Chih-Lun Chen

Association study of catechol‐O‐methyltransferase gene polymorphisms with schizophrenia and psychopathological symptoms in Han Chinese

Although dysfunction of catechol‐O‐methyltransferase (COMT)‐mediated dopamine transmission is implicated in the etiology of schizophrenia, the human COMT gene has not been associated consistently with schizophrenia. The purpose of this study was to investigate whether the COMT gene is associated with the development of schizophrenia and whether the polymorphisms of this gene influence the psychopathological symptoms in patients with schizophrenia. Fourteen polymorphisms of the COMT gene were analyzed in a case–control study of 876 Han Chinese individuals (434 patients and 442 controls). All participants were screened using a Chinese version of the modified Schedule for Affective Disorders and Schizophrenia‐Lifetime Version (SADS‐L) and all patients met the criteria for schizophrenia. Furthermore, pretreatment of psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) in a subset of 224 hospitalized schizophrenia patients, who were drug‐naÏve or drug‐free, to examine the association between clinical symptomatology and COMT polymorphisms. No significant differences in allele or genotype frequencies were observed between schizophrenia patients and controls, for all variants investigated. Haplotype analysis showed that three haplotype blocks of the COMT gene were not associated with the development of schizophrenia. Moreover, these COMT polymorphisms did not influence the PANSS scores of schizophrenia patients. This study suggests that the COMT gene may not contribute to the risk of schizophrenia and to the psychopathological symptoms of schizophrenia among Han Chinese.

Diphenhydramine dependence through deep intramuscular injection resulting in myonecrosis and prolonged QT interval

Diphenhydramine (DPH) is a first‐generation antihistamine, which is useful in treating allergic reaction, and is usually considered innocuous. We describe a retired nurse with history of depression, who began to develop drug‐seeking behaviour after her first receiving of an intramuscular (IM) DPH injection due to urticaria.

A Study of Prematurely Discharged from Service and Related Factors in Taiwanese Conscript Soldiers with Mental Illness

Background: The aim of this study was to analyze the clinical data of Taiwanese conscript soldiers who were prematurely discharged from service due to mental illness and identify factors predictive of psychiatric hospitalization leading to subsequent separation from service. Methods: We retrospectively collected medical records of conscript soldiers who were prematurely discharged from service due to mental illness from September 2003 to September 2004. Their demographic data, clinical characteristics, the distribution of main psychiatric diagnoses for medical discharge, and psychiatric comorbidities were registered and statistically described. Furthermore, all participants were subdivided into inpatient and outpatient groups, and the differences between both groups examined. Results: During the one-year period, 463 (24.2%) conscript soldiers were prematurely discharged from service due to psychiatric disorders. The first four psychiatric diagnoses for medical discharge were major depression, mental insufficiency, bipolar Ⅱ depression, and personality disorder. Adjustment disorder and substance use disorder were the common psychiatric comorbidities. The common methods used in suicide attempts after enlistment included drug ingestion, wrist cutting, and carbon monoxide poisoning. There were many significant differences between the inpatient and outpatient groups. Several variables were significantly predictive of psychiatric hospitalization and subsequent separation from service: specific main psychiatric diagnoses, service on offshore islands, family psychiatric history, the presence of a substance-use disorder, postenlistment suicide attempts, and higher educational levels. Conclusions: Our study indicated that depressive disorders were the major psychiatric problems to be dealt with in Taiwanese conscript soldiers. Further work is warranted to investigate the role of mental illness in the early attrition of Taiwanese voluntary soldiers.

Ziprasidone-associated Hypomania in Schizophrenia

Objective: Previous studies suggest that ziprasidone may result in hypomania or mania. However, most reported cases involved patients with mood disorders and only two schizophrenic patients developed mania during ziprasidone treatment. We describe a Taiwanese patient with schizophrenia who developed hypomanic symptoms following ziprasidone therapy. Case Report: A 37-year-old Taiwanese man who was hospitalized due to acute exacerbation of chronic schizophrenia was treated with 160mg per day of ziprasidone. Ten days after starting ziprasidone therapy, he developed hypomanic symptoms including expansive and euphoric mood, inflated self-esteem, decreased sleep desire, overtalkativeness, and hyperactivity. His mood symptoms resolved after switching from ziprasidone to risperidone therapy. However, his schizophrenic symptoms including persecutory delusions and auditory hallucinations relapsed after the switch in treatment. Due to the relapse of schizophrenic symptoms, his risperidone treatment was changed to olanzapine (20mg/d) and his schizophrenic symptoms were stabilized 12 days afterwards. Conclusion: This case suggests the need for awareness that hypomania or mania may occur as a result of ziprasidone treatment in schizophrenic patients.

Nephropathy and Heroin Addiction

Objective: Heroin addiction is a chronic and relapsing psychiatric disorder, characterized by compulsive seeking and use of heroin. Among the diverse medical complications associated with heroin addiction, heroin-related nephropathy is relatively uncommon. We report two cases of severe nephrotic syndrome with poor clinical outcome in patients with heroin addiction. Case reports: Both of these patients with heroin-related nephropathy presented with several distinct clinical features, including a very short duration of heroin addiction before the development of the renal disease and profound proteinuria. These complications have not been previously reported. Conclusion: Heroin addiction can cause profound nephrotic syndrome. The development of nephropathy in heroin addicts has a multifactorial etiology, including heroin-mediated effects, the effects of adulterants mingling with heroin, hepatitis C, as well as possible ethnic variations which may be influenced by genetic and environmental factors. Early psychiatric intervention is essential to deter hazardous addictive behavior and to prevent the development of heroin associated nephropathy.