Hsiu-Fen Lin

Homocysteine Levels;MTHFR C677T Genotype;and MRI Hyperintensities in Late-onset Major Depressive Disorder

OBJECTIVE Epidemiological studies suggest that elevated plasma homocysteine is associated with an increased risk of depression and cerebrovascular disease. There are no published reports of homocysteine levels and methylenetetrahydrofolate reductase (MTHFR) C677T genotype in clinical samples of patients with late-onset major depressive disorder (MDD). The purpose of this study was to examine the association of homocysteine levels or MTHFR C677T genotype and late-onset MDD and assess whether this may be affected by brain magnetic resonance imaging (MRI) hyperintensities. METHODS Authors recruited 39 elderly patients with MDD with first episode occurring after age 50 and 20 comparison subjects and assessed total plasma homocysteine levels, MTHFR genotype, and brain MRIs. RESULTS Plasma total homocysteine levels were higher in elderly patients with late-onset MDD versus comparison subjects. The association did not change after controlling for MRI hyperintensities, and the distribution of MTHFR C677T genotype was not different between the groups. CONCLUSIONS In this exploratory study, elevated homocysteine levels were associated with late-onset MDD, and the association did not appear to be mediated by vascular pathology as identified by brain MRI hyperintensities.

Proton magnetic resonance spectroscopy of late-life major depressive disorder

The primary goal of this study was to examine the biochemical abnormalities of late-life major depression by using 3-tesla (3-T) proton magnetic resonance spectroscopy ((1)H-MRS). The antidepressant effects on the biochemical abnormalities were investigated as well. Study participants were 27 elderly patients with major depressive disorders (among which 9 were on antidepressant medication) and 19 comparison elderly subjects. (1)H-MRS spectra were acquired from voxels that were placed in the left frontal white matter, left periventricular white matter, and left basal ganglia. Ratios of N-acetylaspartate (NAA), choline (Cho) and myo-inositol to creatine were calculated. Patients with late-life major depressive disorder had a significantly lower NAA/creatine ratio in the left frontal white matter, and higher Cho/creatine and myo-inositol/creatine ratios in the left basal ganglia when compared with the control subjects. The myo-inositol correlated with global cognitive function among the patients. The biochemical abnormalities in late-life major depressive disorder were found on the left side of the frontal white matter and the basal ganglia. Neuron degeneration in the frontal white matter and second messenger system dysfunction or glial dysfunction in the basal ganglia are suggested to be associated with late-life depression.

Structural Abnormality on Brain Magnetic Resonance Imaging in Late-Onset Major Depressive Disorder

The purpose of this study was to examine the structural abnormalities of patients with late‐onset major depressive disorder using brain magnetic resonance imaging (MRI) and to assess clinical correlates of these structural abnormalities. Thirty‐seven elderly patients with DSM‐IV major depressive disorder that first occurred after the age of 50 years, and 18 control subjects without depression were recruited. All participants underwent comprehensive psychiatric assessment and cerebral MRI. Brain ventricular and sulcal sizes and white matter hyperintensities were assessed visually. Relative to control subjects, patients with late‐life major depressive disorder showed more severe brain atrophy (p = 0.043) and white matter hyperintensities (p = 0.024), especially in the periventricular area (p = 0.012). Over 60% of the patient group had significant brain MRI hyperintensities. White matter hyperintensity was correlated with later onset of depressive illness (r = 0.49, p = 0.002) among patients. Brain atrophy and white matter hyperintensities are prevalent in patients with late‐onset major depressive disorders. These two abnormalities may represent different pathophysiologic processes of depressive disorders. White matter hyperintensities may be predisposing factors for late‐onset major depressive disorder.

Reappraisal of heart rate variability in acute ischemic stroke.

