·In This Issue·

·In This Issue·

The Seminar and Forum in this issue both address a subject central to the daily work of most clinical psychiatrists in China:the diagnosis of schizophenia and other psychosis.This subject has come to the fore because of the recent publication of the proposed revisions in the diagnositic criteria for psychosis in DSM-5（www.dsm5.org）,which are sumarized in the paper by Tandon［1］.One of the most controversial aspects of the changes is the addition of a new disorder to identify prodromal schizophrenia—Attenuated Psychosis Syndrome. The difficulties of identifying persons at high-risk of developing schizophrenia and the benefits and risks of preemptively treating these individuals are discussed in the seminar by Zhao and Guo［2］.Another controversial recommendation is the com plete elimination of the subtypes of schizophrenia that have been used by clinicians and reserchers for over more than a century.Alternative view s that recommend retaining some subclassifications of schizophrenia are presented by xu［3］and by Yang and colleagues［4］.

The Forum in the previous issue addressed the question of involuntary treatment,a problem that has bedeviled the practice of psychiatry for hundreds of years.W e are p leased to inaugurate the Correspondence section of the journal with two follow-up letters about this topic:one by Herrman［5］advocating ongoing dialogue about the matter between all the relevant stakeholders and the other by Bertolote［6］suggesting that clinicians need to make sure that they are working in the best interests of their patients and not functioning as uncritical implementers of policies that excessively restrict the freedom s of the mentally ill.

We encourage our Chinese and international readers to let us know what other topics they think deserve discussion and debate in our Forum section so we can invite Chinese and international experts to provide their opinions on these topics.We also encourage readers to send us letters with comments or opinions about the topics addressed in our Forum section,about the regular articles,or about other topics they consider of interest.

Given our goal of increasing the English-language content of the journal,the current issue also includes two research articles that have been translated from Chinese into English.The first,by Chen and colleagues［7］,addresses a common clinical problem that has not received sufficient attention in China or elsewhere:the m isdiagnosis of bipolar disorder patients as having unipolar major depression.Detailed assessment of 100 outpatients with a current diagnosis of unipolar major depression seen at psychiatric clinics in a tertiary（high-level）psychiatric hospital and in a tertiary general hospital found that6 patients met criteria of Biplar Idisorder and 23 met criteria of Bipolar II disorder.This 29% misdiagnosis rate may help to explain the low prevalence of bipolar disorder identified in epidemiological studies in China［8］and,as discussed in the seminar by Fang and Wang in the previous issue［9］, highlights the need for improved training of psychiatric clinicians.As pointed out in the Commentary on the article by Dunner［10］,this issue is important because of the negative consequences of treating bipolar patients with monotherapy antidepressants.

The second research article by Zheng and colleagues［11］addresses an issue that,though not unique to Shanghai,is particularly im portant in Shanghai because of the rapid rate of aging of its population:how to maintain the social and psychological wellbeing of senior citizens.They find that the provision of community-based services to elderly retired citizens（including communal meals, home help,community recreational activities,etc.）results in significantly improved social support and mental health outcomes when com pared to traditional care from family members or placement in a residential home.Given the size of the elderly population in China（114 million in 2005）,these findings have significant public health implications.The next step will be to conduct cost-benefit studies to compare different methods of providing communitybased services for the elderly in both urban and rural settings.The models developed in China could subsequently be adapted and tested in other lowand middle-income countries.

1. Tandon R.Proposed changes in the diagnostic criteria of schizophrenia in DSM-5.Shanghai Archives of Psychiatry,2011,23（2）:102-105.

2. Zhao JP,Guo x F.Clinical identification of ultra-high risk groups for schizophrenia.Shanghai Archives of Psychiatry, 2011,23（2）:67-70.

3. xu TY.The subtypes of schizophrenia.Shanghai Archives of Psychiatry,2011,23（2）:106-108.

4. Yang LH,Tu MC,Liu HT,Opler M.The role of subtypes in understanding disease processes w ithin schizophrenia:a case exam p le of‘Deficit Syndrome’.Shanghai Archives of Psychiatry,2011,23（2）:109-111.

5. Herrman H.Service users,families,psychiatrists and other providers need to work together towards a common understanding.Shanghai Archives of Psychiatry,2011,23（2）:112-114.

6. Bertolote JM.Involuntary adm ission or involuntary treatment？Shanghai Archives of Psychiatry,2011,23（2）:115-116.

7. Chen FZ,Lu Z,Guo Z,Zhang x,Yang CQ.Clinical features of unrecognized bipolar disorder in outpatients with major depressive disorder.Shanghai Archives of Psychiatry,2011,23（2）:71-78.

8. Phillips MR,Zhang Jx,Shi QC,Song ZQ,Ding ZJ,Pang ST,Li x Y,Zhang YL,W ang ZQ.Prevalence,associated disability and treatment of mental disorders in four provinces in China,2001 -2005:an epidemiological survey.Lancet,2009,373:2041-2053.

9. Fang YR,W ang ZW.Current status and future trends in clinical research in bipolar disorder.Shanghai Archives of Psychaitry, 2011,23（1）:12-16.

10. Dunner D.Unrecognized bipolar disorder in patients with a diagnosis of unipolar depression.Shanghai Archives of Psychiatry,2011,23（2）:96-97.

11. Zheng H,Chen SL,Ji YW,Tao H,Ji WD.Comparison of the psychological status and quality of life and of elderly urban Shanghai residents who receive different types of support services.Shanghai Archives of Psychiatry,2011,23（2）:79-86.