To investigate the correlation between thyroid hormone levels and cognitive function in schizophrenia (SCZ) patients with metabolic syndrome (MetS), as well as the mediating role of thyroid hormones in the relationship between MetS-related indicators and cognitive function.

A cross-sectional trial was conducted on 120 SCZ inpatients and outpatients (40 cases of MetS and 80 cases of non-MetS) and 80 healthy controls admitted in the Chongqing Mental Health Center from August 2023 to December 2024. Thyroid function indicators [Thyroid-stimulating hormone TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4)], MetS-related parameters [blood glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and waist circumference], Positive and Negative Syndrome Scale (PANSS) score, and Montreal Cognitive Assessment (MoCA) scores were collected. One-way ANOVA or Kruskal-Wallis rank sum test was applied to analyze the differences among the 3 groups, and LSD test or Bonferroni correction was performed for post hoc analysis. Pearson correlation analysis was conducted to assess the relationship between thyroid hormone levels and metabolic parameters as well as cognitive/clinical scale scores (MoCA, PANSS) in the MetS group.

The MetS group exhibited significantly lower FT4 level (P<0.05) and MoCA score (P=0.001), but higher TSH level (P<0.05) and PANSS negative symptom score (P<0.001) when compared to the non-MetS group. Correlation analysis indicated that in the MetS group, TSH level was positively correlated with TG (r=0.672, P<0.001) and PANSS negative symptom score (r=0.458, P<0.05), and negatively with HDL-C (r=-0.377, P=0.017) and MoCA score (r=-0.667, P<0.001); FT4 level was positively correlated with MoCA score(r=0.534, P<0.001). In the non-MetS group, TSH level was positively correlated with PANSS negative symptom score (r=0.267, P=0.017) and negatively with HDL-C (r=-0.236, P=0.036), T3 was positively with waist circumference (r=0.268,P=0.017). No correlation was observed in FT4 level with HDL-C (r=-0.207, P=0.067) or MoCA score (r=0.216, P=0.055). Mediation analysis revealed that TSH partially mediated the association between TG and MoCA score, with a mediation effect accounting for 29. 91% of the total effect. The mediating effect was not significant in the non-MetS group.

Abnormal elevation of TSH may serve as a critical link between MetS and cognitive impairment in SCZ patients, which providing novel insights into the mechanisms underlying cognitive dysfunction in the patients.

To compare the intervention effects of antidepressants combined with Yi Shu psychodrama or with general health education on depression, anxiety, self-esteem and mental resilience in depression patients with childhood trauma so as to explore a better clinical program.

A total of 68 patients who met the diagnostic criteria of ICD-10 unipolar depressive episode and also were positive for Childhood Trauma Questionnaire 28 item Short Form (CTQ-SF) were recruited from the psychiatric outpatients of our hospital, and then they were randomly divided into antidepressants plus Yi Shu psychodrama group and antidepressants plus general health education group. The patients were subsequently intervened for 6 months and then followed up for another 6 months. Hamilton Depression Rating Scale-17 item (HAMD-17), Beck Anxiety Inventory-21 item (BAI-21), Self-Esteem Scale (SES) and Connor-Davidson Resilience Scale (CD-RISC) were used for assessment. Repeated-measures ANOVA was adopted to compare the effects on depression and anxiety improvement, as well as the results of self-esteem and resilience development between the 2 groups at the end of intervention and during follow-up.

① There were 35 cases enrolled in the psychodrama group and 33 in the joint health education group. By the end of follow-up, 4 cases were lost in the former and 13 in the latter group, with statistical difference in shedding rate between the 2 groups (11.4% vs 39.4%, P<0.01). ② At the end of intervention, the total efficacy rate of the psychodrama group was higher than that of the health education group (63.63% vs 37.04%, Chi-square=4.207, P<0.05). ③ The results of repeated-measures ANOVA and simple effect analysis revealed that at the end of intervention, the scores of depression and anxiety were decreased in both groups, while those of self-esteem, mental resilience and its dimensions were increased, with significant differences in scores of HAMD, SES, CD-RISC and its dimensions (P<0.05), except for BAI score. During the follow-up, the scores of self-esteem and strength dimension were higher in the psychodrama group than the health education group (P<0.05).

In the treatment of major depressive disorder with childhood trauma, antidepressants combined with Yi Shu psychodrama has better overall efficacy and maintenance effect in improving depression, anxiety, self-esteem and mental resilience than the joint general health education program, with better treatment compliance as well.