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Pediatric bipolar disorder (PBD) is a severely debilitating illness, which is characterized by episodes of mania and depression separated by periods of remission. Previous fMRI studies investigating PBD were mainly task-related. However, little is known about the abnormalities in PBD, especially during resting state. Resting state brain activity measured by fMRI might help to explore neurobiological biomarkers of the disorder. Regional homogeneity (ReHo) was examined with resting-state fMRI (RS-fMRI) on 15 patients with PBD in manic state, with 15 age-and sex-matched healthy youth subjects as controls. Compared with the healthy controls, the patients with PBD showed altered ReHo in the cortical and subcortical structures. The ReHo measurement of the PBD group was negatively correlated with the score of Young Mania Rating Scale (YMRS) in the superior frontal gyrus. Positive correlations between the ReHo measurement and the score of YMRS were found in the hippocampus and the anterior cingulate cortex in the PBD group. Altered regional brain activity is present in patients with PBD during manic state. This study presents new evidence for abnormal ventral-affective and dorsal-cognitive circuits in PBD during resting state and may add fresh insights into the pathophysiological mechanisms underlying PBD.

Background Recently, a decreasing trend has been observed in the frequency and duration of outdoor activity among children, which has garnered concern regarding the potential impacts of this decline during mental health in early childhood. Currently, the association between outdoor activity in early childhood and the symptoms of anxiety disorders in preschoolers remains unclear. The purpose of this study was to investigate the association between the frequency and duration of outdoor activity in children aged 0–1 and 1–3 years and anxiety symptoms in preschoolers. Methods A cross-sectional study was conducted in 2021 using questionnaires, included 69,571 preschoolers residing in Longhua District, Shenzhen. Data on family social demographics, outdoor activity frequency and duration in children aged 0–3 years, and the anxiety symptoms of preschoolers were collected through parent-completed questionnaires. Anxiety symptoms were measured using the Chinese version of the Spence Preschool Anxiety Scale (SPAS), which assesses symptoms across various dimensions. The association between early childhood outdoor activity and anxiety symptoms in preschoolers was analyzed using a binary logistic regression model. Results Children 0–1 years of age who were outdoors < 1 times/week had a higher risk of screening positive for anxiety symptoms in preschool age compared with children who were outdoors ≥ 7 times/week (OR = 2.55, 95% confidence interval(CI): 2.22–2.94). Children in this age group who were outdoors < 30 min/session had a higher risk of screening positive for anxiety symptoms in preschool age compared with children who were outdoors ≥ 120 min/ session (OR = 1.62, 95%CI: 1.38–1.90). Children 1–3 years of age, who were outdoors < 1 time/week had a higher risk of screening positive for anxiety symptoms in preschool age compared with children who were outdoors ≥ 7 times/week, (OR = 3.10, 95%CI: 2.72–3.54). Children in this age group who were outdoors for < 30 min/session had a higher risk of screening positive for anxiety symptoms in preschool age compared with children who were outdoors time ≥ 120 min/ session (OR = 2.07, 95%CI: 1.73–2.48). Conclusion Lower frequency and shorter duration of outdoor activity during infancy (0–1 and 1–3 years) had higher odds of screening positive for anxiety symptoms in preschoolers. A frequency of ≥ 7 outdoor activity per week and a duration of ≥ 120 min/session during infancy were associated with lower levels of anxiety symptoms in preschoolers.These findings provide actionable insights for parents and caregivers, highlighting the importance of promoting outdoor activity in early childhood care and parenting practices. Future studies should further explore the causal relationship between outdoor activity and the prevention of anxiety.

Background Pediatric bipolar disorder (PBD) has attracted increasing attentions due to its high prevalence and great influence on social functions of children and adolescents. However, the pathophysiology underlying PBD remains unclear. In the present study, the resting-state functional magnetic resonance imaging (fMRI) was used to detect abnormalities of baseline brain functions in depressed PBD youth. Methods Seventeen youth with PBD-depression aged 10 - 18 years old and 18 age- and sex-matched normal controls were recruited in this study. The fMRI data under resting state were obtained on a Siemens 3.0 Tesla scanner and were analyzed using the regional homogeneity (ReHo) method. Correlations between the ReHo values of each survived area and the severity of depression symptoms in patients were further analyzed. Results As compared with the control group, PBD-depression patients showed decreased ReHo in the medial frontal gyrus, bilateral middle frontal gyrus and middle temporal gyrus, and the right putamen. Significant negative correlations of the mood and feelings questionnaire scores with mean ReHo values in the medial frontal gyrus and the right middle frontal gyrus in PBD-depression patients were observed. Conclusion Our results suggest that extensive regions with altered baseline brain activities are existed in PBD-depression and these brain regions mainly locate in the fronto-limbic circuit and associated striatal structures. Moreover, the present findings also add to our understanding that there could be unique neuropathophysiological mechanisms underlying PBD-depression.

Previous functional magnetic resonance imaging (fMRI) studies have shown abnormal functional connectivity in regions involved in emotion processing and regulation in pediatric bipolar disorder (PBD). Recent studies indicate, however, that task-dependent neural changes only represent a small fraction of the brain's total activity. How the brain allocates the majority of its resources at resting state is still unknown. We used the amplitude of low-frequency fluctuation (ALFF) method of fMRI to explore the spontaneous neuronal activity in resting state in PBD patients. Eighteen PBD patients during the mania phase and 18 sex-, age- and education-matched healthy subjects were enrolled in this study and all patients underwent fMRI scanning. The ALFF method was used to compare the resting-state spontaneous neuronal activity between groups. Correlation analysis was performed between the ALFF values and Young Mania Rating Scale scores. Compared with healthy controls, PBD patients presented increased ALFF in bilateral caudate and left pallidum as well as decreased ALFF in left precuneus, left superior parietal lobule, and bilateral inferior occipital gyrus. Additionally, ALFF values in left pallidum were positively correlated with Young Mania Rating Scale score in PBD. The abnormal resting-state neuronal activities of the basal ganglia, parietal cortex, and occipital cortex may play an important role in the pathophysiology in PBD patients.

We examined the relationship between self-compassion and hopelessness depression. The participants were 418 students at a technology college in Hunan, China, who completed questionnaires to measure self-compassion, hopelessness depression, and negative cognitive style. The results showed that self-compassion was negatively associated with both hopelessness depression and negative cognitive style, and negative cognitive style emerged as a significant mediator in the relationship between self-compassion and hopelessness depression. The results suggest that self-compassion had buffering effects on hopelessness depression through its positive effects on negative cognitive style. The findings in the present study can help expand current understanding of self-compassion and hopelessness depression.

Tic disorder, characterized by the presence of both motor and vocal tics is common in adolescents and adults. Antipsychotics including typical antipsychotics and atypical antipsychotics are generally recognized by experts as the most effective pharmacological treatment for tics. However, previous studies suggest that tic-like symptoms might manifest during treatment with atypical antipsychotics such as clozapine, quetiapine, but not aripiprazole. We present the first case, to our knowledge, of an adult schizophrenia patient who developed tics during treatment with aripiprazole.

Sodium valproate (SV) is effective and well tolerated for the treatment of epilepsy and mood disorders. There are several cases of SV-induced enuresis noted in epileptic patients. No alternative medication has been suggested to manage this problem. We present the first case of a pediatric bipolar patient who developed diurnal and nocturnal enuresis during SV therapy. Clinicians should be aware of this side effect, as it has not been reported in nonepileptic patients, and it may be detrimental to treatment adherence.

Current approaches to screening for ADHD result in high rates of false positives. A proof of concept study to investigate the added benefits in the school-based detection of ADHD of adding a standardised teacher to teacher interview to traditional parent and teacher report questionnaires. A school-based study of diagnostic accuracy of ADHD using a novel 2-stage screening process. Participants were all 1026 pupils enrolled in grades 1 to 6 (ages 6–12 years) of a school in Hunan Province, China. The primary outcome was a diagnosis of ADHD on the Kiddie Schedule for Affective Disorders and Schizophrenia Present Lifetime version. 230 (22.4%) of the 1026 students screened positive at Stage 1 (parent and teacher questionnaires) (Sensitivity 0.86 [95% CI, 0.75 to 0.96], specificity 0.80 [95% CI, 0.78–0.83], false positive rate 0.20 (95% CI, 0.18 to 0.23), false negative rate was 0.14 (95% CI, 0.12 to 0.16). 65 remained screen-positive at the Stage 2 screen (teacher to teacher SNAP-IV interview). 36/65 (55.4%) of these Stage 2 screen positive participants and 1/144 (0.7%) of the screen negative subjects met DSM-IV criteria for ADHD (sensitivity 0.83 [95% CI, 0.71–0.95]; specificity of 0.97 [95% CI, 0.96–0.98]; false positive rate 0.03 [95% CI, 0.01 to 0.04], false negative rate 0.16 [95% CI, 0.15 to 0.19]. Adding teacher to teacher interviews to traditional questionnaire-based screening has the potential to improve the clinical utility of school-based screening for ADHD reducing the proportion of false positives, without a negative impact on sensitivity.

Dear Editor, The TET family of dioxygenases can oxidize 5-meth- ylcytosine （5mC） to 5-hydroxymethylcytosine （5hmC）, 5-formylcytosine （5fC）, and 5-carboxylcytosine （5caC） in mammalian genomic DNA via a stepwise manner [ 1- 5]. 5fC and 5caC are selectively recognized and excised by mammalian thymine DNA glycosylase （TDG）, and restored to normal cytosine through base excision repair [3, 6-9]. Once converted to 5fC and 5caC, the modified cytosine base is presumably committed to demethylation through the TDG-dependent pathway or other potential mechanisms. Thus 5fC and 5caC specifically mark active demethylation in the mammalian genome.

When investigating the underlying mechanisms linking adverse childhood experiences (ACEs) to non-suicidal self-injury (NSSI), few studies have integrated the well-known mediating variables (impulsivity, depressive symptoms, and psychological resilience) into a single path model to examine their interconnections. Therefore, the present study employed a variety of theoretical explanations to address this limitation from an exploratory perspective. This study aimed to investigate the multiple connections between impulsivity, depressive symptoms, and psychological resilience as underlying mechanisms in the association between ACEs and NSSI. A clinical sample of 219 adolescents in Xianyue Hospital, Xiamen, China, was recruited from 2020 to 2022. The structural equation model (SEM) and the bootstrapping method were used to analyze the multiple pathways and indirect effects of the three mediators on ACEs to NSSI. It was found that: 1) Impulsivity and depressive symptoms respectively played mediating roles in the relationship between ACEs and NSSI. 2) There was an indirect association between ACEs and NSSI through psychological resilience to depressive symptoms. 3) There was also an indirect association between ACEs and NSSI through depressive symptoms to impulsivity. The study enhanced our understanding of how ACEs influence NSSI by elucidating the underlying mediators (impulsivity, depressive symptoms, and psychological resilience), which can inform more effective interventions for NSSI among young Chinese patients. Highlights Impulsivity and depressive symptoms respectively played mediating roles in the relationship between adverse childhood experiences (ACEs) and non-suicidal self-injury (NSSI). There was an indirect association between ACEs and NSSI through psychological resilience to depressive symptoms. There was also an indirect association between ACEs and NSSI through depressive symptoms to impulsivity.