Temporal reciprocal relationships among anxiety, depression, and posttraumatic stress disorder for family surrogates from intensive care units over their first two bereavement years.

BACKGROUND/OBJECTIVE: Bereaved family surrogates from intensive care units (ICU) are at risk of comorbid anxiety, depression, and post-traumatic stress disorder (PTSD), but the temporal reciprocal relationships among them have only been examined once among veterans. This study aimed to longitudinally investigate these never-before-examined temporal reciprocal relationships for ICU family members over their first two bereavement years. METHODS: In this prospective, longitudinal, observational study, symptoms of anxiety, depression, and PTSD were assessed among 321 family surrogates of ICU decedents from 2 academically affiliated hospitals in Taiwan by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised, respectively at 1, 3, 6, 13, 18, and 24 months postloss. Cross-lagged panel modeling was conducted to longitudinally examine the temporal reciprocal relationships among anxiety, depression, and PTSD. RESULTS: Examined psychological-distress levels were markedly stable over the first 2 bereavement years: autoregressive coefficients for symptoms of anxiety, depression, and PTSD were 0.585-0.770, 0.546-0.780, and 0.440-0.780, respectively. Cross-lag coefficients showed depressive symptoms predicted PTSD symptoms in the first bereavement year, whereas PTSD symptoms predicted depressive symptoms in the second bereavement year. Anxiety symptoms predicted symptoms of depression and PTSD at 13 and 24 months postloss, whereas depressive symptoms predicted anxiety symptoms at 3 and 6 months postloss while PTSD symptoms predicted anxiety symptoms during the second bereavement year. CONCLUSIONS: Different patterns of temporal relationships among symptoms of anxiety, depression, and PTSD over the first 2 bereavement years present important opportunities to target symptoms of specific psychological distress at different points during bereavement to prevent the onset, exacerbation, or maintenance of subsequent psychological distress.

Effectiveness of aftercare program for suicide ideators: Real-world evidence from National Suicide Surveillance System in Taiwan.

Aftercare programs' effectiveness for suicide ideators has seldom been reported. This study assessed rates and factors related to the recurrence of suicide-related episodes after the index suicidal ideation episode, index cases, and family members receiving aftercare. This is a secondary data analysis of 1787 suicidal ideation episodes from 1557 individuals reported to the National Suicide Surveillance System in New Taipei City, Taiwan, from January 2012 to June 2013 and followed up until September 2013. Among 1787 index suicidal ideations, 19.1% had recurrences of suicide-related episodes, including suicidal ideation (11.9%), attempt (6.7%), and death (0.5%) within 2 years after index ideation. These recurrences were significantly reduced after the index cases received aftercare twice, three, and four or higher. Family members receiving aftercare twice or more were associated with reduced suicidality in the index cases. Receiving aftercare among index cases was associated with being a woman, suicide due to occupation/finance, and reporting from suicide hotlines. Receiving aftercare among family members was associated with the index cases aged ≤ 19 years old, suicide reasons related to school, occupation/finance, and reporting from schools and hospitals. Aftercare programs for suicide ideators and family members of adolescent suicide ideators (aged ≤ 19 years old) decreased subsequent episodes of suicidal behavior.

Clinical Characteristics of Pesticide Self-Harm as Associated with Suicide Attempt Repetition Status.

PURPOSE: Previous suicide behavior predicts future suicide risk. Studies of suicide repetition are important for suicide prevention. This study examined the clinical characteristics and psychiatric comorbidities of pesticide self-harm as associated with suicide attempt repetition status. PATIENTS AND METHODS: This retrospective, observational study included patients admitted to a medical center in northern Taiwan between 2000 and 2015 following suicide attempts by pesticide. Diagnoses were made by a consultation-liaison psychiatry team based on the DSM IV-TR criteria. Independent samples t-test was used to analyze the quantitative variables and Pearson's Chi-squared test with a Bonferroni adjustment for categorical variables. Univariate binary logistic regression analysis was conducted to determine the predictors for repeated suicide attempt and multivariate binary logistic regression analysis to identify significant associated factors. RESULTS: Among 151 patients, organophosphate pesticides were the most used (80.8%). The average age was 52.9±17.2 years. Most patients were married males from rural areas, with depressive disorder most often diagnosed (40.4%). Nearly one-third of them were suicide repeaters (n=43, 28.5%); these patients were less likely to be married (53.5%, p=0.001), had previously used psychiatric services (72.1%, p<0.001) and chose complex suicide (46.5%, p=0.014) more often compared to nonrepeaters. No significant differences were found between repeaters and nonrepeaters regarding psychiatric comorbidities. Multivariate logistic regression analysis revealed that marital status (odds ratio: 2.916, 95% confidence interval: 1.234-6.891, p=0.015) and previous psychiatric services usage (odds ratio: 6.897, 95% confidence interval: 3.012-15.625, p<0.001) were significant risk factors associated with suicide repetition. CONCLUSION: Pesticide suicide repeaters were characterized by less likely to be married and more likely to use psychiatric services before suicide attempts. These features help ensuring that the needs of people who have made a suicide attempt are addressed, and it reduces the likelihood of repetition.

Psychiatric comorbidities in patients with intentional methanol intoxication.

BACKGROUND: Intentional methanol intoxication (IMI) is an emerging public health issue in Asian countries, but few data are available in the literature on underlying psychiatric comorbidities in these suicide attempters. PATIENTS AND METHODS: We conducted a retrospective chart review on patients with methanol intoxication (MI) treated at Chang-Gung Memorial Hospital, Linkou, Taiwan during 2000-2016. Of the 56 cases of documented MI, 16 were IMI. Baseline demographic, clinical, laboratory, psychiatric diagnoses, and mortality data were collected and analyzed. RESULTS: Patient group with IMI had more females (62.5% vs 7.5%, P=0.000), less alcohol consumption (33.3% vs 92.5%, P=0.000), and less smoking (40.0% vs 79.5%, P=0.009), but higher past psychiatric disease (73.3% vs 10.0%, P=0.000) and past suicide attempts (81.1% vs 2.5%, P=0.000) than patient group with unintentional MI (UMI). Pesticides (50.0%) comprised the most common source used for suicide, followed by industrial methanol (37.5%). There was no significant difference in mortality rates between these two group (25.0% vs 22.5%, P=0.548). Twelve (75.0%) survivors of IMI were referred to a psychiatric consultation-liaison team, and depressive disorder (58.3%) and adjustment disorder (25.0%) were common. CONCLUSION: There is a female predominance and a high prevalence of psychiatric comorbidities, namely depression and adjustment disorder in patients with IMI. Besides, alcohol consumption is a prevalent but not adequately treated condition in UMI group.

Distinct psychopathology of patients who attempted suicide with rodenticide in Taiwan: a comparative study with patients of suicide with paraquat.

OBJECTIVE: Rodenticide as a means of suicide has been documented for centuries. However, this method is often discussed in conjunction with other pesticides. Thus, we aimed to focus on patients who committed suicide with rodenticide and compared them with those who used paraquat for suicide, another frequently used yet lethal method, to highlight the different psychopathology of patients who choose rodenticide as their means of suicide. METHODS: A 12-year retrospective chart review was conducted on the medical records of all patients admitted to Chang Gung Memorial Hospital due to attempted suicide by either rodenticide or paraquat. Psychiatric consultation sheets were collected to ascertain the psychiatric comorbidity and the major stressor for suicide, measured by the Social Readjustment Rating Scale. A χ2 test and logistic regression were used for group comparisons. RESULTS: Seventeen rodenticide and 157 paraquat suicide attempts were identified. Compared with suicides by paraquat, suicides by rodenticide had a more even distribution in the gender ratio but a lower Social Readjustment Rating Scale score (p<0.001). Depressive disorder was the most common diagnosis in suicides by rodenticide and paraquat. However, schizophrenia and psychotic disorder (29.4%) was the second most common diagnosis and a significant predictor of suicide by rodenticide (odds ratio =9.21, 95% confidence interval =1.2-66.07, p=0.027). CONCLUSION: High comorbidity of psychosis in suicide by rodenticide warrants disease-specific suicide prevention and additional large-scale research to confirm this association.

Timing and risk of mood disorders requiring psychotropics in long-term survivors of adult cancers: A nationwide cohort study.

BACKGROUND: The increasing number of long-term cancer survivors over the past few decades poses the challenge of mental health care needs. However, little is known about risks of mood disorders in long-term cancer survivors. METHODS: Long-term survivors (≥5 years) of adult cancers (LSAC) (n = 190,748) newly diagnosed between January 1, 2000 and December 31, 2007 were matched with one control. The primary outcome was diagnosis of mood disorders requiring psychotropics. Cumulative incidences and sub-hazard ratios (SHR) were calculated and multivariate analyses were conducted after accounting for mortality. RESULTS: The mood disorder risk was significantly higher in the LSAC cohort than in the control cohort (adjusted SHR = 1.16, 95% confidence interval [CI] = 1.13-1.18, P < 0.001). Patients with certain cancer types were at increased risk, particularly in the first 2 years after diagnosis. However, patients with head and neck cancers or esophageal cancers had a higher risk after the 5-year follow-up period. Multivariate analysis indicated that being female, aged 40-59 years, with more than two primary cancers, receiving two or more treatment modalities, having CCI scores higher than 3, a higher urbanization level, and lower monthly income were independently associated with an increased risk of mood disorders. LIMITATIONS: Some potential confounders such as lifestyle factors were not available in the study. CONCLUSION: These findings call for increased mental health awareness not only in the early years after the cancer diagnosis, but also during long-term follow-up for certain cancer subtypes.

Body image in head and neck cancer patients treated with radiotherapy: the impact of surgical procedures.

BACKGROUND: In this study, we aimed to investigate the impact of surgical procedures on the body image of head and neck cancer patients treated with radiotherapy and with or without radical surgery. METHODS: A cross-sectional survey of 150 patients with head and neck cancer was conducted. Sixty patients had nasopharyngeal cancer treated with definitive radiotherapy without surgery, and 90 patients had oral cavity cancer treated with radical surgery plus adjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction. Among all patients, the socio-demographic and clinical variables were age, gender, partnership, education, employment, and radical surgery. In surgically-treated patients, the clinical variables were facial skin sacrificed, mouth angle sacrificed, glossectomy, maxillectomy, and mandibulectomy. ANOVAs, t-tests, and multiple regressions were used to evaluate the relationships between these variables and BIS results. RESULTS: In all patients, radical surgery was the strongest independent predictor of BIS scores. Surgically-treated patients had significantly worse BIS scores than the patients without surgery. In surgically-treated patients, facial skin sacrificed, mouth angle sacrificed, maxillectomy, and mandibulectomy were significantly associated with body image. According to multivariable analyses, inferior maxillectomy and segmental mandibulectomy were independent prognosticators of a poor BIS score in surgically-treated patients. CONCLUSION: Radical surgery for head and neck cancer patients has a significant impact on their body image, especially for those undergoing facial bone destructive surgery.

Truth telling in Taiwanese cancer care: patients' and families' preferences and their experiences of doctors' practices.

OBJECTIVE: Despite the significant role played by cancer patients' families in medical decision-making in Asian countries, inconsistencies have hitherto not been evaluated between patients' and families' preferences and doctors' actual practices with regard to cancer truth telling. METHODS: For this quantitative comparative study of cancer patients' and families' truth-telling preferences and their experiences of doctors' practices, 532 patients, 551 family members, and 127 doctors (N = 1 210) were enrolled from five hospitals across Taiwan over 2 years. Truth telling was assessed using the Taiwanese version of a modified Japanese truth-telling scale. RESULTS: Patients' truth-telling preferences and their experiences of doctors' truth-telling practices differed significantly in scores on the overall truth-telling scale and each subscale, including method of disclosure, emotional support, additional information, and setting (P < .001). Similar findings were obtained for families' preferences and doctors' actual practices (P < .001). Patients' and families' truth-telling preference scores were higher than doctors' actual practice scores. Multiple regression analysis revealed a dose-dependent effect of doctors' monthly truth-telling frequency on their truth-telling preferences, but this effect was only borderline significant (P = .08). This multiple regression model explained 30% of the total variance in doctors' truth-telling preferences (F = 1.38, P = .22). CONCLUSIONS: Taiwanese medical educational policies need to be revised to better equip doctors to practice truth telling in accordance with the preferences of cancer patients and families. Communication skills training should be prioritized for doctors who refrain from truth telling in actual practice.

Weight Gain While Switching from Polypharmacy to Ziprasidone: A Case Report.

Second-generation antipsychotics (SGAs), valproate, and sulpiride are related to significant weight gain and risk of metabolic syndrome (MetS). Among SGAs, olanzapine and clozapine are associated with the highest metabolic risk while ziprasidone is among one of the SGAs with the lowest risk. Several reports suggest that weight loss is observed in switching other antipsychotics to ziprasidone. Here we describe a female patient with chronic paranoid schizophrenia who had an unexpected weight gain and developed MetS during a cross-switch from a polypharmacy of olanzapine, valproate and sulpiride to ziprasidone monotherapy.

