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Shuy YK, Santharan S, Chew QH, Lin SK, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Tan CH, Xiang YT, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Pharmacoepidemiology and Clinical Correlates of Lithium Treatment for Bipolar Disorder in Asia. J Clin Psychopharmacol 2024; 44:117-123. [PMID: 38230861 DOI: 10.1097/jcp.0000000000001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND As clinical practices with lithium salts for patients diagnosed with bipolar disorder (BD) are poorly documented in Asia, we studied the prevalence and clinical correlates of lithium use there to support international comparisons. METHODS We conducted a cross-sectional study of use and dosing of lithium salts for BD patients across 13 Asian sites and evaluated bivariate relationships of lithium treatment with clinical correlates followed by multivariate logistic regression modeling. RESULTS In a total of 2139 BD participants (52.3% women) of mean age 42.4 years, lithium salts were prescribed in 27.3% of cases overall, varying among regions from 3.20% to 59.5%. Associated with lithium treatment were male sex, presence of euthymia or mild depression, and a history of seasonal mood change. Other mood stabilizers usually were given with lithium, often at relatively high doses. Lithium use was associated with newly emerging and dose-dependent risk of tremors as well as risk of hypothyroidism. We found no significant differences in rates of clinical remission or of suicidal behavior if treatment included lithium or not. CONCLUSIONS Study findings clarify current prevalence, dosing, and clinical correlates of lithium treatment for BD in Asia. This information should support clinical decision-making regarding treatment of BD patients and international comparisons of therapeutic practices.
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Affiliation(s)
- Yao Kang Shuy
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sanjana Santharan
- Department of Emergency and Crisis Care, Institute of Mental Health, Singapore
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | | | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changnyong, South Korea
| | - Jun Hyuk Park
- Jeju National University Hospital, Jeju University School of Medicine, Jeju, South Korea
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Kwong Sen Ding
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan, Malasia
| | - Jamaline Chong
- Hospital Permai Johor Bahru, Ministry of Health, Johor Bahru, Malaysia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing, China
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, Hebei, China
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Margarita M Maramis
- Department of Psychiatry, Dr Soetomo Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Paing Phyo Aung
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Chay Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | | | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | | | - Kang Sim
- West Region, Institute of Mental Health, Singapore
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2
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Chen CK, Yang SY, Park SC, Jang OJ, Zhu X, Xiang YT, Ouyang WC, Javed A, Sayeed Khan MN, Grover S, Avasthi A, Kallivayalil RA, Chee KY, Chemi N, Kato TA, Hayakawa K, Pariwatcharakul P, Maramis M, Seneviratne L, Sim K, Lin SK. Corrigendum to "Clinical use of mood stabilizers beyond treatment for bipolar disorder: The REAP-MS study" [Asian J. Psychiatry 85 (2023) 103613]. Asian J Psychiatr 2023; 89:103650. [PMID: 37308390 DOI: 10.1016/j.ajp.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, the Republic of Korea; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changyeong, the Republic of Korea; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences & Centre for Cognitive and Brain Sciences, University of Macau, Macao Sepcial Administrative Region of China; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan, Taiwan; Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - M Nasar Sayeed Khan
- Department of Psychiatry, Services Hospital, Lahore, Pakistan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Roy Abraham Kallivayalil
- Pushpagiri Institute of Medical Sciences, Tiruvalla, India; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Norliza Chemi
- Department of Psychiatry and Mental Health, Hospital Kajang, Selangor, Malaysia; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Kohei Hayakawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Pornjira Pariwatcharakul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Margarita Maramis
- Department of Psychiatry, Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Lakmi Seneviratne
- Department of Psychiatry, University of Sri Jayewardenepura, Sri Lanka; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore; Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Shih-Ku Lin
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China; Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar; Association for the Improvement of Mental Health Programs, Geneva, Switzerland; Department of Pharmacology, National University of Singapore, Singapore; Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia; School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan; Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan.
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3
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Wang SM, Lam BYH, Kuo LC, Hsu HM, Ouyang WC. Facial and upper-limb movement abnormalities in individuals with psychotic-like experiences: a motion analysis study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1369-1377. [PMID: 36350375 DOI: 10.1007/s00406-022-01517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
Slow movements and irregular muscle contraction have been reported separately in different studies targeting individuals with psychotic-like experiences (PLEs). To date, it remains unknown whether these two movement abnormalities, possibly associated with hypo- and hyper-dopaminergia, respectively, co-existed in one sample with PLEs and interrelated in the early stage of psychotic progression. Therefore, this study was to examine if facial and upper-limb slow movements and irregular muscle contraction co-existed in individuals with PLEs, interrelated, and were associated with PLEs. A total of 26 individuals with PLEs, who were identified using the 16-item Prodromal Questionnaire, and 26 age- and gender-matched healthy controls received the facial and upper-limb movement measurement. A motion capture system was used to record the movement procedure and thus calculate kinematic variables that represented severity of slow movements and irregular muscle contraction. Results showed that facial and upper-limb slow movements and facial irregular muscle contraction existed in individuals with PLEs. For the total sample, slower facial movements were associated with less regular facial muscle contraction; slower upper-limb movements were associated with less regular upper-limb muscle contraction. Slower and less regular facial and upper-limb movements were associated with more severe PLEs. Compensatory changes in dopaminergic neural pathways in response to elevated dopamine might explain connection between slow movements and irregular muscle contraction. Because of the ability to detect facial and upper-limb movement abnormalities objectively and sensitively, motion analysis has great applicability to sensorimotor studies for people in the psychosis continuum.
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Affiliation(s)
- Shu-Mei Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, Hong Kong.
| | - Bess Yin-Hung Lam
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Man Hsu
- Clinical Medicine and Advanced Applied Research Department, Point Robotics Medtech Incorporation, Taipei, Taiwan
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fang IL, Hsu MC, Ouyang WC. Lived Experience of Violence Perpetrated by Treated Patients and Their Visitors in Intensive Care Units: A Qualitative Study of Nurses. J Nurs Res 2023; 31:e284. [PMID: 37252848 DOI: 10.1097/jnr.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Patient and visitor violence (PVV) is a widespread problem for health professionals. Nurses working in intensive care units (ICUs) face a relatively high risk of experiencing PVV, which significantly impacts both the health of nurses and the institution as a whole. The subjective perceptions of ICU nurses regarding PVV are inadequately explored in the literature. PURPOSE The purpose of this study was to explore the perspectives, experiences, and perceptions of PVV in ICU nurses and to better understand the precipitating factors of violence. METHODS A phenomenological qualitative design and purposive sampling were used. A semistructured interview guide was used to conduct in-depth interviews with 12 ICU nurses with PVV experiences. Giorgi's method of analysis was used to discover and identify the essential categories of experience. RESULTS Five main experience categories were identified: family and patient factors as flashpoints, managing suppressed emotions by weathering the emotional storm, spiritual awakening after violence, and strategies for surviving further violence. The participants' experiences with PVV included a range of caring and mental health difficulties. In ICU settings, patient progress is often unpredictable, resulting in discrepancies between patient/family expectations and reality. Because feelings of frustration and powerlessness can eventually cause exhaustion in ICU nurses, implementing effective emotional management, stress adjustment, psychological counseling, team support, and violence intervention programs are crucial. CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study provides new information on the process by which nurses can progress from inner trauma to self-recovery, moving from a negative affectivity disposition to a better understanding of threat appraisals and coping response options. Nurses should increase their awareness of the complexity of the phenomenon and of the interplay among the factors underlying PVV. The results of this study suggest that routine confusion and delirium assessments to rule out patients with ICU delirium in ICUs are important to preventing PVV. This study considers some of the implications of the research findings for nursing managers. Interventions, training programs, and/or management action should be used to ensure psychological and mental support is extended to all witnesses of PVV events and not only to those targeted by violence.
