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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 35 | Issue 2
Page Nos. 47-102

Online since Tuesday, June 22, 2021

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EDITORIAL  

Contemporary psychotherapeutic approaches to patients with schizophrenia in Taiwan p. 47
Shih- Ming Li, Kun- Hua Lee, Shu- Jen Lu, Wen- Shing Peng
DOI:10.4103/tpsy.tpsy_21_21  
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REVIEWS Top

Mental health services and research and development in South Korea p. 50
Young- Chul Chung, Subin Park, Sungwon Roh, Bomi Lee, Youngmin Lee, Fatima Zahra Rami, Ling Li, Jie Shen
DOI:10.4103/TPSY.TPSY_22_21  
Background: South Korea or the Republic of Korea has an area of 100,412.6 km2, and population of 52 million (51,781,000). Methods: Besides our lifetime experiences in receiving training, teaching, and practicing psychiatry, the authors collected information from the literature pertinent to the mental health care in South Korea. This review is intended to familiarize the readers of the Taiwanese Journal of Psychiatry with the information of mental health-care service as well as research and development (R and D) in South Korea. Results: Despite consistent improvement in the overall health status in Korea, the mental health status of the population is low compared with other countries in the Organization for Economic Co-operation and Development (OECD). For example, Korea has the highest suicide-related mortality and more years of life lost due to mental/behavioral diseases, compared to those of the average and a longer-than-average duration of hospital stay, respectively, of the OECD. Conversely, the government has made efforts to overhaul the mental health system. Several remarkable changes have been made in the areas of community-based service, involuntary admission, and unequal treatment. Conclusion: The mental health status is closely associated with the mental health service system, prevalence of mental disorders, health insurance system, admission system, and R and D budget for mental health. To change attitudes related to mental health, strong leadership among mental health professionals is urgently needed.
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Loneliness in patients with schizophrenia p. 59
Hui- Yuan Liao, Yu Lee, Su- Ting Hsu, Cheng- Fang Yen
DOI:10.4103/tpsy.tpsy_14_21  
Background: The treatment goals for patients with schizophrenia are to address subjective well-being, quality of life, and recovery in recent decades. Loneliness is a negative subjective feeling and related to social isolation, which is thought to be a barrier to recovery. Few research exist to study loneliness in-depth in patients with schizophrenia. Methods: In this review, the authors intend to address the issues of the prevalence, the impacts, the associated factors, and the interventions of loneliness in patients with schizophrenia. Results: Studies showed that patients with schizophrenia have a greater degree of loneliness than those without. The physical and mental health problems associated with loneliness in patients with schizophrenia include hypertension, high blood level of glycated hemoglobin, activated hypothalamus–pituitary–adrenal axis, poor subjective quality of life, depression, anxiety, suicide, use of addictive substances, high perceived stress, low self-esteem, low sense of pleasure, pessimism, and low resilience. From an ecological approach, loneliness in patients with schizophrenia is associated with several personal disease factors, personal cognitive factors, personal socioeconomic factors, community integration, and residence. Social prescribing projects, cognitive behavioral therapy, mindfulness, and positive psychology interventions have been used to reduce loneliness in patients with schizophrenia. Conclusion: Loneliness is an important indicator of the physical and mental health in patients with schizophrenia. Several factors associated with loneliness in patients with schizophrenia have been identified in the past studies. Further intervention research are required for establish effective methods to reduce loneliness in patients with schizophrenia.
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ORIGINAL ARTICLES Top

Using early recollections to explore personality trait, self-efficacy, and insight in depressive patients p. 64
Wei- Jen Chen, Frank Huang-Chih Chou
DOI:10.4103/tpsy.tpsy_15_21  
Objective: Early life experience forms a template for the self-perception of an individual, and negative representations make individuals vulnerable to depression. To explore the deep inner world of patients with depression using objective early life experience measures is not easy. In the present study, we intended to clarify the use of subjective early recollections (ER) in exploring the inner world of depressive patients. Methods: We interviewed 80 depressive inpatients with ER and evaluated whether they had a feeling sense of belonging to their caregivers, and whether they had a positive self-image. They were also assessed using the Taiwanese version Type D Scale-14, Chinese version General Self-efficacy Scale, the Taiwanese version of the Mini-International Neuropsychiatric Interview, and Insight Interview. Results: Independent t-test was used to test the significant differences between feeling belonging/not feeling belonging groups and between positive or negative self-image groups on the variables of Type D personality traits, self-efficacy, illness insight, and comorbid psychiatric disorders with effect sizes ranging from 0.4 to 1.3. Conclusion: Our study showed that ER could function as a window through which depressive patients' inner life. Thus, we suggested that ER can be considered an important part of the clinical assessment methods for depressive patients.
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Psychotropic drug prescription patterns and their predictors among older adult patients with schizophrenia in a tertiary-referral psychiatric hospital p. 70
Mu- Chun Lin, Hsing- Kang Chen
DOI:10.4103/tpsy.tpsy_16_21  
Objective: Medical treatments for patients with refractory schizophrenia can be roughly divided into three strategies – clozapine administration, adjuvant use of mood stabilizers, and antipsychotic polypharmacy. Few studies exist on older adult patients with schizophrenia. In this study, we intended to assess the prevalence of clozapine administration, adjuvant use of mood stabilizers, and antipsychotic polypharmacy, and to find their predictors in those patients with schizophrenia. Methods: In this cross-sectional study, we collected information of patients' sociodemographic and clinical details. Their psychotic symptoms were evaluated using a clinical interview with a positive and negative syndrome scale (PANSS). Results: We enrolled 240 study participants, with 74 patients (30.8%) receiving clozapine, 40 patients (16.7%) receiving adjuvant use of mood stabilizers, and 42 patients (17.5%) receiving antipsychotic polypharmacy. Younger age (p < 0.05), higher PANSS general symptoms subscales (p < 0.001), and higher dosage of antipsychotics (p < 0.01) were significantly related to patients with clozapine administration. As to patients with adjuvant therapy with mood stabilizers, only younger age (p < 0.01) and male gender (p < 0.05) showed significant association. Finally, patients receiving antipsychotic polypharmacy were significantly related to lower body mass index (BMI) (p < 0.05), higher PANSS positive symptoms subscale (p < 0.05), and higher dosage of antipsychotics (p < 0.001). Conclusions: Our findings showed that patients with clozapine prescription were 30.8% in prevalence which is higher than other studies in Asia. The prevalence of adjuvant mood stabilizers and antipsychotic polypharmacy were 16.7% and 17.5%, respectively. Those two findings are lower than those in other studies in Asia.
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A pilot study of antidepressant therapy on sleep architecture in patients with depression in Congo p. 76
Harpreet Singh Dhillon, Shibu Sasidharan
DOI:10.4103/tpsy.tpsy_17_21  
Background: A pilot prospective cohort study was conducted to study the sleep architecture and correlated perceived sleep disturbances in depressed Congolese patients with objective changes in sleep architecture using polysomnography (PSG) before and after antidepressant therapy. Methods: Patients were recruited into the study after applying strict inclusion and exclusion criterion to rule out other comorbidities which could influence sleep. A diagnosis of depressive episode was made based on the International Classification of Diseases-10 Edition DCR. Patients were evaluated using Beck Depressive inventory (BDI) and (Hamilton Depression Rating Scale (HAM-D) insomnia subscale on day 1 of admission. Patients also received sleep study using polysomnography on day 3 of the hospitalization. Patients were started on antidepressant treatment after polysomnography. Patients received an eight-week adequate trial of antidepressants, and BDI score being lower than 9 was considered as being remitted from depression. Polysomnography was repeated after that the patients achieved remission. Statistical analysis was done using Kruskal–Wallis test and Pearson's correlation coefficient. Results: The study results showed that significantly improved polysomnographic findings existed in total sleep time (p < 0.001), sleep efficiency (p < 0.001), wake after sleep onset (p < 0.001), and percentage wake time (p < 0.001) after taking antidepressants. HAM-D insomnia subscale was correlated with total sleep time (p < 0.001), sleep efficiency (p < 0.001), wake after sleep onset (p < 0.001), total wake time (p < 0.001), and N2 stage percentage (p < 0.001). Conclusion: Antidepressant treatment effectively improved sleep architecture in depressive disorder. HAM-D insomnia subscale was correlated with objective findings of total sleep time, sleep efficiency, wake after sleep onset, as well as total wake time and duration of N2 stage of nonrapid eye movement (NREM).
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Prescription patterns and trends of anxiolytics and hypnotics/sedatives among child and adolescent patients with psychiatric illnesses in a psychiatric center of northern Taiwan p. 82
Shu- Wen Cheng, Hsiao- Ju Sun, Hung- Yu Chan
DOI:10.4103/tpsy.tpsy_18_21  
Background: The prevalence of prescriptions of anxiolytics and hypnotics/sedatives for child and adolescent patients with psychiatric illnesses is increasing over the world. No studies exist to focus on the prescription trends and patterns of anxiolytics and hypnotics/sedatives for child and adolescent patients in psychiatric hospitals of Taiwan. Methods: In this retrospective study for all outpatients who were equal or younger than 18 years of age in a psychiatric service, we collected related study variables from the study psychiatric services from 2006 to 2015. Reviewing the electronic medical information system, we extracted both patients' demographic or clinical data (such as sex, age, as well as psychiatric diagnoses), and prescriptions of anxiolytics and hynotics/sedatives. Results: During the study period, the proportion of patients received anxiolytics and hypnotics/sedatives was decreased significantly (from 9.16% in 2006 to 5.85% in 2015, p < 0.001). The proportion of patients received anxiolytics was significantly decreased (from 5.34% in 2006 to 4.54% in 2015, p > 0.05), while hypnotics/sedatives was also decreased significantly (from 5.35% to 2.27%, p < 0.001). Logistic regression analysis showed that the use of anxiolytics and hypnotics/sedatives was significantly associated with age (p < 0.001), gender (p < 0.001), patients' status of catastrophic illnesses (p < 0.001), and diseases (p < 0.001). Conclusion: Anxiolytics and hypnotics/sedatives have the rôles in the treatment of child and adolescent patients with psychiatric Illnesses. Clinicians should be aware of the adverse events of these medications and prescribe them carefully for this population. Certainly, we need more well-designed clinical studies to study the safety and efficacy of anxiolytics and hypnotics/sedatives medications for children and adolescents.
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BRIEF REPORTS Top

The association between depression or stress and internet addiction p. 90
Akash Vishwakarma, Manoj Kumar Sharma
DOI:10.4103/tpsy.tpsy_19_21  
Objective: In the current study, we intended to examine the association between affective states (depression, stress, and anxiety) and Internet addiction (IA). Methods: The study sample consisted of 291 individuals with the age of 18–40 years. We used an online survey on study participants with the IA Scale (20 items) and the Depression Anxiety Stress Scale-21. Results: The mean age ± standard deviation of the sample was 23.58 ± 4.40 years. The results of stepwise regression analysis indicated that depression (p < 0.001) and stress (p < 0.01) significantly contributed to IA. Anxiety did not significantly contribute to IA. Conclusion: This study showed that depression and stress were related to Internet use. This finding implies the need for early identifying depression and stress for giving an appropriate intervention for the individuals with IA.
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The Prevalence of Constipation and Its Risk Factors in Patients with Schizophrenia p. 95
Chih- Chieh Chang, Hsing- Kang Chen
DOI:10.4103/tpsy.tpsy_20_21  
Objective: Constipation is a common symptom in schizophrenia population. Patients treated with antipsychotic drugs are more likely to have constipation. In this study, we intended to identify possible associations and risk factors between schizophrenia patients and constipation. Methods: Patients with schizophrenia (n = 240) were recruited. In this cross-sectional study, we collected information of their socio-demographic and clinical details. Their psychotic symptoms were evaluated using clinical interview with positive and negative syndrome scale (PANSS). Results: In this study, the prevalence of constipation was 59.8%. Odds ratio (OR) (95% confidence interval [CI]) of PANSS average score, 1.018 (1.003–1.034), p < 0.05); OR (95% CI) of using second-generation antipsychotics (SGAs) solely, 3.475 (1.201–10.056), p < 0.05); and OR (95% CI) of using anticholinergic drugs, 1.853 (1.024–3.353), p < 0.05) were significantly associated with constipation. Conclusion: The prevalence of constipation is extremely high in this sample. In those patients who had severe psychotic symptoms, prescription of SGAs or anticholinergic agents, the focus should be on early detection, monitoring the constipation side effect, and early intervention.
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LETTERS-TO-THE EDITOR Top

Malingering by proxy presenting with symptoms of posttraumatic stress disorder: A case report of child abuse p. 99
Hsing- Jung Li, Frank Huang-Chih Chou, Wen- Huei Lin, Kuan- Hsu Chen, Ching- Hong Tsai
DOI:10.4103/tpsy.tpsy_12_21  
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Using lorazepam-assisted interview to help with narrative exposure therapy in posttraumatic stress disorder: A case report p. 101
Lue- En Lee, Chih- Min Liu
DOI:10.4103/tpsy.tpsy_13_21  
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