Kaohsiung, Taiwan
Kaohsiung, Taiwan

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Lee T.-W.,Chang Gung Memorial Hospital | Lee T.-W.,Chang Gung University | Yu Y.W.-Y.,Yus Psychiatric Clinic | Chen M.-C.,Kai Suan Psychiatric Hospital | Chen T.-J.,E DA Hospital
Journal of Affective Disorders | Year: 2011

Background: Diagnosis and treatment rely on symptom criteria in modern psychiatry. However, the cortical mechanisms of symptomatology in major depressive disorder (MDD) are still not clear. This study examined neural correlates of symptom clusters of MDD by electroencephalography (EEG). Methods: Resting state eye-closed EEG signals were recorded in 196 depressive patients. Quantitative EEG (qEEG) of regional power, coherence and power series correlation across delta, theta, alpha and beta frequencies were used to correlate with overall depression severity evaluated by the Hamilton Depression Rating Scale (HDRS). Further, statistical comparisons between patients with high vs. low qEEG indices (median-split) were undertaken regarding symptom severity of core depression, sleep, activity, psychic anxiety, somatic anxiety, and delusion. Results: None of the qEEG indices significantly correlated with overall depression severity or differentiated symptom severity of core depression, sleep, activity and psychic anxiety. A higher symptom severity of somatic anxiety was associated with higher regional power over widespread cortical regions and lower strengths at bi-temporal, temporo-parietal and fronto-parietal connections. A higher symptom severity of delusion was associated with higher regional power in the frontal and temporal regions, and lower strengths at inter-hemispheric (frontal, temporal and parietal) and fronto-temporo-parietal connections. Limitations: Our EEG recording with sampling rate of 128 Hz and 20 electrodes may provide restricted spatial and temporal precision. Conclusions: Our results suggest that cortical mechanisms play important roles in the symptom manifestation of cognitive distortion (sub-score of delusion) and somatic anxiety in MDD. Our findings further imply that psychic anxiety and somatic anxiety are distinct entities. © 2010 Elsevier B.V. All rights reserved.


Lee P.,I - Shou University | Li P.-C.,I - Shou University | Liu C.-H.,Kai Suan Psychiatric Hospital | Hsieh C.-L.,National Taiwan University Hospital
Archives of Clinical Neuropsychology | Year: 2011

The Symbol Digit Modalities Test (SDMT) and Digit Vigilance Test (DVT), both well-recommended attention tests for schizophrenia, are measures of switching and sustained attention, respectively. The purpose of this study was to investigate the test-retest reliability of the two attention tests in schizophrenia. A rater administered both tests on 147 participants with schizophrenia twice at a 1-week interval. Test-retest reliability was determined through the calculation of the intra-class correlation (ICC) coefficient. We also carried out the Bland-Altman analysis, which include a scatter plot of the differences between test and retest against their mean. System biases were evaluated by use of a paired t-test. The ICC for the SDMT was 0.87 and that for the DVT was 0.83. The limits of agreement (LOAs) of the SDMT and DVT were 11.5 to -9.9 correct responses and 156.3 to -249.2 s, respectively. The mean difference scores of the SDMT and DVT were 1.5 (4.7% of the first session mean; p = .002) and -46.4 (7.6% of the first session mean; p < .001). The ICCs show that the SDMT and DVT are stable measures across assessment in different sessions in schizophrenia. However, the paired t-test indicates a practice effect, and the LOAs show large variations. Thus, the SDMT and DVT are reliable for a group of subjects but limited for individual subjects with schizophrenia in 1-week interval clinical trials. © The Author 2011. Published by Oxford University Press. All rights reserved.