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Affiliation(s)
- I-Lu Fang
- MSN, RN, Head Nurse, Department of Nursing, E-DA Hospital, Kaohsiung City, Taiwan
| | - Mei-Chi Hsu
- PhD, RN, Professor, Department of Nursing, I-Shou University, Kaohsiung City, Taiwan
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Chen CK, Yang SY, Park SC, Jang OJ, Zhu X, Xiang YT, Ouyang WC, Javed A, Khan MNS, Grover S, Avasthi A, Kallivayalil RA, Chee KY, Chemi N, Kato TA, Hayakawa K, Pariwatcharakul P, Maramis M, Seneviratne L, Sim K, Tang WK, Oo T, Sartorius N, Tan CH, Chong MY, Park YC, Shinfuku N, Lin SK. Clinical use of mood stabilizers beyond treatment for bipolar disorder: The REAP-MS study. Asian J Psychiatr 2023; 85:103613. [PMID: 37163943 DOI: 10.1016/j.ajp.2023.103613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Mood stabilizers are psychotropic drugs mainly used to treat bipolar disorder in the acute phase or for maintenance therapy to prevent relapse. In clinical practice, mood stabilizers are commonly prescribed for conditions other than bipolar disorder. This study investigated the distribution of mood stabilizer prescriptions for different psychiatric diagnoses and studied differences in the drugs, dosage, and plasma concentration in 10 Asian countries including Taiwan, South Korea, Malaysia, China, Thailand, India, Pakistan, Singapore, Indonesia, and Myanmar. METHODS Patients prescribed mood stabilizers (lithium, carbamazepine, valproic acid, or lamotrigine) for a psychiatric condition other than bipolar disorder (codes F31.0-F31.9 in the International Classification of Diseases, 10th Edition, Clinical Modification) were recruited through convenience sampling. A website-based data entry system was used for data collection. RESULTS In total, 1557 psychiatric patients were enrolled. Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders (F20-F29, 55.8 %) was the most common diagnosis, followed by non-bipolar mood disorders (F30, F31- F39, 25.3 %), organic mental disorder (F00-F09, 8.8 %), mental retardation (F70-F79, 5.8 %) and anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (F40-F48, 4.4 %). The most frequently targeted symptoms (>20 %) were irritability (48 %), impulsivity (32.4 %), aggression (29.2 %), anger (20.8 %), and psychosis (24.1 %). Valproic acid was the most frequently used medication. CONCLUSIONS Clinicians typically prescribe mood stabilizers as empirically supported treatment to manage mood symptoms in patients with diagnoses other than bipolar disorders, though there is on official indication for these disorders. The costs and benefits of this add-on symptomatic treatment warrant further investigation.
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Affiliation(s)
- Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital and School of Medicine, Chang Gung University, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea; Department of Psychiatry, Hanyang University Guri Hospital, Guri, the Republic of Korea
| | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changyeong, the Republic of Korea
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Faculty of Health Sciences & Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan, Taiwan; Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Norliza Chemi
- Department of Psychiatry and Mental Health, Hospital Kajang, Selangor, Malaysia
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohei Hayakawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Margarita Maramis
- Department of Psychiatry, Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Lakmi Seneviratne
- Department of Psychiatry, University of Sri Jayewardenepura, Sri Lanka
| | - Kang Sim
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Tin Oo
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia
| | - Yong Chon Park
- Department of Psychiatry, Hanyang University College of Medicine, Seoul, the Republic of Korea
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | - Shih-Ku Lin
- Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan.
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Loo LWJ, Chew QH, Lin SK, Yang SY, Ouyang WC, Chen CK, Park SC, Jang OJ, Park JH, Chee KY, Ding KS, Chong J, Zhang L, Li K, Zhu X, Jatchavala C, Pariwatcharakul P, Kallivayalil RA, Grover S, Avasthi A, Ansari M, Maramis MM, Aung PP, Sartorius N, Xiang YT, Tan CH, Chong MY, Park YC, Kato TA, Shinfuku N, Baldessarini RJ, Sim K. Clozapine Use for Bipolar Disorder: An Asian Psychotropic Prescription Patterns Consortium Study. J Clin Psychopharmacol 2023; 43:278-282. [PMID: 37068038 DOI: 10.1097/jcp.0000000000001693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Pharmacoepidemiological studies of clozapine use to treat bipolar disorder (BD), especially in Asia, are rare, although they can provide insights into associated clinical characteristics and support international comparisons of indications and drug dosing. METHODS We examined the prevalence and clinical correlates of clozapine treatment for BD in 13 Asian countries and regions (China, Hong Kong SAR, India, Indonesia, Japan, Korea, Malaysia, Myanmar, Pakistan, Singapore, Sri Lanka, Taiwan, and Thailand) within an Asian Prescription Patterns Research Consortium. We compared BD patients treated with clozapine or not in initial bivariate comparisons followed by multivariable logistic regression modeling. RESULTS Clozapine was given to 2.13% of BD patients overall, at a mean daily dose of 275 (confidence interval, 267-282) chlorpromazine-equivalent mg/day. Patients receiving clozapine were older, more likely males, hospitalized, currently manic, and given greater numbers of mood-stabilizing and antipsychotic drugs in addition to clozapine. Logistic regression revealed that older age, male sex, current mania, and greater number of other antipsychotics remained significantly associated with clozapine treatment. Clozapine use was not associated with depressed mood, remission of illness, suicidal risk, or electroconvulsive treatment within the previous 12 months. CONCLUSIONS The identified associations of clozapine use with particular clinical features call for vigilance in personalized clinical monitoring so as to optimize clinical outcomes of BD patients and to limit risks of adverse effects of polytherapy.
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Affiliation(s)
- Lek Wei Javier Loo
- From theLee Kong Chian School of Medicine, Nanyang Technological University
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | | | - Su-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei
| | | | - Chih-Ken Chen
- Chang Gung Memorial Hospital, Keelung Branch, Keelung
| | | | - Ok-Jin Jang
- Department of Psychiatry, Inje University School of Medicine, Haeundae Paik Hospital, Pusan
| | - Jun Hyuk Park
- Jeju National University Hospital, Jeju University School of Medicine, Jeju, South Korea
| | - Kok-Yoon Chee
- Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur
| | - Kwong Sen Ding
- Department of Psychiatry, Hospital Bahagia Ulu Kinta, Tanjung Rambutan, Perak Darul Ridzwan
| | - Jamaline Chong
- Hospital Permai Johor Bahru, Ministry of Health, Johor Bahru, Malaysia
| | - Ling Zhang
- The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, School of Mental Health, Capital Medical University, Beijing
| | - Keqing Li
- Hebei Provincial Mental Health Center, Baoding, Hebei
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Roy A Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Margarita M Maramis
- Department of Psychiatry, Dr. Soetomo Hospital-Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Paing Phyo Aung
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | | | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Health Management International, Singapore; Regency Specialist Hospital, Johor, Malaysia
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, South Korea
| | - Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
| | | | - Kang Sim
- West Region, Institute of Mental Health, Singapore
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Tsai CF, Huang MH, Cheng CM, Lee JJ, Wang WF, Huang LC, Huang LK, Lee WJ, Sung PS, Liu YC, Ouyang WC, Hsu CC, Fuh JL. Determinants of long-term care service use by persons with dementia: A national dementia registry study conducted in Taiwan. Int J Geriatr Psychiatry 2022; 37. [PMID: 35437817 DOI: 10.1002/gps.5719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study investigated the determinants and use of Taiwan's long-term care (LTC) Plan Version 2.0 (LTC 2.0) services by persons with dementia (PWDs) and their caregivers. METHODS In total, 1268 PWD-caregiver dyads were enrolled for analysis from a national dementia registry. Andersen's Behavioral Model of Health Services Use was used to investigate the association of LTC service use with several factors, namely the demographic data of PWDs and their caregivers, migrant caregiver employment, monthly household income, caregiver burden as determined by the Zarit Burden Interview (ZBI), Mini-Mental State Examination score, Clinical Dementia Rating scores, neuropsychiatric inventory scores for the behavioral and psychological symptoms of dementia, and PWDs' activities of daily living (ADLs). RESULTS Among the studied family caregivers, 81.4% did not use LTC resources. A multivariable logistic analysis revealed that aberrant motor behaviors (odd ratio [OR] = 1.31, 95% confidence interval [CI] = 1.10-1.56, p = 0.003), dysfunction in ADLs (OR = 1.06, 95% CI = 1.02-1.10, p = 0.002), higher ZBI scores (OR = 1.02, 95% CI = 1.01-1.03, p = 0.004), not residing with family members (OR = 1.88, 95% CI = 1.32-2.66, p < 0.001), and not employing a migrant caregiver (OR = 4.41, 95% CI = 2.59-7.51, p < 0.001) were the factors most significantly associated with LTC service use. CONCLUSION Factors such as whether PWDs live alone, specific neuropsychiatric symptoms, and impaired function should be considered in future policy amendments to provide required activities and care resources for PWDs and their caregivers.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, YuanShan and Suao Branches of Taipei Veterans General Hospital, Ilan, Taiwan
| | - Chih-Ming Cheng
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wen-Fu Wang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Li-Kai Huang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
- The PhD program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ju Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chien Liu
- Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan
- Fu Jen University School of Medicine, Taipei, Taiwan
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Rende, Taiwan
- Departemnt of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Tsai CF, Huang MH, Lee JJ, Jhang KM, Huang LC, Huang LK, Lee WJ, Sung PS, Liu YC, Ouyang WC, Cheng CM, Hsu CC, Fuh JL. Factors associated with burden among male caregivers for people with dementia. J Chin Med Assoc 2022; 85:462-468. [PMID: 35286289 DOI: 10.1097/jcma.0000000000000704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a dearth of information on male dementia caregivers in Asia and, in particular, on the factors relating to caregiver burden. We aimed to identify factors that may be associated with burden among male caregivers of people with dementia (PWD). METHODS Data were collected from a national dementia registration survey. The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). We analyzed the correlation between ZBI scores and variables, such as demographic data of PWD and their male caregivers, caregivers' monthly income, the relationship between PWD and caregivers, the severity of dementia, physical comorbidities and activities of daily living (ADL) of PWD, and neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI). RESULTS A total of 509 PWD and their male caregivers were included. The majority of caregivers were sons (72.1%) and husbands (22.0%). Sons had higher ZBI scores than husbands (28.5 ± 15.2 vs 22.0 ± 17.0; p < 0.001). Multivariable linear regression showed that sons as caregivers (β = 7.44, p = 0.034), ADL (β = 0.52, p = 0.002), and NPI_severity subscore of apathy (β = 2.74, p = 0.001) were positively associated with ZBI scores. CONCLUSION Poor ADL and apathy in PWD and being a patient's son were associated with higher levels of burden among male dementia caregivers. Effective interventions are needed to assist male caregivers in accomplishing their caregiving role and at the same time to alleviate their caregiver burden.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Ilan, Taiwan, ROC
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan, ROC
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Li-Kai Huang
- Department of Neurology, Shuang Ho Hospital, Taipei, Taipei Medical University, New Taipei City, Taiwan, ROC
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Ju Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yi-Chien Liu
- Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan, ROC
- Fu Jen University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, ROC
- Departemnt of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chih-Ming Cheng
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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9
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Lin SK, Yang SY, Park SC, Jang OJ, Zhu X, Xiang YT, Ouyang WC, Javed A, Khan MNS, Grover S, Avasthi A, Kallivayalil RA, Chee KY, Chemi N, Kato TA, Hayakawa K, Pariwatcharakul P, Maramis M, Seneviratne L, Kang S, Tang WK, Oo T, Sartorius N, Tan CH, Chong MY, Park YC, Shinfuku N. Prescription Patterns for Bipolar Disorder in Asian Countries: Findings from Research on Asian Prescription Pattern-Bipolar Disorder. Clin Psychopharmacol Neurosci 2022; 20:61-69. [PMID: 35078949 PMCID: PMC8813322 DOI: 10.9758/cpn.2022.20.1.61] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/25/2020] [Accepted: 12/26/2020] [Indexed: 12/29/2022]
Abstract
Objective Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.