Psychiatric comorbidity and its impact on mortality in patients who attempted suicide by paraquat poisoning during 2000-2010.

BACKGROUND: Paraquat poisoning is a lethal method of suicide used around the world. Although restricting its accessibility had been widely discussed, the underlying psychopathological mechanism of paraquat self-poisoning and its association with mortality have not yet been explicitly evaluated. METHODS: We included all patients admitted to a tertiary general hospital in Taiwan between 2000 and 2010 following a suicide attempt by paraquat self-administration. Diagnoses were made upon psychiatric consultation based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The risk of mortality was calculated by logistic regression with various psychiatric or medical covariates. RESULTS: The consultation-liaison psychiatry team assessed 157 patients who attempted suicide by paraquat poisoning. Mood disorders (54.0%), including dysthymic (26.7%) and major depressive disorders (24.7%), were the most common psychiatric diagnoses among the self-poisoning patients. Among those who attempted suicide, 87 patients (58.0%) died and dysthymic disorder (OR = 5.58, 95% CI: 1.13-27.69; p < 0.05) significantly increased the mortality risk after adjustment for relevant medical variables, including age, gender, severity index of paraquat poisoning (SIPP), and risk for respiratory failure. CONCLUSIONS: Awareness of comorbid psychiatric illnesses, especially dysthymic disorder, is vital in the prevention and treatment of suicide by paraquat poisoning.

Effect of social support and donation-related concerns on ambivalence of living liver donor candidates.

Ambivalence in the decision-making process for living liver donors has the potential to result in their experiencing a negative mental status. To promote donor candidates' well-being, it is important to study the factors related to ambivalence. Thus, the aim of this study was to explore the ambivalence of living liver donor candidates and to investigate the effect of social support and donation-related concerns on their ambivalence. A cross-sectional design was used. In total, 100 living liver donor candidates who underwent a preoperative evaluation between April and October 2009 were recruited for the study. Participants completed a self-administered questionnaire that contained items related to ambivalence, donation-related concerns, and social support. The mean score for ambivalence was 3.14 (standard deviation = 1.8), and the median was 3. Only 7% of the study sample reported no ambivalence during the assessment stage. Ambivalence was positively correlated with donation-related concerns (physical concerns, r = 0.39; psychosocial concerns, r = 0.43; financial concerns, r = 0.29) and negatively correlated with social support (r = -0.16 to -0.33). Those with psychosocial concerns had significantly worse ambivalence (ß = 0.29, P = 0.03), but social support mitigated ambivalence (ß = -0.34, P = 0.01). When intimacy and social support were included in the model, the effect of psychosocial concerns on ambivalence became nonsignificant (ß = 0.24, P = 0.08). Ambivalence is common among living liver donor candidates, but instrumental social support can mediate the negative effect of donation-related concerns. Recommendations include providing appropriate social support to minimize donation-related concerns and, thus, to reduce the ambivalence of living liver candidates.

Effectiveness of Japanese SHARE model in improving Taiwanese healthcare personnel's preference for cancer truth telling.

BACKGROUND: Communication skills training (CST) based on the Japanese SHARE model of family-centered truth telling in Asian countries has been adopted in Taiwan. However, its effectiveness in Taiwan has only been preliminarily verified. This study aimed to test the effect of SHARE model-centered CST on Taiwanese healthcare providers' truth-telling preference, to determine the effect size, and to compare the effect of 1-day and 2-day CST programs on participants' truth-telling preference. METHOD: For this one-group, pretest-posttest study, 10 CST programs were conducted from August 2010 to November 2011 under certified facilitators and with standard patients. Participants (257 healthcare personnel from northern, central, southern, and eastern Taiwan) chose the 1-day (n = 94) or 2-day (n = 163) CST program as convenient. Participants' self-reported truth-telling preference was measured before and immediately after CST programs, with CST program assessment afterward. RESULTS: The CST programs significantly improved healthcare personnel's truth-telling preference (mean pretest and posttest scores ± standard deviation (SD): 263.8 ± 27.0 vs. 281.8 ± 22.9, p < 0.001). The CST programs effected a significant, large (d = 0.91) improvement in overall truth-telling preference and significantly improved method of disclosure, emotional support, and additional information (p < 0.001). Participation in 1-day or 2-day CST programs did not significantly affect participants' truth-telling preference (p > 0.05) except for the setting subscale. Most participants were satisfied with the CST programs (93.8%) and were willing to recommend them to colleagues (98.5%). CONCLUSIONS: The SHARE model-centered CST programs significantly improved Taiwanese healthcare personnel's truth-telling preference. Future studies should objectively assess participants' truth-telling preference, for example, by cancer patients, their families, and other medical team personnel and at longer times after CST programs.

