The Association between Baseline Subjective Anxiety Rating and Changes in Cardiac Autonomic Nervous Activity in Response to Tryptophan Depletion in Healthy Volunteers

The aim of this study was to investigate the influence of serotonin on anxiety and autonomic nervous system (ANS) function; the correlation between subjective anxiety rating and changes of ANS function following tryptophan depletion (TD) in healthy volunteers was examined. Twenty-eight healthy participants, consisting of 15 females and 13 males, with an average age of 33.3 years, were recruited.Baseline Chinese Symptom Checklist-90-Revised and ANS function measurements were taken. TD was carried out on the testing day, and participants provided blood samples right before and 5 hours after TD. ANS function, somatic symptoms, and Visual Analogue Scales (VASs) were determined after TD. Wilcoxon signed rank test and Spearman ρ correlation were adapted for analyses of the results.The TD procedure reduced total and free plasma tryptophan effectively. After TD, the sympathetic nervous activity increased and parasympathetic nervous activity decreased. Baseline anxiety ratings positively correlated with post-TD changes in sympathetic nervous activity, VAS ratings, and physical symptoms. However, a negative correlation with post-TD changes in parasympathetic nervous activity was found.The change in ANS function after TD was associated with the severity of anxiety in healthy volunteers. This supports the fact that the effect of anxiety on heart rate variability is related to serotonin vulnerability. Furthermore, it also shows that the subjective anxiety rating has a biological basis related to serotonin.

The readmission rate and medical cost of patients with schizophrenia after first hospitalization - A 10-year follow-up population-based study

BACKGROUND

Hospital readmissions caused by relapse in patients with schizophrenia are associated with prognosis. Identifying individuals at high risk of readmission and providing interventions to lower the readmission rate are important.

METHODS

Patients with schizophrenia who were hospitalized for the first time were recruited from the National Health Insurance Research Database from 2001 to 2010 (n=808, mean age 28.9years) and compared with matched controls. Data on the demographics, cost, and utilization of medical resources of patients who were readmitted were compared with non-readmitted patients. The readmission time curve was analyzed by the Kaplan-Meier method.

RESULT

570 (70.5%) patients were readmitted within 10years; the median time between admissions was 1.9years, and 25% of subjects were readmitted within 4months of the first hospitalization. There were no significant differences in age, gender, or length of hospitalization between the readmission and non-readmission groups. Taking into account all psychiatric medical services, the readmission group had a significantly higher mean frequency of care and a greater medical cost than the non-readmission group and matched controls. However, there were no significant differences with regard to non-psychiatric medical services.

CONCLUSION

Schizophrenia has a high rate of readmission and high medical cost in naturalistic settings. In addition to the traditional hospital-based treatment model for patients with schizophrenia, the development of an effective intervention program is important, especially in the early years of the disease.

A comparison of the effectiveness of risperidone, haloperidol and flupentixol long-acting injections in patients with schizophrenia--A nationwide study

BACKGROUND

Risperidone long-acting injection (RLAI), the first licensed, long-acting second-generation antipsychotic (SGA), has not yet been studied in terms of its effectiveness compared with first-generation antipsychotic (FGA) LAIs.

METHODS

The differences in the effectiveness of RLAI and two other FGA LAIs, haloperidol and flupentixol, were assessed by conducting a one-year pre-post study based on the Taiwanese National Health Insurance Research Database. Effectiveness was defined as reduced medical care utilization and relapse prevention.

RESULTS

A decreased number of relapses were identified in the haloperidol injection group in the post-LAI period than in the pre-LAI period (Wilcoxon signed rank test, p<0.05). The RLAI group had the largest number of acute admissions and relapses, the longest duration of admission (Wilcoxon signed rank test, p<0.005), and the lowest utilization of anticholinergic agents, such as benzodiazepine (BZD) and SGAs (except oral risperidone), among all of the LAI groups in the post-LAI period.

CONCLUSIONS

According to the results of this observational study, we suggest that the effectiveness of RLAI is not superior to that of FGA (haloperidol or flupentixol) LAIs, but that RLAI might have fewer adverse effects.

Development of the psychometric property of a Minimum Data-Set-Based Depression Rating Scale for use in long-term care facilities in Taiwan

OBJECTIVES

Our aim is to develop the psychometric property of the Minimum Data-Set-Based Depression Rating Scale (MDS-DRS) to ensure its use to assess service needs and guide care plans for institutionalized residents.

METHODS

378 residents were recruited from the Haoran Senior Citizen Home in northern Taiwan. The MDS-DRS and GDS-SF were used to identify observable features of depression symptoms in the elderly residents.

