Search

BackgroundAnhedonia, a core diagnostic feature for major depressive disorder (MDD), is defined as the loss of pleasure and interest in daily activities. Its prevalence in MDD patients vary from 35 to 70%. Anhedonia in MDD negatively impacts functioning and is associated with treatment resistance and poorer prognosis for various clinical outcomes. Owing to its complexity, there remains considerable heterogeneity in the conceptualization, diagnosis and clinical management of anhedonia in MDD.MethodsThis modified Delphi panel was conducted to elicit expert opinion and establish consensus on concepts relating to clinical features, diagnosis and treatment of MDD with anhedonia (MDDwA) amongst psychiatrists in the Asia-Pacific region. Seven themes were covered. A three-stage process was adopted for consensus generation (two online survey rounds, followed by a moderated consensus meeting). Statements were developed based on a literature review and input from a steering committee of six regional experts. The panel included 12 psychiatrists practicing in Australia, China, Hong Kong, Japan, South Korea and Taiwan with ≥5 years of specialist clinical experience, including assessment or management of patients with MDDwA.ResultsOverall, consensus was achieved (median ≥8) on 89/103 statements (86%). About half of the statements (55/103, 53%) achieved consensus in Round 1, and 29/36 modified statements achieved consensus in Round 2. At the moderated consensus meeting, five modified statements were discussed by the steering committee and consensus was achieved on all statements (5/5). The findings highlighted a lack of clear and practical methods in clinical practice for assessing anhedonia in MDD patients and limited physician awareness of anhedonia in Asia-Pacific.ConclusionInsights from this Delphi consensus provide a reference point for psychiatrists in Asia-Pacific to optimize their strategies for personalized diagnosis and management of patients with MDDwA. Identification of distinct and clinically relevant subtypes in MDD may be valuable for guiding personalized diagnosis and management approaches, including type-specific therapies.

The effectiveness of a community-based psychiatric rehabilitation (CBPR) program had been proven for people with severe mental illness (SMI), but a high discontinuation rate was also noted. The aim of this study was to explore predictors of utilization and outcome of the CBPR program. This retrospective design explored predictors of the program utilization. The data of demographics, illness history, and occupational functioning were collected during an 8-year period and after 2 years follow-up. 162 participants were referred. Forty nine participants (30.25%) refused to participate in (non-attendance group) and 113 (69.75%) attendance in the program (rehabilitation utilizing group). Compared to the non-attendance group, the rehabilitation utilizing group had single status, higher education level, younger age of onset, lived during the hospital-based day center services, a higher proportion of day center services referral, work experience prior to onset, and less than 3 months consecutive work experience prior to onset. Furthermore, the individuals in the rehabilitation utilizing group had higher successfully return to the community and significantly lower acute hospitalization at 1 and 2 years follow-up. In addition to the demographic factors, that individuals’ previous and current occupational functioning were potential factors for those who successfully attended CBPR service. CBPR may be beneficial to people with SMI in prompted occupational functioning and reduced relapse. We should consider the factors, and make corresponding plans to support engagement in recovery and wellness for people with mental illness.

Objectives: Neuropsychiatric symptoms are related to hyperthyroidism. Whether global cognitive function is impaired is unclear. In this study, we intended to investigate whether patients with Graves' disease (GD) are characterized by a lower intelligence quotient (IQ) and gray matter volume loss. Methods: We enrolled 36 patients with GD and 36 healthy controls. Intelligence quotient and other cognitive functions, such as memory and attention, were assessed. Magnetic resonance imaging (MRI) study was used to measure the gray matter volume for those study participants. Results: Significantly lower IQ scores (p < 0.001) and poor memory function (p < 0.05) were found among the patients with GD. We also found that patients with GD had a nonsignificant larger gray matter volume in the precuneus compared with that in healthy controls. Conclusion: The deficits on global and complex cognitive testing among patients with GD should be noted. We speculate that the larger gray matter volume in the precuneus might be due to compensation.

Abstract Bipolar disorder (BD) and metabolic disturbance represent a chronic state of low-grade inflammation and corticostriatal circuitry alterations. Herein, we aimed to investigate whether plasma leptin, an adipokine that plays a key role in the interplay of metabolism and inflammation, is associated with corticostriatal connectivity in patients with BD. Twenty-eight BD I patients, 36 BD II patients and 66 healthy controls were enrolled and completed the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Recent Life Change Questionnaire. Fasting plasma leptin and C-reactive protein (CRP) levels were measured, and corticostriatal connectivity was examined using functional magnetic resonance imaging (fMRI). The relationships between leptin, CRP and body mass index (BMI) identified in the controls and BD II patients were absent in the BD I patients. We did not find a significant group difference in the leptin level; nevertheless, the negative correlation between leptin level and corticostriatal connectivity (ventrolateral prefrontal cortex and inferior temporal gyrus) observed in the healthy controls was absent in the BD patients. The disproportionate increase in leptin level with increasing BMI in BD indicated a potential inflammatory role of white adipose tissue in BD. Furthermore, higher CRP levels in BD I patients might induce leptin resistance. Collectively, our results implied vulnerability to inflammatory and metabolic diseases in patients with BD, especially BD I.

