One-year follow up of PTSD and depression in elderly aboriginal people in Taiwan after Typhoon Morakot.

AIM: This paper describes a 1-year follow-up of post-traumatic stress disorder (PTSD) symptomatology and depression in an elderly minority population who experienced Typhoon Morakot in Taiwan. METHODS: The PTSD Symptom Scale--Interview and the 10-item short form Center for Epidemiological Studies Depression Scale were used to examine PTSD symptomatology and depression in 120 victims at 3-6 months and in 88 victims (73.3% reinterview rate) at 11-12 months after the disaster. Further, we looked for associations between stress, prognosis, and development of PTSD symptomatology and depression. RESULTS: The prevalence of PTSD symptomatology decreased from 29.2% (35/120) at 3-6 months to 15.9% (14/88) at 11-12 months. The prevalence of depression, however, increased from 43.3% (52/120) to 46.6% (41/88). No factor was associated with follow-up PTSD symptomatology, and only the level of education was related to follow-up depression. Generally, the risk factors of age, sex, symptomatology of PTSD and depression at baseline, and stressor of unemployment predicted new-onset or chronic PTSD symptomatology and depression. Delayed-onset depression 48.0% (24/50) was more common than delayed-onset PTSD symptomatology 11.3% (7/62). Chronic and delayed-onset PTSD symptomatology were more easily developed with depression. CONCLUSION: Although PTSD and depression were separate consequences of trauma, they emerged and affected mental health together. We documented the courses of PTSD and depression among elderly aboriginal people, and the possible effects of demographic, symptomatology, and adverse life stressors were discussed.

Association between school bullying levels/types and mental health problems among Taiwanese adolescents.

BACKGROUND: Few studies have compared the risks of mental health problems among the adolescents with different levels and different types of bullying involvement experiences. METHOD: Bullying involvement in 6,406 adolescents was determined through use of the Chinese version of the School Bullying Experience Questionnaire. Data were collected regarding the mental health problems, including depression, suicidality, insomnia, general anxiety, social phobia, alcohol abuse, inattention, and hyperactivity/impulsivity. The association between experiences of bullying involvement and mental health problems was examined. The risk of mental health problems was compared among those with different levels/types of bullying involvement. RESULTS: The results found that being a victim of any type of bullying and being a perpetrator of passive bullying were significantly associated with all kinds of mental health problems, and being a perpetrator of active bullying was significantly associated with all kinds of mental health problems except for general anxiety. Victims or perpetrators of both passive and active bullying had a greater risk of some dimensions of mental health problems than those involved in only passive or active bullying. Differences in the risk of mental health problems were also found among adolescents involved in different types of bullying. CONCLUSIONS: This difference in comorbid mental health problems should be taken into consideration when assessing adolescents involved in different levels/types of bullying.

Working memory deficit in premenstrual dysphoric disorder and its associations with difficulty in concentrating and irritability.

OBJECTIVE: This study evaluates working memory deficit among women with premenstrual dysphoric disorder (PMDD) and whether such a deficit and its premenstrual aggravation is associated with difficulty in concentrating, irritability, and impaired daily function or not. METHOD: Sixty women with PMDD (PMDD group) and 60 women without PMDD (control group) completed the assessment. Severity of irritability, difficulty concentrating, total symptoms, and functional impairment of PMDD were evaluated by the Premenstrual Symptoms Screening Tool. All participants performed N2 and N3 back tasks to assess working memory in both luteal and follicular phases. RESULTS: The PMDD group had significantly poorer performance on N2 and N3 back tasks than the control group did in the luteal phase but not in the follicular phase. Compared to the control group, the PMDD group also exhibited more deterioration in performance of N3 back task in the luteal phase. Performance of N2 and N3 back tasks in luteal phase was significantly associated with irritability, symptom severity, and functional impairment by PMDD. CONCLUSIONS: Working memory deficit is aggravated in the luteal phase among women with PMDD. Appropriate interventions are needed to prevent negative consequences of working memory deficit.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia.

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

Cue-induced positive motivational implicit response in young adults with Internet gaming addiction.

This study evaluated the positive motivational implicit response to Internet gaming cues (i.e., screenshots of popular online games) to identify potential mechanisms of dyscontrolled Internet use in young adults with Internet gaming addiction (IGA). The final analysis included 64 young adults with IGA and 71 control subjects. The subjects completed the implicit association task to test their reaction to congruent pairing (Internet gaming screenshot paired with liked words) and incongruent pairing (Internet gaming screenshot paired with disliked words). The results demonstrated that, compared to the control group, the IGA group reacted faster to congruent pairing. It suggests that the IGA group had a positive motivational implicit response to screenshots of online games. Implicit cognition is an important mechanism of dyscontrolled substance use, such as alcohol dependence. This result suggests that implicit cognition might also be associated with dyscontrolled online gaming. The findings also demonstrate the important role of implicit cognition in dyscontrolled Internet use in young adults with IGA.

Effects of motivational enhancement therapy on readiness to change MDMA and methamphetamine use behaviors in Taiwanese adolescents.

The aim of this study was to examine the effect of brief modified motivational enhancement therapy (MET) on readiness to change patterns of methylenedioxymethamphetamine (MDMA) and methamphetamine (MAMP) use behaviors in adolescents. A total of 94 adolescents who used MDMA or MAMP were consecutively recruited from a juvenile abstinence center; 46 received a three-session MET intervention (intervention group), and 48 received educational materials only and no MET intervention (control group). Analysis of covariance was performed to examine the effect of motivational interviewing on the readiness of change scores on the University of Rhode Island Change Assessment and on the scores of its subscales. By using the pretreatment scores as covariates, the intervention group demonstrated higher posttreatment scores of readiness to change and of the contemplation subscale on the University of Rhode Island Change Assessment than the control group. The results of this study support the finding that brief modified MET is effective in promoting readiness to change MAMP and MDMA use behaviors in adolescents who receive short-term treatment programs.

Cognitive profile difference between Allen Cognitive Levels 4 and 5 in schizophrenia.

OBJECTIVE: We compared the pattern of cognitive deficits exhibited by people with schizophrenia at Allen Cognitive Level (ACL) 4 with that of people at Level 5. METHOD: Participants were classified into two groups on the basis of their ACL Screen scores: ACL 4 (n = 35) and ACL 5 (n = 41). We assessed cognitive functions and psychotic symptoms in all participants. RESULTS: Multivariate analysis of covariance controlling for gender and negative symptoms revealed that people at ACL 4 performed significantly worse than those at ACL 5 on processing speed, verbal memory, and working memory. The discriminant analysis with all cognitive variables produced a classification accuracy of 78% in differentiation of cognitive levels. CONCLUSION: We verified the validity of the hierarchy of cognitive disability for ACLs 4 and 5 in people with schizophrenia.

Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model.

BACKGROUND: The aims of this study were to examine the direct and indirect effects of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), disaster-exposure experience, gender, and perceived family support on suicide risk (including suicide ideation and attempt) in adolescents 3 months after they had experienced Typhoon Morakot-associated mudslides in Taiwan using a structural equation model (SEM). METHODS: Two hundred and seventy-one adolescents in the worst affected mountainous regions of southern Taiwan were recruited. Suicide risk and diagnoses of PTSD and MDD were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. The direct and indirect effects of PTSD, MDD, disaster-exposure experience, gender, and perceived family support on suicide risk were examined using SEM. RESULTS: The results of SEM indicated that increased disaster-exposure experience and female gender had direct influences on an increased suicide risk and indirect influences on increased suicide risk that were mediated by PTSD and MDD. Perceived high family support directly decreased suicide risk. Both PTSD and MDD had direct influences on an increased suicide risk, and PTSD had an indirect influence on an increased suicide risk that was mediated by MDD. CONCLUSIONS: Gender, disaster-exposure experience, perceived high family support, PTSD, and MDD all had effects on suicide risk in adolescents who had experienced the threat of mudslides caused by Typhoon Morakot. The results provide healthcare professionals with a comprehensive understanding to develop intervention programs to prevent and intervene in suicide risk.

The association between short and long nocturnal sleep durations and risky behaviours and the moderating factors in Taiwanese adolescents.

