Bipolar Disorder In China Research Articles

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BackgroundNon-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. MethodsNSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. ResultsThe enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were “cutting” (41.2 %) and “hitting” (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LimitationsAs a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. ConclusionOur study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Trends in Incidences, Prevalence Cases, and the Disability-Adjusted Life-Years of Bipolar Disorder in China, 1990-2019

Objectives: Studies on Chinese bipolar disorders are incomplete and lagged to date. Methods: We used the join point regression program to assess the incidence, prevalence, and disease burdens of Chinese bipolar disorders, based on the Global Burden of Disease exchange database. Results: We observed the increasing trends in the incidence and prevalence of Chinese bipolar disorder in 1990- 2019, with increases of 22.26% in incidence number, 40.73% in prevalence number, and 17.12% in prevalence rate; wherein females had a higher prevalence rate in 1990-2019 and a higher incidence rate in 1990-2013 but a reversed trend thereafter; the Disability-Adjusted Life Years (DALY) increased by 78% for number and 15.81% for rate, respectively; those aged 30-34 shared the highest DALY number in 2019 (73,194; 95% UI (Uncertainty Interval): 43,128-113,623); the DALY-related Annual Percentage Change (APC) in 1990-2019 was 1.21% (P=0.000). Conclusion: Bipolar disorder is being developed into an immense societal burden in China. An essential intervention strategy should be formulated earlier to better identify and treat bipolar disorders so that we can reduce negative outcomes and DALY in China.

Evaluation of a novel instrument for detecting bipolar disorders in China: The Rapid Mood Screener (RMS)

ObjectiveBipolar disorder is easily misdiagnosed with major depressive disorder (MDD). The Rapid Mood Screener (RMS) was developed to address this unmet clinical need. This study aims to translate and evaluated the reliability and validity of the RMS in Chinese adults with bipolar I/II disorder (BD-I/II). MethodsBrislin's translation and Delphi method were conducted to formulate the RMS-Chinses version (RMS-C). Patients with MDD (N = 99), BD-I (N = 77) and BD-II (N = 78) were included to assess the validity and reliability of RMS-C. The area under the curve (AUC) was computed to ascertain the ability of the Mood Disorder Questionnaire (MDQ) and RMS-C to distinguish BD-I and BD-II from MDD. The optimal cut-off scores for classification were also calculated by the maximum sensitivity and specificity. ResultsThe intraclass correlation coefficient of the RMS-C was 0.82 (95%CI, 0.71–0.89). The content validity index by six items were 0.71, 0.86, 1.00, 0.86, 1.00, and 1.00 in turn, and by scales was 0.90. The AUCs of the RMS-C in both BD-I/II, BD-I alone and BD-II alone were 0.83 (95 % CI, 0.78–0.89), 0.82 (95 % CI, 0.75–0.89) and 0.85 (95 % CI, 0.79–0.91), respectively, and were comparably to the MDQ. The optimal RMS-C values of the presence of BD-I and BD-II were >4 and 3, respectively. ConclusionThe RMS-C is a valid, simple self-administer screening tool to help identify BD-I or BD-II in persons experiencing a depressive episode. Validating the impact of screening with the RMS-C on health outcomes and health economics is warranted.

Prevalence and Risk Factors of Comorbid Obesity in Chinese Patients with Bipolar Disorder.