Abstract Emotion recognition deficit is related to impaired community functioning. Loneliness is also associated with impaired social performance. However, the way in which emotion recognition and loneliness may contribute to social functioning remains unclear in euthymic patients with bipolar disorder. We aimed to examine emotion recognition ability in Han Chinese euBD patients relative to healthy controls (HCs) and to investigate the associations between emotion recognition, loneliness, and social functioning. Thirty‐nine HCs and 46 euthymic BD patients completed an emotion recognition task and nonsocial cognitive measures related to executive function and attention. The UCLA loneliness scale and Social Performance Scale were administered to evaluate psychological loneliness and social functioning, respectively. We observed lower emotion recognition accuracy, higher loneliness, and poorer social functioning in the BD patients after adjustment for demographic data. Loneliness was negatively associated with global social functioning in both the BD and HC groups. Higher loneliness and lower emotion recognition accuracy were associated with poorer social functioning in euthymic BD in different subdomains. Our study confirmed a subtle impairment of emotion recognition ability in euthymic BD. Loneliness impacts globally on social functioning, while emotion recognition ability may affect specific subdomains of social functioning in euthymic BD. Alleviation of loneliness and enhancement of social cognition might improve social functioning in BD patients.

Abstract The aim of this study was to investigate whether loneliness and personality traits correlate with the treatment outcome of methamphetamine use disorder. In this 1-year longitudinal study, a total 106 participants (98 males, 8 females), with a mean age 36.3 ± 9.6 years were enrolled. We measured UCLA Loneliness Scale and Tridimensional Personality Questionnaire at baseline, while craving level at baseline, week 12, 24, 36, and 48. Urinary methamphetamine tests were given 17 times. For the evaluation of the data, multiple linear regression and generalized linear mixed models were used. The baseline results showed lower levels of the harm avoidance trait and higher levels of loneliness were significantly associated with higher craving levels (p=0.04 and 0.04). Moreover, loneliness was not only positively associated with craving levels (B=0.05, p

Background: Individuals with childhood trauma may experience loneliness throughout their lives, which can potentially aggravate mental and physical health conditions. Moreover, accumulating evidence suggests that associations exist between childhood trauma and certain features of bipolar disorder (BD), including cognitive dysfunction, severity, and clinical course. But, it remains unclear whether loneliness is associated with childhood trauma or quality of life in adult patients with BD. Methods: We recruited 83 patients with euthymic BD and 40 control participants from the psychiatric outpatient clinic at National Cheng Kung University Hospital. Their severity of mood symptoms was measured according to the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS). All study participants completed the childhood trauma questionnaire (CTQ), World Health Organization Quality of Life (WHOQOL) Scale and University of California, Los Angeles Loneliness Scale. Results: Compared with controls, patients with euthymic BD had significantly higher scores of HDRS (p < 0.01), YMRS (p < 0.001), CTQ (p < 0.001), loneliness scores (p < 0.001), but significantly lower WHOQOL scores (p < 0.001). In patients with euthymic BD, a significantly positive correlation was found between loneliness and CTQ scores (p < 0.001) and a significantly negative correlation was present between loneliness and WHOQOL scores (p < 0.001). These correlations were also present in the control group (p < 0.05 and p < 0.001). Conclusion: Euthymic BD patients had stronger feelings of loneliness than controls overall. In both euthymic BD and control patients, loneliness was positively correlated with childhood trauma and negatively correlated with quality of life. These findings warrant further investigations to strengthen the findings of the causal relationship between childhood trauma and loneliness.

Background/purpose: The association between sex and diagnostic behavior of autism spectrum disorder (ASD), and the effects of comorbid mental retardation (MR) and attention-deficit hyperactivity disorder (ADHD), were explored. Methods: Based on the Taiwan Longitudinal Health Insurance Database (LHID)-2000 and data from 1996 through 2008, the cumulative incidence of ASD over time was compared between the sexes (both cohorts n = 38,117) using the log-rank test. The effects of comorbid MR and ADHD on the incidence of ASD were evaluated using Cox proportional hazard regression analysis. The age at first diagnosis of ASD in the two sexes was compared using the independent-sample t-test. Results: The incidence was higher in males than in females (0.0007 vs. 0.0002) across ages. Comorbid MR or ADHD increased the incidence of ASD in both sexes; comorbid MR or ADHD also decreased the male to female hazard ratio of ASD, with no significant differences in the incidence density of ASD between sexes. ADHD delayed diagnosis in both sexes (males: 6.61 vs 5.10, p

