Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments.Results: Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.Keywords: intellectual disability, intelligence screening, two-stage positive screening, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Revise

The effects of beta2 adrenergic receptor gene polymorphism in lipid profiles

<p>Abstract</p> <p>Background</p> <p>Explore the interaction between apolipoprotein E (Apo E), phospholipase A2 (PLA2) and β2 adrenergic receptor (β2-AR) gene polymorphisms and lipid profiles in an elderly Chinese population.</p> <p>Methods</p> <p>Five hundred subjects aged 65 to 74 years were randomly selected from a community in southern Taiwan to assess the relationship between Apo E, PLA2 and β2-AR gene polymorphisms and lipid profiles. Two hundred sixty-seven participants agreed to have venous blood drawn for DNA studies.</p> <p>Results</p> <p>Two statistically significant differences were noted in TC and LDL-C in the Gln27Glu of the β2-AR gene polymorphism (P = 0.007, P = 0.022). The low-income group had a higher HDL-C level (p = 0.076). The Gln27Glu polymorphism Glu/Glu or Gln/Glu subjects had lower TC levels compared to the Gln27Glu polymorphism Gln/Gln subjects (p = 0.092). Lower TC levels (p = 0.082) and lower LDL-C levels (p = 0.045) in subjects with the Cys¹⁹Arg¹⁶Glu²⁷haplotype. Lower TC levels (p = 0.06) were also noted in subjects with the Cys¹⁹Gly ¹⁶Glu²⁷haplotype. On the other hand, higher VLDL-C levels (p = 0.185) and higher triglyceride (TG) levels (p = 0.190) were noted in subjects with the Cys¹⁹Gly ¹⁶Gln²⁷haplotype. The ε2 allele combined with low income had a positive effect on HDL-C (p = 0.0011), after adding the income factor in this study.</p> <p>Conclusion</p> <p>When the effects of Apo E and PLA2 on lipid profiles were included in this study, β2-AR gene polymorphisms reduced significant effect on lipid profiles. Similarly, low income increased effect on HDL-C. This study appeared that the results of gene-gene and gene-environment interaction, it should be considered in further studies for lipid profiles.</p

Parental bonding and personality characteristics of first episode intention to suicide or deliberate self-harm without a history of mental disorders

BACKGROUND: There is substantial overlap between deliberate self-harm (DSH) and intention to suicide (ITS), although the psychopathologies and motivations behind these behaviors are distinctly different. The purpose of this study was to investigate (i) the pathway relationship among parental bonding, personality characteristics, and alexithymic traits, and (ii) the association of these features with ITS and DSH using structural equation modeling to determine the risks and protective factors for these behaviors. METHODS: Sixty-nine first-time DSH and 36 first-time ITS patients without medical or psychiatric illnesses, and 66 controls were recruited. The Parental Bonding Inventory (PBI), Eysenck Personality Questionnaire (EPQ), 20-item Toronto Alexithymia Scale (TAS-20), and the Chinese Health Questionnaire (CHQ) were filled out by the participants. RESULTS: Our structural equation models showed that parental bonding had the greatest influence on the development of DSH behavior in patients. On the other hand, participants who were younger, less extraverted, with a greater extent of the alexithymic trait of difficulty identifying feeling (DIF), and a worse mental health condition, were more likely to develop ITS behavior. Males were more likely than females to develop the alexithymic trait of DIF. CONCLUSIONS: Although there are many covariates that affect both ITS and DSH behaviors, these covariates may have different functions in the development of these behaviors, thus revealing the psychopathological difference between DSH and ITS. Policymakers should consider these differences and build intervention and prevention programs for gender- and age-specific high-risk groups to target the differences, with a focus on family counseling to treat DSH and a focus on attempting to increase emotional awareness to treat ITS

Parental bonding in males with adjustment disorder and hyperventilation syndrome

BACKGROUND: The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder. METHODS: A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY), 273 with adjustment disorder without hyperventilation syndrome (AD–HY), and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire. RESULTS: Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD–HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD–HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls. CONCLUSIONS: Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder

Anxiety and mood disorder in young males with mitral valve prolapse

For-Wey Lung1&amp;ndash;4, Chih-Tao Cheng5, Wei-To Chang6, Bih-Ching Shu71Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical Center, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, Taiwan; 5School of public Health, University of California, Berkeley, CA, USA; 6Liu Chia-Hsiu Hospital, Kaohsiung County, Taiwan; 7Institute of Allied Health Sciences and Department of Nursing, National Cheng Kung University, Tainan, TaiwanObjective: This study explored the prevalence of panic disorder and other psychiatric disorders in young Han Chinese males with mitral valve prolapse (MVP). With the factors of age, sex, and ethnicity controlled, the specific&amp;nbsp;role of MVP in panic disorder was analyzed. Methods: Subjects with chest pain aged between 18 and 25 years were assessed with the echocardiograph for MVP and the Chinese version of the Mini-International Neuropsychiatric Interview for panic disorder (n = 39).Results: Of the 39 participants, 35.9% met the diagnosis of anxiety disorder, 46.2% met at least one criterion of anxiety disorder, and 23.1% met the diagnostic criteria of major depressive disorder. There was no statistically significant difference in the prevalence of panic disorder between one of the (8.3%) MVP patients, and two (7.4%) control participants.Conclusions: There is a high prevalence of psychiatric disorder, including anxiety disorder and major depressive disorder, in those who report pain symptoms, so that diagnosis and treatment of these patients is of great importance. In addition, individuals with MVP did not have an increased risk for panic disorder. Whether MVP may be a modifier or mediating factor for panic disorder needs to be further assessed in a larger scale study.Keywords: mitral valve prolapse, panic disorder, Han Chinese males, major depressive disorder, echocardiograph, MIN

Purple urine bag syndrome in nursing homes: Ten elderly case reports and a literature review

Purple urine bag syndrome (PUBS) is a rare occurrence, in which the patient has a purple-colored urine bag following urinary catheterization for hours to days. Most of authors believe it is a mixture of indigo (blue) and indirubin (red) that becomes purple. Previous study showed that PUBS occurred predominantly in chronically catheterized, constipated women. We collected 10 elderly patients with PUBS in two nursing homes. The first two cases were identified by chart review in 1987 and 2003, and then later eight cases (42.1%) were collected among 19 urinary catheterized elderly in the period between January 2007 and June 2007. In the present report, PUBS probably can occur in any patients with the right elements, namely urinary tract infection (UTI) with bacteria possessing these enzymes, diet with enough tryptophan, and being catheterized. Associations with bed-bound state, Alzheimer’s, or dementia from other causes are reflections of the state of such patients who are at higher risk for UTI, and hence PUBS occurred. Although we presented PUBS as a harmless problem, prevention and control of the nosocomial catheter-associated UTIs (CAUTIs) has become very important in the new patient-centered medical era. Thus, we should decrease the duration of catheterization, improve catheter care, and deploy technological advances designed for prevention, especially in the elderly cared for in nursing homes

Association of DRD4 uVNTR and TP53 codon 72 polymorphisms with schizophrenia: a case-control study

<p>Abstract</p> <p>Background</p> <p>The tumour supressor gene TP53 is thought to be involved in neural apoptosis. The polymorphism at codon 72 in TP53 and the long form variants of the upstream variable number of tandem repeats (uVNTR) polymorphism in the dopamine D4 receptor (DRD4) gene are reported to confer susceptibility to schizophrenia.</p> <p>Methods</p> <p>We recruited 934 patients with schizophrenia and 433 healthy individuals, and genotyped the locus of the TP53 codon 72 and DRD4 uVNTR polymorphisms by combining the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP) with direct sequencing.</p> <p>Results</p> <p>No significant differences were found in the frequency of the genotype of the TP53 codon72 polymorphism between patients with schizophrenia and their controls. However, the long form alleles (≥ 5 repeats) of the DRD4 uVNTR polymorphism were more frequent in patients with schizophrenia than in controls (p = 0.001). Hence, this class of alleles might be a risk factor for enhanced vulnerability to schizophrenia (odds ratio = 3.189, 95% confidence interval = 1.535-6.622). In the logistic regression analysis, the long form variants of the DRD4 polymorphism did predict schizophrenia after the contributions of the age and gender of the subjects were included (p = 0.036, OR = 2.319), but the CC and GG genotypes of the codon 72 polymorphism of TP53 did not.</p> <p>Conclusions</p> <p>The long form variants of the uVNTR polymorphism in DRD4 were associated with schizophrenia, in a manner that was independent of the TP53 codon 72 polymorphism. In addition, given that the genetic effect of the TP53 codon 72 polymorphism on the risk of developing schizophrenia was very small, this polymorphism is unlikely to be associated with schizophrenia. The roles that other single nucleotide polymorphisms (SNPs) in the TP53 gene or in other apoptosis-related genes play in the synaptic dysfunction involved in the pathogenesis of schizophrenia should be investigated.</p

Outcomes at late childhood of Chinese-speaking preschoolers with developmental language disorders comorbid with behavioral-emotional

As part of an ongoing clinical service program for children with developmental delay in morphosyllabic Chinese-speaking Taiwan, we investigated the late childhood cognitive, functional and psychiatric outcomes of a specific cohort of preschool children with developmental language delay comorbi d wi th behavi oral-emoti onal problems. The institutional database of a developmental clinic was reviewed and preschoolers meeting the inclusion criteria were invited to be subjects. Follow-up evaluations included Wechsler Intelligence tests, parents’ version of the Child Behavioral Checklist and psychiatric interview of the adolescents themselves. Of the eligible subjects (initial preschool visit at average of 3.8 ± 1.3 years old), 44 individuals completed follow-up evaluations at average of 11.8 ± 1.5 years old. The follow-up results showed that 75% of the late childhood children still had problems in language and 38.6% had problems in academic performance. The mean nonverbal cognitive score at follow-up was 83.9 ± 15.4 while the mean verbal cognitive measure was 83 ±17.3. Total 75% of the subjects had current psychiatric disorders and the most frequent di agnosi s was attenti on defici t/hyperactivity disorder, which was noted to be increased from 50% in the preschool period to 70.5% in late childhood. We concluded that the majority of Chinese-speaking preschoolers with language delay and behavioral-emotional problems turned out to have communication and psychiatric conditions when they reached late childhood. Western researches on developmental course of preschool children with alphabetic language impairment could be extended to morphosyllabic Chinese. Specialized services are warranted for this group of preschool children to lessen prolonged vulnerabilities. Our findings may be helpful in the context of an Asian developing country, so that priorities can be established for the allocation of finite resources for intervention