Sleep quantity and risky behaviours are important health issues in adolescents. This cross-sectional study aimed to examine the association between short and long nocturnal sleep durations and a variety of adolescent risky behaviours, including suicidality, violence, regular alcohol consumption, illicit drug use, truancy, unprotected sex, tattooing and criminal record of theft in a large-scale, representative population of Taiwanese adolescents, and to examine the moderating factors for the association between nocturnal sleep duration and risky behaviours. A total of 8319 adolescent students in southern Taiwan were recruited into this study and completed the questionnaires. The associations between short and long nocturnal sleep durations and adolescent risky behaviours, as well as the moderating effects of depression and socio-demographic characteristics on these associations, were examined. The results indicated that short nocturnal sleep duration was significantly associated with all risky behaviours, and long nocturnal sleep duration was significantly associated with all risky behaviours except for suicidality. Meanwhile, depression, sex, age, and maternal education level had moderating effects on the association between nocturnal sleep duration and several risky behaviours. The findings imply that professionals should investigate the concomitant risky behaviours in adolescents with short or long nocturnal sleep duration.

Internalizing and externalizing problems in adolescent aggression perpetrators, victims, and perpetrator-victims.

The aims of this study were to examine the risks of internalizing and externalizing problems in aggression perpetrators, victims, and perpetrator-victims and their sex differences, and to examine the effects of the level of aggression involvement on internalizing and externalizing problems. Eight thousand eighty-five adolescents in Taiwan completed the questionnaires. The associations of aggression involvement and the level of aggression involvement with internalizing and externalizing problems were examined. Compared with the neutrals, pure aggression perpetrators and perpetrator-victims had higher risks for internalizing and externalizing problems and pure victims had higher risks for internalizing problems and theft. Differences in the risks for internalizing and externalizing problems were found among 3 groups with aggression involvement. Levels of aggression involvement increased the risks for some internalizing and externalizing problems. Sex differences were also found. Internalizing and externalizing problems need to be detected among adolescents involved in aggression, especially among perpetrator-victims, those with high levels of aggression involvements, and females.

Association between quality of life and self-stigma, insight, and adverse effects of medication in patients with depressive disorders.

BACKGROUND: The aims of this study were to examine whether different domains of quality of life (QOL) are differently affected by depressive disorders by comparing QOL of subjects with and without depressive disorders, and to examine the association of QOL with self-stigma, insight and adverse effects of medication among subjects with depressive disorders. METHOD: The QOL on the four domains of the WHOQOL-BREF Taiwan version were compared between the 229 subjects with depressive disorders and 106 control subjects. Among the depressive subjects, the association between the four QOL domains and subjects' self-stigma, insight, and adverse effects of medication were examined using multiple regression analyses by controlling for the influence of depression, socio-demographic and clinical characteristics and family function. RESULTS: Depressive subjects had poorer QOL on the physical, psychological and social relationship domains than the non-depressive control group. The depressive subjects who had more severe self-stigma had poorer QOL on all four domains. The depressive subjects who perceived more severe adverse effects from medication had poorer QOL on the physical, psychological and environmental domains. However, insight was not associated with any domain of QOL in patients with depressive disorders. CONCLUSIONS: The results of this study demonstrate that different domains of QOL are differently affected by depressive disorders, and that clinicians must consider the negative influences of self-stigma and adverse effects from medication on QOL of subjects with depressive disorders.

Predictive value of self-stigma, insight, and perceived adverse effects of medication for the clinical outcomes in patients with depressive disorders.

The aims of this prospective study were to examine the predictive values of self-stigma, insight, and perceived adverse effects of medication for remission of depressive symptoms, suicidal risk, and medication adherence in patients with depressive disorders over a 1-year follow-up period. One hundred seventy-four participants who were in a state of obvious depression underwent an index interview to determine their degree of self-stigma, insight, and perceived adverse effects of medication. One year later, they were reassessed to determine the severity of their depressive symptoms, suicidal risk, and the level of the medication adherence, and their associations with the 3 possible predictors at the index interview were examined. The results of this study indicated that perceiving more severe adverse effects of medication at the index interview increased the risks of the nonremission of depressive symptoms, occurrence of suicidal ideation or attempt, and medication nonadherence in patients with depressive disorders in the 1-year period. However, the degrees of self-stigma and insight did not predict the severity of depressive symptoms, suicidal risk, or the level of the medication adherence. Based on the results of this study, we suggest that it is important for clinicians to prevent the occurrence of and to help patients manage the adverse effects of medication. We also suggest that further prospective studies are needed to examine the predictive values of self-stigma and insight for clinical outcomes and medication adherence.