Cardiac autonomic dysfunction is a common complication after acute ischemic stroke (IS). Prior investigators have emphasized that infarction of brain stem or hemispheres with insular involvement is related to this dysfunction and may predict poor clinical outcome. From the viewpoint of stroke physicians, however, all stroke patients, particularly large‐artery atherosclerosis (LAA) should be monitored for possible cardiac complications after acute IS. This study aimed to investigate cardiac autonomic impaction in patients with acute IS and to make the comparison between LAA and small‐vessel occlusion (SVO) subtypes. Of the 126 acute IS patients prospectively enrolled in this study, 32 had LAA, 56 had SVO, and 38 had undetermined etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria. Cardiac autonomic function of all patients was assessed by measuring heart rate variability (HRV). The low‐ and high‐frequency components of HRV in all stroke patients were significantly lower than those of control subjects after comparing multivariable models, including additional adjustments for age, gender, and all risk factors. There were no significant differences on HRV between LAA and SVO although post hoc comparisons showed that stroke patients of SVO had increased sympathetic modulation and reduced vagal activity. In conclusion, in acute IS patients, both LAA and SVO are predisposed to have cardiac autonomic dysfunction, manifesting as abnormalities in HRV, whether in hemispheric or brain stem lesions. Stroke patients of SVO are at higher risks of cardiac abnormalities, which might suggest an early cardiac dysfunction because of long‐term hypertension. The HF component of HRV thought to be for vagal control might be a cardinal marker for predicting cardiac autonomic dysfunction after acute IS. Short‐term HRV spectral analysis is a convenient approach for stroke clinicians to assess autonomic function in acute stroke. Long‐term follow‐up for HRV and clinical outcome relative to LAA and SVO stroke subtypes is warranted, particularly when an abnormal HRV is found at admission.

Brain Biochemical Correlates of the Plasma Homocysteine Level: A Proton Magnetic Resonance Spectroscopy Study in the Elderly Subjects

BACKGROUND An elevated plasma homocysteine level has been reported to be associated with various neuropsychiatric diseases. However, little is known about the brain biochemical changes associated with the higher plasma homocysteine level. The main goal of this study was to examine the sex difference in brain biochemical concentrations using brain proton magnetic resonance spectroscopy (H MRS), and to elucidate the biochemical changes associated with plasma homocysteine levels by sex in healthy elderly subjects. METHODS Seventy elderly subjects without any clinical psychiatric and neurological disease underwent 3-T brain H MRS. MRS spectra were acquired from voxels placed on the left side of the basal ganglia, frontal lobe, and hippocampus. Brain biochemical concentrations were compared between the elderly male and female participants. Correlations between these biochemical concentrations and plasma homocysteine levels by sex were analyzed. RESULTS Female participants had significantly higher levels of choline in the left frontal lobe and hippocampus, and lower creatine and myo-inositol, in the left basal ganglia than did males. A higher homocysteine level was correlated with a lower N-acetylaspartate (NAA) concentration in the left hippocampus in elderly women (r = -0.44; p = 0.03) but not in elderly men. CONCLUSIONS This study found that there was a sex difference in brain biochemical concentrations in the elderly participants. A higher plasma homocysteine level was associated with a lower NAA in the hippocampus of elderly women. The sex difference in association between brain biochemical concentrations and plasma homocysteine levels needs further investigation. We speculate that after menopause, women lose protection of estrogen from the neurotoxic effects of homocysteine in the hippocampus. Future studies are required to examine this speculation.

Mass hysteria and perceptions of the supernatural among adolescent girl students in Taiwan.

Introduction Persons with mass hysteria present in various ways, yet the condition itself exhibits common features: sudden onset, immediate escalation and remission, and prevalence among adolescent females (Boss, 1997). Mass hysteria also occurs worldwide regardless of ethnicity, but it can be controlled effectively through early diagnosis and intervention. Pinpointing the root cause is problematic in spite of proposed theories. According to Tseng et al. (1992), who cite sexual taboos of Koro males in southern China, cultural belief systems serve as the catalyst. Boss (1997) and Wessely et al. (1990) suggest that mass hysteria is more likely a function of environmental toxicity or infectious disease, and discredit demonic possession as a significant source in contemporary Western societies. However, it remains uncertain whether or not it can be said of all others. It is agreed that people in distress tend to seek therapies and/or treatments administered in concert with cultural or personal beliefs. In Taiwan, for example, folk remedies are as popular as clinical treatment. The perception of mass hysteria is unclear since documentation is relatively non-existent. This paper presents an isolated outbreak of mass hysteria occurring in a class of 48 female students in Taiwan, and examines the situation from the perspective of both patients and families in order to contribute some understanding. In October 2000, the student identified as the dominant character of the class, suddenly and in front of her classmates, appeared to have intense difficulty breathing and swallowing, followed by dizziness, fainting, and verbal outbursts. This was followed by a similar presentation by a group of adolescent girl classmates. They were brought to the Emergency Department of a municipal hospital. During preliminary examinations, symptoms were unrelenting, so much so that each new attack would elicit similar behavior from others in the group. Mass hysteria was diagnosed. The consulting psychiatrist suggested that the girls be kept apart. Meanwhile, hospital staff and teachers provided reassurance, and sedatives were prescribed to prevent new attacks. Six girls required medical treatment. Three students remained ill for two weeks, and the others recovered within one week.

