Air pollution during the perinatal period and neurodevelopment in children: A national population study in Taiwan.

AIM: To evaluate the association between ambient particulate matter no larger than 2.5 µm in diameter (PM2.5 ) during the prenatal and postnatal periods and infant neurodevelopmental parameters. METHOD: We conducted a population-based birth cohort study using the Taiwan Birth Cohort Study. Participants were assessed for developmental conditions through home interviews at 6 months and 18 months of age. Exposure to PM2.5 of mothers and infants during perinatal periods was estimated using hybrid kriging/land-use regression. The exposure was linked to each participant by home address. Logistic regression was then conducted to determine the risk of neurodevelopmental delay in relation to PM2.5 . RESULTS: A total of 17 683 term singletons without congenital malformations were included in the final analysis. PM2.5 during the second trimester was associated with increased risks of delays in gross motor neurodevelopmental milestones (adjusted odds ratio [aOR] 1.09 per 10 µg/m3 increase in exposure to PM2.5 ). Delayed fine motor development was also found to be related to exposure to PM2.5 in the second and third trimesters (aOR 1.06), as was personal-social skill (aOR 1.11 for the second trimester and 1.06 for the third). These neurodevelopmental parameters were unrelated to postnatal PM2.5 exposure. INTERPRETATION: Exposure to ambient PM2.5 during pregnancy was significantly related to delay in gross motor, fine motor, and personal-social development in this population-based study. WHAT THIS PAPER ADDS: Prenatal exposure to higher PM2.5 was associated with increased risk of delayed early neurodevelopment. The critical period for delayed gross motor development was the second trimester. The critical period for fine motor and personal-social development was the second and third trimesters.

The synergistic interaction between urbanicity and maternal education affecting childcare pressure related to autism spectrum disorder in two national birth cohort studies.

To gain a holistic approach for parental help-seeking behavior and ASD diagnosis, this study aimed to use two national birth cohort study datasets to investigate the pathway relationship between personal and social/environmental factors, including maternal perceived childcare pressure, maternal level of education, urbanization at age 3, and the chance of receiving a autism spectrum disorder (ASD) diagnosis at when children are aged 5.5 years (2.5 years later). The 2003 Taiwan Birth Cohort Pilot Study (TBCS-p; N = 1618) and 2005 Taiwan Birth Cohort Study (TBCS; N = 19,183) datasets were used. The TBCS-p and TBCS both showed similar prevalence of ASD (0.3-0.4%). Children with ASD characteristics, as measured using the Modified Checklist of Autism in Toddlers, had 8.27-18.20 times increased likelihood of receiving ASD diagnosis [TBCS confidence interval (CF) of 5.32-12.86; TBCS-p CF of 2.03-163.46]. Pathway analysis showed that, although having a mother with higher education or who lived in a city decreased the chance for ASD diagnosis, the interactive effect of a maternal higher level of education and living in a city led to an increased likelihood for ASD diagnosis. Additionally, mothers who perceived a higher level of childcare pressure were also more likely to seek medical assistance and diagnosis. Access to healthcare (living in the city), maternal level of awareness (level of education), and perceived childcare pressure are all factors that influence help-seeking behavior and diagnosis. Therefore, medical professionals should pay special attention to the developmental condition of children in underserved backgrounds and rural areas to prevent delayed diagnosis.

Dissociative Trait as a Mediator of Problematic Internet Use in Children with attention-deficit/hyperactivity Disorder and Learning Disabilities.

