Mei-Chih Meg Tseng

Inpatient suicide in a general hospital

OBJECTIVES This study aimed to compare the characteristics of psychiatric and nonpsychiatric suicidal inpatients in one general hospital and examine the predictors of completed suicide in the patients with suicidal acts during hospitalization. METHODS One hundred ten study subjects were identified by the adverse event reports of suicidal acts during hospitalization from 1995 to 2004. Demographic data and clinical information were collected by chart reviews. RESULTS Psychiatric inpatients with suicidal acts were mainly younger females with psychiatric diagnoses and previous suicide attempts. Nonpsychiatric suicidal inpatients had less suicide communication, performed suicidal acts more rapidly after admission and used more violent suicidal methods than the psychiatric inpatients did. Suicidal acts performed outside the hospital, use of violent suicidal methods and male gender increased the risk of suicide mortality in our suicidal inpatients. CONCLUSION This study suggests that suicide prevention efforts need to be tailored in psychiatric and nonpsychiatric wards according to differing patient risk characteristics in these patient cohorts.

Prevalence and psychiatric comorbidity of self-reported electromagnetic field sensitivity in Taiwan: A population-based study

BACKGROUND/PURPOSE Psychological factors have been implicated in the etiology of idiopathic environmental illness in many studies. Few studies have ever reported psychiatric morbidity among individuals with electromagnetic hypersensitivity. We aimed to estimate the prevalence and identify the associated factors of self-reported electromagnetic field sensitivity (SREMFS) in adults of Taiwan. METHODS A total of 1251 adults selected from a nationwide Computer-Assisted Telephone Interviewing system received a telephone survey about the perception of risk from various environmental agents and their effects on health and well-being. RESULTS The estimated prevalence of people with SREMFS was 13.3 % (95% confidence interval: 11.2-15.3). People aged >65 years were associated with a lower risk of reporting sensitivity to electromagnetic fields, whereas people with a very poor self-reported health status, those who were unable to work, and those who had psychiatric morbidity were associated with a higher risk of having SREMFS. CONCLUSION The prevalence of SREMFS in the general population of Taiwan is higher than that reported in western countries. People with psychiatric morbidity are more likely to report sensitivity to electromagnetic fields. The cross-sectional design precludes the causal inference of all identified correlates and electromagnetic field sensitivity.

The Relationships Among Sleep Quality and Chronotype, Emotional Disturbance, and Insomnia Vulnerability in Shift Nurses

Background:Shift work is a prominent feature of most nursing jobs. Although chronotype, emotional disturbance, and insomnia vulnerability are important factors for patients with insomnia in general, their effects on shift nurses are unknown. Purpose:This study explores the relationships between the sleep quality of shift nurses and the variables of chronotype, emotional disturbance, and insomnia vulnerability. Methods:A survey was conducted with 398 shift nurses in a medical center. Chronotype, emotional disturbance, insomnia vulnerability, and sleep quality were evaluated using the Smith Morningness–Eveningness Questionnaire, the Brief Symptom Rating Scale, the Ford Insomnia Response to Stress Test, and the Pittsburgh Sleep Quality Index, respectively. Results:On the Pittsburgh Sleep Quality Index, 70.1% of the participants scored higher than 5. Multiple regression analysis revealed that, together with night shift work (b [SE] = 1.05 [0.35], p = .003), higher levels of emotional disturbance (b [SE] = 0.30 [0.05], p < .001) and higher insomnia vulnerability (b [SE] = 0.18 [0.03], p < .001) were predictors of poor sleep quality and that chronotype was not a predictor of poor sleep quality. The multiple mediator model indicated that emotional disturbance significantly mediated an indirect effect of evening chronotype preference on poor subjective sleep quality (one subscale of the Pittsburgh Sleep Quality Index). Conclusions/Implications for Practice:In addition to shift patterns, emotional disturbance and high insomnia vulnerability are factors that may be used to identify shift nurses who face a higher risk of sleep disturbance. Because evening chronotype may indirectly influence subjective sleep quality through the pathway of emotional disturbance, further research into the mechanism that underlies this pathway is warranted.