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Affiliation(s)
- Shih-Ku Lin
- Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Yu Yang
- Department of Pharmacy, Taipei City Hospital, Taipei, Taiwan
| | - Seon-Cheol Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Korea
| | - Ok-Jin Jang
- Department of Psychiatry, Bugok National Hospital, Changyeong, Korea
| | - Xiaomin Zhu
- Department of Psychiatry, Suzhou Guangji Hospital, the Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yu-Tao Xiang
- Department of Psychiatry, Beijing Anding Hospital of Capital Medical University, Beijing, China
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan, Taiwan
- Department of Psychiatry, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kok Yoon Chee
- Department of Psychiatry & Mental Health, Tunku Abdul Rahman Institute of Neurosciences, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Norliza Chemi
- Department of Psychiatry and Mental Health, Hospital Kajang, Selangor, Malaysia
| | - Takahiro A. Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohei Hayakawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Margarita Maramis
- Department of Psychiatry, Dr. Soetomo Hospital - Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Lakmi Seneviratne
- Department of Psychiatry, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Sim Kang
- Institute of Mental Health, Buangkok Green Medical Park, Singapore
| | - Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong, China
| | - Tin Oo
- Mental Health Hospital, Yangon University of Medicine, Yangon, Myanmar
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
| | - Chay-Hoon Tan
- Department of Pharmacology, National University of Singapore, Singapore
| | - Mian-Yoon Chong
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung & Chang Gung University School of Medicine, Linkou, Taiwan
| | - Yong Chon Park
- Department of Neuropsychiatry, Hanyang University Guri Hospital, Guri, Korea
| | - Naotaka Shinfuku
- School of Human Sciences, Seinan Gakuin University, Fukuoka, Japan
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10
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Hsu MC, Chou MH, Ouyang WC. Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study. Int J Environ Res Public Health 2022; 19:ijerph19052661. [PMID: 35270354 PMCID: PMC8909790 DOI: 10.3390/ijerph19052661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023]
Abstract
Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan; (M.-C.H.); (M.-H.C.)
| | - Mei-Hsien Chou
- Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan; (M.-C.H.); (M.-H.C.)
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City 71742, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Correspondence: ; Tel.: +886-6-2795019
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Hsu MC, Ouyang WC. Effects of Integrated Moral Reasoning Development Intervention for Management of Violence in Schizophrenia: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11051169. [PMID: 35268258 PMCID: PMC8911519 DOI: 10.3390/jcm11051169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 02/06/2023] Open
Abstract
Moral cognition is an important and multidimensional, but often overlooked, determinant of violence. Very few interventions have systematically examined the role of moral reasoning, anger management and problem-solving together in violence. A randomized controlled trial was conducted to comprehensively evaluate the sustained effects of an integrated Moral Reasoning Development Intervention (MRDI) in the management of repetitive violence in schizophrenia. This study placed special emphasis on essential components related to moral reasoning and violence in patients with schizophrenia. Evaluations, including measures of violence, moral reasoning, ethical valuation and judgement, decision-making, conflict management style, and personality traits, were performed at baseline, end of intervention, and 1-month follow-up after intervention. We found that MRDI was superior to treatment-as-usual, in improving moral reasoning and related variables and violence outcomes (p < 0.05). In comparison with the treatment-as-usual group (n = 22), patients in the MRDI group (n = 21) showed improved levels of moral reasoning, with decreased levels of violent behaviors. The MRDI participants also experienced significantly greater improvements or changes (p < 0.05) in their ethical valuation and judgement, decision-making style and preferences, and conflict management style. Our findings provide important implications for risk assessment and violence management and prevention.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan;
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City 71742, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Correspondence: ; Tel.: +886-6-2795019
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12
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Wang SM, Ouyang WC, Hsu HM, Hsu LT. An Instrumental Measure of Hand and Facial Movement Abnormalities in Patients With Schizophrenia. Front Psychiatry 2022; 13:803661. [PMID: 35308887 PMCID: PMC8931260 DOI: 10.3389/fpsyt.2022.803661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Movement disorders have been suggested to be a cardinal component of schizophrenia. With increased research interests in this area, instrumental measures are needed. This study was to examine if the motion capture system was reliable in measuring hand and facial bradykinesia and dyskinesia and more sensitive to detecting movement differences between schizophrenia patients and healthy people than traditional rating scales. METHODS Sixteen schizophrenia patients and 20 control subjects were recruited. Hand and facial bradykinesia and dyskinesia were measured using the motion capture system and rated using the Extrapyramidal Symptom Rating Scale and the Abnormal Involuntary Movement Scale. RESULTS The system showed strong test-retest reliability and generated larger effect sizes of group differences than did the rating scales. CONCLUSIONS The results may support researchers and clinical practitioners to apply the system to sensitively measuring the hand and facial movement symptoms in schizophrenia patients, which contributes to gaining a deep understanding of movement issues in schizophrenia.
