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The defective platelets of end-stage renal disease patients might be further incapacitated by the antiplatelet effect of selective serotonin reuptake inhibitor, and bleeding tendency in these patients could be aggravated. Here we demonstrate an end-stage renal disease patient who was admitted for duodenal ulcer bleeding during the treatment with fluoxetine, and the bleeding did not stop by various active treatments until the cessation of fluoxetine., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age > or =65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.

Forty-one delirious patients who received risperidone treatment and 36 who received haloperidol treatment were retrospectively analysed. Ten-point visual analog scales (scored 0 for none to 10 for extremely severe) for hyperactive and hypoactive syndromes of delirium were used for efficacy evaluation. Psychiatrists scrutinized the medical records and determined the global severity of the syndrome for each patient. The results showed that risperidone and haloperidone were both effective for treating hyperactive symptoms of delirium. The liaison psychiatrists tended to recommend haloperidol for patients with severely hyperactive symptoms and risperidone for older patients and patients with moderate hyperactive symptoms. The patients on risperidone needed much less anticholinergic agent. The maximal daily dose of risperidone was in the range 0.5-4.0 mg, with a mean of 1.17+/-0.76 mg, which was much lower than that for schizophrenia. The present study showed that risperidone appears to be effective and safe for the treatment of delirium.

There have been few studies of the psychiatric characteristics of analgesics addiction. The physician's perceptions that patients were addicted to analgesics might be partially attributable to frustration with poor response to treatment. In this retrospective study, we evaluated the medical records of 20 subjects (15 male and 5 female) who were perceived as having addiction to meperidine by general physicians. The most common medical diagnosis among these patients was chronic pancreatitis (7/20). Among them, five had a past history of suicide attempt and three had self-injury behavior during the index admission. The fact that subjects were perceived as being addicted might be attributable to a vicious cycle of the following factors: 1) chronic intractable pain; 2) poor staff-patient relationship; 3) lower pain threshold or tolerance due to anxiety or depression; 4) patients with a history or tendency of substance abuse; 5) placebo use and inadequate analgesics regimen. The findings of this study suggest that the importance of the following diagnostic and treatment procedures in these patients: 1) suicide risk should be evaluated; 2) comorbid psychiatric diseases should be treated; 3) factors that cause a vicious cycle in pain control should be identified; 4) misconceptions of opiate analgesics among medical staff should be discussed; 5) poor staff-patient relationship should be managed aggressively; and 6) "addiction" is a critical diagnosis that should be avoided if possible.

Background: In this paper, we investigate the reasons for treatment refusal at Linkou and Kaohsiung Chang Gung Memorial Hospitals, and offer ways to improve the doctor-patient relationship., Methods: Cases were collected during a 2-year period according to the criterion of notification of "refused treatment" on consultation sheets, with a total of 1631 consultation sheets. All cases were discussed once a week in detail by psychiatrists and the consulting medical staff, and were followed up from 1 to 4 weeks. All cases were treated by the processes of informed consent and crisis intervention. The final results for the reasons of treatment refusal and psychiatric diagnoses were made by psychiatrists and the consulting medical staff., Results: The number of cases compatible with the criterion was 15 (10 men and 5 women). The reasons for treatment refusal included poor communication, inadequate information, lack of competency, denial and shock reaction, reappearance of the suffered experience, and autonomy of patients. The distribution of psychiatric diagnoses included 8 with major depressive disorders, 2 with delirium, 1 with schizophrenic disorder, 1 with adjustment disorder, 1 with acute stress disorder (post-traffic accident), 1 with alcohol dependence, and 1 was deferred. After adequate processes of informed consent and crisis intervention, 12 persons accepted medical treatment., Conclusion: We should give patients adequate informed consent and crisis intervention to establish a good doctor-patient relationship and to respect the patients' autonomy for their choice of treatment.

Although several articles about suicide in general hospitals have been published, the rates of self-destructive individuals among various diseases and departments have not been reported previously. Moreover, self-destructive acts in Chinese general hospital inpatients have been neglected. We retrospectively investigated self-destructive incidents among medical general inpatients. A total of 75 self-destructive incidents, including 15 fatalities, were identified during the 10-year study period. The self-destructive rate was 8.7 per 100,000, and the fatality rate was 1.8 per 100,000 admissions. The highest self-destructive rate occurred in patients admitted to the rehabilitation ward (33.4 per 100,000) followed by the neurology ward (29.9 per 100,000). The highest fatality rate occurred among patients in the neurology ward (6.7 per 100,000). The majority of self-destructive patients suffered from a chronic or terminal illness with the most frequent types of illnesses being malignant neoplasm (31.1%), neurological disease (20.3%), and chronic obstructive pulmonary disease (COPD, 10.8%). COPD patients had the highest rate of self-destructive behavior (64.0 per 100,000) and the highest fatality rate (16.0 per 100,000) due to these incidents. The most common self-destructive incident was knife-cutting. More than one-half (53.4%) of the self-destructive incidents occurred within the first 2 weeks of admission, and nearly one-half (46.7%) occurred during the night shift. Moreover, the majority of severe or fatal incidents also occurred during the night shift. The results suggest that close supervision of high-risk patients should be mandatory within the first 2 weeks following admission, especially during the night shift.

Patients who visited the psychiatric outpatient service of Chang Gung Medical Centre, Tao-Yuan, Taiwan during an 8-year period were studied retrospectively. Among the 10,418 outpatients, 86 (0.83%) were diagnosed as having DSM-IV delusional disorder (DD), including 61 (70.9%) with persecutory type, 12 (14.0%) with the mixed type, seven (8.1%) with jealous type, two (2.3%) with somatic type, two (2.1%) with unspecified type, one (1.2%) with erotomanic type, and another one with grandiose type. The ratio of women to men was 0.86. The mean age at onset was 42.4 +/- 15.41 years, with women being older than men. Thirty-seven cases (43.0%) presented with depressive symptoms at their first visit. Subjects were divided into four groups: persecutory type, jealous type, mixed type and others. There were no significant differences between the four groups in terms of gender, age at onset, time-lapse before seeking psychiatric help, the presence of hallucination or the presence of depression.

Ramsay Hunt syndrome (RHS) is a rare condition within the progressive myoclonic epilepsies syndrome (PME), with a triad of action myoclonus, grand mal seizure and severe cerebellar ataxia. There are few reports about the psychiatric disturbances associated with PME or RHS. The present study examines the evidence that RHS may accompany an organic mental syndrome, ethanol's effective suppression of myoclonus, and the possible resultant problem of alcohol dependence in RHS patients. Two brothers with the previous long-standing diagnosis of RHS and their mental symptoms of persecutory delusion and depression are reported, as well as the additional problem of alcohol dependence in one of them. The cerebellar dysfunction found in RHS may be associated with an underlying organic condition. Determination of the relationship between cerebellar dysfunction and psychosis in RHS will require further study. Although the mechanism of the suppression of myoclonus by alcohol remains unclear, patients should be allowed to drink socially, and alcohol consumption should not be totally prohibited. However, effective treatment of the problems of alcohol tolerance, abuse, or dependence requires the cooperation of both neurologists and psychiatrists.

Background: There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data., Methods: Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand., Results: The lifetime prevalence rates/100 for suicide ideation ranged from 2.09 (Beirut) to 18.51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0.72 (Beirut) to 5.93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married., Conclusions: While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

The legislation of the Mental Health Law which came into effect on 7 December 1990 was the most important event among a series of innovatory measures and actions taken by the government during the 1980s and the years that followed to improve the nation's mental health program. The law consists of 52 articles classified into seven chapters. The impact of the law on the development of mental health program has been significant in many aspects. There are, however, issues and controversies in this new law which need continuous monitoring as the mental health program progresses.

Socioeconomic development has led to a progressive increase of alcohol consumption in Taiwan, with an accompanying increase in alcohol-related psychiatric problems, traffic accidents, and liver disease. The prevalent rates of alcohol dependence for Han Chinese and Fomosan aborigines were 0.1% and 1%, respectively in 1950. The rate of alcohol dependence increased to 23% for aborigines in 1995. The number of cases of death and serious injuries due to alcohol-related traffic accident has decreased, and the number of fatalities resulting from these accidents has decreased from third to eighth since the inception of a program of random traffic stops with alcohol breath test in 1997. Alcohol liver disease (ALD) was defined as daily alcohol consumption of 60 g, for a duration of longer than 5 years. We classified ALD patients into two groups: (1) those whose average daily consumption of alcohol exceeded 120 g for a duration longer than 15 years (group A); and (2) all other patients (group B). The case records of 33 cases of biopsy-confirmed ALD were obtained for study. The average of daily alcohol consumption in these cases was 160 g. All but one of these patients were male, age ranged from 26 to 69 years, with an average of 43.1. Clinically, ill-defined gastrointestinal symptoms were the most common presentation (61%), and hepatomegaly was the main physical sign (73%). The average mean corpuscular volume values of ALD and non-ALD patients were 102.3 +/- 10.94 and 94.5 +/- 8.1, respectively (p < 0.01). The mean corpuscular volume values of group A and group B were 102.9 +/- 9.7 vs. 96.5 +/- 9.11 (p < 0.05). Result from serum SGOT/SGPT and gamma-glutamyltransferase/alkaline phosphatase for ALD and non-ALD revealed statistically significant differences between these groups. Using the avidin-biotin complex technique, tissue IgA deposition for ALD patients was found to be different from that of non-ALD patients. Ten of 13 ALD patients vs. 2 of 13 non-ALD patients had continuous-form IgA deposition. Histologically, 45.5% of ALD patients had alcoholic cirrhosis, whereas alcoholic hepatitis was present in only 9.1% of patients. Overall, 88% of cases showed various severity of fatty metamorphosis.