Latent class analysis of eating and impulsive behavioral symptoms in Taiwanese women with bulimia nervosa

OBJECTIVE The implications of impulsivity in its relationship with binge-eating or purging behaviors remain unclear. This study examined the patterns of eating behaviors and co-morbid impulsive behaviors in individuals with bulimia nervosa n optimally homogeneous classes using latent class analysis (LCA). METHODS All participants (n=180) were asked to complete a series of self-reported inventories of impulsive behaviors and other psychological measures. Information regarding the lifetime presence of symptoms of eating disorder was assessed by clinical interviews. LCA was conducted using eating disorder symptoms, impulsive behaviors, and the number of purging methods. RESULTS Three latent classes of bulimic women were identified. These were women who exhibited relatively higher rates of purging, symptoms of impulsive behavior, and multiple purging methods (17.8%), women who used no more than one purging method with a low occurrence of impulsive behavior (41.7%), and women who showed higher rates of purging behaviors and the use of multiple purging methods with a low rate of impulsive behavior (41.7%). The impulsive sub-group had comparable severity of eating-related measures, frequency of binge-eating, and higher levels of general psychopathology than that of the other two sub-groups. CONCLUSION This study provides empirical support for the existence of an impulsive subgroup with distinctive features among a non-Western group of BN patients. This study also suggests that mechanisms other than impulse dysregulation may exist for the development of binge-eating and purging behaviors in bulimia nervosa patients, or the mechanisms contributing to binge-eating and impulsive behaviors may be different.

Standardized mortality ratio of inpatient suicide in a general hospital.

Inpatient suicide rates are seldom reported using age-standardized methods. This study aimed to estimate the standardized suicide rate in a general hospital. A total of 27 suicidal patients were identified by the adverse event reports during hospitalization from 1995 to 2004. Standardized suicide mortality ratios (SMR) were examined using the Poisson regression model. The SMR of inpatient suicide was 8.25 (95% CI = 5.67-12.06). Hospital suicide rates were considerably higher than the corresponding general population rates for all age groups and were particularly high in age categories of 25-29, 30-34, 40-44, and 55-59 years after controlling for sex and calendar year. Hospitalized patients had an eight times higher risk of suicide mortality than that of the general population. While the elderly are at increased risk for suicide in the general population, young- and middle-aged patients are the age group at risk for suicide mortality during hospitalization.

Cumulative traumatization associated with pathological dissociation in acute psychiatric inpatients

Clinical studies of patients with dissociative disorders and prospective studies of childhood trauma survivors show inconsistent findings regarding the relationship between childhood trauma and dissociation. This study aims to resolve this inconsistency by investigating how dissociation is related to parental dysfunctions, general psychopathology, childhood trauma, and adulthood trauma. Specifically, we focus on the role of cumulative traumatization in pathological and non-taxon dissociation. Eighty acute psychiatric inpatients were administrated standardized measures on dissociation, perceived parental dysfunctions, traumatizing events, and general psychopathology. Parental dysfunctions and trauma correlated with both types of dissociation and general psychopathology. When general psychopathology and parental dysfunctions were controlled, a unique link between trauma and dissociation remained significant. Moreover, the pattern of relationships differed for non-taxon and pathological dissociations. The effect of childhood but not adulthood trauma was significant on non-taxon dissociation. In contrast, an interactive model incorporating both childhood and adulthood trauma was the best model for explaining pathological dissociation. Childhood trauma is important for developing non-taxon dissociation, and adulthood trauma exacerbates its effects on the emergence of pathological dissociation. Cumulative traumatization from childhood to adulthood should be incorporated into the trauma hypothesis of pathological dissociation.

Comparative validity of the chinese versions of the bulimic inventory test edinburgh and eating attitudes test for DSM-IV eating disorders among high school dance and nondance students in Taiwan.

