Wei-Lieh Huang

Auditory event-related potential of subjects with suspected pre-psychotic state and first‐episode psychosis

BACKGROUND Recent schizophrenia research exploring the complicated pathogenesis of schizophrenia has focused on the subjects with at-risk mental states in order to exclude the influence of confounding factors. This study explores 3 sets of auditory-related event potentials in subjects with different risk levels of psychosis. METHODS Subjects were recruited from the SOPRES study in Taiwan. P50 and N100 using an auditory paired-click paradigm and duration MMN were assessed on 32 first-episode psychosis (FEP), 30 ultra-high risk (UHR), 37 E-BARS (early/broad at-risk mental states) participants and 56 controls. RESULTS MMN was correlated with neither P50 nor N100, whereas many parameters of the latter two were intercorrelated with each other. Compared to healthy controls, MMNs were significantly lower in all 3 clinical groups (E-BARS, UHR and FEP). A gradient of sensory-gating deficits, manifested by increased P50 ratios (S2/S1) and decreased N100 differences, across different levels of clinical severity was suggested by a linear trend. For the UHR subjects, P50 gating ratio, N100 gating ratio, N100 difference, and N100S2 amplitude might be potential indicators to discriminate converters from non-converters. CONCLUSIONS By including subjects with E-BARS, our results provide new insight regarding pre-attentive auditory event-related potential in subjects across different risk levels of psychotic disorders. Impaired deviance detection shown by MMNs already exists in people at a pre-psychotic state regardless of clinical severity, while sensory-gating deficits shown by P50/N100 varies depending on the risk levels in prodromal period. Further longitudinal research exploring the relationship between ERPs and subjects with a suspected pre-psychotic state is needed.

Impact of antipsychotics and anticholinergics on autonomic modulation in patients with schizophrenia.

Abstract Antipsychotics are associated with cardiovascular risk, but the relationship between their anticholinergic properties and cardiac function is not clear. We hypothesize that antipsychotics with a high muscarinic affinity (HMA) may reduce parasympathetic modulation, which should be observable by means of heart rate variability (HRV) measurement. We also assume that anticholinergics, which are commonly used in patients with schizophrenia to treat drug-induced parkinsonism, interact with antipsychotics, and this may also affect HRV. Fifty-five patients with schizophrenia were recruited into this study. Twenty-eight subjects used antipsychotics with an HMA and 27 subjects used antipsychotics with a low muscarinic affinity (LMA). Heart rate variability values between the patients on antipsychotics with HMA and those on antipsychotics with LMA were compared. Correlation and regression analysis were then performed to clarify the relationship between HMA, LMA, and HRV. The influence of anticholinergics was also assessed by correlation analysis. The HMA group showed significantly reduced low-frequency (LF) power, high-frequency (HF) power, total power (TP), and normalized LF (LF%) than the LMA group. Regression analysis supported the hypothesis that muscarinic affinity was related to LF (&bgr; = −0.447; P < 0.001), HF (&bgr; = −0.390; P = 0.002), and TP (&bgr; = −0.399; P = 0.001). The interaction between LMA and anticholinergic use also influenced LF% (&bgr; = 0.326; P = 0.006). In the LMA group, the use of anticholinergics was positively correlated with LF% and LF/HF. In the HMA group, after exclusion of the patients using anticholinergics, the equivalent dose of antipsychotics showed a negative correlation with HF. Our results suggest that the muscarinic affinity of antipsychotics affects both sympathetic and parasympathetic modulation and that anticholinergics interact with antipsychotics to influence HRV.

Gender differences in personality and heart-rate variability

Both personality traits and autonomic functioning show as gender differences, but their relationship is not well understood. Medically unexplained symptoms are related to personality features and can be assessed by autonomic measurement. The patterns are hypothesised to identify gender differences. We recruited 30 male and 30 female healthy volunteers. All participants completed the Tridimensional Personality Questionnaire (TPQ) and heart-rate variability (HRV) measurement. Correlation analysis was performed to identify the relationships between TPQ scores and HRV parameters. For the subjects as a whole, the subdimension harm avoidance 4 (HA4, fatigability and asthenia) was found to be negatively correlated with low-frequency (LF) power, high-frequency (HF) power and total power (TP) of HRV. Novelty seeking 1 (NS1, exploratory excitability) was found to be positively correlated with LF power and TP. Multiple linear regression analysis revealed that the interactions exploratory excitability x gender and fatigability x gender are predictors of LF and HF power, respectively. Our result supports the hypothesis that personality features such as exploratory excitability and fatigability are associated with autonomic functioning and that gender is a moderator in these relationships.

Self-reported psychopathology and health-related quality of life in heroin users treated with methadone.