Suicide and its association with individual, family, peer, and school factors in an adolescent population in southern Taiwan.

A representative sample of 10,233 adolescent students was recruited to examine the rate of suicidal attempt and its correlates in the adolescents living in southern Taiwan. Five questions from the Kiddie Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS-E) were used to inquire about the participants' suicidality. The associations between suicidal attempt and multidimensional factors were examined by using logistic regression analysis: 9.1% of the participants reported a suicidal attempt in the preceding year. Female gender, low self-esteem, weekly alcohol use, illicit drugs use, depression, high family conflict, low maternal education level, poor family function, low connectedness to school, low rank, poor feeling in peer group, and drop out from school were associated with adolescent suicidal attempt. The rate of suicidal attempt was found to be high in Taiwanese adolescents, and multidimensional factors were correlated to adolescent suicidal attempt.

Randomized study of school-based intensive interpersonal psychotherapy for depressed adolescents with suicidal risk and parasuicide behaviors.

AIM: The aim of the present study was to examine the intervention effects of intensive interpersonal psychotherapy for depressed adolescents with suicidal risk (IPT-A-IN) by comparison with treatment as usual (TAU) at schools. METHODS: A total of 347 students from one-fifth of the classes of a high school in southern Taiwan completed the Beck Depression Inventory-II, the Beck Scale for Suicide Ideation, the Beck Anxiety Inventory and the Beck Hopelessness Scale for screening for suicidal risk. Of them, 73 depressed students who had suicidal risk on screening were randomly assigned to the IPT-A-IN or TAU group. Analysis of covariance (ANCOVA) was performed to examine the effect of IPT-A-IN on reducing the severity of depression, suicidal ideation, anxiety and hopelessness. RESULTS: Using the pre-intervention scores as covariates, the IPT-A-IN group had lower post-intervention severity of depression, suicidal ideation, anxiety and hopelessness than the TAU group. CONCLUSION: Intensive school-based IPT-A-IN is effective in reducing the severity of depression, suicidal ideation, anxiety and hopelessness in depressed adolescents with suicidal risk.

Symptoms of problematic cellular phone use, functional impairment and its association with depression among adolescents in Southern Taiwan.

The aims of this study were: (1) to examine the prevalence of symptoms of problematic cellular phone use (CPU); (2) to examine the associations between the symptoms of problematic CPU, functional impairment caused by CPU and the characteristics of CPU; (3) to establish the optimal cut-off point of the number of symptoms for functional impairment caused by CPU; and (4) to examine the association between problematic CPU and depression in adolescents. A total of 10,191 adolescent students in Southern Taiwan were recruited into this study. Participants' self-reported symptoms of problematic CPU and functional impairments caused by CPU were collected. The associations of symptoms of problematic CPU with functional impairments and with the characteristics of CPU were examined. The cut-off point of the number of symptoms for functional impairment was also determined. The association between problematic CPU and depression was examined by logistic regression analysis. The results indicated that the symptoms of problematic CPU were prevalent in adolescents. The adolescents who had any one of the symptoms of problematic CPU were more likely to report at least one dimension of functional impairment caused by CPU, called more on cellular phones, sent more text messages, or spent more time and higher fees on CPU. Having four or more symptoms of problematic CPU had the highest potential to differentiate between the adolescents with and without functional impairment caused by CPU. Adolescents who had significant depression were more likely to have four or more symptoms of problematic CPU. The results of this study may provide a basis for detecting symptoms of problematic CPU in adolescents.

Heart Rate Variability Biofeedback Increased Autonomic Activation and Improved Symptoms of Depression and Insomnia among Patients with Major Depression Disorder.