Background: Sleep quality is an important predictor for prognosis of bipolar disorder (BD). Factors associated with sleep quality in BD such as childhood trauma experience merit investigation. Methods: We used the Pittsburgh Sleep Quality Index (PSQI), Childhood Trauma Questionnaire (CTQ), and Measurement of Support Functions (MSF) to access patients with BD-I (n = 31), and those with BD-II (n = 34). Results: We found that 71.4% of patients with BD-I and 90.9% of those with BD-II had poor sleep quality. Significantly higher CTQ physical abuse score and poor life quality were found among patients with BD-II (b = −0.008, Wald χ2 (1) = 5.024, p < 0.05). This effect remained robust (b = −0.012, Wald χ2 (1) = 8.150, p < 0.01) after controlling the use of drug (sedative, benzodiazepine, antipsychotic, and antidepressant). Moreover, the experience of childhood trauma was associated with poor sleep quality among patients with BD-II. A buffer effect of social support between physical abuse and daytime dysfunction, as measured by PSQI, was found in patients with BD-II, but not in those with BD-I. Conclusion: Social adversity and support were associated with sleep quality in patients with BD-II. This finding implied a stress-buffering model in patients with BD-II. But the underlying biological mechanism remains unclear.

Background/Purpose: Although social cognitive deficits were found in euthymic patients of bipolar disorder (BD), the characteristics of social cognition in Han Chinese euthymic BD patients remain obscure. This study aimed to examine social cognition in Han Chinese euthymic BD patients relative to healthy controls (HC). Moreover, we explore the differences in social cognition between euthymic BD I and BD II patients. Methods: 43 Han Chinese BD patients (BD-I:25, BD-II:18) and 28 HC were recruited. All patients were euthymic (Young Mania Rating Scale (YMRS) ≤ 7 and Hamilton Depression Rating Scale (HDRS) ≤ 7). Social cognitive ability was measured using Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT), including 4 branches: perceiving emotions, facilitating emotions, understanding emotions, and managing emotions. Continuous performance Test (CPT) and Wisconsin Card Sorting Test (WCST) were used to examine attention and executive function. Results: Significant difference in understanding emotions branch of MSCEIT was found between BD patients and HCs (Mann–Whitney U test, p = 0.005). Besides, BD patients had significantly worse performance in WCST and CPT. However, the differences in WCST, CPT, MSCEIT total scores and its subscales were not significant between BD I and BD II patients. Conclusion: Euthymic Han Chinese BD patients exhibit significant social cognitive deficits in understanding emotion and cognitive dysfunction in attention and executive function. Furthermore, Han Chinese BD I patients showed similar social cognitive and general cognitive ability as compared with BD II patients. Social cognitive rehabilitation on both euthymic BD I and II patients should be considered.

Abstract Patients with schizophrenia have difficulties in social cognitive domains including emotion recognition and mentalization, and in sensorimotor processing and learning. The relationship between social cognitive deficits and sensorimotor function in patients with schizophrenia remains largely unexplored. With the hypothesis that impaired visual motor processing may decelerate information processing and subsequently affects various domains of social cognition, we examined the association of nonverbal emotion recognition, mentalization, and visual motor processing in schizophrenia. The study examined mentalization using the verbal subset of the Chinese version of Theory of Mind (CToM) Task, an equivalent task of the Faux Pas Test; emotion recognition using the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW), and visual motor processing using a joystick tracking task controlled for basic motor function in 34 individuals with chronic schizophrenia in the community and 42 healthy controls. Patients with schizophrenia had significantly worse performance than healthy controls in social cognition, including facial, prosodic emotion recognition, and mentalization. Visual motor processing was also significantly worse in patients with schizophrenia. Only in patients with schizophrenia, both emotion recognition (mainly in prosodic modality, happy, and sad emotions) and mentalization were positively associated with their learning capacity of visual motor processing. These findings suggest a prospective role of sensorimotor function in their social cognitive deficits. Despite that the underlying neural mechanism needs further research, our findings may provide a new direction for restoration of social cognitive function in schizophrenia by enhancing visual motor processing ability.

Objective: Few studies have identified a relationship between cognitive deficits and altered event-related potentials (ERPs), which measure the synchronous activity of neurons in response to a stimulus in patients with generalized anxiety disorder (GAD). In this study, we intended to explore the relation between cognitive function and ERP in patients with GAD. Methods: Fourteen drug-free participants with GAD and 14 healthy controls were recruited. ERPs were measured, and neuropsychological tests were administered. We compared the differences of the data between two groups of the study participants. Results: Poor performances of full IQ and the numbers of the categories completed on the Wisconsin Card Sorting Test were found significantly correlated with increased frontal lobe latency in the patients with GAD (Spearman's ρ = −0.70, p < 0.05; Spearman's ρ = −0.85, p < 0.01), respectively, but not in the controls. Conclusion: As ERPs represent an index of information speed, we propose that patients with GAD could exhibit deficits in tasks requiring mental speed.

Objectives: Depression with partial remission and residual symptoms following treatments is common. Elucidating the problems remaining in the remitted patients would help optimize treatment. In this study, we intended to study remission rate and related factors as well as their unresolved problems in patients with treated depressive disorder. Methods: We included 65 medicated patients with depression for 6–12 months. We also chose 65 healthy persons as a control group. The study participants completed Beck Depression Inventory (BDI), checklists of side effects, Sheehan Disability Scale, World Health Organization Quality-of-Life-brief version, and Pittsburgh Sleep Quality Index (PSQI). Remission was defined as a BDI score of ≤ 15. Results: We found that the PSQI score was still higher in the remission group than the control group. Conclusion: Sleep problems, which may still be a commonly unresolved problem in medicated patients with depression, should be noticed by clinicians.

