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   Table of Contents - Current issue
July-September 2020
Volume 34 | Issue 3
Page Nos. 101-148

Online since Monday, September 28, 2020

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Mental health care in Sweden Highly accessed article p. 101
Christer Allgulander
Background: Reforming psychiatric services in Sweden in the 1960s and 1970s caused a shift from inpatient to outpatient units. Methods: Besides my lifetime experiences in receiving training, teaching, and practicing psychiatry, I collected information from the literature pertinent to the mental health care in Sweden. Results: In this review, I have highlighted some of the more important mental health events in Sweden. The number of psychiatric beds in Sweden has reduced from 37,000 to 4,500. The national health insurance and the ethos of the welfare state have created an equitable and generous environment for patients who are mentally ill. The suicide rate has gone down over the last three decades. There has been a substantial increase in a Swedish diagnosis called exhaustion disorder (burnout), especially in medical staff, office workers, and in the schools. Also, against all predictions, children and adolescents increasingly report having aches, insomnia, and depressive symptoms. Diagnosis and treatment for attention deficit hyperactivity disorder has increased substantially in the last 15 years. Moving from the International Classification of Diseases, version 9 (ICD-9) in the 1980s to ICD-11 and the DSM nosologies was accompanied by evidence-based guidelines, resulting in revised curricula for undergraduate and graduate training. Current researchers are showing a growing interest in autoimmune conditions that are comorbid with traditional psychiatric disorders. Neurovirology and psychiatry have an interface with the COVID-19 pandemic that will require an immediate action plan and collaborative efforts. Conclusion: Demographic changes due to increasing proportions of elderly and multiethnic populations, as well as the COVID-19 epidemic, will profoundly affect the future provision of services.
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Decreased serum S100A10 levels in patients with both schizophrenia and metabolic syndrome p. 110
Chin- Chuen Lin, Meng- Chang Tsai, Tiao- Lai Huang
Background: Brain-derived neurotrophic factor (BDNF) is involved in the pathophysiology of schizophrenia and metabolic syndrome. S100A10 is associated with the antidepressant effect of BDNF, and decreased S100A10 mRNA has also been found in schizophrenia. S100A10 also interacts with serotonin and annexin A2, both are associated with obesity. In this study, we intended to investigate the serum BDNF and S100A10 levels in patients with schizophrenia with and without metabolic syndrome. Methods: We recruited patients with schizophrenia, collected their demographic data, and measured their metabolic profiles, serum BDNF, and S100A10 levels. Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale. Metabolic syndrome was determined using the criteria provided by the Ministry of Health and Welfare of Taiwan. Results: In this study, 38.7% of 93 participants had metabolic syndrome. No statistical significance was found in serum BDNF levels between patients with and without metabolic syndrome. Patients with metabolic syndrome had significantly lower S100A10 levels compared to those without (p < 0.01). Conclusion: Decreased serum S100A10 levels were found in patients with schizophrenia and metabolic syndrome compared to schizophrenic patients without. Those data suggested that serum S100A10 level could play a rôle in metabolic syndrome among patients with schizophrenia.
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Maternal hyperthyroidism during pregnancy and offspring risks of attention-deficit/hyperactivity disorder and autism spectrum disorder: A nationwide study p. 115
Mu- Hong Chen, Kai- Lin Huang, Ju- Wei Hsu, Ya- Mei Bai, Tzeng- Ji Chen, Shih- Jen Tsai
Objective: Thyroid hormones are crucial in normal brain development. Abnormal thyroid hormones in pregnancy may impair neurodevelopment in the offspring. In this study, we intended to determine whether prenatal hyperthyroidism can increase the offspring risk of autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD). Methods: In our study, we identified 330 study pairs (mothers with hyperthyroidism and their children) and 1,320 matched control pairs (mothers without hyperthyroidism and their children) between 1998 and 2008 from the Taiwan Longitudinal Health Insurance. The offspring risk of major neurodevelopmental disorders, including ADHD and ASD, was analyzed in the follow-up period (from childbirth to the end of 2011). Results: The results of logistic regression analysis using adjustment for demographic data and maternal mental health disorders showed that prenatal hyperthyroidism significantly increased the offspring risk of ADHD (odd ratio = 2.23; 95% confidence interval [CI] = 1.19–4.18, p < 0.05) and nonsignificantly increased the risk of ASD (odds ratio = 6.62; 95% CI = 1.08–40.47) after having adjusted for children's demographical data and for maternal mental disorders. Conclusion: Those results suggest that prenatal hyperthyroidism increased the risk of ADHD and ASD in offspring, regardless of demographic conditions and maternal mental health disorders. We suggest that hyperthyroidism in pregnant women should be carefully managed and that additional studies are necessary to clarify the underlying mechanisms which maternal hyperthyroidism leads to neurodevelopmental risks.
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Adjunctive sensory integration therapy for children with developmental disabilities in a family-based early intervention program p. 121
Hsiao- Yu Hsieh, Ling- Yu Chen, Kuang- Ling Ko, Hsiu- Hsiang Liu, Wen- Jiun Chou, Miao- Chun Chou, Ching- Shu Tsai, Liang- Jen Wang
Objective: In this study, we investigated whether adjunctive sensory integration therapy (SIT) can benefit children with developmental disabilities (DD) who participated in a family-based early intervention program. Methods: Children aged 2–4 years who had been diagnosed with a DD were placed into 1 of 3 intervention groups. Children in the day-care group (n = 15) received a daily, family-based treatment program in a day-care center. Those in the outpatient clinic (OC) + SIT group (n = 15) participated in a weekly outpatient family-based treatment program with an adjunctive SIT. The OC group (n = 15) participated in a weekly outpatient family-based treatment program, which was used as the control group. With the copy of Mullen Scale of Early Learning (MSEL), we assessed all children both before and after a six-month of intervention. Furthermore, we asked children's caregivers to fill out the both survey copies of the World Health Organization Quality of Life-BREF and the Parenting Stress Index-Short Form. Results: Children in the day-care group demonstrated significant improvements in all development domains as measured with MSEL (p < 01 or p < 0.001). Children in the OC + SIT group exhibited similar developmental progress as those in the day-care group. Furthermore, the OC + SIT group demonstrated significantly greater improvements in receptive language (p < 01) and early learning composite score (p < 01) than the children in the OC group. But the caregivers' quality of life and parenting stress remained unchanged through the six-month intervention. Conclusion: Our findings revealed the potential effect of adjunctive SIT on children's development. The authors hope that our study data can provide a reference for early intervention strategies for children with DD.
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Critical incident stress debriefing for frontline military rescuers in a helicopter crash disaster in Taiwan: A preliminary report p. 128
Ming-Wei Lin, Chu-Wei Tsai, Chung-Chih Hsu, Lien-Cheng Kao, Yueh-Ming Tai, Szu-Nian Yang
Objective: With the goal of optimizing the outcome of frontline rescuers from psychiatric morbidities, especially posttraumatic stress disorder, preventive interventions is necessary. But the effectiveness and timing of the group debriefing programs remain controversial. In this study, we intended to share the process of a debriefing group, consisting of several therapeutic elements and showing the benefits and effectiveness of each therapeutic element. Methods: A helicopter crash tragedy took place on January 2, 2020, in Taiwan. We recruited 71 frontline military rescuers for providing a group debriefing program, a semi-structured critical incident stressing debriefing (CISD). After the program was finished, all participants filled out their demographic data and a copy of an anonymous questionnaire, the Sharing Support Group for Crisis Intervention Questionnaire for the attendant's self-perceived benefits with 11 elements. Comparing to their perceived therapeutic elements and demographic information, we later discussed the factors associated with the therapeutic effectiveness of this program. Results: The male dominant participants perceived the benefits of all therapeutic elements with no significant differences between gender. Those with service-year < 4 years showed significantly higher self-perceived benefits from this program (p < 0.05). The sergeant rank showed significantly lesser self-perceived benefits from the program, for example, emotion catharsis (Q4, p < 0.05), reviewing of what the group members experienced (Q5, p < 0.01), and coping skills extension (Q8, p < 0.05). Conclusion: This study revealed that the sociodemographic factors, rescuers' ranks and years of service but no gender, play rôles in the effectiveness of the group debriefing programs for the frontline military rescuers. We hope that further understanding can improve the therapeutic effectiveness of debriefing management in the future.
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Type of mental health lifestyle required in Taiwan p. 134
Cheng- Chieh Li, Yao Tang, Shih- Ming Li, Tsung- Yen Tsai
Objective: Mental health lifestyle (MHL) enhances one's well-being and function. In this study, we used the Rasch analysis on participants' demographic and characteristic data to determine the appropriate MHLs required for mental health (MH) promotion in communities in Taiwan. Methods: We surveyed four communities for MHLs, based on therapeutic lifestyle changes and their responses. Then, we analyzed the data with Rasch analysis. Results: In all, 35 men and 169 women (average age ± standard deviation = 34.34 ± 9.94 years) from four MH promotion courses with an invited speaker completed the copies of the questionnaire, including four items for course satisfaction and eight items on MHL. According to the results of the Rasch analysis, the most easy MHL activity was engaging in relaxation and stress management, and the most difficult MHL was service to others such as volunteering. Moderate-difficulty MHL activities were engaging in exercise, recreational activities, and being involved in nature. Conclusion: In this study, recreation, regular exercise, and contacting nature were identified as moderate-difficulty MHL activities. We suggest that the effectiveness of intervention programs can be confirmed through randomized controlled trials in the future.
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Possible piracetam-induced Raynaud's phenomenon in a male patient p. 138
Ming- Chuan Hu, Mu- Shiang Huang, Carol Sheei-Meei Wang
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A Case of Clozapine-induced fatal bowel infarction after more than a 13-year treatment p. 141
Shih- Shin Yen, Hsing- Kang Chen
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Pancreatitis as a rare side effect of paliperidone use p. 143
Chien- Lin Wu, Tsung- Hua Lu
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Did patients with schizophrenia exist in ancient Japan? p. 146
Edmund S Higgins
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In reply: Did patients with schizophrenia exist in ancient Japan? p. 147
Francisco Lopez-Munoz
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Corrigendum: Mental healthcare in Pakistan p. 148

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