Clinical factors related to acute electroconvulsive therapy outcome for patients with major depressive disorder.

The aim of this study was to explore the significant predictors associated with electroconvulsive therapy (ECT) outcome for patients with major depressive disorder. Major depressive disorder inpatients (N=130) requiring ECT were recruited from a major psychiatric center in South Taiwan. ECT was generally performed for a maximum of 12 sessions. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) and Clinical Global Impression of Severity (CGI-S) before ECT, after every three ECT sessions, and after the last ECT. The generalized estimating equations method was used to analyze the influence of potential variables over time on the HAMD-17 and CGI-S, respectively. Fourteen patients not completing the first three sessions of ECT were excluded. The remaining 116 patients were included in the analysis. Patients with treatment-resistant depression, longer duration of the current depressive episode, and higher levels of pain were more likely to have less symptom reduction after acute treatment with ECT, irrespective of how the depressive symptoms were rated using HAMD-17 or CGI-S. To improve efficacy, earlier application of ECT and pain control should be considered during an acute course of ECT. Other clinical predictors related to ECT outcome require further investigation in future studies.

Early improvement predicts outcome of major depressive patients treated with electroconvulsive therapy.

The aim of this study was to test whether early symptom improvement predicts final response and remission for patients with major depressive disorder (MDD) receiving electroconvulsive therapy (ECT). MDD inpatients (N=130) requiring ECT were recruited. ECT was generally performed for a maximum of 12 sessions. Symptom severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17) before ECT, after every 3 ECT sessions, and after the last ECT. Early improvement was defined as a reduction in the HAMD-17 score by at least 20%, 25%, or 30% after 3 and 6 ECT sessions. Response was defined as 60% HAMD-17 score reduction, while remission was defined as an end point HAMD-17 score of ≦7. Receiver operating characteristic (ROC) curves were used to determine whether 3 or 6 ECT sessions had better discriminative capacity. Sensitivity, specificity and predictive values were calculated for the different definitions of early improvement. Of the 105 patients entering the analysis, 85.7% (n=90) and 70.5% (n=74) were classified as responders and remitters, respectively. Early improvement after 6 ECT sessions showed better discriminative capacity, with areas under the ROC curve at least 0.8. It had high sensitivity and high negative predictive value for all cutoffs in predicting response and remission. High response and remission rates were observed. Final response and remission could be predicted by early improvement after 6 ECT sessions. Patients without early improvement were unlikely to reach response and remission.

The relationship between symptom relief and functional improvement during acute fluoxetine treatment for patients with major depressive disorder.

BACKGROUND: The purpose of this study was to compare the rate of symptom relief to functional improvement and examine the relationships between symptom relief and functional improvement during the acute phase of treatment. METHODS: A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Symptom severity, using the 17-item Hamilton Depression Rating Scale (HAMD-17), and functioning, using the Modified Work and Social Adjustment Scale (MWSAS), were measured regularly. The outcome measures were the HAMD-17 score and MWSAS score at weeks 1, 2, 3, 4, and 6. We compared the effect size and the reduction rate of HAMD-17 to those of MWSAS at week 1, 2, 3, 4, and 6. Structural equation modeling was used to examine relationships among the study variables. RESULTS: Of the 131 participants, 126 had at least one post-baseline assessment at week 1 and were included in the analysis. The HAMD-17 had a larger effect size and reduction rate than the MWSAS at weeks 1, 2, 3, 4, and 6. Parsimonious model satisfied all indices of goodness-of-fit (Chi-Square/df=1.479, TLI=0.978, CFI=0.986, RMSEA=0.062) and had all paths with significant path coefficients. MWSAS at week 0 predicted HAMD-17 at week 1. LIMITATION: This was an open-labeled study with small sample size. CONCLUSION: Depressive symptoms improved more quickly than functioning during the acute phase of treatment. Depressive symptoms and functional impairment are distinct domains, and should be assessed independently.

Newly diagnosed erectile dysfunction and risk of depression: a population-based 5-year follow-up study in Taiwan.