Abstract Studies on the cholesterol‐serotonin hypothesis and its link to mood disorders are scarce. In addition, little is known about the association between cholesterol and the effects of tryptophan depletion (TD). The aim of the present study was to investigate the association between plasma cholesterol and changes in heart rate variability (HRV), an important marker of depression and anxiety, after TD. The plasma cholesterol levels of 28 healthy participants were noted, and their HRVs were measured by spectrum analysis. TD was carried out on testing day, and participants provided blood samples just before and 5 hours for tryptophan level after TD. HRV was measured again after TD. An association was found between plasma cholesterol levels and the change in HRV. Decreased high frequency HRV was marginally associated with lower levels of high‐density lipoprotein cholesterol, while increased low frequency HRV was significantly associated with lower levels of total and low‐density lipoprotein cholesterol. Our findings indicate that low cholesterol levels may play parts of role in the mechanism of the deactivation of parasympathetic, and activation of sympathetic, functions induced by altered serotonergic function.

Objective: Few studies have examined the outcome predictors in methamphetamine (MA) use disorder patients referred from the justice system. Craving and personality trait, such as novelty seeking (NS) and harm avoidance (HA), have important rôles in developing and sustaining addiction. Therefore, we investigated whether craving severity and personality traits are correlated with the MA use disorder treatment outcomes in those under the deferred prosecution status. Methods: We measured craving levels and personality traits of NS and HA at the beginning of a one-year treatment program for MA use disorder. We monitored urinary MA/amphetamine results during the one-year treatment program. Multiple linear regressions were used to examine the correlation between craving severity, personality traits, and MA use disorder treatment outcomes. Results: We first enrolled 98 patients, but only 56 patients completed the end-of-treatment assessments. We did not find any association between craving severity, personality traits, and MA treatment outcomes in those populations. But we found that age and percentage of positive urine MA/amphetamine results were significantly related to treatment completion (p < 0.05). Higher percentages of positive urine MA/amphetamine results were also significantly associated with shorter treatment duration (p = 0.01). In addition, positive urine results at baseline were significantly associated with higher percentages of positive urine tests in the following treatment course (p = 0.001). Conclusion: Our study data did not find that craving severity and personality traits were associated treatment outcomes in this special population. But urine MA/amphetamine results were more related with completion of programs. Further studies to evaluate the treatment outcomes and other potential outcome predictors in those were referred from the justice system are needed.

Background: An emotional intelligence (EI) deficit has been noticed in euthymic bipolar spectrum disorder (BD) patients. However, whether this deficit is affected by mood or subtype is unclear.Objectives:The aim of this study was to investigate whether an EI deficit is mood-dependent, and which mood symptoms have more impact on EI in BD.Methods: Two hundred and thirty participants aged between 18 and 65 years old were recruited [130 BD patients (51 bipolar I disorder (BDI) and 79 bipolar II disorder (BDII): 39.2% males; 91 healthy controls (HCs): 48.4% males)]. The Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT), which contains experiential and strategic EI ratings, was used to assess social cognition. The Hamilton Depression Rating Scale (HDRS) and the Young's Mania Rating Scale (YMRS) were used for evaluating the severity [HAMD and YMRS scores ≦7 were euthymic (BDeut) and HAMD YMRS sores ≧8 were episodic (BDepi)]. Analyses of covariance (ANCOVA) were performed, with adjustment for background information between the BD patients and HCs.Results: The results showed that, compared to the HCs, the BDeut patients showed no difference in any MSCEIT measures, while the BDepi patients showed lower scores in all MSCEIT measures, except for perceiving emotions. In addition, a main effect of mood state instead of BD subtype was found for the managing emotions branch (p < 0.0007). Regression analyses showed that the duration of illness and HDRS scores were correlated with the scores in the strategic area of the MSCEIT, while age and YMRS scores were more relevant to the scores in the experiential area of the MSCEIT.Conclusion: The results confirm that an EI deficit is mood-dependent in BD patients. In addition, a depressive mood is more related to the strategic EI area, while a manic mood is correlated with the experiential EI area. Understanding the different domains of EI deficits in BD patients may be helpful for developing interventions for BD.

AbstractBackgroundPrevious studies suggested that a disturbance of the dopamine system underlies the pathophysiology of bipolar disorder (BD). In addition, the therapeutic action of medications for treating BD, such as valproate (VPA), might modulate dopamine system activity, but it remains unclear. Here, we aimed to investigate the role of the striatal dopamine transporter (DAT) in BD patients and in social defeat (SD) mice treated with VPA.MethodsWe enrolled community-dwelling controls (N = 18) and BD patients (N = 23) who were treated with VPA in a euthymic stage. The striatal DAT availabilities were approached by TRODAT-1 single photon emission computed tomography. We also established a chronic SD mouse model and treated mice with 350 mg/kg VPA for 3 weeks. Behavioral tests were administered, and striatal DAT expression levels were determined.ResultsIn humans, the level of striatal DAT availability was significantly higher in euthymic BD patients (1.52 ± 0.17 and 1.37 ± 0.23, p = 0.015). Moreover, the level of striatal DAT availability was also negatively correlated with the VPA concentration in BD patients (r = −0.653, p = 0.003). In SD mice, the expression of striatal DAT significantly increased (p

Abstract Objectives Cases of patients with bipolar disorder (BD) having neuropsychological impairment have been reported, although inconsistently. The possibility of comorbidity with anxiety disorder (AD) has been suggested. The association between mood episodes and AD comorbidity on neuropsychological performance is unclear and thus was investigated in the current study. Methods All participants were informed about and agreed to participate in this study. Patients with BD were recruited from outpatient and inpatient settings, and healthy controls (HCs) were recruited as a comparison group. Six hundred and twenty‐eight participants (175 HCs and 453 BD—56 BDI and 397 BDII) were studied based on their current mood episode, namely, depressive (BDd), manic/hypomanic (BDm), mixed (BDmix), and euthymic (BDeu), compared with/without AD comorbidity (164 with AD). Results Compared to HCs, all BD groups had significantly more impaired neuropsychological profiles, but the BDeu group was found to have less impairment in memory and executive function than the episodic BD groups. The percentage of AD comorbidity in BDd, BDm, BDmix, and BDeu was 33.9%, 40.3%, 33.0%, and 35.6%, respectively (χ2 = 1.61, p > .05). The results show that AD plays a different role in neuropsychological impairment across various mood episodes in BD. Conclusion Memory impairment and executive dysfunction may be state‐like cognitive phenotypes and are affected by AD comorbidity during mixed and depressive episodes in BD, while sustained attention deficiencies are more like trait markers, regardless of mood episodes, and persist beyond the course of the illness. The AD comorbidity effect on attentional deficit is greater when suffering from a manic episode.

The aim of this study was to investigate whether autism spectrum disorder (ASD) is associated with birth in certain months in Taiwan, as has been found in other countries. A case–control study (1:4) matched according to sex and age was conducted. The study population comprised 4.3% of the population of Taiwan, using the National Health Insurance Research Database (NHIRD) from 1996 through 2008. Multiple logistic regressions were performed after adjusting for socioeconomic factors of urbanization level and income level. A total of 965 people with ASD and 3,860 controls were recruited. In comparison with a March birth, a higher risk of ASD was found for June and August births. After adjusting for level of urbanization and income, the risk of developing ASD was still higher for June, July, and August births over the year. There was higher risk of ASD in urban area when comparing with rural area. A higher risk of ASD was found in the highest income level. A higher risk of ASD was identified among children born in summer months, and a higher risk of ASD in urban area and high socioeconomic status suggested the presence of social-environmental causes of ASD.

It has been proposed that the dopaminergic system and heritability may play roles in attention deficit/hyperactivity disorder (ADHD). We assessed the performance of healthy parents of children with ADHD in the finger tapping test (FTT) in this study, which is a reliable test and sensitive to central dopamine activity. A total of 16 parents of children with ADHD and 32 controls were enrolled. The FTT was conducted. The 16 healthy parents of children with ADHD exhibited a significantly poorer performance in the FTT, using the nondominant hand, than the 32 healthy controls. This finding indicated that poor motor function could be a potential characteristic in parents of offspring with ADHD.

Studies suggest that a functional polymorphism of brain-derived neurotrophic factor (BDNF), polymorphism BDNF Val66Met affects cognitive functions, however, the effect is unclear in bipolar II (BD-II) disorder. We used the Wechsler Memory Scale-third edition (WMS-III), the presence of the BDNF Val66Met polymorphism, and plasma concentrations of BDNF to investigate the association between memory impairment and BDNF in BD-II disorder. We assessed the memory functions of 228 BD-II patients and 135 healthy controls (HCs). BD-II patients had significantly lower scores on five of the eight WMS-III subscales. In addition to education, the BDNF polymorphism were associated with the following subscales of WMS-III, auditory delayed memory, auditory delayed recognition memory and general memory scores in BD-II patients, but not in HC. Moreover, BD-II patients with the Val-homozygote scored significantly higher on the visual immediate memory subscale than did those with the Met/Met and Val/Met polymorphisms. The significantly positive effect of the Val-homozygote did not have a significantly positive effect on memory in the HC group, however. We found no significant association between BDNF polymorphisms and plasma concentrations of BDNF. The plasma BDNF was more likely to be associated with clinical characteristics than it was with memory indices in the BD-II group. The impaired memory function in BD-II patients might be dependent upon the association between the BDNF Val66Met polymorphism and peripheral BDNF levels.