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.

Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: a 10-year study in a general hospital in Taiwan.

OBJECTIVE: Over the last decade, charcoal burning has become a common method of suicide in Taiwan; however, the underlying psychiatric diagnoses and gender differences have yet to be examined. METHODS: We conducted a retrospective chart review on inpatients after suicide attempt by charcoal burning during 2000-2010. The patients were referred to the psychiatric consultation team and diagnoses were made according to DSM-IV. We chose those who were admitted to the nephrology ward in the same period due to accidental carbon monoxide intoxication as controls. Demographic and laboratory data, psychiatric diagnoses and reasons for suicide were obtained and analyzed. RESULTS: Among seventy-three patients, major depressive disorder (49.3%) and adjustment disorder (41.1%) were most frequently diagnosed. Breaking-up, financial debt and physical/mental illnesses were the top three reasons for suicide (17.8% each). The male-to-female gender ratio was 1.5:1. Female patients had higher rates of major depressive disorders, while male patients presented more adjustment disorders comorbid with alcohol use disorders. CONCLUSION: There were gender differences in patients of suicide attempt by charcoal burning, in terms of demographic profiles and psychiatric diagnoses. Suicide risk assessment and prevention should be tailored by gender.

The role of consulting psychiatrists for obstetric and gynecologic inpatients.

BACKGROUND: The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. METHOD: A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. RESULTS: One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). CONCLUSION: The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

Zolpidem dependence and withdrawal seizure--report of two cases.

Zolpidem is a non-benzodiazepine property which binds selectively to the ?1-GABAA receptors, and has been widely prescribed to patients suffering from insomnia. We report two cases of zolpidem dependence with withdrawal seizure in the Asian population. The first case is a 43-year-old woman who took zolpidem up to the dosage of 200 to 400 mg per night. The second case is a 35-year-old woman who even began to take zolpidem every 15 to 30 minutes to get euphoric and relaxed, and she gradually increased the dosage to 400 to 500mg per day. After abrupt discontinuation of zolpidem, both cases immediately developed anxiety, global insomnia, restlessness, and tonic seizure. The purpose of this case report is to suggest that clinicians should pay close attention to the potential of zolpidem tolerance, abuse and dependence. The possibility of withdrawal seizure cannot be excluded especially at high doses.

A single-blind, comparative study of zotepine versus haloperidol in combination with a mood stabilizer for patients with moderate-to-severe mania.

AIMS: Atypical antipsychotics are increasingly used in the management of acute mania. This study was conducted to investigate the efficacy and tolerability of zotepine compared to haloperidol in combination with a mood stabilizer (lithium or valproate) for treatment of acute mania. METHODS: This was a multi-center, randomized, rater-blinded, parallel-group, flexible-dose study. Forty-five hospitalized patients with moderate-to-severe manic, bipolar disorder (DSM-IV) were randomly assigned to a zotepine or a haloperidol 4-week treatment group. RESULTS: There was no significant between-group difference in the Young Mania Rating Scale total scores between the zotepine and haloperidol groups (-23.7 + or - 12.1 vs -22.3 + or - 11.0, respectively). The adverse events in both groups were mild to moderate. The haloperidol group reported a higher incidence of treatment-related adverse events, especially parkinsonism and akathisia, compared to the zotepine group. Serum uric acid decreased more in the zotepine group than in the haloperidol group. CONCLUSION: In combination with a mood stabilizer, zotepine appears to be as effective as haloperidol in treating moderate-to-severe mania in the acute phase, but has the advantages of lowering hyperuricemia and fewer extrapyramidal side-effects. Double-blinded studies with larger sample sizes are warranted to confirm these findings.

Somatic symptoms: an important index in predicting the outcome of depression at six-month and two-year follow-up points among outpatients with major depressive disorder.