Background: A high comorbidity of alcohol use disorders among Western bipolar patients is recognized and worsens the outcome of bipolar illness. In view of lower prevalence of alcohol use disorders in some Asian groups, we attempted to investigate the alcohol problems among Chinese bipolar patients in Taiwan., Methods: The clinical data of bipolar patients (DSM-III-R) having been followed-up naturally for at least 15 years were obtained by a combination of chart reviews and interviews with patients and family members., Results: Based on a retrospective chart review of 158 patients, 8.2% of them were found to have alcohol problems. The lifetime prevalence of alcohol abuse was 6.9%, and of alcohol dependence 3.0% among 101 subjects accepting interview. According to the Global Assessment of Functioning Scale (APA, 1994) nearly one-third of them were clearly dysfunctional., Limitation: As subjects had a greater mean age, the age-related effects probably worsened the psychosocial outcome and reduced the incidence of new substance abuse., Conclusion: Chinese bipolar patients, despite a lower comorbidity of alcohol use disorders, do not have a more favorable long-term psychosocial outcome (marriage, work, and social adjustment) than Western patients.

In a recent issue of the Harvard Review of Psychiatry, results from the Stirling County Study showed that the prevalence and incidence rates of depression were similar in men and women when "gender-fair" criteria were used and help-seeking was not required. We attempted to replicate these findings by applying the criteria for depression from the Stirling County Study to two national and six international epidemiologic surveys conducted in the 1980s and 1990s. Depression was defined as dysphoric mood and disturbances of sleep, appetite, and energy, with at least a mild degree of impairment. The rates of depression were computed using this algorithm with data from the US Epidemiologic Catchment Area Study, conducted in the 1980s, the US National Comorbidity Survey, conducted in the 1990s, and independent community surveys from Canada, Puerto Rico, France, Taiwan, Korea, and New Zealand. For the US studies, these rates were recalculated after persons seeking treatment were removed from the analyses, where such data were available. Using Stirling County Study criteria, the lifetime prevalence rate of depression remains approximately twice as high in women as in men cross-nationally, except in Puerto Rico. Excluding help-seeking as a criterion and controlling for birth cohort do not change the findings. The Stirling County findings on absence of a sex difference in rates of depression using "gender-fair" criteria may be due to methodological variance in the collection of data, sample size, or the social and/or genetic uniqueness of the Atlantic Canadian community.

Background: Epidemiological data on panic disorder from community studies from 10 countries around the world are presented to determine the consistency of findings across diverse cultures., Method: Data from independently conducted community surveys from 10 countries (the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand), using the Diagnostic Interview Schedule and DSM-III criteria and including over 40,000 subjects, were analyzed with appropriate standardization for age and sex differences among subjects from different countries., Results: The lifetime prevalence rates for panic disorder ranged from 1.4 per 100 in Edmonton, Alberta, to 2.9 per 100 in Florence, Italy, with the exception of that in Taiwan, 0.4 per 100, where rates for most psychiatric disorders are low. Mean age at first onset was usually in early to middle adulthood. The rates were higher in female than male subjects in all countries. Panic disorder was associated with an increased risk of agoraphobia and major depression in all countries., Conclusions: Panic disorder is relatively consistent, with a few exceptions, in rates and patterns across different countries. It is unclear why the rates of panic and other psychiatric disorders are lower in Taiwan.

The lifetime prevalence rate of major depressive disorder (MDD), as defined by the Chinese Diagnostic Interview Schedule, is 1.14% in Taiwan. This is significantly lower than the lifetime prevalence rates reported in Western studies and similar to other studies in the Chinese population using similar methods for assessing cases of MDD. Epidemiological data from 136 MDD cases were analyzed to provide possible explanations for this difference in lifetime prevalence rates. The low rate of broken families in Chinese culture, low comorbidity rate, and older age of onset of MDD may suggest a reality of low lifetime prevalence rates of MDD in Taiwan.

