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.

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.

Prevalence and incidence of mental illness in diabetes: a national population-based cohort study.

BACKGROUND: This study aimed to investigate the prevalence and incidence of mental illness among diabetic patients in Taiwan. METHODS: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of mental illness, and at least two claims for ambulatory care or one claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004. RESULTS: The one-year prevalence of mental illness among diabetic patients was 20.6% in 2000, and the cumulative prevalence increased to 42.2% in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age ≥45 and low income, and a lower prevalence with male gender and residing in rural areas. Cox regression analysis revealed that a higher incidence was associated with female gender, age ≥45, and low income. CONCLUSIONS: The prevalence and annual incidence density of mental illness in diabetic patients were significantly higher than in the general population. Females had higher prevalence and incidence density of mental illness among diabetic patients. Mental illness in diabetic patients was more prevalent in elderly females of low income, and less in rural areas.

Prevalence and incidence of anxiety disorders in diabetic patients: a national population-based cohort study.

OBJECTIVE: This study aimed to investigate the prevalence and incidence of anxiety disorders among diabetic patients in Taiwan. METHODS: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of anxiety disorders and at least two service claims for ambulatory care or one service claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004 in the National Health Insurance database. RESULTS: The 1-year prevalence rate of anxiety disorders among diabetic patients was 128.76 per 1000 in 2000, and the cumulative prevalence increased to 289.89 per 1000 in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age (≥65, 55-64), female sex and low income by multiple logistic regression analysis. Cox regression analysis revealed that a higher incidence was associated with female sex and low income. CONCLUSIONS: The prevalence and annual incidence density of anxiety disorders in diabetic patients were significantly higher than in patients with mental illness only in the general population. Female diabetic patients had a higher prevalence and incidence density of anxiety disorders. Anxiety disorders in diabetic patients were more prevalent in elderly women and in those with low income.

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.

The association between prenatal depression and obstetric outcome in Taiwan: a prospective study.

BACKGROUND AND METHODS: The present follow-up study aims to assess the association between depressive symptomatology during the second or third trimester of pregnancy and obstetric-neonatal outcomes in Taiwan. Follow-up evaluations of delivery and birth records in the immediate postpartum period were carried out on 265 nondepressed, 107 mildly to moderately depressed, and 59 severely depressed women and their newborns in three hospitals in Southern Taiwan. Prenatal depression was identified using the Edinburgh Perinatal Depression Scale (EPDS). The medical records of the participant women and their newborns were reviewed after delivery. RESULTS: Prenatally depressed women reported significantly lower marital satisfaction than nondepressed women. Follow-up examination of the women's obstetric birth records revealed that prenatal depression had no statistically significant association with obstetric outcome (type of delivery, use of epidural anesthesia, or instrument-assisted delivery), nor did depression influence the neonatal outcome (incidence of prematurity, birth weight, and Apgar score). CONCLUSIONS: Prenatal depression does not lead to unfavorable obstetric outcomes. However, the finding between marital satisfaction and prenatal depression may have implications in terms of social support.

A comparative study of menopausal hot flashes and their psychosocial correlates in Taiwan and the United States.

OBJECTIVE: To compare the frequency, severity, and interference of menopause-related hot flashes and their psychosocial correlates in Taiwanese and U.S. women. STUDY DESIGN: Cross-sectional study, using a convenience sample of 101 Taiwanese and 121 U.S. midlife women. MAIN OUTCOME MEASURES: Hot-flash measures, including frequency, severity (Women's Health Initiative Symptom Scale), hot flash related daily interference; and psychosocial measures: Attitudes toward Menopause and Aging Scale, Coping Strategies Questionnaire, Sense of Coherence Questionnaire, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventory, and State-Trait Anger Scale. RESULTS: Using ANCOVA with demographic variables as covariates, U.S. women reported greater frequency and daily interference from hot flashes compared with Taiwanese women. Greater depression, greater catastrophizing about hot flashes, lower sense of coherence, lower state/trait anger, and more positive attitudes toward aging were reported in the U.S. cohort. The groups were similar in their frequency of specific coping strategies, and they did not differ significantly in menopause symptom severity, attitudes towards menopause, state/trait anxiety, or overall negative psychosocial characteristics. Hierarchical multiple regression analyses indicated that hot-flash related daily interference was predicted by marital status, frequency of hot flashes, and negative psychosocial characteristics among the U.S. women; and by frequency of hot flashes and negative psychosocial characteristics among the Taiwanese women. CONCLUSIONS: Despite differences in the frequency and daily interference from hot flashes in the two samples, the predictors of interference were similar. Results highlight the importance of considering both psychosocial factors and cultural differences in providing guidance and treatment for women experiencing menopause-related hot flashes.

Body weight statuses and their sociodemographic correlates among adolescents in southern Taiwan: results using two sets of cutoff references.

PURPOSE: To examine the differences in the prevalence of overweight and obesity based on the cutoff references established by the International Obesity Task Force (IOTF) and the Working Group on Obesity in China (WGOC), the prevalence of underweight on the IOTF reference, and the sociodemographic correlates of body weight statuses in Taiwanese adolescents. METHODS: Overweight and obesity in 10,371 Taiwanese adolescents were determined by the IOTF and WGOC cutoff references for body mass index (BMI). Underweight was determined by the IOTF. The prevalence of overweight and obesity using the IOTF standard were compared to those using the WGOC standard. Associations of body weight statuses with gender, age, residential status, and parental education level were also examined. RESULTS: Using the IOTF standard, 3.4% were underweight, 15.2% were overweight, and 6.1% obese, whereas 14.1% were considered overweight and 8.7% were obese by the WGOC standard. For both genders, more adolescents were classified as overweight by the IOTF standard and as obese by the WGOC standard. Although females were more likely to be underweight than males, males were more likely to be overweight or obese than females. For both genders, although older age increased the risk of being underweight, younger age increased the risk of being overweight or obese. For males, living in urban areas was associated with being overweight, and low paternal education level was associated with being obese. CONCLUSIONS: The prevalence of overweight and obesity may differ depending on the reference standard consulted. Paternal education level and urbanicity were associated with gender differences in the proportion of adolescents who were overweight or obese.

The relationships between body mass index and television viewing, internet use and cellular phone use: the moderating effects of socio-demographic characteristics and exercise.

OBJECTIVE: This study aimed to examine the relationships between body mass index (BMI) and television viewing, Internet use and cellular phone use and the moderators for these relationships in adolescents. METHOD: The relationship between BMI and the time spent on three kinds of sedentary activities and the moderators for these relationships were analyzed among 9,278 Taiwanese adolescents. The different relationships between BMI and various Internet and cellular phone-related activities were analyzed. RESULTS: High television viewing and high Internet use were associated with increased BMI in adolescents. Exercising had a moderating effect on the relationship between BMI and television viewing. Several Internet and cellular phone-related activities were associated with increased BMI. DISCUSSION: The results support the relationships between adolescent BMI and television viewing and Internet use. The moderating effect of exercise and various Internet and cellular phone-related activities should be considered when developing intervention strategies for overweight adolescents.

Valproate-related peripheral oedema: a manageable but probably neglected condition.

Valproate-related peripheral oedema is usually regarded as a problem occurring after long-term administration of valproate. The scarcity of reports is partially responsible for the lack of a full understanding of this condition. This report describes two patients acquiring peripheral oedema after short-term use of add-on therapy with valproate. The oedema could appear and reappear quickly. Discontinuing valproate resulted in rapid improvement of this condition, and the cause-effect relationship was supported by double challenge. We also put forward a preliminary hypothesis to explain this treatable situation.

Multidimensional discriminative factors for unprotected sex among adolescents in southern Taiwan.

Establishing the discriminative factors for unprotected sex among adolescents is essential for early identification of at-risk teens and for the prevention of unplanned pregnancy and sexually transmitted diseases. The aim of this study was to examine the discriminative effects of demographic, individual, family, peers, and school life factors on unprotected sex in a large-scale, representative adolescent population in Southern Taiwan. A total of 9,736 adolescent students were recruited into this study and completed the questionnaires. The multidimensional discriminative factors for unprotected sex were examined using chi2 automatic interaction detection analysis and logistic regression models. The results of the chi2 automatic interaction detection analysis revealed that having friends, using illicit drugs, being of an older age, suspension from school, and low family monitoring had discriminative effects on unprotected sex in adolescents. The logistic regression analysis further confirmed the discriminative effect of these factors. Because of the adverse effects of unprotected sex in adolescents, we suggest that parents and health professionals should pay attention to adolescents with the discriminative factors for unprotected sex identified in this study.

Zolpidem-induced amnesia and somnambulism: rare occurrences?

Zolpidem, a non-benzodiazepine hypnotic of the imidazopyridine class, is very effective in treating insomnia with previous claims of little adverse effects. However, zolpidem-induced somnambulism and amnesic sleep-related behavioral problems were begun to be reported in literature but no systemic investigation has been undertaken in non-Western cultures. In our current retrospective survey, 5.1% (13 out of 255) of Taiwanese patients reported change in sleep-related behavior as adverse effects. This serves as a reminder for clinicians to inquire regarding any unusual behavior of parasomniac activities when prescribing zolpidem.

Factors affecting time to rehospitalization in Han Chinese patients with schizophrenic disorder in Taiwan.

Schizophrenic disorder is a lifelong illness. Hospitalization is a major event for the patient and his/her family, often indicating that the clinical symptoms have reached an intolerable level. The purpose of this study was to investigate the risk factors affecting the time to rehospitalization. Rehospitalization status was monitored for all schizophrenic patients discharged from Kai-Suan Psychiatric Hospital from January 1, 2002 to December 31, 2002. Patients were followed-up regarding rehospitalization until December 31, 2003. The Kaplan-Meier method was used to calculate the mean time to rehospitalization. Risk factors associated with rehospitalization were examined by Cox proportional hazards regression model. Three hundred and thirty-six patients were recruited for this study. The mean time to rehospitalization was 239 +/- 7 days, with a rehospitalization rate of 54.5%. The mean time to discontinuation was 329 +/- 5 days. Age at onset (hazard ratio = 0.978, 95% CI = 0.959-0.998, p = 0.031) and the number of previous hospitalizations (hazard ratio = 1.108, 95% CI = 1.058-1.161, p < 0.001) were found to be risk factors of shorter time to rehospitalization within 1 year after discharge. Further research should be carried out to test risk factors in a prospective study, and to assess the cost-effectiveness of interventions to prevent rehospitalization.

Exercise behavior in asthmatic children: effects of a summer camp fitness program in Taiwan.

This quasi experimental study aimed to examine the effects of a swimming-focused summer camp program on self-efficacy and exercise behavioral change in schoolchildren with asthma and their parental support. Forty-one asthmatic schoolchildren were recruited from a medical center and an asthma education association in southern Taiwan. The participants in the summer camp program were assigned to the experimental group; the control group comprised those who did not attend the summer camp program. Each child was paired with a parent. A total of 16 child-parent pairs in the experimental group and 25 pairs in the control group were followed-up. This 1.5-day asthma summer camp program included 20 minutes of health education in physical activity, two sessions of swimming practice for the children, and a 2-hour conference with the parents. The outcome measures included an Exercise Self-Efficacy Questionnaire, Stages of Exercise Behavior Change Questionnaire, and a Parental Support for Exercise Questionnaire. Before implementing the program, the two groups differed significantly in terms of the severity of their asthma, as well as their pre-camp test scores of exercise self-efficacy. Therefore, asthma severity levels and scores from the pre-camp exercise self-efficacy test were selected as two ANCOVA covariates. The adjusted means for stages of exercise behavior change on the 2-month post-camp test were significantly different between the two groups, F(1, 37) = 5.88 and p = 0.02. Compared with the control group, subjects who attended the summer camp reported more regular exercise behavior at the 2-month post-camp test. Thus, a summer camp program with swimming instruction can enhance the exercise behavior of schoolchildren with asthma. This program is highly recommended for managing schoolchildren with asthma.

The association between Internet addiction and belief of frustration intolerance: the gender difference.

This study evaluated the association between Internet addiction and frustration intolerance, the gender difference of frustration intolerance, and the gender differences of the association between Internet addiction and frustration intolerance. Participants were 2,114 students (1,204 male and 910 female) who were recruited to complete the Chen Internet Addiction Scale and Frustration Discomfort scale. Females had higher scores on the subscale of entitlement and emotional intolerance and the total scale of the frustration intolerance. There was a significant gender difference on the association between Internet addiction and frustration intolerance. The association was higher in male adolescents. Regression analysis revealed male adolescents with Internet addiction had higher intolerance to frustration of entitlement and emotional discomfort, and female adolescents with it had higher intolerance to emotional discomfort and lower tolerance to frustration of achievement. Frustration intolerance should be evaluated for adolescents with Internet addiction, especially for males. Rational emotive behavior therapy focusing on different irrational beliefs should be provided to male and female adolescents with Internet addiction.

Fluorescent high-performance liquid chromatographic analysis of vigabatrin enantiomers after derivatizing with naproxen acyl chloride.

Vigabatrin is widely used as an anticonvulsant in the treatment of seizures. Vigabatrin is usually supplied as racemate in formulation, but only the (S)-(+)-enantiomer of vigabatrin is pharmacologically active. A simple and sensitive liquid chromatographic method is described for the separation and quantification of vigabatrin enantiomers. The method is based on derivatizing racemic vigabatrin with a fluorescent chiral reagent (naproxen acyl chloride). The resulting diastereomeric derivatives are highly responsive to a fluorimetric detector (lambda(ex)=230 nm, lambda(em)=350 nm). The lower quantitation limit of the method is attainable at 25 nM for (S)-(+)-vigabatrin or (R)-(-)-vigabatrin with a detection limit of about 2.5 nM (S/N=3 with 10 microl injected). Application of the method to the analysis of vigabatrin in serum of dosed patients proved feasible.

Comparison of time to rehospitalization among schizophrenic patients discharged on typical antipsychotics, clozapine or risperidone.

BACKGROUND: The purpose of this study was to compare the time to rehospitalization of schizophrenic patients who were discharged from a psychiatric hospital while being treated with typical antipsychotics, clozapine or risperidone. We also assessed other possible predictors of time to rehospitalization. METHODS: The study monitored the rehospitalization status of all the schizophrenic patients who were discharged from a psychiatric hospital between July 1, 2001 and June 30, 2002 while they were taking typical antipsychotics (n=272), clozapine (n=61) or risperidone (n=49). Rehospitalizations were tracked over a 2-year period using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined by the Cox proportional hazards regression model. RESULTS: No significant differences in time to rehospitalization were observed among the groups in the first or second year after discharge. Age at onset of schizophrenia was a risk factor for time to rehospitalization over the 1- and 2-year periods. CONCLUSION: This study demonstrated that atypical antipsychotics did not lengthen the time to rehospitalization. The earlier the age at onset of schizophrenia, the shorter is the time to rehospitalization. Some other factors thought to impact rehospitalization need to be further assayed.

Being reborn: the recovery process of postpartum depression in Taiwanese women.

AIM: This paper reports a qualitative study describing the process of recovery from postpartum depression in Taiwanese women. METHODS: We carried out a study using grounded theory with a purposive sample of 23 postnatally depressed women in 2001-2002. The Beck Depression Inventory was used to screen for severe depression. Women with scores higher than 16 at 6 weeks after childbirth were categorized as having postpartum depression. Only two out of the 23 mothers were being treated for depression at the time. The data were analysed by constant comparative method. FINDINGS: 'Being reborn' was the core concept that emerged from the data on the mothers' experience of going through postnatal depression, which was a process of descent into near-death insanity and eventual rebirth. Such postnatally depressed mothers often underwent four stages of coping with the loss of self or loss of former identity and attachment to their new lives as mothers. The four stages were: (1) shattered role identity, (2) feeling trapped and breaking down, (3) struggling for self-integrity and (4) regaining vitality. CONCLUSION: The experience of postpartum depression should be examined within the social and cultural contexts in which it occurs. These Taiwanese data can be used to develop culturally-sensitive health care. The nursing role is primarily that of reflective listening to help the women adjust to the process of being reborn--an internal process of painful growth represented by motherhood and striving to protect the real self in order to maintain emotional health while negotiating a developmental transition. Preventive interventions might include providing guidance for parenting, counselling of individual mothers, and facilitating the development of support groups.

A survey of quality of life and depression for police officers in Kaohsiung, Taiwan.

OBJECTIVE: The enormous job stress of police work may result in depression, which is highly correlated with work disability and poor quality of life. We investigated the quality of life, the probability of depression, and the related risk factors for police officers in Kaohsiung, Taiwan. METHODS: We used the 12-item Short-Form Health Survey (SF-12) and the Disaster-Related Psychological Screening Test (DRPST) to assess the quality of life and prevalence of depression for 832 police officers in Kaohsiung. RESULTS: The estimated rate of probable major depression was 21.6% (180/832). Those with an educational level of university or above and nondepressed police officers had higher scores in every subscale for quality of life. Police officers older than 50 had higher scores in the mental aspects of quality of life. Family problems and job stress related to achievement, peer pressure about performance, and heavy workloads were predictive factors for depression. CONCLUSION: Police officers might have a higher estimated rate of depression than previously thought, and those with depression have a poorer quality of life.

Psychosocial health of Taiwanese postnatal husbands and wives.

OBJECTIVE: The purpose of this study was to compare the differences in stress, social support, self-esteem, and depression in fathers and mothers during the postpartum period. METHODS: Eighty-three postnatal Taiwanese couples participated in the study. Four structured questionnaires were used to analyze the differences between fathers and mothers. RESULTS: For the first-time couples, fathers perceived lower social support than mothers, but the couples experienced similar depression level. Experienced mothers compared to fathers reported significantly higher stress, lower self-esteem, and higher depression. There were differential gender-based predictors of depression where mothers' depressive outcomes were related to high stress and low social support and fathers' depression were related to low self-esteem and low social support. CONCLUSION: These findings confirm the predominance among females of postpartum depression in experienced couples in an East Asian setting. Preventive interventions might include antenatal guidance for parenting, counseling of gender role stress, and development of support groups for postnatal couples in making a smoother transition.