BACKGROUND: Few studies have simultaneously compared the ability of depression, anxiety, and somatic symptoms to predict the outcome of major depressive disorder (MDD). This study aimed to compare the MDD outcome predictive ability of depression, anxiety, and somatic severity at 6-month and 2-year follow-ups. METHODS: One-hundred and thirty-five outpatients (men/women=34/101) with MDD were enrolled. Depression and anxiety were evaluated by the Hamilton Depression Rating Scale, Hospital Anxiety and Depression Scale, and depression subscale of the Depression and Somatic Symptoms Scale (DSSS). Somatic severity was evaluated by the somatic subscale of the DSSS. Subjects undergoing pharmacotherapy in the follow-up month were categorized into the treatment group; the others were categorized into the no-treatment group. Multiple linear regressions were used to identify the scales most powerful in predicting MDD outcome. RESULTS: Among the 135 subjects, 119 and 106 completed the 6-month and 2-year follow-ups, respectively. Somatic severity at baseline was correlated with the outcomes of the three scales at the two follow-ups. After controlling for demographic variables, somatic severity independently predicted most outcomes of the three scales at the two follow-ups in the no-treatment group and the cost of pharmacotherapy and DSSS score at the 6-month follow-up in the treatment group. LIMITATIONS: Division of the subjects into treatment and no-treatment groups was not based on randomization and bias might have been introduced. CONCLUSIONS: Somatic severity was the most powerful index in predicting MDD outcome. Psychometric scales with appropriate somatic symptom items may be more accurate in predicting MDD outcome.

The impact of anxiety and migraine on quality of sleep in patients with major depressive disorder.

OBJECTIVE: The aim of this study was to investigate the impact of anxiety disorders and migraine on sleep quality and to find the independent factors that predict sleep quality among patients with major depressive disorder (MDD). METHOD: Psychiatric outpatients diagnosed with MDD were enrolled in the study. Major depressive disorder and 7 anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Migraine was diagnosed based on the International Classification of Headache Disorders, Second Edition. Headache intensity and frequency were reported by the subjects. The Pittsburgh Sleep Quality Index and Hamilton Depression Rating Scale were used to evaluate quality of sleep and depression severity, respectively. Multiple linear regressions were used to identify independent factors related to sleep quality. RESULTS: One hundred thirty-five subjects (34 men and 101 women) with MDD were enrolled in the study. Subjects with panic disorder and agoraphobia were found to have poorer Pittsburgh Sleep Quality Index scores. Subjects with panic disorder, agoraphobia, and migraine had higher scores for items relating to sleep quality in the Hamilton Depression Rating Scale. Headache intensity and frequency correlated with sleep disturbance. Panic disorder was independently predictive of poor sleep quality. Both migraine and panic disorder independently predicted a greater severity of depression. CONCLUSION: Our study demonstrates the negative impact of panic disorder and migraine on MDD and some of the interrelations between depression, anxiety, and sleep quality. Future studies should further explore these interactions and consider possible therapeutic interventions.

Internal consistency of the traditional Chinese character version of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N).

BACKGROUND: This study investigated the internal consistency of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) translated version in traditional Chinese characters (TChi). The FACT-H&N quality of life instrument is composed of the FACT-General (FACT-G) assessing four primary areas of well-being (physical, social/family, emotional, and functional) and 11 additional items specific to H&N cancer patients. METHODS: Two hundred and three patients with H&N cancer were recruited at a medical center in northwestern Taiwan. All completed the TChi FACT-H&N along with demographic and clinical questionnaires written in traditional Chinese characters. Several psychometric properties of the TChi FACT-H&N were examined, including Cronbach's alpha coefficients. RESULTS: Most of the 203 enrolled patients were men (78%). The median age was 52.5 years (range 23-81 years) and the median number of years of education was 9. All patients had a Karnofsky score of 70 or higher. The results showed that the TChi FACT-H&N scales demonstrated acceptable internal consistency. Translation of the physical and functional concepts was most straightforward. Translation of emotional items, however, posed some difficulties. The social/family well-being subscale was problematic, as expected, based upon observations of cultural differences in social values and functioning. We also noted that concerns about hearing were different between patients with nasopharyngeal carcinoma (NPC) and those with other H&N cancers. CONCLUSION: The TChi FACT-H&N is reliable. Items related to problems with hearing should be added to better evaluate the quality of life in patients with NPC.