Objective: To estimate the rates and patterns of major depression and bipolar disorder based on cross-national epidemiologic surveys., Design and Setting: Population-based epidemiologic studies using similar methods from 10 countries: the United States, Canada, Puerto Rico, France, West Germany, Italy, Lebanon, Taiwan, Korea, and New Zealand., Participants: Approximately 38000 community subjects., Outcome Measures: Rates, demographics, and age at onset of major depression and bipolar disorder. Symptom profiles, comorbidity, and marital status with major depression., Results: The lifetime rates for major depression vary widely across countries, ranging from 1.5 cases per 100 adults in the sample in Taiwan to 19.0 cases per 100 adults in Beirut. The annual rates ranged from 0.8 cases per 100 adults in Taiwan to 5.8 cases per 100 adults in New Zealand. The mean age at onset shows less variation (range, 24.8-34.8 years). In every country, the rates of major depression were higher for women than men. By contrast, the lifetime rates of bipolar disorder are more consistent across countries (0.3/100 in Taiwan to 1.5/100 in New Zealand); the sex ratios are nearly equal; and the age at first onset is earlier (average, 6 years) than the onset of major depression. Insomnia and loss of energy occurred in most persons with major depression at each site. Persons with major depression were also at increased risk for comorbidity with substance abuse and anxiety disorders at all sites. Persons who were separated or divorced had significantly higher rates of major depression than married persons in most of the countries, and the risk was somewhat greater for divorced or separated men than women in most countries., Conclusions: There are striking similarities across countries in patterns of major depression and of bipolar disorder. The differences in rates for major depression across countries suggest that cultural differences or different risk factors affect the expression of the disorder.

In 200 cases for psychiatric consultation, 73 (36.5%) cases, 51 males and 22 females, were diagnosed as suffered from organic mental syndrome/disorder according to DSM-III-R criteria. Their mean age was 47.9 +/- 18.9 years. The leading psychiatric diagnosis were delirium (45.2%) and substance intoxication/withdrawal (20.5%). The main reasons for psychiatric consultation were psychotic symptoms (31.5%) and conscious disturbance (19.2%). The most common presumed etiologies for organic mental disorders were psycoactive substance related (39.7%) and metabolic (15.1%) causes. The comparisons of the results reported by several medical centers in recent years were further discussed in the text.

Genetic variation at two polymorphic alcohol dehydrogenase loci, ADH2 and ADH3, and at the polymorphic mitochondrial aldehyde dehydrogenase locus, ALDH2, may influence the risk of developing alcoholism by modulating the rate of elimination of ethanol and the rate of formation and elimination of acetaldehyde. Populations differ in allele frequencies at these loci. We determined the genotypes at all three of these loci in Atayal natives of Taiwan. The frequencies of ADH2*2, ADH3*1, and ALDH2*1 alleles (0.91, 0.99, and 0.95, respectively) were significantly higher among the Atayal than among a predominantly Han Chinese population from Taiwan. Among the Atayal, the group with alcohol use disorders (alcohol dependence and alcohol abuse) had a significantly lower frequency of the ADH2*2 allele (0.82) than those without alcohol use disorders (0.91). The ADH2*2 allele encodes the beta 2 subunit; isozymes containing beta 2 subunits oxidize alcohol faster in vitro than the beta 1 beta 1 isozyme encoded by ADH2*1. Thus, the simplest explanation for these data is that individuals with a beta 2 isozymes have a higher rate of ethanol oxidation, which is a deterrent to alcohol abuse and dependence in some individuals. The Atayal with alcohol use disorders also had a lower frequency of ALDH2*2 than the controls; this allele is known to be responsible for the alcohol-flush reaction among Asians, and thereby deters drinking.

Objective: Cross-cultural psychiatric research has suffered from many methodological shortcomings. To answer some of these shortcomings, the present study compared rates of psychiatric disorders in Taiwan and the United States by combining data from both countries into a single data set., Method: Results from large, community-based surveys in the United States and Taiwan, the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area survey and the Taiwan Psychiatric Epidemiological Project, were combined into a single data set. This integration of the data sets was possible because both surveys used the NIMH Diagnostic Interview Schedule to ascertain cases. The integrated data sets were then analyzed with identical algorithms to generate lifetime prevalence rates of psychiatric disorders according to DSM-III criteria for both the United States and Taiwan., Results: Lifetime prevalence rates of psychiatric illness in Taiwan were generally lower than U.S. rates. The rates of any disorder were 21.56% in Taiwan and 35.55% in the United States (Z = 22.34, p less than 10(-109]. The rates of most specific disorders were lower in Taiwan, and none of the rates was higher in Taiwan., Conclusions: While a culturally determined response bias may have lowered the rates in Taiwan somewhat, the results appear to be valid. Implications for the future use of structured diagnostic interviews in cross-cultural research are discussed.

