Erratum: Title Correction.

Clin Psychopharmacol Neurosci 2019;17(2):222-232.

Heart Rate Variability Biofeedback Increased Autonomic Activation and Improved Symptoms of Depression and Insomnia among Patients with Major Depression Disorder.

OBJECTIVE: Autonomic imbalance is considered a psychopathological mechanism underlying major depressive disorder (MDD). Heart rate variability (HRV) is an index for autonomic activation. Poor sleep quality is common among patients with MDD. HRV biofeedback (BF) has been used for regulating autonomic balance among patients with physical illness and mental disorders. The purpose of present study was to examine the effects of HRV-BF on depressive symptoms, sleep quality, pre-sleep arousal, and HRV indices, in patients with MDD and insomnia. METHODS: In this case-controlled study, patients with MDD and Pittsburgh Sleep Quality Index (PSQI) score higher than 6 were recruited. The HRV-BF group received weekly 60-minute protocol for 6 weeks, and the control group who have matched the age and sex received medical care only. All participants were assessed on Beck Depression Inventory-II, Back Anxiety Inventory, PSQI, and Pre-Sleep Arousal Scale. Breathing rates and electrocardiography were also performed under resting state at pre-testing, and post-testing conditions and for the HRV-BF group, also at 1-month follow-up. RESULTS: In the HRV-BF group, symptoms of depression and anxiety, sleep quality, and pre-sleep arousal were significantly improved, and increased HRV indices, compared with the control group. Moreover, in the HRV-BF group, significantly improved symptoms of depression and anxiety, decreased breathing rates, and increased HRV indices were detected at post-testing and at 1-month follow-up, compared with pre-testing values. CONCLUSION: This study confirmed that HRV-BF is a useful psychosocial intervention for improving autonomic balance, baroreflex, and symptoms of depression and insomnia in MDD patients.

Efficacy, tolerability, and safety of oral paliperidone extended release in the treatment of schizophrenia: a 24-week, open-label, prospective switch study in different settings in Taiwan.

PURPOSE: Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. PATIENTS AND METHODS: This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists' judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication. RESULTS: Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed. CONCLUSION: Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation.

The effects of aerobic exercise on cognition in schizophrenia: A 3-month follow-up study.

Aerobic exercise (AE) has been shown to improve cognition in patients with schizophrenia. However, it remains unclear whether these exercise-induced cognitive benefits persist beyond the training period. Accordingly, the present study sought to examine the immediate and maintenance effects of AE on a wide range of cognitive functions in 75 schizophrenia patients randomized to 12 weeks of either moderate-intensity treadmill exercise or stretching and toning exercise that served as a control. Participants completed assessments of neurocognition and cardiovascular fitness at pretest, posttest, and 3-month follow-up. The results showed that the AE group outperformed the controls on processing speed and attention at the end of intervention. The two groups did not differ significantly in any cognitive outcome measured at follow-up; however, improvement over time was noted in certain cognitive domains in AE group. The average effect sizes at follow-up were 0.53 and 0.35 for AE and control groups, respectively. There were no significant between-group differences in aerobic fitness at posttest and follow-up, and that fitness level was not related to changes in cognitive performance. These findings provide preliminary evidence for a trend towards beneficial effects of physical activity on cognition over a short follow-up period in favor of AE.

Eye movement desensitization and reprocessing for treating psychological disturbances in Taiwanese adolescents who experienced Typhoon Morakot.

In this case-control study, we aimed to assess the intervention effects of four-session eye movement desensitization and reprocessing (EMDR) on reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in Taiwanese adolescents who experienced Typhoon Morakot. A total of 83 adolescents with posttraumatic stress disorder related to Typhoon Morakot, major depressive disorder, or current moderate or high suicide risk after experiencing Typhoon Morakot were allocated to a four-session course of EMDR (N = 41) or to treatment as usual (TAU; N = 42). A multivariate analysis of covariance was performed to examine the effects of EMDR in reducing the severity of disaster-related anxiety, general anxiety, and depressive symptoms in adolescents by using preintervention severity values as covariates. The multivariate analysis of covariance results indicated that the EMDR group exhibited significantly lower preintervention severity values of general anxiety and depression than did the TAU group. In addition, the preintervention severity value of disaster-related anxiety in the EMDR group was lower than that in the TAU group (p = 0.05). The results of this study support that EMDR could alleviate general anxiety and depressive symptoms and reduce disaster-related anxiety in adolescents experiencing major traumatic disasters.

Aripiprazole augmentation versus antidepressant switching for patients with major depressive disorder: A 6-week, randomized, rater-blinded, prospective study.

No study has directly compared the efficacy and tolerability of aripiprazole augmentation (AA) and antidepressant switching (SW) in patients with major depressive disorder (MDD). This is the first 6-week, randomized, rater-blinded, direct comparison study between AA and SW in outpatients. An inadequate response to antidepressants was defined as a total score ≥ 14 on the Hamilton Depression Rating Scale-item 17 (HDRS-17) despite adequate antidepressant dosage for at least 6 weeks in the current depressive episode. The primary endpoint was change in the total score of the Montgomery-Åsberg Depression Rating Scale (MADRS) from baseline to the end of treatment. Secondary efficacy measures included the response and remission rates as priori defined at the end of treatment: changes in total scores of the HDRS-17, Iowa Fatigue Scale (IFS), and Sheehan Disability Scale (SDS) from baseline to the end of treatment and the proportion of patients who scored 1 or 2 on the Clinical Global Impression-Improvement Score (CGI-I) at the end of treatment. Tolerability was assessed with the Barnes Akathisia Rating Scale (BARS) and Arizona Sexual dysfunction scale (ASEX), and the numbers of adverse events were compared between the two groups. A total of 101 patients were randomized to either AA (n = 52) or SW (n = 49). The mean change in the MADRS score from baseline was significantly higher in the AA, with a difference in magnitude of -8.7 (p < 0.0001). The intergroup difference was first evident in week 2. The numbers of responders (p = 0.0086) and remitters (p = 0.0005) were also significantly higher in the AA (60% and 54%, respectively) compared with the SW (32.6% and 19.6%, respectively). On most secondary endpoints, AA showed better clinical outcomes compared to SW. The tolerability profiles were comparable between the two groups. Overall, AA yielded potentially beneficial clinical outcomes compared to SW. Given the methodological shortcomings of the present study, adequately powered, more rigorously controlled clinical trials are strongly warranted to confirm the present findings.

One-year follow up of PTSD and depression in elderly aboriginal people in Taiwan after Typhoon Morakot.

AIM: This paper describes a 1-year follow-up of post-traumatic stress disorder (PTSD) symptomatology and depression in an elderly minority population who experienced Typhoon Morakot in Taiwan. METHODS: The PTSD Symptom Scale--Interview and the 10-item short form Center for Epidemiological Studies Depression Scale were used to examine PTSD symptomatology and depression in 120 victims at 3-6 months and in 88 victims (73.3% reinterview rate) at 11-12 months after the disaster. Further, we looked for associations between stress, prognosis, and development of PTSD symptomatology and depression. RESULTS: The prevalence of PTSD symptomatology decreased from 29.2% (35/120) at 3-6 months to 15.9% (14/88) at 11-12 months. The prevalence of depression, however, increased from 43.3% (52/120) to 46.6% (41/88). No factor was associated with follow-up PTSD symptomatology, and only the level of education was related to follow-up depression. Generally, the risk factors of age, sex, symptomatology of PTSD and depression at baseline, and stressor of unemployment predicted new-onset or chronic PTSD symptomatology and depression. Delayed-onset depression 48.0% (24/50) was more common than delayed-onset PTSD symptomatology 11.3% (7/62). Chronic and delayed-onset PTSD symptomatology were more easily developed with depression. CONCLUSION: Although PTSD and depression were separate consequences of trauma, they emerged and affected mental health together. We documented the courses of PTSD and depression among elderly aboriginal people, and the possible effects of demographic, symptomatology, and adverse life stressors were discussed.

Association between school bullying levels/types and mental health problems among Taiwanese adolescents.

BACKGROUND: Few studies have compared the risks of mental health problems among the adolescents with different levels and different types of bullying involvement experiences. METHOD: Bullying involvement in 6,406 adolescents was determined through use of the Chinese version of the School Bullying Experience Questionnaire. Data were collected regarding the mental health problems, including depression, suicidality, insomnia, general anxiety, social phobia, alcohol abuse, inattention, and hyperactivity/impulsivity. The association between experiences of bullying involvement and mental health problems was examined. The risk of mental health problems was compared among those with different levels/types of bullying involvement. RESULTS: The results found that being a victim of any type of bullying and being a perpetrator of passive bullying were significantly associated with all kinds of mental health problems, and being a perpetrator of active bullying was significantly associated with all kinds of mental health problems except for general anxiety. Victims or perpetrators of both passive and active bullying had a greater risk of some dimensions of mental health problems than those involved in only passive or active bullying. Differences in the risk of mental health problems were also found among adolescents involved in different types of bullying. CONCLUSIONS: This difference in comorbid mental health problems should be taken into consideration when assessing adolescents involved in different levels/types of bullying.

The associations between suicidal ideation and attempt and anxiety symptoms and the demographic, psychological, and social moderators in Taiwanese adolescents.

The objectives of this study were to examine the associations between suicidal ideation and attempt and anxiety symptoms and the moderators in 5,027 Taiwanese adolescents. The associations between suicidal ideation and attempt and anxiety symptoms on the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T) were examined using logistic regression analysis. The moderating effects of demographic (gender and age), psychological (problematic alcohol use, severe depressive symptoms, and low self-esteem), and social factors (bullying victimization, and low family function) on the associations were examined. Adolescents who had anxiety symptoms were more likely to have suicidal ideation and attempt than those who did not have anxiety symptoms. Bullying victimization had a moderating effect on the association between suicidal ideation and anxiety symptoms. Assessment of suicidal ideation and attempt should be routine practice among adolescents who present with anxiety symptoms.

Association between types of involvement in school bullying and different dimensions of anxiety symptoms and the moderating effects of age and gender in Taiwanese adolescents.

OBJECTIVE: The aims of this cross-sectional study were to examine the associations of various types of school bullying involvement experiences with different dimensions of anxiety symptoms on the Multidimensional Anxiety Scale for Children (MASC) and to examine the moderating effects of gender and age on the associations in Taiwanese adolescent students aged at 11-18. METHOD: Involvement in passive and physical bullying and belongings snatch and multiple dimensions of anxiety symptoms in 5537 adolescents were determined through use of the self-reported Chinese version of the School Bullying Experience Questionnaire (C-SBEQ) and the Taiwanese version of the MASC, respectively. The associations between four types of bullying involvement and four dimensions of anxiety symptoms and the moderating effects of gender and age were examined using linear mixed model analysis. RESULTS: The results indicated that except for the non-significant association between victimization by verbal and relational bullying and harm avoidance, both victims of verbal and relational bullying and physical bullying and belongings snatch reported more severe anxiety symptoms on all four dimensions of MASC-T than non-bullied subjects. While the perpetrators of verbal and relational bullying reported more severe physical symptoms and social anxiety than did non-perpetrators of verbal and relational bullying, the perpetrators of physical bullying and belongings snatch reported less harm avoidance, social anxiety and separation/panic than did non-perpetrators of physical bullying and belongings snatch. Perpetrator-victims of verbal and relational bullying showed more physical symptoms than those who were pure victims or perpetrators of verbal and relational bullying. Perpetrator-victims of physical bullying and belongings snatch had more social anxiety than those who were pure victims or perpetrators. This study also found that gender and age had the moderating effect on the association between some forms of bullying involvement and some dimensions of anxiety symptoms. CONCLUSIONS: The results of this study support the necessity to apply the multi-dimensional scale to evaluate anxiety symptoms in adolescents who are involved in bullying and to take the different directions of association into consideration when developing prevention and intervention programs.

Attentional biases for betel nut cues in heavy and light chewers.

The betel nut (Areca catecu) is regarded by the World Health Organization as the fourth most prevalent human carcinogen. Our study aims to investigate whether habitual chewers show bias in their attention toward betel nut usage. In the current study, heavy and light betel nut chewers were instructed to respond to a probe presented immediately after either one of a pair of areca-related picture and non-areca-matched picture. The presentation durations of these pictures were manipulated to investigate attentional biases under awareness threshold (17 ms), in initial orienting (200 ms), and maintenance of attention (2,000 ms). Faster response to the probe replacing the areca-related picture, in comparison with a matched picture, indicated attentional bias. The results showed that neither group showed subliminal attentional biases. Further, heavy chewers, but not light chewers, exhibited supraliminal biases toward betel nut cues in initial orienting of attention and maintained attention. Moreover, attentional bias scores at 2,000 ms were also shown to be positively associated with betel nut craving and dependence. Implications of the current findings are thoroughly discussed in the article.

Moving toward personalized medicine in the methadone maintenance treatment program: a pilot study on the evaluation of treatment responses in Taiwan.

This pilot study simultaneously evaluated the effects of various factors, including genetic variations of CYP2B6, CYP2C19, and ABCB1, demographic characteristics, disease states, methadone-drug interactions (MDIs), and poly-substance use, on the treatment responses among non-HIV patients in the methadone maintenance treatment program (MMTP) in Taiwan. A total of 178 patients were recruited from two major hospitals that provided MMTP services in southern Taiwan, and information regarding concomitant medications and diseases was acquired from the National Health Insurance (NHI) program. The results demonstrated that the methadone maintenance dose, CYP2B6 785G allele, and ABCB1 2677T allele have positive effects on the methadone plasma concentration. In contrast, patients with HCV coinfection, alcohol problems, and psychiatric diseases may have a negative response to treatment. Thus, a comprehensive evaluation of treatment responses in the MMTP should include not only genetic polymorphisms in methadone metabolism and transporter proteins, but also concomitant diseases, MDIs, and poly-substance use. The results also suggest that personalized medicine may be indispensable for a better outcome of the MMTP.

Factor structure, reliability, and validity of the Chinese version of the School Bullying Experience Questionnaire.

The aims of this study were to examine the factor structure, internal consistency, 1-month test-retest reliability, and congruent validity of the Chinese version of the School Bullying Experience Questionnaire (C-SBEQ). Study 1, in which 5751 Taiwanese adolescents in Southern Taiwan participated, examined the adequacy of the original four-factor structure of the C-SBEQ using confirmatory factor analysis (CFA) and internal-consistency reliability using Cronbach α. Study 2, in which 108 adolescents in Southern Taiwan participated, examined the 1-month test-retest reliability using intraclass correlation coefficients (ICCs). We examined the congruent validity of the C-SBEQ by examining the consistency between self-reported and teacher- and classmate-nominated experiences of bullying involvement in Study 2. The results of CFA supported the four-factor structure of the C-SBEQ in Taiwanese adolescents. The test-retest and internal reliability values of all subscales of the C-SBEQ were at acceptable to satisfactory levels. Nominated adolescents had significantly higher self-reported scores on three C-SBEQ subscales than non-nominated ones, and the levels of agreement between self-reported and nominated victims were moderate. The results of this study indicate that the C-SBEQ is appropriate for assessing bullying experiences in Taiwanese adolescents.

Processing speed mediates gender differences in memory in schizophrenia.

The primary aim of this study was to examine whether processing speed mediates the association between gender and episodic memory in schizophrenia. Participants were 51 female and 51 male outpatients comparable on demographic, clinical, and cognitive variables. Memory tests included both verbal and visual measures. Both groups scored below the normative mean of the memory and processing speed tests, except that females performed slightly above the mean on face recognition. Females outperformed males on verbal memory, visual recognition, and processing speed. Mediation regression analyses showed processing speed mediated immediate and delayed recall for both verbal and visual memory measures. Thus processing speed appears to be a critical variable for understanding cognitive deficits in schizophrenia and may be an important target for cognitive rehabilitation.

The Chinese version of the Severity of Dependence Scale as a screening tool for benzodiazepine dependence in Taiwan.

The development of an instrument to estimate the incidence, characteristics, and risk factors of benzodiazepine (BZD) dependence broadly in Taiwan is an important task. This study assessed the validity of the Chinese version of the Severity of Dependence Scale (SDS([Ch])) among regular BZD users in Taiwan (n=228). A positive correlation was shown between SDS([Ch]) and Mini-International Neuropsychiatric Interview diagnosed of BZD dependence. Thirty-six percent of the users received a Mini-International Neuropsychiatric Interview diagnosis of current BZD dependence. The dependent users tended to be divorced/widowed; not schizophrenic; and have higher SDS([Ch]) scores, a longer duration of use, and multiple-BZD use. The SDS([Ch]) for BZD dependence was shown to have high diagnostic utility (area under the receiver operating characteristic curve=0.779), a sensitivity of 80.5%, and a specificity of 85.7%, with a cutoff point of 7. The findings support that the SDS([Ch]) is a valid brief self-reported questionnaire for the assessment of BZD dependence among chronic users in Taiwan.

Working memory deficit in premenstrual dysphoric disorder and its associations with difficulty in concentrating and irritability.

OBJECTIVE: This study evaluates working memory deficit among women with premenstrual dysphoric disorder (PMDD) and whether such a deficit and its premenstrual aggravation is associated with difficulty in concentrating, irritability, and impaired daily function or not. METHOD: Sixty women with PMDD (PMDD group) and 60 women without PMDD (control group) completed the assessment. Severity of irritability, difficulty concentrating, total symptoms, and functional impairment of PMDD were evaluated by the Premenstrual Symptoms Screening Tool. All participants performed N2 and N3 back tasks to assess working memory in both luteal and follicular phases. RESULTS: The PMDD group had significantly poorer performance on N2 and N3 back tasks than the control group did in the luteal phase but not in the follicular phase. Compared to the control group, the PMDD group also exhibited more deterioration in performance of N3 back task in the luteal phase. Performance of N2 and N3 back tasks in luteal phase was significantly associated with irritability, symptom severity, and functional impairment by PMDD. CONCLUSIONS: Working memory deficit is aggravated in the luteal phase among women with PMDD. Appropriate interventions are needed to prevent negative consequences of working memory deficit.