INTRODUCTION: Depression might increase the risk of erectile dysfunction (ED), and ED might further exacerbate depression. The causal relationship between these two diseases remains controversial. In addition, limited evidence is available regarding the age-dependent and time-dependent effects on the association of depression and ED. AIM: We investigated the hypothesis that ED increases the risk of depression by using a nationwide Taiwanese population-based claims database. In addition, we assessed the age-dependent and time-dependent effects on the association of depression and ED. METHODS: A longitudinal cohort study was conducted to determine the association between patients with ED and depression development during a 5-year follow-up period, using claims data from the Taiwanese National Health Insurance Research Database. MAIN OUTCOME MEASURES: The study cohort comprised patients who were diagnosed with ED during 1997 to 2005 (N = 2,527). For a comparison cohort, 5 age- and sex-matched patients for every patient in the study cohort were selected using random sampling (N = 12,635). All of the patients were followed-up for 5 years from the date of cohort entry to identify the development of depression. RESULTS: The main finding of this study was that patients with ED are at an increased risk of developing depression. The adjusted hazard ratio (AHR) for depression was 2.24-fold higher in the patients with ED than in the comparison cohort (95% confidence interval [CI]: 1.83-2.74; P < 0.001). Regarding the time-dependent effect, the incidence of depression was highest during the first year of follow-up (AHR: 3.03, 95% CI = 2.08-4.40; P < 0.001). CONCLUSIONS: This study demonstrates that patients with ED are at a higher longitudinal risk of developing depression in Asian men, particularly within the first year after the diagnosis of ED.

Depression and pain impair daily functioning and quality of life in patients with major depressive disorder.

BACKGROUND: Depression and pain frequently occur together. The objective of this study was to investigate the effects of depression and pain on the impairment of daily functioning and quality of life (QOL) of depressed patients. METHODS: We enrolled 131 acutely ill inpatients with major depressive disorder. Depression, pain, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed using three primary domains of the SF-36: social functioning, vitality, and general health perceptions. Pearson׳s correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. RESULTS: In all, 129 patients completed all the measures. Model 5, both depression and pain impaired daily functioning and QOL, was the most fitted structural equation model (χ(2)=9.2, df=8, p=0.33, GFI=0.98, AGFI=0.94, TLI=0.99, CFI=0.99, RMSEA=0.03). The correlation between pain and depression was weak (r=-0.27, z=-2.95, p=0.003). LIMITATION: This was a cross-sectional study with a small sample size. CONCLUSION: Depression and pain exert a direct influence on the impairment of daily functioning and QOL of depressed patients; this impairment could be expected regardless of increased pain, depression, or both pain and depression. Pain had a somewhat separate entity from depression.

Relief of depression and pain improves daily functioning and quality of life in patients with major depressive disorder.

OBJECTIVE: The objective of this study was to investigate the effects of depression relief and pain relief on the improvement in daily functioning and quality of life (QOL) for depressed patients receiving a 6-week treatment of fluoxetine. METHOD: A total of 131 acutely ill inpatients with major depressive disorder (MDD) were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Depression severity, pain severity, daily functioning, and health-related QOL were assessed at baseline and again at week 6. Depression severity, pain severity, and daily functioning were assessed using the 17-item Hamilton Depression Rating Scale, the Short-Form 36 (SF-36) Body Pain Index, and the Work and Social Adjustment Scale. Health-related QOL was assessed by three primary domains of the SF-36, including social functioning, vitality, and general health perceptions. Pearson's correlation and structural equation modeling were used to examine relationships among the study variables. Five models were proposed. In model 1, depression relief alone improved daily functioning and QOL. In model 2, pain relief alone improved daily functioning and QOL. In model 3, depression relief, mediated by pain relief, improved daily functioning and QOL. In model 4, pain relief, mediated by depression relief, improved daily functioning and QOL. In model 5, both depression relief and pain relief improved daily functioning and QOL. RESULTS: One hundred and six patients completed all the measures at baseline and at week 6. Model 5 was the most fitted structural equation model (χ(2) = 8.62, df = 8, p = 0.376, GFI = 0.975, AGFI = 0.935, TLI = 0.992, CFI = 0.996, RMSEA = 0.027). CONCLUSION: Interventions which relieve depression and pain improve daily functioning and QOL among patients with MDD. The proposed model can provide quantitative estimates of improvement in treating patients with MDD.

Electroconvulsive therapy improves clinical manifestation with plasma BDNF levels unchanged in treatment-resistant depression patients.

Electroconvulsive therapy (ECT) is the most effective treatment in treatment-resistant depression; it may modulate intracellular processes in such patients. This study aimed to investigate the association between changes in plasma brain-derived neurotrophic factor (BDNF) levels and the clinical improvements after ECT for patients with treatment-resistant depression. Fifty-five inpatients with treatment-resistant depression were recruited. The severity of depression was measured using the 17-item Hamilton Rating Scale for Depression (HAMD-17) and the Clinical Global Impression-Severity (CGI-S) before ECT, after every 3 sessions of ECT, and at the end of ECT. Plasma BDNF levels were measured in all subjects before and after ECT. The severity of depression was significantly reduced on the HAMD-17 (p < 0.001) and the CGI-S (p < 0.001) after the end of ECT. There were no significant differences in plasma BDNF levels after ECT (p = 0.615). No significant correlation was found between changes in plasma BDNF levels and changes in HAMD-17 scores (r = 0.188, p = 0.169). Our results do not support the hypothesis that improvements in treatment-resistant depression patients after ECT are due to changes in BDNF levels.

Quality of life and its associated factors among patients with two common types of chronic mental illness living in Kaohsiung City.

AIM: This study explored the associations of personal, disease, family, and social factors with quality of life (QoL) in patients with two common types of chronic mental illness (CMI) living in Kaohsiung City, Taiwan. METHODS: Using a convenience sample and a cross-sectional design, 714 patients (50.1% male, 49.9% female) with CMI (72.1% schizophrenia and 27.9% affective disorder) and their caregivers were recruited. Demographic information was collected via the following questionnaires: 12-Item Short-Form Health Survey (SF-12), five-item Brief Symptom Rating Scale (BSRS-5), Caregiver Burden Scale, and Clinical Global Impressions (CGI-S) Scale. Pearson correlations and hierarchical regression analyses were used to predict QoL. RESULTS: Disease factors accounted for 17-50% of the change in variance. Predictors of low mental subscale scores included the following: high psychological distress and high family burden as well as a history of suicide attempts, negative caregiver attitudes, and living away from home. Disease factors also explained the greatest variance in the physical subscales. Predictors of low physical subscale scores included the following: high psychological distress, age, unemployment, a history of suicide attempts, high family burden, and living alone. CONCLUSIONS: Disease factors were the most important predictors of QoL in patients with CMI. Family factors were more important than social factors on the mental subscales. Differential relationships were also found for the other two dimensions. Together, these results indicate that a wide range of factors improve the QoL in patients with CMI.

The implication of functional connectivity strength in predicting treatment response of major depressive disorder: a resting EEG study.

Predicting treatment response in major depressive disorder (MDD) has been an important clinical issue given that the initial intent-to-treat response rate is only 50 to 60%. This study was designed to examine whether functional connectivity strengths of resting EEG could be potential biomarkers in predicting treatment response at 8 weeks of treatment. Resting state 3-min eyes-closed EEG activity was recorded at baseline and compared in 108 depressed patients. All patients were being treated with selective serotonin-reuptake inhibitors. Baseline coherence and power series correlation were compared between responders and non-responders evaluated at the 8th week by Hamilton Depression Rating Scale. Pearson correlation and receiver operating characteristic (ROC) analyses were applied to evaluate the performance of connectivity strengths in predicting/classifying treatment responses. The connectivity strengths of right fronto-temporal network at delta/theta frequencies differentiated responders and non-responders at the 8th week of treatment, such that the stronger the connectivity strengths, the poorer the treatment response. ROC analyses supported the value of these measures in classifying responders/non-responders. Our results suggest that fronto-temporal connectivity strengths could be potential biomarkers to differentiate responders and slow responders or non-responders in MDD.

No association of angiotensin I converting enzyme I/D polymorphism with domain-specific cognitive function in aged men without dementia.

Previous research studies have related the insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene to cognitive function in various neuropsychiatric or neurodegenerative disorders, but not yet investigated its genetic association with specific cognitive domains. Thus, the aim of this study was to assess the possible association of the ACE I/D polymorphism with domain-specific cognitive function in normal cognitive aging. Four hundred and sixty-nine-aged ethnic Chinese men without dementia were enrolled for genotyping and evaluated using several neuropsychological tests [Mini-Mental Status Examination (MMSE), Digit Span Forward and Backward, and Cognitive Ability Screening Instrument Chinese language version (CASI C-2.0)]. No direct association was found between ACE genotypes and the MMSE, Digit Span tests, or CASI total scores. Although subjects with I/I genotype had the lowest cognitive performance in the CASI visual construction domain (P = 0.031), this statistical difference disappeared after correction for multiple comparisons. This study suggests that the ACE I/D polymorphism does not have any genetic association with global or specific cognitive domain in aged men without dementia.

Varenicline prevents affective and cognitive exacerbation during smoking abstinence in male patients with schizophrenia.

To explore the effects of varenicline on the psychopathology and cognition of chronic inpatients with schizophrenia, we conducted a non-randomized control group time series investigation between March 2009 and April 2010. In a mandatory smoking cessation intervention, 41 male inpatient smokers were scheduled to undergo either a 5-week varenicline treatment (varenicline group) or the use of no drugs (non-treatment group). Depression (HAM-D), anxiety (HAM-A), and psychosis (PANSS) were evaluated at baseline, and at the 2nd, 4th, 8th and 12th week after abstinence; four neuropsychological tests, including Digit Span Forward and Backward (DSF and DSB), and Trail Making Test-A and -B, were evaluated at baseline and at the 4th, 8th and 12th week. .Thirty patients completed the study. Among 15 patients in the non-treatment group, the HAM-D, HAM-A, DSF, and DSB scores were exacerbated during the 2-8 weeks of abstinence, but there were no changes in psychotic symptoms and the other two neuropsychological tests. Compared with the non-treatment group, varenicline users experienced less impairment in HAM-D and HAM-A scores at the 2nd and 4th weeks, and in DSF tasks at the 4th week after abstinence. In conclusions, varenicline can attenuate abstinence-induced adverse outcomes and appears to be well-tolerated in smokers with schizophrenia.

Cortical mechanisms of the symptomatology in major depressive disorder: a resting EEG study.

BACKGROUND: Diagnosis and treatment rely on symptom criteria in modern psychiatry. However, the cortical mechanisms of symptomatology in major depressive disorder (MDD) are still not clear. This study examined neural correlates of symptom clusters of MDD by electroencephalography (EEG). METHODS: Resting state eye-closed EEG signals were recorded in 196 depressive patients. Quantitative EEG (qEEG) of regional power, coherence and power series correlation across delta, theta, alpha and beta frequencies were used to correlate with overall depression severity evaluated by the Hamilton Depression Rating Scale (HDRS). Further, statistical comparisons between patients with high vs. low qEEG indices (median-split) were undertaken regarding symptom severity of core depression, sleep, activity, psychic anxiety, somatic anxiety, and delusion. RESULTS: None of the qEEG indices significantly correlated with overall depression severity or differentiated symptom severity of core depression, sleep, activity and psychic anxiety. A higher symptom severity of somatic anxiety was associated with higher regional power over widespread cortical regions and lower strengths at bi-temporal, temporo-parietal and fronto-parietal connections. A higher symptom severity of delusion was associated with higher regional power in the frontal and temporal regions, and lower strengths at inter-hemispheric (frontal, temporal and parietal) and fronto-temporo-parietal connections. LIMITATIONS: Our EEG recording with sampling rate of 128Hz and 20 electrodes may provide restricted spatial and temporal precision. CONCLUSIONS: Our results suggest that cortical mechanisms play important roles in the symptom manifestation of cognitive distortion (sub-score of delusion) and somatic anxiety in MDD. Our findings further imply that psychic anxiety and somatic anxiety are distinct entities.

Time to rehospitalization in patients with major depression vs. those with schizophrenia or bipolar I disorder in a public psychiatric hospital.

