Forensic Psychiatric Evaluation for Military Absenteeism in Taiwan.

The relationship between military absenteeism and mental health problems has been noted; however, factors affecting military absenteeism by enlisted personnel have not been studied systematically. In a medical center in Taiwan, we performed a chart review of 26 forensic psychiatric evaluations of enlisted personnel who were absent without leave (AWOL) or deserted their service from 1994 to 2014. The findings showed that many of these recruits had a lower level of education (50.00% had just nine years of education), intellectual disability (46.15%), depressive disorders (30.76%), and suicidal ideation (53.85%). Depressive disorder was overrepresented in comparison with findings in a previous study. Further study is needed to confirm whether psychiatric screening before service enlistment and early psychiatric intervention for service members with mental illness or emotional disturbance could help in the prevention of desertion or going AWOL.

Service suspension for mental disorders in armed forces draftees in the Penghu area.

BACKGROUND: It is important to monitor draftees for mental disorders before or at an early stage of military service. The aim of this study was to characterize the draftees who were suspended from service for mental disorders among draftees in a high readiness military zone in the Taiwan Strait. METHOD: A total of 152 draftees consulted the outpatient service of the Department of Psychiatry at Penghu branch, Tri-Service General Hospital in Taiwan during the period between August 2004 and July 2008, and whose severity of mental disorder fit the criteria for service suspension were recruited as the study group (SG). Draftees who had adjusted normally were the control group (CG). RESULTS: The major causes for suspension were major depressive disorders and personality disorders. In the study group, the number of draftees seeking psychiatric outpatient treatment increased from 49.3% before service to 100% during service. In addition, higher rates of suicidal ideation, suicide plans, attempted suicide, and homicidal ideation were found in the study group than in the control group. The percentages of draftees who were unwilling to serve and absent without official leave (AWOL) during military service in Penghu were also significantly higher in the study group than in the control group. CONCLUSIONS: Based on the characteristics of the draftees who were suspended from service for mental disorders, psychological factors such as suicidal ideation, suicide attempts and adjustment disorders should be surveyed and monitored before the draft and at an early stage of military service.

Effect of spot size and fluence on Q-switched alexandrite laser treatment for pigmentation in Asians: a randomized, double-blinded, split-face comparative trial.

BACKGROUND: Q-switched laser treatment for pigment disorders commonly leads to postinflammatory hyperpigmentation (PIH) in Asians. OBJECTIVES: To evaluate the effect of spot size and fluence on Q-switched alexandrite laser (QSAL) treatment for pigmentation in Asians. METHODS: Ten patients with freckles, 18 with lentigines, and 8 with acquired bilateral nevus of Ota-like macules (ABNOM) received 1 session of QSAL treatment for a 3-mm spot on one cheek and a 4-mm spot on the other cheek. The lowest fluences to achieve a visible biologic effect were chosen. RESULTS: The patients with freckles experienced the highest improvement rate (83-84%), followed by those with lentigines (52%) and ABNOM (35%). Similar efficacy was observed for both cheeks (p > 0.05). PIH developed in 10% (1/10), 44% (8/18), and 75% (6/8) of the patients with freckles, lentigines, and ABNOM, respectively. The severity of PIH was lower in the 4-mm spot with a lower fluence than in the 3-mm spot with a higher fluence in patients with lentigines (p = 0.03), but not in those with freckles or ABNOM. CONCLUSIONS: Using a larger spot to achieve the same biologic effect at a lower fluence is associated with equal efficacy and less-severe PIH in patients with lentigines.

Comparison of two Q-switched lasers and a short-pulse erbium-doped yttrium aluminum garnet laser for treatment of cosmetic tattoos containing titanium and iron in an animal model.

BACKGROUND: Cosmetic tattoos contain titanium and ferric oxide and darken through reduction after Q-switched laser irradiation. The optimal treatment for removing these pigments remains unknown. OBJECTIVE: To compare the effects of two Q-switched lasers and a short-pulse erbium-doped yttrium aluminum garnet (SP Er:YAG) laser to remove cosmetic tattoos in an animal model. MATERIALS AND METHODS: Rats were tattooed using white, flesh-colored, and brown inks (4 bands of each color) on their backs. For each color, one band was left untreated, and one each was treated with a Q-switched neodymium-doped YAG laser, a Q-switched alexandrite laser, and a SP Er:YAG laser every 3 weeks until the pigments were clear. RESULTS: The two Q-switched lasers were equally effective; all three pigments darkened initially and then resolved gradually. Up to 20, 18, and 10 sessions were required to remove white, flesh-colored, and brown tattoos, respectively. Only six sessions were required with the SP Er:YAG laser. Minimal scarring was observed with all lasers. Skin biopsies confirmed pigment granule fragmentation after Q-switched laser treatment and a decrease in the amount of pigment after SP Er:YAG laser treatment. CONCLUSION: The SP Er:YAG laser was superior to the Q-switched lasers for removing cosmetic tattoos.

Demographic and clinical characteristics of users of psychiatric emergency services on an off-shore island in Taiwan.

Abstract Objective. This study assessed the socio-demographic and clinical characteristics of psychiatric emergency service (PES) patients treated in a hospital on an off-shore island of Taiwan. Method. Data were gathered on 472 identified psychiatric patients presenting to PES over a 4-year period. Results. The majority of patients were male and were in the 50-59 age group with no previous psychiatric treatment or family history of mental illness. Hospitalization rates were low for both genders, but males spent a longer time in the emergency department. Males were more often seen for violence and homicidal behaviours, while females showed more evidence of suicidal behaviour. Males were more likely to receive medication by injection with or without physical restraint as opposed to oral medication and emotional support. Conclusions. The clinical characteristics of male and female PES patients in this remote island showed differences in length of stay, psychiatric diagnoses, behaviour characteristics, and final disposition. These findings differ from those in studies of PES patients on the main island of Taiwan, the United States and Europe. Future studies of other remote areas may confirm these findings and highlight the need to provide more and particular mental health services to these underserved areas.