A study was performed to verify that the prevalence of alcohol abuse and dependence in Formosan aborigines differs from that of Taiwanese (Chinese Han people), using analysis of aldehyde dehydrogenase (ALDH) isozymes and flush patterns on randomly sampled 70 Atayal, 66 Paiwan, 61 Yami and 94 Taiwanese subjects were studied. The activity of an isomer of ALDH having a low Km (ALDH-I) in hair roots was analysed by isoelectric focusing assay. The subjective experience of flushing response after alcohol ingestion was assessed. Results showed that the rate of ALDH-I deficiency in Taiwanese (51.1%) was significantly higher than in aborigines, i.e., 6.4%, 3.9%, and 0% in Atayal, Paiwan, and Yami subjects, respectively. The percentage occurrence of ALDH-I deficiency and prevalence of alcohol dependence in Taiwanese and aborigines were negatively correlated. The predominant pattern of self-reported flush response after alcohol use among aborigines was of slow onset. The flush response to alcohol ingestion was examined in relation to aldehyde metabolizing enzyme. Since alcohol sensitivity is an important factor in the development and maintenance of the alcohol ingestion habit in humans, our results support the hypothesis that there is a biological basis in the different rates of alcohol abuse and dependence among different ethnic groups.

Twenty-two patients, 8 males and 14 females, who had been lithium-free for at least 1 week were included in this study. All patients took 900 mg of Lithonate at 8:00 a.m. while in a fasting state. A 5 ml blood sample was taken at 9:00 a.m., 10 a.m., 12 noon, 3 p.m., 5 p.m., 11 p.m., and at 9 a.m. and 3 p.m. on the next day. Plasma was separated immediately, and the lithium level was measured by atomic absorption spectrophotometry. The pharmacokinetic parameters were as follows: K12 (microconstant) = 0.3455 +/- 0.5345 (mean +/- SD) h-1; K21 (microconstant) = 0.1691 +/- 0.1242 h-1; K10 (microconstant) = 0.1320 +/- 0.1112 h-1; Vl (volume of distribution of central compartment) = 16.9057 +/- 5.9384 1; Vss (volume of distribution at steady state) = 38.8917 +/- 11.4540 1; V-beta (volume of distribution of elimination phase) = 46.3809 +/- 13.8742 1; alpha (distribution rate constant) = 0.5932 +/- 0.7090; and beta (excretion rate constant) = 0.0361 +/- 0.0141. The mean elimination half-life, AUC (the area under the curve) and clearance were 22.5 +/- 9.9 h (range from 9.6 to 50.4 h), 16.33 +/- 5.52 mmoll-1h (8.69 to 31.81 mmoll-1 h), and 1.65 +/- 0.53 1h-1 (0.76 to 2.28 1h-1) or 28.59 +/- 9.58 ml/kg-1 h-1, respectively. There were no statistically significant differences in beta, AUC and clearance between Taiwanese/Chinese and Danish results. The possibility of lowering the traditional prophylactic therapeutic range of lithium to around 0.5-0.8 mmol/L is supported by the results of this study.

The prevalence of alcoholism was reported to be 0.1% in an aboriginal study on Taiwan using the census survey method in the 1950s. This study adopted a modified Chinese Diagnostic Interview Schedule to determine the prevalence of DSM-III-defined alcohol abuse (AA) and alcohol dependence (AD) in the Atayal, Paiwan and Yami ethnic groups of Taiwan aborigines. Stratified random sampling was used. The sample sizes of Atayal, Paiwan and Yami were 793, 656 and 106 respectively. The prevalence rates of DSM-III-defined AA and AD were 11.6%, 11.4% and 14.2%; and 9.0%, 8.1% and 6.4% respectively. No significant difference was found between the 3 ethnic groups. These prevalence figures are significantly higher than those for Chinese. In this comparative analysis, 2 distinct etiological hypotheses are proposed for the AA and the AD.

This study investigated the risk factors of alcohol abuse and alcohol dependence, as defined by DSM-III criteria, in 11,004 Chinese subjects in the Taiwan community. Risk factors were analyzed using chi-square and multivariate logistic regression statistics. The logistic regression shows that the risk factors of alcohol dependence include male, having had childhood or adulthood behavior problems; of alcohol abuse include male, having had childhood or adulthood behavior problems, non-metropolitan community, age cohort, job-holder. The etiological models proposed are biological for Chinese alcohol dependence and interactional for Chinese alcohol abuse.

