Search

Abstract Background Cognitive impairment is a growing problem with increasing burden in global aging. Older adults with major depressive disorder (MDD) have higher risk of dementia. Neurofilament light chain (NfL) has been proven as a potential biomarker in neurodegenerative disease, including dementia. We aimed to investigate the association between cognitive deficits and NfL levels in older adults with MDD. Methods In this cross-sectional study, we enrolled 39 MDD patients and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer’s type, as controls, from a tertiary psychiatric hospital. Both groups were over age 65 and with matched Mini-Mental State Examination (MMSE) score. Demographic data, clinical variables, and plasma NfL levels were obtained. We used cluster analysis according to their cognitive profile and estimated the correlation between plasma NfL levels and each cognitive domain. Results In the MDD group, participants had higher rate of family psychiatry history and current alcohol use habit compared with controls. Control group of neurocognitive disorders showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits clustered with that of neurocognitive disorders (cluster A). In cluster A, the total MMSE score (r=-0.58277, p=0.0287) and the comprehension domain (r=-0.71717, p=0.0039) were negatively correlated to NfL levels after adjusting for age, while the associations had not been observed in the other cluster. Conclusions We noted the negative correlation between NfL levels and cognition in MDD patients clustered with neurodegenerative disorder, Alzheimer’s type. NfL could be a promising candidate as a biomarker to predict subtype of patients in MDD to develop cognitive decline. Further longitudinal studies and within MDD cluster analysis are required to validate our findings for clinical implications.

Abstract Background Bipolar disorder (BD) is a severe mental disorder related to neurocognitive deficits. Exposure to childhood trauma is associated with worse cognitive performance. Different compositions of childhood trauma in BD and their impacts on cognition are rarely reported. Methods We used the Brief Assessment of Cognition in Affective Disorders (BAC-A) to assess cognitive performance and the Chinese version of the Short Form of the Childhood Trauma Questionnaire (C-CTQ-SF) to assess childhood trauma experience among 55 euthymic BD patients. Cluster analysis was applied to dissect their childhood trauma experiences, which revealed three distinct clusters: a low trauma group, neglect-focus group, and multiple-trauma-experience group. We compared the cognitive function between the three clusters and used a generalized linear model to evaluate the impact of childhood neglect on cognitive domains. Results The neglect-focus cluster showed prominent exposures to physical and emotional neglect (41.8%). BD patients in this cluster performed worse in BAC-A compared with patients in the multiple trauma cluster, especially in working memory and processing speed. The neglect-focus group revealed a significant negative effect on the composite score (ß = -0.904, p = 0.025) and working memory (ß = -1.150, p = 0.002) after adjusting sex, age, education year, BMI and total psychotropic defined daily dose. Conclusions Distinct patterns of childhood trauma experience are seen in BD patients and are related with different cognitive profiles. Early exposure of neglect-focus trauma was associated with the worst cognitive performance in current study. Further studies investigating the intensity of the neglect, as well as individual resilience and coping mechanisms in BD, are warranted.

Abstract Aims Quetiapine is widely used to treat psychiatric disorders such as major depression, generalized anxiety disorder, dysthymic disorder, and insomnia other than schizophrenia and bipolar disorder. This study investigated the diagnostic distribution of quetiapine use in patients in a psychiatric hospital, the doses of quetiapine prescribed, and the plasma concentrations (Cps) of quetiapine and active metabolites. Methods We enrolled 107 patients who had been prescribed quetiapine for at least 4 weeks. Diagnoses, demographics, and concomitant medications were recorded. Blood sampling was performed in the morning, approximately 12 h after the before‐bed dose of quetiapine. Results Diagnoses comprised schizophrenia (n = 25), bipolar disorder (n = 51), major depression (n = 15), dysthymic disorder (n = 9), and others (n = 7). The daily dose (DD) of quetiapine ranged from 25 to 800 (175.9 ± 184.4) mg, with the mean Cp being 105.6 ± 215.3 ng/ml, with a mean Cps/DD ratio of 0.58 ± 0.55 ng/ml/mg. There was a moderate positive linear correlation between the dose and Cps of quetiapine (r = 0.60), and the interpatient variation in Cps/DD ratio was up to 26‐fold. Conclusion Quetiapine is used in various doses to treat many psychiatric disorders other than psychosis, and it is usually prescribed as a secondary antipsychotic for symptoms such as insomnia or agitation. A wide interpatient variation of the Cps/DD ratio was noticed. Patients of East Asian descent may exhibit a 50% to 100% increase in the Cps/DD ratio for quetiapine compared with patients of Western descent.

Background/purpose: To the best of our knowledge, no studies have examined longitudinal changes in the accessibility of suicide-related content on Chinese-language websites. We investigated changes between 2016 and 2019 in suicide-related materials likely to be accessed by individuals through websites in Taiwan. Methods: In March 2019, we searched the Taiwanese versions of Google and Yahoo! using six suicide-related terms and compared the results to a search performed in 2016. Website characteristics (e.g., pro- or anti-suicide) generated by various keywords were calculated and compared in 2016 and 2019. Results: The number of anti-suicide websites exceeded that of pro-suicide websites in 2016 and 2019. Between 2016 and 2019, the proportion of pro-suicide sites decreased slightly from 16.3% (61 out of 375 sites) to 12.3% (51 out of 417 sites) (p = 0.10). User-generated webpages constituted the primary source of pro-suicide content at both time points. Over the same period, the proportion of pro-suicide information on internet forums decreased from 59.1% to 17.8% (p

Abstract Background Difficulties in prognostication are common deterrents to palliative care among dementia patients. This study aimed to evaluate the effectiveness of palliative care in reducing the extent of utilization of medical services and the potential risk factors of mortality among dementia patients receiving palliative care. Methods We surveyed dementia patients involved in a palliative care program at a long-term care facility in Taipei, Taiwan. We enrolled 57 patients with advanced dementia (clinical dementia rating ≥ 5 or functional assessment staging test stage 7b). We then compared the extent of their utilization of medical services before and after the provision of palliative care. Based on multivariable logistic regression, we identified potential risk factors before and after the provision of palliative care associated with 6-month mortality. Results The utilization of medical services was significantly lower among dementia patients after the provision of palliative care than before, including visits to medical departments (p

Cytochrome P450 2E1 (CYP2E1) gene is one of the candidate genes for alcohol dependence (AD). Four single nucleotide polymorphisms (SNPs) of CYP2E1 gene (CYP2E1*1D, *5B, *6 and *1B) have been associated with AD previously in other ethnic populations. To date, only CYP2E1*5B and *6 SNPs have been investigated in relation to AD in our population. The objective of the study was to examine the genetic associations of CYP2E1 covering the four above-noted SNPs conjointly with AD in Han Taiwanese population based on single SNP analysis and haplotype-based approach. We enrolled a total of 340 patients fulfilling DSM-IV-TR diagnostic criteria of AD and 319 healthy controls and genotyped them for the above four SNPs of CYP2E1 gene. By comparing the differences of genotype, allele, and pertinent haplotype frequencies, we did not support a genetic association between CYP2E1 and AD in Han Taiwanese either by single allele tests or haplotype-based analyses. Keywords: Alcohol dependence, CYP2E1 gene, Single nucleotide polymorphisms, Haplotype, Taiwan

Background: Bipolar disorder (BD) is a severe mental disorder associated with neurocognitive deficits. The exposure to childhood trauma experiences is also linked to poorer cognitive performance. However, there is limited reporting on the distinct compositions of childhood trauma in BD and their specific impacts on cognitive performance. Methods: In this cross-sectional study, we utilized the Brief Assessment of Cognition in Affective Disorders (BAC-A) to evaluate cognitive performance and the Chinese version of the Childhood Trauma questionnaire-short form (C-CTQ-SF) to assess childhood trauma experiences in a sample of 55 euthymic BD patients. We applied Two-Step cluster analysis to dissect their childhood trauma experiences, revealing distinct clusters: a low-trauma group, a neglect-focus group, and a multiple trauma experience group. We compared cognitive function among these three clusters and employed a generalized linear model to assess the impact of childhood neglect trauma on cognitive domains. Results: The neglect-focus cluster exhibited notably high levels of exposure to physical and emotional neglect (41.8%). Moreover, BD patients in this cluster performed even worse on the BAC-A compared to patients in the multiple trauma cluster, particularly in working memory and processing speed. Using the low trauma cluster as a reference, the neglect-focus group revealed a significant negative effect on the composite score (ß = -0.904, p = 0.025) and working memory (ß = -1.150, p = 0.002), after adjusting for confounding factors. Conclusions: Distinct patterns of childhood trauma experience are observed in BD patients and are associated with different cognitive profiles. Early exposure to neglect-focus trauma is linked to the poorest cognitive performance in the current study. Further studies investigating the intensity of neglect, as well as individual resilience and coping mechanisms in BD, are warrant. [ABSTRACT FROM AUTHOR]

Background: Cognitive aging is a known phenomenon in individuals with bipolar disorder (BD), but the underlying biological mechanisms responsible for this cognitive decline remain poorly understood. One potential avenue of investigation is the dysfunction of the Klotho/Fibroblast Growth Factor 23 (FGF23) system, which has been linked to reduced lifespan and age-related diseases, including dementia. However, there is limited research on the relationship between Klotho/FGF23 levels and aging in BD patients, as well as their association with cognitive decline in elderly individuals with BD. Aims: The aim of this study was to explore the levels of Klotho and FGF23 in elderly BD patients and their relationship with the aging profile and cognitive domains. Methods: The study included 85 euthymic, elderly participants aged 50 or older, who also had adequate kidney function and were diagnosed with BD-I. Cognitive function was assessed using the Brief Assessment of Cognition in Affective Disorders. The study examined the correlations between Klotho and FGF23 levels and other aging-related assessments. General linear models were then used to identify associations between Klotho and FGF23 levels and various cognitive domains. Results: The average age of the participants was 59.64 years. The mean Klotho and FGF23 levels were 0.71 ng/ml and 15.02 ng/ml, respectively. Positive correlations were found between Klotho and FGF23 (r= 0.352, p = 0.002) and between creatine levels and Klotho/FGF23 (r = 0.328, p = 0.016 for Klotho and r= 0.302, p = 0.028 for FGF23). Higher levels of FGF23 were significantly associated with lower composite cognitive scores (ß= -0.003, p = 0.005), particularly in verbal memory (ß= -0.002, p = 0.013), motor speed (ß= -0.002, p = 0.027), and processing speed (ß= -0.002, p = 0.029). No significant association was observed between Klotho levels and cognitive domains. Conclusion: In elderly individuals with BD, this study found that higher FGF23 levels were associated with negative effects on cognitive domains, particularly in verbal memory, motor speed, and processing speed. However, no significant association was found between Klotho levels and cognitive performance. Future research is needed to further define the dysfunction of the Klotho/FGF23 axis and conduct longitudinal studies that incorporate validated aging clinical markers to better understand the underlying mechanisms of cognitive aging in BD. [ABSTRACT FROM AUTHOR]

Background: Clozapine stands as the drug of choice for treating individuals with treatment-resistant schizophrenia (TRS). However, only 40% of patients with TRS respond to clozapine, forming a subgroup of clozapine- resistant patients. Recently, the neuropeptide orexin-A has emerged its relevance in the pathophysiology of schizophrenia (Chien et al., 2015) and higher orexin-A levels has been found in patients treated with clozapine compared with drug-free patients (Chen et al., 2022). Aims & Objectives: This study aimed to evaluate the association between peripheral orexin-A levels and the clozapine response in patients with TRS. Method: One hundred and sixty-two clozapine-treated patients were categorized into clozapine-responsive (n = 100) and clozapineresistant (n = 62) groups based on whether they had achieved psychotic remission defined by the 18-item Brief Psychiatric Rating Scale (BPRS-18). We compared blood orexin-A levels between the two groups and performed regression analysis to determine the effects of orexin-A level on the treatment response and BPRS-18 scores. We also examined the correlation between orexin-A levels and cognitive function assessed by the CogState Schizophrenia Battery. Results: Clozapine-responsive patients exhibited higher orexin-A levels compared to their clozapine-resistant counterparts as well as drug-free patients (n = 37) adopted from our previous study (Chen et al., 2022). Orexin-A level was the only factor significantly associated with clozapine treatment response in regression model after adjustment for age, sex, years of education, and clozapine dosage. Orexin-A levels were negatively correlated with BPRS- 18 full scale, as well as positive, negative, and general symptoms subscale scores. Furthermore, there was also a positive correlation between orexin-A levels and cognitive function domains such as verbal memory, visual learning and memory, and working memory. Discussion & Conclusion: This cross-sectional study showed that higher levels of orexin-A are associated with a more favorable clinical response to clozapine treatment in terms of psychopathology and cognitive function in patients with TRS. The hypofunction of N-methyl-D-aspartate receptors (NMDARs) on parvalbuminlabeled (PV+) GABAergic interneurons is considered to be a potential mechanism underlying TRS (Grace and Gomes, 2019). Our finding was relevant to orexin-A shown activating effect on PV+ GABAergic interneurons (Usui et al., 2019). Future prospective studies examining changes in orexin-A level following clozapine treatment and the potential benefit of augmenting orexin-A signaling are warranted. [ABSTRACT FROM AUTHOR]