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Affiliation(s)
- Shu-Mei Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiao-Man Hsu
- Institute of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Ta Hsu
- Department of Aeronautical and Aviation Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Hsu MC, Ouyang WC. A Systematic Review of Effectiveness of Omega-3 Fatty Acid Supplementation on Symptoms, Social Functions, and Neurobiological Variables in Schizophrenia. Biol Res Nurs 2021; 23:723-737. [PMID: 34281415 DOI: 10.1177/10998004211020121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Disturbance of lipid, particularly omega-3 polyunsaturated fatty acid (PUFA), metabolism is associated with the etiology and symptoms of schizophrenia. Numerous clinical studies have tried to evaluate whether omega-3 PUFA supplementation can ameliorate the disorder, but the results are inconclusive. OBJECTIVES This systematic review integrates and refines the research evidence of the effectiveness of omega-3 PUFA nutritional supplementation on schizophrenia during the different developmental phases of the disease (prodromal, first-episode, and chronic phases) and examines whether different developmental stages modulate the efficacy of omega-3 PUFA supplementation. DATA SOURCES Scientific articles from 2000 to 2020 in PubMed/Medline, Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews guidelines. METHODS A systematic review was performed. We reviewed electronic databases and identified 1,266 clinical studies. Of these, 26 met the inclusion criteria. RESULTS The effectiveness of omega-3 dietary supplementation on symptoms varies among different phases of illness. Omega-3 supplementation significantly improves positive and negative symptoms at the prodromal phase, improves mainly the negative symptoms in patients with the first-episode, and effects symptoms partly in patients with chronic schizophrenia. DISCUSSION The effectiveness of omega-3 PUFA dietary supplementation is modulated by age, duration of untreated psychosis and illness, baseline levels of omega-3 fatty acids, and status of antioxidant capacity of patients. The important implications for psychiatric research and clinical practice developments as well as nursing care are presented and discussed.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, 54791I-Shou University, Kaohsiung City, Taiwan
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, 63443Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City, Taiwan.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Hsu MC, Lee SC, Ouyang WC. Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia. Healthcare (Basel) 2021; 9:healthcare9070783. [PMID: 34206232 PMCID: PMC8304975 DOI: 10.3390/healthcare9070783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000–2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Shang-Chi Lee
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan 71742, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung 82144, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: ; Tel.: +886-6-2795019
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Hsu MC, Huang YS, Ouyang WC. Beneficial effects of omega-3 fatty acid supplementation in schizophrenia: possible mechanisms. Lipids Health Dis 2020; 19:159. [PMID: 32620164 PMCID: PMC7333328 DOI: 10.1186/s12944-020-01337-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Schizophrenia is a serious long-term psychotic disorder marked by positive and negative symptoms, severe behavioral problems and cognitive function deficits. The cause of this disorder is not completely clear, but is suggested to be multifactorial, involving both inherited and environmental factors. Since human brain regulates all behaviour, studies have focused on identifying changes in neurobiology and biochemistry of brain in schizophrenia. Brain is the most lipid rich organ (approximately 50% of brain dry weight). Total brain lipids is constituted of more than 60% of phospholipids, in which docosahexaenoic acid (DHA, 22:6n-3) is the most abundant (more than 40%) polyunsaturated fatty acid (PUFA) in brain membrane phospholipids. Results from numerous studies have shown significant decreases of PUFAs, in particular, DHA in peripheral blood (plasma and erythrocyte membranes) as well as brain of schizophrenia patients at different developmental phases of the disorder. PUFA deficiency has been associated to psychotic symptoms and cognitive deficits in schizophrenia. These findings have led to a number of clinical trials examining whether dietary omega-3 fatty acid supplementation could improve the course of illness in patients with schizophrenia. Results are inconsistent. Some report beneficial whereas others show not effective. The discrepancy can be attributed to the heterogeneity of patient population. METHODS In this review, results from recent experimental and clinical studies, which focus on illustrating the role of PUFAs in the development of schizophrenia were examined. The rationale why omega-3 supplementation was beneficial on symptoms (presented by subscales of the positive and negative symptom scale (PANSS), and cognitive functions in certain patients but not others was reviewed. The potential mechanisms underlying the beneficial effects were discussed. RESULTS Omega-3 fatty acid supplementation reduced the conversion rate to psychosis and improved both positive and negative symptoms and global functions in adolescents at ultra-high risk for psychosis. Omega-3 fatty acid supplementation could also improve negative symptoms and global functions in the first-episode patients with schizophrenia, but improve mainly total or general PANSS subscales in chronic patients. Patients with low PUFA (particularly DHA) baseline in blood were more responsive to the omega-3 fatty acid intervention. CONCLUSION Omega-3 supplementation is more effective in reducing psychotic symptom severity in young adults or adolescents in the prodromal phase of schizophrenia who have low omega-3 baseline. Omega-3 supplementation was more effective in patients with low PUFA baseline. It suggests that patients with predefined lipid levels might benefit from lipid treatments, but more controlled clinical trials are warranted.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, No.8, Yida Road, Jiaosu Village Yanchao District, Kaohsiung, 82445 Taiwan
| | - Yung-Sheng Huang
- College of Medicine, I-Shou University, No.8, Yida Road, Jiaosu Village Yanchao District, Kaohsiung, 82445 Taiwan
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, No.539, Yuzhong Rd., Rende Dist., Tainan City, 71742 Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, No.452, Huanqiu Rd. Luzhu Dist, Kaohsiung, 82144 Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, No.100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708 Taiwan
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Wang SM, Ouyang WC, Wu MY, Kuo LC. Relationship between motor function and psychotic symptomatology in young-adult patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2020; 270:373-382. [PMID: 30976916 DOI: 10.1007/s00406-019-01004-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/21/2019] [Indexed: 12/29/2022]
Abstract
Motor abnormalities have been indicated to be a core manifestation of schizophrenia and not just motor side-effects of antipsychotics. However, little is known about whether all of the complete motor function, including fine motor function, muscle strength, and balance is linked to psychotic symptoms. Therefore, this study was to investigate association between complete motor function and psychotic symptoms in young-adult schizophrenia patients who had no extrapyramidal motor symptoms, which were assessed using the Extrapyramidal Symptom Rating Scale. Seventy schizophrenia patients were recruited. Fine motor function, muscle strength, and balance were assessed using The McCarron Assessment of Neuromuscular Development. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. Given gender differences in muscle power, the correlation between muscle strength and psychotic symptoms was analyzed by gender separately. Partial correlation controlling for effects of the chlorpromazine equivalent dosage of antipsychotics was conducted. Better fine motor function was correlated with less-severe negative symptoms (r = - 0.49, p < 0.001) in the total sample. In men, better muscle strength was correlated with more severe positive symptoms and less-severe negative symptoms (r = 0.41, p = 0.008; r = - 0.55, p < 0.001). The link between motor function and psychotic symptoms may support the cerebellar and basal ganglia hypotheses of schizophrenia, proposing that diverse schizophrenia symptoms may share the same neural deficiency, that is, dysfunction of cerebellum or basal ganglia. Considering the moderate-to-strong association between muscle strength and psychotic symptoms, muscle strength might be a powerful physical predictor of psychotic progression.
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Affiliation(s)
- Shu-Mei Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yi Wu
- Graduate Institute of Counseling Psychology and Rehabilitation Counseling, College of Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 70101, Taiwan. .,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Abstract
BACKGROUND/OBJECTIVE Patients with schizophrenia not only have psychiatric symptoms, but also have movement problems, which might also be associated with their reduced quality of life. Little is known about how to improve their movement performance for patients. Manipulating object size and distance is common in occupational therapy practice to evaluate and optimize reaching performance in patients with physical disabilities, but effects of the manipulation in patients with schizophrenia remain unclear. The purpose of this study was to examine whether object size and distance could change performance of reaching kinematics in patients with mild schizophrenia. METHODS Twenty-nine patients with mild schizophrenia and 15 age- and gender-matched healthy controls were required to reach for, as quickly as possible, a small or large object that was placed at a near or far distance. We measured movement time, peak velocity, path length ratio, percentage of time to peak velocity, and movement units to infer movement speed, forcefulness, spatial efficiency (directness), control strategies, and smoothness. RESULTS Patients' reaching movements were slower (p = .017) and less direct (p = .007) than those of controls. A larger object induced faster (p = .016), more preprogrammed (p = .018), and more forceful (p = .010) movements in patients. A farther object induced slower, more feedback dependent, but more forceful and more direct movements (all p < .001). CONCLUSION The results of kinematic deficiencies suggest the need of movement training for patients with mild schizophrenia. Occupational therapists may grade or adapt reaching activities by changing object size and distance to enhance movement performance in patients with schizophrenia.
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Abstract
BACKGROUND There are currently no systematic reviews or meta-analyses of Chinese calligraphy therapy (CCT) to reduce neuropsychiatric symptoms. The aim of this systematic review and meta-analysis was to explore the efficacy of CCT for people with neuropsychiatric symptoms. METHODS We searched Chinese and English databases, including the Cochrane Central Register of Controlled Trials and Wanfang Data for relevant articles published between the earliest year available and December 2016. The search was limited to randomized controlled trials and controlled clinical studies and the associated keywords were "handwriting," "Chinese calligraphy," "Chinese calligraphy therapy," "Calligraphy exercise," and "Calligraphy training." The 21 articles that met these criteria were used in the analysis. The Joanna Briggs Institute critical appraisal checklist was used to assess methodological quality. RESULTS CCT significantly reduced psychosis (10 studies, 965 subjects, standardized mean difference [SMD] = - 0.17, 95% confidence intervals [CI] [- 0.30, - 0.40], Z = 2.60, p < 0.01), anxiety symptoms (9 studies, 579 subjects, SMD = - 0.78, 95% CI [- 0.95, - 0.61], Z = 8.98, p < 0.001), and depressive symptoms (7 studies, 456 subjects, SMD = - 0.69, 95% CI [- 0.88, - 0.50], Z = 7.11, p < 0.001). CCT also significantly improved cognitive function (2 studies, 55 subjects, MD = 2.17, 95% CI [- 0.03, 4.38], Z = 1.93, p = 0.05) and neurofeedback (3 studies, 148 subjects, SMD = - 1.09, 95% CI [- 1.44, - 0.73], Z = 6.01, p < 0.001). The therapy also significantly reduced the positive psychopathological expression of schizophrenia symptoms (4 studies, 287 subjects, SMD = - 0.35, 95% CI [- 0.59, - 0.12], Z = 2.96, p = 0.003) and reduced the negative symptoms of schizophrenia (4 studies, 276 subjects, SMD = - 1.39, 95% CI [- 1.65, - 1.12], Z = 10.23, p < 0.001). CONCLUSIONS CCT exerts a curative effect on neuropsychiatric symptoms, but the evidence remains insufficient. A large number of RCTs are needed to facilitate additional systematic reviews of evidence for CCT.
