Gender difference on the mediation effects of filial piety on the association between chronic obstructive pulmonary disease and depressive symptoms in older adults: A community-based study.

Filial piety is viewed as strong family support for older Chinese people, and strongly associated with depressive symptoms. It is unknown if there exists gender difference in the mediation effects of filial piety on the relationship between chronic obstructive pulmonary disease (manifested as lung function) and depression. We investigated whether filial piety mediates the association between lung function and depression in community-dwelling older men and women using the Healthy Aging Longitudinal Study in Taiwan (HALST). Community dwelling adults aged 65 and above were analyzed. Pulmonary function, depressive symptoms, and filial piety expectation (FPE) and receipt of filial piety (RFP) were collected. The interaction and mediation of filial piety between lung function and depression was analyzed. We found that in older men, forced expiratory volume in the first second (FEV1) was inversely correlated with depression (ß = -0.1281, p = 0.004) with no mediation effect of FPE. In older women, FEV1 was negatively associated with FPE, but FPE did not increase the risk of depression (ß = 0.0605, p = 0.12). In both older men and women, FEV1 was negatively associated with RFP, while RFP reduced the risk of depression (p< 0.001). In older women, the correlation between FEV1 was complete mediation of RFP. Results indicate that feelings of insufficient filial piety may increase the likelihood of depression, especially in elderly women with worse lung function. Although modest, the main mediation effect of filial piety was improvement of lung function in older subjects, which might decrease depression.

Comparison of Attitude and Insight Toward Illness Between in Patients with Bipolar I Disorder Manic Episode and Major Depressive Disorder.

Background: Studies comparing insight toward illness in patients with bipolar I disorder manic episode and in patients with major depressive disorder are scarce. The aim of this study was to investigate the attitudes and insight of patients with bipolar I disorder in manic episode and in patients with major depressive disorder. Methods: In total, 86 patients were recruited, including 52 inpatients with bipolar I disorder in manic episodes and 34 inpatients with major depressive disorder. Attitudes toward illness were evaluated using the Self-Appraisal of Illness Questionnaire. Higher Self-Appraisal of Illness Questionnaire scores indicate better awareness and positive attitudes toward one's illness. Insights were assessed using the Insight Scale for Affective Disorders. Higher scores indicate poorer insight. To identify group differences, we used Mann-Whitney U test for statistical analysis. Results: In the Self-Appraisal of Illness Questionnaire, items 1, 2, 3, 4, 6, 7, 10, 15, and 17 showed significantly lower scores in patients with bipolar I disorder than those with major depressive disorder (P < .05). All 3 subscales (presence/outcome of illness, need for treatment, and worry) of the Self-Appraisal of Illness Questionnaire revealed significantly lower scores in the bipolar I disorder group (P < .05). In the Insight Scale for Affective Disorders, items 3, 4, 12, and 16 showed significantly higher scores in the bipolar I disorder group (P < .05). Conclusion: Patients with major depressive disorder had significantly more positive attitudes and greater insight than those with bipolar I disorder. Patients with bipolar I disorder are less aware of their symptoms, including changes in mood, speed of mental functioning, and social relationships. The clinicians may integrate the findings into treatment plans for mood disorders.

Depression among caregivers of patients with dementia: Associative factors and management approaches.

As elderly people increasingly come to represent a higher proportion of the world's population, various forms of dementia are becoming a significant chronic disease burden. The World Health Organization emphasizes dementia care as a public health priority and calls for more support for family caregivers who commonly play a significant, central role in dementia care. Taking care of someone with dementia is a long-term responsibility that can be stressful and may lead to depression among family caregivers. Depression and related behavioral and cognitive changes among caregivers could in turn affect the status and prognosis of the dementia patient. This review article explores depression in dementia caregivers and summarizes proposed mechanisms, associated factors, management and research findings, and proposes future research directions.

Hyperammonemia-Associated Delirium Mimics Dementia: A Case Report.

Ammonia is considered to be a neurotoxin that affects various physiological pathways, including energy metabolism, mitochondria function, and inflammatory response. Dysfunctions of these pathways contribute to the development of cognitive and executive function impairments. A case of a 67-year-old female patient who presented with unusual features of delirium after spine surgery was reported in this study. The patient initially developed acute hepatitis, and 3 weeks later, liver functions gradually improved. However, the acute onset of cognitive impairment and mild hyperammonemia was found. The patient mainly presented with cognitive deficits and impairment of executive functions without a fluctuating course. Her cognitive impairment was resolved when the serum ammonia level returned to the normal range. Consequently, we considered the diagnosis for this patient was delirium rather than a major neurocognitive disorder (dementia). Thus, the clinical diagnosis for delirium and etiologies are discussed.

Severity and prevalence of behavioral and psychological symptoms among patients of different dementia stages in Taiwan

Abstract Background To better understand the trends of behavioral and psychological symptoms of dementia (BPSD) over the disease progression is important to provide psychoeducation for dementia caregivers. Objective This study examined the severity and occurrence of BPSD across the various degrees of the disease. Methods This study was a cross-sectional design. Patients (N = 276) who had dementia from July 2001 to October 2008 were surveyed and assessed for dementia stage, using the clinical dementia rating scale (CDR). BPSD was evaluated using the Neuropsychiatric Inventory (NPI). We examined the differences between the severities and occurrence of the individual's BPSD among various CDR stages with the Kruskal-Wallis test and Chi-square test. Results Delusion (p = 0.01), agitation/aggression (p = 0.033), apathy/indifference (p = 0.009), aberrant motor behavior (p < 0.001), nighttime behavior disturbances (p < 0.001), and eating abnormalities (p = 0.001) were significantly different among stages of dementia. The severity of BPSD became exacerbated over the course of the disease, and was highest in moderate (CDR = 2) or severe (CDR = 3) dementia. The occurrence of BPSD was highest when the CDR equaled 2 (97.5%). Discussion The association of global (or certain) BPSD, across different stages of dementia, is a non-linear relationship. These findings suggest the importance of taking into account clinical dementia stage for managing BPSD.

Association between caregiver depression and individual behavioral and psychological symptoms of dementia in Taiwanese patients.

INTRODUCTION: The aim of this study was to investigate caregiver depression associated with neuropsychiatric symptoms in Taiwanese people. METHODS: A cross-sectional design was used in this study. Two hundred seventy-six pairs of patients with dementia and their caregivers who visited the memory clinic of a general hospital from July 2001 to October 2008 were recruited. Caregiver depression was evaluated with the Center for Epidemiologic Studies Depression Scale (CES-D); the behavioral and psychological symptoms of dementia were evaluated using the Neuropsychiatric Inventory. Demographic data of the patients and caregivers, including cognitive functions and clinical dementia ratings, were collected. In addition to descriptive statistics, we examined the relationship between each parameter and caregiver depression using Pearson correlation, independent t-test, or analysis of variance. RESULTS: The results showed a statistically significant positive correlation between the total Neuropsychiatric Inventory score and CES-D score (r = 0.345, P < 0.001) in the bivariate analyses. For individual behavioral and psychological symptoms of dementia, agitation/aggression, anxiety, nighttime behavior disturbances, irritability/lability, and hallucinations were the five leading symptoms significantly associated with caregiver depression (CES-D). DISCUSSION: Carefully managing these symptoms is likely to reduce depression in dementia caregivers.

Clinical features of delirious mania: a series of five cases and a brief literature review.

BACKGROUND: Little is known about the cause and psychopathology of delirious mania, a type of disorder where delirium and mania occur at the same time. This condition still has no formal diagnostic classification. To provide more information about this potentially life-threatening condition, we studied five patients with delirious mania. METHODS: We describe the cases of five patients with delirious mania admitted to an acute inpatient psychiatric unit between January 2005 and January 2007, and discuss the cases in the context of a selective review of the clinical literature describing the clinical features and treatment of delirious mania. RESULTS: Two patients had two episodes of delirious mania. Delirium usually resolved faster than mania though not always the case. Delirious mania remitted within seven sessions of the electroconvulsive therapy (ECT). CONCLUSIONS: Delirious mania is a potentially life-threatening but under-recognized neuropsychiatric syndrome. Delirious mania that is ineffectively treated may induce a new-onset manic episode or worsen an ongoing manic episode, and the patient will need prolonged hospitalization. Delirious mania also has a close relationship with catatonia. Early recognition and aggressive treatment, especially with electroconvulsive therapy, can significantly reduce morbidity and mortality.

Caregiver burden associated with behavioral and psychological symptoms of dementia (BPSD) in Taiwanese elderly.

The purpose of this study was to investigate caregiver burden associated with BPSD in Taiwanese people. The study had a cross-sectional design. Eighty-eight patients with dementia and 88 caregivers who visited the memory clinic of a medical center from January 2007 to December 2007 were recruited. The BPSD were assessed using the neuropsychiatric inventory (NPI); caregiver burden was evaluated using the NPI caregiver distress scale (NPI-D). Demographic data on the patients and caregivers along with patients' cognitive functions and clinical dementia ratings were collected. In addition to descriptive statistics, we analyzed the relationship between each parameter and caregiver burden using binary correlation. The results showed a statistically significant positive correlation between the total NPI-D score and the total NPI score (r=0.898, p<0.001). For individual BPSD, delusions had the highest mean NPI-D score, followed by agitation/aggression, anxiety, irritability/lability, and dysphoria/depression. The symptom frequency of anxiety, delusions, and agitation/aggression showed a statistically significant positive correlation with caregiver's NPI-D score. These findings suggest that improvement of treatments for delusions, agitation/aggression, anxiety, irritability/lability, and dysphoria/depression among dementia patients may reduce caregiver burden.

Poorer Wisconsin card-sorting test performance in healthy adults with higher positive and negative schizotypal traits.

Non-clinical schizotypy was found to be related to poorer Wisconsin Card-Sorting Test (WCST) performance, but the results were inconsistent. Two subgroups, the higher negative-higher positive and the lower negative-lower positive (15 vs 16), were selected from the top and the bottom quartiles of negative and positive scale scores of the Schizotypal Personality Questionnaire (SPQ) completed by 177 healthy volunteers, respectively. The higher negative-higher positive SPQ score subgroup had significantly poorer performance regarding the completed categories of WCST than the lower negative-lower positive SPQ score subgroup. Subjects with higher non-clinical schizotypy trait showed relatively mild cognitive dysfunction.

Escitalopram for psychogenic nausea and vomiting: a report of two cases.

Psychogenic nausea and vomiting is defined as vomiting without any obvious organic pathology or vomiting with a psychological etiology. The treatment for such a condition is a challenge in clinical practice. The first patient was a 46-year-old married factory worker who was repeatedly hospitalized for recurring bouts of nausea and vomiting. After consultation, she was diagnosed with major depressive disorder. The frequency of nausea and vomiting decreased after treatment with daily doses of 10-20 mg escitalopram. The second patient was a 37-year-old married teacher who had bouts of nausea and vomiting and was also hospitalized repeatedly. She was diagnosed with mixed anxiety-depressive disorder. After treatment with 10 mg/day escitalopram, her episodes of nausea and vomiting decreased. Escitalopram may be an effective treatment for psychogenic nausea and vomiting associated with depression.

Comparison of intramuscular olanzapine, orally disintegrating olanzapine tablets, oral risperidone solution, and intramuscular haloperidol in the management of acute agitation in an acute care psychiatric ward in Taiwan.

INTRODUCTION: The purpose of this study was to compare efficacy and safety among intramuscular olanzapine, intramuscular haloperidol, orally disintegrating olanzapine tablets, and oral risperidone solution for agitated patients with psychosis during the first 24 hours of treatment in an acute care psychiatric ward. METHODS: Forty-two inpatients from an acute care psychiatric ward of a medical center in central Taiwan were enrolled. They were randomly assigned to 1 of the 4 treatment groups (10-mg intramuscular olanzapine, 10-mg olanzapine oral disintegrating tablet, 3-mg oral risperidone solution, or 7.5-mg intramuscular haloperidol). Agitation was measured by using the excited component of the Positive and Negative Syndrome Scale (PANSS-EC), the Agitation-Calmness Evaluation Scale, and the Clinical Global Impression--Severity Scale during the first 24 hours. RESULTS: There were significant differences in the PANSS-EC total scores for the 4 intervention groups at 15, 30, 45, 60, 75, and 90 minutes after the initiation of treatment. More significant differences were found early in the treatment. In the post hoc analysis, the patients who received intramuscular olanzapine or orally disintegrating olanzapine tablets showed significantly greater improvement in PANSS-EC scores than did patients who received intramuscular haloperidol at points 15, 30, 45, 60, 75, and 90 minutes after injection. CONCLUSIONS: These findings suggest that intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution are as effective treatments as intramuscular haloperidol for patients with acute agitation. Intramuscular olanzapine and disintegrating olanzapine tablets are more effective than intramuscular haloperidol in the early phase of the intervention. There is no significant difference in effectiveness among intramuscular olanzapine, orally disintegrating olanzapine tablets, and oral risperidone solution.

Catatonia associated with coadministration of tramadol and meperidine.

Tramadol and meperidine are frequently prescribed medications in the management of oncologic patients. The pharmacologic interaction of these two drugs may induce mental disturbance. This was demonstrated by our case of a 39-year-old woman with gastric mucosa associated lymphoid tissue lymphoma (MALToma), stage III after chemotherapy. She was admitted to our medical ward with the complaint of abdominal pain. Pantoprazole 40 mg and tramadol 150 mg daily were prescribed with intravenous route after hospitalization. Two days later, the patient developed transient visual hallucinations and disorientation after additional injection of meperidine (25 mg). Six hours later, catatonic features appeared. The duty doctor stopped all the medications. Two days later, the catatonic features disappeared. From the clinical course, we suggest that the catatonia was caused by drug interactions between tramadol and meperidine. The pharmacodynamic mechanism might be related to the dopamine and serotonin systems.

Combination antipsychotic therapy in psychiatric outpatient clinics in Taiwan.

OBJECTIVE: The purpose of this study is to survey the use of combination antipsychotic therapy (CAT) in the psychiatric outpatient clinic of a general hospital. METHODS: Patients who received at least 2 antipsychotics in the psychiatric outpatient clinic of a general hospital in 1 month (August 1-31, 2003) were identified, and their retrospective chart review was performed. Using a questionnaire, we surveyed the clinicians on why 2 antipsychotics were prescribed, why long-term CAT was used, and whether the problems were solved by CAT. RESULTS: We studied 957 patients diagnosed with schizophrenia and related disorders in 1 month. A total of 119 patients (12%) were prescribed at least 2 antipsychotics. Among these 119 patients, 91 (76%) were prescribed 2 types of first-generation antipsychotics (FGAs), and 15 patients (16%) were prescribed a second-generation antipsychotic medication and a low-dose FGA medication. The clinicians' main reasons for CAT were to treat insomnia (84%) and psychotic symptoms (83%). CONCLUSIONS: The results of this study revealed that 12% of the patients received CAT in the clinical practice. Most patients were prescribed 2 FGAs. The clinicians' reasons for prescribing CAT in Taiwan were to treat insomnia and psychotic symptoms.