Background Health-related quality of life (HRQoL) remains poor among heroin users, even after being treated with methadone. Evidence regarding self-reported psychopathology and HRQoL in heroin users is also limited. The present study aimed to investigate the association between self-reported psychopathology and HRQoL in Asian heroin users treated with methadone. Methods Thirty-nine heroin users treated with methadone and 39 healthy controls were recruited. Both groups self-reported on demographic data, the Brief Symptom Rating Scale, EuroQoL-5D, and World Health Organization Questionnaire on Quality of Life: Short Form. We compared clinical characteristics, psychopathology, and HRQoL between the two study groups. Correlation and regression analyses were conducted to explore the association between psychopathology and HRQoL in the heroin user group. Results Heroin users had more psychopathology and worse HRQoL than healthy controls. The HRQoL of heroin users had significant correlations with Brief Symptom Rating Scale scores. HRQoL could be predicted by depression, anxiety, paranoia, and additional symptoms (ie, poor appetite and sleep difficulties) independently. Conclusion Self-reported psychopathology, depression, anxiety, paranoia, poor appetite, and sleep difficulties had a negative impact on each domain of HRQoL among heroin users treated with methadone. The importance of the environmental domain of HRQoL is discussed. Clinicians should recognize comorbid psychiatric symptoms early on to improve HRQoL in heroin users.

Influence of Disruptive Behavior Disorders on Academic Performance and School Functions of Youths with Attention-Deficit/Hyperactivity Disorder

Childhood attention-deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant disorder/conduct disorder (ODD/CD) are associated with negative school outcomes. The study aimed to examine the impact of ADHD and ODD/CD on various school functions. 395 youths with ADHD (244 with ADHD + ODD/CD and 151 with ADHD only) and 156 controls received semi-structured psychiatric interviews. School functions were assessed and compared between each group with a multiple-level model. The results showed that youths with ADHD had poorer performance across different domains of school functioning. Youths with ADHD + ODD/CD had more behavioral problems but similar academic performance than those with ADHD only. The multiple linear regression models revealed that ADHD impaired academic performance while ODD/CD aggravated behavioral problems. Our findings imply that comorbid ODD/CD may specifically contribute to social difficulties in youths with ADHD. Measures of early detection and intervention for ODD/CD should be conducted to prevent adverse outcomes.

Psychopathology, rehospitalization and quality of life among patients with schizophrenia under home care case management in Taiwan.

BACKGROUND/PURPOSE To study the outcome of a group of patients with schizophrenia receiving community home care case management programs by delineating the relationship among their psychopathology, rehospitalization rates and health-related quality of life (HRQoL). METHODS This is a cross-sectional study on HRQoL, functioning and associating factors and a retrospectivehistorical control study by comparing the frequency and duration of rehospitalization in a sample of 60 patients with schizophrenia under nonintensive case management (non-ICM) in Taiwan. All participants were assessed on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on EuroQoL-5D (EQ-5D) and EQ visual analogue (EQ-VAS) for HRQoL, andGlobal Assessment of Functioning (GAF) for socio-occupational dysfunction. Other clinical characteristics are also gathered. RESULTS Patients with schizophrenia treated with non-ICM had a significant reduction in admission frequency (-0.10 ± 0.36 times per year, p = 0.042) and length of inpatient stay (-27.8 ± 78.0 days per year, p = 0.008). Better EQ-5D and EQ-VAS are significantly associated with lower general psychopathology score, while better EQ-VAS is significantly associated with older age and higher negative symptoms subscale score. GAF is negatively associated with higher positive symptoms and negative symptoms subscale scores, while positively correlated with a greater reduction in number and frequency of admission. CONCLUSION Non-ICM can help to decrease rehospitalization of home care patients. HRQoL and functioning can be assessed by the three perspectives we used, and each measure was correlated to different dimensions of patient psychopathology. It will be better if we include baseline and post-intervention PANSS scores, HRQoL and functioning as outcome indicators.

Depression and anxiety among patients with somatoform disorders, panic disorder, and other depressive/anxiety disorders in Taiwan

The aim of this study is to compare the severity of depression and anxiety in individuals with somatoform disorders, panic disorder, other depressive/anxiety disorders, and healthy controls in a Han Chinese population. According to the DSM-IV-TR-based diagnostic interviews, we recruited 152 subjects with somatoform disorders (SG), 56 with panic disorder (PG), 85 with other depressive/anxiety disorders (OG), and 179 without any psychiatric disorder (NG). The four groups reported on the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) for depressive and anxiety symptoms, respectively. Correlation analysis and multivariate regression analysis were used to determine the effects of demographic factors and psychiatric diagnoses on depressive and anxiety symptoms separately. BDI-II scores were not significantly different in SG, PG, and OG but were higher than NG. SG and PG had the highest BAI scores, whereas NG had the lowest. Multiple linear regression analyses revealed that the associated factors for BDI-II were gender, residential location, somatoform disorders, panic disorder, major depressive disorder (MDD), and generalized anxiety disorder, whereas BAI was significantly associated with somatoform disorders, panic disorder, and MDD. Our results strongly suggest the inclusion of clinical assessment of depressive and anxious symptoms in patients with somatoform disorders.

