Cheng-Cheng Hsiao

Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis.

BACKGROUND The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis. METHOD Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without. RESULTS The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder. CONCLUSIONS Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.

Psychiatric comorbidity and gender differences of persons incarcerated for methamphetamine abuse in Taiwan

Abstract  Methamphetamine (MAP) abuse has been common in Taiwan for the past decade. The purpose of the present study was to investigate MAP abuse in Taiwan, with specific attention to psychiatric comorbidity and gender differences. A total of 325 MAP abuse subjects (180 male, 145 female) from a detention center in Taipei were assessed with the Diagnostic Interview for Genetic Studies. The following were studied: drug use behavior, treatment‐seeking behavior, lifetime prevalence of mood disorders, MAP psychosis, alcohol use disorders, pathological gambling and antisocial personality. The MAP‐abuse subjects in Taiwan had high psychiatric morbidity and low access to mental health services. There also exist certain differences in the prevalence of psychiatric illnesses and treatment‐seeking behavior between male and female subjects. Compared with their male counterparts, more female subjects reported experience of mental disturbance and experience of psychiatric treatment. The female subjects more commonly reported suicidal behaviors than the male subjects.

No correlation of depression and anxiety to plasma estrogen and progesterone levels in patients with premenstrual dysphoric disorder

Abstract  A number of studies have demonstrated the correlation of depression and anxiety to estrogen and progesterone in premenstrual dysphoric disorder (PMDD), but the findings are still controversial. The purpose of this study was to determine the correlation of depression and anxiety to estrogen and progesterone concentrations in blood plasma in Taiwanese women with PMDD. A total of 43 women who met the 4th edition of the Diagnostic and Statistical Manual diagnostic criteria for PMDD were enrolled in this study. Blood samples were obtained for determination of estrogen and progesterone levels, and depression and anxiety ratings were summed for each subject during one menstrual cycle to obtain a premenstrual result (2–6 days before menses) and a postmenstrual result (menstrual cycle days 7–11). Anxiety was assessed using the 14‐item Hamilton Anxiety Scale‐A and was also assessed by the patients themselves using the Trait Anxiety Inventory. Depression was rated using the 21‐item Hamilton Anxiety Scale‐D. Calculations were made to determine the relationships between hormonal changes and mood changes. There were no statistically significant correlations between depression or anxiety ratings and estrogen or progesterone concentrations.

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Abstract  Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication‐free patients experiencing a major depressive episode. Twenty‐eight medication‐free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM‐D 17] score ≥17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900–1100 h Depression severity was assessed with the HAM‐D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM‐D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication‐free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non‐depressed subjects. The present result needs subsequent replication.

Differential add-on effects of aripiprazole in resolving hyperprolactinemia induced by risperidone in comparison to benzamide antipsychotics

UNLABELLED Hyperprolactinemia is associated with typical antipsychotic agents and atypical antipsychotics such as risperidone and amisulpride. This study investigates the effects of 8-week adjunctive treatment with aripiprazole in patients with hyperprolactinemia induced by risperidone in comparison to benzamide antipsychotics (amisulpride and sulpiride). Aripiprazole was administered to 24 patients with antipsychotic-induced hyperprolactinemia. The doses of pre-existing antipsychotics were fixed, while the aripiprazole dose was 5-20 mg/day during the 8-week study period. Serum prolactin levels were measured at weeks 4 and 8. Symptoms and side effects were assessed using the Positive and Negative Syndrome Scale (PANSS), Arizona Sexual Experience Scale, Abnormal Involuntary Movement Scale, Simpson-Angus Scale, Barnes Akathisia Scale, and metabolic measures at weeks 2, 4 and 8. Mean (standard error) prolactin levels decreased from 77.0±13.3 ng/mL to 18.3±2.1 ng/mL (p<0.001 vs. baseline), from 144.9±24.4 ng/mL to 127.5±21.7 ng/mL (p=0.099 vs. baseline) and 71.4±24.6 ng/mL to 43.3±14.7 ng/mL (p=0.106 vs. baseline) for those taking risperidone, amisulpride, and sulpiride, respectively. For those who took risperidone before the study started, 14 of 15 (93.3%) patients had normalized prolactin levels, while only 1 of 10 (10%) taking benzamide antipsychotics had normalized prolactin levels. The PANSS score improved significantly, and aripiprazole had no significant influence on metabolic measures or scales of movement side effects. Adjunctive aripiprazole treatment reversed effectively hyperprolactinemia induced by risperidone, but was less effective for that induced by benzamide antipsychotics. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00541554.

Obesity in schizophrenic outpatients receiving antipsychotics in Taiwan

Abstract  This investigation estimates and compares, for the first time, the distribution of body mass index (BMI: kg/m2) and the prevalence of obesity among Chinese outpatients with schizophrenia treated with antipsychotics. The BMI of 201 outpatients with schizophrenia‐spectrum disorders was studied via a cross‐sectional naturalistic study. This investigation also compared the BMI of the subjects with a Taiwanese reference population. This investigation found no significant difference in the prevalence of obesity between male and female subjects. The prevalence of obesity among male and female patients in this investigation was, respectively, 2.74‐ and 2.51‐fold greater than the Taiwanese reference population, and the prevalence of severe obesity among male and female patients was 4.66‐ and 3.53‐fold greater than that in the Taiwanese reference population, respectively. The rate of severe obesity was especially high in patients treated with olanzapine. Atypical antipsychotics other than olanzapine did not seem to be more closely associated with obesity or severe obesity compared to typical antipsychotics.

Difference in pre- and post-treatment plasma DHEA levels were significantly and positively correlated with difference in pre- and post-treatment Hamilton depression scores following successful therapy for major depression.

