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The present study aimed to investigate the factors associated with the level of rumination about the war among people living in Poland and Ukraine. This cross-sectional study recruited internet users from advertisements on social media. Levels of rumination, Depression, Anxiety and Stress Scale (DASS), Impact of Event Scale-Revised (IES-R), time spent on news of the war, and related demographic variables were collected. The reliability and construct validity of rumination were estimated. Potential factors associated with the level of rumination were identified using univariate linear regression analysis, and further entered into a stepwise multivariate linear regression model to identify independent factors. Due to the non-normality of distribution, multivariate linear regression with 5000 bootstrap samples was used to verify the results. A total of 1438 participants were included in the analysis, of whom 1053 lived in Poland and 385 lived in Ukraine. The questionnaires on rumination were verified to have satisfactory reliability and validity. After analysis with stepwise and bootstrap regression, older age, female gender, higher DASS and IES-R scores, and longer time spent on news of the war were significantly associated with higher levels of rumination for both people living in Poland and Ukraine. Lower self-rated health status, history of chronic medical illness and coronavirus disease 2019 infection were also positively associated with rumination for people living in Poland. We identified several factors associated with the level of rumination about the Russo-Ukrainian War. Further investigations are warranted to understand how rumination affects individuals' lives during crises such as war., (© 2023 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.)

The aims of this study were to evaluate the predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, significant depression, and suicidality among college students at follow-up assessments conducted 1 year later. A sample of 500 college students aged between 20 and 30 years participated in this study. Their levels of borderline personality symptoms, self-concept and identity disturbances, internet addiction, depression, and suicidality at baseline and at follow-up interviews were assessed through the Borderline Symptoms List, Self-concept and Identity Measure, Chen Internet Addiction Scale, Beck Depression Inventory-II, and questions related to suicidality from the Epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. A total of 324 college students received follow-up assessments 1 year later. Among them, 15.4%, 27.5%, and 17% had internet addiction, significant depression, and suicidality, respectively. Our result revealed the severity of borderline symptoms, disturbed identity, unconsolidated identity, and lack of identity at initial assessment increased the occurrence of internet addiction, significant depression, and suicidality at follow-up assessment except for the predictive effect of unconsolidated identity on internet addiction. The results indicated that self-concept and identity and borderline symptoms may have a significant role in the risk of mental health problems in college students., (© 2019 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia on behalf of Kaohsiung Medical University.)

This study examined the associations of boredom proneness with Internet addiction and activities as well as the moderators for such associations in adolescents with attention-deficit/hyperactivity disorder (ADHD). In total, 300 adolescents with ADHD participated in this study. Their Internet addiction, the scores for lack of external and internal stimulation on the Boredom Proneness Scale-short form (BPS-SF), ADHD, parental characteristics, and the types of Internet activities were examined. The associations of boredom proneness with Internet addiction and Internet activities and the moderators of the associations were examined using logistic regression analyses. Higher scores for lack of external stimulation on the BPS-SF were significantly associated with a higher risk of Internet addiction. Maternal occupational socioeconomic status moderated the association of lack of external stimulation with Internet addiction. Higher scores for lack of external stimulation were significantly associated with a high tendency to engage in online gaming, whereas higher scores for lack of internal stimulation were significantly associated with a low tendency to engage in online studies. Lack of external stimulation on the BPS-SF should be considered a target in prevention and intervention programs for Internet addiction among adolescents with ADHD., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

This study compared the levels of the five domains of neurocognitive function-executive function, attention, memory, verbal comprehension, and perceptual organization-among clinically stable individuals with long-term bipolar I disorder, individuals with long-term schizophrenia, and a group of controls. We recruited a total of 93 clinically stable individuals with bipolar I disorder, 94 individuals with schizophrenia, and 106 controls in this study. Their neurocognitive function was measured using a series of neurocognitive function tests: the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Line Cancellation Test, Visual Form Discrimination, Controlled Oral Word Association Test, Wisconsin Card Sorting Test, Continuous Performance Task, and Wechsler Memory Scale-Third Edition. Neurocognitive function was compared among the three groups through a multivariate analysis of variance. The results indicated that when the effect of age was controlled, clinically stable individuals with bipolar I disorder and those with schizophrenia demonstrated poor neurocognitive function on all tests except for the WAIS-III Similarity and Information and the Line Cancellation Test. The individuals with bipolar I disorder had similar levels of neurocognitive function compared with the schizophrenia group, but higher levels of neurocognitive function on the WAIS-III Comprehension, Controlled Oral Word Association Test, and Wechsler Memory Scale-Third Edition Auditory Immediate and Delayed Index and Visual Immediate and Delayed Index. The conclusions of this study suggest that compared with controls, individuals with long-term bipolar I disorder and those with long-term schizophrenia have poorer neurocognitive function, even when clinically stable. Individuals with long-term bipolar I disorder and those with long-term schizophrenia have similar levels of deficits in several domains of neurocognitive function., (Copyright © 2017. Published by Elsevier Taiwan.)

The aim of this study was to examine the associations of behavioral temperamental traits, comorbid autism spectrum disorder (ASD), and bullying involvement with anxiety and depression among adolescents with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. A total of 287 adolescents aged 11-18 years diagnosed with ADHD participated in this study. Their severities of anxiety and depression were assessed. Multiple regression analysis was used to examine the correlates of anxiety and depression. The results show that adolescents with ADHD who reported a higher behavioral inhibition system (BIS) score, had comorbid ASD, and were bullying victims, reported more severe anxiety and depressive symptoms. Adolescents with ADHD who bullied others reported more severe depressive symptoms than those who did not bully. The results of this study indicated that behavioral temperamental traits on the BIS, comorbid ASD, and bullying involvement were significantly associated with anxiety and depression among the adolescents with ADHD., (Copyright © 2016. Published by Elsevier Taiwan.)

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., (Copyright © 2015. Published by Elsevier Taiwan.)

Individuals with adult attention deficit/hyperactivity disorder (ADHD) have a deficit in their cognitive control. The aim of this study was to reveal the brain correlates of the deficits in response inhibition or error processing in adult ADHD. A total of 29 adults with ADHD and 25 control individuals were recruited. They completed an event-related-design Go/No-go task under functional magnetic resonance imaging scanning. Both the ADHD group and the control group exhibited activation of the frontostriatal network when processing response inhibition. They also exhibited activation of the frontoinsula cortex and anterior cingulate in error processing. Adults with ADHD have a lower brain activation of error processing over the right inferior frontal lobe adjacent to the insula than control individuals. The altered frontoinsula cortex activation may represent the mechanism of error processing deficit among adults with ADHD., (Copyright © 2015. Published by Elsevier Taiwan.)

The aims of this cross-sectional study were to examine the associations between body weight and mental health indicators including depression, social phobia, insomnia, and self-esteem among Taiwanese adolescents in Grades 7-12. The body mass index (BMI) of 5254 adolescents was calculated based on self-reported weight and height measurements. Body weight status was determined by the age- and gender-specific International Obesity Task Force reference tables. By using participants of average weight as the reference group, the association between body weight status (underweight, overweight, and obesity) and mental health indicators (depression, social phobia, insomnia, and self-esteem) were examined by using multiple regression analysis. The possible moderating effects of sociodemographic characteristics on the association were also examined. After controlling for the effects of sociodemographic characteristics, both overweight (p < 0.05) and obese adolescents (p < 0.001) had a lower level of self-esteem than did those of average weight; however, no significant differences in depression, social phobia, or insomnia were found between those who were overweight/obese and those of average weight. No significant differences in the four mental health indicators were found between those who were underweight and those of average weight. Sociodemographic characteristics had no moderating effect on the association between body weight and mental health indicators. In conclusion, mental health and school professionals must take the association between overweight/obesity and self-esteem into consideration when approaching the issue of mental health among adolescents., (Copyright © 2014. Published by Elsevier Taiwan.)

We evaluated neural substrates related to the loss of control in college students with internet gaming disorder (IGD). We hypothesized that deficit in response inhibition under gaming cue distraction was the possible mechanism for the loss of control internet use. Eleven cases of IGD and 11 controls performed Go/NoGo tasks with/without gaming distraction in the functional magnetic resonance imaging scanner. When the gaming picture was shown as background while individuals were performing Go/NoGo tasks, the IGD group committed more commission errors. The control group increased their brain activations more over the right dorsolateral prefrontal cortex (DLPFC) and superior parietal lobe under gaming cue distraction in comparison with the IGD group. Furthermore, brain activation of the right DLPFC and superior parietal lobe were negatively associated with performance of response inhibition among the IGD group. The results suggest that the function of response inhibition was impaired under gaming distraction among the IGD group, and individuals with IGD could not activate right DLPFC and superior parietal lobe to keep cognitive control and attention allocation for response inhibition under gaming cue distraction. This mechanism should be addressed in any intervention for IGD., (Copyright © 2013. Published by Elsevier B.V.)

The aims of this study were (1) to examine differences in the level of self-esteem among adolescents with different roles in aggression involvement (aggression perpetrators, victims, perpetrator-victims and neutrals) according to gender and (2) to examine the moderating effects of depression and family support on association between aggression involvement and self-esteem. A total of 8085 adolescents in Taiwan completed questionnaires. The relationships between self-esteem and aggression involvement were examined by multiple regression analysis. The moderating effects of depression and family support on the association between aggression involvement and self-esteem were examined. The results showed that in females, aggression victims had lower self-esteem than those in the other three groups (t=-2.940 to 2.173, p<0.05); however, there was no significant difference in self-esteem among perpetrators, perpetrator-victims, and neutrals (t=0.693-0.933, p>0.05). In males, self-esteem in victims and perpetrator-victims was lower than in neutrals and perpetrators (t=-3.339 to -2.704, p<0.01); however, there was no difference in self-esteem between victims and perpetrator-victims (t=-1.115, p>0.05) or between perpetrators and neutrals (t=-1.396, p>0.05). Family support had a moderating effect on the association between self-esteem and victimization in males. Depression had a moderating effect on the association between self-esteem and perpetration-victimization and victimization in males. The results indicate that self-esteem in adolescents with different patterns of involvement in aggression is not the same as in those without involvement. The moderating effects of depression and family support should be considered when developing intervention strategies to raise self-esteem in adolescents with aggression involvement., (Copyright © 2012. Published by Elsevier B.V.)

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., (Copyright © 2012. Published by Elsevier B.V.)

This study aims to examine the prevalence and sociodemographics, family and peer correlates of tattooing among high school students in southern Taiwan, and to examine the associations between tattooing and a variety of adolescent risk-taking behaviors and depression. A total of 9755 high school students (grades 7 to 12) in southern Taiwan were recruited into this study and completed the questionnaires. The prevalence of tattooing among the adolescents was calculated. The responses were analyzed using the logistic regression analysis models. It was found that 1% of high school students in southern Taiwan had 1 or more tattoos on their bodies. The older students who were perceived to have low family monitoring and who had friends who drink regularly, used illicit drugs, had a criminal record or were in a gang were more likely to have a tattoo. Tattooing was also found to be associated with violence, weekly alcohol consumption, illicit drug use, dropping out of school, unprotected sex, suicidal ideation/attempt, and depression. The results indicate that several demographics, family and peer factors are associated with adolescent tattooing. Tattooing may be an indicator of risk-taking behaviors in high school students., (Copyright © 2012. Published by Elsevier B.V.)

Quality of life (QOL) in methylphenidate treatment-responsive adolescents with attention deficit/hyperactivity disorder (ADHD) was assessed. Patients were 12- to 18-year-old adolescents with ADHD (total n = 45) who had been on methylphenidate treatment for at least 3 months and were clinically judged to be improved. The self-completed Taiwanese Quality of Life Questionnaire for Adolescents (TQOLQA) was used, and the resulting measures were compared between adolescents with ADHD and: (1) community adolescents (n = 2316); (2) treatment-responsive adolescents with a chronic medical condition (i.e., adolescents with leukemia in its first and complete continuous remission for at least 3 years after chemotherapy) (n = 39). Patients' cognitive profile and their daily executive functioning were also obtained for analysis. The QOL of the treated adolescents with ADHD was reported to be worse than that of both the community healthy adolescents and the adolescent leukemia survivors in the self-reported TQOLQA domain of "psychological well-being". Treated adolescents with ADHD still had impaired executive skills in natural, everyday environments, and the scores for daily executive abilities could predict the QOL measures. Factors besides pharmacotherapy should be explored to further improve the QOL of medication-treated adolescents with ADHD., (Copyright © 2012. Published by Elsevier B.V.)

The purpose of this study was to validate the Impact of Event Scale-Revised (IES-R) for adolescents who had experienced the floods and mudslides caused by Typhoon Morakot in Taiwan. The internal consistency, construct validity, and criteria validity of the instrument were examined. Principal component analysis followed by an oblique rotation was used to derive a three-factor solution. These factors were labeled intrusion, hyperarousal, and avoidance; all three factors together accounted for 58.1% of the variance. The total Cronbach's alpha of 0.94 reflected the good internal consistency of the instrument. With reference to diagnosis of posttraumatic stress disorder, the IES-R cutoff point for posttraumatic stress disorder was 19 of 20 with a sensitivity of 85.7% and specificity of 84.1%. In conclusion, the IES-R can be used as a reliable and valid instrument when evaluating psychological distress among adolescents who have experienced a natural disaster, such as flooding and mudslides., (Copyright © 2011. Published by Elsevier B.V.)

The aim of the study was to explore the association between the severity of psychosomatic symptoms and perceived work stress among male police officers in southern Taiwan. By stratified random sampling, a total of 698 male police officers were recruited into this study (the response rate was 73.4%; 512 of 698). A structured self-administered questionnaire on demographic and working characteristics, the severity of psychosomatic symptoms, perceived work stress, and social support was used to collect data anonymously. The results of multiple regression analysis revealed that (1) the police officers who perceived high-work stress reported more severe psychosomatic symptoms than those who perceived low-work stress; and (2) perceived social support had a moderating effect on the association between severity of psychosomatic symptoms and perceived work stress. Perceived work stress is an indicator of psychosomatic symptoms in police officers. Strategies for reducing psychosomatic symptoms of police officers include police administrators taking into account the level of work stress as well as more attention being paid to the resources of social support., (Copyright © 2011 Elsevier Taiwan LLC. All rights reserved.)

The aims of this study were to examine unfavorable attitudes toward receiving methadone maintenance therapy (MMT) and associated factors among inmates using intravenous heroin in Taiwan. A total of 315 inmates using intravenous heroin were recruited. Their unfavorable attitudes toward receiving MMT after discharge from prison were evaluated using the Client Attitudes Toward Methadone Programs Scale. The associations of unfavorable attitudes toward receiving MMT with sociodemographic and drug-using characteristics, human immunodeficiency virus serostatus, perceived family support, and depression were examined using multiple regression analysis. The results of this study showed that the mean score of unfavorable attitudes toward receiving MMT, determined on the Client Attitudes Toward Methadone Programs Scale, was 9.918 (standard deviation=2.277, range=5-20). Heroin-using inmates who were young, started using heroin earlier, perceived many advantages and few disadvantages of heroin use, had never received MMT, and had severe depression, had unfavorable attitudes toward receiving MMT. Based on the results of this study, we suggest that inmates who have the factors associated with unfavorable attitudes toward receiving MMT should receive intervention and motivational interviewing to improve their attitudes toward MMT and to increase their opportunity to receive MMT after discharge from prison., (Copyright © 2011. Published by Elsevier B.V.)

Caregivers of patients with late-life major depressive disorder experience a significant level of general caregiver burden. Disability in patients is possibly one of the origins of caregiver burden. Frontal lobe dysfunction might be the source of disability. This study investigated if frontal lobe dysfunction (body level) of patients with late-life major depressive disorder was associated with their disability (individual level), and if it led to a high level of caregiver burden (societal level). Thirty-four unselected pairs of caregivers and their family members with late-life major depressive disorder were recruited. Frontal Assessment Battery and Timed Instrumental Activities of Daily Living (TIADL) were used to assess patients' frontal function and disability, and Caregiver Burden Inventory was used to measure caregiver burden. Frontal Assessment Battery correlated with TIADL (r= -0.47; p<0.006). TIADL score was also associated with two subscales of the Caregiver Burden Inventory: social (r = 0.38, p=0.026) and time-dependent (r= 0.37, p= 0.033). This study supported the hypothesis that frontal lobe dysfunction in elderly patients with depression is associated with their disability in instrumental activities of daily living. Disability is related to social and time-dependent aspects of caregiver burden. Further studies to examine proposed cognitive interventions are suggested to reduce patient disability and caregiver burden., (Copyright © 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

The care of patients with obsessive-compulsive disorder (OCD) has raised quality of life (QOL) issues. The purpose of this study was to compare the level of QOL between patients with and without OCD, and to examine the associations between QOL and sociodemographic data, course of illness, psychopathology, perceived social support, and treatment characteristics. The QOL levels measured with the Taiwan version of the Short Form of the World Health Organization Questionnaire on Quality of Life were compared between 57 subjects with OCD and 106 subjects without OCD. The correlates of QOL were examined among subjects with OCD. The analysis revealed that QOL scores for the general, physical, psychological and social relationship domains were lower in the OCD group than in the control group; however, no difference in the environmental domain was found. Multiple factors were associated with poor QOL in subjects with OCD, including comorbid depression, severe obsession symptoms, perceived low social support, severe adverse effects of medication, combined use of mood stabilizers, and low social status. Different domains of QOL are differently affected by OCD. The QOL of subjects with OCD was correlated to multiple factors that were specific to individual subjects and influenced by interactions with treatment and the social environment., (Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

The aim of this study was to analyze the association between substance use and body mass index (BMI) among adolescents in Southern Taiwan. A total of 10,259 adolescent students aged 11-19 years were selected by stratified random sampling for proportional representation of districts, schools and grades in Southern Taiwan, and completed the questionnaires. The body weight, body height, experience of substance use and sociodemographic characteristics including sex, age, residential background and paternal/maternal educational levels were collected. The association between substance use and BMI, and the moderating effects of sociodemographic characteristics were examined. After adjusting for sociodemographic characteristics, BMI was higher for adolescents who smoke cigarettes or drink alcohol than for those who do not regularly smoke or drink. Chewing betel nuts and using illicit drugs were not significantly associated with BMI. Paternal education level had a moderating effect on the association between smoking and BMI. Smoking, alcohol drinking, and low paternal education level were associated with higher BMI among adolescents. Thus, healthcare professionals should pay more attention to the weight-related problems among these adolescents., (Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.)

Changes in moods are one of the comorbid psychiatric manifestations that frequently occur in patients with Tourette's syndrome. The assessment of a manic episode in children with Tourette's syndrome is challenging. Furthermore, the treatment of children with comorbid mania and Tourette's syndrome has not been extensively studied. We present a 10-year-old boy who suffered from both Tourette's syndrome and mania, whose symptoms improved after using lithium and risperidone. The child was diagnosed with Tourette's syndrome at 7 years of age when he suffered from tics and experienced his first manic episode. He received monotherapy, including haloperidol, risperidone and aripiprazole, and the response was poor. When the combination of lithium and risperidone was used, the tics and mania subsided. It is important to assess individuals with Tourette's syndrome for associated bipolar disorder. The treatment of children with both disorders is a major clinical issue, and our case may serve as an example for successful treatment strategies.

This study aimed to investigate the adverse personal, family, peer and school situations encountered by adolescent students who had returned to school after being suspended. This was a large-scale study involving a representative population of Taiwanese adolescents. A total of 8,494 adolescent students in Southern Taiwan were recruited in the study and completed the questionnaires. The relationships between their experiences of suspension from school and adverse personal, family, peer, and school situations were examined. The results indicated that 178 (2.1%) participants had been suspended from school at some time. Compared with students who had never been suspended, those who had experienced suspension were more likely to report depression, low self-esteem, insomnia, alcohol consumption, illicit drug use, low family support, low family monitoring, high family conflict, habitual alcohol consumption, illicit drug use by family members, low rank and decreased satisfaction in their peer group, having peers with substance use and deviant behaviors, low connectedness to school, and poor academic achievement. These results indicate that adolescent students who have returned to school after suspension encounter numerous adverse situations. The psychological conditions and social contexts of these individuals need to be understood in depth, and intervention programs should be developed to help them to adjust when they return to school and to prevent school dropouts in the future.

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.

The aim of this study was to examine the factors related to abstinence from heroin and methamphetamine (MAMP) use and to seeking help from medical services in Taiwanese drug users. A total of 196 heroin users and 226 MAMP users were recruited in this study. Their experience of previous abstinence from drug use and the routes taken to seek help for abstinence were determined at interview. Demographic data, characteristics of drug use and reasons to abstain from drug use were compared between subjects who had and those who had never tried to abstain from drug use before, as well as between the subjects who had previously sought help from medical services and those who had tried to abstain from drug use by themselves. Those who had previously tried to abstain from heroin use had longer durations of heroin use, spent more money on getting heroin, were more likely to have a criminal record of illicit drug use and had longer durations of being detained due to illicit drug use compared with those who had never tried to abstain from heroin use. Those who had sought help from medical services for abstinence were more likely to be heroin users and to spend more money on getting illicit drugs, and tried to abstain due to concerns about relationships with family. Demographic data, characteristics of drug use and reasons to abstain from drug use were different between drug users who had different experiences of abstinence.

This study aimed to examine the correlations between academic achievement and levels of anxiety and depression in medical students who were experiencing curriculum reform. The differences in academic achievement and the directions of correlations between academic achievement and anxiety and depression among the medical students with different levels of anxiety and depression were also examined. Grade 1 students from graduate-entry program and grade 3 students from undergraduate-entry program in their first semester of the new curriculum were recruited to complete the Zung's Anxiety and Depression Scale twice to examine their levels of anxiety and depression. Their academic achievement ratings in the four blocks of the first semester of the new curriculum were collected. The results indicated that no significant correlation was found between academic achievement and global anxiety and depression. However, by dividing the medical students into low, moderate and high level anxiety or depression groups, those who had poorer academic achievement in the first learning block were more likely to have higher levels of depression in the first psychologic assessment. Among the medical students who were in the high anxiety level group in the first psychologic assessment, those who had more severe anxiety had poorer academic achievement in the fourth learning block. Among the medical students who were in the low anxiety level group in the second psychologic assessment, those who had more severe anxiety had better academic achievement in the fourth learning block. Among the medical students who were in the moderate anxiety level group in the second psychologic assessment, those who had more severe anxiety had poorer academic achievement in the second learning block. Among the medical students who were in the high depression level group in the second psychologic assessment, those who had more severe depression had poorer academic achievement in the fourth learning block. The results of this study indicate that there are both positive and negative correlations between academic achievement and anxiety and depression in medical students, regarding differing levels of severity of anxiety or depression. The results could represent a reference for teachers on the planning of teaching and assessment programs.

The aim of this study was to examine the hypothesis that Taiwanese aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents who live in the same mountainous region of southern Taiwan, and to test the hypothesis by controlling other individual and environ-mental factors. In this study, a total of 251 aboriginal and 79 non-aboriginal Taiwanese adolescents were enrolled. Their psychopathology was measured by the Symptom Checklist-90-Revised Scale; demographic and family characteristics, and their affinity with their peer group and with their school were also assessed. The results of the multiple regression analysis revealed that aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents, and indicated that females and adolescents perceiving higher levels of family conflict and lower family support were more likely to experience more severe psychopathology than those perceiving the contrary. Those who devise strategies to improve the mental health of adolescents living in impoverished regions must take into consideration their ethnicity, gender, and family context when devising such treatment strategies.

This study examined the association between attitudes toward homosexual individuals and intention to provide care and demographic and occupational factors, sexual orientation, knowledge about homosexuality, and experiences of contact with homosexual people among psychiatric nurses in southern Taiwan. In total, 133 psychiatric nurses from a medical center, three regional teaching hospitals, and one psychiatric hospital in southern Taiwan were recruited into this study. Their attitudes toward homosexual people as recorded on the Attitudes Toward Homosexuality Questionnaire, intention to provide care to homosexual individuals, and related factors were examined. The results revealed that psychiatric nurses who had a bachelor's or master's degree, higher level of knowledge about homosexuality, and friends or relatives with a homosexual orientation had a more positive attitude toward homosexuality. These psychiatric nurses, with more positive attitudes, and who worked in the medical center or regional teaching hospitals had a higher intention to care for homosexual people. The factors related to attitudes toward homosexuality and intention to care for homosexual people identified in this study should be taken into consideration when intervening in psychiatric nurses' attitudes toward homosexuality and intention to care for homosexual people.

Few studies have directly compared atypical antipsychotics (e.g. risperidone) with typical antipsychotics as adjunctive therapy in patients hospitalized for acute mania, especially during a lengthy hospital stay. Our retrospective, case-controlled study is a chart review of 64 patients with Diagnostic and Statistical Manual of Mental Disorders, 4th edition, defined bipolar I disorder (current episode, mania). Patients were divided into two groups according to the adjunctive medications used: the risperidone group (mood stabilizers plus risperidone) and the control group (mood stabilizers plus typical antipsychotics). Outcome at discharge, medications, adverse drug effects, and length of hospital stay were compared between groups, controlling for gender, age, number of prior admissions, and duration of illness. Results indicated no statistically significant differences between groups in the controlled factors, Global Assessment of Functioning and Clinical Global Impression-Improvement scores, and adverse drug events. Patients in the risperidone group used significantly lower doses of trihexyphenidyl than those in the control group (p < 0.05). Patients treated with risperidone had a shorter hospital stay than those treated with typical antipsychotics (p < 0.01). In conclusion, antipsychotics are effective as adjunctive agents in the treatment of acute mania. The use of risperidone, in particular, decreases the need for anticholinergics and may lead to a shorter hospital stay compared with typical antipsychotics.

The aim of this study was to establish the optimal cut-off points of the Chen Internet Addiction Scale (CIAS), to screen for and diagnose Internet addiction among adolescents in the community by using the well-established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58) and diagnostic (63/64) cut-off points of the CIAS, a self-reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%). The screening cut-off point had high sensitivity (85.6%) and the diagnostic cut-off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two-stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one-stage massive epidemiologic research.

Treatment-emergent obsessive-compulsive symptoms (OCSs) have raised concern since the widespread introduction of serotonin-dopamine antagonists (SDAs) for the treatment of schizophrenia. Further investigations of SDA-emergent OCSs and their response to anti-obsessional agents will be beneficial for clinicians in helping patients who suffer from this problem. We present three cases of schizophrenia in which distressing OCSs occurred during clozapine or risperidone treatment. OCSs were assessed consecutively using the Yale-Brown Obsessive-Compulsive Scale. The OCSs of these three patients were responsive to anti-obsessional agents, including fluvoxamine, clomipramine, and paroxetine. We also review the current literature and discuss the possible pathophysiology and psychopathology of SDA-emergent OCSs.

Substance abuse and risky sexual behavior have been identified as behaviors that can endanger adolescent psychosocial development. This study examined the relationship between methamphetamine (MAMP) use and risky sexual behavior in adolescents. Risky sexual behavior was compared not only between MAMP users and non-users, but also between high-frequency and low-frequency MAMP users. We compared the sexual intercourse histories of 85 adolescents formally charged as MAMP users with those of 170 gender-matched adolescents with no record of MAMP use. MAMP usage characteristics were compared between users who had and those who had not experienced sexual intercourse. Previous sexual experience was more likely in MAMP users than in non-users. MAMP users were also more likely to have had a greater total number of sexual partners and were more likely to have had unplanned sex under the influence of alcohol. High-frequency MAMP use was associated with increased tendencies to engage in unprotected sex and to use MAMP before sexual intercourse. In general, the chance of sexual intercourse increased in proportion to frequency of MAMP use. Given the clear link between MAMP use and risky sexual behavior, risk-reduction programs directed at teen MAMP users are urgently needed.

The aim of this study was to evaluate the factors contributing to the psychological recovery from the 1999 Taiwan earthquake from the perspective of adolescents in Chungliao. A total of 22 junior high school students who had significant decrease of Impact of Event Scale (IES) scores in the follow-up period of 9 months were recruited to participate in one of three focus groups. By applying the method of focus group interviewing, adolescents' attributions of factors relating to the improvements of psychological reactions were collected. All interviews were tape-recorded and the transcripts were approached by content analysis. Four major factors contributing to psychological recovery from the earthquake are clustered: (1) self-healing effect as time passed away; (2) assistance from people of the non-afflicted areas; (3) being engaged in interests in leisure time; and (4) other important events happening after the earthquake. Several factors contributed to the psychological recovery of adolescents from the experience of the earthquake. The results of this study can serve as the basis of further treatment strategies for the adolescent refugees from major disasters.

This study aims to construct a multidimensional instrument in assessing insight of schizophrenic patients and further to examine its relationships with other factors such as psychiatric symptoms, demographic characteristics, and course of illness. An instrument (the Schedule for assessment of Insight in Psychosis, SIP) with a 4-point rating scale was constructed to assess the insight of schizophrenic patients in five dimensions. One hundred schizophrenic patients were recruited for the study and all of them received a semi-structured interview using the SIP. Their demographic variables, length of illness and severity of psychotic symptoms were analyzed for insight. The reliability and validity of the SIP were satisfactory. Significant factors related to insight were psychotic symptoms, including both positive and negative symptoms. This study showed insight was affected by a multitude of factors, and it could be assessed quantitatively in various dimensions.

Severe chlorpromazine-induced granulocytopenia where the white-cell count decreases to below 1,000/mm3 rarely occurs and lithium is known to cause leucocytosis. The use of lithium in the prevention of granulocytopenia induced by drugs is still controversial. This report describes a patient with bipolar disorder suffering from severe granulocytopenia and severe respiratory infection after receiving chlorpromazine 50 to 150 mg per day along with long term lithium therapy. Bone-marrow aspiration and biopsy revealed inhibited maturation of myeloid series in the promyelocyte stage. The findings were consistent with a drug-induced effect. White-cell count return to normal after the discontinuation of chlorpromazine. It was proved in this case that combined lithium therapy had no effect in preventing agranulocytosis induced by chlorpromazine.

Creutzfeldt-Jakob disease (CJD) is considered to be very rare in the population, and the psychiatric manifestation of the disease even rarer with only one report in the past few years in Taiwan. To clarify whether the psychiatric manifestation of CJD is really rare or whether it is neglected in Taiwan, the authors reviewed the discharge notes of patients who had been admitted to a neurological unit in the past 15 years and conducted a chart review of the patients of CJD supported by the clinical courses, EEG finding and brain biopsies. An inquiry was made by telephoning their families to follow up their condition after discharge. Five of the 8 cases with CJD had psychiatric symptoms including changes of mood, thought, behavior and perception during their course of illness. Four cases had been sent to the psychiatric unit and received treatment under several kinds of psychiatric diagnoses. Two patients had been admitted to the psychiatric unit and one had received electroconvulsive treatment. Two of the patients had been suspected to be the victims of neuroleptic malignant syndrome. It is likely that it is psychiatrists who will meet CJD patients first in the early stages of disease. CJD should be kept in mind and EEGs with detailed neurological checkups should be completed, if the cognitive functions of the patients with unusual neurological symptoms deteriorate quickly and their psychiatric symptoms fail to respond to any treatment.

Postinfectious encephalomyelitis is a kind of demyelinating disease with pathological characteristics and a monophasic clinical course. Herein, we describe a patient who had the symptoms of binge eating, fatigue, memory impairment, hypotalkativeness, hypoactivity, lethargy, incoherent speech, dysphoric mood, and episodic disorientation. Only elevation of CSF protein was noted upon initial admission; however, blurred vision of the eyes developed progressively after discharge. A magnetic resonance image (MRI) scanning of the brain demonstrated scattered lesions of low signal intensity on T1-weighted images and high areas on T2-weighted images in the left thalamus, bilateral hypothalamus and midbrain. The findings of MRI image, CSF, and clinical course all suggested postinfectious encephalomyelitis. After a treatment of prednisolone, a follow-up MRI revealed evidence of improvement, and the binge eating also improved.