Cue-induced positive motivational implicit response in young adults with Internet gaming addiction.

This study evaluated the positive motivational implicit response to Internet gaming cues (i.e., screenshots of popular online games) to identify potential mechanisms of dyscontrolled Internet use in young adults with Internet gaming addiction (IGA). The final analysis included 64 young adults with IGA and 71 control subjects. The subjects completed the implicit association task to test their reaction to congruent pairing (Internet gaming screenshot paired with liked words) and incongruent pairing (Internet gaming screenshot paired with disliked words). The results demonstrated that, compared to the control group, the IGA group reacted faster to congruent pairing. It suggests that the IGA group had a positive motivational implicit response to screenshots of online games. Implicit cognition is an important mechanism of dyscontrolled substance use, such as alcohol dependence. This result suggests that implicit cognition might also be associated with dyscontrolled online gaming. The findings also demonstrate the important role of implicit cognition in dyscontrolled Internet use in young adults with IGA.

Cognitive profile difference between Allen Cognitive Levels 4 and 5 in schizophrenia.

OBJECTIVE: We compared the pattern of cognitive deficits exhibited by people with schizophrenia at Allen Cognitive Level (ACL) 4 with that of people at Level 5. METHOD: Participants were classified into two groups on the basis of their ACL Screen scores: ACL 4 (n = 35) and ACL 5 (n = 41). We assessed cognitive functions and psychotic symptoms in all participants. RESULTS: Multivariate analysis of covariance controlling for gender and negative symptoms revealed that people at ACL 4 performed significantly worse than those at ACL 5 on processing speed, verbal memory, and working memory. The discriminant analysis with all cognitive variables produced a classification accuracy of 78% in differentiation of cognitive levels. CONCLUSION: We verified the validity of the hierarchy of cognitive disability for ACLs 4 and 5 in people with schizophrenia.

The association between verbal memory, processing speed, negative symptoms and functional capacity in schizophrenia.

The aim of this paper is to explore the links among verbal memory, processing speed, negative symptoms, and functional capacity, using structural equation modeling techniques. Model A is a multiple regression model with cognitive and symptom variables as predictors and functional capacity as the latent outcome variable. Model B consists of three two mediator models that assess the ability of each variable to mediate the effect of the other variable on outcome conditional on the inclusion of the other mediator in the model. Ninety-eight community-dwelling patients with schizophrenia (mean age=35.8years, S.D.=10.1) participated in the study. Results indicate that verbal memory, processing speed and negative symptoms significantly contributed to functional status. Verbal memory was at least partially mediated by processing speed in its effect on outcome, while the impact of processing speed on outcome was mediated by both verbal memory and negative symptoms. The influence of negative symptoms on functional capacity was partially mediated by processing speed. These findings enrich our understanding of the direct and indirect effects of these three interrelated variables and provide a basis for the development of intervention strategies.

Posttraumatic stress disorder in adolescents after Typhoon Morakot-associated mudslides.

The aims of this study were to examine prevalence rate of post-traumatic stress disorder (PTSD), its associated factors and co-occurring psychological problems in a group of displaced adolescents 3 months following Typhoon Morakot in Taiwan. The relationship of trauma dimension and PTSD was also explored. A total of 271 adolescents who had been evacuated from their homes participated in this school-based survey. Adolescents were interviewed using the Mini-International Neuropsychiatric Interview for Children and Adolescents. Subjects themselves completed the following questionnaires: an inventory of exposure experiences to Typhoon Morakot, the Chinese version of Impact of Events Scale-Revised, the Center for Epidemiological Studies Depression Scale, and the Family APGAR Index. Teachers completed the Teacher's Report Form in the Achenbach system of Empirically Bases Assessment. Results revealed that the prevalence of PTSD related to Typhoon Morakot was 25.8%. Adolescents who were female, had PTSD related to previous traumatic events before Typhoon Morakot, had more exposure experiences, were physically injured, or had family member in same household died or seriously injured were more likely to have the diagnoses of PTSD. Meanwhile, adolescents with PTSD had more severe depression, internalizing, externalizing, social, thought, and attention problems than those without PTSD. Our findings indicate that specialized trauma services are needed for these youngsters to lessen prolonged vulnerabilities.