A senior psychiatrist in Taiwan with MD and MSc degrees from Kaohsiung Medical University, and PhD degree from Johns Hopkins University School of Public Health. Appointed as the Director of Department of Psychiatry in E-Da Hospital, and Professor of Psychiatry at the School of Medicine, I-Shou University, Taiwan.
Background: Tuberous sclerosis complex is a genetic disorder affecting multiple organs including ... more Background: Tuberous sclerosis complex is a genetic disorder affecting multiple organs including the heart, lungs, brain, skin, and kidneys. But manic features are seldom documented in a previous literature review. Case Report: The female adolescent patient had tuberous sclerosis complex manifesting with manic symptoms. Her initial presentation included akathisia, poor concentration and queer behavior such as spinning around during her preschool years. She did not get a satisfactory treatment effect with medication under an original suspicion of absence seizure. Based on cutaneous findings such as hypomelanotic macules, a shagreen patch and facial angiofibromas, the diagnosis of tuberous sclerosis complex was confirmed at age 10 years. Her first manic episode appeared when she was 18 years old. Conclusion: Clinicians should be alert to have the possibility of tuberous sclerosis complex with the presentation of any specific cutaneous findings along with seizure attacks. Secondary mania may be associated with tuberous sclerosis complex although further genetic research are needed to clarify the etiological relationship.
Background: Severe mental disorders are chronic, recurrent and usually combined chronic physical ... more Background: Severe mental disorders are chronic, recurrent and usually combined chronic physical illness. The pathophysiology of mental disorder still remains a mystery. Convincing evidence supports that cytokines play an integral role in the pathophysiology of certain psychiatric disorders including schizophrenia, major depressive disorder, and bipolar disorder. Method: In this comprehensive overview, we reviewed all available published articles on the topic of cytokines and major psychiatric disorders. Results: Cytokine are generally known as chemical messengers between immune cells. As such, they play a crucial role in mediating inflammatory and immune responses. Cytokines can signal the brain and serve as a mediators between immune and nerve cells. The brain is now seen as capable of influencing immune processes. Conversely, changes in brain activity can occur in association with an immunologic response. Cytokines can act as neuromodulators within the brain. Therefore, cytokines can affect important brain activities such as sleep, appetite, and neuroedocrine regulation. Conclusion: Discoveries about these processes have led to speculations about a possible link between cytokines and psychopathology. If we could identify the immunologic defects in psychiatric disorders, novel treatment strategies involving cytokines and/or cytokine inhibitors would be designed and tried clinically in the future.
Background: Suicide risk evaluation is a public health priority in Taiwan. In this preliminary st... more Background: Suicide risk evaluation is a public health priority in Taiwan. In this preliminary study, we intended to do a correlation study between 13 individual items derived from the Modified SAD PERSONS scale and the SAD PERSONS scale relative to suicide among ethnic Chinese subjects. Methods: We retrospectively reviewed 210 inpatient medical records and classified patients' suicidal severity into three groups: (A) non-suicide group, (B) suicidal ideation group, and (C) attempted suicide group for analysis. Results: Seven items-age (p<0.01), depression (p<0.001), previous attempt (p<0.001), rational thought loss (p<0.001), organized plan (p<0.001), stated future intent (p<0.001), and current life stressor (p<0.001) were significant, indicating that these seven risk factors are distinctly important among these groups. Further group-to-group relationships showed that the "the proportion of the suicidal ideation group or attempted suicide group was always significantly greater than that of the non-suicide group" in most factors, except those correlated to "age" and "rational thought loss" factors. Conclusion: Five factors-depression (p<0.05), previous attempt (p<0.01), organized plan (p<0.01), stated future intent (p<0.01), and current life stressor (p<0.01) were significantly to be strongly associated with suicide in our study. Among the factors, "organized plan" and "previous attempt" were strongest significant predictors.
The objective of this study was to investigate the effects of adherence to postoperative recommen... more The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.
Psychiatry and Clinical Neurosciences, Apr 21, 2015
We wanted to present a picture of patients with schizophrenia receiving risperidone long-acting i... more We wanted to present a picture of patients with schizophrenia receiving risperidone long-acting injection (RLAI) treatment in a real-world setting. This was a retrospective cohort study; 379 patients with schizophrenia were enrolled and treated with different kinds of antipsychotic agents at E-Da Hospital, and received a 12-month follow-up. The patients were distributed into 3 groups, including all-oral antipsychotic, oral risperidone and RLAI groups. The antipsychotic agents and dosages they used were recorded. The rate of rehospitalization, length of hospital stay, emergency room visits and medical expenditures were assessed. The RLAI group had a significantly higher rate of hospitalization before enrolment (the all-oral antipsychotic group was 32.1%, the oral risperidone group, 35.9%, and the RLAI group, 88.4%, p<0.0001). After a 1-year follow-up, all 3 groups were similar in rehospitalization rates (the all-oral antipsychotic group was 28.9%, the oral risperidone group, 30.1%, and the RLAI group, 30.2%, p>0.999), length of hospital stay and number of emergency room visits during follow-up. The most commonly used oral antipsychotics were risperidone (0.5-7 mg/day), quetiapine (65-1200 mg/day), and olanzapine (2-25 mg/day). Using RLAI reduces the severity of disease in more difficult patients.
Background: Tuberous sclerosis complex is a genetic disorder affecting multiple organs including ... more Background: Tuberous sclerosis complex is a genetic disorder affecting multiple organs including the heart, lungs, brain, skin, and kidneys. But manic features are seldom documented in a previous literature review. Case Report: The female adolescent patient had tuberous sclerosis complex manifesting with manic symptoms. Her initial presentation included akathisia, poor concentration and queer behavior such as spinning around during her preschool years. She did not get a satisfactory treatment effect with medication under an original suspicion of absence seizure. Based on cutaneous findings such as hypomelanotic macules, a shagreen patch and facial angiofibromas, the diagnosis of tuberous sclerosis complex was confirmed at age 10 years. Her first manic episode appeared when she was 18 years old. Conclusion: Clinicians should be alert to have the possibility of tuberous sclerosis complex with the presentation of any specific cutaneous findings along with seizure attacks. Secondary mania may be associated with tuberous sclerosis complex although further genetic research are needed to clarify the etiological relationship.
Background: Severe mental disorders are chronic, recurrent and usually combined chronic physical ... more Background: Severe mental disorders are chronic, recurrent and usually combined chronic physical illness. The pathophysiology of mental disorder still remains a mystery. Convincing evidence supports that cytokines play an integral role in the pathophysiology of certain psychiatric disorders including schizophrenia, major depressive disorder, and bipolar disorder. Method: In this comprehensive overview, we reviewed all available published articles on the topic of cytokines and major psychiatric disorders. Results: Cytokine are generally known as chemical messengers between immune cells. As such, they play a crucial role in mediating inflammatory and immune responses. Cytokines can signal the brain and serve as a mediators between immune and nerve cells. The brain is now seen as capable of influencing immune processes. Conversely, changes in brain activity can occur in association with an immunologic response. Cytokines can act as neuromodulators within the brain. Therefore, cytokines can affect important brain activities such as sleep, appetite, and neuroedocrine regulation. Conclusion: Discoveries about these processes have led to speculations about a possible link between cytokines and psychopathology. If we could identify the immunologic defects in psychiatric disorders, novel treatment strategies involving cytokines and/or cytokine inhibitors would be designed and tried clinically in the future.
Background: Suicide risk evaluation is a public health priority in Taiwan. In this preliminary st... more Background: Suicide risk evaluation is a public health priority in Taiwan. In this preliminary study, we intended to do a correlation study between 13 individual items derived from the Modified SAD PERSONS scale and the SAD PERSONS scale relative to suicide among ethnic Chinese subjects. Methods: We retrospectively reviewed 210 inpatient medical records and classified patients' suicidal severity into three groups: (A) non-suicide group, (B) suicidal ideation group, and (C) attempted suicide group for analysis. Results: Seven items-age (p<0.01), depression (p<0.001), previous attempt (p<0.001), rational thought loss (p<0.001), organized plan (p<0.001), stated future intent (p<0.001), and current life stressor (p<0.001) were significant, indicating that these seven risk factors are distinctly important among these groups. Further group-to-group relationships showed that the "the proportion of the suicidal ideation group or attempted suicide group was always significantly greater than that of the non-suicide group" in most factors, except those correlated to "age" and "rational thought loss" factors. Conclusion: Five factors-depression (p<0.05), previous attempt (p<0.01), organized plan (p<0.01), stated future intent (p<0.01), and current life stressor (p<0.01) were significantly to be strongly associated with suicide in our study. Among the factors, "organized plan" and "previous attempt" were strongest significant predictors.
The objective of this study was to investigate the effects of adherence to postoperative recommen... more The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.
Psychiatry and Clinical Neurosciences, Apr 21, 2015
We wanted to present a picture of patients with schizophrenia receiving risperidone long-acting i... more We wanted to present a picture of patients with schizophrenia receiving risperidone long-acting injection (RLAI) treatment in a real-world setting. This was a retrospective cohort study; 379 patients with schizophrenia were enrolled and treated with different kinds of antipsychotic agents at E-Da Hospital, and received a 12-month follow-up. The patients were distributed into 3 groups, including all-oral antipsychotic, oral risperidone and RLAI groups. The antipsychotic agents and dosages they used were recorded. The rate of rehospitalization, length of hospital stay, emergency room visits and medical expenditures were assessed. The RLAI group had a significantly higher rate of hospitalization before enrolment (the all-oral antipsychotic group was 32.1%, the oral risperidone group, 35.9%, and the RLAI group, 88.4%, p<0.0001). After a 1-year follow-up, all 3 groups were similar in rehospitalization rates (the all-oral antipsychotic group was 28.9%, the oral risperidone group, 30.1%, and the RLAI group, 30.2%, p>0.999), length of hospital stay and number of emergency room visits during follow-up. The most commonly used oral antipsychotics were risperidone (0.5-7 mg/day), quetiapine (65-1200 mg/day), and olanzapine (2-25 mg/day). Using RLAI reduces the severity of disease in more difficult patients.
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