·In This Issue·

·In This Issue·

As part of our plan to increase the English content of the journal，starting with the current issue all research articles in the Shanghai Archivdes of Psychiatry will be published in English with a Chinese abstract.

The first research article［1］in this issue is about a randomized，double-blind，sham-controlled study of repetitive transcranial magnetic stimulation(rTMS).The authors report that 4 weeks of adjunctive treatment with rTMS to the left dorsolateral prefrontal cortex of patients with schizophrenia taking antipsychotic medications can significantly improve negative symptoms.Negative symptoms are usually difficult to treat with antipsychotics and tend to be strongly correlated with increased disability，so the introduction of a treatment modality that can improve these symptoms is an important advance. Further research in this promising area is needed to determine the appropriate duration，intensity and interval between courses of treatment with rTMS.

The second article［2］reports on a study of serum brain-derived neurotrophic factor(BDNF)in 228 patients with bipolar disorder.Like other，smaller，studies it finds that BDNF is significantly lower in all phases of bipolar disorder(manic，euthymic，depressed)than in normal control subjects.But it also finds that serum BDNF is positively associated with the severity of mania，so it is higher in bipolar patients in a manic phase than in bipolar patient in depressed or euthymic phases.BDNF levels in bipolar patients was not associated with family history，duration of illness，subtype(i.e.，Bipolar I or Bipolar II)or age of onset.One interesting new finding that needs to be replicated in future studies was that during the manic and euthymic phases of bipolar illness BDNF level was positively correlated with the severity of depressive symptoms but during the depressive phase of illness it was negatively correlated with the severity of depressive symptoms.

The third article［3］evaluates life events，social support and psychological defense mecahnisms in 38 subjects with a DSM diagnosis of social phobia. Compared to controls，subjects with social phobia had the same number and type of life events but they reported much greater psychological distress related to these events.They also report substantially less social support and a lower willingness to employ available social support.As expected these subjects were more likely than controls to use immature defense mechanisms and less likely to use mature defense mechanisms.Longitudinal prospective studies starting in childhood are needed to assess the relationship of these three classes of factors—life events，social support and defence mechanisms—to the etiology and course of this chronic disabling condition.

The last research article in the current issue［4］reports on the use of a ketamine-induced rat model of schizophrenia to replicate previous research on the effect of antipsychotic medication in reversing the increased pain threshold seen in schizophrenia. The authors found that the thermal pain threshold was increased in ketamine-treated rats but，surprisingly，the pressure pain threshold was decreased. (They speculate that the latter finding may be due to increased motor activity with the ketamine and，thus，not a real decrease in the pain threshold.) They did not confirm prevous studies about reversal of the ketamine-induced change in the pain threshold by pretreatment with antipsychotics.An interesting secondary finding that could have important clinical implications for elderly patients was that falls(i.e.，ataxia)were much more comon in ketamine-treated rats that were pretreated with haloperidol than in rats that were pretreated with respiridone or normal saline(the ketamine control group).

This issue also includes commentaries by international researchers on two papers from our previous issue.Professor Scott Stroup［5］discusses the findings of the assessment of antipsychotic use in 398 first-episode，drug-naive patients with schizophrenia reported by Yang and colleagues［6］and finds that the clinical efficacy and side-effect profile reported in China are similar to those seen in large randomized trials in the West such as the CATIE study.But the proportion of patients in China who continue taking the initial drug one year after starting treatment(67%)is much higher than seen in other countries.The reasons for this high rate of adherence in China are unknown but，given the importance of adherence in the treatment of schizophrenia，further research to identify these reasons is strongly recommended.A second commentary by Professor Robert Rosenheck［7］about the paper on homeless mentally ill in Shanghai by Chen and colleagues［8］clarifies how different the situation in China is from that seen in developed countries.In China's urban regions almost all homeless people have severe mental disorders(primarily schizophrenia)or mental retardation while in Western countries alcohol abuse，drug abuse and economic hardship are more important determinants of homelessness than severe mental illnesses.But China has only just started to recognize and address this prob-lem.More detailed，longitudinal data will be needed to help craft policies that can effectively coordinate the wide range of agencies that need to be involved in addressing the problem of homelessness in China.