Compared rehospitalization rates in patients with schizophrenia or bipolar I disorder to patients with major depressive disorder remains unclear. This study aimed to compare the time to rehospitalization of the three groups. Other clinical variables were also examined. Rehospitalization status was monitored for all admitted inpatients with schizophrenia (n=637), bipolar I disorder (n=197), or major depressive disorder (n=191), from January 1, 2006 to December 31, 2006. Time to rehospitalization within 1 year after discharge was measured using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. The three groups were comparable for comorbid alcohol abuse/dependence, family history of severe psychiatric illness, years of education, and number of previous hospitalizations. No significant differences were noted among the three groups for the time to rehospitalization or the time to discontinuation. Age onset and number of previous admission were associated with risks of rehospitalization. This study suggests that the major depressive disorder, schizophrenia, and bipolar I disorder have comparable influences on time to rehospitalization and discontinuation from treatment and that earlier onset of illness and more previous hospitalizations are associated with higher risks of rehospitalization. Further prospective research is warranted.

Correlation of attention deficit, rapid eye movement latency and slow wave sleep in schizophrenia patients.

AIM: Schizophrenia patients present both reduced slow wave sleep (SWS) and shortened rapid eye movement latency (REML) in polysomnographic (PSG) profiles, which have been linked to dopaminergic and muscarinic impairment, respectively. Two main selective attentional systems involve different anatomical structures. The first system is the parietal cortical areas and thalamic areas, which are linked to cholinergic neurotransmission. This is responsible for automatic attention response. The second system is the frontal regions, which are linked to dopaminergic neurotransmission. This is responsible for voluntary control of attentional resources. It was hypothesized that low attentional performance in schizophrenia patients is associated with shortened REML and reduced SWS. METHODS: The PSG profile was correlated with the continuous performance test (CPT) in 15 schizophrenia inpatients under treatment with risperidone. Schizophrenia was diagnosed according to DSM-IV criteria, and clinical symptoms were evaluated on the Brief Psychiatric Rating Scale. RESULTS: REML was negatively correlated with errors of omission (P < 0.05), reaction time (RT; P < 0.05) and positively correlated with hit rate (HR; P < 0.05). No association was found between SWS and CPT performance. CONCLUSIONS: The significant indicators of CPT represent different attention processes. Errors of omission, which are linked to the problems with automatic attention processing, RT, which represent the speed of automatic processing, and HR, are involved in the integration of autonomic and voluntary attention control. The present results suggest that REML is associated with thalamus-related automatic attention response. Due to study limitations, however, confirmation of these findings in a large-scale controlled study of drug-naïve patients is needed.

Factors affecting time to rehospitalization in Han Chinese patients with schizophrenic disorder in Taiwan.

Schizophrenic disorder is a lifelong illness. Hospitalization is a major event for the patient and his/her family, often indicating that the clinical symptoms have reached an intolerable level. The purpose of this study was to investigate the risk factors affecting the time to rehospitalization. Rehospitalization status was monitored for all schizophrenic patients discharged from Kai-Suan Psychiatric Hospital from January 1, 2002 to December 31, 2002. Patients were followed-up regarding rehospitalization until December 31, 2003. The Kaplan-Meier method was used to calculate the mean time to rehospitalization. Risk factors associated with rehospitalization were examined by Cox proportional hazards regression model. Three hundred and thirty-six patients were recruited for this study. The mean time to rehospitalization was 239 +/- 7 days, with a rehospitalization rate of 54.5%. The mean time to discontinuation was 329 +/- 5 days. Age at onset (hazard ratio = 0.978, 95% CI = 0.959-0.998, p = 0.031) and the number of previous hospitalizations (hazard ratio = 1.108, 95% CI = 1.058-1.161, p < 0.001) were found to be risk factors of shorter time to rehospitalization within 1 year after discharge. Further research should be carried out to test risk factors in a prospective study, and to assess the cost-effectiveness of interventions to prevent rehospitalization.

Time to rehospitalization in patients with major depressive disorder taking venlafaxine or fluoxetine.

