Screening, Brief Intervention, and Referral to Treatment Model Based on ICD-11 Criteria of Gaming Disorder and Hazardous Gaming During the COVID-19 Pandemic.

Purpose of Review: This commentary aimed to propose the screening, brief intervention, and referral to treatment (SBIRT) model for gaming disorder (GD) and hazardous gaming (HG) on the basis of the International Classification of Disease, 11th version (ICD-11) classification. Recent Findings: COVID-19 and its preventive measures increase the risk of GD and the treatment needs could exceed the capacities of mental health systems. Brief intervention could be provided for adolescents with HG after screening. Psychiatrists make diagnoses of GD or HG and then refer them to school counselors, specialized psychologists, or integrated teams based on the severity, comorbidity, and complication of GD. Summary: The classification of GD and HG was suitable to develop a SBIRT model intervention. The SBIRT should work through the shortage of resources and provide a brief intervention guild to make it practical.

From folk therapy to evidence-based psychiatry practice: The benefit of evidence-based psychiatry in treatment-naive psychotic patients.

BACKGROUND: As Taiwan's Mental Health Act (MHA) clearly states that the human rights and legal rights of psychotic patients should be respected and guaranteed; however, a temple asylum violates the law in the 21st century. Hundreds of patients were constrained in the asylum for years without consent. Because of outbreak of infectious diseases, patients were evacuated from the asylum by the official intervention. AIMS: To evaluate the outcomes of these patients from folk therapy to conventional treatment. METHOD: The study recruited the drug-naive psychotic patients constrained in an asylum for decades. Before and after the formal treatment, 253 patients were diagnosed with schizophrenia and other psychotic disorders with assessment of using the Mini Positive and Negative Syndrome Scale (Mini-PANSS) and Comprehensive Occupational Therapy Evaluation (COTE) scale. In addition, family function, self-care ability and nutritional status were also evaluated. RESULTS: The initial data show the improvement in psychotic symptoms and occupational function in these patients. Furthermore, the ratio of patients who were classified as being at risk for malnutrition was decreased by 21.7% after treatment. There was no statistically significant difference in self-care ability before and after treatment. CONCLUSION: The psychotic symptoms and occupational function of these patients were improved after the formal treatment compared to the folk therapy. The care model for the psychotic patients in the temple asylum should be more thoroughly discussed in consideration of the medical ethics principles.

Effects of cognitive behavioral therapy in patients with depressive disorder and comorbid insomnia: A propensity score-matched outcome study.

OBJECTIVE: We evaluated the effects of cognitive behavioral therapy for insomnia (CBT-I) in inpatients with a diagnosis of depression and comorbid insomnia. METHOD: This study used a prospective, parallel-group design. The experimental group received CBT-I for no more than 90 min once weekly for 6 weeks and the control group only have health education manuals for insomnia. The following questionnaires were administered at baseline: the Hamilton Rating Scale for Depression (HAM-D), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Presleep Arousal Scale (PSAS), Sleep Hygiene Practice (SHP), and Pittsburgh Sleep Quality Index. The questionnaires were readministered after the completion of the 6-wk CBT-I intervention and 1 month following the completion of CBT-I, to determine the effects of the CBT-I intervention over time. The analysis of Generalized Estimation Equations was identified the difference between the experimental group and the control group by controlling for the variables in BZD dose and propensity score of gender, age, and the scores for the DBAS-16, PSAS, SHPS, and HAM-D. RESULTS: Consequently, the significant difference in the PSQI scores was observed at the 1-month follow-up assessment however, no significant intergroup difference in the PSQI scores was found at the completion of the CBT-I intervention between two groups. CONCLUSIONS: As a conclusion, we found that overall sleep quality significantly improved in patients who received CBT-I after we controlled for the BZD dose and propensity score, which suggests that CBT-I may represent a useful clinical strategy for improving sleep quality in patients with depression and comorbid insomnia.

[The development of psychiatric and mental health nursing in Taiwan].

Psychiatric mental health is critical to ensuring the health and wellbeing of individuals, families, and communities. While psychiatric mental health work continues to become increasingly complex and challenging, the demand for psychiatric nurses with evidence-based skills continues to grow. Psychiatric mental health nurses (PMHNs) are the primary providers of professional psychiatric mental health care services. PMFNs emphasize humanistic values and focus on servicing patient and family needs. In Taiwan, the Psychiatric Mental Health Nursing Association constructs the competence-credentialing model for psychiatric mental health nursing that underpins the values, attitudes, and beliefs of PMHNs and ensures that the mental health nursing practice promotes public health and wellbeing. In addition, this association promotes advanced psychiatric nursing education, research, and practice, influences the national health agenda, and discusses and disseminates information on psychiatric mental health care issues in order to influence the direction, nature, and quality of psychiatric and mental health care.

