Aspidistradaibuensis var. longkiauensis, a new variety of Aspidistra (Asparagaceae) from Taiwan, identified through morphological and genetic analyses.

Aspidistra Ker Gawl. is one of the the most diverse and fastest-growing genera of angiosperm. Most Aspidistra species have been discovered in a limited area or a single site through morphological comparison. Because of the lack of population studies, morphological variation within species and the boundaries of some species remain unclear. In recent years, combining genetic and morphological markers has become a powerful approach for species delimitation. In this study, we performed population sampling and integrated morphometrics and microsatellite genetic diversity analyses to determine the species diversity of Aspidistra in Taiwan. We identified three species, namely Aspidistraattenuata Hayata; A.daibuensisHayatavar.daibuensis; A.mushaensisHayatavar.mushaensis; and reduced A.longiconnectiva C.T.Lu, K.C.Chuang & J.C.Wang to the variety level, and described a new variety, A.daibuensisHayatavar.longkiauensis. The description, diagnosis, distribution, and photographs of this new variety as well as a key to the known Taiwanese Aspidistra are provided.

The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction.

This study aimed to identify risk factors involved in Internet addiction. A total of 216 college students (132 males and 84 females) were given the following: (a) the diagnostic interview for Internet addiction, (b) the Iowa gambling test for decision-making deficits, (c) the Balloon Analog Risk Test (BART) to assess risk-taking tendencies, and (d) the Tridimensional Personality Questionnaire (TPQ) for personality characteristics. The results revealed the following: (a) 49% of males and 17% of females were addicted, (b) the addicted students tended to select more advantageous cards in the last 40 cards of the Iowa test, indicating better decision making, (c) no difference was found for the BART, indicating that addicted subjects were not more likely to engage in risk-taking behaviors and (d) TPQ scores showed lower reward dependence (RD) and higher novelty seeking (NS) for the addicts. Their higher performance on the Iowa gambling test differentiates the Internet addiction group from the substance use and pathologic gambling groups that have been shown to be deficient in decision making on the Iowa test. Thus, students that fit these characteristics should be closely monitored to prevent Internet addiction.

Proposed diagnostic criteria and the screening and diagnosing tool of Internet addiction in college students.

The aims of this study were to develop diagnostic criteria of Internet addiction for college students (DC-IA-C) with diagnostic interviews and to establish the optimal cutoff points of the Chen Internet Addiction Scale (CIAS) for the purposes of screening for and making the diagnosis of Internet addiction. A total of 216 college students (132 male and 84 female) were recruited in the study. The results demonstrated that 5/6 cutoff points of criteria A in DC-IA-C had the best diagnostic accuracy (95.9%). Besides, 63/64 and 67/68 cutoff points of the CIAS were evaluated to be the best screening and diagnostic cutoff points, respectively. The DC-IA-C can provide health care professionals with a means to diagnose and communicate about Internet addiction among college students, and the screening and diagnostic cutoff points of CIAS could provide a screening instrument or a discriminative instrument in surveys for Internet addiction among college students.

Nurses' perceptions of environmental pressures in relation to their occupational stress.

AIM: The aim of this paper was to explore nurses' stress experiences of working under the current health care system in Taiwan (the context) using a qualitative approach. BACKGROUND: Although most global health care institutions have been changing in response to the economic contraction, there is a deficit of information in understanding the changes of the ecology of the health care system in Taiwan from nurses' perspectives. DESIGN: Grounded theory. METHODS: A grounded theory approach was used to collect the data from a sample of 28 critical care nurses from seven hospitals in Taiwan. Data were analysed using a multi-step analytic procedure, based on the approaches of Glaser, Chesler and Strauss and Corbin. FINDINGS: The health care system changes were found to increase critical care nurses' occupational stress and work dilemmas. For the purpose of this study, the two categories that emerged in the 'context' component of the paradigm model are investigated. They were: hospital reorganisation and cultural burden of the nurse's role. CONCLUSIONS: The findings indicated that hospital organisational changes and people's own belief of the nurse's role were recognised as the environmental pressures which increase critical care nurses' occupational stress. Cultural background may play an important role in influencing nurses' work atmosphere and their ways of being seen. RELEVANCE TO CLINICAL PRACTICE: Critical care nurses perceived that their hospitals were under huge demands due to the changes in health care policies; these had subsequently caused them a high level of occupational stress. Beliefs in the embedded culture were also identified as significant factors in causing nurses' role stress. These findings could enhance the knowledge of critical care nurses' occupational stress and identify the most appropriate stress management skills available to them. Findings will add to the understanding of Chinese nurses who may work globally.