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Affiliation(s)
- Kuan-Yu Chu
- Taoyuan General Hospital, Taoyuan City, Taiwan. .,Department of Fine Art & Culture Creative Design, Hua-Fan University, New Taipei City, Taiwan. .,College of General studies, Yuan-Ze University, Taoyuan City, Taiwan.
| | - Chih-Yang Huang
- grid.445071.3Department of Fine Art & Culture Creative Design, Hua-Fan University, New Taipei City, Taiwan
| | - Wen-Chen Ouyang
- Jianan Psychiatric Center, Tainan City, Taiwan ,0000 0000 9476 5696grid.412019.fDepartment of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chou PH, Ouyang WC, Lan TH, Chan CH. Secondary mania due to AIDS and cryptococcal meningitis in a 78-year-old patient. Psychogeriatrics 2016; 16:135-8. [PMID: 25919146 DOI: 10.1111/psyg.12127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/16/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
We report a 78-year-old man without past psychiatric history who experienced his first manic episode successfully treated with quetiapine and lorazepam, but was ultimately found to have AIDS and Cryptococcus neoformans meningitis. Our presented case highlights the importance of comprehensive differential diagnoses to rule out secondary causes of psychiatric symptoms presenting for the first time in elderly patients.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Chen Ouyang
- Department of Psychiatry, Changhua Christian Hospital, Changhua, Taiwan.,Section of Psychiatry, Lutung Christian Hospital, Changhua, Taiwan.,Department of Psychiatry, Kaohsiung Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chin-Hong Chan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
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Hsu YH, Cheng JS, Ouyang WC, Lin CL, Huang CT, Hsu CC. Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study. PLoS One 2015; 10:e0140510. [PMID: 26469976 PMCID: PMC4607300 DOI: 10.1371/journal.pone.0140510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/25/2015] [Indexed: 01/21/2023] Open
Abstract
Schizophrenia is closely associated with cardiovascular risk factors which are consequently attributable to the development of chronic kidney disease and end-stage renal disease (ESRD). However, no study has been conducted to examine ESRD-related epidemiology and quality of care before starting dialysis for patients with schizophrenia. By using nationwide health insurance databases, we identified 54,361 ESRD-free patients with schizophrenia and their age-/gender-matched subjects without schizophrenia for this retrospective cohort study (the schizophrenia cohort). We also identified a cohort of 1,244 adult dialysis patients with and without schizophrenia (1:3) to compare quality of renal care before dialysis and outcomes (the dialysis cohort). Cox proportional hazard models were used to estimate the hazard ratio (HR) for dialysis and death. Odds ratio (OR) derived from logistic regression models were used to delineate quality of pre-dialysis renal care. Compared to general population, patients with schizophrenia were less likely to develop ESRD (HR = 0.6; 95% CI 0.4–0.8), but had a higher risk for death (HR = 1.2; 95% CI, 1.1–1.3). Patients with schizophrenia at the pre-ESRD stage received suboptimal pre-dialysis renal care; for example, they were less likely to visit nephrologists (OR = 0.6; 95% CI, 0.4–0.8) and received fewer erythropoietin prescriptions (OR = 0.7; 95% CI, 0.6–0.9). But they had a higher risk of hospitalization in the first year after starting dialysis (OR = 1.4; 95% CI, 1.0–1.8, P < .05). Patients with schizophrenia undertaking dialysis had higher risk for mortality than the general ESRD patients. A closer collaboration between psychiatrists and nephrologists or internists to minimize the gaps in quality of general care is recommended.
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Affiliation(s)
- Yueh-Han Hsu
- Department of Public Health and Department of Health Services Administration, China Medical University, Taichung City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan
| | - Jur-Shan Cheng
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Chen Ouyang
- Department of Psychiatry, Changhua Christian Hospital and Changhua Christian Healthcare System, Changhua, Taiwan
- Lutung Christian Hospital, Changhua, Taiwan
- Department of Nursing, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Psychiatry, Kaohsiung Medicine University, Kaohsiung, Taiwan
| | - Chen-Li Lin
- Taipei City Hospital Fuyou Branch; Taipei, Taiwan
| | - Chi-Ting Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Department of Health Services Administration, China Medical University, Taichung City, Taiwan
- * E-mail:
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Wang SM, Kuo LC, Ouyang WC, Hsu HM, Lin KC, Ma HI. Effects of object size on unimanual and bimanual movements in patients with schizophrenia. Am J Occup Ther 2014; 68:230-8. [PMID: 24581410 DOI: 10.5014/ajot.2014.009811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Schizophrenia affects not only mental function but also movement. We compared the movement of patients with mild schizophrenia and healthy control participants during a bimanual assembly task and examined whether changes in object size affected unimanual and bimanual movements. Fifteen patients with schizophrenia and 15 age- and gender-matched control participants were instructed to bimanually reach for and assemble objects. We manipulated the object size for the left hand (large vs. small) and measured movement time, peak velocity, and bimanual synchronization to represent movement speed, forcefulness, and bimanual coordination. Patients with schizophrenia showed slower and less forceful unimanual movements and less coordinated bimanual movements than control participants. Increasing the object size elicited faster and more forceful unimanual movements and more coordinated bimanual movements in patients. The results suggest the need for movement rehabilitation in patients with schizophrenia and the possibility of manipulating object size to optimize patients' movements. These results benefit the practice of evidence-based therapy.
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Affiliation(s)
- Shu-Mei Wang
- Shu-Mei Wang, MS, OT, is Doctoral Candidate, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Li-Chieh Kuo, PhD, OT, is Associate Professor, Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chen Ouyang
- Wen-Chen Ouyang, PhD, MD, is Director, Department of Geriatric Psychiatry, Jianan Mental Hospital, Department of Health, Executive Yuan, Tainan, Taiwan
| | - Hsiao-Man Hsu
- Hsiao-Man Hsu, MS, OT, is Doctoral Candidate, Institute of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Keh-Chung Lin
- Keh-Chung Lin, ScD, OTR, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Hui-Ing Ma
- Hui-Ing Ma, ScD, OT, is Professor, Department of Occupational Therapy and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 701, Taiwan;
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Affiliation(s)
- Norman Sartorius
- *To whom correspondence should be addressed; Association for the Improvement of Mental Health Programmes, 14 chemin Colladon, 1209 Geneva, Switzerland; tel: 22-788-2331, fax: 22-788-2334, e-mail:
| | - Helen Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Kua Ee Heok
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
| | - Min-Soo Lee
- Department of Psychiatry, Korea University, Seoul, Republic of Korea
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Tainan City, Taiwan
| | - Mitsumoto Sato
- Japanese Society for the Elimination of Barriers to Mental Health, Tokyo, Japan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University, Tainan City, Taiwan
| | - Xin Yu
- Institute of Mental Health, Peking University, Beijing, China
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Chen CH, Lee CS, Lee MTM, Ouyang WC, Chen CC, Chong MY, Wu JY, Tan HKL, Lee YC, Chuo LJ, Chiu NY, Tsang HY, Chang TJ, Lung FW, Chiu CH, Chang CH, Chen YS, Hou YM, Chen CC, Lai TJ, Tung CL, Chen CY, Lane HY, Su TP, Feng J, Lin JJ, Chang CJ, Teng PR, Liu CY, Chen CK, Liu IC, Chen JJ, Lu T, Fan CC, Wu CK, Li CF, Wang KHT, Wu LSH, Peng HL, Chang CP, Lu LS, Chen YT, Cheng ATA. Variant GADL1 and response to lithium therapy in bipolar I disorder. N Engl J Med 2014; 370:119-28. [PMID: 24369049 DOI: 10.1056/nejmoa1212444] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lithium has been a first-line choice for maintenance treatment of bipolar disorders to prevent relapse of mania and depression, but many patients do not have a response to lithium treatment. METHODS We selected subgroups from a sample of 1761 patients of Han Chinese descent with bipolar I disorder who were recruited by the Taiwan Bipolar Consortium. We assessed their response to lithium treatment using the Alda scale and performed a genomewide association study on samples from one subgroup of 294 patients with bipolar I disorder who were receiving lithium treatment. We then tested the single-nucleotide polymorphisms (SNPs) that showed the strongest association with a response to lithium for association in a replication sample of 100 patients and tested them further in a follow-up sample of 24 patients. We sequenced the exons, exon-intron boundaries, and part of the promoter of the gene encoding glutamate decarboxylase-like protein 1 (GADL1) in 94 patients who had a response to lithium and in 94 patients who did not have a response in the genomewide association sample. RESULTS Two SNPs in high linkage disequilibrium, rs17026688 and rs17026651, that are located in the introns of GADL1 showed the strongest associations in the genomewide association study (P=5.50×10(-37) and P=2.52×10(-37), respectively) and in the replication sample of 100 patients (P=9.19×10(-15) for each SNP). These two SNPs had a sensitivity of 93% for predicting a response to lithium and differentiated between patients with a good response and those with a poor response in the follow-up cohort. Resequencing of GADL1 revealed a novel variant, IVS8+48delG, which lies in intron 8 of the gene, is in complete linkage disequilibrium with rs17026688 and is predicted to affect splicing. CONCLUSIONS Genetic variations in GADL1 are associated with the response to lithium maintenance treatment for bipolar I disorder in patients of Han Chinese descent. (Funded by Academia Sinica and others.).
