Correlations between sexual dysfunction, depression, anxiety, and somatic symptoms among patients with major depressive disorder.

BACKGROUND: The purpose of this study was to investigate the degree of correlation between sexual dysfunction and depression, anxiety, and somatic symptoms among patients with major depressive disorder (MDD) and to identify the dimension most predictive of sexual dysfunction. METHODS: One-hundred and thirty-five outpatients with MDD were enrolled and were treated with open-label venlafaxine 75 mg daily for one month. The Arizona Sexual Experience Scale-Chinese Version (ASEX-CV), Depression and Somatic Symptoms Scale (DSSS), Hamilton Depression Rating Scale, and Hospital Anxiety and Depression Scale (HADS) were administered at baseline and at one-month follow-up and the improvement percentage (IP) of each scale posttreatment was calculated. Multiple linear regression was used to determine the dimension most predictive of the total ASEX-CV score. RESULTS: Seventy subjects (20 men, 50 women) completed the one-month pharmacotherapy and the four scales. The depression subscale of the HADS was most strongly correlated with the ASEX-CV scale and was the only subscale to independently predict the total ASEX-CV score at the two points. However, the somatic subscale of the DSSS was not correlated with any ASEX-CV item. At the endpoint, depression, anxiety, and somatic symptoms were significantly improved (IP 48.5% to 26.0%); however, very little improvement was observed in the total ASEX-CV score (IP -1.6%). CONCLUSION: The severity of sexual dysfunction among patients with MDD was most correlated with the severity of the depressive dimension, but not the severity of the somatic dimension. Further studies are indicated to explore the relationships between sexual dysfunction, depression, anxiety, and somatic symptoms.

Monoamine oxidase A gene polymorphism and suicide: an association study and meta-analysis.

BACKGROUND: Abnormalities in brain monoamine transmission have been implicated in the pathogenesis of suicidal behavior. Studies examining the association between monoamine oxidase A (MAOA)-uVNTR polymorphism and suicide revealed inconsistent findings. This study aims to evaluate the possible association between the MAOA-uVNTR polymorphism and suicidal behaviors by examining our own subjects and conducting a meta-analytic review. METHODS: 373 unrelated psychiatric patients (including 160 suicide attempters and 213 non-suicide attempters) were genotyped for the MAOA-uVNTR polymorphism. A meta-analysis was then performed by pooling data from seven case-control association studies by random effects model. RESULTS: Our results indicate that there is no association between the MAOA-uVNTR polymorphism and suicide attempts in both genders. It also reveals that there is no association with violent suicide attempts. In the meta-analysis, there is no association between the polymorphism and suicidal behaviors. Also, there is no difference in the allelic distribution between psychiatric patients with and without suicidal behaviors. Limitations Our study was constrained by the insufficient information about environmental risk factors of suicide. CONCLUSIONS: Our study is the first one to use meta-analysis in exploring the role of the MAOA-uVNTR polymorphism in suicidal behavior in psychiatric patients. No significant association was found in our study, suggesting MAOA-uVNTR polymorphism is unlikely to contribute significantly to suicide behavior. Further studies investigating the gene-environment interaction or focusing on the genetic risk factors of endophenotypes of suicidal behaviors are warranted.

Association between suicide attempt and a tri-allelic functional polymorphism in serotonin transporter gene promoter in Chinese patients with schizophrenia.

Mounting evidence supports the association between a polymorphism in the serotonin transporter gene promoter region (5-HTTLPR) and suicidal behaviour. Recently, a novel variant of the 5-HTTLPR L allele was identified. The previously unknown L(G) allele produced similar levels of gene expression to the S allele and might have been misclassified as a "high-expression" allele in previous association studies. In this study, we aimed to compare the genotype distribution of the tri-allelic 5-HTTLPR polymorphism in 168 Chinese patients with schizophrenia, including 60 suicide attempters and 108 non-suicide attempters. In our analysis, which used the L(A) dominant model, it was found that the L(A) allele carriers were significantly more likely to have attempted suicide (p=0.035). Further analysis showed this association existed only in male patients (p=0.012). A similar association between the L(A) allele and violent suicide attempt was also found (p=0.028). In addition, logistic regression confirmed our findings that male L(A) allele carriers were at a higher risk of suicide, although the lack of a significant association in females may reflect insufficient power due to small sample size. However, no association was found when we examined the traditional bi-allelic 5-HTTLPR. These findings differ from those reported in Caucasian subjects, where no associations have been reported. Different genetic backgrounds may give rise to different allelic distribution, causing differential effects on the expression of endophenotypes of suicide behaviours. Although the potential influence of multiple comparisons might weaken our findings, our study provides preliminary evidence for a potentially gender-specific role of a "high-expression" 5-HTTLPR polymorphism in susceptibility to suicide in Chinese patients with schizophrenia.

Reliability and validity of the 20-item taiwan version of the borderline personality inventory.

BACKGROUND: The Borderline Personality Inventory (BPI) is a self-reported questionnaire for screening patients with borderline personality disorder. This study aims to construct and validate a shorter version of the original 53-item BPI suitable for use in Taiwan. METHODS: A two-stage translation of the BPI was conducted and modified into colloquial language for use in Taiwan. It was tested against 3 groups of patients (borderline personality disorder, schizophrenia, neurotic disorders) and healthy subjects. After item analyses, a 20-item BPI was selected (BPI-T20), and its internal consistency was assessed. The validity was examined using relative operating characteristic (ROC) analysis. RESULTS: Altogether, 544 subjects successfully completed the study. The Cronbach's alpha coefficient was 0.92, while 3 factors were extracted from the questionnaire. The BPI-T20 had significant discriminatory power with satisfactory validity for borderline personality disorder, with an area under the ROCcurve of 0.93 at a cut-off point of 11/12. The sensitivity and specificity were 89.8% and 82.8% respectively, with a misclassification rate of 14.7%. CONCLUSION: The BPI-T20 appears to be reliable, effective and valid in screening borderline personality disorder. It could be applied in large-scale epidemiological community surveys.

Sexual behaviour of institutionalised residents with dementia--a qualitative study.

AIMS: The purpose of this study was to explore the characteristics of and the contexts related to sexual behaviours among institutionalised residents with dementia. BACKGROUND: Institutionalised residents with dementia are frequently unable to manage their sexual needs properly resulting in caregivers having a more conservative and passive attitude toward residents with dementia than those with higher cognitive status. DESIGN: A grounded theory study. METHODS: The participants in this study were institutionalised older people with dementia and their formal caregivers. Data were collected using in-depth, face-to-face interviews of 12 formal caregivers and by observing 12 institutional older people with dementia for three days. All observations were recorded and interview data were tape recorded and transcribed verbatim. RESULTS: The results indicated that the predisposing factors included having opportunity, presence of a cooperative target and personal space without privacy. The sexual expressions of institutionalised older people with dementia included: physically intimate touch, sexual expression without touching others and sexual talk. Responses by individuals to sexual behaviour from another resident included neutral response, negative response and positive response. CONCLUSION: To provide better care, it is recommended that an inventory regarding sexual expression for clinical and research usage be constructed from the research results. RELEVANCE TO CLINICAL PRACTICE: The findings of this study can provide the basis to develop on-the-job training programmes for sexual education of residents with dementia in institutions. Regular seminars on sexual care for the residents with dementia might be beneficial for managing sexual issues among residents and to decrease caregivers' burden.

Comparing the use of the Taiwanese Depression Questionnaire and Beck Depression Inventory for screening depression in patients with chronic pain.

BACKGROUND: Studies have shown that the validity of self-reported depression questionnaires may be influenced by somatic symptoms such as chronic pain. The purpose of this study was to compare the validity of two self-reported questionnaires, the Taiwanese Depression Questionnaire (TDQ) and the Beck Depression Inventory (BDI), for screening depression in patients with chronic pain. METHODS: One hundred patients with chronic pain were enrolled and assessed using the TDQ, BDI, McGill Pain Questionnaire, and Structured Clinical Interview for DSM-III-R. Seventy-three of them were diagnosed with depressive disorders. Conventional validity indices of the TDQ and BDI were examined and compared. RESULTS: Both the TDQ and BDI had satisfactory sensitivity, specificity, positive predictive value, and negative predictive value. Our results showed a trend that the validity of the TDQ was better than that of the BDI, and the validity of the cognitive/affective components of the TDQ was significantly better than that of the BDI. CONCLUSION: Our results suggest that the TDQ is superior to the BDI in detecting depression in patients with chronic pain in Taiwan.

In-prison treatment for sexual offenders in Taiwan.

The present study was designed to investigate the current status of mandated treatment in prison for sexual offenders in Taiwan. The information-gathering methods were composed of two parts: questionnaires and interviews. The results showed the difficulties of mandated treatment in prison, including poor client adherence, the lack of consistent disciplines for the therapists, a standardized algorithm, and explicit laws and rules, the safety concerns of the therapists, and a shortage of staff. The development of mandated treatment in prison of sexual offenders in Taiwan is still in its early stage, and the treatment models have not yet been integrated. A cooperative and collaborative center for the mandated treatment in prison of sexual offenders and an integrated rule and treatment model should be set up in the future.

Development of a Taiwanese computerized database for psychiatric consultation in a general hospital.

OBJECTIVE: The aim of this study was to evaluate the applicability of a modified questionnaire in psychiatric consultation and a new computerized software at one general hospital in Taiwan. METHOD: The Micro-Cares Clinical Information System for Consultation/Liaison Psychiatry (CISCL), an English language-based patient management application, has multiple clinical variables that were translated into Mandarin Chinese. The Mandarin Chinese version of the Micro-Cares Questionnaire (MCMQ) was further modified after extensive testing and clinical use by two staff psychiatrists and eight senior resident doctors. In addition, the structure of the Mandarin Chinese version of the Micro-Cares CISCL Program (MCMP) was created for direct information entry through a specialized Microsoft Access-based support module. RESULTS: The MCMQ has been adapted to regular medical practice. Up to 66% of the consultation cases (618/913 patients) were recorded in 2003. Among those registered, 519 (84%) received psychiatric diagnoses. Eight of the 10 participants evaluated agreed that the MCMQ was clinically applicable. CONCLUSION: MCMQ and MCMP have been routinely applied in the clinical, administrative, research and educational services of our psychiatric consultation.

Clozapine withdrawal catatonia associated with cholinergic and serotonergic rebound hyperactivity: a case report.

Catatonia as a clozapine withdrawal syndrome has not been well documented. There is only 1 case of excited catatonia described with the diagnosis made according to strict criteria. The authors report a patient who developed a catatonic stuporous state following abrupt discontinuation of clozapine, associated with features of cholinergic and serotonergic hyperactivity. The catatonic state resolved within 1 week with reinstatement of clozapine. It is suggested that serotonergic hyperactivity was involved, contributed by cholinergic rebound, in the pathogenesis of this patient's clozapine withdrawal catatonic syndrome.

Penile tumescence assessment used for a diagnosis of paraphilia: a pedophilia case report.

We report on the use of penile tumescence assessment to diagnose a paraphiliac client who was in denial about his problem. An 18-year-old male was accused of sexually assaulting a 4-year-old girl using physical restraint and vaginal penetration with a finger. During a psychiatric evaluation requested by the court, a comprehensive psychosexual assessment revealed that the subject was in denial about clarification of the paraphiliac experience. Penile tumescence under distinct visual stimulus was evaluated with electrobioimpedence volumetric assessment using child and adult female pictures in separate time frames. Both types of stimuli evoked arousal responses. However, child female stimuli demonstrated stronger responses than did adult female ones. Deviant sexual interest in children as well as a diagnosis of pedophilia was implied. Paraphiliac clients tend to be in denial toward psychosexual assessment which limits the interpretation of its results. Penile tumescence assessment may be more reliable than psychosexual assessment alone for detecting and diagnosing paraphilia. Further study is warranted in order to aid in more accurate diagnoses of paraphilia.

Cerebrotendinous xanthomatosis with psychiatric disorders: report of three siblings and literature review.

Cerebrotendinous xanthomatosis (CTX), a rare familial lipid metabolic disease inherited via an autosomal recessive trait, is caused by mutations of the sterol 27-hydroxylase gene. Psychiatric disorders may occur in patients with CTX. In Taiwan, Chang et al presented patients with CTX. However, there has not been a case presented about CTX with psychiatric disorders in Taiwan. We present three siblings in one family with CTX combined with moderate mental retardation. One of the siblings had long-term depressed mood, irritability, poor appetite, insomnia, fatigability, and pessimistic thinking and was diagnosed as dysthymic disorder. After 2.5 years of antidepressant treatment at our outpatient clinic, the depressive symptoms of the dysthymic sibling improved greatly. However, the results of the IQ tests of the three siblings did not change after effective treatments for physical manifestations of CTX. In addition, the authors reviewed the literature of CTX combined with psychiatric disorders.