PURPOSE: This study used data from a national birth cohort study to investigate the duration of internet use at the age of 12 years among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities (IDs) and learning disabilities (LDs) at the age of five and a half years (66 months) to understand whether an ADHD, ASD, ID and LD diagnosis in childhood increases the risk of problematic internet use (PIU) in adolescence. Furthermore, the pathway relationship of dissociative absorptive trait with PIU and these diagnoses was also investigated. METHODS: The 5.5- and 12-year-old Taiwan Birth Cohort Study dataset was used (N = 17,694). RESULTS: More boys were diagnosed with LDs, IDs, ADHD and ASD; however, girls were at increased likelihood of PIU. ID and ASD diagnoses were not associated with increasing PIU likelihood. However, children who had been diagnosed with LDs and ADHD, along with higher dissociative absorptive trait, had an indirectly increased likelihood of PIU in adolescence. CONCLUSIONS: Dissociative absorption was found to be a mediating factor between childhood diagnosis and PIU and can be used as a screening indicator in prevention programs to reduce the duration and severity of PIU in children diagnosed with ADHD and LDs. Furthermore, with the increased prevalence of smartphone usage in adolescents, education policy-makers should pay greater attention to the issue of PIU in female adolescents.

Recalled Parental Gender Preference in Chinese Culture: A Taiwan Birth Cohort Study.

Chinese culture has long favored sons over daughters. With the development of reproductive technology, the methods can be used not only in facilitation of conception, but also in sex-selective termination of pregnancies. Therefore, this study aimed to investigate: (1) the rate of pregnant expectancy/planning of children; (2) whether the Chinese cultural influence of son preference still exists, and factors effecting sex preference; and (3) whether artificial reproductive technology plays a role in parents giving birth to a child of their preferred sex. We used the Taiwan Birth Cohort Study dataset at six-months, which included 21,248 babies born in 2005. More mothers than fathers reported this pregnancy as unexpected (29.0% vs. 20.5%). Over half of the parents showed no preference for the sex of their child (mothers: 52.6%, fathers: 55.8%). However, among those who showed a preference, significantly more preferred sons than daughters (son preference, mothers: 24.8%, fathers: 24.3%; daughter preference, mothers: 22.5%, fathers: 19.9%). Additionally, structural equation modeling found that parents who had planned their pregnancy were more likely to prefer sons and less likely to prefer daughters. Parents who used artificial reproductive technology for conception were more likely to prefer and conceive sons. A preference for male children still exists in Taiwan, contributing to the high sex ratio at birth of 110 in our 2005 birth cohort. However, over half of the parents reported being neutral in the preference of the gender of their offspring. This suggests that Taiwan is moving toward a more gender-equitable society.

The Psychometric Properties of the Chinese Oxford Happiness Questionnaire in Taiwanese Adolescents: Taiwan Birth Cohort Study.

The application of the eight-item Oxford Happiness Questionnaire has rarely been investigated cross-culturally. This study examined the psychometric properties and use of the eight-item Oxford Happiness Questionnaire in Taiwan, using a national birth cohort dataset of 12 year olds as a sample. The dataset of 12-year-old children in the Taiwan Birth Cohort Pilot Study, which included 17,694 adolescents, was used for this study. The eight-item Oxford Happiness Questionnaire was double-translated into Mandarin Chinese. Item analysis, exploratory factor analysis, and structural equation modeling for construct validity were conducted. The four-point Likert scale for the eight-item Chinese Oxford Happiness Questionnaire showed good inter-item correlation. Having deleted the item "mentally alert", the remaining seven items were separated into two dimensions of social adaptation status (SAS) and psychological well-being (PWB), resulting in Cronbach's alpha scores of 0.63 and 0.55, respectively. The two dimensions showed good construct validity. The differences in the language and cultural connotations of being "mentally alert" are discussed. Furthermore, being of a collective culture, the two dimensions of SAS and PWB were found in Chinese adolescents, allowing distinction between social- and individual-oriented happiness. Our study showed that the seven-item Oxford Happiness Questionnaire has a scale that is easy to use and comprehend, with good psychometric properties for use with Chinese adolescents.

Measurement of Social Communication, Emotion and Cognitive Development from 6 Months to 8 Years Old: In a Taiwan Birth Cohort Study.