Anxiety disorders (ADs), the most common comorbid illnesses with bipolar disorder (BP) has been reported to associate with dopamine system. Dopamine, metabolized to 3,4-dihydroxyphenylacetic acid (DOPAC) by aldehyde dehydrogenase 2 (ALDH2), and the distribution of the ALDH2*1/*1, and ALDH2*1/*2+ALDH*2/*2 alleles in the Han Chinese general population is relatively equal. The association between dopamine metabolic enzymes and cognitive performance in patients with bipolar II disorder (BP-II) comorbid with AD is unclear. This study proposed to explore the role of ALDH2 polymorphisms on neuropsychological performance between BP-II comorbid with or without AD. One hundred ninety-seven BP-II patients with and without a comorbid AD were recruited and compared with 130 healthy controls (HCs). A polymerase chain reaction and a restriction fragment length polymorphism analysis were used to determine genotypes for ALDH2, and study participants underwent neuropsychological tests. An interaction between AD comorbidity and the ALDH2 polymorphisms was found in different domain of cognitive dysfunction in the BP-II patients. The ALDH2 polymorphisms might have different effects on the neuropsychological performance of BP-II patients with and without comorbid AD.

Background: Premenstrual syndrome (PMS) is a common condition, and for 5% of women, the influence is so severe as to interfere with their mental health, interpersonal relationships, or studies. Severe PMS may result in decreased occupational productivity. The aim of this study was to investigate the influence of perception of PMS on evaluation of work performance. Methods: A total of 1971 incoming female university students were recruited in September 2009. A simulated clinical scenario was used, with a test battery including measurement of psychological symptoms and the Chinese Premenstrual Symptom Questionnaire. Results: When evaluating employee performance in the simulated scenario, 1565 (79.4%) students neglected the impact of PMS, while 136 (6.9%) students considered it. Multivariate logistic regression showed that perception of daily function impairment due to PMS and frequency of measuring body weight were significantly associated with consideration of the influence of PMS on evaluation of work performance. Conclusion: It is important to increase the awareness of functional impairments related to severe PMS.

Cerebral serotonin metabolism has an important but controversial role in obesity. However, it is not given enough attention in morbidly obese young adults. We used single photon emission computed tomography (SPECT) with [I-123]-labeled 2-((2-((dimethylamino)methyl)phenyl)thio)-5-iodophenylamine (ADAM) to investigate changes in serotonin transporter (SERT) availability in 10 morbidly obese young adults without an eating disorder (M/F = 5/5, body mass index (BMI): 40.3 ± 4.1 kg/m2, percentage of body fat (BF%): 46.0 ± 3.9%) and 10 age- and sex-matched non-obese controls (BMI: 20.3 ± 1.2 kg/m2, BF%: 20.6 ± 8.9%). All participants underwent SPECT at 10 min and 6 h after an injection of 200 MBq of [I-123]-ADAM. The SERT binding site (midbrain) was drawn with cerebellum normalization. The BF% and fat distribution were measured using dual-energy X-ray absorptiometry. The midbrain/cerebellum SERT binding ratios (2.49 ± 0.46 vs. 2.47 ± 0.47; p = 0.912) at 6 h were not significantly different between groups, nor was the distribution of the summed images at 10 min (1.36 ± 0.14 vs. 1.35 ± 0.11; p = 0.853). There were no significant correlations between midbrain/cerebellum SERT binding ratio and age, BMI, BF%, or fat distribution. No significant difference in SERT availability in the midbrain between morbidly obese and non-obese young adults without an eating disorder indicates an unmet need for investigating the role of cerebral serotonin in obesity.

Attention Deficit Hyperactivity Disorder (ADHD) affects in both children and adults leading to poor executive functioning and quality of life. However, very little study focuses on neuroimaging and psychophysiology in the adults with ADHD. This preliminary study aimed to report neuroimaging and psychophysiology outcomes in the adults with ADHD. Participants in this study consisted of three groups: unaffected fathers of offspring with ADHD, adults with ADHD, and matched controls, were enrolled. A psychological battery was used in order to assess the participants’ cool cognitive function. Levels of dopaminergic activity were assessed by using the single positron emission computed tomography (SPECT) with [99mTc] TRODAT-1. In a pilot test for further study, the Iowa gambling test in a mock functional MRI was conducted. Molecular neuroimaging indicated the pivotal role of dopaminergicactivity altered a swellas functional brain imaging demonstrated difference between cool and hot executive functions. Using the Event-Related Potentials (ERP), the P300 amplitude of adults with ADHD was found to be lower than healthy group. In conclusions, Neuroimaging and psychophysiology outcome were effectively identified in adult with ADHD. Further study of neuroendocrinological factors might be related.