Factors related with the ability to maintain wakefulness in the daytime after fast and forward rotating shifts.

The aim of this study was to explore changes in cognitive function, sleep propensity, and sleep-related hormones (growth hormone, cortisol, prolactin, and thyrotropin) and to investigate the factors related to the ability to maintain wakefulness in the daytime after one block of fast forward rotating shift work (2 days, 2 evenings, and 2 nights). Twenty female nurses (mean age: 26.0 ± 2.0 years; range: 22-30 years) were recruited from an acute psychiatric ward. The nurses completed the Maintenance of Wakefulness Test (MWT), State Anxiety Inventory (SAI), Stanford Sleepiness Scale (SSS), Digit Symbol Substitution Test, Symbol Searching Test, Taiwan University Attention Test, Wisconsin Card Sorting Test (WCST), and Multiple Sleep Latency Test (MSLT) four times throughout the day at 2-hour intervals, and their hormone levels were measured at the same time. There was no time of day effect on sleep propensity as measured by the MWT or MSLT despite an increase in self-reported sleepiness. Anxiety state and neuropsychological tasks, including executive function, attention, and perceptual and motor abilities were not affected during the daytime sleep restriction period. The number of omissions and perceptual and motor abilities showed a practice effect. The thyrotropin levels were significantly elevated, and cortisol levels significantly decreased during the daytime sleep restriction period. There were no significant changes in growth hormone or prolactin throughout the daytime period. Age was negatively associated with the mean sleep latency (MSL) of the MWT and positively associated with the MSL of the MSLT. The perseverative errors in WCST and SSS scores were negatively associated with the MSL of the MWT. SAI scores and thyrotropin levels were positively associated with the MSL of the MWT. In conclusion, there was no change in sleep propensity in the daytime after one block of rotating shift work. An attempt to preserve daytime alertness was also related to maintaining neuropsychological performance. Maintaining this ability was related to thyrotropin and age, and this cognition required a high attentive load.

Nurses working on fast rotating shifts overestimate cognitive function and the capacity of maintaining wakefulness during the daytime after a rotating shift.

OBJECTIVES: The objective of our study was to explore changes in cognitive functions, sleep propensity, and sleep-related hormones (growth hormone [GH], cortisol, prolactin [PRL], thyrotropin [TSH]) in the daytime of nurses working on fast rotating shifts. METHODS: Twenty nurses who worked two consecutive night shifts and 23 off-duty nurses were recruited from an acute psychiatric ward. The maintenance of wakefulness test (MWT), Stanford sleepiness scale (SSS), visual attention tasks, Wisconsin card sorting test (WCST), multiple sleep latency test (MSLT), and measuring hormones were administered four times throughout the daytime at 2-hour intervals. RESULTS: The subjects in the off-duty group were more able to maintain wakefulness than those in the night-shift group; however, there were no differences in self-reported total sleep time or sleep latency on the MSLT and SSS scores between the two groups. The subjects in the night-shift group had poorer performances on visual attentive tasks and higher levels of TSH than those in the off-duty group, and this resulted in a lack of a learning effect on the tasks that required a high attentive load. CONCLUSIONS: Nurses working on fast rotating shifts overestimate the cognitive functions and capacity of maintaining wakefulness following daytime sleep restriction. Attention performance depended on the attentive load requirement and was possibly related to TSH level.

Synergistic analgesic effects between neuronostatin and morphine at the supraspinal level.

Neuronostatin, a 13-amino acid peptide, is encoded in the somatostatin pro-hormone. I.c.v. administration of neuronostatin produces a significant antinociceptive effect in the mouse tail-flick test, which is mediated by endogenous opioid receptor. However, the direct functional interaction between morphine and neuronostatin has not been characterized. In the present study, effect of neuronostatin on morphine analgesia was investigated in the tail-flick test. Our findings showed that i.c.v. administration of neuronostatin (0.3nmol/mouse i.c.v.) significantly enhanced the antinociceptive effect of morphine (2.5, 5 or 10µg/kg) at the supraspinal level. Results of antagonism experiments suggested that the synergistic analgesia induced by morphine and neuronostatin was mediated by µ- and к-opioid receptors not δ-opioid receptor. In conclusion, there may be a cascade amplification phenomenon when morphine and neuronostatin were co-administered in acute pain model. The above results provide evidence for the potential use of neuronostatin in combination with morphine to control pain and addiction.

Acupressure improves sleep quality of psychogeriatric inpatients.

BACKGROUND: Acupressure, a noninvasive form of acupuncture, may be used as a low-cost and noninvasive means of improving sleep quality. Although it has been evaluated to improve self-reported sleep quality, it has not been assessed with regard to effectiveness in improving perceived and objective measures of sleep quality outcomes. OBJECTIVES: The aim of this study was to investigate the effectiveness of acupressure in improving sleep quality of psychogeriatric inpatients. METHODS: Using a convenience sample, 60 psychogeriatric inpatients with affective disorders from southern Taiwan were recruited. They were assigned randomly to an experimental or control group. Although both groups received standard medical care, those in the experimental group received 9-minute acupressure treatment daily for 4 consecutive weeks. Acupressure was applied to three acupoints: shenmen, yangchuan, and neiguan. Outcomes were measured using the Pittsburgh Sleep Quality Index and actigraphy. Data were collected at baseline and after 4 weeks of intervention. RESULTS: Participants in the experimental group improved significantly in subjective sleep quality as measured by the Pittsburgh Sleep Quality Index and in objective sleep quality as measured by actigraphy (p < .001 for all) after 4 weeks of intervention. Although the control participants also had some improvement in sleep quality, those in the experimental group had significantly greater improvements (p < .05) in all domains of subjective and objective sleep quality than the control group. DISCUSSION: Acupressure may be an effective means of improving sleep quality of psychogeriatric inpatients.

[Identification of new markers for childhood acute lymphoblastic leukemia by MALDI-TOF-MS].

The aim of this study was to identify new biomarkers for early diagnosis of childhood acute lymphoblastic leukemia (ALL). The total protein samples of ALL cells and normal peripheral lymphocytic cells were extracted respectively. The two-dimensional gel electrophoresis (2-DE), matrix-assisted laser desorption ionization time-of-flight-mass spectrometer (MALDI-TOF-MS) and database searching were used to identified differentially upregulated proteins, the S-P immunohistochemical method was performed for confirming and validating these proteins. The results indicated that two differentially upregulated proteins were preliminarily identified as glutathione S-transferase P (GST-P) and prohibitin (PHB) in ALL group. The immunohistochemistry detection revealed that the positive ratio of GST-P/PHB in ALL group was statistically higher than that in control group. It is concluded that GST-P and PHB may become the promising diagnostic biomarkers and drug targets for childhood patients with ALL.

Intracerebroventricular administration of neuronostatin delays gastric emptying and gastrointestinal transit in mice.

Neuronostatin is a 13-amino acid amidated peptide widely distributed in various organs including gastrointestinal tract. However, the effect of neuronostatin on gastrointestinal motility has not been well characterized. In the present work, effects of central administration of neuronostatin on gastric emptying and gastrointestinal transit were investigated. The results indicated that intracerebroventricular (i.c.v.) administration of neuronostatin (1, 5, 10 or 20nmol/mouse) delayed gastric emptying and gastrointestinal transit in a dose-related manner in mice. The effects were significantly reversed by melanocortin 3/4 receptor antagonist SHU9119 or classical opioid receptor antagonist naloxone, suggesting that the central melanocortin system and opioid system may be involved in the gastrointestinal effects elicited by i.c.v. administration of neuronostatin. In addition, we found that C-terminal amidation modification of neuronostatin is essential to exert its gastrointestinal effects. These results indicated that neuronostatin may play an important role in regulating gastrointestinal function.

Neuronostatin induces hyperalgesia in formalin test in mice.

Neuronostatin, a newly identified peptide encoded by the somatostatin (SST) gene, was proved to produce significant antinociceptive effect in mouse tail immersion test. However, the effect of neuronostatin on tonic pain was still not clear. The aim of this study was to investigate the effect of neuronostatin in the formalin test and its possible mechanism. We found that intracerebroventricular (i.c.v.) administration of neuronostatin (1, 3, 6, 12nmol/mouse) increased licking in a dose-related manner during the late phase, but did not affect the early phase of formalin test in mice. In addition, the hyperalgesic effect during the late phase was completely reversed by melanocortin 3/4 receptor antagonist SHU9119 (50pmol/mouse) or opioid receptor antagonist naloxone (5nmol/mouse), but not GABAA receptor antagonist bicuculline (1086pmol/mouse). These data suggested that the hyperalgesic response induced by neuronostatin was dependent upon the central melanocortin system and endogenous opioid system. In conclusion, these results indicated that neuronostatin may be a new neuropeptide with important role in the modulation of acute and tonic pain.

Impairment of perceptual and motor abilities at the end of a night shift is greater in nurses working fast rotating shifts.

OBJECTIVE: A three-shift work schedule with fast rotation is common among healthcare workers in Taiwan. This study compared cognitive performance at the time of maximum fatigue (3-4am on the last night shift of the rotation) between nurses working two, three, and four consecutive night shifts. METHODS: Sixty-two nurses [mean age 26.4 (standard deviation 2.0) years] were recruited from the acute psychiatric ward and assigned at random to three groups: two, three, and four consecutive night shifts. The exclusion criteria were: current use of hypnotic drugs, regular consumption of coffee, psychiatric illness, major systemic disease, and sleep disorders. Cognitive performance was assessed using the State-Trait Anxiety Inventory, Stanford Sleepiness Scale, Wisconsin Card Sorting Test, Taiwan University Attention Test, Digit Symbol Substitution Test, and Symbol Searching Test. RESULTS: Greater impairment of perceptual and motor ability was seen among subjects who worked two consecutive night shifts compared with those who worked four consecutive night shifts. No differences in demographic data, executive function or attention were found between the three groups. CONCLUSION: The main duties of nurses working night shifts at the study hospital include checking medical orders and prescriptions, which require perceptual and motor abilities. The results of this study suggested that a fast shift rotation may increase the risk of medical errors.

Central administration of neuronostatin induces antinociception in mice.

Neuronostatin, a recently discovered endogenous bioactive peptide, was encoded by pro-mRNA of somatostatin that contributes to modulation of nociception. However, nociceptive effect of neuronostatin is still not fully known. The aim of this study was to evaluate effect of neuronostatin on nociception and elucidate its possible mechanism of action. Intracerebroventricular (i.c.v.) administration of neuronostatin (0.3, 3, 6, 12nmol/mouse) produced a dose- and time-related antinociceptive effect in the tail immersion assay in mice, an acute pain model. The antinociceptive effect of neuronostatin was significantly antagonized by naloxone, and was strongly inhibited by co-injection with ß-funaltrexamine or nor-binaltorphimine, but not by naltrindole. Also, melanocortin 3/4 receptor antagonist, SHU9119, completely blocked the effect of neuronostatin. These data indicated the involvement of both µ- and κ-opioid receptors and central melanocortin system in the analgesic response induced by neuronostatin. In addition, neuronostatin (6nmol, i.c.v.) increased c-Fos protein expression in the periaqueductal gray (PAG) and the nucleus raphe magnus (NRM) that have a pivotal role in regulating descending pain pathways. Taken together, this study is the first to reveal that neuronostatin produces antinociceptive effect via opioid and central melanocortin systems, which is associated with an increase in neuronal activity the PAG and NRM.

Intracerebroventricular administration of neuronostatin induces depression-like effect in forced swim test of mice.

Neuronostatin is a recently discovered endogenous bioactive peptide that is encoded by pro-mRNA of somatostatin. In the present study, we investigated the effect of neuronostatin on mood regulation in the forced swim test of mice. Our results showed intracerebroventricular (i.c.v.) administration of neuronostatin produced an increase in the immobility time, suggesting that neuronostatin induced depression-like effect. In order to rule out the possibility that neuronostatin had increased immobility time by a non-specific reduction in general activity, the effect of neuronostatin on locomotor activity was examined. Neuronostatin had no influence on locomotor activity in mice. In addition, the depression-like effect of neuronostatin was completely reversed by melanocortin 3/4 receptor antagonist SHU9119 or GABAA receptor antagonist bicuculline, but not by opioid receptor antagonist naloxone. These data suggested that the depression-like effect induced by i.c.v. administered neuronostatin was dependent upon the central melanocortin system and GABAA receptor. In conclusion, the results of this study report that neuronostatin induces depression-like effect. These findings reveal that neuronostatin is a new neuropeptide with an important role in regulating depressive behavior.

Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan.

OBJECTIVE: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years. METHODS: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period. RESULTS: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred. CONCLUSIONS: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

A survey of quality of life and depression for police officers in Kaohsiung, Taiwan.

OBJECTIVE: The enormous job stress of police work may result in depression, which is highly correlated with work disability and poor quality of life. We investigated the quality of life, the probability of depression, and the related risk factors for police officers in Kaohsiung, Taiwan. METHODS: We used the 12-item Short-Form Health Survey (SF-12) and the Disaster-Related Psychological Screening Test (DRPST) to assess the quality of life and prevalence of depression for 832 police officers in Kaohsiung. RESULTS: The estimated rate of probable major depression was 21.6% (180/832). Those with an educational level of university or above and nondepressed police officers had higher scores in every subscale for quality of life. Police officers older than 50 had higher scores in the mental aspects of quality of life. Family problems and job stress related to achievement, peer pressure about performance, and heavy workloads were predictive factors for depression. CONCLUSION: Police officers might have a higher estimated rate of depression than previously thought, and those with depression have a poorer quality of life.