OBJECTIVE: Autonomic imbalance is considered a psychopathological mechanism underlying major depressive disorder (MDD). Heart rate variability (HRV) is an index for autonomic activation. Poor sleep quality is common among patients with MDD. HRV biofeedback (BF) has been used for regulating autonomic balance among patients with physical illness and mental disorders. The purpose of present study was to examine the effects of HRV-BF on depressive symptoms, sleep quality, pre-sleep arousal, and HRV indices, in patients with MDD and insomnia. METHODS: In this case-controlled study, patients with MDD and Pittsburgh Sleep Quality Index (PSQI) score higher than 6 were recruited. The HRV-BF group received weekly 60-minute protocol for 6 weeks, and the control group who have matched the age and sex received medical care only. All participants were assessed on Beck Depression Inventory-II, Back Anxiety Inventory, PSQI, and Pre-Sleep Arousal Scale. Breathing rates and electrocardiography were also performed under resting state at pre-testing, and post-testing conditions and for the HRV-BF group, also at 1-month follow-up. RESULTS: In the HRV-BF group, symptoms of depression and anxiety, sleep quality, and pre-sleep arousal were significantly improved, and increased HRV indices, compared with the control group. Moreover, in the HRV-BF group, significantly improved symptoms of depression and anxiety, decreased breathing rates, and increased HRV indices were detected at post-testing and at 1-month follow-up, compared with pre-testing values. CONCLUSION: This study confirmed that HRV-BF is a useful psychosocial intervention for improving autonomic balance, baroreflex, and symptoms of depression and insomnia in MDD patients.

Erratum: Title Correction.

Clin Psychopharmacol Neurosci 2019;17(2):222-232.

Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan.

AIMS: The aim of the present study was to gain insight into the prevalence of depression and its association with self-esteem, family, peer and school factors in a large-scale representative Taiwanese adolescent population. METHODS: A total of 12,210 adolescent students were recruited into the present study. Subjects with a score >28 on the Center for Epidemiological Studies' Depression Scale were defined as having significant depression; the Rosenberg Self-Esteem Scale, Adolescent Family and Social Life Questionnaire and Family C-APGAR Index were applied to assess subjects' self-esteem, family, peer and school factors. The association between depression and correlates were examined on t-test and chi(2) test. The significant factors were further included in logistic regression analysis. RESULTS: Among 9586 participants (response rate: 86.3%), the prevalence of depression was 12.3%. The risk factors associated with depression in univariate analysis included female gender, older age, residency in urban areas, lower self-esteem, disruptive parental marriage, low family income, family conflict, poorer family function, less satisfaction with peer relationships, less connectedness to school, and poor academic performance. After adjusting the effects of sex, age and location, only subjects with lower self-esteem, higher family conflict, poorer family function, lower rank and decreased satisfaction in their peer group, and less connectedness to school were prone to depression on logistic regression. CONCLUSION: The prevalence of depression is high in Taiwanese adolescents, and the multiple factors of family, peer, school and individuals are associated with adolescent depression. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Factors related to abstinence from drug use and seeking help from medical services in Taiwanese heroin and methamphetamine users.

The aim of this study was to examine the factors related to abstinence from heroin and methamphetamine (MAMP) use and to seeking help from medical services in Taiwanese drug users. A total of 196 heroin users and 226 MAMP users were recruited in this study. Their experience of previous abstinence from drug use and the routes taken to seek help for abstinence were determined at interview. Demographic data, characteristics of drug use and reasons to abstain from drug use were compared between subjects who had and those who had never tried to abstain from drug use before, as well as between the subjects who had previously sought help from medical services and those who had tried to abstain from drug use by themselves. Those who had previously tried to abstain from heroin use had longer durations of heroin use, spent more money on getting heroin, were more likely to have a criminal record of illicit drug use and had longer durations of being detained due to illicit drug use compared with those who had never tried to abstain from heroin use. Those who had sought help from medical services for abstinence were more likely to be heroin users and to spend more money on getting illicit drugs, and tried to abstain due to concerns about relationships with family. Demographic data, characteristics of drug use and reasons to abstain from drug use were different between drug users who had different experiences of abstinence.

Efficacy, tolerability, and safety of oral paliperidone extended release in the treatment of schizophrenia: a 24-week, open-label, prospective switch study in different settings in Taiwan.

PURPOSE: Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. PATIENTS AND METHODS: This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists' judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication. RESULTS: Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed. CONCLUSION: Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation.