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November 2011
Report on Activities of "WPA International Mental Health Research Fellowship" at Department of Psychiatry in University of Maryland School of Medicine, Baltimore, MD, USA (one year)

WPA Fellow: Yu-Tao Xiang, MD, PhD
Mentors: Alan Bellack, PHD, and Lisa Dixon, MD
Department of Psychiatry, University of Maryland School of Medicine

I received one-year training in the Department of Psychiatry at the University of Maryland Medical School as the World Psychiatry Association (WPA) Fellow during the period from October 2010 to September, 2011. I was mainly attached to the Division of Services Research (DSR) and the Center on Behavioral Treatment of Schizophrenia (CBTS) under the supervision of Dr Lisa Dixon and Dr Alan Bellack, with a focus on the development and evaluation of behavioral treatments and the integration of psychosocial and pharmacological treatments for severe mental illness, and substance abuse in people with serious mental illness. I was warmly introduced to the team members of the two centers and several major professors in the department. My research activities in the past year are summarized as follows.

Training
My training started with attending the regular research supervision meetings for the ongoing studies in DSR and CBTS. Colleagues in the two centres introduced me to several of their studies, and then showed me the research procedures, including how to use diagnostic tools, conduct a clinical interview, data collection, management and analyses, and quality control and supervision. I also observed the relevant protocol assessments and intervention sessions in their daily research activities. In addition, I attended the weekly departmental journal club meetings and learnt how to evaluate the advantages and limitations of research reports. I had meetings with my mentors every several weeks, and reviewed the training regularly.

Research
I have been involved in several studies with supervision and support of Dr Lisa Dixon, Dr Faith Dickerson and Dr Julie Kreyenbuhl, including:

First, in a study on maintenance treatment for schizophrenia, we found that weight change is a common, long-term, but heterogeneous side effect in risperidone maintenance treatment for Chinese schizophrenia patients. The report was published in Pharmacopsychiatry (Xiang YT, Wang CY, Ungvari GS, Kreyenbuhl JA, Chiu HF, Lai KY, Lee EH, Bo QJ, Dixon LB. Weight changes and their associations with demographic and clinical characteristics in risperidone maintenance treatment for schizophrenia. Pharmacopsychiatry. 2011, 44:135-141).

Second, together with my colleagues in China, we conducted a randomized controlled trial testing the efficacy of case management in Chinese schizophrenia patients. In total we completed three papers in which we examined patients’ quality of life, the prevalence of smoking, suicidal behaviors and their demographic and clinical correlates. One paper has been published in Journal of Psychiatry Research (Hou YZ, Xiang YT, Yan F, Ungvari GS, Dickerson F, Chiu HF, Lai KY, Lee EH, Li WY, Li WX, Zhu YL, Dixon LB. Cigarette smoking in community-dwelling patients with schizophrenia in China. J Psychiatr Res. 2011, 45: 1551-1556). Another two papers, (1) Yan F; Xiang YT; Hou YZ; Ungvari GS; Dixon LB.; Chan SSM; Lee EHM; Li WY; Li WX; Zhu YL, Chiu HFK. Suicide attempt, suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients; and (2) Xiang YT; Yan F; Hou YZ; Dickerson F, Ungvari GS; Dixon LB.; Chan SSM; Lee EHM; Li WY; Li WX; Zhu YL, Chiu HFK. Quality of life in community-dwelling patients with schizophrenia in China) are currently under review by international journals.

Third, I attended the Research on Asian Psychotropic Prescription Pattern (REAP) project that is an ongoing pharmaco-epidemiological survey on prescription trends for psychotropic drugs in schizophrenia inpatients in Asia. During the past year, We worked out seven papers. Of them, one paper has been published formally: Xiang YT, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Shinfuku N, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Dixon LB, Kreyenbuhl JA, Tan CH. Clozapine use in schizophrenia: findings of the Research on Asia Psychotropic Prescription (REAP) studies from 2001 to 2009. Aust N Z J Psychiatry. 2011, 45:968-975. Another six papers are under review by international journals, as follows.

(1) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Common use of anticholinergic medications in older patients with schizophrenia: findings of the Research on Asian Psychotropic Prescription Pattern (REAP) study, 2001-2009;

(2) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Common use of antipsychotic polypharmacy in older Asian patients with schizophrenia (2001-2009);

(3) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Adjunctive mood stabilizer and benzodiazepine use in older Asian patients with schizophrenia, 2001-2009;

(4) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N.Use of first- and second-generation antipsychotic medications in older patients with schizophrenia in Asia (2001-2009);

(5) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Prescribing patterns of low doses of antipsychotic medications in older Asian patients with schizophrenia (2001-2009);

(6) Xiang YT, Dickerson F, Kreyenbuhl JA, Wang CY, Si TM, Lee EH, He YL, Ungvari GS, Chiu HF, Tan CH, Yang SY, Chong MY, Kua EH, Fujii S, Sim K, Yong MK, Trivedi JK, Chung EK, Udomratn P, Chee KY, Sartorius N, Shinfuku N. Antipsychotic treatment in older schizophrenia patients suffering from extrapyramidal side effects and tardive dyskinesia in Asia (2001-2009).

Grant application
Cognitive deficits and negative symptoms are core symptoms in schizophrenia patients, and usually do not well respond to antipsychotic treatment. Currently I am applying for a grant in the US with the help of Dr Faith Dickerson and Dr Lisa Dixon and will examine the effect of oxytocin on cognitive deficits, psychopathology and social functioning in patients with schizophrenia. In addition, it is reported that the prevalence of smoking is approximately 65-90% in schizophrenia patients and it is one of the leading preventable causes of morbidity and premature mortality in this population. I am applying a grant from Health Service Research Foundation of China with a protocol introducing psychosocial intervention from the US for smoking cessation in Chinese schizophrenia patients.

The one-year training funded by World Psychiatry Association dramatically enhanced my knowledge and expertise in research. I learnt how to apply for research funding, start a study design, use quantitative or qualitative research methods, choose appropriate sample and outcome measures, develop and validate psychosocial interventions, collect data in a clinical interview, conduct data analyses and write the final research report and journal papers.  More importantly, I also learnt how to guide a young researcher to gain new insight into psychiatry. Undoubtedly, the experience in the past year will positively influence my research and practice in the future, and will be helpful for us to provide more comprehensive mental health services to psychiatric patients in China.

I am very grateful to the World Psychiatry Association and the University of Maryland for this training opportunity. I will be going to work closely with my colleagues and mentors in University of Maryland School of Medicine and apply what I have learnt in China in the future.

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