?In this issue (February 2015) ?

We are delighted to report that our new Chineselanguage website is now up and running at hp://www. shanghaiarchivesofpsychiatry.org/cn/. The content on the website is parallel to that on our English-language website (hp://www.shanghaiarchivesofpsychiatry.org). Both websites have now added an article search page that can be used to fi nd and download full-text arcles of everything published in the journal in both English and Chinese since 2011. We intend to gradually expand this search system backward to include all materials published in the journal since publication started in 1959. Full-text English-language arcles published from 2012 onwards are now also available on Pubmed and Pubmed Central. In the six months since the journal was registered in Pubmed Central, full-text articles from the journal have been downloaded (free of charge) more than 25,000 times! Readers are encouraged to visit our websites and to look for articles published in theShanghai Archives of Psychiatryon Pubmed or Pubmed Central.

The current issue starts with a meta-analysis by Meng and colleagues[1]about the use of adjunctive aripiprazole for treating antipsychotic-induced hyperprolactinemia. This is a troublesome and often severe adverse effect of the long-term use of antipsychotic medications that, unlike most issues related to the use of antipsychotic medications, has received much more aenon from researchers in China than in the West. After an extensive literature search, the authors identified 21 randomized controlled trials (RCTs) about the issue, 19 of which were conducted in mainland China. Meta-analysis of the 8 studies that reported the proportion of participants whose serum prolactin returned to normal by the end of follow-up showed a clear advantage of aripiprazole over placebo or no treatment (risk ratio=19, 95%CI=11-35). No serious side-effects were reported, but adjunctive use of aripiprazole was associated with increased reports of headaches and somnolence. However, substantial methodological problems identified in many of the included RCTs will need to be addressed in future studies before the conclusion - that adjunctive aripiprazole is effective and safe for treatment of antipsychoticinduced hyperprolacnemia - can be considered strong enough to merit recommending aripiprazole as a standard treatment for hyperprolacnemia.

The first original research article by Zhang and colleagues[2]reports on the adequacy of guardianship, a central component of the ‘Shanghai Model’ of community mental health care and a cornerstone of the support network for the seriously mentally ill envisioned in China’s new mental health law.[3]In China, the vast majority of legally responsible guardians for mentally ill individuals are co-resident family members. Their formal responsibilies include (a) aending semiannual training sessions provided by community mental health workers, (b) supervising prescribed medicaons, (c) providing psychological support and assistance in daily life needs, (d) cooperang in the rehabilitaon of their ill family members, and (e) reporting changes in the individual’s condition to treating clinicians and, if emergent, local offi cials. This survey of 4283 registered mentally ill individuals in one of Shanghai’s 19 districts found that 84% of the guardians for these individuals were adequately fulfilling these responsibilities. In most cases where guardianship was not working the legal guardian was elderly (over 70) or ill; in a minority of cases the individual lived alone and there were no family members available or willing to undertake the guardianship role. Overall, the guardianship program is working well in Shanghai, partly due to the substanal financial support from the local government that makes regular monitoring and support of the guardians possible. However, the rapid aging of the populaon and the increasing number of mentally ill individuals who do not live with family members highlights the need for alternave service models that can supplement the guardianship program.

The second research article by Robinson and colleagues[4]considers the potenal role of social media as a tool to promote suicide prevenon. The rapid global expansion of the internet and the many di ff erent social networks that it supports presents both opportunities and risks for suicide prevention. The internet-based survey reported in this paper assessed atudes about the relative benefits and risks of social media among three stakeholder groups - 10 researchers who study the media and suicide, 13 administrators of suicide prevention centers that employ social media, and 64 users of social media. Respondents reported that social media can help idenfy and provide emoonal support to individuals contemplating suicide but they can also be sources of increased stress for vulnerable individuals and provide platforms for promoting suicide. Overall, the different stakeholders agreed that the potential benefits of using social media, particularly Facebook, as a vehicle for delivering a range of suicide prevenon activities outweigh the risks. The major caveats to this conclusion are (a) currently available research methodologies are unable to reliably and validly assess the presumed benefits and risks of social media, and (b) there are, as yet, no widely accepted guidelines and ethical standards to ensure that social media-based intervenons are delivered carefully and safely.