Yen J.-Y.,Kaohsiung Medical University | Chang S.-J.,Kaohsiung Medical University | Ko C.-H.,Kaohsiung Medical University | Yen C.-F.,Kaohsiung Medical University | And 3 more authors.
Psychoneuroendocrinology | Year: 2010

This study aimed to: (1) evaluate food craving and high-sweet-fat food craving across the menstrual cycle; (2) compare the craving and explicit/implicit emotional response to different food; and (3) investigate the reward sensitivity among PMDD and control groups. The PMDD group without treatment history and control group were evaluated for food craving, emotional response to food, implicit attitude task to food, and responsiveness to reward both in luteal and follicular phases. A total of 59 women with PMDD and 60 controls had completed the study. The results revealed that both PMDD diagnosis and luteal phase were associated with higher body mass index. The high-sweet-fat food provoked higher craving, positive emotional, and positive implicit response more than other foods. The luteal phase contributed to higher food and high-sweet-fat food cravings. Besides, the PMDD women had higher reward sensitivity, emotional response, positive implicit attitude, and craving response to high-sweet-fat foods. Further, the rewarding sensitivity was associated with emotional response to high-sweet-fat food which was associated with high-sweet-fat food craving. These results would suggest emotional response and implicit attitude might play a role for high-sweet-fat food craving of PMDD. Further, PMDD women with higher reward sensitivity should be a target group of intervention for high-sweet-fat food craving. © 2010 Elsevier Ltd.


Wang P.-W.,Kaohsiung Medical University | Wu H.-C.,Kai Suan Psychiatric Hospital | Yen C.-N.,Tainan Hospital | Yeh Y.-C.,Kaohsiung Medical University | And 3 more authors.
American Journal of Drug and Alcohol Abuse | Year: 2012

Background: A good quality of life (QOL) is associated with successful treatment in patients with opioid dependence. Therefore, it is of clinical benefit to examine what factors can predict a change in QOL among heroin users in the course of a methadone maintenance treatment (MMT) program. Objectives: This longitudinal study aimed to examine the patterns and predictors of change in QOL among heroin users during the period of an 18-month MMT program. Methods: A total of 368 intravenous heroin users receiving MMT in southern Taiwan between 2007 and 2008 were interviewed using the Taiwan version of the Brief Version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF) at baseline and after 3, 6, 9, 12, 15, and 18 months of treatment. Demographic and substance-use characteristics, severity of heroin use, HIV serostatus, criminal record, and family function data were collected during baseline interviews. Data on methadone dosage at each follow-up point and the duration of retention in the MMT program were also collected. Results: Improvement in QOL was rapid during the first 3 months after initiation of MMT and slowed beyond the 3-month point. A higher dosage of methadone predicted a better QOL. In addition, longer retention in the program may be associated with a better QOL. Conclusions: The results supported the hypothesis that, regarding QOL, heroin users can benefit rapidly and continuously from a MMT. A higher dose of methadone and longer treatment may predict improvement in QOL. Scientific significance: Efforts are needed to amend the modifiable factors related to poor QOL for heroin users in MMT programs.


Chang Y.S.,Kai Suan Psychiatric Hospital | Wu Y.H.,Kai Suan Psychiatric Hospital | Hsu C.Y.,Kaohsiung Medical University | Tang S.H.,Kai Suan Psychiatric Hospital | And 2 more authors.
Sleep Medicine | Year: 2011

Objective: A three-shift work schedule with fast rotation is common among healthcare workers in Taiwan. This study compared cognitive performance at the time of maximum fatigue (3-4 am on the last night shift of the rotation) between nurses working two, three, and four consecutive night shifts. Methods: Sixty-two nurses [mean age 26.4 (standard deviation 2.0) years] were recruited from the acute psychiatric ward and assigned at random to three groups: two, three, and four consecutive night shifts. The exclusion criteria were: current use of hypnotic drugs, regular consumption of coffee, psychiatric illness, major systemic disease, and sleep disorders. Cognitive performance was assessed using the State-Trait Anxiety Inventory, Stanford Sleepiness Scale, Wisconsin Card Sorting Test, Taiwan University Attention Test, Digit Symbol Substitution Test, and Symbol Searching Test. Results: Greater impairment of perceptual and motor ability was seen among subjects who worked two consecutive night shifts compared with those who worked four consecutive night shifts. No differences in demographic data, executive function or attention were found between the three groups. Conclusion: The main duties of nurses working night shifts at the study hospital include checking medical orders and prescriptions, which require perceptual and motor abilities. The results of this study suggested that a fast shift rotation may increase the risk of medical errors. © 2011 Elsevier B.V.


