Experience of cognitively intact residents cohabitating with residents with dementia in long-term care facilities.

A qualitative research approach was used to explore the life experience of cognitively intact (CI) residents cohabitating with residents with dementia in mixed placement facilities. Purposive sampling was used to recruit 21 CI residents from 6 long-term care facilities in southern Taiwan. Using a semi-structured interview guide, data were analyzed by content analysis. Two themes emerged: emotional diversity and coping. Emotional diversity described the wide range of responses, both positive and negative, expressed by the participants. Coping referred to the CI residents' ability to adapt to behaviors exhibited by the residents with dementia and the environment. Results of this study provide nurses and other health care providers with an understanding of the life experience of CI residents who live among residents with dementia. An understanding can lead to improved quality of life and positive social interactions among CI residents and those with dementia.

Epidemiologic psychiatric studies on post-disaster impact among Chi-Chi earthquake survivors in Yu-Chi, Taiwan.

The aim of the present study was to survey a cohort population for the risk factors of post-traumatic stress disorder (PTSD) and major depression, and the prevalence of different psychiatric disorders at 6 months and 2 and 3 years after a major earthquake. The Disaster-Related Psychological Screening Test (DRPST), part I, and the Mini-International Neuropsychiatric Interview (MINI) were, respectively, administered by trained interviewers and psychiatrists in this community-interview program. The prevalence of PTSD decreased from 8.3% at 6 months to 4.2% at 3 years after the earthquake. Suicidality increased from 4.2% at 6 months and 5.6% at 2 years to 6.0% at 3 years after the earthquake; drug abuse/dependence increased from 2.3% at 6 months to 5.1% at 3 years after the disaster. The risk factors for PTSD and major depression in various post-disaster stages were determined. Earthquake survivors had a high percentage of psychiatric disorders in the first 2 years, and then the prevalence declined. Following the devastation caused by the Chi-Chi earthquake, it is important to focus on treating symptoms of major depression and PTSD and eliminating the risk factors for both of these disorders in survivors to avoid the increase in suicidality.

Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan.

OBJECTIVE: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years. METHODS: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period. RESULTS: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred. CONCLUSIONS: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

Genome scan of Han Chinese schizophrenia families from Taiwan: confirmation of linkage to 10q22.3.

OBJECTIVE: Genome-wide linkage analyses of schizophrenia have identified several regions that may harbor schizophrenia susceptibility genes, but given the complex etiology of the disorder, it is unlikely that all susceptibility regions have been detected. To address this issue, the authors ascertained 606 Han Chinese families comprising 1,234 affected members. METHOD: Probands with schizophrenia were recruited from six data collection field research centers in Taiwan. Each proband underwent a diagnostic screen with supplemental medical records and a semistructured interview. Following this screen, the authors administered the Mandarin Chinese version of the Diagnostic Interview for Genetic Studies. Best-estimate final diagnoses were made by two board-certified psychiatrists. The genotyping was conducted by the Center for Inherited Disease Research, with 386 markers spaced at an average of 9-centimorgan (cM) intervals. Empirical simulations were generated to determine genome-wide significance. RESULTS: The authors found five regions with nonparametric linkage z scores 2.0 or greater. These were the following: 2.08 was reached for D1S551 (113.7) cM at 1p31.1 and 2.31 for D2S410 (125.2 cM) at 2q14.1; 2.00 was reached for D4S2361 (93.5 cM) at 4q21.23, and 2.07 for D15S1012 (36 cM) at 15q14, the largest nonparametric linkage z score was 2.88 for D10S2327 (100.92 cM) at 10q22.3. CONCLUSIONS: Our 10q22.3 finding at 100.9 cM is consistent with a previously reported nonparametric linkage score of 4.27 at 107.2 cM on chromosome 10, although it did not attain genome-wide significance in this study.

Survey of quality of life and related risk factors for a Taiwanese village population 3 years post-earthquake.

OBJECTIVE: To investigate quality of life (QOL) and related risk factors in Taiwanese earthquake survivors diagnosed with different psychiatric disorders 3 years after the 1999 Chi-Chi earthquake. METHOD: This study was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 405 respondents (189 men and 216 women) aged 16 years or older, who had been exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview, with an adjusted response rate of 70.2%. RESULTS: The prevalence range for psychiatric disorders in the earthquake survivors was 0.2-7.2% 3 years after the Chi-Chi earthquake, with rates for major depression (MD) and posttraumatic stress disorder (PTSD) of 6.4% and 4.4%, respectively. The QOL scores for the PTSD/MD group were lower than for the other two diagnostic groups, as determined by assessment of physical and mental aspects of functional integrity from MOS SF-36 scores. The predictors for poor QOL were age, female gender, economic problems, physical illness, subjective assessment of memory and social-activity decline and diagnosis of PTSD or MD. CONCLUSION: The QOL for earthquake survivors with psychiatric disorders, especially PTSD or MD, was inferior compared with the mentally healthy analogues, with contemporaneous decreases in mental and physical function scores across the QOL subscales. The persistence of long-term economic problems was one of many important factors affecting QOL.