The lithium index, a ratio of erythrocyte (intracellular) to plasma (extracellular) lithium concentrations, were studied by in vitro method in 22 healthy volunteers, 15 men and 17 women. Their mean age was 31.0 +/- 4.6 years (ranging from 26 to 41 years). In the study design, 20 ml of venous blood was taken from each subject into a test tube containing sodium citrate at the room temperature and erythrocytes were separated from plasma immediately. Then, the whole procedures for preparation and determination of lithium index were performed by using Pandey's method. Lithium levels were measured by atomic absorption spectrophotometry. Values of lithium index in vitro thus obtained were: 0.43 +/- 0.13 (range, 0.23-0.73) in men plus women; 0.37 +/- 0.10 (range, 0.23-0.57) in men; 0.49 +/- 0.13 (range, 0.26-0.73) in women. Women had a significantly higher Li+ index in vitro than men (t = 2.86, d.f. = 30, p less than 0.005). The possible reasons for the difference of the Li+ index in vitro between our result and other studies were discussed.

The Diagnostic Interview Schedule (DIS) is a highly structured instrument that enables lay examiners to gather the clinical information necessary to generate psychiatric disorders according to the DSM-III, Feighner, and Research Diagnostic Criteria. It was developed originally as the diagnostic interview for the Epidemiologic Catchment Area (ECA) survey. Because it adheres to DSM-III and can be used by lay interviewers, thus making it practical for studies involving large samples, it has been used for other population surveys in North and South America, Europe, and Asia. This investigation compares the epidemiology of DSM-III-defined alcohol abuse and addiction in DIS-based population surveys cross-nationally (in St Louis, Mo; Edmonton, Canada; Puerto Rico; Taipei City, Taiwan; and South Korea). We found considerable variation in the lifetime prevalence of alcoholism but a similarity in the age of onset, the symptomatic expression, and the associated risk factors. We also found an inverse correlation between the prevalence of alcoholism and the strength of the association of the risk factors we examined. The work described herein demonstrates the utility of consistent definition and method in cross-cultural psychiatric research. The substantive findings have implications for the definition of alcoholism and for a better understanding of genetic and environmental interactions in its etiology.

Plasma homovanillic acid (pHVA) and plasma methoxyhydroxyphenyl glycol (pMHPG), as well as plasma haloperidol, were measured in 33 schizophrenic patients before and during 6 weeks of haloperidol treatment. Good responders had higher baseline pHVA values compared with poor responders (17.4 +/- 8.8 ng/ml, n = 22 versus 11.4 +/- 5.0 ng/ml, n = 11, p less than 0.05). A higher than 15 ng/ml pretreatment pHVA level was associated with a more consistent clinical response to the subsequent treatment. Differential pHVA changes during treatment were also found between good and poor responders. Within the good responder group, a significant decline in pHVA over time was found. By contrast, pHVA showed a transient increase in the poor responder group. Plasma MHPG changes showed a similar pattern during treatment in good responders, although no significant differences in baseline values were found between the good (n = 13) and poor (n = 9) responders, and pMHPG showed no change during treatment in poor responders. Significant correlations between baseline pHVA and pMHPG values were found in 22 patients. Good responders and poor responders did not differ significantly in terms of age, duration of illness, severity of presenting symptoms, haloperidol dose, or plasma drug concentration. Two hypothetical subtypes of schizophrenia and both dopamine and norepinephrine systems involved in schizophrenic psychopathology are proposed.

Dose-response curves for the elevation of homovanillic acid (HVA) levels, determined by high performance liquid chromatography using electrochemical detection, in the pre-frontal cortex and caudate of rats after acute treatment with 12 antipsychotic drugs are presented. The order of potency in both brain regions was: haloperidol greater than or equal to fluphenazine greater than loxapine greater than trifluoperazine greater than thiothixene greater than molindone greater than clopenthixol greater than chlorpromazine greater than metoclopramide greater than thioridazine greater than clozapine greater than sulpiride. This ranking is roughly correlated with that based on clinical potencies. The relative elevation of the content of HVA was weaker in the pre-frontal cortex than in the caudate for all drugs tested, except clozapine at a high dose.

