Psychiatry

The Taiwanese Journal of Psychiatry becomes an open-access peer-reviewed journal Winston W Shen Taiwanese Journal of Psychiatry 2019 33(1):1-2

In Memoriam: Eng-Kung Yeh, M.D., Ph.D., 1924-2018 Winston W Shen Taiwanese Journal of Psychiatry 2019 33(1):3-5

Mental health care in Singapore: Current and future challenges Ee Heok Kua, Mahendran Rathi Taiwanese Journal of Psychiatry 2019 33(1):6-12 Objectives: Singapore is a city-state of about 5.7 million in population, having multi-ethnicities–Chinese (74.3%), Malays (13.4%), Indians (9.1%), and others (3.2%). In this review, the authors intended to familiarize the readers with the present state of mental health care in Singapore and to discuss the present and future challenges in service provision in handling psychiatric care and promoting mental health for all Singaporeans. Methods: Through published papers and personal experiences, the authors collected descriptive data on mental health-care service research, psychotherapy, training, stigma, and preventive psychiatry from the published papers and books. Information on recent and future developments was from interviews with clinicians and administrators. Results: There is a steady expansion of mental health-care service, training, and research in Singapore. Community and preventive psychiatry is currently emphasized. There are about 115 practicing psychiatrists in Singapore, giving a psychiatrist-to-population ratio of about 2.6/100,000, which is low compared with other developed countries such as the USA (13.7/100,000), the UK (11/100,000), and Australia (14/100,000). Conclusion: The authors suggest that the focus of mental health care should be on the community and on the Agency for Integrated Care to coordinate the plethora of services by hospitals, clinics, day centers, and nongovernmental organizations. We further stress the need of anchoring the service to a mental or general hospital community care or day hospital beside inpatient care in general hospital or institutions. We also recommend gathering community support, proper use of technology in early detection, referral management, and exploiting the benefits of artificial intelligence for mental health promotion in the future.

Antidepressant therapy in patients with cancer: A clinical review Shen- Chieh Chang, Winston W Shen Taiwanese Journal of Psychiatry 2019 33(1):13-19 Background: The prevalence of major depressive disorder (MDD) by DSM criteria among cancer patients is about 14%–15% in oncological, hematological, and palliative services and the number is risen up to 20%–25% when other depressive disorders are also included. Like MDD patients in general, patients with cancer are thought to be underdiagnosed and undertreated. Untreated depression in cancer patients may lead to having distressed symptoms and signs, decreased quality of life, higher suicide risk, greater psychological burden on the family, longer hospital stays, poorer anticancer treatment compliance, as well as even increased risk for mortality. Methods: In this review, the authors reviewed published articles on the use of antidepressant use for patients with cancer, to familiarize the readers with the use of antidepressants. Results: Antidepressants have been found to be more effective than placebo in relieving depressive symptoms in patients with cancer, and the efficacy is positively associated with length of treatment. Although the rate of antidepressant prescription is increasing, still about 75% of cancer patients with depression have not yet received antidepressant treatment. Besides the use in treating mood and anxiety symptoms, antidepressants have also been found to have versatile rôles as palliative treatment for cancer-related symptoms – pain, hot flushes, nausea, anorexia/cachexia, and fatigue. Furthermore, antidepressants have been studied for their anticancer potentials. They can inhibit tumor growth through either indirectly regulating immunity by enhancing cytotoxic activity and modulating cytokine production, or directly initiating cancer cell death and arresting cancer cell proliferation. We also found important drug-drug interaction between antidepressants and tamoxifen. Conclusion: Besides treating depressive and anxiety disorders, antidepressants are effective in treating cancer-related symptoms (pain, hot flushes, nausea, anorexia/cachexia, and fatigue). Cancer patients are eager to receive more effective treatment against their cancer as well as comorbid depression, and physicians should be more aggressive in providing every beneficial regimen – including an antidepressant.