Lane H.-Y.,China Medical University at Taichung | Lin C.-H.,Kai Suan Psychiatric Hospital | Huang Y.-J.,China Medical University at Taichung | Liao C.-H.,China Medical University at Taichung | And 2 more authors.
International Journal of Neuropsychopharmacology | Year: 2010

Recent evidence indicates that enhancing N-methyl-d-aspartate (NMDA) neurotransmission with the treatment of NMDA/glycine site agonists, such as d-serine, or a glycine transporter-1 (GlyT-1) antagonist, N-methylglycine (sarcosine), can improve symptoms of schizophrenia. To compare these two novel approaches, 60 patients with chronic schizophrenia were enrolled into a 6-wk double-blind, placebo-controlled trial of add-on treatments at the reported effective dosages (2 g/d). Clinical assessments were conducted every other week. Treatment grouptreatment duration interaction analysis by multiple linear regression showed that sarcosine was superior to placebo at all four outcome measures of Positive and Negative Syndrome Scale (PANSS) total (p=0.005), Scale for the Assessment of Negative Symptoms (SANS) (p=0.021), Quality of Life (QOL) (p=0.025), and Global Assessment of Functioning (GAF) (p=0.042). However, d-serine did not differ significantly from placebo in any measure. Sarcosine treatment was better than d-serine in effect sizes for all outcome measures. Sarcosine also surpassed placebo in most of the measures of five PANSS factors and five SANS subscales. All treatments were well tolerated. These findings suggest that the GlyT-1 inhibitor is more efficacious than the NMDA/glycine site agonist in treatment for schizophrenia, including life quality and global function, at the dosages tested. Copyright © CINP 2009.


Chou F.H.C.,Kai Suan Psychiatric Hospital | Chou F.H.C.,Meiho University | Tsai K.-Y.,Kai Suan Psychiatric Hospital | Su C.-Y.,I - Shou University | And 3 more authors.
Schizophrenia Research | Year: 2011

Objective: To estimate the incidence and relative risk of developing cancer as well as the mortality rate after cancer diagnosis for patients with schizophrenia compared with the general population. Methods: Our population for this study was identified before the end of 1999. The study included 59,257 patients with schizophrenia and 178,156 age- and gender-matched individuals without schizophrenia as controls, who were selected from the 23,981,020 subjects in the National Health Insurance Research Database (NHIRD), which consists of 96% of the entire Taiwanese population. From the 2000 to 2008 NHIRD, we calculated the cancer incidence and survival time after cancer diagnosis in each of the two groups. Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), the cancers were divided into nine groups. Results: During the nine-year follow-up period, 1145 (1.93%) of the patients with schizophrenia and 5294 (2.97%) of the control group developed cancer. The patients with schizophrenia had a significantly lower cancer incidence than those in the control group in both the male (OR = 0.50, 95% CI, 0.46-0.55) and female (OR = 0.81, 95% CI, 0.74-0.88) populations. Patients with schizophrenia were less likely to develop cancer than individuals in the control group for every cancer type except breast and cervical/uterine cancer. After adjustment using the Cox regression model, patients with schizophrenia had an overall decreased cancer risk (adjusted hazard ratio 0.71, 95% CI, 0.66-0.76) compared to the control population. For all cancer patients, the mortality adjusted hazard ratio for patients with schizophrenia versus the control group was 1.36 (95% CI, 1.24-1.50) after adjusting for other variables. Conclusions: Although the likelihood of developing cancer among patients with schizophrenia (0.64) was less than that of the non-schizophrenia group, the mortality rate among patients with schizophrenia was higher than that of the control group. © 2011 Elsevier B.V.


Tsai K.-Y.,Kai Suan Psychiatric Hospital | Lee C.-C.,National Yang Ming University | Lee C.-C.,Buddhist Dalin Tzu Chi General Hospital | Lee C.-C.,Tzu Chi University | And 4 more authors.
Schizophrenia Research | Year: 2012

Objective: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. Methods: This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. Results: Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI = 1.05-1.22; P = 0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI = 1.06-1.41; P = 0.0052). Conclusions: During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group. © 2012 Elsevier B.V.


Lin C.-H.,Chang Gung University | Lin C.-H.,China Medical University at Taichung | Lin P.-P.,China Medical University at Taichung | Lin C.-Y.,Tsaotun Psychiatric Center | And 4 more authors.
Journal of Psychiatric Research | Year: 2016

Background: The cystine/glutamate antiporter system xc -, playing a critical role in the regulation of glutamate release, might be implicated in the pathogenesis of schizophrenia. This study examined whether peripheral expressions of the system xc - subunits are characteristic of schizophrenia. Methods: Expression of system xc - genes including SLC3A2 and SLC7A11 in peripheral WBCs of patients with schizophrenia and healthy individuals were measured using quantitative PCR. Both psychotropic-free and medicated patients with schizophrenia were recruited. Results: A total of 96 schizophrenia patients (48 medicated and 48 drug-free) and 96 healthy individuals were enrolled. The mRNA expression levels using the 2-δδC T Method of both SLC3A2 and SLC7A11 in WBCs of schizophrenia patients were markedly lower than that of healthy individuals (0.22 and 0.48, respectively, the mRNA expression level of normal controls was normalized to 1). There was no significant difference between medicated and drug-free patients in the mRNA expressions of both SLC3A2 and SLC7A11. The Receiver Operating Characteristics (ROC) analysis of SLC3A2 mRNA levels using δδCT values for drug-free schizophrenia patients vs. healthy controls determined an optimal cutoff value, 0.801, with high sensitivity (1.000) and modest specificity (0.694) (area under curve of ROC = 0.794). Conclusion: This is the first study indicating that the peripheral mRNA expression levels of SLC7A11 and SLC3A2 may be lower in patients with schizophrenia than healthy individuals. The finding supports the hypo-glutamatergic neurotransmission hypothesis in schizophrenia. Whether mRNA expression of system xc - subunits genes, particularly SLC3A2, could serve as a potential biomarker of schizophrenia needs further studies. © 2015 Elsevier Ltd.


Lee T.-W.,Laureate Institute for Brain Research | Wu Y.-T.,National Yang Ming University | Yu Y.W.-Y.,Yus Psychiatric Clinic | Chen M.-C.,Kai Suan Psychiatric Hospital | And 2 more authors.
Psychiatry Research - Neuroimaging | Year: 2011

Predicting treatment response in major depressive disorder (MDD) has been an important clinical issue given that the initial intent-to-treat response rate is only 50 to 60%. This study was designed to examine whether functional connectivity strengths of resting EEG could be potential biomarkers in predicting treatment response at 8. weeks of treatment. Resting state 3-min eyes-closed EEG activity was recorded at baseline and compared in 108 depressed patients. All patients were being treated with selective serotonin-reuptake inhibitors. Baseline coherence and power series correlation were compared between responders and non-responders evaluated at the 8th week by Hamilton Depression Rating Scale. Pearson correlation and receiver operating characteristic (ROC) analyses were applied to evaluate the performance of connectivity strengths in predicting/classifying treatment responses. The connectivity strengths of right fronto-temporal network at delta/theta frequencies differentiated responders and non-responders at the 8th week of treatment, such that the stronger the connectivity strengths, the poorer the treatment response. ROC analyses supported the value of these measures in classifying responders/non-responders. Our results suggest that fronto-temporal connectivity strengths could be potential biomarkers to differentiate responders and slow responders or non-responders in MDD. © 2011 Elsevier Ireland Ltd.

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