The Forum pieces[8-10]present three di ff erent views about another controversial diagnosis: attenuated psychosis syndrome (APS). The as yet unproven belief that early intervention may prevent or decrease the severity of a subsequent full-blown psychoc illness has led to a dramac increase in research about prodromal or high-risk conditions for psychosis. A variety of labels have been applied to the condion; in 2013 the(DSM-5),[11]used the label ‘a(chǎn)enuated psychosis syndrome’ (APS) and included it in the appendix as a condition worthy of further study. However, there remains controversy about the benefits of labelling this condition as a separate mental disorder (in which case it would become a separate diagnosis in the main text of DSM-5.1). On one side of the debate, Xu and colleagues[8]argue against classifying APS as a separate diagnosis because it is a transient state that usually does not progress to full-blown psychosis; they contend that such a diagnosis would result in unnecessary, and potentially harmful, labelling and treatment of many individuals who are not destined to become psychotic. The intermediate position is adopted by Lv and colleagues[9]who believe that characterizing a highrisk state would improve understanding of the evoluon of psychotic conditions and aid in the identification of effective prevention of full-blown psychosis, but they think that more research is needed before the creaon of a separate diagnosis is jusfi ed. On the other end of the debate, Schiffman and Carpenter[10]contend that formal recognion of the APS diagnosis will decrease -not increase - the over-diagnosis and over-treatment of individuals with prodromal psychoc condions and that all individuals who meet the criteria for the diagnosis (regardless of whether or not they are destined to convert to full-blown psychosis) have existing clinical needs that will be more likely to be addressed if they are given a formal psychiatric diagnosis.

The case report in this issue by Wang and colleagues[12]presents a case of rabies that was not treated early enough to prevent rabies encephalitis, but instead of developing the typical progressive paralysis (which is frequently fatal) the paent became disoriented, paranoid, and agitated. These psychological symptoms became chronic and six years later a MRI indicated serious brain atrophy. This case shows that mental symptoms may be the most prominent presenting symptoms of rabies, so psychiatrists should include rabies as one of the infecous diseases on the list of di ff erenal diagnoses they consider when evaluang new paents, parcularly those from rural communies.

The research methods in psychiatry article by He and colleagues[13]describes the development of a scale to assess caregiver burden of family members of persons with mental disorders in China. Given the central role of guardians - most of who are co-resident family members - in the community management of persons with serious mental illnesses in China,[2,3]assessing and reducing the burden they experience when ful fi lling this role is an important step in ensuring the long-term viability of the guardianship network for mentally ill individuals. But the scales for assessing family burden available from Western countries are not suitable for use in China. To help fi ll this gap, the authors administered a Chinese translaon of a comprehensive 114-item family burden scale developed in the West (the Family Experience Interview Schedule[14]) to 606 caregivers of psychiatric inpaents and used exploratory and con fi rmatory factor analysis to idenfy the subset of items that were most meaningful in the Chinese context. The resulting 28-item scale included five dimensions: (a) paents’ violent behavior; (b) paents’suicidal tendency; (c) caregivers’ depression and anxiety; (d) disrupon of caregivers’ daily rounes; and (e) caregivers’ satisfaction with health services. These dimensions had good internal consistency and, thus, appeared appropriate for assessing family burden in China. But further work with the scale is needed to assess its test-retest reliability and the ability of the scale to reflect changes in the level of family burden overme.

The biostatistics in psychiatry article by Tang and colleagues[15]provides the background and methods for assessing kappa, an important stasc for assessing rater agreement. Psychiatric research often involves comparing independent assessment of a diagnosis, symptom, or outcome of interest by multiple raters; somemes it involves comparing the results of di ff erent assessment methods for evaluating the presence or absence of a diagnosis, symptom, or outcome of interest. For example, comparing the diagnosisobtained when interviewing a paent to that obtained when interviewing the patient’s family members, or comparing multiple clinician’s opinions about the presence of tardive dyskinesia. When reporting these results, kappa is the most commonly used metric to indicate the level of agreement between raters or between rating methods. This paper describes the method of computing kappa by hand or by using common statistical software packages to evaluate the degree of agreement beyond chance agreement of two raters (or of two rating methods) when the outcome is dichotomous (e.g., the presence or absence of a diagnosis), when the outcome has mulple independent categories (e.g., one of 4 di ff erent diagnosis), or when the outcome is ranked (e.g., fi ve levels of improvement in clinical symptoms).

1. Meng ML, Li W, Zhang SW, Wang HY, Sheng JH, Li CB. Using aripiprazole to reduce antipsychotic-induced hyperprolactinemia: meta-analysis of currently available randomized controlled trials.Shanghai Arch Psychiatry. 2015; 27(1): 4-17. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215014

2. Zhang QT, Chen H, Ju K, Niu X, Song LJ, Chui J. Crosssectional evaluation of the adequacy of guardianship by family members of community-residing persons with mental disorders in Changning District, Shanghai.Shanghai Arch Psychiatry. 2015; 27(1): 18-26. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.214094

3. Chen HH, Phillips MR, Cheng H, Chen QQ, Chen XD, Fralick D, et al. Mental health law of the People’s Republic of China (English translation with annotations).Shanghai Arch Psychiatry. 2012; 24(6): 305-321. doi: http://dx.doi. org/10.3969/j.issn.1002-0829.2012.06.001

4. Robinson J, Rodrigures M, Fisher S, Bailey E, Herrman H. Social media and suicide prevention: findings from a stakeholder survey.Shanghai Arch Psychiatry. 2015; 27(1): 27-35. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.214133

5. Chen Q, Quan X, Lu HM, Fei P, Li M. Comparison of the personality and other psychological factors of students with internet addicon who do and do not have associated social dysfuncon.Shanghai Arch Psychiatry. 2015; 27(1): 36-41. doi: hp://dx.doi.org/10.11919/j.issn.1002-0829.214129

6. Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, M??le T, et al. An international consensus for assessing internet gaming disorder using the new DSM-5 approach.Addiction. 2014; 109(9): 1399-1406. doi: http:// dx.doi.org/10.1111/add.12457

7. Young KS. Internet addiction: symptoms, evaluation, and treatment. In: Creek LV, Jacksons TL editors.. Sarasota, FI: Professional Resource Press. 1999; 17: 19-31

8. Xu LH, Zhang TH, Wang JJ. Psychosis risk syndrome isnotprodromal psychosis.Shanghai Arch Psychiatry. 2015; 27(1): 42-44. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.214178

9. Lv HL, Zhou X, Zhao JP. Challenges in the early detection and intervention of psychosis-risk syndrome.Shanghai Arch Psychiatry. 2015; 27(1): 45-47. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.215016

10. Schi ff man J, Carpenter WT. Aenuated psychosis syndrome: benefits of explicit recognition.Shanghai Arch Psychiatry. 2015; 27(1): 48-51. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.215015

11. American Psychiatric Associaon.. Washington, DC: APA Press; 2013

12. Wang XQ, Yu XW, Guan YT. Case report of rabies-induced persistent mental symptoms.Shanghai Arch Psychiatry. 2015; 27(1): 52-54. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.214174

13. He HB, Zhou YL, Sun B, Guo YG, Rosenheck RA. Brief Chinese version of the Family Experience Interview Schedule to assess caregiver burden of family members of individuals with mental disorders.Shanghai Arch Psychiatry. 2015; 27(1): 55-61. doi: http://dx.doi.org/10.11919/ j.issn.1002-0829.214138

14. Perlick DA, Rosenheck RA, Kaczynski R, Swartz MS, CaniveJM, Lieberman JA. Components and correlates of family burden in schizophrenia.Psychiatr Serv. 2006; 57(8): 1117-1125. doi: hp://dx.doi.org/10.1176/appi.ps.57.8.1117

15. Tang W, Hu J, Zhang H, Wu P, He H. Kappa coefficient: a popular measure of rater agreement.Shanghai Arch Psychiatry. 2015; 27(1): 62-67. doi: http://dx.doi. org/10.11919/j.issn.1002-0829.215010

nghai Arch Psychiatry. 2015; 27(1): 1-3.

10.11919/j.issn.1002-0829.215020]

A full-text Chinese translaon of this arcle will be available at www.shanghaiarchivesofpsychiatry.org/cn on March 25, 2015.