Objective: Studies of the Caucasian population showed that the treatment response rate of 0.5 mg/kg ketamine infusion is as high as 70% in patients with treatment-resistant depression (TRD). By contrast, our earlier study has found a response rate of about 50% in Taiwanese patients with TRD, with much lower blood levels of ketamine and norketamine. In the current study, we intended to investigate whether a higher (0.8 mg/kg) dose of ketamine infusion can improve the treatment outcome. Methods: An open-label study with six TRD patients was done. Every participant received a single dose (0.8 mg/kg) of ketamine infusion and was followed up for two weeks for depressive symptoms. The blood levels of ketamine and norketamine were also assessed. We combined the data from the current open-label study and our previous randomized double-blind study (0.5 mg/kg, 0.2 mg/kg, and placebo) for further analyses. Results: The treatment response rate in the 0.8 mg/kg group was 66.7% at 240 min after ketamine infusion, which is higher than that in the 0.5 mg/kg group. A generalized estimating equation model indicated a group effect (p < 0.001), a time effect (p < 0.001), and a group*time effect (p < 0.001) for the trajectory of the total depression score among four groups. Ketamine and norketamine levels were dose related (0.8 mg/kg > 0.5 mg/kg > 0.2 mg/kg). Adverse effects, such as a floating feeling and dizziness, did not differ in subjects between the 0.8 mg/kg and 0.5 mg/kg groups. Conclusion: A single higher dose (0.8 mg/kg) of ketamine infusion was a safe and effective treatment strategy for Taiwanese patients with TRD. A 0.8 mg/kg ketamine infusion may achieve optimal blood levels of ketamine and norketamine and may have a superior treatment response in Taiwanese patients.

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Objectives: In this study, we intended to examine the differences in patients' attendance profile during psychotherapy process among three patient groups who ultimately completed treatment, prematurely terminate treatment with or without informing therapist in advance. We also attempted to find an effective predicting model to discriminate those three groups. Methods: We used the data of the process notes of 982 time-limited individual therapy sessions over five years, composing of 97 adult patients who were treated by a therapist in a Taiwan psychiatric center. We analyzed 10 attendance variables retrospectively in coded session by session. Results: Three patient groups existed with notable differences in their punctuality, cancellation, no-show, treatment-stage attendance, and overall attendance rates. But no clear difference was observed in the other six variables (time change, early or delayed leave, between-session contact, and evaluation-stage attendance rates). Cancellation and no show were effective variables to distinguish three patient groups. The overall correct predicting rate of the regression model was 67%, and the individual correct predicting rate for treatment completers, informers, and noninformers was 75%, 52.8%, and 75.9%, respectively. No show as a variable clearly discriminated completers from noninformers and informers from noninformers, whereas cancellation variable clearly distinguished completers from informers. Conclusion: Patients with and without informing their therapists before premature termination showed different characteristics. Cancellation and no show in each therapy session were pre-dropout warning signs for later premature termination. Those two behaviors had substantial implications and strong predicting power on the patients' termination conditions.

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Objectives: In this general review, we provide a timeline of how psychiatry in the United States of America has evolved and developed since the nation's inception in the 18th century. Methods: Besides our life time experiences in receiving training, teaching, and practicing psychiatry, we collected information from the literature pertinent to the history of development of American psychiatry in this review. Results: In this review, we have highlighted some of the more cardinal events in American history – the shift from asylums to deinstitutionalization of patients in chronic state hospitals; the birth and evolution of the Diagnostic and Statistical of Mental Disorders by the American Psychiatric Association inspired by a dire need to unite a field; the revolutionary discovery of psychotropic medications and the galvanization of pharmaceutical research, development, and use of psychotropic medications in America; and the growing passion for psychiatry over the last several years among senior medical students. Conclusion: In tandem with their colleagues in other countries, American psychiatrists have overcome many trials and tribulations in their endeavor to ease the suffering of the mentally ill in the United States. We are optimistic for the future of American psychiatry as exemplified by a growing passion for psychiatry among American senior medical students, the expansion of US psychiatry residencies, the continued commitment by the National Institute of Mental Health to fund psychiatric research, and the exciting and thoughtful research of our colleagues domestically and abroad.

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Background: Intimate partner violence (IPV) desistance is rare, and the subjective experience of change in IPV relation needs to be clarified. In this study, we intended to study potential factors of IPV desistance from exploring their subjective experience of the feelings, interpretation of IPV, and interpretation of desistance. Methods: In this qualitative study, the researcher recruited and interviewed eight IPV offenders who achieved desistance for more than one year. The interview style was supportive and noninstructive, allowing a free elaboration of the individual's subjective feelings and reasoning of their violence and their desistance. The data breakdown, recombination, and condensation processes were used to code the information obtained from the source data. Results: Identified factors among eight IPV offenders were found to be related to desistance in the change process of individual levels. They included empathy (cognitive transformation), isolation of affect (emotional adaptation), and nonviolent life arrangement (behavioral transformation), combined with enhanced responsibility, and hope for the future. The affection and responsibility could develop only when the offenders found a way to link to the environment. Therefore, how the environment responded to the IPV desistance behavior was important. Conclusion: IVP relationships can be understood through a qualitative approach in the context of subjective experience in the desistance process. Further studies are needed to reconfirm those study findings.

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Objective: Benzodiazepines and related drugs (BZDRs) increase the risk of undesirable health outcomes in the elderly and should be prescribed judiciously. In this study, we intended to evaluate the prevalence of BZDRs among patients with dementia and to identify the risks associated with BZDR use. Methods: This study was conducted at a public psychiatric hospital in northern Taiwan. Patients with Taiwan National Health Insurance catastrophic illness certificate of dementia were recruited. We reviewed their medical records for a two-year period since the issued date of patients' certificates. Results: The prevalence of BZDRs among the patients with dementia was up to 49% (151/308). The most popular BZDRs in this study were estazolam (16.2%), followed by zopiclone (11.4%) and zolpidem (7.5%). The most common adverse events (AEs) related to BZDRs were delirium (6.0%), followed by somnolence (4.6%) and fall (2.0%). Patients with physical comorbidities had significantly higher risk of BZDR-related AEs compared to those without physical comorbidities (adjusted odds ratio = 2.097, 95% confidence interval = 1.225–3.589, p < 0.05). Conclusion: In this study, we identified that BZDRs were highly prevalent in patients with dementia and physical comorbidities, that BZDRs were associated with higher risk of AEs, and that delirium, somnolence, and fall were common AEs during the period of BZDR treatment. Clinicians should be aware of the AEs of BZDRs and prescribe BZDRs carefully for older-demented patients.

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