Bipolar disorder (BD) predisposes patients to comorbid obesity and increases the risk of metabolic syndrome and cardiovascular disease. In this study, we investigated the prevalence of comorbid obesity and its risk factors in patients with BD in China. We conducted a cross-sectional retrospective survey of 642 patients with BD. Demographic data were collected, physical examinations were performed, and biochemical indexes, including fasting blood glucose, alanine aminotransferase (ALT), aspartate aminotransferase, and triglycerides (TG) levels, were measured. Height and weight were measured on an electronic scale at admission, and body mass index (BMI) was in kg/m2. Pearson's correlation analysis was used to analyze the correlation between BMI and variable indicators. Multiple linear regression analysis was used to analyze the risk factors for comorbid obesity in patients with BD. The prevalence of comorbid obesity in Chinese patients with BD was 21.3%. Obese patients had high levels of blood glucose, ALT, glutamyl transferase, cholesterol, apolipoprotein B (Apo B), TG, and uric acid in the plasma; however, the levels of high-density lipoprotein and apolipoprotein A1 were lower than those in non-obese patients. Partial correlation analysis showed that BMI was associated with ApoB, TG, uric acid, blood glucose, GGT, TC, ApoA1, HDL, and ALT levels. Multiple linear regression showed that ALT, blood glucose, uric acid, TG, and Apo B levels were important risk factors of BMI. The prevalence of obesity is higher in patients with BD in China, and TG, blood glucose, liver enzymes, and uric acid are closely related to obesity. Therefore, more attention should be paid to patients with comorbid obesity. Patients should be encouraged to increase their physical activity, control sugar and fat intake, and reduce the prevalence of comorbid obesity and risk of serious complications.

Research development on medication compliance of patients with bipolar disorder in China

Research development on medication compliance of patients with bipolar disorder in China

Cyclothymic Temperament, Physical Neglect, and Earlier Age of Onset Predict Poor Medication Adherence in Patients With Bipolar Disorder.

Individual-level risk factors may predict poor medication adherence (PMA) in bipolar disorder (BD). This study aimed to evaluate the association between affective temperament, childhood trauma, age of first onset, and PMA in patients with BD in China. A total of 168 patients completed the eight-item Morisky Medication Adherence Scale; the Short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire; and the Childhood Trauma Questionnaire-Short Form. Scores were then compared between PMA and non-PMA groups. Binary logistic regression showed that age of first onset was negatively correlated with PMA ( β = -0.106, p = 0.002), whereas physical neglect and cyclothymic temperament were positively correlated with PMA ( β = 0.143, p = 0.029; β = 0.19, p = 0.001, respectively). These findings indicate that cyclothymic temperament, physical neglect, and earlier onset are predictors of PMA in patients with BD and that such patients may require further attention to improve medical compliance.

Prevalence and associated factors of obesity and overweight in Chinese patients with bipolar disorder.

ObjectDespite abundant literature demonstrating a high prevalence of obesity and overweight in people with bipolar disorder (BD), little is known about this topic in China. Therefore, we assessed the prevalence and associated factors of obesity and overweight among inpatients with BD in our hospital, one of the largest public psychiatric hospitals in China.MethodsIn this retrospective, cross-sectional study, 1,169 inpatients ≥18 years with BD during 2019 were included. Obesity was defined as having a BMI ≥25 kg/m2, and overweight was defined as having a BMI from 23 kg/m2 to <25 kg/m2. Binary logistic regression analysis was performed to identify factors associated with obesity and overweight.ResultsThe prevalence of obesity and overweight was 21.0% and 32.2% in patients with BD, respectively. Compared to patients with overweight and normal weight, patients with obesity were older, had a longer duration of BD and a longer length of hospital stay, had a higher prevalence of diabetes and hypertension, and had a higher level of all metabolic indices, except for HDL cholesterol. Binary logistic regression analysis showed that duration of BD, uric acid, alanine aminotransferase (ALT), triglyceride, and LDL cholesterol were significantly associated with obesity, and male sex and uric acid level were significantly associated with overweight (p < 0.05).ConclusionsObesity and overweight were fairly prevalent in Chinese BD patients, and several factors were related to obesity and overweight. The results of the present study call for the need to implement early screening, prevention and interventions for obesity and overweight in patients with BD in China.

Prevalence and risk factors for non-suicidal self-injury among patients with depression or bipolar disorder in China

BackgroundsNon-suicidal self-injury is a serious health problem among patients with depression or bipolar disorder. However, few studies within the Chinese context have investigated the prevalence of NSSI and its risk factors in above populations. The purpose of this study was to investigate the prevalence of non-suicidal self-injury and its risk factors in patients with depression or bipolar disorder in China.MethodsThe final sample comprised of 394 inpatients(Mage = 29.71; SDage = 11.95) with depression or bipolar disorder from two psychiatric hospitals in Beijing, China. A General Demographic Data Form, the Non-suicidal Self-injury Questionnaire(NSSI-Q), Impulsivity Item and the Adverse Childhood Experiences-International Questionnaire(ACE-IQ) were completed by all patients.ResultsOf the 394 patients examined, 245(62.2%) of this sample reported NSSI in past year. Of the 245 patients with NSSI, 135(55.1%) were diagnosed with depression and 110(44.9%) were diagnosed with bipolar disorder. The most common methods of NSSI for female was “pinching”(23.1%) and “scratching”(22.8%), while for male it was “hiting hard objects”(12.7%). By multivariate regression analysis, young age, unemployment, a higher monthly family income, single, impulsivity, long duration of illness and ACEs were risk factors for NSSI in patients with depression and bipolar disorder(P<0.05).ConclusionsOur study points to the fact that there was an unfortunate message about the prevalence of NSSI among patients with depression or bipolar disorder in China. It is necessary not only to raise the awareness of NSSI in families and society, but also to formulate targeted assessment and intervention. Moreover, future research should not only focus on individuals being hospitalized, but should be representative of individuals treated at home or in the community because there are no national statistics on NSSI among such patients in China.

The Study of Diagnostic Value of Bipolarity Index for Bipolar Disorder in China: Meta-analysis of Sensitivity and Specificity.

Bipolarity index (BI) is one of the diagnostic scales that assist the diagnosis of bipolar disorder (BD), and should be analyzed comprehensively for use in China. We searched the Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG, and Chinese Social Sciences Citation Index (CSSCI) in Chinese to find literature from July 31, 2004 to July 31, 2020, for results related to BI in the diagnosis for bipolar disorder (BD), among which results such as comments, letters, reviews, and case reports were excluded. The rates of sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosis were synthesized and discussed.A total of 1237 patients were included in 5 studies. The criteria used for their selection were an anlysis of their results on the BI, and the diagnostic indexes of BI for BD in China.Thesensitivity, specificity, positive predictive value, negative predictive value, and accuracy of BI for BD in China were summarized in every study.Results: A total of 1237 subjects were included in 5 studies. The random effect model was used to account for the data with RevMan 5.2. The results showed that the diagnostic sensitivity of BI was 0.93 (95% CI: 0.93-1.00), and the specificity was 85% (95% CI: 0.69-0.96). The positive predictive value (PPV)was 74% (95% CI: 0.53-0.91). The negative predictive value (NPV) was 95% (95% CI: 0.81-1.00), and accuracy was 86% (95% CI: 0.77-0.93). Significant heterogeneity was detected across studies regarding these incidence estimates.Conclusion: The ideal diagnostic value of BI was found, although the studies showed significant heterogeneity. The results must be cautiously and attentively interpreted, in comparison to other diagnostic scales, to perfect the use of BI in clinical psychiatry.

Psychometric Properties of the Chinese Version of the Bipolar Depression Rating Scale for Bipolar Disorder.

IntroductionUnlike unipolar depression, depressive episode of bipolar disorder is often associated with clinical characteristics, such as atypical and mixed symptoms. However, there are currently no valid and reliable specific tools available to assess the specific psychiatric symptomatology of depressive episode of bipolar disorder in China. Therefore, we aimed to evaluate the psychometric properties of the Chinese version of the Bipolar Depression Rating Scale (BDRS) in Chinese patients with bipolar disorder.MethodsThe sample of this study included 111 patients with bipolar disorder (30 male, 81 female). All participants were interviewed with the Chinese version of the BDRS (BDRS-C), the 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). A psychometric analysis of the BDRS was conducted.ResultsThe Cronbach’s alpha coefficient of the BDRS-C reached a value of 0.869. The BDRS-C score and scores for the HAMD-17 (r = 0.819, p < 0.01), the MADRS (r = 0.882, p < 0.01) and the YMRS (r = 0.355, p < 0.01) exhibited significant positive correlations. Close correlations were observed between the mixed subscale score of the BDRS-C and the YMRS score (r = 0.784, p < 0.01). Exploratory factor analysis resulted in three factors: a primary depressive symptoms cluster, a secondary depressive symptoms cluster, and a mixed symptoms cluster.ConclusionThe Chinese version of the BDRS has satisfactory psychometric properties. This is a valid and reliable instrument to assess depressive symptomatology in patients with bipolar disorder.