Relationship between ischemic stroke location and autonomic cardiac function

Autonomic cardiac dysfunction is a common complication after acute ischemic stroke (IS). We recruited 75 patients with acute IS with measurements of autonomic cardiac function, including heart rate variability (HRV) and associated parameters, and compared them with 81 controls. Of the 75 patients, 28 had right hemispheric infarctions (RH), 29 had left hemispheric infarctions (LH), and 18 had brainstem infarctions (BS). A comparison of HRV in all patients with stroke and in control subjects showed significant differences between IS subgroups and controls in low frequency (LF), high frequency (HF), normalized LF, normalized HF, and LF/HF ranges. A post-hoc comparison identified significant differences between patients with IS with BS infarctions and the control group in LF, HF, and LF/HF ranges. BS infarction may cause a much greater increase in sympathetic modulation and reduced vagal activity compared to RH or LH infarction. Our findings provide evidence that acute IS causes significant damage to the cardiovascular autonomic system, manifesting as abnormalities of HRV. BS stroke might correlate with a significant reduction in parasympathetic and an increase in sympathetic influence on HRV.

Timing of stroke onset determines discharge-functional status but not stroke severity: A hospital-based study

Circadian variation of the onset time of acute ischemic stroke has been well studied. However, little is mentioned about the circadian variation of discharge‐stroke severity and discharge‐functional status. This study evaluated the impact of onset time on discharge‐stroke severity and the functional status of acute ischemic stroke. Brain magnetic resonance imaging was performed on 274 acute ischemic stroke patients (66.42% male; mean age = 64.81 ± 12.80 years). All times of onset were assigned to 4‐hourly periods (six groups) starting from midnight. Stroke severity/functional status was evaluated on admission and discharge using the National Institute of Health Stroke Scale (NIHSS) score/modified Rankin Scale (mRS) and Barthel Index (BI), respectively. Using mRS, but not NIHSS score and BI, it was possible to differentiate the best and worst groups on discharge. Patients in group 2 (4 to <8 am) and group 6 (8 to <12 pm) had best and worst functional status, respectively. To control other stroke risk factors, multiple logistic regression analyses were conducted to examine the role of onset time in discharge mRS. Aside from age, onset time was a significant indicator in mRS, while gender, hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, and current smoking were not. In conclusion, there is also circadian variation of discharge‐functional status in patients with acute ischemic stroke when assessed by mRS.

Dichotic multiple-frequency auditory steady-state responses in evaluating the hearing thresholds of occupational noise-exposed workers

An objective, fast, and reasonably accurate assessment test that allows for easy interpretation of the responses of the hearing thresholds at all frequencies of a conventional audiogram is needed to resolve the medicolegal aspects of an occupational hearing injury. This study evaluated the use of dichotic multiple‐frequency auditory steady‐state responses (Mf‐ASSR) to predict the hearing thresholds in workers exposed to high levels of noise. The study sample included 34 workers with noise‐induced hearing impairment. Thresholds of pure‐tone audiometry (PTA) and Mf‐ASSRs at four frequencies were assessed. The differences and correlations between the thresholds of Mf‐ASSRs and PTA were determined. The results showed that, on average, Mf‐ASSR curves corresponded well with the thresholds of the PTA contours averaged across subjects. The Mf‐ASSRs were 20 ± 8 dB, 16 ± 9 dB, 12 ± 9 dB, and 11 ± 12 dB above the thresholds of the PTA for 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz, respectively. The thresholds of the PTA and the Mf‐ASSRs were significantly correlated (r = 0.77–0.89). We found that the measurement of Mf‐ASSRs is easy and potentially time saving, provides a response at all dichotic multiple frequencies of the conventional audiogram, reduces variability in the interpretation of the responses, and correlates well with the behavioral hearing thresholds in subjects with occupational noise‐induced hearing impairment. Mf‐ASSR can be a valuable aid in the adjustment of compensation cases.

Relationship between psychological inflexibility and experiential avoidance and internet addiction: Mediating effects of mental health problems

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study. The level of PIEA was examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The levels of depression, anxiety, interpersonal sensitivity, and hostility were evaluated using the Symptom Checklist-90 item-Revised Scale. The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems. The PIEA should be one of the target objectives when administer cognitive-behavioral therapy to college students with IA and mental health problems.