A study of well-being in drunken driving recidivists Jui- Cheng Lin, Chun- Hung Lee, Yu- Hsin Liu Taiwanese Journal of Psychiatry 2019 33(1):20-26 Objectives: Drunk driving is related to accidents and poorer health, as well as causes a considerable economic cost. In this study, we intended to determine which sociodemographic factors can reduce health-related quality of life (QoL). Methods: We recruited 552 drunken driver recidivists and measured their alcohol use history and sociodemographic factors. We used the Alcohol Use Disorders Identification Test (AUDIT) and the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to evaluate severity of alcohol disorder. Psychological distress was measured using Beck Depression Inventory-II (BDI-II) and the status of well-being using the Short Form 12-Health Survey Questionnaire. We classified into several categories and analyzed with one-way analysis of variance or the Welch's test. Significant factors were further divided into subcategories for comparisons. Results: Alcohol use disorder according to DSM-5 criteria was found to be 34.2% mild, 16.7% moderate, and 44.7% severe in severity. The Depression Index according to BDI-II showed 70.5% in minimal, 13.2% mild, 10.5% moderate, and 5.8% severe depressed participants. In comparing subcategories according to the physical component summary (PCS), men who were older (p < 0.05), had fewer than 6 years of education (p < 0.001), unemployed (p < 0.05), homeless (p < 0.05), had monthly incomes below 15 thousand New Taiwan dollars (p < 0.05), and AUDIT scores ≥ 20 for severe depression (p < 0.001) had significantly lower QoL in PCS. In comparing subcategories according to the mental component summary (MCS), men who were unemployed (p < 0.05), homeless (p < 0.01), and AUDIT ≥ 20 for severe depression (p < 0.001) also had significantly lower QoL on MCS. Conclusion: Unemployment, homelessness, AUDIT scores ≥ 20, and higher BDI-II scores showed a reduction not only in PCS scores but also in MCS scores. Those findings could be used to determine the drunk drivers' behaviors and the well-being among those recidivists. Instead of incarceration or fining for drunk drivers, we need identification and referring them to treatment in those population, especially individuals with poor socioeconomic status, depression, and severe alcohol use disorder.

Predictors of excessive daytime sleepiness in patients with obstructive sleep apnea syndrome Hung- Ta Liao, Tsung- Yi Tsai, Dai- Yueh Lin Taiwanese Journal of Psychiatry 2019 33(1):27-32 Objective: Excessive daytime sleepiness (EDS) in patients with obstructive sleep apnea syndrome (OSAS) is a known risk factor for various accidents and can cause poor quality of life. In this study, we intended to study the demographic and clinical characteristics of EDS in patients with OSAS. Methods: This retrospective study gathered data from 283 patients. We classified patients with Epworth Sleepiness Scale (ESS) scores ≥ 10 points as the EDS group and those with an ESS score <10 were the non-EDS group. We also compared the results of physiological and polysomnographic examinations to determine if EDS could be used to predict in patients with OSAS. A stratified analysis was also done to study subpopulation-related factors associated with EDS in OSAS patients. Results: Male OSAS patients with EDS had significantly shortened rapid eye movement latency (REML, p < 0.01), significantly greater sleep efficiency (p < 0.05), and significantly higher EES score (p < 0.001), compared to those without EDS. Female OSAS patients with EDS had significantly higher body mass index (BMI) (p < 0.05) and had significantly more EES score (p < 0.001). Female OSAS patients with EDS in childbearing age had significantly higher EES score (p < 0.001) and had significantly higher BMI (p < 0.05). OSAS patients with severe EDS had significantly shortened REML (p < 0.01) and significantly more EES score (p < 0.001). Conclusion: This study showed that there were differences in the characteristics of OSAS patients with and without EDS and they differed in their subgroups. All findings are mostly in line with those in existing literature.

A gene-based analysis of variants in the Brain-derived Neurotrophic Factor gene with psychological distress in a Taiwanese population Eugene Lin, Po- Hsiu Kuo, Yu- Li Liu, Albert C Yang, Shih- Jen Tsai Taiwanese Journal of Psychiatry 2019 33(1):33-38 Background: Brain-derived neurotrophic factor (BDNF), the most abundant and widely expressed neurotrophin in the brain, is believed to play an important role in depression and anxiety. In this study, we hypothesized that single-nucleotide polymorphisms (SNPs) within the BDNF gene should be linked with depression and anxiety through complex interactions in the general population. Methods: We analyzed 7,098 Taiwanese participants from the Taiwan Biobank. Measures of anxiety and depression were evaluated using the Patient Health Questionnaire-4 (PHQ-4). We used 43 BDNF polymorphisms in the genetic analysis. Results: We found a nominal association between nine BDNF genetic variants and depression state, after having adjusted for the factors of age and gender. Furthermore, three BDNF SNPs showed evidence of nominal association with PHQ-4 scores. In addition, an interaction significantly existed between the BDNF rs73430670 and BDNF rs4923461 in influencing depression state (p < 0.05). Finally, we found that influence of interaction significantly existed between BDNF rs12418745 and physical activity (p < 0.05) in depression state. Conclusion: Those results suggest that the BDNF genetic variants may contribute to psychological distress independently as well as through SNP-SNP and gene-physical activity interactions in the general population.