This study aimed to investigate (1) the reliability and validity of the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI) 8-year-old scale; (2) the pathway relationship among the cognitive, emotional and social-communication dimensions of the TBCS-DI 8-year-old scale; (3) the predictive validity and association of the TBCS-DI dimensions at 6, 18, 36, and 66 months, with the dimensions of the 8-year-old scale. The Taiwan Birth Cohort Study dataset of 19,516 children followed from 6 months to the age of eight was used. The TBCS-DI 8-year-old scale showed good reliability and validity. A recursive relationship of emotion as the basis, affecting cognition and later social communication was found. Children's 18-month development was able to predict the development of children at 8 years, implying that 18 months may be a critical age for screening and intervention. Clinical intervention should also take into consideration the cultural disparity of emotional development in Asian countries.

Early predictors of poor treatment response in patients with schizophrenia treated with atypical antipsychotics.

BACKGROUND: The aims of this study were to explore the relationship between early reduction in psychotic symptoms and the ultimate response in patients with schizophrenia treated by atypical antipsychotics, and to determine the best time to switch or maitain the regimen. We also explore the possible predictors for the clinical response. METHODS: One hundred eleven inpatients with acutely exacerbated schizophrenia were randomized to give optimal therapy of olanzapine, risperidone, and paliperidone in one-week run-in period and 12 weeks' intervention. All participants were assessed using Positive and Negative Syndrome Scale (PANSS). Early Response, defined as reduction of 25% in PANSS score, was examined at weeks 1, 2, 3, 4 and 8, and these ratings were used to predict ultimate response (25% PANSS reduction) at week 12. We hypothesized that early treatment response at Week 1 or 2 could predict Week 12's treatment outcome. RESULTS: The early treatment response at Week 2 had a greater negative prediction value (NPV, 93.6%) than did the response at Week 1 (NPV, 69.7%), Week 3 (NPV, 91.5%), Week 4 (NPV, 90.7%) and Week 8 (NPV, 87.2%). The positive predictive value became more acceptable (65%) until Week 4. There was no any other potential predictors, including types of antipsychotics medication and treatment dosage, were associated with ultimate response in this study. CONCLUSION: The treatment non-response at Week 2 optimally predicted the ultimate (Week 12) non-response, in terms of negative predictive value (NPV). These finding suggests that the revision of treatment strategy should be considered t if patients with schizophrenia was not responsive to them after 2 weeks' treatment, and for those who are responders at Week 2, another two weeks are needed to further evaluate whether they will be continuously responsive. TRIAL REGISTRATION: NCT03730857 at ClinicalTrial.gov . Date of registration: 30/Oct/2018.

Advanced Maternal Age and Maternal Education Disparity in Children with Autism Spectrum Disorder.

Objective Previous studies have shown inconsistent results with regard to the association between advanced parental age and autism spectrum disorder (ASD). The sociodemographic status of parents has been found to be associated with children with ASD, however. Therefore, a pathway analysis was undertaken of the roles of maternal age and education in ASD diagnosis and community screening, in a national birth cohort database, using a propensity score matching (PSM) method. Method The 6- and 66-month Taiwan Birth Cohort Study dataset was used (N = 20,095). The PSM exact matching method was used to select 1700 families (ratio of 1:4 between ASD diagnosis and control) from the Taiwan Birth Cohort Study dataset. Results (1) The results from the complete dataset and the PSM exact matching dataset both show that the risk of a child being diagnosed with ASD was increased by the mother being over 40 years old. (2) Although more children of mothers with lower-than-average education were positive on screening, more children of mothers with higher-than-average education were also diagnosed with ASD. Conclusions for Practice Advanced maternal age had a higher association with the diagnosis of ASD, and maternal educational disparity was found between ASD clinical diagnosis and community screening. Community and primary medical care services should pay more attention to children of parents with lower education during ASD screening to prevent delayed diagnosis.

Personality and Alexithymic Disparity in Obsessive-Compulsive Disorder Based on Washing and Checking.