The habit of drinking tea is highly prevalent in Asian countries. The aim of this study was to investigate the prevalence of tea drinking and to explore the correlated factors on tea drinking among young new students in the university, using a validated self-reported questionnaire. This study was carried out with 5936 new students in a university in Taiwan. It comprised a self-administered structured questionnaire, including items related to personal and medical history, and lifestyle habits, using the Pittsburgh Sleep Quality Index (PSQI) and the 12-item Chinese Health Questionnaire (CHQ-12). Anthropometric measurements and laboratory tests were also performed. In total, 2065 (36.1%) students were in the tea-drinking group. Multiple logistic regression analysis showed the following factors were significant predictors of tea drinking: postgraduate students (p

The relationship between the autonomic nervous system (ANS) index, hostility scale and generalized anxiety disorder (GAD) in the long-term treatment outcome has been rarely studied. The aim of this study was to explore whether the ANS index and hostility scale at baseline are predictors of long-term outcome in GAD. Nine patients with GAD were recruited. At baseline (week 0), blood pressure (BP), heart rate (HR), and mean heart rate range (MHRR) were measured as ANS index; the Cook–Medley Hostility Scale was assessed as hostility. The Hamilton Anxiety Rating Scale (HAM-A) was administered at baseline, short-term (week 6) and long-term (week 52). The aggressive response subscale of the hostility scale was significantly negatively correlated with the HAM-A change ratio in short-term and long-term, while MHRR were significantly positively correlated with these change ratios. The MHRR and the aggressive response subscale at baseline could be predictors of long-term outcome in GAD.

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 123I-iodobenzamide. A marginally positive correlation was noted between NS and striatal dopamine D2/D3 receptor availability (r = 0.25, p =0.07). A positive association was noted between the NS scores and left striatal D2/D3 receptor availability (r= 0.29, p =0.04). The results suggest that a relationship might exist between NS score and dopaminergic activity.

This study was to investigate whether various region-of-interest (ROI) methods for measuring dopamine transporter (DAT) availabilities by single photon emission computed tomography (SPECT) are statistically different, whether results of medical research are thereby influenced, and causes of these differences. Eighty-four healthy adults with Tc99m-TRODAT-1 SPECT and magnetic resonance imaging (MRI) scans were included. Six major analysis approaches were compared: (1) ROI drawn on the coregistered MRI; (2) ROIs drawn on the SPECT images; (3) standard ROI templates; (4) threshold-ROIs; (5) atlas-based mappings with coregistered MRI; and (6) atlas-based mappings with SPECT images. Using the atlas-based approaches we assessed the influence of striatum ROIs by slice-wise and voxel-wise comparisons. In (5) and (6), three partial-volume correction (PVC) methods were also explored. The results showed that DAT availabilities obtained from different methods were closely related but quite different and leaded to significant differences in determining the declines of DAT availability per decade (range: 5.95–11.99%). Use of 3D whole-striatum or more transverse slices could avoid biases in measuring the striatal DAT declines per decade. Atlas-based methods with PVC may be the preferable methods for medical research.

UNLABELLED:Inflammation is thought to be involved in the pathophysiology of bipolar disorder (BP) and metabolic syndrome. Prior studies evaluated the association between metabolic profiles and cytokines only during certain mood states instead of their changes during treatment. We enrolled drug-naïve patients with BP-II and investigated the correlation between changes in mood symptoms and metabolic indices with changes in plasma cytokine levels after 12 weeks of pharmacological treatment. Drug-naïve patients (n = 117) diagnosed with BP-II according to DSM-IV criteria were recruited. Metabolic profiles (cholesterol, triglyceride, HbA1C, fasting serum glucose, body mass index (BMI) and plasma cytokines (TNF-α, CRP, IL-6, and TGF-β) were measured at baseline and 2, 8, and 12 weeks post-treatment. To adjust within-subject dependence over repeated assessments, multiple linear regressions with generalized estimating equation methods were used. Seventy-six (65.0%) patients completed the intervention. Changes in plasma CRP were significantly associated with changes in BMI (P = 1.7E-7) and triglyceride (P = 0.005) levels. Changes in plasma TGF-β1 were significantly associated with changes in BMI (P = 8.2E-6), cholesterol (P = 0.004), and triglyceride (P = 0.006) levels. However, changes in plasma TNF-α and IL-6 were not associated with changes in any of the metabolic indices. Changes in Hamilton Depression Rating Scale scores were significantly associated with changes in IL-6 (P = 0.003) levels; changes in Young Mania Rating Scale scores were significantly associated with changes in CRP (P = 0.006) and TNF-α (P = 0.039) levels. Plasma CRP and TGF-β1 levels were positively correlated with several metabolic indices in BP-II after 12 weeks of pharmacological intervention. We also hypothesize that clinical symptoms are correlated with certain cytokines. These new findings might be important evidence that inflammation is the pathophysiology of clinical symptoms and metabolic disturbance in BP-II. TRIAL REGISTRATION:ClinicalTrials.gov NCT01188148.

Clinical and psychosocial deterioration associated with schizophrenia occurs within the first few years following the onset of the illness. Therefore, to improve the long-term prognosis, it is important to provide schizophrenia patients with intensive treatment following their first episode. Relapse is highly associated with partial medication adherence or nonadherence in patients with first-episode schizophrenia. Recent studies suggest that long-acting injectable (LAI) antipsychotics compared with oral antipsychotics are more effective for medication adherence and relapse prevention. Moreover, some clinical guidelines for the treatment of schizophrenia suggested that LAI antipsychotics should be considered when patients are nonadherent “at any stage.” Decreased compliance is a common cause of relapse during the initial stages of the disease. Therefore, LAI antipsychotics should be highly considered when treating patients with first-episode schizophrenia. In the present paper, clinical trial data and current guidelines on the use of LAI antipsychotics for first-episode schizophrenia are discussed as well as the pros and cons of this treatment option.