A multilevel analysis of the influence of Apolipoprotein E genotypes on depressive symptoms in late-life moderated by the environment.

OBJECTIVE: This study aimed to clarify the relationship between the APOE alleles and depressive symptoms of older adults, considering individual characteristics and the effect of neighborhood environment. METHODS: Using a multilevel, stratified sampling strategy, 500 elders were recruited from official household records. Depressive symptoms were assessed using the Taiwanese Depression Questionnaire [TDQ]. Cognitive function was assessed by the Short Portable Mental Status Questionnaire [SPMSQ]. Blood samples were collected for the determination of the Apolipoprotein E [APOE] polymorphism. Perceived neighborhood experience was brought together using the Neighborhood Quality Index [NQI]. RESULTS: Three hundred and three subjects (58.8% male, with a mean age of 69.2 [SD=2.7] years) completed all questionnaires and the collection of blood samples. Risk factors for depressive symptoms of elders included lower educational level, cognitive impairment, having 2 or more chronic diseases, and having the APOE epsilon4 allele. In the 2-level model with individual characteristics and neighborhood environmental factors, the effect of the APOE epsilon4 allele on depressive symptoms was significantly attenuated. CONCLUSIONS: The APOE epsilon4 allele is correlated with depressive symptoms among older adults, but moderated by neighborhood environmental factors.

Evaluation of effect of cognitive intervention programs for the community-dwelling elderly with subjective memory complaints.

PURPOSE: To compare the efficacy of cognitive training (CT) and cognitive stimulation (CS) programs for the community elderly with subjective memory complaints (SMC). METHOD: The single-blind non-randomized controlled study was applied. The numbers of CT and CS participants were 14 and 11. The mean ages of CT and CS participants were 68.71 and 70.36. Memory training and problem solving strategies were applied in the CT group. There were ten 2-hourly sessions of CT, held twice weekly. CS group met once weekly in a 1.5-h class for eight classes. Cognitive performance tests of general cognitive performance, verbal memory and executive function were measured before/after the training and at 6 months follow-up. RESULTS: In both training conditions, the general cognitive performance were enhanced. The CT group showed improvement in the verbal memory test. The CS group did not trigger any training effect in the verbal memory test but the executive function. All cognitive progresses remained at follow-up. CONCLUSION: Both cognitive training and cognitive stimulation programs showed training effects and remained until 6 months.

Suicidal thoughts among elderly Taiwanese aboriginal women.

OBJECTIVES: The aims of this study were to investigate prevalence of suicidal thoughts among a population of elderly aboriginal women in Taiwan over a 1-month period and to examine the risk factors for suicidal thinking in terms of individual (self-perceived health, disability and financial difficulty), family (marital discord) and social (medical accessibility) aspects. The mediating effects of depression on the above risk factors were also investigated. Furthermore, we examined the buffer effect on suicidal ideation of emotional social support for dealing with marital discord. METHODS: One thousand three hundred and forty-seven elderly Taiwanese aboriginal women were enrolled. Suicide thoughts within the past month, demographic data, adverse life events, emotional social support and depressive state were assessed. The 1-month prevalence of suicide thoughts was calculated. The risks of suicide thought based on individual, family and community aspects were estimated. RESULTS: The 1-month prevalence of suicidal thoughts among the community-dwelling aboriginal elderly women was 17.8%. Those subjects with poorer self-perceived health, difficulty in accessing medical resources, or experiencing marital discord were at higher risk of having suicidal thoughts. After controlling for depression, the odds ratio of self-perceived health and marital discord remained statistically significant. The odds ratio of interaction of marital discord and emotional social support was 0.41. CONCLUSION: Suicidal thoughts are common among the community-dwelling aboriginal elderly women in Taiwan. Risk factors for suicidal thoughts comprise individual (depression and physical condition), family (marital discord) and community (medical resources) aspects. Better emotional social support can effectively buffer the effect of marital discord.

Effects of childhood physical abuse on depression, problem drinking and perceived poor health status in adolescents living in rural Taiwan.

AIMS: The aim of the present study was to investigate the magnitude and independence of the effects of childhood physical abuse on adolescent depression, problem drinking and perceived poor mental health in Taiwanese indigenous and non-indigenous adolescents living in rural areas controlling for individual and familial characteristics. METHODS: A sample of adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. The associations between childhood physical abuse and adolescent depression, problem drinking and perceived poor health status were examined on univariate and multivariate logistic regression. RESULTS: Of the 1684 adolescents who completed the questionnaires, 374 (22.2%) reported that they had experienced physical abuse in childhood. Controlling for individual and familial factors, childhood physical abuse significantly increased the risk of depression, problem drinking and perceived poor health status in the present sample of adolescents on multivariate logistic regression. CONCLUSION: History of childhood physical abuse should be elicited from adolescents in treatment for depression, alcohol abuse or physical discomfort of unknown etiology. This finding may be of clinical benefit in terms of the design and implementation of intervention.

Childhood physical and sexual abuse: prevalence and correlates among adolescents living in rural Taiwan.

OBJECTIVE: The aims of this cross-sectional survey study were to examine the prevalence and correlates of childhood physical and sexual abuse in adolescents living in the rural areas of Taiwan. METHOD: A sample of indigenous (n=756) and non-indigenous (n=928) adolescents was randomly selected from junior high schools in the rural areas of southern Taiwan. Structured questionnaires were used to collect data anonymously. The prevalence of childhood physical and sexual abuse was examined and their correlates were examined using univariate and multivariate logistic regression. RESULTS: A total of 374 (22.2%) adolescents reported experience of physical abuse and 42 (2.5%) reported sexual abuse in their childhood. Multivariate logistic regression analyses revealed that the adolescents who perceived poor family function, frequent family conflicts and whose parents drank habitually were more likely to experience physical abuse. The adolescents who were indigenous and perceived frequent family conflicts were more likely to experience childhood sexual abuse. Further analyses indicated that indigenous boys had a higher risk of being the victims of sexual abuse than non-indigenous boys, while no difference was found between indigenous and non-indigenous girls. CONCLUSION: The results remind clinical workers of the importance of taking abuse histories from adolescents on a routine basis, and this is especially important in the case of dysfunctional families. PRACTICE IMPLICATIONS: Adolescents who live in rural areas have less social and medical resources for early detection and intervention of physical and sexual abuse. Correlates of physical and sexual abuse identified in this study may be helpful for the design and implementation of preventive intervention.

Factors predictive for incidence and remission of internet addiction in young adolescents: a prospective study.

The aim of the study is to determine the incidence and remission rates for Internet addiction and the associated predictive factors in young adolescents over a 1-year follow-up. This was a prospective, population-based investigation. Five hundred seventeen students (267 male and 250 female) were recruited from three junior high schools in southern Taiwan. The factors examined included gender, personality, mental health, self-esteem, family function, life satisfaction, and Internet activities. The result revealed that the 1-year incidence and remission rates for Internet addiction were 7.5% and 49.5% respectively. High exploratory excitability, low reward dependence, low self-esteem, low family function, and online game playing predicted the emergency of the Internet addiction. Further, low hostility and low interpersonal sensitivity predicted remission of Internet addiction. The factors predictive incidence and remission of Internet addiction identified in this study could be provided for prevention and promoting remission of Internet addiction in adolescents.

Employment experience in relation to alcohol, tobacco, and betel nut use among youth in Taiwan.

The aim of this study is to assess the association linking employment experience with alcohol, tobacco, and betel nut involvement among youth in Taiwan. In 2004, an outreach program was conducted during weekdays to recruit youth sample in seven major geographic regions. A total of 5886 youth aged 12-18 years drawn from 26 cities or towns were assessed by a two-page anonymous self-administered questionnaire, including sociodemographic characteristics, employment-, development-, and drug-related experiences. In Taiwan, youthful experience of alcohol, tobacco, and polydrug use varies by employment status, work intensity, and job type. Holding a full-time job and working in certain settings (e.g., grocery, restaurants) were found associated with an excess of drug-using behaviors. With taking age, male gender, family context, disposable allowance, and school attendance into account, working youths were two to four times as likely to have recent drug involvement than their non-working counterparts, especially for tobacco and polydrug (OR=3.32, 95% CI: 2.58-4.27, p<0.001; OR=3.76, 95% CI: 2.76-5.13, p<0.001). Youths in the labor force emerge as a subgroup experiencing greater use of alcohol, tobacco, betel nut, and polydrug. Future prevention programs may target this high-risk group to reduce possible drug-related negative consequences in developmental and health domains in Taiwan.