Striatal homovanillic acid (HVA) levels and drug concentrations in striatum and plasma were examined in guinea pigs after acute and subchronic administrations of haloperidol (HAL) and reduced HAL (RHAL). HVA and drug levels were measured by high performance liquid chromatography with electrochemical detection. HAL and RHAL were interconverted in 10 min. Both maximal HVA responses and peak levels of HAL and RHAL in the striatum were reached at 2 h after injections of both HAL and RHAL. The potency of RHAL in HVA elevation was about one-half that of HAL, consistent with the HAL levels after RHAL and HAL administration. The higher the dose of HAL or RHAL injected, or after repeated injections, the greater the RHAL to HAL ratio produced. In addition, the RHAL to HAL ratios after RHAL were higher than those after HAL. These results suggest that the oxidative drug metabolizing systems are weaker than the reductive processes.

The validity of DIS-CM (Chinese modified version of Diagnostic Interview Schedule) was examined by analyzing lifetime prevalence of each age group, age at onset, and recency of illness. The magnitude of the discrepancy between the empirical and the estimated data was adopted as the criterion of the degree of deviation. Manic and depressive episodes were found to be seriously underestimated. Schizophrenic, panic, phobic and antisocial personality disorders were probably underestimated. The observed lifetime prevalence figures with DIS-CM are rather conservative for these disorders. The prevalence data of a recent 1-year period are less biased and more reliable. The nature of the disease, recall effect, active or passive psychological resistance, mortality, and uncooperative attitude are considered factors that induce an underestimate of lifetime prevalence.

The effects of acute and chronic administration of haloperidol on homovanillic acid (HVA) in plasma and the brain were examined in the rat. Acute haloperidol treatment (1 mg/kg) resulted in highly significant elevations in HVA within 30 min and produced a maximal increase of HVA in 3-6 hr in both plasma and the whole brain. The response of brain HVA to increasing doses (0.05-30 mg/kg) of haloperidol showed an inverted U pattern. Plasma HVA showed a very flat response to lower doses (less than or equal to 5 mg/kg) of haloperidol and a dramatically elevated one to higher doses (greater than or equal to 10 mg/kg). Haloperidol produced a parallel increase in plasma and brain HVA at lower doses (less than or equal to 2 mg/kg) only. After chronic administration of haloperidol for up to 28 days, the response of HVA in plasma correlated mainly with, but tolerated later than, those in the whole brain and the olfactory tubercle.

The Taiwan Psychiatric Epidemiological Project, conducted from 1982 to 1986, used the multistage random sampling method with 5005, 3004 and 2995 subjects selected respectively from metropolitan Taipei (MT), 2 small towns (ST) and 6 rural villages (RV). The case identification tool was the Chinese modified Diagnostic Interview Schedule (DIS-CM). This study presents the lifetime and one-year prevalence of 27 and of 17 specific psychiatric disorders respectively. The lifetime prevalence of any disorder defined by the DIS-CM -- excluding tobacco dependence -- was 16.3%, 28.0% and 21.5% in the MT, ST and RV samples respectively. The differences in lifetime prevalence between the sexes and between the 3 sampling areas were significant for 15 and 8 disorders respectively. The ST sample seemed to have the most disorders, with the highest prevalence among 3 sampling areas. The mean ratio of one-year to lifetime prevalence was 0.67. The differences in prevalence rates between the 3 sampling areas and between the international studies are discussed from methodological, social and cultural points of view.

It is known that aldehyde dehydrogenase (ALDH) responsible for metabolism of acetaldehyde deriving from ethanol has two distinct forms of isozymes: ALDH-I (low Km ALDH) and ALDH-II (high Km ALDH), and that many Orientals lack ALDH-I isozyme genetically. In the present study, the role of ALDH isozyme variance in the alcohol sensitivity, drinking habits formation and the development of alcoholism was investigated in Japan, Taiwan and the Phillipines. Isozyme analysis using isoelectric focusing of hair roots specimens from normal volunteers or schizophrenics revealed that about 42% of Japanese, 35% of Taiwanese and 12% of Phillipines were ALDH-I deficient. Questionnaire study of Japanese volunteers indicated that ALDH-I deficient individuals showed flushing, palpitation and other uncomfortable somatic signs, due to reduced metabolism of acetaldehyde, much more frequently than ALDH-I positive ones. Consequently, it occurred that only 19% (8/42) of ALDH-I deficient persons, in contrast to 49% (29/59) of ALDH-I positive ones, were drinking habitually. Patients with alcoholism showed much smaller percentages of ALDH-I deficiency: 4% (5/113) in Japan and 10% (3/29) in Taiwan, than those of control subjects. Summarizing these data, a hypothesis can be presented that genetically derived difference of ALDH activities is one of the determining factors in the sensitivity to alcohol, formation of drinking habits, and finally in the development of alcoholism, at least among Oriental peoples.