Survey of psychiatric disorders in a Taiwanese village population six months after a major earthquake.

BACKGROUND AND PURPOSE: The catastrophic Chi-Chi earthquake of September 21, 1999 in Taiwan provided a unique opportunity to study the disaster's psychiatric impact on survivors. This study assessed the development of psychiatric disorders among residents in a Taiwanese village near the epicenter of the earthquake within 6 months of the disaster. METHODS: A total of 442 of the 602 actual living residents of Tong-Chi village who were over 16 years of age and were present in the community at the time of the earthquake were included in this population survey. Subjects were interviewed by psychiatrists using the Mini-International Neuropsychiatric Interview and questionnaires to collect demographic information and risk factors for psychiatric disorders 4 to 6 months after the earthquake. RESULTS: The prevalence rates were 9.5% for current major depression, 2.8% for past major depressive episode, and 7.9% for post-traumatic stress disorder (PTSD). Females had significantly higher rates of most psychiatric disorders. After controlling for covariates, the significant risk factors for PTSD were female gender and having sought medical service after the earthquake. Significant risk factors for major depressive episode were divorced/widowed status, education level equal to or below primary school, and prominent house damage. CONCLUSION: This population survey of earthquake disaster survivors found an increased prevalence of psychiatric disorders after exposure to a catastrophic earthquake. These results highlight the need for prompt therapeutic attention to residents of earthquake disaster areas after the event.

Linkage evidence of schizophrenia to loci near neuregulin 1 gene on chromosome 8p21 in Taiwanese families.

Positive linkage of schizophrenia to chromosome 8p22-21 loci had been reported in the Caucasian samples. This study was designed to replicate this finding by using eleven microsatellite markers on chromosome 8p22-21 in 52 Taiwanese schizophrenic families with at least two affected siblings. Two phenotype models (narrow: DSM-IV schizophrenia only; and broad: including schizophrenia, schizoaffective, and other non-affective psychotic disorders) were used to define the disease phenotype. Maximum non-parametric linkage scores (NPL score) of 2.45 (P = 0.008) and 1.89 (P = 0.02) were obtained for the marker D8S1222 under the broad and narrow models, respectively. Positive linkage was found across about a 4-cM region. The marker D8S1222 was about 400 kbp distal to the exon 1 of glial growth factor 2 (GGF2), an isoform of Neuregulin 1 gene (NRG1), which has been highly suggested to be a candidate gene for schizophrenia. The results provide suggestive linkage evidence of schizophrenia to loci near NRG1 on chromosome 8p21 in an ethnically distinct Taiwanese sample. Further exploration of the candidate gene and nearby chromosome regions is warranted.

Quality of life and related risk factors in a Taiwanese Village population 21 months after an earthquake.

OBJECTIVE: To investigate quality of life and related risk factors of Taiwanese earthquake survivors with different psychiatric disorders 21 months after the earthquake. METHOD: This was a population survey. Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and questionnaires to interview 461 respondents (209 males and 252 females) 16 years or older who were equally exposed to the earthquake. Psychiatrists interviewed the same respondents using the Mini-International Neuropsychiatric Interview (MINI), with an adjusted response rate of 79.9%. RESULTS: The prevalence of varied psychiatric disorders in earthquake survivors ranged from 3.3% to 18%. However, there was almost a positive trend in quality of life in survivors among the following groups: posttraumatic stress disorder combined with major depressive episode; major depressive episode; posttraumatic stress disorder; other psychiatric diseases; and healthy mentality groups on the physical aspect or mental aspect of the MOS SF-36. When survivors were elderly or female and had experienced prominent financial loss immediately after the earthquake, social network change, and mental impairment, their quality of life tended to be worse. CONCLUSION: The earthquake survivors had a higher percentage of psychiatric disorders. The risk factors that affected quality of life in survivors were age, female sex, financial loss, social network change, and mental impairment.

Establishment of a disaster-related psychological screening test.

OBJECTIVE: To create a short screening scale for the detection of posttraumatic stress disorder (PTSD) and major depressive disorder (MDE) in earthquake survivors in Taiwan. METHOD: Trained research assistants used the Disaster-Related Psychological Screening Test (DRPST) to assess 461 residents of a village that had experienced a major earthquake. The participants were also evaluated by psychiatrists using the Mini-International Neuro-psychiatric Interview (MINI). Best subset regression analysis and the receiver operating characteristics curve were used to select a subset of items and cut-off points from the DRPST. RESULTS: A seven-symptom scale and a three-symptom analogue were selected for PTSD and MDE screening, respectively. Scores of three or more on the PTSD scale and two or more on the MDE scale were used to define a group of positive cases that provide useful information for the patient cohort and will be valuable in long-term follow-up studies of the prevalence of psychiatric diseases following a natural disaster. However, higher scores could also be used to define positive cases under limited psychiatric care resources. CONCLUSION: The DRPST, which was administered for phase 1 of this two-phase study, may be used for effective and rapid screening for PTSD and MDE after an earthquake, despite the usual limitations on resources following a disaster.