Intimate partner violence and minor psychiatric morbidity of aboriginal Taiwanese women.

OBJECTIVES: Experiences of abuse increase the risk of psychiatric morbidity in women. This study assesses the prevalence of intimate partner violence and minor psychiatric morbidity and analyzes their association among aboriginal women in Taiwan. METHODS: Using system random sampling, 840 aboriginal women between the ages of 18 and 50 years old were recruited from four townships with aboriginal communities in southern Taiwan. Trained primary care nurses interviewed the participants at home by structured questionnaire. RESULTS: One hundred twenty-six of 840 (15%) of the aboriginal women had experienced physical abuse perpetrated by an intimate partner (her husband or cohabitant) during their lifetime; 10.1% had experienced it during the past 12 months; 4.0% had experienced sexual abuse by the partner; and 6.3% had experienced physical abuse during childhood at the hands of one or both parents. Multiple logistic regression revealed that after adjusting for women's age, alcohol and drug use, religious activity and husband's employment status, the experience of abuse (including partner physical abuse, partner sexual abuse, and childhood physical abuse) was significantly associated with suicidal ideation and depression. CONCLUSIONS: Health care professionals need to provide adequate support and health education, develop interventions, and use referrals in primary care in the community in order to reduce and prevent domestic violence against aboriginal women in Taiwan.

Physical abuse against pregnant aborigines in Taiwan: prevalence and risk factors.

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.

Zotepine-induced catatonia as a precursor in the progression to neuroleptic malignant syndrome.

A 39-year-old man with schizophrenia developed severe catatonia, hyperthermia, muscle rigidity, tachycardia, leukocytosis, and elevated muscle enzyme levels while receiving zotepine therapy. Neuroleptic malignant syndrome (NMS) was diagnosed. After withdrawal of zotepine therapy, transfer to a neurologic intensive care unit, provision of supportive care, and administration of adjunctive bromocriptine therapy, the patient's fever and catatonia subsided. Biochemical irregularities spontaneously returned to normal with no complications. Antipsychotic therapy was restarted with risperidone 12 days after the patient's NMS resolved. After more than 1 year of follow-up, he experienced no adverse events. A recent decrease in mortality from NMS is related to increased awareness of this disorder, but not to treatment with specific agents. Clinicians need to recognize NMS early; although rare, it is a potentially fatal complication of antipsychotic treatment.

Adjunctive treatment of acute mania with risperidone versus typical antipsychotics: a retrospective study.

Few studies have directly compared atypical antipsychotics (e.g. risperidone) with typical antipsychotics as adjunctive therapy in patients hospitalized for acute mania, especially during a lengthy hospital stay. Our retrospective, case-controlled study is a chart review of 64 patients with Diagnostic and Statistical Manual of Mental Disorders, 4th edition, defined bipolar I disorder (current episode, mania). Patients were divided into two groups according to the adjunctive medications used: the risperidone group (mood stabilizers plus risperidone) and the control group (mood stabilizers plus typical antipsychotics). Outcome at discharge, medications, adverse drug effects, and length of hospital stay were compared between groups, controlling for gender, age, number of prior admissions, and duration of illness. Results indicated no statistically significant differences between groups in the controlled factors, Global Assessment of Functioning and Clinical Global Impression-Improvement scores, and adverse drug events. Patients in the risperidone group used significantly lower doses of trihexyphenidyl than those in the control group (p < 0.05). Patients treated with risperidone had a shorter hospital stay than those treated with typical antipsychotics (p < 0.01). In conclusion, antipsychotics are effective as adjunctive agents in the treatment of acute mania. The use of risperidone, in particular, decreases the need for anticholinergics and may lead to a shorter hospital stay compared with typical antipsychotics.

The Chinese drinking problem: a review of the literature and its implication in a cross-cultural study.

Alcoholism as a problem has never been widely understood in Chinese society. The rarity of alcoholism in Chinese society may be due to marked sensitivity to alcohol, associated with high levels of acetaldehyde, in this population. In addition, sociocultural reasons such as alcoholic beverages generally being consumed only at parties and during mealtimes, strong social sanctions against drunkards and drunken behavior, and the presence of a strong Confucian moral ethic, have accounted for the drinking behavior of Chinese individuals. However, there is evidence that alcohol consumption and the prevalence of alcoholism have skyrocketed in the past 40 years in Taiwan. Social and cultural changes may be expected to affect the incidence and prevalence of alcoholism and other mental disorders in terms of changes in a traditional culture, and social integration-disintegration. Differences in methodology for case identification, and the fact that Chinese alcoholic patients do not seek psychiatric treatment primarily for drinking problems, are also considered to account for some of the discrepancy between the actual rate and the lower identified rate of alcoholism. It can also be speculated that the low rate of alcoholism in psychiatric settings depends largely on the attitudes of patients, their families, and the general public towards drinking problems. Hence, this paper will review the theories and compare epidemiologic data about drinking problems in Chinese individuals, and then point to areas for future research.

Obsessive-compulsive symptoms associated with clozapine and risperidone treatment: three case reports and review of the literature.

Treatment-emergent obsessive-compulsive symptoms (OCSs) have raised concern since the widespread introduction of serotonin-dopamine antagonists (SDAs) for the treatment of schizophrenia. Further investigations of SDA-emergent OCSs and their response to anti-obsessional agents will be beneficial for clinicians in helping patients who suffer from this problem. We present three cases of schizophrenia in which distressing OCSs occurred during clozapine or risperidone treatment. OCSs were assessed consecutively using the Yale-Brown Obsessive-Compulsive Scale. The OCSs of these three patients were responsive to anti-obsessional agents, including fluvoxamine, clomipramine, and paroxetine. We also review the current literature and discuss the possible pathophysiology and psychopathology of SDA-emergent OCSs.

Patient- and family-rated scale for bipolar disorder symptoms: Internal State Scale.

The monitoring of patients, by themselves and their caregivers, is very important in the prophylaxis of bipolar disorder. This study aimed to develop a Chinese-language version of an instrument for assessment of manic and depressive symptoms by patients and their families. Fifty-eight inpatients and outpatients with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnosis of bipolar disorder were recruited. All subjects underwent clinical psychopathologic assessment by experienced psychiatrists using the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). At the same time, each patient and key family members filled out the Chinese-language version of the Internal State Scale (ISS) for monitoring mental symptoms. Patients were examined a second time if they had entered remission or a new episode of the opposite polarity. The ISS was divided into two subscales, of well-being/activation and of irritability. Patients' well-being/activation and irritability subscales were significantly correlated with YMRS scores and the well-being/activation subscale was also significantly correlated with the HDRS score. Family members' irritability subscales were significantly correlated with HDRS scores only. The reliability and constructive validity of the ISS was good in both patients with bipolar disorder and their families.

Brain activities associated with gaming urge of online gaming addiction.

The aim of this study was to identify the neural substrates of online gaming addiction through evaluation of the brain areas associated with the cue-induced gaming urge. Ten participants with online gaming addiction and 10 control subjects without online gaming addiction were tested. They were presented with gaming pictures and the paired mosaic pictures while undergoing functional magnetic resonance imaging (fMRI) scanning. The contrast in blood-oxygen-level dependent (BOLD) signals when viewing gaming pictures and when viewing mosaic pictures was calculated with the SPM2 software to evaluate the brain activations. Right orbitofrontal cortex, right nucleus accumbens, bilateral anterior cingulate and medial frontal cortex, right dorsolateral prefrontal cortex, and right caudate nucleus were activated in the addicted group in contrast to the control group. The activation of the region-of-interest (ROI) defined by the above brain areas was positively correlated with self-reported gaming urge and recalling of gaming experience provoked by the WOW pictures. The results demonstrate that the neural substrate of cue-induced gaming urge/craving in online gaming addiction is similar to that of the cue-induced craving in substance dependence. The above-mentioned brain regions have been reported to contribute to the craving in substance dependence, and here we show that the same areas were involved in online gaming urge/craving. Thus, the results suggest that the gaming urge/craving in online gaming addiction and craving in substance dependence might share the same neurobiological mechanism.