OBJECTIVES To compare the validity of the Eating Attitudes Test (EAT) and the Bulimic Investigatory Test Edinburgh (BITE) as screening tools for eating disorders (EDs), and to identify a new threshold for each questionnaire to detect ED cases among dance and nondance students. METHOD Dance students enrolled in high schools with gifted dance programs and nondance students randomly chosen from the same or nearby schools were invited to participate in a 2-phase ED survey. Participants completed the EAT and BITE questionnaires in the first phase. All participants who screened positive and 10% of the participants who screened negative were interviewed blindly using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Patient Edition. RESULTS The BITE had better accuracy than the EAT in detecting ED in general among both dance and non-dance students. BITE scores of 19 and 16 were the optimal cutoff values for determining ED among dance and nondance students, respectively. The optimal cutoff value for the EAT to diagnose an ED was 19 for dance students and 12 for nondance students. Both questionnaires showed higher sensitivity and lower specificity in dance students than nondance students at the same cutoff points. DISCUSSION The BITE had better diagnostic performance than the EAT in this nonclinical population, although its ability to detect restrictive behaviors is likely as limited as that of the EAT. Plausible explanations for these results and limitations of this study are discussed in the text.

Recurrent escitalopram-induced hyponatremia in an elderly woman with dementia with Lewy bodies.

We report the development of hyponatremia following initiation of escitalopram therapy in a 73-year-old woman. The patient, with a history of dementia with Lewy bodies, had presented with multiple neuropsychiatric symptoms. Within 2 months of escitalopram, she became delirious with a serum sodium level of 122 mmol/L. After discontinuation of escitalopram, her consciousness improved with resolving hyponatremia. Delirium and hyponatremia (122 mmol/L), however, recurred after escitalopram was rechallenged. Apart from eight other cases to date, this is the only one with recurrent hyponatremia. Rechallenge of the same antidepressant is discouraged especially in patients at risk of developing hyponatremia.

Detoxification of high-dose zolpidem using cross-titration with an adequate equivalent dose of diazepam ☆

BACKGROUND There have been numerous case reports of zolpidem abuse and dependence in the recent decade, giving rise to a focus on adverse withdrawal events such as seizure. No standard detoxification regimen has been proposed to date, despite the similarity of effects of zolpidem and benzodiazepines at high doses. CASE DESCRIPTIONS We describe the results, in a 53-year-old female patient, of undergoing three different zolpidem detoxification programs. CONCLUSIONS Because of her experiences, we recommend using the cross-titration strategy with an adequate equivalent dose of diazepam.

Misattributing the Source of Self-Generated Representations Related to Dissociative and Psychotic Symptoms

Objective: An intertwined relationship has been found between dissociative and psychotic symptoms, as the two symptom clusters frequently co-occur, suggesting some shared risk factors. Using a source monitoring paradigm, previous studies have shown that patients with schizophrenia made more errors in source monitoring, suggesting that a weakened sense of individuality may be associated with psychotic symptoms. However, no studies have verified a relationship between sense of individuality and dissociation, and it is unclear whether an altered sense of individuality is a shared sociocognitive deficit underlying both dissociation and psychosis. Method: Data from 80 acute psychiatric patients with unspecified mental disorders were analyzed to test the hypothesis that an altered sense of individuality underlies dissociation and psychosis. Behavioral tasks, including tests of intelligence and source monitoring, as well as interview schedules and self-report measures of dissociative and psychotic symptoms, general psychopathology, and trauma history, were administered. Results: Significant correlations of medium effect sizes indicated an association between errors attributing the source of self-generated items and positive psychotic symptoms and the absorption and amnesia measures of dissociation. The associations with dissociative measures remained significant after the effects of intelligence, general psychopathology, and trauma history were excluded. Moreover, the relationships between source misattribution and dissociative measures remained marginally significant and significant after controlling for positive and negative psychotic symptoms, respectively. Limitations: Self-reported measures were collected from a small sample, and most of the participants were receiving medications when tested, which may have influenced their cognitive performance. Conclusions: A tendency to misidentify the source of self-generated items characterized both dissociation and psychosis. An altered sense of individuality embedded in self-referential representations appears to be a common sociocognitive deficit of dissociation and psychosis.