New onset somnambulism associated with different dosage of mirtazapine: a case report.

Somnambulism consists of variously complex behaviors that may result in harm to self or to others. Many different medications have been reported to induce somnambulism, and a few of them are newer antidepressants. A 40-year-old woman with history of major depression who experienced new onset somnambulism for successive 3 nights, whereas the antidepressant mirtazapine was increased from 30 to 45 mg/d. The notable and complex sleepwalking symptoms terminated dramatically on the first night after withdrawal of mirtazapine. There is clearly a cause-and-effect relationship between the treatment of higher-dosage mirtazapine and development of somnambulism. It might be related to the different affinities to 5-hydroxytryptamine 2 (5-HT(2)) and H(1) receptors at different dosages of mirtazapine, which explain the patient experiencing sleepwalking episodes exclusively at higher doses of mirtazapine. Clinical physicians should be aware of this adverse effect and taper or discontinue the regimen if sleepwalking develops.

Psoriasis independently associated with hyperleptinemia contributing to metabolic syndrome.

OBJECTIVE: To evaluate the role of leptin, a 16-kDa adipocyte-derived hormone, in the development of metabolic dysregulation of psoriasis. DESIGN: Case-control study. SETTING: Referral centers. Patients Seventy-seven patients with psoriasis and 81 age- and sex-matched control subjects were included in the study. Intervention Enzyme-linked immunoassay of serum samples from study subjects. MAIN OUTCOME MEASURES: Serum leptin levels and proportions of comorbidities (including hypertension, diabetes mellitus, metabolic syndrome, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol concentrations) in cases vs controls were compared using chi(2) and Mann-Whitney tests. The clinical significance of leptin in psoriasis was analyzed using logistic regression models. RESULTS: Significantly more obesity (odds ratio [OR], 2.67) and hypertension (2.17) (P =.04 for both) were observed in subjects with psoriasis. High serum leptin levels (>or=7397.43 pg/mL) were found in female subjects (OR, 6.05; P < .001) and in subjects with obesity (3.45; P =.01), hypertension (2.19; P =.04), metabolic syndrome (3.58; P =.008), and psoriasis (2.25; P =.02). On multivariate analysis, psoriasis (OR, 4.57; P =.009) was significantly associated with hyperleptinemia independent of female sex (26.36; P < .001), metabolic syndrome (4.37; P =.04), and obesity (2.83; P =.12). Finally, patients with psoriasis who had hyperleptinemia tended to be female (P < .001) and manifested obesity (P =.002) and metabolic syndrome (P =.003). CONCLUSIONS: Hyperleptinemia is associated with psoriasis independent of female sex and other conventional cardiovascular risk factors such as obesity and metabolic syndrome. Hyperleptinemia in psoriasis may contribute to metabolic syndrome.

Ziprasidone in the treatment of delayed carbon monoxide encephalopathy.

Delayed carbon monoxide (CO) encephalopathy is a serious complication of acute CO poisoning. We present a case of successful treatment of ziprasidone, a newer atypical antipsychotic, in delayed CO encephalopathy. A 52-year-old depressed woman suffered acute CO intoxication after an attempt of suicide by burning charcoal. She was initially treated with hyperbaric oxygen (HBO) therapy for the acute intoxication. One week later, the patient developed neuropsychiatric symptoms including parkinsonism, tardive dyskinesia (TD), cognitive deterioration, urinary incontinence, gait disturbance, mutism, disorientation to time, place and person, and disorganized as well as disturbing behavior. During her psychiatric hospitalization, the patient had been treated with daily HBO therapy, bromocriptine (2.5 mg/day), the conventional antipsychotic sulpiride (600 mg/day), and atypical antipsychotics such as risperidone (5 mg/day) and quetiapine (400 mg/day). However, her delayed neuropsychiatric sequelae of CO intoxication persisted despite of these treatments. It was until she had been treated with ziprasidone (80 mg/day) for 10 days that her mental condition was improved. With ziprasidone therapy, the patient obtained substantial improvement in her neuropsychiatric symptoms, cognitive function, and daily activities. Our case indicates that ziprasidone can be used effectively in the treatment of delayed CO encephalopathy.

A comparison of Q-switched alexandrite laser and intense pulsed light for the treatment of freckles and lentigines in Asian persons: a randomized, physician-blinded, split-face comparative trial.

BACKGROUND: Q-switched (QS) pigmented lasers and intense pulsed light (IPL) successfully treat pigment disorders. OBJECTIVE: We sought to compare efficacy and side effects of QS alexandrite laser (QSAL) and IPL for freckle and lentigo treatment in Asians. METHODS: In all, 15 patients with freckles and 17 patients with lentigines were treated randomly with one session QSAL in one cheek and two sessions IPL in the other cheek at 4-week intervals. Efficacy was determined using a new pigmentation area and severity index score. RESULTS: All patients experienced improvement (P < .0001). Postinflammatory hyperpigmentation developed in one patient with freckles and 8 patients with lentigines after QSAL. No postinflammatory hyperpigmentation occurred after IPL. Freckles achieved greater improvement after QSAL than IPL (P = .04). In lentigines, the results after IPL were better than QSAL among those with postinflammatory hyperpigmentation after QSAL. LIMITATIONS: Limitations include a small case number and short follow-up period. CONCLUSION: QSAL was superior to IPL for freckle treatment. IPL should be used for lentigines in Asian persons.