The reinforcement sensitivity of male adults with attention-deficit/hyperactivity disorder: The association with internet addiction Tai- Ling Liu, Chen- Hsiang Su, Jia- In Lee, Chih- Hung Ko Taiwanese Journal of Psychiatry 2019 33(1):39-44 Objective: In this study, we intended to evaluate the association between reinforcement sensitivity and male adults with attention-deficit/hyperactivity disorder (ADHD), as well as the association between reinforcement sensitivity and Internet addiction. Methods: We recruited 52 male adults with ADHD and 52 healthy male controls. All participants received a diagnostic interview for ADHD and completed ratings with the Behavior Inhibition Scale (BIS), Behavior Activation Scale (BAS), Adult ADHD Self-report Scale, and Chen Internet Addiction Scale to assess their reinforcement sensitivity, ADHD severity, and Internet addiction severity. Results: The study data showed that males with ADHD had significantly higher scores in BIS (22.06 ± 3.02 vs. 19.52 ± 2.49, p < 0.001), fun seeking (13.33 ± 2.03 vs. 11.10 ± 2.01, p < 0.001), BAS (44.42 ± 5.10 vs. 41.17 ± 4.79, p < 0.001), and Internet addiction (71.52 ± 14.60 vs. 51.98 ± 13.62, p < 0.001). Findings from the data showed that fun seeking was the most associated factor, followed by BIS. Furthermore, interpersonal and health problems were the most associated dimensions of Internet addiction associated with adult ADHD. The findings using the Pearson's correlation among adults with ADHD revealed that reward sensitivity, drive, and BAS were associated with the severity of hyperactivity. Additionally, BIS was associated with the severity of Internet addiction. Conclusion: Adult ADHD is associated with fun seeking, BAS, and BIS. We suggest that clinicians need to pay attention to reinforcement sensitivity when treating adults with ADHD. Furthermore, male adults with ADHD had higher severity of Internet addiction. Their BIS was positively associated with the severity of Internet addiction; thus, Internet addiction should be well assessed and treated among adults with ADHD, particularly among those with higher BIS.

Maker activities in a psychiatric day care center Ching- Yi Wang, Li- Zhen Zheng, Chin Ying Wu, Shih- Ming Li Taiwanese Journal of Psychiatry 2019 33(1):45-47 Objective: Many Maker empirical studies have been published in Taiwan educational field, and the Maker has also been applied to health-care field. The purpose of this study was to apply the Maker activities to patients at a psychiatric day care center. Methods: We included 10 schizophrenia patients in an eight-week Maker program at a psychiatric day care center. Being shown to have good reliability and validity, the clinical symptom checklist was used to assess patients' symptoms of schizophrenia. We also assess the effect between the scores between pre- and posttests. Results: The mean score of the clinical symptom checklist with standard deviation in the pretest was 3.75 ± 1.83 and that in a posttest was 0.50 ± 0.54. Using the Wilcoxon sum rank test, the difference between two tests in knitting Maker activity showed a significant decrease during the eight-week program (Z = −2.32, p < 0.05). Conclusion: Based on those findings, we suggest that the knitting Maker activity program can be used for patients in the psychiatric day care center to reduce the distress and to enhance their well-being.

The correlations between results of short-form wechsler adult intelligence Scale-III and demographic/clinical factors in patients with schizophrenia: Preliminary findings Chia- Ju Lin, Chin- Chuen Lin, Yi- Yung Hung, Meng- Chang Tsai, Ya- Ling Wang, Ming- Che Tsai, Ming- Hsiung Liu, Yung- Hsuan Lee, Tiao- Lai Huang Taiwanese Journal of Psychiatry 2019 33(1):48-50 Objectives: Previous studies showed that the illness duration is related with cognitive performance in patients with schizophrenia. The Wechsler Adult Intelligence Scale (WAIS) has been used extensively to assess the cognitive function in schizophrenia in both research and clinical practice. In this study, we intended to analyze whether a correlation exists between the indices of short-form WAIS-III and demographic/clinical data (including illness duration, age at onset, and years of education). Methods: We included 34 patients with schizophrenia from a tertiary hospital in Taiwan. Each participant received assessment with the short-form WAIS-III, consisting of seven core subtests. It provided scores for verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), full-scale intelligence quotient (FSIQ), and four secondary indexes (verbal comprehension, working memory, perceptual organization, and processing speed). Data were analyzed for correlation. Results: The results showed that patients' age at onset was significantly negatively correlated with years of education (p < 0.05). Significantly positive correlations existed between years of education and WAIS-III, including VIQ (p < 0.01), PIQ (p < 0.05), FSIQ (p < 0.05), VC (verbal comprehension) (p < 0.05), PS (processing speed) (p < 0.05), similarities (p < 0.05), information (p < 0.05), picture completion (p < 0.05), and digit symbol coding (p < 0.05). The negative correlations also significantly existed between age at onset and WAIS-III (p < 0.05), including VIQ (p < 0.05), FSIQ (p < 0.05), PO (Perceptual Organization) (p < 0.05), similarities (p < 0.05), arithmetic (p < 0.05), and block design (p < 0.05). The significant positive correlations were also found between illness duration and WAIS-III, including PS (p < 0.05), digit span (p < 0.05), and digit symbol coding (p < 0.01). Conclusion: The study that positive correlations existed between illness duration and cognitive function differs from previous studies. Those preliminary results also suggest that the education can maintain cognitive function, at least partially, even those have early-onset schizophrenia.

Alexandros Sfakianakis
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