The Forum in this issue includes two preliminary comments on the draft version of the National Mental Health Law that was released on the web for public comment on 10 June 2011［9］by the Legal Affairs Office of the State Council prior to its (hopefully)final revision and passage by the National People's Congress.Twenty-five years in the making，this law has integrated international perspectives on the recognition and management of persons with mental illnesses and adapted them to the current situation in China.It confirms the importance of voluntary treatment whenever possible; provides clear criteria and procedures for involuntary treatment;emphasizes the principle of access to services based on need，not ability to pay;highlights the importance of using scientific approaches to prevention，treatment and rehabilitaiton;and details the specific responsibilities of families and all sectors of the community in the effort to provide services to the mentally ill.As pointed out in the comment by Professor Xiehe Liu—a leading early proponent of China's national mental health law—there remain several problems with the current draft that will need to be resolved during its implementation phase［10］.The comment by Professor Graham Mellsop［11］points out the innovative aspects of the law that may provide valuable models that can be adapted for the provision of mental health services in other countries.Depite the likely ongoing debate about specific provisions and regulations，it is clear that the law will be a"game changer".Once passed，mental health services in China will start on a new trajectory.We will follow this trajectory with interest in the Shanghai Archives of Psychiatry.

1. Chen HY，Zhang ZJ，Wang JJ，Chen YM，Xiang ZQ，Shi SX，Sheng JH.Effect of adjunctive treatment with repetitive transcranial magnetic stimulation on exploratory eye movement and negative symptoms in schizophrenic patients：a randomized，double-blind，sham-controlled study.Shanghai Arch Psychiatry，2011，23(4)：200-206.

2. Ye CY，Xu YQ，Hu H，Li CB，Lin ZG，Shi SX，Wang W.Crosssectional study of the association between serum concentration of brain-derived neurotrophic factor and bipolar disorder. Shanghai Archives of Psychiatry，2011，23(4)：207-213.

3. Dong DY，Zhou GY.Comparison of the life events，social support and defense mechanisms between patients with social phobia and normal controls in China.Shanghai Arch of Psychiatry，2011，23(4)：214-220.

4. Li G，Ji MM，Yang S，Cui DH，Cao HJ，Yu JF.Effects of antipsychotic drugs on the pain threshold and motor behavior in a rat model of schizophrenia.Shanghai Arch Psychiatry，2011，23 (4)：221-228.

5. Stroup ST.Antipsychotics for previously untreated individuals with schizophrenia.Shanghai Arch Psychiatry，2011，23(4)：229-230.

6. Yang XM，Zhang HX，Wang HF，Jiang KD.Efficacy and side effects of monotherapy risperidone，olanzapine and quetiapine in previously untreated patients with schizophrenia：a oneyear prospective cohort study.Shanghai Arch Psychiatry，2011，23(3)：137-147.

7. Rosenheck RA.Homelessness in China and the West.Shanghai Arch Psychiatry，2011，23(4)：231-232.

8. Chen Q，Xu JN，Wang JJ.Retrospective comparison of the characteristics of 98 homeless psychiatric inpatients in Shanghai with those of 98 inpatients who were not homeless.Shanghai Arch Psychiatry，2011，23(3)：148-153.

9. Legal Affairs Office of the State Council.Draft version of Mental Health Law.http：//yijian.chinalaw.gov.cn/lisms/action/ guestLoginAction.do(accessed 21 August 2011)

10. Liu XH.Hope for China's mental health law.Shanghai Arch Psychiatry，2011，23(4)：241-242.

11. Mellsop G.China's new approaches to an old problem.Shanghai Arch Psychiatry，2011，23(4)：243-244.