OBJECTIVE: The combined serotonin-norepinephrine reuptake inhibitor, venlafaxine, has demonstrated better short-term efficacy than selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine in pooled analyses. This study aimed to compare venlafaxine and fluoxetine treatment in the long-term outcome measure, time to rehospitalization, in patients with major depressive disorder. Other clinical factors that may influence time to rehospitalization were also explored. METHOD: Han Chinese patients were admitted to the depression inpatient unit of a major psychiatric center in Taiwan from January 1, 2002, to December 31, 2003. Patients with major depressive disorder (DSM-IV) who showed favorable treatment response to venlafaxine (mean +/- SD dose = 116.5 +/- 42.5 mg/day; N = 122) or fluoxetine (mean +/- SD dose = 25.1 +/- 9.0 mg/day; N = 80) during hospitalization were followed up for 1 year after discharge under naturalistic conditions. The 2 treatment groups were similar in demographic and clinical characteristics: sex, age, age at illness onset, comorbid anxiety disorders, personality disorders, nicotine dependence, psychotic features, adjunctive antipsychotics use, duration of index hospitalization, and number of previous hospitalizations. Time to rehospitalization was measured by the Kaplan-Meier method. Possible associations of rehospitalization with other covariates were analyzed using the Cox proportional hazards regression model. RESULTS: No significant difference for the time to rehospitalization was found between the 2 groups by the log-rank test. The number of previous admissions (hazard ratio = 1.331, 95% CI = 1.153 to 1.538, p = .000), but not other factors, increased the risk of rehospitalization. CONCLUSION: The findings suggest that venlafaxine and fluoxetine have similar effects on time to rehospitalization in patients with major depressive disorder. The relatively low dose of venlafaxine may have contributed to the negative finding. Previous hospitalization history may raise the risk of rehospitalization. Longer-term, double-blind, randomized, fixed-dose studies are warranted to better delineate the effectiveness of different pharmacotherapeutic regimens for the outcomes of patients with major depressive disorder.

The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan.

OBJECTIVE: The work of firefighters involves the risk of exposure to the harmful effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan. METHODS: This is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version. RESULTS: The estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition. CONCLUSION: Firefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.

Epidemiologic psychiatric studies on post-disaster impact among Chi-Chi earthquake survivors in Yu-Chi, Taiwan.

The aim of the present study was to survey a cohort population for the risk factors of post-traumatic stress disorder (PTSD) and major depression, and the prevalence of different psychiatric disorders at 6 months and 2 and 3 years after a major earthquake. The Disaster-Related Psychological Screening Test (DRPST), part I, and the Mini-International Neuropsychiatric Interview (MINI) were, respectively, administered by trained interviewers and psychiatrists in this community-interview program. The prevalence of PTSD decreased from 8.3% at 6 months to 4.2% at 3 years after the earthquake. Suicidality increased from 4.2% at 6 months and 5.6% at 2 years to 6.0% at 3 years after the earthquake; drug abuse/dependence increased from 2.3% at 6 months to 5.1% at 3 years after the disaster. The risk factors for PTSD and major depression in various post-disaster stages were determined. Earthquake survivors had a high percentage of psychiatric disorders in the first 2 years, and then the prevalence declined. Following the devastation caused by the Chi-Chi earthquake, it is important to focus on treating symptoms of major depression and PTSD and eliminating the risk factors for both of these disorders in survivors to avoid the increase in suicidality.

Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan.

OBJECTIVE: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years. METHODS: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period. RESULTS: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred. CONCLUSIONS: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

Comparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone.

BACKGROUND: The purpose of this study was to compare the time to rehospitalization of schizophrenic patients who were discharged from a psychiatric hospital while being treated with typical antipsychotics, clozapine or risperidone. We also assessed other possible predictors of time to rehospitalization. METHODS: The study monitored the rehospitalization status of all the schizophrenic patients who were discharged from a psychiatric hospital between July 1, 2001 and June 30, 2002 while they were taking typical antipsychotics (n=272), clozapine (n=61) or risperidone (n=49). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined by the Cox proportional hazards regression model. RESULTS: No significant differences in time to rehospitalization were observed among the groups in the first or second year after discharge. Age at onset of schizophrenia was a risk factor for time to rehospitalization over the 1- and 2-year periods. CONCLUSION: This study demonstrated that atypical antipsychotics did not lengthen the time to rehospitalization. The earlier the age at onset of schizophrenia, the shorter is the time to rehospitalization. Some other factors thought to impact rehospitalization need to be further assayed.