Differences in Demographic and Clinical Characteristics of Patients With Depressive vs. Manic First Episode of Bipolar Disorder.

Background: Bipolar disorder is a serious mental disease marked by episodes of depression, mania, hypomania, or mixed states. Patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to compare demographic and clinical variables based on a patient's first episode of bipolar disorder, including risk of recurrence over a 2-year period.Methods: A large cohort (N = 742) of patients with bipolar disorder in China was analyzed. Patients were divided into two groups according to their first episode of bipolar disorder, either depression or mania. Patients in mixed state first episode were classified based on predominant symptoms. Three hundred eighteen patients of the cohort had a first episode of mania and 424 patients had initial symptoms of depression. Demographic and clinical data were collected. All patients were followed up for 24 months. Data on compliance with follow-up appointments and recurrence of symptoms after 6, 12, 18, and 24 months were collected. Clinical characteristics (course of disease, age of onset, psychiatric family history, etc.) were compared between the mania group and depression groups.Results: More patients with bipolar disorder had a first episode of depression than mania (57.14 vs. 42.86%). Compared with the depression group, the mania group had later age of diagnosis of bipolar disorder [(38.64 ± 13.50) vs. (36.34 ± 14.94), P = 0.028], lower education level [(9.37 ± 4.34) vs. (10.17 ± 4.81), P = 0.017] and longer latency between an initial episode of psychiatric symptoms and formal bipolar diagnosis [(10.80 ± 10.76) vs. (8.85 ± 9.90), P = 0.012]. More patients in the mania group were male and without psychotic symptoms (all P < 0.05). In comparison with the mania group, more patients in the depression group were female, with higher frequency of a reported precipitating event before first mood episode (all P < 0.05). Compared with the depression group, the mania group had more recurrences of illness at the end of 12 months (Z =-2.156, P = 0.031), 18 months (Z =-2.192, P = 0.028), and 24 months (Z = −2.364, P = 0.018).Conclusions: In our study, there are a number of differences in demographic and clinical characteristics of patients with different onset syndromes of bipolar disorder. These differences include gender, education level, diagnosis age, the rate of recurrences, and others. These data of a cohort of Chinese patients add to the growing international literature on the relationship between index episode of bipolar disorder and clinical variables and outcomes. These results and further study may allow clinicians to offer patients and families more reliable prognostic information at the onset of disease.

Perspective on Etiology and Treatment of Bipolar Disorders in China: Clinical Implications and Future Directions.

Perspective on Etiology and Treatment of Bipolar Disorders in China: Clinical Implications and Future Directions.

Social cognition and interaction training (SCIT) for partially remitted patients with bipolar disorder in China

Bipolar disorder (BD) is associated with functional impairment. Social Cognition and Interaction Training (SCIT) has been shown to be feasible and effective at improving social functioning in patients with schizophrenia. We aimed to explore the association between SCIT and improvements in the clinical symptoms and functioning of partially remitted patients with BD in China. Seventy-four BD patients were randomly assigned to the SCIT and psychoeducation (Control) groups. All subjects participated in group interventions weekly for 8 weeks. Furthermore, the participants were administered the Young Mania Rating Scale (YMRS), the 17-item Hamilton Depression Rating Scale (HDRS-17), the Function Assessment Short Test (FAST) and neurocognitive measures at baseline and after eight weeks. There were no differences in demographics, the HDRS-17, YRMS, and FAST scores or neurocognitive measures between the groups at baseline (p>0.05). The repeated-measures analysis revealed that SCIT resulted in greater improvement in the HDRS, YMRS, and FAST scores (including six domains) (p<0.01) and two neurocognitive measures (p<0.05) compared to psychoeducation. Our findings suggest that SCIT is a feasible and promising intervention for the clinical symptoms and functioning of partially remitted patients with BD. Further longitudinal studies are needed to observe the long-term impact of SCIT on emotional and functional improvement in these patients.