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Chung MS, Yang AC, Lin YC, Lin CN, Chang FR, Shen SH, Ouyang WC, Loh EW, Chiu HJ. Association of altered cardiac autonomic function with psychopathology and metabolic profiles in schizophrenia. Psychiatry Res 2013; 210:710-5. [PMID: 23978730 DOI: 10.1016/j.psychres.2013.07.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/23/2013] [Accepted: 07/27/2013] [Indexed: 12/29/2022]
Abstract
Schizophrenia has been associated with autonomic dysregulation and increased cardiovascular co-morbidity. We hypothesised that autonomic dysregulation in patients with schizophrenia is associated with psychopathology and metabolic profiles. In this study, we aimed to evaluate psychopathology, comprehensive metabolic profiles and cardiac autonomic function using heart-rate variability (HRV) analysis in patients with schizophrenia. A total of 94 patients with schizophrenia and 51 healthy controls were recruited. Each patient underwent a physical examination, laboratory tests and rating scale evaluation, and all subjects underwent a 1-h electrocardiogram monitoring. Analysis of variance was used to compare demographic and HRV variables between control and patient groups. We applied multiple regression analysis with backward selection to examine the association between HRV indices and demographic, metabolic and psychopathology profiles. A decreased HRV was found in patient groups, compared to controls. Reduced vagal-related and complexity domain of HRV indices in patient groups were correlated with increased body mass indices, diastolic pressure, triglycerides, high- and low-density lipoprotein and severity of psychosis mainly in the negative symptom domain. This study provides evidence that altered autonomic function is associated with both psychopathology and metabolic profiles in patients with schizophrenia. These findings may warrant future research in using HRV as objective markers to monitor cardiovascular health and the severity of psychosis in patients with schizophrenia.
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Lee YT, Tsai CF, Ouyang WC, Yang AC, Yang CH, Hwang JP. Daytime sleepiness: a risk factor for poor social engagement among the elderly. Psychogeriatrics 2013; 13:213-20. [PMID: 24289462 DOI: 10.1111/psyg.12020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 08/13/2012] [Accepted: 04/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between social engagement and daytime sleepiness among aged residents of a veterans' housing facility in Taiwan. METHODS A total of 597 men were enrolled in this cross-sectional study. Each subject was assessed with the Resident Assessment Instrument-Minimum Data Set, Geriatric Depression Scale, Pittsburgh Sleep Quality Index, and Mini-Mental State Examination. Social engagement was measured with the Index of Social Engagement (ISE), and daytime sleepiness was defined according to the relevant Pittsburgh Sleep Quality Index subcomponent. Subjects were divided into two groups according to their ISE levels. A multivariate logistic regression model was used to examine the association between ISE and other variables. RESULTS The sample's mean age was 80.8 ± 5.0 years (range: 65-99 years). Mean ISE score was 1.5 ± 1.3 (range 0-5), with 52% of participants reporting poor social engagement (ISE = 0-1). Mean Pittsburgh Sleep Quality Index global score was 5.6 ± 3.6 (range: 0-18), and 31% of participants reported daytime sleepiness. The analysis was adjusted for level of depression, cognitive impairment, dependence in activities of daily life, unsettled relationships, and illiteracy. After adjustment, daytime sleepiness was found to be independently associated with subjects' level of social engagement (odds ratio: 2.5; 95% confidence interval: 1.7-3.8; P < 0.001). CONCLUSIONS Daytime sleepiness and poor social engagement are common among aged residents of a veterans' housing facility. Subjects experiencing daytime sleepiness but not poor general sleep quality were at increased risk of poor social engagement. The clinical care of older residents must focus on improving daytime sleepiness to enhance their social engagement.
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Affiliation(s)
- Yao-Tung Lee
- Department of Psychiatry, Taipei Veterans General Hospital, New Taipei City, Taiwan; Department of Psychiatry, Shuang Ho Hospital, New Taipei City, Taiwan
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Wang SM, Kuo LC, Ouyang WC, Hsu HM, Ma HI. A fast-moving target in the Valpar assembly task improved unimanual and bimanual movements in patients with schizophrenia. Disabil Rehabil 2013; 35:1608-13. [PMID: 23311672 DOI: 10.3109/09638288.2012.748837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the effects of target speed on unimanual and bimanual movements during a bimanual prehension and assembly task in patients with mild schizophrenia and healthy controls. METHOD Fifteen patients with schizophrenia and 15 age- and gender-matched healthy controls were instructed to reach and assemble spacers with both hands for a target that moved at two speeds: fast or slow. Dependent variables were movement kinematics: movement time, number of movement units and timing intervals between both hands. RESULTS A fast-moving target induced shorter movement times, fewer movement units and shorter timing intervals than did a slow-moving target for patients. Under the slow-target condition, patients had longer movement times and a longer timing interval during prehension, as well as longer movement times, more movement units and a longer timing interval during assembly than did controls. Under the fast-target condition, patients still had slower and less-synchronized prehension than did controls, but their assembly improved to a level similar to that of controls. CONCLUSIONS A fast-moving target induced faster, smoother and more synchronized movements than did a slow-moving target for patients with schizophrenia, especially during assembly. IMPLICATIONS FOR REHABILITATION A fast-moving target might elicit faster, smoother, and more synchronized movements than might a slow-moving target during a bimanual assembly task for patients with mild schizophrenia. The findings of impaired movement kinematics under the slow-target condition suggest that patients with schizophrenia need movement training.
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Ouyang WC, Hsu MC, Yeh IN, Kuo CC. Efficacy and safety of combination of risperidone and haloperidol with divalproate in patients with acute mania. Int J Psychiatry Clin Pract 2012; 16:178-88. [PMID: 22404731 DOI: 10.3109/13651501.2011.644564] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The current study evaluated the efficacy and safety of risperidone and haloperidol as an adjunctive agent in combination with divalproate in patients with an episode of acute mania. METHODS This 6-week randomized, single-blind study was conducted in psychiatric wards of a mental hospital. A total of 41 patients were randomly assigned to the risperidone (risperidone plus divalproate) or haloperidol groups (haloperidol plus divalproate). Efficacy was assessed by changes in symptom rating scales [Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impression (CGI) scores]. Safety and tolerability were assessed by monitoring the Extrapyramidal Symptom Rating Scale (ESRS) and Hamilton Rating Scale for depression. RESULTS Mean doses at baseline, and at weeks 4 and 6 were 3.77, 4.95 and 5.00 mg/day of risperidone and 5.89, 9.95 and 8.58 mg/day of haloperidol, respectively. Risperidone was shown to have significant anti-manic effects which was observed as early as week 1, following start of treatment. The BPRS scores were in favor of risperidone at week 2. Patients receiving risperidone exhibited significant greater global improvement on the CGI, as early as week 2 and over the entire treatment period, than haloperidol after 4 weeks of treatment. The ESRS at endpoint were significantly higher in the haloperidol patients. CONCLUSIONS Risperidone plus divalproate was more efficacious than haloperidol plus divalproate for treatment of acute mania, and was well tolerated due to its evidence showing rapid anti-manic action, effective and sustained control of manic and psychotic symptoms and a favorable safety and tolerability profile in acute mania.
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Affiliation(s)
- Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Mental Hospital, Taiwan.
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Yeh YC, Ouyang WC. Mood stabilizers for the treatment of behavioral and psychological symptoms of dementia: an update review. Kaohsiung J Med Sci 2012; 28:185-93. [PMID: 22453066 DOI: 10.1016/j.kjms.2011.10.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/28/2011] [Indexed: 01/21/2023] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) are common and debilitating problems, but current treatments are limited. Antipsychotic agents show some efficacy on BPSD, but their use is limited by the associated risk of cerebrovascular events and mortality. Reports have shown the efficacy of mood stabilizers on BPSD, but systemic reviews on this issue are scant. This article aims to review studies of the efficacy of mood stabilizers on BPSD, and the quality of the available evidence. We searched for articles published in English during the period 1990 to 2010 and included in the PubMed database that concerned treatment of BPSD with mood stabilizers, such as carbamazepine, valproate, gabapentin, topiramate, lamotrigine, oxcarbazepine and lithium. The quality of the studies was assessed by considering the trial designs, analyses, subjects and results. We found one meta-analysis and three randomized controlled trials (RCTs) supporting the efficacy of carbamazepine in managing global BPSD, particularly aggression and hostility. With regard to valproate, current evidence from one meta-analysis and five RCTs did not strongly support its efficacy for global BPSD, including agitation and aggression. Only open trials or case series showed some efficacy of gabapentin, topiramate and lamotrigine in controlling BPSD. The single RCT investigating the effect of oxcarbazepine on agitation and aggression showed negative results. Case series reports on lithium tended to show it to be ineffective. Thus far, among mood stabilizers, carbamazepine has the most robust evidence of efficacy on BPSD. More RCTs are needed to strengthen evidence regarding the efficacy of gabapentin, topiramate and lamotrigine. Valproate, oxcarbazepine and lithium showed low or no evidence of efficacy. Large and well designed RCTs focusing on specific symptoms of BPSD are needed to deal with the issue.