Twelve male chronic schizophrenic inpatients, neuroleptic-free for at least 4 weeks, were given an oral test dose of 10 mg haloperidol (HAL) and reduced HAL (RHAL) in a random order, with a 2-week interval. Two weeks after the last test dose, the patients were given HAL, 5 mg orally twice daily for 7 days. Blood samples were drawn at baseline and between 0.5 and 24 hr after the test doses, and during HAL treatment as well. Plasma drug concentrations and homovanillic acid (HVA) levels were measured with high-performance liquid chromatography using electrochemical detection. HAL, but not RHAL, produced increments in plasma HVA (pHVA) levels at 24 hr after a test dose. pHVA levels remained higher than baseline during HAL treatment. Detectable interconversion between HAL and RHAL was observed in eight patients. The capacity of the reductive drug-metabolizing enzyme system, however, was greater than that of the oxidative processes. The plasma RHAL:HAL ratios on days 6 and 7 were higher than and positively correlated with those at Tmax after a single dose of HAL and were negatively correlated with the HAL:RHAL ratios at Tmax after a single dose of RHAL. Thus, both reductive and oxidative drug-metabolizing systems probably contribute to individual differences in plasma RHAL:HAL ratios in HAL-treated schizophrenic patients.

A community survey in metropolitan Taipei (MT) and two small towns (ST) by using the Chinese modified diagnostic interview schedule (DIS-CM) revealed a significant difference in the prevalence of alcohol abuse (AA) defined by DSM-III between two study samples (MT 3.4%; ST 8.0%), but the prevalence of alcohol dependence (AD) was not different (MT 1.5%; ST 1.8%). These figures are significantly higher than that of an earlier Formosan study. Demographic data, psychiatric symptoms, medical complications and impairment of social functions were adopted as the variables to validate the nosological status of AA and AD. The results of this study substantiated that AA and AD identified by the DIS-CM were nosologically different from a non-alcoholic group. The possible reasons for an increasing prevalence of alcoholism in Taiwan Chinese were discussed. An etiological hypothesis was proposed for AA and AD on account of their differential prevalences.

Plasma levels of homovanillic acid (HVA), a major metabolite of dopamine, were measured in a group of 24 schizophrenic inpatients before and during 6 weeks of haloperidol (HAL) treatment. Steady-state plasma HAL levels were measured in parallel with plasma HVA. Differential plasma HVA responses to HAL treatment were found between good and poor outcome patients. The two groups did not differ significantly in plasma HAL levels. Two hypothetical subtypes of schizophrenia are proposed.

Plasma levels of homovanillic acid (pHVA), a major metabolite of dopamine (DA), were measured in a group of 51 schizophrenic inpatients before and during 6 weeks of neuroleptic treatment. Steady-state plasma drug concentrations were monitored in parallel with pHVA. Good responders (n = 22) had higher pretreatment pHVA levels as compared to poor responders (n = 22). Differential pHVA changes during neuroleptic treatment were also found between each group. The two groups did not differ significantly in terms of age, duration of illness, severity of presenting symptoms, neuroleptic, dose, or plasma drug concentration. Two hypothetical subtypes in the group of schizophrenics were proposed.

NIMH-DIS was translated into Chinese and modified to the Chinese version of DIS (DIS-CM). One hundred clinical patients and 187 community subjects were studied for diagnostic agreement between the DIS-CM and the psychiatrist's clinical diagnosis. In the community sample, DIS-CM overdiagnosed the cases of manic episode, phobic disorder, obsessive-compulsive disorder and alcoholic problem, while it underdiagnosed the cases of tobacco dependence in the community sample and manic episode in the clinical cases. Standard diagnostic criteria, method of symptom detection, and social desirability, were identified as the major factors contributing to the diagnostic disparity. Variables related to life situations, language habit and medical histories were also analysed to test the external validity of the DIS-CM in case identification. The results affirm that the DIS-CM is reliable as a psychiatric epidemiological tool.

Description among Zhenjiang Psychiatric Hospital (ZPH) Taipei City Psychiatric Center (TCPC), and New York State Psychiatric Hospital, Rockland Psychiatric Center (RPC) admission cohorts during the identical year indicates that the RPC cohort demonstrates different frequencies of major psychiatric illness than the ZPH and TCPC cohorts which are remarkably similar. Schizophrenia is more prevalent among RPC public admissions than ZPH and TCPC. Mania exceeds depression in ZPH and TCPC samples while depression exceeds mania in RPC. Females predominate among ZPH and TCPC admissions, in contrast to male predominance in RPC. Wherease alcoholism is almost non-existant among ZPH and TCPC admissions, over half the RPC sample had a diagnosis of substance abuse.