OBJECTIVE Clinical studies of endogenous concentrations of dehydroepiandrosterone (DHEA) and its relation to depression are limited. This study examined whether pre- and post-treatment changes in plasma DHEA levels are correlated with pre- and post-treatment differences in Hamilton depression scores following successful antidepressant therapy for major depression with venlafaxine XR. METHOD Thirty-four medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17, HAM-D 17 score > or = 17) were treated with antidepressants. At baseline, plasma DHEA levels of all subjects were measured but only those who remitted (HAM-D 17 score < or = 7) before the end of this study had their plasma DHEA levels measured at remission-onset. Blood from subjects was drawn at 0900-1100 h. Depression severity was assessed with the HAM-D 17 scale at baseline, and on day 7, 14, 28, 56 and 84. Subjects were administered at minimum 75 mg/day venlafaxine XR until remission onset. RESULTS Fifteen patients remitted before the end of this study. Plasma DHEA levels decreased from baseline to remission was significant (P=0.017). After controlling for age and gender, pre- and post-treatment difference in Hamilton depression scores and the pre- and post-treatment difference in DHEA concentrations were significantly correlated (P=0.044). CONCLUSION This preliminary study provides the first clinical evidence identifying that difference in pre- and post-treatment plasma DHEA levels were significantly and positively correlated with difference in pre- and post-treatment Hamilton depression scores following successful therapy with venlafaxine XR for major depression in remitters; but non-remitters were not examined. It is not known if DHEA levels would show similar or dissimilar changes in non-remitters.

Adjunctive effects of aripiprazole on metabolic profiles: Comparison of patients treated with olanzapine to patients treated with other atypical antipsychotic drugs ☆

Metabolic abnormalities are serious adverse effects of atypical antipsychotic treatment. This study aims to determine the effects of adjunctive aripiprazole on metabolic profiles among patients receiving treatment with atypical antipsychotics, and to examine whether these effects are different from that of pre-existing atypical antipsychotics. In the 8-week open-label trial, aripiprazole was added to patients who were receiving treatment with atypical antipsychotics and had experienced weight gain or dyslipidemia. The dosage of pre-existing atypical antipsychotics was fixed, while the dosage of aripiprazole ranged from 5 to 20 mg/day during the study period. Metabolic profiles, including body weight, body mass index (BMI), plasma levels of fasting glucose, triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and adiponectin, were measured at baseline and week 8. As a result, 43 subjects (16 males and 27 females, mean age: 37.8±10.8 years) completed the study. The pre-existing antipsychotics were olanzapine (n=12), risperidone (n=19), quetiapine (n=6) and amisulpiride (n=6). The mean dosage of adjunctive aripiprazole was 9.9±3.2 mg/day. After the aripiprazole-augmented regimen for 8 weeks, patients treated with olanzapine had significant decreases in body weight, BMI and triglyceride levels, and had significant increases in adiponectin levels. For patients treated with other atypical antipsychotics, none of the metabolic parameters significantly changed after administering aripiprazole. In conclusion, aripiprazole-augmented treatment might be beneficial for the metabolic regulation of patients being treated with a stable dose of olanzapine, but not for those treated with other atypical antipsychotics. A long-term, randomized, double-blind controlled design is suggested to confirm these findings.

Association of salivary dehydroepiandrosterone levels and symptoms in patients with attention deficit hyperactivity disorder during six months of treatment with methylphenidate

This prospective study aimed to determine whether salivary levels of dehydroepiandrosterone (DHEA) in patients with attention deficit hyperactivity disorder (ADHD) change significantly during 6 months of treatment with methylphenidate (MPH), and to investigate long-term relationship between these levels and ADHD symptoms. Fifty ADHD patients aged between 6 and 12 years, and 50 age- and gender-matched healthy subjects were recruited. ADHD patients were prescribed oral MPH with a dose range of 5-15 mg/day at the discretion of the psychiatrist. DHEA levels were determined from saliva samples collected from both ADHD patients and healthy subjects at pretreatment and 1, 3, and 6 months from pretreatment visit. ADHD symptoms were evaluated with the Swanson, Nolan, and Pelham, Version IV Scale for ADHD and the ADHD Rating Scale, and computerized Continuous Performance Test (CPT). The results showed that salivary DHEA levels significantly increased in ADHD patients during the 6-month course of methylphenidate treatment, but the DHEA levels did not significantly change in the untreated healthy group during the 6-month period of natural observation. For the longitudinal observation, among ADHD patients, the salivary DHEA levels were independently correlated with distraction and impulsivity performance in the CPT, but not correlated with inattention and hyperactivity in the clinical ADHD symptoms. Whether DHEA exerts effects on neurocognitive functions as mediators or independently of MPH warrants further investigation.

The Trend in Morning Levels of Salivary Cortisol in Children With ADHD During 6 Months of Methylphenidate Treatment

Objective: To determine the trend in cortisol levels in children with ADHD treated with methylphenidate (MPH) and nontreated healthy controls over a 6-month period. Method: The morning salivary cortisol levels of 50 patients with ADHD (40 boys and 10 girls, mean age = 7.6 years) and 50 age- and gender-matched healthy controls were measured at baseline and at 1, 3, and 6 months from baseline. The neuropsychological performance of the ADHD patients was measured via administration of the Continuous Performance Test. Results: The cortisol levels of ADHD patients increased significantly after 1 month of MPH treatment before decreasing to an intermediate level, but were significantly positively correlated with neuropsychological performance throughout the 6-month treatment period. The cortisol levels of the controls did not change significantly over the 6-month period. Conclusion: MPH administration appears to positively influence the functioning of the hypothalamic–pituitary–adrenal axis in ADHD patients.