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Affiliation(s)
- Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Tsai CF, Ouyang WC, Tsai SJ, Hong CJ, Lin TL. Risk factors for poor sleep quality among patients with interstitial cystitis in Taiwan. Neurourol Urodyn 2010; 29:568-72. [PMID: 19899148 DOI: 10.1002/nau.20799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Previous research has suggested that patients with interstitial cystitis have more sleep disturbances and higher levels of depression. However, reports that employ validated sleep questionnaires are rare for this population. The present study investigates the relationship between sleep quality, anxiety, depression, and the severity of urologic interstitial cystitis symptoms in outpatients, and risk factors for poor sleep quality. METHODS A total of 69 patients (52 female) with interstitial cystitis met National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases (NIDDK) criteria, completed all instruments. The O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI) was performed to assess interstitial cystitis severity. The Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate quality of sleep and depression level, respectively. Multiple linear regressions were used to identify independent factors of sleep quality. RESULTS Mean PSQI global score was 9.5 +/- 4.2 (range: 1-19); 81.2% of subjects had poor sleep quality (PSQI > 5). Regression analysis suggested that the severity of interstitial cystitis (Beta coefficient = 0.42, P < 0.001) and level of anxiety and depression (Beta coefficient = 0.26, P < 0.05) were significant independent risk factors for poor sleep quality, after controlling for age, gender, marital status, years of education, and years of symptomatic duration. Further analysis of ICSI subdomain scores shows that association between nighttime urination and poor sleep quality remains significantly (Beta coefficient = 0.32, P < 0.05), after adjustment for demographic data and anxiety and depression. CONCLUSIONS Poor sleep quality is common in interstitial cystitis patients and severity of urological symptoms and depression levels are important independent risk factors.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
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Hsu MC, Moyle W, Creedy D, Venturato L, Ouyang WC, Sun GC. Attitudes toward and education about complementary and alternative medicine among adult patients with depression in Taiwan. J Clin Nurs 2010; 19:988-97. [PMID: 20492043 DOI: 10.1111/j.1365-2702.2009.02848.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS To investigate patients' attitudes toward complementary and alternative medicine, the education nurses provided about complementary and alternative medicine for treating depression and to test whether such education mediates the effect of complementary and alternative medicine use and attitudes toward complementary and alternative medicine. BACKGROUND Although we know that attitudes influence behaviour, very few studies simultaneously explore the relationship between attitudes, education and complementary and alternative medicine use. DESIGN Survey. METHODS This study was conducted as part of a larger survey, using face-to-face survey interviews with 206 adult patients aged 50 years or over and hospitalised in conventional hospitals in Taiwan for treatment of depression. The attitudes toward complementary and alternative medicine and patient education about complementary and alternative medicine instruments were specially developed for the study. RESULTS Participants expressed slightly favourable attitudes toward complementary and alternative medicine. Many participants (50%) expressed that they were willing to try any potential treatment for depression. They believed that complementary and alternative medicine helped them to feel better and to live a happier life. However, 66.5% of participants reported that they had inadequate knowledge of complementary and alternative medicine. Participants with a higher monthly income, longer depression duration and religious beliefs hold more positive attitudes toward complementary and alternative medicine. Most participants were not satisfied with the education they received about complementary and alternative medicine. Patient education about complementary and alternative medicine was found to be a mediator for the use of complementary and alternative medicine. CONCLUSION Patient education from nurses may predict patients' attitudes toward complementary and alternative medicine. Continuing nursing education is needed to enable nurses to respond knowledgeably to concerns patients may have about complementary and alternative medicine and treatment options. RELEVANCE TO CLINICAL PRACTICE This study highlights the potential role of patient education about complementary and alternative medicine as an effective way of adjusting patients' attitudes toward complementary and alternative medicine and to link both patients' preferences for complementary and alternative medicine and health professionals' concerns about the proper use of complementary and alternative medicine for depression management and adverse drug interactions.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung County, Taiwan
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Tsai CF, Ouyang WC, Chen LK, Lan CF, Hwang SJ, Yang CH, Su TP. Depression is the strongest independent risk factor for poor social engagement among Chinese elderly veteran assisted-living residents. J Chin Med Assoc 2009; 72:478-83. [PMID: 19762316 DOI: 10.1016/s1726-4901(09)70411-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Social engagement prolongs the lifespan and preserves cognition in the elderly. However, most studies concerning social engagement have been conducted in Western countries; few have been performed in the Chinese population. This study attempted to identify the risk factors for poor social engagement among elderly veterans in Taiwan. METHODS A total of 597 male veterans were enrolled, with a mean age of 80.8 +/- 5.0 years. This cross-sectional study employed the Resident Assessment Instrument (RAI) Minimum Data Set (MDS), the Geriatric Depression Scale-Short Form (GDS-SF), and the Mini-Mental State Examination (MMSE). Multivariate logistic regression analysis was done to investigate significant independent risk factors for poor social engagement, which were identified using the MDS Index of Social Engagement (ISE). RESULTS Mean ISE score was 1.5 +/- 1.3 (range, 0-5); 52% of subjects had poor levels of social engagement (ISE < 2; 312/597). Regression analyses suggested that depression (OR, 6.6; 95% CI, 2.7-16.1; p < 0.001), illiteracy (OR, 2.2; 95% CI, 1.3-3.8; p = 0.003), the presence of unsettled relationships (OR, 3.6; 95% CI, 1.5-8.7; p = 0.004), and cognitive impairment (OR, 2.0; 95% CI, 1.1-3.9; p = 0.03) were significant independent risk factors for poor social engagement, after controlling for age, marital status, level of daily living activity and degree of sensory impairment. CONCLUSION Poor social engagement is common among Chinese assisted-living veteran home residents. Depression is the greatest risk factor of poor social engagement in this population.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Hsu MC, Moyle W, Creedy D, Venturato L, Ouyang WC, Tsay SL. Use of antidepressants and complementary and alternative medicine among outpatients with depression in Taiwan. Arch Psychiatr Nurs 2009; 23:75-85. [PMID: 19216991 DOI: 10.1016/j.apnu.2008.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 01/24/2008] [Accepted: 03/29/2008] [Indexed: 10/21/2022]
Abstract
Understanding use of complementary and alternative medicine (CAM) and antidepressants during patient's recovery for depression is important to enhance their psychological functioning and promote positive health care outcomes. This study investigated the use of antidepressant treatment and CAM in outpatients with depression 1 month after discharge from psychiatric hospitalization. Telephone surveys were conducted. Of the 201 participants, 50.2% reported using CAM 1 month after discharge. Nearly 41% (n = 82) used a combination of both antidepressant treatment and CAM after hospital discharge. The most commonly used CAMs were spiritual healing, relaxation techniques, and herbal medicine. Symptom relief was the top reason participants used CAM for depression. A number of factors were associated with higher odds of using CAM. CAM is often considered as a valued component of holistic care plan after discharge. It is important for nurses to identify the CAM approaches patients are using so that this information can assist in the education of patients and family about the benefits of contemporary treatments for depression, possible interactions when combining treatments, and the CAM and conventional medicine that can be helpful to relieve depression symptoms and psychological distress.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Taiwan, R.O.C
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Hsu MC, Creedy D, Moyle W, Venturato L, Tsay SL, Ouyang WC. Use of Complementary and Alternative Medicine among adult patients for depression in Taiwan. J Affect Disord 2008; 111:360-5. [PMID: 18442859 DOI: 10.1016/j.jad.2008.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 03/18/2008] [Accepted: 03/18/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND This descriptive exploratory study investigated the prevalence and type of Complementary and Alternative Medicine (CAM) use among older Taiwanese patients with a diagnosis of depression. METHOD Self-report questionnaire. RESULTS A convenience sample of 206 in-patients (98% response rate) completed the survey. Nearly 70% (69.9%) reported using at least one form of CAM in the past 12 months. Twenty-one kinds of CAM were identified in the treatment of depression, the most common being herbal medicines, spiritual healing, and folk remedies. Only one-third (35.4%, n=73) had discussed CAM use with their psychiatrists. Participants with mild to moderate depression tended to use more CAM than participants with severe depression (GDS-SF: Cramer's V=-.233; HDRS: Cramer's V=.201). CONCLUSIONS This study confirms the high prevalence of CAM use among older adults with a diagnosis of depression in Taiwan. The popularity of CAM appears to be a consequence of people's preference for a more holistic approach to health care. CAM use needs to be explicitly discussed between patients and health professionals as part of ongoing assessment, patient education and management.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, No. 8, Yida Rd., Yanchao Township, Kaohsiung County 82445, Taiwan.
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Liu YL, Fann CSJ, Liu CM, Chen WJ, Wu JY, Hung SI, Chen CH, Jou YS, Liu SK, Hwang TJ, Hsieh MH, Ouyang WC, Chan HY, Chen JJ, Yang WC, Lin CY, Lee SFC, Hwu HG. A single nucleotide polymorphism fine mapping study of chromosome 1q42.1 reveals the vulnerability genes for schizophrenia, GNPAT and DISC1: Association with impairment of sustained attention. Biol Psychiatry 2006; 60:554-62. [PMID: 16997000 DOI: 10.1016/j.biopsych.2006.04.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Revised: 04/21/2006] [Accepted: 04/25/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The marker D1S251 of chromosome 1q42.1 showed significant association with schizophrenia in a Taiwanese sample. We used single nucleotide polymorphism (SNP) fine mapping to search for the vulnerability genes of schizophrenia. METHODS We selected 120 SNPs covering 1 Mb around D1S251 from the public database. These selected SNPs were initially validated if allele frequency was >10%. Forty-seven validated SNPs were genotyped in 102 families with at least 2 siblings affected with schizophrenia. RESULTS Two SNP blocks showed significant association with schizophrenia. Block 1 (five-SNP), located between intron 2 and intron 13 of the glyceronephosphate O-acyltransferase (GNPAT) gene, showed the most significant associations using single-locus TDT (z = -2.07, p = .038, df = 1) and haplotype association analyses (z = -1.99, p = .046, df = 1). Block 2 (two-SNP), located between intron 4 and intron 5 of the disrupted-in-schizophrenia 1 (DISC1) gene, also showed the most significant results in both the single-locus (z = -3.22, p = .0013, df = 1) and haplotype association analyses (z = 3.35, p = .0008, df = 1). The association of the DISC1 gene with schizophrenia was mainly in the patient group with sustained attention deficits as assessed by the Continuous Performance Test. CONCLUSIONS Chromosome 1q42.1 harbors GNPAT and DISC1 as candidate genes for schizophrenia, and DISC1 is associated with sustained attention deficits.
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Affiliation(s)
- Yu-Li Liu
- Division of Mental Health and Substance Abuse Research, National Health Research Institutes, Taipei, Taiwan
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Liu YL, Shen-Jang Fann C, Liu CM, Wu JY, Hung SI, Chan HY, Chen JJ, Lin CY, Liu SK, Hsieh MH, Hwang TJ, Ouyang WC, Chen CY, Lin JJ, Chou FHC, Chueh CM, Liu WM, Tsuang MM, Faraone SV, Tsuang MT, Chen WJ, Hwu HG. Evaluation of RGS4 as a candidate gene for schizophrenia. Am J Med Genet B Neuropsychiatr Genet 2006; 141B:418-20. [PMID: 16526029 DOI: 10.1002/ajmg.b.30286] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several studies have suggested that the regulator of G-protein signaling 4 (RGS4) may be a positional and functional candidate gene for schizophrenia. Three single nucleotide polymorphisms (SNP) located at the promoter region (SNP4 and SNP7) and the intron 1 (SNP18) of RGS4 have been verified in different ethnic groups. Positive results have been reported in these SNPs with different numbers of SNP combinatory haplotypes. In this study, these three SNP markers were genotyped in 218 schizophrenia pedigrees of Taiwan (864 individuals) for association analysis. Among these three SNPs, neither SNP4, SNP7, SNP18 has shown significant association with schizophrenia in single locus association analysis, nor any compositions of the three SNP haplotypes has shown significantly associations with the DSM-IV diagnosed schizophrenia. Our results fail to support the RGS4 as a candidate gene for schizophrenia when evaluated from these three SNP markers.
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Affiliation(s)
- Yu-Li Liu
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Liu YL, Fann CSJ, Liu CM, Wu JY, Hung SI, Chan HY, Chen JJ, Pan CC, Liu SK, Hsieh MH, Hwang TJ, Ouyang WC, Chen CY, Lin JJ, Chou FHC, Chueh CM, Liu WM, Tsuang MM, Faraone SV, Tsuang MT, Chen WJ, Hwu HG. Absence of significant associations between four AKT1 SNP markers and schizophrenia in the Taiwanese population. Psychiatr Genet 2006; 16:39-41. [PMID: 16395129 DOI: 10.1097/01.ypg.0000180681.80546.f3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AKT1 (V-akt murine thymoma viral oncogene homolog 1) is a protein kinase isoform of AKT. Five single-nucleotide polymorphisms, rs3803300, rs1130214, rs3730358, rs2498799 and rs2494732, at the genomic region of AKT1 have been reported to be significantly associated with schizophrenia. We tested for the presence of these five single-nucleotide polymorphisms in a Taiwanese population by genotyping 218 co-affected schizophrenia families. Both single locus and haplotypes analyses showed no association of these single-nucleotide polymorphisms with schizophrenia. These findings fail to support AKT1 as a susceptibility gene for schizophrenia in the Taiwanese population.
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Affiliation(s)
- Yu-Li Liu
- Department of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
In contrast with two previous western reports, a recent study on a Chinese population found an association for allele 12 of the variable number tandem repeat (VNTR) in the second intron of the serotonin transporter (5-HTT) gene and schizophrenic disorders. We have replicated this finding for a Chinese population in Taiwan (114 schizophrenic patients and 127 controls), demonstrating a modest but significant statistical association for the 5-HTT-VNTR allele 12 and schizophrenic patients (one-sided p = 0.043). This positive finding further supports the proposition that the 5-HTT-VNTR allele 12 is a risk factor for schizophrenic disorders in Chinese populations, although the effect is weak.
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Affiliation(s)
- Shih-Jen Tsai
- Department of Psychiatry, Veterans General Hospital-Taipei, Taipei, Taiwan, ROC
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Abstract
Angiotensin-converting enzyme (ACE) is a key enzyme in the renin-angiotensin system and can modulate dopamine turnover in the midbrain. Previous studies have revealed changes in the central ACE levels for schizophrenic patients, possibly related to the polydipsia commonly demonstrated for chronic schizophrenia. An insertion (I)/deletion (D) polymorphism of the ACE gene has been associated with ACE levels. Therefore, we elected to investigate the ACE I/D polymorphism for 124 schizophrenic patients and 117 control subjects. No significant differences for the genotype distribution or the allele frequency were revealed comparing controls and schizophrenic patients. The ACE genotypes were not associated with onset age or psychiatric symptoms for the schizophrenic cases. A modest association was revealed for this ACE polymorphism and polydipsia diagnosis for these patients. Using bearers of the D allele as baseline, the ratio for I/I homozygote was 2.31 (95% CI 0.95-5.65). This association needs further replication as it may have implications for the pathogenesis and the treatment of polydipsia for schizophrenic patients.
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Affiliation(s)
- W C Ouyang
- Section of Geriatric Psychiatry, Provisional Chia-Nan Psychiatric Center, Tainan, Taiwan, ROC
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Abstract
Schizophrenic disorders are equally distributed for both sexes; however, later onset, milder psychopathology and better outcome are associated with the female gender. This sex difference is thought to be partly due to the estrogen system. Recent studies have determined that estrogen receptor alpha subtype (ER alpha) genetic polymorphisms may affect the expression of ER alpha, and are associated with Alzheimer's disease. For this study, we investigated the association of ER alpha polymorphisms for 125 schizophrenic patients and 142 control subjects. No significant differences for genotype distribution or allele frequency were revealed comparing controls and schizophrenic patients. The ER alpha genotypes were not associated with onset age, psychiatric symptoms or outcome for schizophrenic cases. With new research highlighting the prominent role of sex hormones in neurological and psychological dysfunction, further study is needed to explore the genetic effect of the sex hormone receptor gene on susceptibility mental disorders and associations with different phenotypes.
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Affiliation(s)
- W C Ouyang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan, ROC
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Huang OL, Ouyang WC, Zhou JX, Wu Z, Zhang KY, Huang JK, Cai XZ, Pang XJ, Fu SG, Wang XF. Effectiveness of amodiaquine, sulfadoxine-pyrimethamine, and combinations of these drugs for treating chloroquine-resistant falciparum malaria in Hainan Island, China. Bull World Health Organ 1988; 66:353-8. [PMID: 3048759 PMCID: PMC2491139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The study was carried out in 1985-86 in Hainan Island where Plasmodium falciparum is resistant to chloroquine. Fifty cases of falciparum malaria were treated with 1800 mg amodiaquine for 3 days: the cure rate was 65.3%, and the mean time to clear fever and asexual parasitaemia was 30.7 and 60.3 hours, respectively; 34.7% of cases showed RI or RII recrudescence, and one patient's temperature did not come down to normal within 7 days.Twenty-one cases were treated with sulfadoxine-pyrimethamine (1500 mg and 75 mg, respectively): 19 were cured, I showed RI and another had an S or RI response; the mean time for fever control was 56.1 hours.Fifty cases were treated with amodiaquine plus sulfadoxine and 49 received amodiaquine plus sulfadoxine-pyrimethamine: the cure rate was 97.9% and 100%, respectively; the mean time for fever clearance was 25.0 and 25.7 hours and for parasite clearance 57.1 and 52.8 hours, respectively. These drug combinations gave much better results for cure and for symptom control than amodiaquine or sulfadoxine-pyrimethamine alone, and may be considered for treatment of chloroquine-resistant falciparum malaria.
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