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Background: Whether bipolar II disorder is a distinct disorder or simply a milder form of bipolar I disorder has been debated. Family, twin, and adoption studies provide robust evidence of genetic contributions to bipolar disorder, and heritable temperaments are also believed to contribute to the susceptibility to bipolar disorders. In this study, we sought to clarify the relationship between bipolar I and bipolar II disorder., Method: In this cross-sectional survey, 314 participants (82 bipolar I disorder patients, 121 bipolar II disorder patients, and 111 healthy controls) completed the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Tridimensional Personality Questionnaire, which assessed the personality dimensions of novelty seeking and harm avoidance. We also determined which participants carried the serine-to-glycine substitution at amino acid position 9 polymorphism of the dopamine D3 receptor gene (DRD3) and the serotonin transporter gene-linked polymorphic region (5-HTTLPR) genotypes. All patients met the DSM-IV-TR diagnosis criteria for bipolar disorder. This study was conducted from September 2005 to July 2009 at National Cheng Kung University Hospital, Tainan, Taiwan, and Tri-Service General Hospital, Taipei, Taiwan., Results: Binary logistic regression analysis showed significant main effects for the 5-HTTLPR polymorphism (P = .045), novelty seeking (P = .022), and harm avoidance (P = .017) scores and a significant interaction effect between harm avoidance and 5-HTTLPR genotypes (P = .042) in distinguishing between bipolar I and bipolar II disorder patients. Bipolar I disorder patients with the long allele at 5-HTTLPR had lower harm avoidance scores than did bipolar II disorder patients (bipolar I disorder = 16.23, bipolar II disorder = 19.80; P = .023); however, the difference was not significant after multiple test correction. All these data suggest a distinction between bipolar I and bipolar II disorder., Conclusions: We provide initial evidence that 5-HTTLPR genotypes might moderate the association between harm avoidance and bipolar I and bipolar II disorder. There appear to be unique differences in the gene-temperament interactions of bipolar I and bipolar II disorder patients., (© Copyright 2012 Physicians Postgraduate Press, Inc.)

Rationale and Objective: Serotonin is one of the key neuromodulators involved in fundamental cerebral functions and behaviors. Previous study has demonstrated that somatization symptoms are probably associated with central serotonergic circuits, which are implicated in anxiety and nociception regulation. This study aims to examine the correlation between somatization subscale score and serotonin transporter (SERT) availability in healthy volunteers., Methods: Sixty-four healthy participants, 26 males and 38 females, were enrolled from the community and were administered the single somatization subscale of the Chinese symptom checklist 90 revised (SCL90-R). Single photon emission computed tomography with [(123)I] 2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine was also performed to examine SERT availability., Results: The somatization scores were negatively correlated with SERT availability (Spearman's ρ = -0.35, p = 0.005), particularly in males (Spearman's ρ = -0.54, p = 0.004)., Conclusion: This result reconfirmed the correlation between central serotonergic activity and the intensity of somatization symptoms, even in healthy participants. However, a gender difference exists in this correlation.

Objectives: Studies report high comorbidity of lifetime anxiety disorders with bipolar disorders in Western patients, but it is unclear in Taiwan. The authors explored the comorbidity of anxiety disorders in different bipolar disorder subtypes in Han Chinese in Taiwan., Methods: Three hundred twenty-five patients with bipolar disorder (bipolar I: 120; bipolar II: 205) disorder were recruited from two general medical outpatient services. They were evaluated and their diagnoses confirmed by a psychiatrist using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime. The exclusion criteria were: any DSM-IV-TR Axis I diagnosis, other than bipolar disorder, being outside the 18-65-year-old age range, any other major and minor mental illnesses except anxiety disorder, any neurological disorders or organic mental disorders., Results: Thirty-two (26.7%) of patients were comorbid with lifetime anxiety disorder and bipolar I, 80 (39.0%) with lifetime anxiety disorder and bipolar II, 7 (5.8%) were comorbid with two or more anxiety disorders and bipolar I, and 27 (13.2%) with two or more anxiety disorders and bipolar II., Conclusion: That more than twice as many bipolar II than bipolar I patients reported two or more anxiety disorders implies that the complication is more prevalent in bipolar II patients., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: Bipolar-I disorder (BPI) often co-occurred with anxiety (ANX) and substance use disorders (SUD), which poses challenges in public health and clinical treatment, and adds complexity in searching for relevant etiologic factors. The present study sought to identify subgroups of BPI patients using comorbidity patterns with ANX and SUD., Methods: Clinical patients (N=306) diagnosed with BPI were recruited and interviewed using the Composite International Diagnostic Interview to collect data on demographics and clinical features, including episodic information, impairments, and lifetime diagnoses of ANX (panic, agoraphobia, generalized anxiety disorder, specific and social phobia) and SUD (nicotine dependence, alcohol use and drug use disorder). We applied latent class analysis to empirically derive classes of BPI. A number of exogenous variables were examined for each class., Results: A three-class model provides excellent discriminability for subgrouping BPI patients with different comorbidity patterns. The BPI-LOW class (83.99%) had more pure mania without most lifetime comorbidity, higher numbers of last year mania episodes, and less suicidality and impairments. The BPI-ANX class (3.60%) was female predominant, tended to comorbid with multiple anxiety disorders but no SUD, and had early onset age. The BPI-SUD class (12.42%) was male predominant, had high prevalence of lifetime SUD and frequent mood episodes in the last year. Both the BPI-ANX and BPI-SUD classes had severe functional impairments and suicidal behaviors., Limitations: Clinical information was retrospectively collected. Besides, we did not comprehensively access lifetime comorbidity for all psychiatric disorders., Conclusion: The three empirically identified subgroups of BPI patients exhibited distinguished comorbidity patterns and clinical features, including suicidal behaviors, frequent mood episodes and functional impairments. Our findings have clinical implication in intervention and treatment as well as to explore their different underlying mechanisms., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Although the Dexamethasone Suppression Test (DST) plays an important role in psychosomatic research, confounding factors limit the sensitivity and specificity of the DST. The aim of this study was to investigate the relationship between the intensity of daily life stressors and DST results in healthy participants after controlling the confounding factors. The subjects of this study consisted of 75 healthy volunteers. The intensity of daily life events was assessed using the Taiwanese version of the Recent Life Change Questionnaire (RLCQ). Neuroticism was assessed using the Maudsley Personality Inventory (MPI). The Dexamethasone Suppression Test (DST) was also performed. The regression model showed that daily life events (RLCQ score) were correlated significantly with cortisol level on day 1 and D% only in women. This finding implies that daily life events should be considered as an independent variable in women in further studies when the DST is applied.

Background: Determining the influences of genes involved in metabolizing dopamine and encoding dopamine receptors, such as the aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) genes, is critical for understanding addictive behavior. Therefore, we investigated the association between the ALDH2 and DRD2/ANKK1 Taq IA polymorphisms and heroin dependence., Methods: Heroin-dependent Han Chinese patients (250) and healthy controls (312) were recruited. ALDH2 and DRD2/ANKK1 Taq IA polymorphisms were genotyped., Results: The frequency of ALDH2*1/*2 and *2/*2 genotypes was significantly higher in heroin-dependent patients than in controls, but the frequency of DRD2 Taq IA genotypes was not significantly different. Logistic regression analysis showed no significant interaction between ALDH2 and DRD2 Taq IA genotypes in patients., Conclusions: The ALDH2 polymorphism, but not the DRD2, was associated with heroin dependence., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Sunlight exposure is considered responsible for seasonal serotonin changes. Sixty-six healthy participants were recruited, and single photon emission computed tomography ([¹²³I]-ADAM SPECT) was used to investigate the association between serotonin transporter (SERT) availability and duration of sunlight exposure in Taiwan, a subtropical country. No significant correlation between SERT availability and the duration of sunlight exposure was found., (2011 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Our previous study using (123)I-iodo-benzamide single photon emission computed tomography (SPECT) showed a positive relationship in healthy adults between striatal postsynaptic D(2)/D(3) receptor availability and sleep duration in good sleepers. To further investigate the role of dopamine (DA) in the sleep-wake cycle, we explored the correlation between presynaptic dopamine transporter (DAT) availability and sleep quality in healthy volunteers., Methods: A total of 83 healthy volunteers (33 males, 50 females; mean age, 34.62 years), including 39 good sleepers and 44 poor sleepers, were recruited. The sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Striatal DAT availability was determined by (99m)Tc-TRODAT-1 SPECT, and the DAT availability in the good and poor sleepers was compared. Furthermore, the correlation between PSQI and DAT availability was analyzed., Results: There was no significant difference in DAT availability between the good and poor sleepers. No significant relationship was found between the global score or individual-component PSQI scores and DAT availability in the good sleepers. However, the sleep duration component score in the poor sleepers negatively correlated with DAT availability in the caudate (ρ = -0.31, P = 0.049)., Conclusions: The study demonstrates that healthy poor sleepers, with a lower DAT availability in the caudate, sleep for a shorter length of time. This suggests that a decrease in DA reuptake due to reduced DAT availability causes a shorter sleep duration in poor sleepers.

Objectives: Bipolar disorder (BP) is often comorbid with anxiety disorder (ANX), especially in bipolar II disorder (BP-II). BP patients with comorbid ANX often manifest intensified symptoms and harmful dysfunctions. However, most studies have focused on bipolar I disorder (BP-I); few have investigated the effect of comorbid ANX on the neuropsychological function of BP-II patients. We examined neuropsychological functions in BP-II patients with and without comorbid ANX., Methods: Fifty-nine participants were recruited: 20 patients with interepisode (symptom-free) BP-II without comorbid ANX, 20 with interepisode BP-II with comorbid ANX, and 19 healthy controls. All participants were screened using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime (SADS-L). Individuals comorbid with major or minor mental illness other than BP-II were excluded. Comparisons were made between the three groups using neuropsychological tests to assess memory, attention, psychomotor speed, and frontal executive function., Results: BP-II patients with comorbid ANX showed poorer neuropsychological functions than those in the BP-II-only and control groups. Additionally, BP-II-only patients and controls showed equal cognitive performance., Conclusions: Because BP-II patients with comorbid ANX had the lowest scores in the majority of neuropsychological functional tests, we conclude that they have greater cognitive impairments than do BP-II patients without comorbid ANX. Neuropsychological dysfunctions seemed more strongly associated with ANX than with BP-II in interepisode periods. Identifying and managing ANX comorbidity is critical when treating BP-II patients., (Copyright © 2011. Published by Elsevier Inc.)

It has been suggested that dopamine may play an important role in human evolution and adaptive behaviors. Recent studies have revealed an association between the dopamine system and social support among healthy individuals. However, the underlying mechanism remains unclear. In the present study, we propose a dopamine hypothesis, which states that the level of dopaminergic system activity could influence social support via the capacity of cognitive function. Two lines of literature supporting the mechanism of this hypothesis are reviewed. Further experimental and longitudinal study is required to test this hypothesis. This hypothesis may help to identify the mechanism explaining the influence of dopamine on social support and provide support for dopaminergic pharmacotherapy for deficits in social behaviors., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Regulation of gene expression plays an integral role in adaptation of cells to hypoxic stress. In mammals, prolyl hydroxylases control levels of the central transcription factor hypoxia inducible factor (HIF) through regulation of HIFα subunit stability. Here, we report that the hydroxylase Ofd1 regulates the Sre1 hypoxic transcription factor in fission yeast by controlling DNA binding. Prolyl hydroxylases require oxygen as a substrate, and the activity of Ofd1 regulates Sre1-dependent transcription. In the presence of oxygen, Ofd1 binds the Sre1 N-terminal transcription factor domain (Sre1N) and inhibits Sre1-dependent transcription by blocking DNA binding. In the absence of oxygen, the inhibitor Nro1 binds Ofd1, thereby releasing Sre1N and leading to activation of genes required for hypoxic growth. In contrast to the HIF system, where proline hydroxylation is essential for regulation, Ofd1 inhibition of Sre1N does not require hydroxylation and, thus, defines a new mechanism for hypoxic gene regulation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

OBJECTIVES. Clarifying the association between bipolar I and bipolar II disorders at the genetic level is essential for improving our understanding of them. In this study, we evaluated the hypothesis that the dopaminergic polymorphisms are risk factors for bipolar disorders. We examined the association between the catechol-O-methyltransferase (COMT) Val158Met and dopamine D3 receptor (DRD3) Ser9Gly polymorphisms and bipolar I and II disorders, as well as possible interactions between these genes. METHODS. Seven hundred and eleven participants were recruited: 205 with bipolar I, 270 with bipolar II, and 236 healthy controls. The genotypes of the COMT Val158Met and DRD3 Ser9Gly polymorphisms were determined using polymerase chain reactions plus restriction fragment length polymorphism analysis. RESULTS. Logistic regression analyses showed a statistically significant main effect for the Met/Met genotype of the COMT Val158Met polymorphism (P=0.032) and a significant interaction effect for the Met/Met genotype of the COMT Val158Met and Ser/Ser genotypes of the DRD3 Ser9Gly polymorphism (P=0.001) predicted bipolar I patients. However, there was no association between the COMT Val158Met or DRD3 Ser9Gly and bipolar II. CONCLUSIONS. We provide initial evidence that the COMT Val158Met and DRD3 Ser9Gly genotypes interact in bipolar I and bipolar II disorders and that bipolar I and bipolar II are genetically distinct.

Striatal dopaminergic activity is significantly correlated with various cognitive activities, mood regulation, and even metabolic homeostasis, and is modulated by the dopamine transporter (DAT). The availability of DAT could be regulated by presynaptic autoreceptors, which are G-protein coupled receptors; however, whether functional variations in the common downstream signaling molecule, G-protein, could cause individual differences in presynaptic transporter availability remains unclear. To investigate this relationship, the DAT availability in seventy-eight healthy subjects was approximated using single photon emission computed tomography (SPECT) with [(99m)Tc] TRODAT-1, a radio-labeled form of tropan derivative for the selective labeling of DAT. The C825T single nucleotide polymorphism (SNP) (rs5443) of the beta subunit of the G-protein second messenger (GNβ3) gene was genotyped, and analysis of variance showed a significant difference in striatal DAT when referenced to the entire occipital lobe among the three genotypes. Post hoc independent t tests were also performed, and showed that the striatal DAT availability of the CC genotype was higher than that of the other two genotypes. These results indicated that genetic variation in the common downstream signaling molecule of the dopamine autoreceptor could affect the functional status of the striatal dopamine system. These results together with the known role of the GNβ3 gene might provide further evidence to support the common effect of the striatal dopamine system on mood and metabolic regulation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Fission yeast protein Sre1, the homolog of the mammalian sterol regulatory element-binding protein (SREBP), is a hypoxic transcription factor required for sterol homeostasis and low-oxygen growth. Nro1 regulates the stability of the N-terminal transcription factor domain of Sre1 (Sre1N) by inhibiting the action of the prolyl 4-hydroxylase-like Ofd1 in an oxygen-dependent manner. The crystal structure of Nro1 determined at 2.2 Å resolution shows an all-α-helical fold that can be divided into two domains: a small N-terminal domain, and a larger C-terminal HEAT-repeat domain. Follow-up studies showed that Nro1 defines a new class of nuclear import adaptor that functions both in Ofd1 nuclear localization and in the oxygen-dependent inhibition of Ofd1 to control the hypoxic response., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Rationale and Objective: Although loudness dependence of auditory evoked potentials (LDAEPs) had been suggested as a noninvasive measure of central serotonin functions, recent studies suggest that LDAEP may be modulated by multiple neuromodulatory systems, such as dopamine. Here, we explore the relationship between LDAEP and dopamine and serotonin in the level of monoamine transporter availability., Methods: Forty-nine healthy volunteers received LDAEP and single-photon emission computed tomography (SPECT) using [(99m)Tc] TRODAT and [(123)I] ADAM to approximate the availability of dopamine transporters (DATs) and serotonin transporters (SERTs)., Results: LDAEP was found to be positively associated with DAT, after adjusting for age and gender, and the log-transformed slope of loudness dependence at Cz was negatively associated with SERT., Conclusion: Our findings provide further evidence for the possible involvement of dopamine and serotonins in the genesis of LDAEP.

Huntington disease results from an expanded polyglutamine region in the N terminus of the huntingtin protein. HD pathology is characterized by neuronal degeneration and protein inclusions containing N-terminal fragments of mutant huntingtin. Structural information is minimal, though it is believed that mutant huntingtin polyglutamine adopts β structure upon conversion to a toxic form. To this end, we designed mammalian cell expression constructs encoding compact β variants of Htt exon 1 N-terminal fragment and tested their ability to aggregate and induce toxicity in cultured neuronal cells. In parallel, we performed molecular dynamics simulations, which indicate that constructs with expanded polyglutamine β-strands are stabilized by main-chain hydrogen bonding. Finally, we found a correlation between the reactivity to 3B5H10, an expanded polyglutamine antibody that recognizes a compact β rich hairpin structure, and the ability to induce cell toxicity. These data are consistent with an important role for a compact β structure in mutant huntingtin-induced cell toxicity.

Rationale: Tryptophan hydroxylase 1 (TPH1), which encodes the rate-limiting enzyme tryptophan hydroxylase in the biosynthesis of serotonin, is a candidate gene in the development and treatment response of major depressive disorder (MDD); however, its actual role is uncertain., Objectives: We aimed to compare the allele frequencies of TPH1 in MDD patients and healthy controls in Taiwan, and also to investigate the association between TPH1 A218C and treatment response to either fluoxetine or venlafaxine in a Taiwanese population with MDD., Methods: One hundred five healthy controls and 115 outpatients diagnosed with MDD were recruited and genotyped for the TPH1 218A/C (rs1800532) polymorphism. Patients were randomized into either the fluoxetine or venlafaxine treatment group. The 21-item Hamilton rating scale for depression (HAM-D) was administered to evaluate depressive symptoms at baseline and bi-weekly over 6 weeks of treatment., Results: The TPH1 218A/C allele frequencies differed significantly between healthy controls and MDD patients in Taiwan, with a higher prevalence of the A allele in the patient group (p = 0.025). The odds ratio of the A allele to the C allele was 0.507 for the subjects with MDD. There was no significant correlation between the percentage change in HAM-D score and either TPH1 218A/C genotype or TPH1 allele frequencies., Conclusions: This study indicated that the TPH1 218A/C genotype and allele frequencies differed between the Taiwanese healthy controls and MDD patients but could not be used to predict treatment outcome in Taiwanese MDD patients. Further research with larger sample sizes is needed to confirm the role of TPH1 218A/C.

Aims: Although cognitive deficits are a common and potentially debilitating feature of major depressive disorder (MDD), such subjective declines in cognitive function are seldom validated by objective methods as a clinical routine. The aim of this study was to validate the Taiwanese Depression Questionnaire (TDQ) for detecting cognitive deficits in a sample of drug-free patients with MDD., Methods: The subjects consisted of 40 well-characterized medication-free patients with MDD and 40 healthy controls. Clinical and neuropsychological assessments, including the Wisconsin Card Sorting Test, the Wechsler Memory Scale-Revised, the Continuous Performance Test, and the Finger-Tapping Test, were administered at the time of recruitment., Results: Factor analyses of the TDQ yielded three factors. Memory, attention and psychomotor performance were significantly poorer in patients with MDD. The performances of verbal and delayed memory of the Wechsler Memory Scale-Revised were correlated with the cognitive domains of the TDQ. Generalization of our results must be undertaken with caution considering the relatively small sample size, which could lead to increased β-error., Conclusion: Cognitive subdomains might be considered important for including in patient-administered questionnaires used to measure symptoms of MDD when developing a new scale., (© 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.)

Objective: Studies exploring neuropsychological functions of bipolar disorder (BP) specifically include patients comorbid with alcohol abuse (AB), alcohol dependence (AD), or both (AB/AD). Contradictory assessments of neuropsychological impairment may be caused by not excluding the confounding effects of comorbid AB/AD. Most of the literature discusses BP without subtyping, which overlooks that BP-II may be a valid diagnosis different from BP-I. Because neuropsychological functions are involved in overall BP-II outcomes, we hypothesized that the neuropsychological functions of patients with BP-II comorbid with AD (BP(+AD)) are significantly different from and more impaired than those of patients with BP-II not comorbid with AD (BP(-AD))., Methods: Using DSM-IV criteria, the study included 69 patients with BP-II (19 with BP(+AD); 28 with BP(-AD)) and 22 healthy controls compared using a battery of neuropsychological tests that assessed memory, psychomotor speed, and certain aspects of frontal executive function. All BP-II patients were in an inter-episode period (a period of remission between states of mania, hypomania, and depression)., Results: BP(+AD) patients had lower scores than did BP(-AD) patients and controls in verbal memory, visual memory, attention, psychomotor speed, and executive function. Working memory was poorer for BP(+AD) than BP(-AD) patients and for both BP groups than for controls., Conclusions: BP(+AD) patients manifested wide neuropsychological dysfunctions, and BP(-AD) patients showed a reduction in working memory, which suggested that working memory might be related to a history of BP-II. Neuropsychological dysfunctions seemed more strongly associated with AB/AD than with BP-II in inter-episode periods., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: In addition to the serotonergic system, the central dopaminergic system has been reported to be correlated with seasonality. The aim of this study was to explore the difference in striatal dopamine D(2)/D(3) receptor availability between healthy volunteers who had a high-sunshine exposure and those who had a low exposure., Methods: Sixty-eight participants were enrolled, and those in the upper and lower quartiles in terms of sunshine exposure were categorized into high- (n = 17) and low-sunshine-exposure (n = 18) subgroups. Single photon emission computed tomography with [(123)I] iodo-benzamide was used to measure striatal dopamine D(2)/D(3) receptor availability., Results: Striatal dopamine D(2)/D(3) receptor availability was significantly greater in the subjects with high-sunshine exposure than in those with low-sunshine exposure (F = 7.97, p = 0.01) after controlling for age, sex, and smoking status., Limitations: Different subjects were examined at different time points in our study. In addition, the sex and tobacco use distributions differed between groups., Conclusion: The central dopaminergic system may play a role in the neurobiological characteristics of sunshine-exposure variation., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Serotonin transporter (SERT) and dopamine transporter (DAT) levels differ in patients with major depression who are in a depressed state in comparison with healthy controls. The aim of this study was to examine the distribution volume ratios (DVRs) of SERT and DAT in drug-free and euthymic patients with a history of major depression. Subjects comprised 13 patients with a history of major depression and 26 sex- and age-matched healthy controls. The euthymic state of depression was defined as a score of 7 or less on the Hamilton Depression Rating Scale. The DVRs of SERT and DAT were approximated using SPECT, with [(123)I] 2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine (ADAM) and [(99m)Tc] TRODAT-1 as the ligands, respectively. There were no significant differences in the DVRs of SERT or DAT between healthy subjects and euthymic patients with a history of major depression; hence, the SERT and DAT DVRs may not therefore be trait markers for patients with major depression, which helps us to understand more about the pathophysiology of depression., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

It has been speculated that novelty seeking (NS) behavior is related to the dopaminergic system. Fifty-two subjects completed the Tridimensional Personality Questionnaire and underwent single photon emission computed tomography with (123)I-iodobenzamide. A marginally positive correlation was noted between NS and striatal dopamine D(2)/D(3) receptor availability (r = 0.25, p =0.07). A positive association was noted between the NS scores and left striatal D(2)/D(3) receptor availability (r= 0.29, p =0.04). The results suggest that a relationship might exist between NS score and dopaminergic activity., (Copyright © 2010 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.)

Aim: Clarifying the association between bipolar I and bipolar II, the two most common subtypes of bipolar disorder, at the genetic level is essential for improving our understanding of these disorders. The dopaminergic system has been implicated in the pathogenesis of bipolar disorder. It may be important to investigate genes involved in metabolizing dopamine and encoding dopamine receptors, such as the aldehyde dehydrogenase 2 (ALDH2) and dopamine D2 receptor/ankyrin repeat and kinase domain containing 1 (DRD2/ANKK1) genes. We examined the association of the ALDH2 and DRD2/ANKK1 Taq IA polymorphisms with bipolar I and II disorders and possible interactions between these genes., Methods: Seven hundred and fifty participants were recruited: 207 with bipolar I disorder, 277 with bipolar II disorder, and 266 healthy controls. The genotypes of the ALDH2 and DRD2/ANKK1 TaqIA polymorphisms were determined using polymerase chain reactions plus restriction fragment length polymorphism analysis., Results: Logistic regression analysis showed a statistically significant interaction for the A1/A1 genotype of the DRD2/ANKK1 TaqIA, and the ALDH2*1*1 genotypes (P=0.009) could predict bipolar II patients compared with individuals without bipolar disorder. However, there was no association between the ALDH2 or DRD2/ANKK1 gene with neither bipolar I nor bipolar II disorder., Conclusion: Our findings may provide initial evidence that the ALDH2 and DRD2/ANKK1 genes interact in specific subtypes of bipolar disorders. Our findings also suggest a unique genetic distinction between bipolar I and bipolar II disorders.

Background/purpose: Systemic-onset juvenile idiopathic arthritis (s-JIA) is a systemic disease often accompanied by a fever. We examined 16 patients with s-JIA and reported the clinical manifestations, laboratory data, treatments and outcomes., Methods: From 1984 to 2007, 16 children (aged 1-16 years), who were diagnosed as having s-JIA, were admitted to the Mackay Memorial Hospital in Taiwan. We retrospectively reviewed their medical charts., Results: There were nine boys and seven girls, with mean age of onset of 7.4±5.5 years. Fever (100%), typical rash (63%), and arthritis (75%) were the three most common symptoms. Lymphadenopathy (50%), hepatosplenomegaly (63%), pleural pulmonary manifestations (13%) and myalgia (25%) were also noted. One patient had Epstein-Barr virus-associated hemophagocytic syndrome complications. Neutrophilic leukocytosis was a common feature. Other laboratory data showed elevated C-reactive protein levels (25.1±50.3 mg/dL), and erythrocyte sedimentation rates (69±28 mm/hr) and abnormal liver enzymes. Marked hyperferritinemia (> 2,000 ng/mL) was noted in 57% (4/7) of the patients. The mean time from onset of symptoms to diagnosis was 9.2 weeks. Non-steroidal anti-inflammatory drugs, steroids, disease-modifying anti-rheumatic drugs and anti-tumor necrosis factor agents were used for treatment. Due to prolonged fever, 2.0±1.6 (maximum=5) different kinds of antibiotics were used before a diagnosis was made. Most cases had satisfactory therapeutic outcomes except one boy, who had permanent joint contracture., Conclusion: The clinical manifestations of s-JIA in Taiwan were often accompanied by a prolonged fever. This results in clinicians often suspecting bacterial infections and prescribing several kinds of antibiotics. In the case of prolonged fever, s-JIA should always be placed on the list of differential diagnoses., (Copyright © 2010 Taiwan Society of Microbiology. Published by Elsevier B.V. All rights reserved.)

We found the main effects of harm avoidance temperament in predicting bipolar I and II, but the interaction between novelty seeking and Ser9Gly polymorphisms of dopamine D3 receptor gene was demonstrated in bipolar-I patients only. This study provided evidence that differences existed between BP-I and BPII in gene and temperament interactions., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: Previous studies on the change of cardiac autonomic function and insulin resistance in metabolic syndrome recruited subjects with cardiovascular-related disease and defined metabolic abnormality with a more severe cutoff. We explored the alteration of cardiac autonomic function and insulin resistance in predisease community dwellers with different numbers of metabolic abnormalities., Methods: A total of 1298 subjects were classified as none (n=539), one (n=378), 2 (n=218), and 3 or more metabolic abnormalities (n=154). Insulin resistance was calculated by homeostatic model assessment. Cardiac autonomic function included 5-minute standard deviation of R-R interval, low- and high-frequency power spectrum, and low-/high-frequency power spectrum ratio, the ratio of the longest R-R interval around the 30th beat and the shortest R-R interval around the 15th beat after standing, and the ratio of the longest expiratory R-R interval to the shortest inspiratory R-R interval during deep breathing., Results: Subjects with a single metabolic abnormality or more had a lower standard deviation of R-R interval and expiratory/inspiratory ratio than subjects without metabolic abnormality in multivariate analysis. Subjects with 3 or more metabolic abnormalities had a higher low-/high-frequency power spectrum ratio, but a lower high-frequency power. Insulin resistance was higher in groups with 2 metabolic abnormalities or more, but not in the group with one metabolic abnormality, than those without metabolic abnormality., Conclusions: Cardiac autonomic function altered in predisease subjects with one or more metabolic abnormalities, while insulin resistance existed in subjects with 2 or more metabolic abnormalities. Thus, autonomic function change may precede insulin resistance in the initiation of metabolic syndrome., (Copyright 2010 Elsevier Inc. All rights reserved.)

The relationship between harm avoidance scores of the Tridimensional Personality Questionnaire and serotonin transporter availability, as approximated using single photon emission computed tomography with [(123)I] ADAM, was examined. Our results showed a significant negative correlation between the harm avoidance total score, as well as the asthenia subscore, and serotonin transporter availability, particularly in males., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Background: Although studies have indicated that the frontal lobe plays an important role in performance on the Wisconsin Card Sorting Test (WCST) and that basal ganglia play a specific role in frontal lobe function, the role of striatal dopamine (DA) activity in performance on the WCST remains unclear., Methods: We assessed the relation between the availability of striatal dopamine transporters (DATs) and performance on the WCST as a measure of executive function in healthy individuals. We approximated the availability of DATs in 53 healthy volunteers aged 19-61 years by use of single photon emission computed tomography with technetium-99m (99mTc)-TRODAT-1 as the ligand. The WCST was administered to all participants., Results: The availability of DAT was significantly negatively correlated with perseverative errors on the WCST, both before and after adjustment for body mass index (r(before) = -0.39, p = 0.004; r(after) = -0.39, p = 0.005)., Limitations: This was an association study; thus, a causal relation between DAT availability and performance cannot be confirmed., Conclusion: Our results suggest that striatal DAT availability may play a role in executive function as measured by the WCST.

Background: Nearly all information processing during cognitive processing takes place during periods of sustained attention. Sustained attention deficit is among the most commonly reported impairments in bipolar disorder (BP). The majority of previous studies have only focused on bipolar I disorder (BP I), owing to underdiagnosis or misdiagnosis of bipolar II disorder (BP II). With the refinement of the bipolar spectrum paradigm, the goal of this study was to compare the sustained attention of interepisode patients with BP I to those with BP II., Methods: In all, 51 interepisode BP patients (22 with BP I and 29 with BP II) and 20 healthy controls participated in this study. The severity of psychiatric symptoms was assessed by the 17-item Hamilton Depression Rating Scale and the Young Mania Rating Scale. All participants undertook Conners' Continuous Performance Test II (CPT-II) to evaluate sustained attention., Results: After controlling for the severity of symptoms, age and years of education, BP I patients had a significantly longer reaction times (F(2,68) = 7.648, P = 0.001), worse detectability (d') values (F(2,68) = 6.313, P = 0.003) and more commission errors (F(2,68) = 6.182, P = 0.004) than BP II patients and healthy controls. BP II patients and controls scored significantly higher than BP I patients for d' (F = 6.313, P = 0.003). No significant difference was found among the three groups in omission errors and no significant correlations were observed between CPT-II performance and clinical characteristics in the three groups., Conclusions: These findings suggested that impairments in sustained attention might be more representative of BP I than BP II after controlling for the severity of symptoms, age, years of education and reaction time on the attentional test. A longitudinal follow-up study design with a larger sample size might be needed to provide more information on chronological sustained attention deficit in BP patients, and to illustrate clearer differentiations between the three groups.

Objectives: Dopamine has been implicated in the etiology of bipolar disorder. The aim of this study was to explore striatal dopamine transporter (DAT) availability in euthymic bipolar patients., Methods: Seventeen drug-free euthymic bipolar patients were recruited. The availability of DAT was approximated using single photon emission computed tomography (SPECT) with [99mTc] TRODAT-1., Results: Compared to the controls, the euthymic bipolar patients had significantly higher availability of striatal DAT., Conclusions: Even for patients in the euthymic state, the DAT availability is still higher than that of the controls.

The rate-limiting enzyme of serotonin biosynthesis, tryptophan hydroxylase 2 (TPH2), is one of the most promising candidate genes for psychiatric disorders. Although evidence strongly suggests that the TPH2 is significant in the etiology of major depression and anxiety disorder, whether it also contributes to the etiology of peripartum major depression and anxiety disorder, a specific subtype influenced considerably by other environmental factors like hormones, is unclear. This study investigated the role of TPH2 in the etiology of peripartum major depression and anxiety disorder in a Han Chinese population in Taiwan. Six single nucleotide polymorphisms were selected from previously profiled genetic information of TPH2 in Han Chinese. A cohort of postpartum Chinese women that included 117 patients with major depression, anxiety disorder, or both and 83 healthy controls were genotyped with selected TPH2 markers. The TPH2 2755A allele was found only in women with peripartum major depression and anxiety disorder (p = 0.043) and exhibited a dominant gene action (p = 0.038) with an estimated disease risk of 1.73. Although the sample size is small, results from this study suggest that the TPH2 C2755A polymorphism may represent a population-specific risk factor for peripartum major depression and anxiety disorder, perhaps by interacting with hormones.

Introduction: The effects of age and gender on sexual function have attracted much attention in recent years, though few studies have focused on this issue in Asian populations., Aims: The Changes in Sexual Functioning Questionnaire (CSFQ) was used to: (i) assess the differences in sexual functioning between unmedicated outpatients with depressive disorders and healthy volunteers; and (ii) investigate the influences of gender and age on sexual functioning in both groups., Main Outcome Measures: The CSFQ was used to assess sexual dysfunction., Methods: Two groups of subjects, 73 unmedicated patients with depressive disorders and 116 healthy volunteers, were recruited to the study, and changes in their sexual function were assessed using the CSFQ. Subjects' global depressive level and psychiatric morbidity were assessed using the Taiwanese Depression Questionnaire (TDQ) and the Chinese Health Questionnaire (CHQ)., Results: The depressed subjects had significantly lower total CSFQ scores than did the controls. A negative correlation between age and total CSFQ score was found in both genders of depressed patients. Age generally predicted the sum of the CSFQ scores for both genders in the depressed group after controlling for TDQ score; however, a positive correlation between age and total CSFQ score was identified in the female controls. We also found that the S-curve was the best-fit curve for both the male and female controls, the cut-off point for which was the age of 40., Conclusions: Our study confirmed that, as a screening tool for clinically significant sexual dysfunction, the CSFQ offered good sensitivity for both the healthy and depressed subjects. In addition, our findings suggested that age and gender differences should be taken into account when measuring sexual satisfaction. It is possible that the age of 40 could be an anchor point in sexual functioning for the female population of Taiwan.

Objectives: Although patients' social support is a critical factor for the prognosis of mental disorder treatments, biological mechanisms responsible for the impact of social support remain scarcely explored. We speculated that there may be an association between social support and central dopaminergic activities in humans., Methods: A total of 65 medicated patients with schizophrenia and their primary first-degree caregivers and 54 healthy volunteers were recruited for Studies 1 and 2, respectively. In Study 1, the extrapyramidal side effects (EPS) of medicated patients with schizophrenia and the social support scores of their caregivers were examined. In Study 2, the availability of striatal D(2)/D(3) receptors, dopamine transporters (DAT) and social support scores were measured in 54 healthy volunteers., Result: Study 1: the EPS scores of medicated patients with schizophrenia were negatively correlated with the social support scores of their relatives. Study 2: a positive correlation between the subjective social support scores and striatal DAT availability was noted., Conclusion: The central dopaminergic activity may be linked to the sense of social support.

Purpose: Choroidal neovascularization (CNV) is the leading cause of blindness in patients with age-related macular degeneration (AMD). This study evaluated the inhibitory effect of vasostatin (VS), an endogenous angiogenesis inhibitor, on CNV., Methods: Anti-angiogenic activity of VS was evaluated in vitro by migration and tube formation assays in human umbilical vein endothelial cells (HUVECs). CNV lesions were induced in Brown Norway rats by fundus argon laser photocoagulation. Beginning one day after CNV induction, rats were treated with eye drops containing 1 microg/ml VS in PBS buffer for three times daily for 20 days. The extent of CNV was examined by flat mount analysis on day 24 or by fundus fluorescein angiography (FAG) on days 21, 28, 35, and 42, respectively. CNV lesions and choroidal vascularity were evaluated by histological analysis. The spatial distribution of topically applied VS in rat eyes was evaluated by immunoblot analysis., Results: VS inhibited migration and tube formation in HUVECs. Flat mount analysis revealed that, after laser-induced photocoagulation, topical VS application for 20 days significantly reduced CNV lesions. Moreover, serial FAG analysis indicated that a 20 day VS treatment significantly reduced CNV lesions on all subsequent days. Histological analysis revealed attenuated lesions, intact Bruch's membrane, and reduced choroidal vascularity in VS-treated eyes. Finally immunoblot analysis reveled VS expression in choroids., Conclusions: Topical VS application suppresses the progression of laser-induced CNV via angiogenesis inhibition and may constitute a therapeutic alternative for excessive neovascularization occurring with ocular diseases.

Unlabelled: The literature reports persistent cognitive impairments in patients with bipolar disorder even after prolonged remission. However, a majority of studies have focused only on bipolar I disorder (BP-I), primarily because bipolar II disorder (BP-II) is often underdiagnosed or misdiagnosed. More attention should be paid to the differences between BP-I and BP-II, especially the aspects of neuropsychological functioning. We examined the different neuropsychological functions in BP-I and BP-II patients and compared them with those of healthy controls., Methods: The study included 67 patients with interepisode bipolar disorder (BP-I: n = 30; BP-II: n = 37) and 22 healthy controls compared using a battery of neuropsychological tests that assessed memory, psychomotor speed, and certain aspects of frontal executive function., Results: The BP-I group performed poorly on verbal memory, psychomotor speed, and executive function compared to the BP-II and control groups. Both bipolar groups performed significantly less well than the control group on measures of working memory and psychomotor speed, while the BP-II group showed an intermediate level of performance in psychomotor speed compared to the BP-I and control groups. There was no difference between the groups on visual memory., Conclusions: BP-I was characterized by reduced performance in verbal memory, working memory, psychomotor speed, and executive function, while BP-II patients showed a reduction only in working memory and psychomotor speed. Cognitive impairment existed in both subtypes of bipolar disorder, and was greater in BP-I patients. Rehabilitation interventions should take into account potential cognitive differences between these bipolar subtypes.

Depression and impaired quality of life (QOL) are frequently observed in patients suffering from a variety of diseases. In addition, it has been reported that an enhanced degradation of the serotonin precursor tryptophan may contribute to QOL deterioration in some diseases. However, it is unclear whether the correlation between the QOL scores and the central serotonergic tone is only mediated by the severity of either the depression symptoms or the physical illness itself. The present study examined the relationship between serotonin transporter (SERT) availability and life quality as measured by the World Health Organization Quality of Life brief version questionnaire (WHO-QOL) in healthy participants in order to exclude the influence of depressive mood and disease. The SERT availability in the midbrain was approximated using SPECT with [(123)I] ADAM ligand in fifty-eight healthy volunteers. The overall rating sub scores of the WHO-QOL correlated positively with serotonin transporter availability in the males. Central serotoninergic activity may play a role in the overall rating scores of the WHO-QOL.

Background: Antisocial alcoholism is related to dopamine and serotonin which are catalyzed by monoamine oxidase A (MAOA) and acetaldehyde dehydrogenase 2 (ALDH2). The objective of this study is to determine whether the interaction between the MAOA and the ALDH2 genes is associated with subjects with antisocial personality disorder (ASPD) having alcoholism., Methods: A total of 294 Han Chinese men in Taiwan including 132 ASPD with alcoholism (Antisocial ALC) and 162 without alcoholism (Antisocial Non-ALC) were recruited in this study. Alcohol dependence and ASPD were diagnosed according to DSM-IV criteria. Genotypes of ALDH2 and MAOA-uVNTR were determined using PCR-RFLP., Results: A significant difference of ALDH2 polymorphisms (p = 3.39E-05), but not of MAOA, was found among the 2 study groups. However, only after the stratification of the MAOA-uVNTR (variable number of tandem repeat located upstream) 3-repeat, a significant association between Antisocial Non-ALC and ALDH2*1/*2 or *2/*2 genotypes was shown (p = 1.46E-05; odds ratio = 3.913); whereas stratification of MAOA-uVNTR 4-repeat revealed no association. Multiple logistic regression analysis further revealed significant interaction of MAOA and ALDH2 gene in antisocial ALC (odds ratio = 2.927; p = 0.032)., Conclusion: The possible interaction of MAOA and ALDH2 gene is associated with Antisocial ALC in Han Chinese males in Taiwan. However, the protective effects of the ALDH2*2 allele against alcoholism might disappear in subjects with ASPD and carrying MAOA-uVNTR 4-repeat allele in the Han Chinese male population.

This study was designed to explore the risk factors of Internet addiction in 1360 freshmen of the National Cheng Kung University in Taiwan in 2003. The test battery included a self-administrated structured questionnaire, the Chinese Internet Addiction Scale-Revision (CIAS-R), the 12-item Chinese Health Questionnaire (CHQ-12), the Measurement of Support Functions (MSF), and the neuroticism subscale of the Maudsley Personality Inventory (MPI). Of the total study population, there were 680 college freshmen (17.9%) in the Internet addiction group, as defined by high CIAS-R scores. Using logistic regression analyses, we found positive relationships between Internet addiction and male gender, neuroticism scores and the CHQ score. In addition, the freshmen who skipped breakfast and those who had poorer social support also had a higher probability of Internet addiction. Internet addiction is prevalent among university freshmen in Taiwan. Risk factors included male gender, habit of skipping breakfast, mental health morbidity, deficient social support; and neurotic personality characteristics.

The aim of this study was to examine the relationships between the daily life events and the availabilities of serotonin transporters (SERT) and dopamine transporters (DAT) in healthy volunteers. Thirty-seven volunteers, 19 males and 18 females, were recruited. The SERT availability was approximated using SPECT and [123I] ADAM while the DAT availability was approximated using SPECT and [99mTc] TRODAT-1. All participants completed the Recent Life Change Questionnaire. The results showed that SERT and DAT may be sensitive to the presence of stressful events.

Objective. Instruments to assess aggressive behaviors in the psychiatric ward are crucial for monitoring risky behaviors. The purpose of this study was to assess the validity and reliability of the Chinese version of the Modified Overt Aggression Scale (MOAS). Methods. We translated the English version of MOAS into Chinese. We interviewed and trained two volunteers to act as agitated patients in the seclusion room. One senior psychiatrist, experienced in using the MOAS, directed scenarios of different aggressive intensity and established the standard scores. The validity was assessed by comparing the other raters' scores with those of the director's. Inter-rater reliability was also assessed. Results. Inter-rater reliability, based on Intra-class correlation coefficient (ICC=0.94, P<0.001) and Kendall's W coefficient of concordance (W=0.83, P= 0.001), was high. The validity was assessed by the Mann-Whitney test. The results showed that the raters adequately differentiated (z=- 2.89, P= 0.002) between the above-average and below-average scores of the MOAS. Conclusion. The Chinese version of the MOAS has modest psychometric properties. The model, which used trained volunteers acting as patients and compared their scores with those of the director, may be used in further studies for developing psychometric instruments to assess abrupt behaviors.

Objective. The aim of this study was to examine the rate of the misdiagnosis of bipolar disorder in outpatients who had been treated for unipolar depression with antidepressants in Taiwan and to verify the validity of the Mood Disorder Questionnaire (MDQ) in this population. Method. Fifty-three outpatients who had been treated for unipolar depression were recruited. All patients completed the MDQ and were administered the Structured Clinical Interview. The sensitivity and specificity were calculated for each possible MDQ symptom cut-off score relative to a Structured Clinical Interview diagnosis of bipolar spectrum disorder. Results. A total of 11.3% were diagnosed with bipolar spectrum disorder. The optimal model we found contained only the first portion of the MDQ with a cut-off score of 2. This model provided both good sensitivity (0.83) and specificity (0.53). Conclusion. The misdiagnosis of bipolar disorder as unipolar depression disorder is prevalent. Based on the results of the current study, the probability of bipolar disorder in depression outpatients who are in a mildly depressed state and score higher than 2 points in the first portion of the MDQ deserves to be investigated.

The aims of this study were to investigate the economic costs of outpatients with schizophrenia in Taiwan, and to survey factors that influence the costs. The direct costs were defined as the costs associated with psychiatric services and other medical treatment. The indirect costs were estimated using the Human Capital Method. Patients' characteristics, including sex, age, duration of education, duration of illness, frequency of hospitalization, type of antipsychotic medication, severity of extrapyramidal side effects caused by antipsychotic medication, and global functions, were used to estimate the costs. The average annual total cost was approximately US$16,576 per patient. The direct and indirect costs were 13% and 87% of the total costs, respectively. Among the direct costs, folk therapy ranked third, just behind prescription drugs and acute ward hospitalization. The productivity loss of both the patients and their caregivers was the major component of the indirect costs. The patient's age and global functions had a significantly negative relationship with the direct costs. The severity of extrapyramidal side effects, type of antipsychotic medication, and the patient's illness duration correlated positively with the indirect costs, while the patient's global function correlated negatively with the indirect costs. Overall, the indirect costs of treating schizophrenia were higher than the direct costs. Improving patients' functionality and decreasing caregivers' burden are essential to reducing costs.

In order to explore the neuropathology of the pre- and post-synaptic dopamine neurons of patients with major depression, we examined striatal D(2)/D(3) receptor uptake and dopamine transporter (DAT) availability simultaneously in drug-free depressed patients using a dual-isotope single photon emission computed tomography (SPECT) imaging technique. Ten unmedicated patients with unmediated depression and ten healthy controls were recruited. The striatal dopamine D(2)/D(3) receptor availability was measured using SPECT and [(123)I] IBZM, while DAT was measured using SPECT and [(99m)Tc] TRODAT-1. The symptom changes of the drug-free patients were reassessed after a 4-week antidepressant treatment. DAT binding in the patient group were significantly higher than in control group. That was not the case, however, for striatal D(2)/D(3) receptor availability. Pre-treatment striatal DAT availability correlated only marginally with changes in the Hamilton Depression Rating Scale after 4 weeks of treatment. Central dopamine functions may be altered in patients with major depression, particularly in the pre-synaptic sites.

Recent lines of research suggest that, in addition to hypothalamic sites, the striatum dopaminergic system may be a target for regulating homeostasis that may be represented by the body mass index (BMI). Although it has been reported that the striatal dopamine receptor (DRD2) availability of very obese individuals was reduced in proportion to their BMI, the correlation between the striatal dopamine system and the BMI in healthy individuals remains unclear. To investigate this relationship, the striatal dopamine transporter (DAT) availability of 50 healthy volunteers was measured using single position emission computational topography (SPECT) and [99mTc]-TRODAT-1. The serum levels of sugar, C-peptide, insulin, glycosylated hemoglobin and leptin were measured. Our results showed that age and the BMI are significantly negatively associated with the striatal DAT availability. Moreover, BMI was the only significant predictor for striatal DAT availability. These results suggest that the striatal dopamine system may be involved in body mass index regulation. Thus, molecular imaging studies measuring the striatal DAT availability should consider the BMI, rather than age, as a covariant.

Although prevalent during antidepressant treatment, sexual dysfunction (SD) is frequently ignored by both physicians and patients in Asia. In spite of impact of SD on medicated patients with major depression, sexual issues and illness remain a forbidden topic for most Asian people. The aims of this study were to: (1) estimate the prevalence of SD among stable outpatients taking different antidepressants in Taiwan; (2) investigate the factors related to SD; (3) compare physician-perceived with patient-reported prevalence rates of antidepressant-associated SD; and (4) study the differences of SD among antidepressant subgroups. In this cross-sectional observational study, 125 medicated patients with major depression were recruited. Patients were assessed using the Changes in Sexual Functioning Questionnaire (CSFQ), Taiwanese Depression Questionnaire (TDQ), Quality of Life Index (QOL), and neuroticism scores in the Maudsley Personality Inventory (MPI). Sixty-two physicians completed the Physician Antidepressant Experience Questionnaire. The estimated prevalence rate of SD was 53.6% (95% CI = 44.9-62.3%) in medicated patients with major depression. There were no significant differences in prevalence rate of SD among different antidepressants. The SD subgroup had poorer quality of life and lower moods than the non-dysfunction subgroup. An underestimation of the prevalence of SD by physicians was noted. Because antidepressant-associated SD is highly prevalent and seriously underestimated by physicians, greater physicians' recognition and better patients' education are imperative when prescribing antidepressants., ((c) 2007 Wiley-Liss, Inc.)

Introduction: Although the mesolimbic dopaminergic system has been shown to play a role in reinforcing tobacco smoking, results of imaging studies that examine the relationship between tobacco smoking and the central dopamine system remain discrepant. To delineate the role of tobacco addiction in central pre- and post-synaptic dopaminergic activities, we analyzed the central D2-family receptors, the dopamine transporters (DAT), and degrees of dependence in male smokers., Methods: Eleven male smokers and 11 healthy non-smokers were recruited. The striatal dopamine D2/D3 receptor availability was approximated using SPECT and [123 I] IBZM while the DAT availability was approximated using SPECT and [99m Tc] TRODAT-1. All of the smokers completed the Fagerström Test for Nicotine Dependence (FTND) and other related questionnaires., Results: A decrease in DAT availability in the striatum of male smokers is noted (p<05). However, the striatal D2/D3 receptor availability in male smokers does not differ from that of non-smokers., Conclusions: These findings suggest that cigarette smoking may alter central dopamine functions in males, particularly at the pre-synaptic sites.

The present study examined the relationship between serotonin transporter (SERT) availability and hostility scores in healthy volunteers. SERT availability was measured by using SPECT with [(123)I] ADAM in 10 healthy participants. Hostility was measured with the Cook-Medley Hostility Scale. Hostile attribution, but not the other subscales of hostility, was negatively correlated with SERT availability. Central serotoninergic activities may play a role in hostility.

Background: Metabolic abnormalities, including insulin resistance and increased leptin levels, were noted in patients with schizophrenia who had received antipsychotics. In this study, we examined the leptin levels of antipsychotic-naïve schizophrenic patients., Method: Seventeen antipsychotic-naïve patients with schizophrenia and 16 sex-, age- and body mass index (BMI)-matched subjects were recruited from the psychiatric outpatient clinic and community, respectively. Serum leptin levels of the healthy controls and antipsychotic-naïve patients were compared. The relationships between leptin level and gender, Positive and Negative Syndrome Scale score, and duration of illness were analyzed by Spearman's correlation., Results: Compared with sex-, age- and BMI-matched subjects, the female schizophrenic patients had elevated serum leptin levels. In the male patients, the results of this preliminary study also revealed a positive correlation between leptin levels and the Aggression Risk Profile subscale of the PANSS., Conclusion: This preliminary study suggests possible gender-specific leptin dysregulation in antipsychotic-naïve schizophrenic patients., (Copyright 2008 S. Karger AG, Basel.)

Background: The relationship between the striatal dopaminergic system and cardiovascular activity is not well known. The aim of this study is to investigate the relationship between striatal D2/D3 receptor binding and cardiovascular activity., Methods: The striatal D2/D3 receptor binding of 34 healthy volunteers was assessed by the single-photon emission computed tomography (SPECT) imaging method with the [123I]-iodobenzoamide (IBZM) ligand. The ratio of the radioactivity in the striatum (St) and the frontal cortex (Fc) (St/Fc ratio) was used as the marker for striatal D2/D3 receptor binding. Their cardiac autonomic functions were measured by continuously monitoring their heart rate and blood pressure (BP) in supine position during 10 min. The heart rate variability (HRV) was analyzed by spectral analysis and the geometric method., Results: The St/Fc ratio of striatal dopamine D2/D3 receptor binding correlated negatively with heart rate (HR), and positively with cardiac vagal index (CVI) and low frequency (LF) power in healthy subjects who were in a supine resting position., Conclusions: Striatal dopamine D2/D3 receptors may play a part in cardiovascular regulation.

Surface plasmon resonance (SPR) sensing and an enhanced data analysis technique are used to obtain precise predictions of the dielectric constant and thickness of a nanolayer. In the proposed approach, a modified analytical method is used to obtain initial estimates of the dielectric constants and thicknesses of the metal film and a nanolayer on the sensing surface of a SPR sensor. A multiexperiment data analysis approach based on a two-solvent SPR method is then employed to improve the initial estimates by suppressing the noise in the measurement data. The proposed two-stage approach is employed to determine the dielectric constant and thickness of a molecular imprinting polymer nanolayer. It is found that the results are in good agreement with those obtained with an ellipsometer and a high-resolution scanning electron microscope.