RESULTS

A total of 378 residents participated in this study. The receiver operating characteristic (ROC) curve indicated that the MDS-DRS has a 43.3% sensitivity and a 90.6% specificity when screening for depression symptoms. The total variance, explained by the two factors 'sadness' and 'distress,' was 58.1% based on the factor analysis.

CONCLUSIONS

Reliable assessment tools for nurses are important because they allow the early detection of depression symptoms. The MDS-DRS items perform as well as the GDS-SF items in detecting depression symptoms. Furthermore, the MDS-DRS has the advantage of providing information to staff about care process implementation, which can facilitate the identification of areas that need improvement. Further research is needed to validate the use of the MDS-DRS in long-term care facilities.

The reductions in monetary cost and gains in productivity with methadone maintenance treatment: one year follow-up

While methadone maintenance treatment (MMT) is beneficial for heroin dependence, there is little information regarding the reductions in monetary cost and gains in productivity following MMT. The aim of this study was to evaluate the changes in the monetary cost of heroin addiction and productivity after one year of MMT. Twenty-nine participants from an MMT clinic were included. The monetary cost, productivity, quality of life (QOL) and mental health status were assessed at both baseline and one year follow-up. The average annual total cost was approximately US$26,485 (1.43 GDP per capita in 2010) at baseline, and decreased by 59.3% to US$10,784 (0.58 GDP) at follow-up. The mean number of months of unemployment dropped from 6.03 to 2.79, the mean income increased to exceed the basic salary, but only reached 45.3% of the national average monthly earnings. The participants׳ mental health improved, but their QOL scores did not increase significantly. After one year of MMT, the monetary cost of heroin addiction fell, both the productivity and mental health of the participants׳ improved, but limited gains were seen with regard to their QOL.

The development of a self-reported scale for measuring functionality in patients with schizophrenia--self-reported version of the graphic Personal and Social Performance (SRG-PSP) scale

BACKGROUND

The Personal and Social Performance (PSP) scale is used for the assessment of patient function by mental health professionals. This study aimed to evaluate the internal reliability and validity of a self-reported graphic version of the PSP (SRG-PSP) scale and its correlations with psychiatric symptoms, daily life ability and quality of life.

METHODS

The SRG-PSP scale was developed following the four PSP domains: socially useful activities, personal and social relationships, self-care, and disturbing and aggressive behavior. In total, 108 patients with schizophrenia were enrolled. All participants completed the SRG-PSP, the Activities of Daily Living Rating Scale II (ADLRS-II), and the World Health Organization Quality of Life-BREF (WHOQOL). They were also assessed using the PSP and the Positive and Negative Syndrome Scale (PANSS). Spearman's ρ was used to examine the correlations between SRG-PSP scores and other variables.

RESULTS

The results of the SRG-PSP were significantly correlated to those of their corresponding criteria on the PSP. The global score of the SRG-PSP and the scores of three domains, socially useful activities, personal and social relationships, and self-care, were positively correlated with most sub items of the ADLRS-II and WHOQOL, and were negatively correlated with the PANSS scores. The disturbing and aggressive behavior domain of the SRG-PSP was negatively correlated with most sub items of the ADLRS-II and WHOQOL (ρ=-0.19 to -0.36, all p<0.05) and positively correlated with the PANSS (ρ=0.24-0.30, all p<0.05), with the exception of negative symptoms (ρ=0.09, p=0.40).

CONCLUSION

The SRG-PSP is a valid self-reported scale for the assessment of functionality in patients with schizophrenia.

Deliberate self-harm by Taiwanese adolescents

AIM

Prevalence rates for deliberate self-harm (DSH) are unusually high among Taiwanese high school students. Several models have been advanced to explain the occurrence of DSH. One, the experiential avoidance model suggests that self-mutilation helps the individual escape from unwanted emotional experiences. The purpose of this study was to examine the demographic, health and behavioral correlates of DSH in a population (Taiwanese adolescents) known to have a high rate of DSH.

METHOD

A structured, self-administered questionnaire survey was completed by a sample of 742 vocational high school students in Taiwan.

RESULTS

Eighty-four students (11.3%) acknowledged DSH behavior. Results of multivariate logistic regression analysis indicated that female students were 3.47 times as likely as male students to be in the DSH group. Avoidance behaviors of running away from school [odds ratio (OR) = 3.45] and suicide attempt (OR = 13.05), a history of headache (OR = 8.96), a history of sexual abuse (OR = 4.26) and drinking (OR = 4.12) were also significantly associated with DSH.

CONCLUSIONS

Gender and a history of headaches, a history of sexual abuse, drinking, running away from school, or suicidal attempts were factors associated with DSH among Taiwanese adolescents. School personnel should be aware of these to formulate appropriate and timely interventions.