Early Identification and Treatment of Bipolar Disorder in China: Challenges and Progress Chair: Gang Wang

Early Identification and Treatment of Bipolar Disorder in China: Challenges and Progress Chair: Gang Wang

The Role of the Magnesium Valproate in Therapy for Patients with Treatment-Resistant Depression (TRD): Meat-Analysis Results of Chinese Data

Background: Major depressive disorder is a prevalent and disabling illnessv, approximately 70% of patients do not remit after first-line antidepressant treatment, and about 20% develop to treatment-resistant depression(TRD). Treatment of TRD have been one of clinical problems. Adjunctive valprovate was a most sued ways for treatment of TRD. The magnesium valproate was common drug for both episode and bipolar disorder in China and also was used for TRD. To systematically evaluate the difference in efficacy of magnesium valproate and antidepressants for therapy of treatment-resistant depression(TRD) in China. Methods: Searches were applied to the following electronic databases in china: Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI), WANFANG and Chinese Social Sciences Citation Index (VIP) databases. A total of 13 RCTs were included. A meta-analysis was performed of all the literatures germane to estimate the treatment-resistant depression patients treated with magnesium valproate combination with antidepressants and only antidepressants randomized controlled trials (RCTs) from 2010 to 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and the meta-analysis was conducted with Revman4.2 software. Results: A total of 13 RCTs were included for meta-analysis. The results of meta-analysis demonstrated by effective rate and depressive symptoms change between two groups of combination treatment with magnesium valproate and only antidepressant. The effective rate was higher in magnesium valproate combination with antidepressants group than that in antidepressants group(81/306, 35/298, Z=4.60, P=0.00001). The depressive scale was lower found in magnesium valproate combination with antidepressants group than that in antidepressants group after treatment (Z=16.20, P <0.00001). These results indicated that magnesium valproate combination with antidepressants maybe one better therapeutic way for TRD. Conclusion: The results indicate that magnesium valproate combination with antidepressants was better than antidepressants group in effective rate and improving depressive symptoms during treatment of patients with TRD. So these results may recommend to the patients with TRD though without the differences between groups.

The prevalence of bipolar disorder in China: A meta-analysis

ObjectiveThis is a meta-analysis of the prevalence of bipolar disorders (BD) in the general population of China. MethodsA systematic literature search was conducted via the following databases: PubMed, EMBASE, PsycINFO, China National Knowledge Infrastructure (CNKI), WanFang and SinoMed. Studies on the prevalence of BD in the general population in China were identified. Statistical analyses were performed using the Comprehensive Meta-Analysis program. ResultsAltogether 32 studies conducted between 1984 and 2013 with 470,411 participants met the inclusion criteria for the analysis; the median age was 44.6 years and 49.6% of participants were female. The estimated point, 12-month and lifetime prevalence of BD in China were 0.09% (95% Confidence interval [CI]: 0.06–0.12%), 0.17% (95% CI: 0.10–0.29%) and 0.11% (95% CI: 0.07–0.17%), respectively. For BD-I, the estimated point, 12-month and lifetime prevalence rates were 0.06% (95% CI: 0.04–0.10%), 0.08% (95% CI: 0.02–0.30%) and 0.09% (95% CI: 0.05–0.16%), respectively. For BD-II, the estimated point and lifetime prevalence rates were 0.04% (95% CI: 0.02–0.06%) and 0.04% (95% CI: 0.02–0.09%), respectively. The 12-month prevalence of BD before the year 2010 was significantly lower than that after 2010 (0.12% vs. 0.26%, P=0.04). Meta-regression analysis revealed that younger age was significantly associated with higher 12-month prevalence of BD (coefficient=0.096, 95% CI: 0.027, 0.164, P=0.006). ConclusionThis first meta-analysis of the pooled prevalence of BD in China found that rates are generally lower than those reported in Western countries. Future studies with more rigorous and refined methodology are needed.

