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   Table of Contents - Current issue
October-December 2020
Volume 34 | Issue 4
Page Nos. 149-200

Online since Thursday, December 17, 2020

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Antipsychotic Prescriptions for Patients with Dementia: The Strengths and Weaknesses of the National Health Insurance System of Taiwan p. 149
Tzung- Jeng Hwang, Helen F K. Chiu, Te- Jen Lai
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A History of Antidementic Drug Development in Japan p. 152
Masatoshi Takeda, Shinji Tagami
Objective: Japan is the top runner in the world in society aging, in which the number of patients with Alzheimer's disease has significantly increased and still keeps increasing. Many countries and societies are still struggling with people with dementia and the burden related to the high number of the elderly. In this study, both authors have been involved with research works on elucidating the pathological process of Alzheimer's disease and developing antidementic drugs for more than 30 years. Methods: Based on lifetime professional experiences in basic research and clinical work as well as our own contribution in the areas of expertise, we describe in this review the changes of the number of dementia patients and the concept of dementia, as well as the development of antidementic drugs in Japan. Results: In this review, we define the super-aged society first. Historical concept changes in Alzheimer's disease, perspectives of research on Alzheimer's disease and drug development, history of antidementic drug developments (for nootropics and drugs for improving brain metabolism and circulation, development of symptom-modifying drugs; hormones, neurotrophic factors, etc.; acetylcholinergic drugs; and glutamatergic drugs), and development of disease-modifying drugs (with amyloid cascade hypothesis, nonsteroidal anti-inflammatory drugs, and amyloid vaccine) have been outlined as review sections. Finally, we devote discussion in two review sections – failure of new drugs and development from the existing drugs as well as development of preemptive medicine. Conclusion: We hope that the whole society, including the elderly with and without cognitive decline, can resolve this issue in the near future.
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Suicidal Ideation, Quality of Life, and Psychometric Outcomes in Taiwanese Military Personnel with Subjective Hypersomnia or Insomnia p. 162
Chu-Wei Tsai, Yueh-Ming Tai, Szu-Nian Yang
Background: To clarify the symptom discrepancies in suicidality, psychiatry outcomes, and quality of life (QOL), we did a cross-sectional study recruiting military personnel with hypersomnia or insomnia in three camps in northern Taiwan. Methods: With consents of volunteer audience attending a one-hour mental health education program, all qualified active service military personnel were asked to fill out copies of questionnaire describing their current situation. Results: About one-fourth of the 135 samples admitted their current condition of subjective feelings of insomnia (28.15%) or hypersomnia (24.44%), but < 15% of them had ever asked health providers for psychological or clinical help. Compared with controls without any sleep problem, individuals with suicidal ideation in the other two groups were more prevalent, with higher anxiety, depression, and significantly lower total score of QOL (p < 0.05). The insomnia group was significantly unsatisfied with their sleep the most (p < 0.001). The hypersomnia group showed significantly higher mean scores of irritability (p < 0.001). Those findings were more vigorous and predominate even adjusting for confounding effects of age and sex. Conclusion: This study revealed a different prevalence and adversity between subjective insomnia and hypersomnia groups among military population. Further relevant evaluation and management are warranted.
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Validation of Brain Health Test-7 for Detecting Patients with Mild Cognitive Impairment and Early Dementia p. 168
Mei- Xian Loi, Hsi- Chung Chen, Ming- Hsien Hsieh, Yi- Ting Lin, Chen- Chung Liu, Pei- Ning Wang, Chih- Cheng Hsu, Tzung- Jeng Hwang
Objectives: We intended to develop a simple dementia screening tool to help primary care physicians identify patients with mild cognitive impairment (MCI) and early dementia. Methods: The brain health test-7 (BHT-7) was developed based on the original BHT study. Study patients aged 50 years and above with normal cognition, MCI, and dementia were recruited. All patients received evaluation with the BHT-7, mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), and clinical dementia rating (CDR) for cognitive function. The performance of BHT-7 in identifying cognitive impairment was compared with that of MMSE and MoCA. Results: We enrolled 376 study participants. The mean BHT-7, MMSE, and MoCA scores showed significant differences among the three groups. Compared to MMSE and MoCA, the BHT-7 (sensitivity = 86%, specificity = 76%, area under curve = 88%) showed better sensitivity in differentiating MCI from the normal group, with a cutoff value of 17/18. The scores of the three tests were all affected by educational level. Conclusion: The BHT-7 is a simple and easy-to-use cognitive screening tool that may be useful in primary care settings to identify patients with MCI or early dementia.
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The Impact of Sex Differences and Oral Health Behaviors on Oral Health-related Quality of Life among Patients with Schizophrenia in Taiwan: A Cross-sectional Study p. 174
Li- Ling Huang, Kuan- Ying Hsieh, Shu- Wen Chen, Shu- Fen Yu, Shu- Mei Chang, Shu- Yun Chen, Frank Huang-Chih Chou
Objective: Oral health denotes general well-being, meaning that the person can perform functions such as eating, talking, and keeping smile. Those functions can impact on oral health-related quality of life (OHRQoL) with differences between sexes. In this study, we intended to examine sex differences and oral health behaviors in OHRQoL among institutionalized patients with schizophrenia. Methods: We recruited 150 institutionalized patients (99 men and 51 women) with schizophrenia in a nursing home. We measured OHRQoL with the 36-item Short-form Health Survey (SF-36) questionnaire, and oral health by oral cleaning habits, oral health problems, and oral health care. Results: The mean values of the SF-36 physical component summary (PCS) score and mental component summary (MCS) score were 62.4 and 49.9, respectively, which were lower in women than those in men. Cooperativeness was a protective factor, but toothache and bleeding gums were risk factors in PCS. The standard cleaning method and cooperativeness were protective factors, but toothache, bleeding gums, and swollen gums were risk factors in MCS. Conclusion: Our study finding showed that women tended to report poorer physical and OHRQoL than men even after controlling oral health behaviors and problems. Toothache and bleeding gums were risk factors for poor OHRQoL. The findings provide useful information for health-care resource planning in patients with schizophrenia.
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Correlates Related to Probable Common Mental Disorders among Ketamine Users: Cognitive and Urinary Impairments p. 181
Chih- Jen Wang, Li- Ling Huang, Yu- San Chang, Ching- Hong Tsai, Yu- Hsuan Wu, Yi- Fan Lin, Wen- Huei Lin, Kuan- Ying Hsieh
Objective: In this study, we intended to determine the prevalence of common mental disorder (probable CMD) in ketamine users in Taiwan and identify whether factors including cognitive and urinary impairments developed over the course of ketamine use were correlated with probable CMD. Methods: Through a cross-sectional study design, 538 participants (115 women and 423 men) were recruited from reformatory educational classes in Taiwan. We used the 12-item Chinese Health Questionnaire to evaluate probable CMD. Furthermore, we designed a copy of questionnaire regarding ketamine use including questions related to age at first contact with ketamine, ketamine use expenses per month, intervals of use, route, concomitant substance use, legal problems, as well as cognitive and urinary impairments developed over the course of ketamine use. The relationships between ketamine use, physical health, concomitant substance use, cognitive impairments, urinary impairments, and probable CMD were examined using logistic regression analysis. Results: In this study, the prevalence of probable CMD among ketamine users in Taiwan was 19.7%. We found that poor physical health (from p < 0.05 to p < 0.001 for all kinds of severity), comorbid sedatives or hypnotic use (p < 0.01), and moderate cognitive impairments (p < 0.05) significantly developed after ketamine use were all independent factors correlated with probable CMD. But urinary impairments developed after ketamine use did not show any significant difference in regression analysis when considering other confounding factors. Conclusion: We suggest that an early survey of physical health, concomitant use of sedatives or hypnotics, and cognitive impairment can detect mental health problems among ketamine users.
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The Validity of Inventory of Depressive Symptomatology, Self-report and the Association of Depression with Professional Help-seeking among Individuals with Social Anxiety Disorder p. 188
Jian- Ting Chen, Yi- Ting Lin, Huai- Hsuan Tseng, An- Sheng Lin, Hsi- Chung Chen, Ya- Mei Bai, Chao- Cheng Lin
Objectives: Patients with social anxiety disorder (SAD) often have a fear of seeking professional help. In this study, we intended to validate the Taiwanese version of the Inventory of Depressive Symptomatology, Self-report (IDS-SR), and to investigate whether severity of depression and/or social anxiety is associated with professional help-seeking among Internet users with SAD. Methods: In the study part I, we recruited volunteers through the internet, assessed their social anxiety and depression, and examined the Taiwanese version of the IDS-SR. In study Part II, we again recruited volunteers from the Internet and outpatient clinic, and did the telephone or face-to-face interview to establish the validity of the IDS-SR. Finally, the results of both parts were integrated to analyze help-seeking behaviors. Results: We included 2,079 participants in study part I, which showed that the IDS-SR was reliable. In the Part II study, the IDS-SR was found to be valid from 104 participants. Among the study Part I participants who reached the threshold of SAD, a high prevalence (52.9%) of major depressive disorder was found. Multiple logistic regression analysis of scores of the participants who met the threshold of SAD (n = 1,483) revealed that the IDS-SR total score was significantly associated with professional help-seeking (p < 0.001), whereas the severity of social anxiety was not. Conclusion: The Taiwanese version of IDS-SR was valid and reliable. The severity of depression, rather than that of social anxiety, was associated with professional help-seeking behaviors among Internet users with SAD. Screening depression in people with SAD has the potential in identifying those who may seek professional help.
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Therapeutic Factors in the Group Singing Therapy by Social Robot for Patients with Schizophrenia: A Pilot Study p. 196
Yin- Huang Liao, Chia- Chun Wu, En- Lin Yang, Yi- Nuo Shih
Objective: Fewer robots are being used for psychological care, the objective of this pilot study was to explore the therapeutic factors in the group singing therapy by social robot to interact with people with schizophrenia. Methods: In this pilot study, we recruited nine subjects who were aged between 28 and 62 years. They received four sections of group singing therapy given by asocial robot and an occupational therapist. Then, we collected a completed copy for therapeutic-factor questionnaire. Results: In this pilot study, the top three therapeutic factors in order were group cohesiveness, universality, and altruism. Conclusion: Social robot may be a good companion tool for chronic schizophrenia, and need to increase the number of subjects to improve the validity of the study results in the future.
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Psychiatric Manifestations in a Patient with Both Huntington's Disease and Hyperthyroidism: A Case Report p. 199
Yu- Tung Lee, Te- Jen Lai, Chun- Te Lee
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