The aim of this study was to investigate pathway relationship of personality characteristics and alexithymic traits in OCD symptoms of obsession, and compulsive behavior of washing and checking. Two-hundred and seventy patients diagnosed with OCD were consecutively recruited from the psychiatric outpatient department of a teaching hospital. Structural equation modeling showed those more neurotic, less extraverted and with higher levels of alexithymia difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT) were more likely to develop obsessive thoughts. Those less extraverted was more prone to develop washing compulsions, and those more neurotic were more likely to develop checking compulsions. EOT was the only alexithymic trait to have no gender difference within this group of patients with OCDs. The different personality and alexithymic trait pathways found between OCD obsession, washing and checking symptoms provide support that they may be different subtypes within the OCD diagnosis. Obsession was associated with washing, but not checking. Furthermore, no gender difference was found between the obsession and compulsive symptoms. Extraversion and neuroticism can be used to differentiate washing and checking, and alexithymia to differentiate washing and obsessions. This should be taken into consideration for intervention targeting patients with different OCD symptoms.

Variant GADL1 and response to lithium therapy in bipolar I disorder.

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.).

Can a 10-Minute Questionnaire Identify Significant Psychological Issues in Patients With Temporomandibular Joint Disease?

PURPOSES: For patients with disc displacement disorders (DDDs), psychiatric illness increases the risk of worsening postsurgical pain, postoperative delirium, postoperative incomplete recovery, and worse postoperative life quality. This study provides a fast and practical protocol to evaluate psychological conditions of patients with DDDs of the temporomandibular joint (TMJ) in clinical care. MATERIALS AND METHODS: The populations under investigation in this cross-sectional study included patients with DDD who received treatment from October 2012 through June 2016. Variables included age, gender, education level, and TMJ (Axis I) and psychological (Axis II) evaluations. The 13-item protocol of Axis II evaluations contained a 5-item Brief Symptom Rating Scale (BSRS-5), a pain visual analog scale (VAS; 1 item), major life events (3 items), suicidal risk (3 items), and substance use (1 item). Analysis of variance, χ2 test, and multivariate logistic regression were used for analyses. RESULTS: Of 177 patients, 75.14% were women (mean age, 37.46 ± 14.06 yr). Pain VAS scores clearly supported the following ranking of psychosocial discomforts: disc displacement without reduction with limited opening (DDWORWLO) > disc displacement without reduction without limited opening > disc displacement with reduction. Pain VAS and BSRS-5 correlated with 5 variables in Axis I (trismus, acute TMJ pain, chronic awake bruxism, chronic sleep bruxism, and deep bite). The DDD study indicated that 9.6% of patients required urgent referrals to mental health resources (MHRs) for their moderate and high suicidal risk DDD and 77% required nonurgent referrals to MHRs for their psychiatric morbidity. CONCLUSIONS: This study found that patients with DDD showed a prevalence of suicidal ideation and mean BSRS scores that were higher for anxiety, hostility, depression, interpersonal hypersensitivity, and insomnia than in the general population. Patients with trismus or acute TMJ pain could have a higher pain VAS score; chronic awake bruxism could involve greater hostility and lower depression; chronic sleep bruxism could increase sensitivity to interpersonal interactions; and deep bite could involve a higher anxiety level. DDWORWLO produced the highest pain VAS score in patients with DDD. The 13-item Axis II evaluations can offer useful clues for oral and maxillofacial surgeons and other specialists to collaborate with MHRs.

Reliability and Validity of the Short Version of Udvalg for Kliniske Undersogelser in Antipsychotic Treatment.

The aim of this study was to develop a reliable and valid short version of the Udvalg for Kliniske Undersogelser (UKU) to efficiently evaluate the side effects of antipsychotics in patients with schizophrenia. This multi-site study included 10 hospitals, which included 331 inpatients and outpatients diagnosed with schizophrenia. UKU, Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP) and dosage of paliperidone were collected. The predictive validity of the UKU-short version, as well as that of the CGI-S, PSP and paliperidone dosages, was analyzed using structural equation modeling (SEM), latent growth models (LGM), and confirmatory factor analysis to test its content and construct validity. The UKU-short included nine-items of sedation, reduced sleep, rigidity, tremor, akathisia, headache, reduced salivation, constipation and orthostatic dizziness, and has good construct and content validity over time. Confirmatory factor analysis showed good construct validity, with the psychic, neurological and autonomic side effect dimensions having correlations between 0.60 and 0.71. The predictive validity of the short-version UKU for psychiatric symptoms (CGI-S), quality of life (PSP) and dosage showed that the effects of drug dosage were negligible, and only neurological side effects were associated with psychiatric symptoms and quality of life. The UKU-short showed good content, construct and predictive validity. It is a more time-efficient instrument than the original UKU. This study only included patients treated with paliperidone, larger scale studies is needed to validate the UKU-short in detection of side effects in routine clinical practice to prevent non-adherence in patients with schizophrenia.