Risk Factors for Anxiety in Major Depressive Disorder Patients.

ObjectiveTo analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD).MethodsThis study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively.ResultsCompared with the non-anxious group, the anxious-depression group had an older age at onset (t=−4.39, p<0.001), were older (t=−4.69, p<0.001), reported more lifetime depressive episodes (z=−3.24, p=0.001), were more likely to experience seasonal depressive episodes (χ2=6.896, p=0.009) and depressive episodes following stressful life events (χ2=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (χ2=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression.ConclusionThese findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD.

Review of double mood stabilizer treatments for bipolar disorder in China

Background: Although treatment guidelines for bipolar disorder in many countries commonly include lithium carbonate joint with sodium valproate, this combination is not effective for all patients. Moreover, some adverse reactions related to this treatment, neurotoxicity and interaction with other drugs justify and call for a new reviewing of the issue. Methods: Evidence base for the interactions of combined drugs, the metabolic features, action mechanism, efficacy and side effects of these treatment combinations were reviewed. Considerable attention was given to the relationship of the mutual action of these drugs with their clinical efficacy but also their side effects. Results: The efficacy of combination therapy of lithium with valproate for treatment and prevention of mania were superior to monotherapy of lithium or valproate. Conclusion: Double mood stabilizer therapy is the best relative treatment for patients with bipolar disorder, especially mania and related episodes.

P01-297-Clinical characteristics of pediatric patients with bipolar disorders in china

ObjectiveTo explore the clinical characteristics, assessment, biological and psychosocial correlates, and treatment of pediatric bipolar disorder (BD) in China.MethodAll the studies published during the past 20 years on pediatric bipolar disorder in China were reviewed.ResultsThere is a lack of a unified diagnosis system in China. A serial of genetic researches showed the family aggregation and genetic predisposition of BD. There are consistent findings on the core symptoms of the disorder. BD has the characteristic of comorbidity with other disorders such as ADHD and OCD. Mood stabilizers and combined use of antipsychotics and TCA are still the main choice of psychiatrists to treat the pediatric patients with BD. The effectiveness of specific psychotherapy does need further studies.ConclusionA unified diagnosis system and criteria of BD for different age groups is crucial for further work. Combination of various treatments, such as mood stabilizers, AC, TCA and traditional Chinese medicine is effective for these patients. More studies, especially randomized controlled trials should be conducted to explore the etiology, pharmacotherapy and psychotherapy of this disease.

Heartache of the State, Enemy of the Self: Bipolar Disorder and Cultural Change in Urban China

Past works in anthropology and psychology have described the Chinese orientation toward life as situation-centered with an external locus of control. This model has also been applied to the understanding of affect disorders in China—depressive patients have been found to focus on outside circumstances surrounding dysphoric moods. However, dramatic economic, sociopolitical and cultural changes in post-Mao China may be affecting these cognitive orientations toward emotional distress. This paper focuses on the subjective experiences of individuals diagnosed with bipolar disorder in China. The study is based on semistructured interviews with patients at a Western-style mental health institution in Shenzhen, the first successful Special Economic Zone in China. My data suggest that the location of agency has shifted across generations. Whereas those who grew up in the Maoist era are inclined to use external circumstances to explain the control over and responsibility for their illness, younger patients tend to emphasize self-blame and individual responsibility. I argue that these intergenerational differences in ethnopsychology relate to the multifaceted rise of individualism in post-Mao China. The paper ends with an examination of this observed shift vis-à-vis recent theories of neoliberal discipline in China and a discussion of potential psychological implications.