Combination of escitalopram and aripiprazole causes significant improvement of negative symptoms of simple schizophrenia

RUSSELL-SILVER SYNDROME (RSS) is a clinically and genetically heterogeneous syndrome characterized by craniofacial symptoms with triangular face and short stature. Very few comorbid psychiatric disorder cases with RSS have been reported. We report an adolescent case of schizophrenia (SZ) with RSS. A 14-year-old boy was referred to our hospital for medical examination from the Department of Psychiatry at X Child General Medical Center. His short height and characteristic appearance were pointed out at a health examination for 18-month-old children. He was diagnosed as having RSS by a pediatrician, and growth hormone therapy was started at 3 years of age. There was no obvious psychiatric family history. The patient began to show unmotivated laughter at 14 years of age. His parents took him to the X Center and SZ was suspected. He was referred to our hospital for medical examination. He was 143.0 cm tall and weighed 34.7 kg. Along with Eggerman’s form, his physical states were as follows: postnatal growth retardation (+), relative macrocephaly (+), asymmetry (–), developmental delay (+), triangular face (+), prominent forehead (+), ear or teeth anomalies (–), and micrognathia (+). No abnormal findings were observed on brain magnetic resonance imaging, electroencephalography, and in biochemical examination of the blood. Other psychiatric symptoms, including hallucination of bodily sensation, loosening of association, and delusion of reference, suddenly appeared 6 months after he was referred to us. He was diagnosed as having SZ definitively and hospitalized for treatment. Risperidone (2 mg/day) was moderately effective in reducing the hallucinations and delusions. After receiving treatment in our hospital for about 2 months, he was referred to the X Center for care of his negative schizophrenic symptoms with occupational therapy. Genetic examination was not completed due to a lack of participation by his parent. Vardi et al. reported a 4.5-year-old boy with RSS who showed autistic regression. An RSS case with a familial history of SZ has also been reported (the mother of a Nigerian RSS infant had been diagnosed with schizophrenia and used haloperidol). PubMed searches revealed no case similar to ours. Therefore, we believe that this is the first reported case of SZ with RSS. Further case accumulation is needed to reveal the correlation between RSS and psychiatric disorders. We are grateful to the parents of the patient for their cooperation and written consent regarding the current report.

Hyperhidrosis under combination of zotepine and haloperidol alleviated by aripiprazole

certain central nervous system 5-HT receptors (i.e. 5-HT-2A, 5-HT-1A, and 5-HT-3). Cyproheptadine is a first-generation, histamine-1 receptor-blocking agent with non-specific antagonist properties at 5HT-1A and 5HT-2A receptors. It has been shown that patients with mild to moderate symptoms of serotonin syndrome that are not hyperthermic typically respond to this pharmacological agent within 30 min to 2 h of administration.

Application of the Chinese Version of the Whiteley Index-7 for Detecting DSM-5 Somatic Symptom and Related Disorders

BACKGROUND The Whiteley Index-7 (WI-7) is frequently used for evaluating patients with suspected hypochondriasis. However, information about its use on somatic symptom and related disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is still lacking. This study investigated the psychometric properties of the Mandarin Chinese version of the WI-7 and its application to evaluation of somatic symptom and related disorders. METHODS Participants completed the WI-7 and received diagnostic interview based on both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and DSM-5 criteria. Exploratory factor analysis was performed, and the test-retest reliability and the internal consistency of the WI-7 were assessed. Receiver Operating Characteristic curves were established, and the area under the curve was calculated to determine the cutoff point to distinguish DSM-IV somatoform disorders and DSM-5 somatic symptom and related disorders, respectively. RESULTS A total of 471 subjects were recruited for this study. The exploratory factor analysis of the WI-7 identified a single factor. The internal consistency and test-retest reliability of the WI-7 were 0.829 and 0.836, respectively. The area under Receiver Operating Characteristic curve using WI-7 to distinguish DSM-5 somatic symptom and related disorders is 0.660, higher than that when applying to distinguish DSM-IV somatoform disorders. The sensitivity and specificity at an optimal cutoff point of 0/1 are 0.645 and 0.675, respectively. CONCLUSION The Mandarin Chinese version of the WI-7 is a potentially useful tool to detect individuals with DSM-5 somatic symptom and related disorders.