A longitudinal study of the effects of long-term exposure to lead among lead battery factory workers in Taiwan (1989-1999)

The objective of this study was to assess the relationship between blood-lead levels (BLL), hematological, liver and renal indicators among workers in a lead battery factory in Taiwan over a 10-year period. Blood samples were taken periodically from 30 workers and BLL, HGB (hemoglobin), RBC (red blood cells), WBC (white blood cells) and HCT (hematocrit) were measured. Levels of GPT (alanine aminotransferase) and Crea (creatinine) in the blood were assessed to indicate liver and renal function, respectively. The results showed that there was a general decrease in BLL over the 10-year period (except for 1993). There was a similar trend for HCT, RBC and Crea. There was no significant trend for the other health indicators. Four generalized estimating equation (GEE) models [correlation model (A), threshold correlation model (B), instant change model (C) and lag change model (D)] were set up to demonstrate the causal relationship between BLL and the other health indicators. Models A and C showed that BLL correlated positively with RBC, but negatively with Crea. Model B showed that BLL correlated positively with GPT. There were no significant correlations of BLL with the other indicators. Models C and D, (GEE with logit link function to analyze the association between changes BLL and the other health indicators) showed that when BLL increased, RBC and HCT increased, both longitudinally and cross-sectionally. The authors conclude that long-term exposure to lead stimulates production of RBC and HCT, but the effect on liver and renal function was unclear.

A metastatic pituitary carcinoid tumor successfully treated with gamma knife radiosurgery

Intracranial metastasis occurs in a certain number of patients with carcinoid tumor. However, carcinoid tumor with metastasis to the pituitary gland is extremely rare. Up to the present, no effective treatment for either a metastatic intracranial carcinoid tumor or a metastatic pituitary lesion of any origin has been documented. We have treated a case of metastatic carcinoid tumor of the pituitary gland with transsphenoidal tumor resection followed by gamma knife radiosurgery. A 59-year-old man presented with headache and left oculomotor palsy. He was treated at the same hospital for bronchial atypical carcinoid tumor one and a half years ago. Magnetic resonance image of the brain showed a pituitary tumor. There were no signs of recurrent or metastatic lesion elsewhere despite thorough investigation. Transsphenoidal approach for removal of tumor was done and the pathology turned out to be a metastatic carcinoid tumor. Subsequent gamma knife radiosurgery was given for residual tumor. The oculomotor palsy improved after radiosurgery. No neurological deficit occurred. Follow-up CT scan of the brain showed complete resolution of the tumor. We concluded that gamma knife radiosurgery could be used to treat a metastatic intracranial carcinoid tumor. It can also be used to treat a metastatic lesion of the pituitary gland without causing neurological deficit.

Predictors of increases in alcohol-related problems among black and white adults: results from the 1984 and 1992 National Alcohol Surveys

We examined increases in self-reported alcohol-related problems among black and white adult drinkers using data from the 1984 and 1992 National Alcohol Surveys. The objectives of the study were to determine whether alcohol consumption, drinking norm, or socioeconomic status were related to increases in alcohol-related problems. Two types of self-reported alcohol-related problems were analyzed using regression methods: drinking consequences and alcohol dependence symptoms. Results indicated that increases in alcohol consumption were associated with increased drinking consequences for white men, but increased consumption had little affect for black men. Changes in drinking norms regarding non-social drinking were associated with increased in drinking consequences among black men, such norms showed little affect on drinking consequences for white men. Despite substantial increases in alcohol consumption among black women from 1984 to 1992, there were no significant racial/ethnic differences in drinking consequences or alcohol dependence symptoms among women. Changes in socioeconomic status were however related to increases in drinking consequences and alcohol dependence symptoms in women, but not in men. Findings suggest that liberal drinking norms may have greater long term consequences for black than white men. Socioeconomic status, on the other hand, may have greater explanatory power in predicting increases in alcohol-related problems in women than in men.

Relationships between socioeconomic status and drinking problems among black and white men

We sought to examine the relationships between socioeconomic status and drinking problems within the Black and White male populations. A two-way interactions of social class with race/ethnicity, and with drinking consequences and alcohol dependence symptoms was hypothesized among drinkers. Drinking problems were regressed on social class, race/ethnicity, age, alcohol consumption, and drinking settings. Social class was based on a composite of respondent's income, education, and main wage earner's occupation. Two types of drinking problems were analyzed: drinking consequences and alcohol dependence symptoms. Our hypothesis was partially confirmed. Interactions of social class with race/ethnicity and with drinking problems were observed. Less affluent Black men reported greater numbers of drinking consequences and total drinking problems than less affluent White men; the reverse was true for affluent Black and White men. Results suggest that the relationships between socioeconomic status and drinking problems may vary by race/ethnicity.