Background: Anhedonia, a core diagnostic feature for major depressive disorder (MDD), is defined as the loss of pleasure and interest in daily activities. Its prevalence in MDD patients vary from 35 to 70%. Anhedonia in MDD negatively impacts functioning and is associated with treatment resistance and poorer prognosis for various clinical outcomes. Owing to its complexity, there remains considerable heterogeneity in the conceptualization, diagnosis and clinical management of anhedonia in MDD. Methods: This modified Delphi panel was conducted to elicit expert opinion and establish consensus on concepts relating to clinical features, diagnosis and treatment of MDD with anhedonia (MDDwA) amongst psychiatrists in the Asia- Pacific region. Seven themes were covered. A three-stage process was adopted for consensus generation (two online survey rounds, followed by a moderated consensus meeting). Statements were developed based on a literature review and input from a steering committee of six regional experts. The panel included 12 psychiatrists practicing in Australia, China, Hong Kong, Japan, South Korea and Taiwan with ≥5 years of specialist clinical experience, including assessment or management of patients with MDDwA. Results: Overall, consensus was achieved (median ≥8) on 89/103 statements (86%). About half of the statements (55/103, 53%) achieved consensus in Round 1, and 29/36 modified statements achieved consensus in Round 2. At the moderated consensus meeting, five modified statements were discussed by the steering committee and consensus was achieved on all statements (5/5). The findings highlighted a lack of clear and practical methods in clinical practice for assessing anhedonia in MDD patients and limited physician awareness of anhedonia in Asia-Pacific. Conclusion: Insights from this Delphi consensus provide a reference point for psychiatrists in Asia-Pacific to optimize their strategies for personalized diagnosis and management of patients with MDDwA. Identification of distinct and clinically relevant subtypes in MDD may be valuable for guiding personalized diagnosis and management approaches, including type-specific therapies. [ABSTRACT FROM AUTHOR]

Objective: The relationship between adverse childhood experiences and methamphetamine use disorder (MUD) has been shown in previous studies; nevertheless, the underlying neural mechanisms remain elusive. Childhood trauma is associated with aberrant functional connectivity (FC) within the default-mode network (DMN). Furthermore, within the DMN, FC may contribute to impaired self-awareness in addiction, while cross-network FC is critical for relapse. We aimed to investigate whether childhood trauma was associated with DMN-related resting-state FC among healthy controls and patients with MUD and to examine whether DMN-related FC affected the effect of childhood trauma on the symptom load of MUD diagnosis. Methods: Twenty-seven male patients with MUD and 27 male healthy controls were enrolled and completed the Childhood Trauma Questionnaire. DMN-related resting-state FC was examined using functional magnetic resonance imaging. Results: There were 47.1% healthy controls and 66.7% MUD patients in this study with adverse childhood experiences. Negative correlations between adverse childhood experiences and within-DMN FC were observed in both healthy controls and MUD patients, while within-DMN FC was significantly altered in MUD patients. The detrimental effects of adverse childhood experiences on MUD patients may be attenuated through DMN-executive control networks (ECN) FC. Conclusion: Adverse childhood experiences were negatively associated with within-DMN FC in MUD patients and healthy controls. However, DMN-ECN FC may attenuate the effects of childhood trauma on symptoms load of MUD. [ABSTRACT FROM AUTHOR]

Objective: Limited evidence exists regarding real-world 3-monthly paliperidone palmitate (PP3M) treatment retention and associated factors. Methods: We conducted a retrospective, nationwide cohort study using the Taiwan National Health Insurance Research Database between October 2017 and December 2019. Adult patients with schizophrenia initiated on PP3M were enrolled. The primary outcomes were time to PP3M discontinuation, time to psychiatric hospitalization, and the proportions of patients receiving the next PP3M dose within 120 days among first-, second-, and third-dose completers. Key covariates included prior PP1M duration and adequate PP3M initiation. Results: The PP3M treatment retention rates were 79.7%, 66.3%, and 52.5% after 6, 12, and 24 months, respectively, with 86.4%, 90.6%, and 90.0% of respective first-, second-, and third-dose completers receiving the next PP3M dose. Adequate PP3M initiation and prior PP1M treatment duration ＞ 180 days were associated with favorable PP3M treatment retention. In multivariate analyses, PP1M durations of 180−360 days (adjusted relative risk [aRR], 1.76) or ＜ 180 days (aRR, 2.79) were associated with PP3M discontinuation at the second dose. Inadequate PP3M initiation was associated with discontinuation at the third dose (aRR, 2.18). Patients fully adherent to PP3M treatment in the first year had a higher probability of being free from psychiatric hospitalization (86.7% at 2 years), compared with those partially adherent or non-adherent to PP3M in the first year. Conclusion: Prior PP1M duration and adequate PP3M initiation are major factors affecting PP3M treatment retention. Higher PP3M treatment retention is associated with a lower risk of psychiatric hospitalization. [ABSTRACT FROM AUTHOR]