Psychiatry

The aims of this study were to examine the mediating effect of bullying involvement on the relationships between body mass index (BMI) and mental health problems, including social phobia, depression, suicidality, and low self-esteem among adolescents in Taiwan. The moderation effect of sex on the mediating role of bullying involvement was also examined. Five thousand two hundred and fifty-two students of high schools completed the questionnaires. Victimization and perpetration of passive and active bullying were assessed using the Chinese version of the School Bullying Experience Questionnaire. BMI was calculated from self-reported weight and height measurements. The Social Phobia Inventory, the Mandarin Chinese version of the Center for Epidemiological Studies-Depression Scale, the suicidality-related questionnaire from the epidemiological version of the Kiddie-Schedule for Affective Disorders and Schizophrenia, and the Rosenberg Self-Esteem Scale were applied to assess social phobia, depression, suicidality, and low self-esteem, respectively. The mediating effect of bullying involvement on the associations between increased BMI and mental health problems was examined by the Sobel test. The moderation effect of sex on the mediating role of bullying involvement was tested by the multiple-group structural equation model. Victimization of passive and active bullying and perpetration of passive bullying, but not perpetration of active bullying, had a mediating effect on the relationships between increased BMI and all four mental health problems. Sex did not have a significant moderation effect on the mediating role of bullying involvement. Bullying involvement should be a target of prevention and intervention in developing a strategy to improve mental health among adolescents with increased BMI.

IntroductionThis study aimed to compare hostility, impulsivity, and behavior inhibition between women with and without premenstrual dysphoric disorder (PMDD) during both luteal and follicular phases and to examine whether these variables contribute to irritability and daily functional impairment of PMDD. PMDD was screened via the Premenstrual Symptoms Screening Tool. A diagnosis of PMDD was confirmed by psychiatric interviewing without 2-month prospective confirmation. Sixty women in the PMDD group and 60 women in the control group completed the Chinese Version of the Buss-Durkee Hostility Inventory-Short Form, Dickman's Impulsivity Inventory, and the Behavior Inhibition System Scale during the luteal and follicular phases. We found that the PMDD group had significantly higher levels of hostility, dysfunctional impulsivity, and behavioral inhibition than the control group in both luteal and follicular phases. The PMDD group also had more premenstrual aggravation on total hostility, hostility affect, and suppressive hostility than the control group. Higher hostility, dysfunctional impulsivity, and behavior inhibition were associated with more severe irritability and functional impairment of PMDD.DiscussionHostility, impulsivity, and behavior inhibition might contribute to irritability and functional impairment in women with PMDD. Assessment and interventions based on these factors should be provided for women with PMDD, especially in the luteal phase.

The aims of this study were to examine the difference in the level of insight into schizophrenia between patients with schizophrenia with and without comorbid alcohol use disorders (AUDs) and to examine the association between insight into schizophrenia and insight into AUDs in patients with comorbid schizophrenia and AUDs. A total of 51 schizophrenic subjects with comorbid AUDs and 67 schizophrenic subjects without AUDs were recruited into this study. The Schedule of Assessment of Insight-Expanded Version and the Hanil Alcohol Insight Scale were used to measure subjects' insight into schizophrenia and AUDs, respectively. Multiple regression analysis models were used to examine the association between insight into schizophrenia and comorbid AUDs in all subjects, as well as the association between insight into schizophrenia and insight into AUDs in the subjects with comorbid schizophrenia and AUDs. The results indicated that schizophrenic subjects with comorbid AUDs had a lower level of insight into schizophrenia than those without AUDs. Meanwhile, among subjects with comorbid schizophrenia and AUDs, those who had a higher level of insight into AUDs had a higher level of insight into schizophrenia. Based on the results of this study, we suggest that evaluating comorbid AUDs and the level of insight into AUDs is important when evaluating the level of insight into schizophrenia among patients with comorbid schizophrenia and AUDs.

The aims of this study were to develop diagnostic criteria of Internet addiction for college students (DC-IA-C) with diagnostic interviews and to establish the optimal cutoff points of the Chen Internet Addiction Scale (CIAS) for the purposes of screening for and making the diagnosis of Internet addiction. A total of 216 college students (132 male and 84 female) were recruited in the study. The results demonstrated that 5/6 cutoff points of criteria A in DC-IA-C had the best diagnostic accuracy (95.9%). Besides, 63/64 and 67/68 cutoff points of the CIAS were evaluated to be the best screening and diagnostic cutoff points, respectively. The DC-IA-C can provide health care professionals with a means to diagnose and communicate about Internet addiction among college students, and the screening and diagnostic cutoff points of CIAS could provide a screening instrument or a discriminative instrument in surveys for Internet addiction among college students.

The aim of the study is to examine the differences in the diversity of family factors between adolescents with and without Internet addiction and substance use experience. A total of 3662 students (2328 boys and 1334 girls) were recruited from seven junior high schools, six senior high schools, and four vocational high schools in southern Taiwan. Internet addiction and substance experience were classified according to the score of Chen Internet Addiction Scale Questionnaires for Experience of Substance use. The family factors assessed included perceived family satisfaction, family economic status, parents' marriage status, care-givers, the frequency of intra-family conflict, families' habitual alcohol use, and perceived parents' or care givers' attitude toward adolescents' substance use. This study demonstrated that the characteristics of higher parent-adolescent conflict, habitual alcohol use of siblings, perceived parents' positive attitude to adolescent substance use, and lower family function could be used develop a predictive model for Internet addiction in the multiple logistic regression analysis. The former three family factors were also sufficient in themselves to develop a predictive model for substance use experience. The results revealed that adolescent Internet addiction and substance use experience shared similar family factors, which indicate that Internet addiction and substance use should be considered in the group of behavioral problem syndromes. A family-based preventive approach for Internet addiction and substance use should be introduced for adolescents with negative family factors.

Working memory (WM) is impaired among adults with attention-deficit hyperactivity disorder (ADHD). This study aimed to investigate the brain activation deficit for low-level or increased-load WM among adults with ADHD. A total of 20 adults with ADHD and controls were recruited according to diagnostic interviewing by a psychiatrist. Phonological and visual-spatial 2-back and 3-back tasks were performed under functional magnetic resonance scanning. The results demonstrated that both the adults with ADHD and the controls exhibited activation of the fronto-parietal network for WM, and the intensity was greater in the adult ADHD group. The ADHD group had higher brain activation over the bilateral anterior cingulate, left inferior frontal lobe, hippocampus, and supplementary motor area (SMA) for phonological WM than the control group. When the task loading increased from 2-back to 3-back tasks, the adults with ADHD perceived greater difficulty. The control group exhibited increased brain activation over the frontal-parietal network in response to increased phonological WM load. However, the ADHD group showed decreased brain activation over the left precuneus, insula, and SMA. Further analysis demonstrated that the ADHD group exhibited a greater decrease in brain activation over the left fronto-parietal network, including the precuneus, SMA, insula/inferior frontal lobe, and dorsolateral prefrontal cortex, than the control group. These results suggest that adults with ADHD pay more effort to low demanding phonological WM. On the other hand, brain activation of the left fronto-parietal network is impaired when the demands of WM exceed the capacity of adults with ADHD.

Estrogen and serotonin play vital roles in the mechanism of premenstrual dysphoric disorder (PMDD). Cognitive deficit in the premenstrual phase contributes to impaired life function among women with PMDD. The aim of this study was to evaluate the difficulties in cognitive control and working memory (WM) in PMDD and to explore the effects of gonadotropic hormone and polymorphism of serotonin 1A receptor (HTR1A; rs6295) on cognitive deficit in PMDD. Women with PMDD completed diagnostic interviewing, questionnaire assessment, the Go/Nogo task, 2-back and 3-back tasks, and gonadotropic hormone analysis in the premenstrual and follicular phases. Further, they were followed up for two menstrual cycles to confirm two consecutive symptomatic cycles. A total of 59 subjects with PMDD and 74 controls completed all evaluation, fulfilled the criteria, and entered into the final analysis. The results demonstrated cognitive control and WM decline in the premenstrual among women with PMDD. The G/G genotype of HTR1A (rs6295) was found to be associated with impaired WM in the premenstrual phase and premenstrual decline of cognitive function. It also contributed to the vulnerability of cognitive function to the menstrual cycle effect and PMDD effect. As the G/G genotype of HTR1A (rs6295) involves in reducing serotonin neurotransmission, our results provide insight into the serotonin mechanism of cognitive function among women with PMDD.

The aim of the present study was to evaluate the impulsivity and brain correlates of response inhibition and error processing among subjects with Internet gaming disorder (IGD). We evaluated the response inhibition and error processing by functional magnetic resonance imaging (fMRI) in subjects with IGD and controls. Twenty-six men with IGD for at least 2 years and 23 controls with no history of IGD were recruited as the IGD and control groups, respectively. All subjects performed the event-related designed Go/No-go task under fMRI and completed questionnaires related to Internet addiction and impulsivity. The IGD group exhibited a higher score for impulsivity than the control group. The IGD group also exhibited higher brain activation when processing response inhibition over the left orbital frontal lobe and bilateral caudate nucleus than controls. Both the IGD and control groups exhibited activation of the insula and anterior cingulate cortex during error processing. The activation over the right insula was lower in the subjects with IGD than the control group. Our results support the fact that the fronto-striatal network involved in response inhibition, and the salience network, anchored by the anterior cingulate and insula, contributes to error processing. Further, adults with IGD have impaired insular function in error processing and greater activation of the fronto-striatal network in order to maintain their response inhibition performance.

To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients.