台灣精神醫學/Taiwanese Journal of Psychiatry
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台灣精神醫學會,正常發行
選擇卷期
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Internet addiction is a newly emerged disorder having great globalized psychosocial impact. Depressive disorder is one of the most reported comorbidities. To understand the comorbidity of Internet addiction and depressive disorder can shed light on the mechanism of Internet addiction. In this overview, we review the association between Internet addiction and depression. The cross-section study has shown a solid association between Internet addiction and depression. The prospective study has also demonstrated both temporal directions of a causal relationship between the two disorders. Covariance analysis has demonstrated a complex interaction between the two disorders. Here, we propose four candidate models-the escape, the negative consequences, the bi-direction, and the shared mechanisms model-as working candidate models in our temporary attempt to explain the association between those two disorders. While awaiting the validation for those models, we also suggest future directions for studies, and for treating subjects with Internet addiction.
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Background: Depression and life attitude (or meaning in life) have been noted to be highly associated with suicidal ideation. But the details in the links among them remain still unclear. In this study, we intended to clarify their associations of the sex factor. Method: We randomly selected 102 participants (male: 54, female: 48) from individuals waiting in a psychiatry clinic waiting room with their consents. They were asked to complete copies of Beck Depression Inventory (BDI), Brief Self-Report Scale (BSRS), and 25-item Life Attitude questionnaire, anonymously. Result: About one third (n = 32) of participants had positive suicidal ideation. They were significantly more to be males participants (p ＜ 0.05) and responded significantly more lower subscales of ＂belonging＂ (p ＜ 0.01), ＂existence＂ (p ＜ 0.01), ＂life experience＂ (p ＜ 0.01), ＂life control＂ (p ＜ 0.01), and ＂goal seeking＂ (p ＜ 0.01). The path analysis showed that, their more positive life attitudes of ＂existence＂ and ＂goal seeking＂ are significantly negatively associated with suicidal ideation and depression (p ＜ 0.05). But in female participants the influence of higher ＂belonging＂ was the most significant on lower depression (p ＜ 0.01), whereas higher ＂death acceptance＂ showed negative association with suicidal ideation (all p ＜ 0.01). Conclusion: In line with existing evidences, sex difference in life attitude and suicidal ideation exists. This study distinguishes the life attitude-depression- suicidal ideation path in gender. Our findings provides further insights in sex-specific suicide prevention interventions.
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Objectives: In this study, we intended to evaluate the retaining rate and effectiveness in a regional integrated early intervention (EI) program for children with developmental delay (DD), and to study the factors associated with outcomes outcome. Methods: During the period from February 2009 to January 2012, we enrolled children of less than 6 years in age who attended the program at a regional medical center in northeastern Taiwan in this study. The caregivers of the children were asked to fill out the Chinese Child Development Inventory (CCDI) at both the first visit and the 6-month follow-up visit. Retaining was defined as a child who was eligible in the program and completed the assessment at month 6. Results: Totally, 186 children with DD (mean age: 4.0 ± 1.4 years) were recruited in this study, and 128 (68.8%) of the subjects were boys. Six months after the initial assessment, 90 (48.4%) children were retained in the EI program. Compared to children who lost follow-up, those who retained had significantly lower birth weight (p ＜ 0.05) and lower body weight (p ＜ 0.05) at baseline. Six dimensions of children's development measured by CCDI were significantly improved during a 6-month intervention (p ＜ 0.05 to p ＜ 0.01). Younger age of children at recruitment was significantly correlated with better improvements in children's development (p ＜ 0.05). Conclusion: This study involved a comprehensive assessment for the outcome and their associated factors of an integrated EI program for children with DD. These findings could provide useful clues for making future improvements to its implementation.
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Objectives: Patients with schizophrenia have higher risk of self-harm and suicide. Previous reviews revealed that previous self-harm, depressive symptoms, and substance abuse increase self-harm risk, but the incidence of self-harm of patients with schizophrenia in Taiwan has rarely been reported. In this study, we intended to explore the incidence, the self-harm methods, associated comorbidities, and socio-demographic factors. Methods: We used National Health Insurance Research Database. We included subjects who had at least two ambulatory claims or one admission with diagnosis of schizophrenia-spectrum disorder and at least one antipsychotic agent prescription during 2001-2012. Excluded were those who were too young or too old at diagnosis, diagnosed before 2001, and having missing data. We also recruited age- and sex-matched comparison group. The outcome was defined as the first hospitalization, emergency department visits, or outpatient visits due to self-harm. Results: Patients with schizophrenia were in higher risk of history of self-harm, mood disorders, anxiety disorder, and substance use disorder. Poisoning by substance was the most common self-harm method. The incidence of self-harm for patients with schizophrenia was 5.6 per 1,000 person-years, and the adjusted hazard ratio was 9.4 (95% confidence interval = 8.3 - 10.7, p ＜ 0.001). History of self-harm was the most significant predictors of self-harm (adjusted HR = 18.56; 95% CI = 16.92 - 20.36, p ＜ 0.001), followed by comorbid psychiatric disorders. Conclusion: Our study revealed that patients with schizophrenia had higher self-harm risk and more associated risk factors. We suggest that further public attention should be paid to self-harm prevention.
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Objectives: In this study, we intended to evaluate the associations between depression, anxiety, hostility, and remission of Internet gaming disorder. The association was also evaluated among student and non-student groups. Methods: We recruited 85 subjects with Internet gaming disorder, and 85 subjects in remission from Internet gaming disorder. All participants received a diagnostic interview based on the Internet gaming disorder in the Fifth Edition of the Diagnostic Manual for Mental Disorders, and completed copies of questionnaire for depression, anxiety, and hostility. Results: We found that subjects with Internet gaming disorder in remission had significant lower depression (20.64 ± 10.04 vs. 15.04 ± 9.10, p ＜ 0.001), anxiety (53.81 ± 10.89 vs. 49.72 ± 11.27, p ＜ 0.05), and hostility (63.62 ± 13.24 vs. 55.00 ± 12.65, p ＜ 0.001) than those with Internet gaming disorder. The logistic regression demonstrated that hostility (β = 1.07, 95% CI = 1.01 - 1.12, p ＜ 0.05) was significant more associated factor. Among student subjects, significantly lower hostility (64.86 ± 13.04 vs. 56.00 ± 10.56, p ＜ 0.01), and significantly lower anxiety (55.68 ± 11.12 vs. 50.12 ± 11.06, p ＜ 0.05), were found in those with Internet gaming disorder in remission. Among non-student subjects, significantly lower depression (20.40 ± 10.15 vs. 13.16 ± 8.19, p ＜ 0.01), and significantly lower hostility (61.86 ± 13.51 vs. 54.07 ± 14.39, p ＜ 0.05), were found in those with Internet gaming disorder in remission. Conclusion: The comorbid psychiatric symptoms could be lessened in those with Internet gaming disorder in remission. Further prospective study is necessary to clarify the causal relationship between comorbid psychiatric symptoms and Internet gaming disorder in remission.
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Objective: Enhancing one's well-being is an important issue in mental healthpromotion. Many studies have found the efficacy of the positive intervention on the well-being or mental health in the healthy population. In this study, the efficacy of writing the happy diary was tested on a sample of college students. Method: We invited 19 male and 19 female college students to write the happy diary for 2 months during October 2014 to January 2015, which involved writing about one positive event every day. In addition, we used the life satisfaction scale (LS) and the brief psychiatric symptom rating scale (BSRS-5) as a mental health index at pre-test, at one month since writing the happy diary commenced, and at the end of two months. Result: Before writing the happy diary, the mean ± standard deviation of life satisfaction and distress scores were 18.6 ± 3.5 and 6.8 ± 3.7, respectively. After 1-month happy diary intervention, the mean ± SD of life satisfaction score was increased to 21.0 ± 3.6 and the distress score reduced to 5.4 ± 3.2, and a paired t-test revealed significant differences (T = 3.6, p = 0.001; T = -2.5 p = 0.05). After the 2-month happy diary intervention, the mean ± SD of life satisfaction score was increased to 22.4 ± 3.5 and the distress score reduced to 5.0 ± 3.6), and a paired t-test revealed significant differences (t = 7.6, p ＜ 0.001 and t = -3.5, p ＜ 0.001, respectively). Conclusion: Writing the happy diary was a simple and positive activity that could reduce mental distress and enhance life satisfaction. This finding could be useful to develop the programs of mental health promotion.
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Objective: Constipation is thought to be both common and overlooked in patients with schizophrenia, with no empirical data about its prevalence in the schizophrenic population in Taiwan. In the current study, we intended to investigate prevalence and risk factors of constipation during routine treatment of patients with schizophrenia. Method: We did a retrospective study of inpatients treated with antipsychotic medications in Kaohsiung Kai Syuan Municipal Psychiatric Hospital between January 2008 and December 2013. Totally, 3,107 inpatients diagnosed as schizophrenic were included in this study. Results: The prevalence of constipation was 28.10%. Female gender (odds ratio = 2.12, 95% confidence interval = 1.76 - 2.55, p ＜ 0.01), older age (OR = 1.02, 95% CI = 1.76 - 2.55, p ＜ 0.01), greater symptom severity (OR = 1.03, 95% CI = 1.01 - 1.04, p ＜ 0.01), and comorbid medical diseases (OR = 1.99, 95% CI = 1.65 - 2.40, p ＜ 0.01) were found to be all significantly positive factors related to the constipation. We also found that the use of second-generation antipsychotic drugs (OR = 1.75, 95% CI =1.24- 2.48, p ＜ 0.01), and the use of SGAs combined with first-generation antipsychotic drugs (OR = 3.78, 95% CI = 2.70 - 5.28, p ＜ 0.01) were significantly more likely to cause constipation than the use of FGAs alone. Conclusion: Those findings suggest that clinicians need greater vigilance and active evaluation of constipation in patients with schizophrenia, to ensure appropriate clinical management and to prevent associated complications.
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Background: In this two-year study, we intended to investigate the sexual assault victims help-seeking behavior, and to access victims, sexual abuse history of trauma. Method: We surveyed 158 subjects (including from 25 staff of sexual violence prevention centers in Taiwan and 133 people of victims of their family). Mailing questionnaire and face-to-face or telephone interviews were proceeded as a two-stage method. This prospective study was conducted on 43 victims and 27 family members in two years. Result: Victim surveys had most concerned about their privacy aspects without revealing the identity (90.2%) and as giving anonymity (82.9%). This findings from the victims were different from those from the families. Recovered by the hospital to provide medical questionnaire show there is an obvious shortage and the plight of the process is not really low (56%). Rehabilitation of sexual victims indicators include cases subjective and objective assessment. Conclusion: The current management of sexual victims is still having room for improvement to establish a client-centered trauma assessment and treatment in Taiwan, as a reference index for the future government policy and hospital accreditation reference.
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Objective: Methadone maintenance treatment (MMT) is recognized as an effective treatment in patients with opiate use disorder. But its effect is compromised due to the high incidence of relapse to use heroin. In this study, we intended to investigate factors related to illicit opioid use in MMT patients. Methods: In 90 MMT patients, we collected information of demographic data, opioid urine screen results, heroin and amphetamine abuse history, daily methadone dose, heroin craving visual analogue scale (VAS), Beck Anxiety Inventory score, Beck Depression Inventory II score, and Pittsburgh Sleep Quality Index (PSQI) score. We tested the difference between groups. Results: Of 90 MMT patients, 48 of them (53.3%) were found to have positive opioid urine. Variables such as age, gender, severity of anxiety and depression, sleep quality, and daily methadone dosages were not found to be significantly related to patients' positive opioid urine. A significant difference existed in the heroin craving scores between patients with positive opioid urine and those with negative opioid urine group (37.94 ± 33.98 vs. 20.07 ± 25.78, p ＜ 0.01). But patients with higher level of heroin craving were more to have illicit opioid use. Conclusion: Heroin craving was associated with persistent heroin use among our MMT patients. Further studies are needed to clarify the complex relationships between the multidimensional nature of craving and severity of heroin dependency or mental distress to develop optimal treatment strategies.