information (NCBI) established and maintained the Gene Expression Omnibus (GEO) database, a gene ex...

Background To construct a diagnostic model for Bipolar Disorder (BD) depressive phase using peripheral tissue RNA data from patients and combining Random Forest with Feedforward Neural Network methods. Methods Datasets GSE23848, GSE39653, and GSE69486 were selected, and differential gene expression analysis was conducted using the limma package in...

Background Long noncoding RNAs (lncRNAs) regulate the pathogenesis of Alzheimer’s disease (AD). Objective To identify lncRNAs in the peripheral blood as potential diagnostic biomarkers for amnestic mild cognitive impairment. Methods In the discovery group, a microarray was used to screen for significant differences in lncRNA expression between pa...

Background To explore the demographic and clinical features of current depressive episode that discriminate patients diagnosed with major depressive disorder (MDD) from those with bipolar I (BP-I) and bipolar II (BP-II) disorder who were misdiagnosed as having MDD . Methods The Mini-International Neuropsychiatric Interview (MINI) assessment was pe...

Background A significant association between women’s reproductive traits and the risk of schizophrenia (SCZ) has been discovered, but the causalities remain unclear. We designed a two-sample univariate Mendelian randomization (MR) study using female-specific SNPs collected from a large-scale genome-wide association study as a genetic tool to explor...

Background This study aimed to explore gender differences in associations between cognitive symptoms and suicidal ideation (SI) among patients with recurrent major depressive disorder (MDD). Methods We recruited 1222 patients with recurrent MDD from the National Survey on Symptomatology of Depression (NSSD), a survey designed to investigate the sy...

Background: DSM-5 proposes the concept of bipolar disorder with “mixed features ”, which is of great benefit to clinical practice. However, the clinical management of BD with mixed features is more challenging.This investigation examined the prescribing patterns and factors influencing guidelines disconcordance for the acute treatment of bipolar di...

Background The problem of suicide has become increasingly common in individuals with major depressive disorder (MDD). Transcranial direct current stimulation (tDCS) is an effective treatment for MDD with 2 milliamperes (mA) for at least 30 min per day for 2 weeks. This study aims to investigate the efficacy of daily duration-doubled tDCS as an adju...

Bipolar disorder (BD) profoundly affects cognitive and psychosocial functioning, leading to a significant illness burden on patients and their families. Genetic factors are predominant in the onset of bipolar disorder and functional impairments. This disorder exhibits a strong family aggregation, with heritability estimates reaching up to 80%. Indi...

Background Data on trends in the epidemiological burden of bipolar disorder are scarce. Aims To provide an overview of trends in bipolar disorder burden from 1990 to 2019. Method Revisiting the Global Burden of Disease Study 2019, we analysed the number of cases, calculated the age-standardised rate (per 100 000 population) and estimated annual p...

Background This research was designed to investigate Algorithm Guided Treatment (AGT) and clinical traits for the prediction of antidepressant treatment outcomes in Chinese patients with major depressive disorder (MDD). Methods This study included 581 patients who had reached treatment response and 406 patients remained non-responded observed afte...

Aim Appraise the clinical features and influencing factors of the hospitalization times and length of stay in bipolar disorder (BD) patients. Methods This is a multicenter, observational, cohort study of patients diagnosed of type I or type II bipolar disorder. Five hundred twenty outpatients in seven hospitals from six cities in China were recrui...

Objective This survey aims to explore the current medical treatment of major depressive disorder (MDD) in China and match its degree with Canadian Network for Mood and Anxiety Treatments (CANMAT). Methods A total of 3275 patients were recruited from 16 mental health centers and 16 general hospitals in China. Descriptive statistics presented the to...

Objective: To explore clinical characteristics and symptomatology of major depressive disorder (MDD) with atypical features based on DSM criteria or only reversed vegetative symptoms. Method: A total of 3187 patients who met DSM-IV TR criteria for MDD were enrolled. Demographics and symptomatology covering multiple symptom domains were assessed...

Background Cognitive impairment is one of the core features of bipolar depression. A unified, reliable, and valid assessment tool is key to screening and assessing cognitive impairment. The THINC-Integrated Tool (THINC-it) is a simple and quick battery for screening cognitive impairment in patients with major depressive disorder. However, the use o...

Group 2 innate lymphoid cells (ILC2s) are a category of heterogeneous cells that produce the cytokines IL-5 and IL-13, which mediate the type 2 immune response. However, specific drug targets on lung ILC2s have rarely been reported. Previous studies have shown that type 2 cytokines, such as IL-5 and IL-13, are related to depression. Here, we demons...

Objective To explore the differences in event-related potentials (ERPs) of the subclinical types of major depressive disorders (MDD): melancholic (MEL), atypical (ATY), and anxious (ANX). Methods Patients with MDD treated in the Clinical Department of Shanghai Mental Health Center between September 2017 and December 2020 were prospectively include...

Background Though deep brain stimulation (DBS) shows increasing potential in treatment-resistant depression (TRD), the underlying neural mechanisms remain unclear. Here, we investigated functional and structural connectivities related to and predictive of clinical effectiveness of DBS at ventral capsule/ventral striatum region for TRD. Methods Sti...

Background Treatment-resistant depression (TRD) carries a high economic burden worldwide. Transcranial direct current stimulation (tDCS) is advantageous for improving cognition and can be safely used in the treatment of depression. The effectiveness of tDCS of the left and right orbitofrontal cortex (OFC) as adjuvant treatment in patients with TRD...

The purpose of this study is to explore the correlation between ferroptosis-related genes and schizophrenia in order to explore the new direction of diagnosis and treatment of schizophrenia. We screened the datasets related to schizophrenia from the Gene Expression Comprehensive Database (GEO) and obtained ferroptosis-related genes from the FerrDB...

Backgroud: The problem of suicide has become increasingly common in individuals with major depressive disorder (MDD). Transcranial direct current stimulation (tDCS) is an effective treatment for MDD with2 milliamperes (mA) for at least thirty minutes per day for two weeks. This study aims to investigate the efficacy of daily duration-doubled tDCS a...

Patients with treatment-resistant depression (TRD) have fewer treatment options and worse prognoses than those without TRD. Although the etiology or pathophysiology of TRD remains unclear, certain clinical variables have been found to be related to its severity and prognosis. Therefore, 1151 patients with recurrent depression were recruited from th...

Background Anhedonia and cognitive impairment are core features of major depressive disorder (MDD), and are essential to the treatment and prognosis. Here, we aimed to investigate anhedonia and its cognitive correlates between first episode of depression (FED) and recurrent depression (RD), which was part of the National Survey on Symptomatology of...

Bipolar disorder is one of the severe mental diseases. Its high misdiagnosis rate and long-time delayed diagnosis are related to the fact that the diagnosis procedure is mainly conducted by doctors' subjective judgment. The diagnosis methods of bipolar disorder mainly include the International Classification of Diseases (ICD) or the Diagnostic and...

Background The association between inflammation and major depressive disorder (MDD) remains poorly understood, given the heterogeneity of patients with MDD. Aims We investigated inflammatory markers, such as interleukin (IL)-6, high-sensitivity C reactive protein (hsCRP) and tumour necrosis factor-α (TNF-α) in melancholic, atypical and anxious dep...

Background The age of onset (AOO) is a key factor for heterogeneity in major depressive disorder (MDD). Looking at the effect of AOO on symptomatology may improve clinical outcomes. This study aims to examine whether and how AOO affects symptomatology using a machine learning approach and latent profile analysis (LPA). Methods The study enrolled 9...

Background: Antidepressant (AD) algorithm is an important tool to support treatment decision-making and improve management of major depressive disorder (MDD). However, little is known about its concordance with real-world practice. This study aimed to assess the concordance between the longitudinal treatment patterns and AD algorithm recommended by...

The onset of bipolar disorder (BD) occurs in childhood or adolescence in half of the patients. Early stages of BD usually present depressive episodes, which makes it difficult to be distinguished from major depressive disorder (MDD). Objective biomarkers for discriminating BD from MDD in adolescent patients are limited. We collected basic demograph...

Background The study was designed to investigate the associations between gastrointestinal (GI) symptoms, medication use, and spontaneous drug discontinuation (SDD) in patients with major depressive disorder (MDD). Methods This cross-sectional study included 3256 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differe...

Background Two-thirds of major depressive disorder (MDD) patients initially present with somatic symptoms, yet no study has used approaches based on somatic symptoms to subtype MDD. This study aimed to classify MDD via somatic symptoms and tracked the prognosis of each subtype. Methods Data were obtained from the study of Algorithm Guided Treatmen...

Background The hippocampus is a core region of interest for all major mental disorders, and its subfields implement distinctive functions. It is unclear whether the mental disorders exhibit common patterns of hippocampal impairments, and we lack knowledge on whether and how the hippocampal subfields represent deficit spectra across mental disorders...

Objectives Conventional biochemical indexes may have predictive values in clinical identification between bipolar disorder (BD) and major depressive disorder (MDD). Methods This study included 2,470 (BD/MDD = 1,333/1,137) hospitalized patients in Shanghai as training sets and 2,143 (BD/MDD = 955/1,188) in Hangzhou as test sets. A total of 35 clini...

The current clinical diagnosis of psychiatric disorders relies heavily on subjective assessment of symptoms. While neuroimaging has made an essential contribution to characterizing the brain of psychiatric disorders, it does not currently serve the clinical diagnosis of major psychiatric disorders. Here, we report a neuroimaging-aided diagnostic sy...

Background: Sleep disturbances and benzodiazepine (BZD)/Z-drug use are common in patients with bipolar disorder (BD). Objective: To investigate the short- and long-term effects of BZD/Z-drug use during acute affective episode. Methods: Participants diagnosed with BD as well as sleep disturbance chose BZDs/Z-drugs or not at will. Manic and depr...

Schizophrenia is a clinical syndrome composed of a group of symptoms involving many obstacles such as perception, thinking, emotion, behavior, and the disharmony of mental activities. Schizophrenia is one of the top ten causes of disability globally, accounting for about 1% of the global population. Previous studies have shown that schizophrenia ha...

Early distinction of bipolar disorder (BD) from major depressive disorder (MDD) is difficult since no tools are available to estimate the risk of BD. In this study, we aimed to develop and validate a model of oxidative stress injury for predicting BD. Data were collected from 1252 BD and 1359 MDD patients, including 64 MDD patients identified as co...

This study was to investigate the characteristics of seasonal symptoms and non-enzymatic oxidative stress in the first hospitalized patients with bipolar and unipolar depression, aiming to differentiate bipolar depression from unipolar depression and reduce their misdiagnosis. A total of 450 patients with bipolar depression and 855 patients with de...

Background Conventional biochemical parameters may have predictive values for use in clinical identification between bipolar disorder (BD) and major depressive disorder (MDD). Methods This study enrolled 2470 hospitalized patients with BD (n = 1333) or MDD (n = 1137) at reproductive age from 2009 to 2018 in China. We extracted 8 parameters, uric a...

Genome-wide association studies (GWAS) have reported substantial genomic loci significantly associated with clinical risk of bipolar disorder (BD), and studies combining techniques of genetics, neuroscience, neuroimaging, and pharmacology are believed to help tackle clinical problems (e.g., identifying novel therapeutic targets). However, translati...

Background: Despite the best treatments, about 20% of patients with major depressive disorder (MDD) receiving drugs and psychological intervention show little or no improvement. There is no trial comparing different treatment methods in patients with anxiety/somatic subtype MDD. Aim: To compare the efficacy and safety of various treatments in pa...

Aberrant topological organization of whole-brain networks has been inconsistently reported in studies of patients with major depressive disorder (MDD), reflecting limited sample sizes. To address this issue, we utilized a big data sample of MDD patients from the REST-meta-MDD Project, including 821 MDD patients and 765 normal controls (NCs) from 16...

Background: Comorbid somatic diseases increase the death risk and affect the condition, treatment, and prognosis of older psychiatric patients. We investigated the comorbidity and drug treatment in older patients with psychosis. Methods: This retrospective study used data from 3,115 older psychiatric in-patients hospitalized at the Shanghai Mental...

Background: In spite of numerous options, the most efficacious treatment for major depressive disorder (MDD) remains elusive. Algorithm-guided treatments (AGTs) are proposed to address inadequate remission and optimize treatment delivery. This study aimed to evaluate the clinical benefit of AGTs for MDD, and to explore specific moderators of treatm...

Background Measurement-based care (MBC) is an evidence-based practice for depression, but its use by clinicians remains low. Enhanced MBC (eMBC), which uses digital technologies, can help to facilitate the use of MBC by clinicians and patients. Understanding factors that act as barriers and drivers to the implementation of MBC and eMBC is important...

The relationship between thyroid function and depression has long been recognized, but little is known about the effect of thyroid function on the risk of readmission after hospitalization for major depressive disorder (MDD). This retrospective cohort study was aimed to explore the effect of thyroid function on psychiatric readmission after hospita...

Background: Biological rhythm plays an important role in major depressive disorder (MDD). The efficacy of antidepressant in biological rhythm remains unclear. This study is designed to explore the efficiency of escitalopram and mirtazapine in improving circadian rhythm, diurnal mood variation(DMV) and daily activity in MDD patients. Methods: Four-h...

Background Fluoxetine, bupropion, cognitive behavioral therapy (CBT), and physical therapies (modified electroconvulsive treatment or repetitive transcranial magnetic stimulation) can be used to manage melancholic depression. Objective To compare the efficacy and safety of various treatments in patients with melancholic depression. Methods This w...

Background Mental disorders are a common finding among patients with unruptured intracranial aneurysms. Case The current case concerns a young man with an anterior communicating artery aneurysm who was misdiagnosed with schizophrenia and bipolar disorder due to his significant psychosis and mood episodes. Having undergone surgery on the unruptured...

A correction to this paper has been published: https://doi.org/10.1007/s12264-021-00694-9

Subsyndromal symptomatic depression (SSD) and major depressive disorder (MDD) have been classified as distinct diseases, due to their dissimilar gene expression profiles and responses to venlafaxine. To identify specific biomarkers of these two diseases, we conducted a secondary analysis of the gene expression signatures of SSD patients, MDD patien...

Background This study investigated cognitive and emotional functioning in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) and disruptive, impulse-control, and conduct disorders (DICCD). Methods Thirty patients with ADHD, 26 with DICCD, 22 with ADHD+DICCD were recruited from the outpatient department of Shanghai Changn...

Classic hypothalamic-pituitary-end-organ feedback loops – the hypothalamic-pituitary-adrenal axis (HPAA), hypothalamic-pituitary-thyroidal axis (HPTA), and hypothalamic-pituitary-gonadal axis (HPGA) – are associated with the neuroendocrine and immune systems in major depressive disorder (MDD). Female patients with MDD present with evident neuroendo...

Background: Most patients with the major depressive disorder (MDD) have varying degrees of impaired social functioning, and functional improvement often lags behind symptomatic improvement. However, it is still unclear if certain neurobiological factors underlie the deficits of social function in MDD. The aim of this study was to investigate the b...

Background: Suicide is a major public health issue and the majority of those who attempt suicide suffer from mental disorders. Beyond psychopharmacotherapy, seizure therapies and noninvasive brain stimulation interventions have been used to treat such patients. However, the effect of these nonpharmacological treatments on the suicidal ideation and...

Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patient...

Effective and targeted interventions for improving quality of life (QOL) in addition to achieving ‘clinical remission’ are imperatives for patients with major depressive disorder (MDD). This study aimed to examine potential predictors and moderators of QOL in depression. Data were obtained from the Algorithm Guided Treatment Strategies for Major De...

Background Inflammation that is mediated by microglia activation plays an important role in the pathogenesis of depression. Microglia activation can lead to an increase in the levels of proinflammatory cytokines, including TNF-α, which leads to neuronal apoptosis in the specific neural circuits of some brain regions, abnormal cognition and treatmen...

Background: Measurement-based care (MBC) is an evidence-based practice for depression, but its use by clinicians remains low. Enhanced MBC (eMBC), which uses digital technologies, can help to facilitate the use of MBC by clinicians and patients. Understanding factors that act as barriers and drivers to the implementation of MBC and eMBC is importan...