Predictive validity of a five-item symptom checklist to screen psychiatric morbidity and suicide ideation in general population and psychiatric settings.

BACKGROUND/PURPOSE: Suicide is a major concern in public health worldwide. Early identification of individuals at risk is critical for suicide prevention. The present study revised the 5-item Brief Symptom Rating Scale (BSRS-5) to a checklist format (BSRS-5R) and validated the BSRS-5R into a screening tool for psychiatric morbidity and suicide ideation in the general public. METHODS: The study participants consisted of two subsets of sample from community residents and psychiatric patients. The community subjects were recruited from stratified proportional randomization sampling in a nationwide community survey, while the psychiatric patients were from psychiatric outpatient service and psychiatric daycare unit in a teaching hospital in northern Taiwan. All participants responded to the questionnaire investigating the BSRS-5, personal experience with suicide, and demographic information. RESULTS: In total, 2147 community respondents and 700 respondents from psychiatric settings completed the survey questions. The BSRS-5R was highly correlated to BSRS-5 with good internal consistency in our study sample. For the community subjects, receiver operating characteristic curve analysis revealed an optimal cutoff of 2/3 for BSRS-5R to discriminate psychiatric morbidity or suicide ideation. The BSRS-5R could also identify psychiatric morbidity in psychiatric outpatients and daycare patients. In addition, the cutoff of 4/5 for BSRS-5R to determine suicide ideation yielded moderately good predictive validity in psychiatric outpatients and in daycare patients. CONCLUSION: The BSRS-5R was validated as an efficient checklist to screen for psychiatric morbidity and suicide ideation in the general public. The result is valuable in translating into general medical and community settings for early detection of suicide ideation.

Depressive symptoms, cognitive impairment, and metabolic syndrome in community-dwelling elderly in Southern Taiwan.

OBJECTIVE: Metabolic syndrome and depression are both thought to be associated with cognitive impairment in the elderly. Metabolic syndrome is also correlated with depression. We examined their possible pathways in a population-based sample. METHODS: We recruited 300 older community participants from Southern Taiwan. Demographics, medical history, severity of depressive symptoms, cognitive function, apolipoprotein genotyping, and lipid profile were collected. The presence of metabolic syndrome was confirmed with the Third Report of the National Cholesterol Education Program's Adult Treatment Panel. Possible relationships between metabolic syndrome, depressive symptoms, and cognitive dysfunction were explored using logistic regression and structured equation modelling. RESULTS: When gender, age, education, marital status, and apolipoprotein genotype were adjusted for logistic regression, metabolic syndrome and depressive symptoms were independent and significant predictors of cognitive dysfunction for community-dwelling elderly. In structural equation modelling, metabolic syndrome and depressive symptoms were correlated to each other, and both contributed to the presence of cognitive dysfunction. CONCLUSIONS: Depressive symptoms and metabolic syndrome are independently associated with cognitive impairment among community-dwelling elderly.

Cancer incidence in people with affective disorder: nationwide cohort study in Taiwan, 1997-2010.

BACKGROUND: Cancer is a serious public health problem worldwide, and its relationship with affective disorders is not clear. Aims To investigate alcohol- and tobacco-related cancer risk among patients with affective disorders in a large Taiwanese cohort. METHOD: Records of newly admitted patients with affective disorders from January 1997 through December 2002 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan. Cancers were stratified by site and grouped into tobacco- or alcohol-related cancers. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with affective disorders and the general population. RESULTS: Some 10 207 patients with bipolar disorder and 9826 with major depression were included. The risk of cancer was higher in patients with major depression (SIR = 2.01, 95% CI 1.85-2.19) than in those with bipolar disorder (SIR 1.39, 95% CI 1.26-1.53). The elevated cancer risk among individuals ever admitted to hospital for affective disorders was more pronounced in tobacco- and/or alcohol-related cancers. CONCLUSIONS: Elevated cancer risk was found in patients who had received in-patient care for affective disorders. They require holistic approaches to lifestyle behaviours and associated cancer risks.

No change of the lipid profile under the control of ApoE gene polymorphism in schizophrenics under paliperidone treatment.

The present study tried to explore the effects of Paliperidone on the lipid profiles of schizophrenia patients. One hundred twenty-nine subjects diagnosed with schizophrenia were enrolled into this study and completed the lipid profile evaluation. Their blood samples were obtained on the morning following a 12-hours fast. Cholesterol and triglyceride (TG) levels in plasma were determined, and lipoproteins were determined by enzymatic methods. All participants provided written informed consent, and underwent additional venous blood withdrawal for DNA extraction for genetic study of the ApoE gene polymorphism. Under T test, TC, TG and HDL levels all declined after Paliperidone treatment although with no statistically significant difference. The ratios of TC/HDL declined after Paliperidone treatment, but without statistically significant difference. After GEE-I analysis, we found that ApoE4 genotype (ß = 34.471; p < 0.001) had a positive effect on the total cholesterol (TC) level; female had positive effect on the high-density lipoprotein (HDL) level (ß = 15.361; p = 0.003); and age had a positive effect on the TG level (ß = 1.317; p = 0.030). Smoking (ß = 0.961; p = 0.016) had a positive effect on the ratio of TC/HDL change. Lipid profiles were not increased after Paliperidone treatment under the control of ApoE gene polymorphism.

DRD4 VNTR 4/4 homozygosity as a genetic biomarker for treatment selection in patients with schizophrenia.

OBJECTIVE: There seems to be an association between the DRD4 48-bp VNTR polymorphisms and antipsychotic treatment response, but there is a rare reference to confirm this finding. Hence, the present study tried to investigate the association between DRD4 48-bp VNTR polymorphisms and the treatment response of antipsychotics in patients with schizophrenia in Taiwan, using a propensity score matching (PSM) method. METHODS: A total of 882 participants were enrolled in this study and completed informed consent, research questionnaires, including demographic information and the revised Chinese version Beliefs about Voices Questionnaire, and blood sampling. For descreasing of the selection bias and confounding variables, the PSM nearest neighbor matching method was used to select 765 paitents with schizophrenia (ratio of 1:8 between 85 persistent auditory hallucination and 680 controls) with matched and controlled the age and gender. RESULTS: Schizophrenia patients with DRD4 4 R homozygosity had a lower rate of good antipsychotic treatment response than the other DRD4 genotype carriers (DRD4 non-4/4). Among those 4 R homozygosity carriers, 60 cases of 503 (11.9%) retain persistent auditory hallucinations. Furthermore, this subgroup of patients is accounted for up to 70.6% of cases with poor neuroleptic treatment response. CONCLUSIONS: A poor treatment outcome for patients with the 4 R homozygosity had presented,that comparing with those DRD non-4/4 genotype carriers. DRD4 VNTR 4 R homozygosity could be a genetic biomarker to predict poor antipsychotic treatment response in schizophrenia. Patients with DRD 4/4 probably receive novel antipsychotic medications preferentially or in combination with alternative therapy, such as psychotherapy or milieu therapy.

Older adults with higher income or marriage have longer telomeres.

BACKGROUND: telomere length has been used to represent biological ageing and is found to be associated with various physiological, psychological and social factors. OBJECTIVE: to explore the effects of income and marriage on leucocyte telomere length in a representative sample of older adults. DESIGN AND SUBJECTS: cross-sectional analysis among 298 adults, aged 65-74, randomly selected from the community by census. METHODS: telomere length was measured by quantitative PCR. Participants provided information on sociodemographics, physical illness and completed questionnaires rating mental state and perceived neighbourhood experience. RESULTS: telomere length was negatively associated with lower income [coefficient -0.141 (95% CI: -0.244 to -0.020), P = 0.021] and positively associated with the marital status [coefficient 0.111 (95% CI: -0.008 to 0.234), P = 0.067] when controlling for gender, age, educational level, physical diseases (including diabetes, hypertension, cardiovascular diseases, cerebrovascular disease and Parkinson's disease), depressive symptoms, minor mental symptoms, cognitive impairment and perceived neighbourhood experience (including social support, perceived security and public facilities). CONCLUSIONS: these results indicate that older adults with higher income or being married have longer telomeres when other sociodemographics, physical diseases, mental status and neighbourhood experience are adjusted.

Parental bonding and personality characteristics of first episode intention to suicide or deliberate self-harm without a history of mental disorders.

BACKGROUND: There is substantial overlap between deliberate self-harm (DSH) and intention to suicide (ITS), although the psychopathologies and motivations behind these behaviors are distinctly different. The purpose of this study was to investigate (i) the pathway relationship among parental bonding, personality characteristics, and alexithymic traits, and (ii) the association of these features with ITS and DSH using structural equation modeling to determine the risks and protective factors for these behaviors. METHODS: Sixty-nine first-time DSH and 36 first-time ITS patients without medical or psychiatric illnesses, and 66 controls were recruited. The Parental Bonding Inventory (PBI), Eysenck Personality Questionnaire (EPQ), 20-item Toronto Alexithymia Scale (TAS-20), and the Chinese Health Questionnaire (CHQ) were filled out by the participants. RESULTS: Our structural equation models showed that parental bonding had the greatest influence on the development of DSH behavior in patients. On the other hand, participants who were younger, less extraverted, with a greater extent of the alexithymic trait of difficulty identifying feeling (DIF), and a worse mental health condition, were more likely to develop ITS behavior. Males were more likely than females to develop the alexithymic trait of DIF. CONCLUSIONS: Although there are many covariates that affect both ITS and DSH behaviors, these covariates may have different functions in the development of these behaviors, thus revealing the psychopathological difference between DSH and ITS. Policymakers should consider these differences and build intervention and prevention programs for gender- and age-specific high-risk groups to target the differences, with a focus on family counseling to treat DSH and a focus on attempting to increase emotional awareness to treat ITS.

Different impacts of aquaporin 4 and MAOA allele variation among olanzapine, risperidone, and paliperidone in schizophrenia.

Apoptosis has been considered to be involved in schizophrenia. Water channels are modulated just before apoptosis. In the aquaporin family, aquaporin 4 (AQP-4) is most highly expressed in the brain and is supposed to play an important role in a neuronal environment. In this clinical study, we investigated the relationship between the AQP-4 polymorphism and drug response in schizophrenia under the control of the MAOA (monoamine oxidase A) promoter gene. We recruited 91 patients with schizophrenia, and they were randomized to receive olanzapine (n = 44), risperidone (n = 23), or paliperidone (n = 24). Genotyping of AQP-4 and MAOA polymorphisms was done in all patients. Patients with the AQP-4 non-C polymorphism needed a higher dosage of olanzapine for treatment (z = 4.163, P = 0.041), and patients with a short form of the MAOA polymorphism needed a higher dosage of risperidone for treatment (z = 5.124, P = 0.024). Patients who smoked cigarettes needed a higher dosage of olanzapine for treatment (z = 4.905, P = 0.027), but cigarette smoking did not affect the dosage of paliperidone. The AQP-4 polymorphism may have an effect in influencing the dosage of olanzapine. However, the roles of AQP-4 polymorphisms in the blood-brain barrier and different neuroprotective effects need further exploration in future studies.