Australian and New Zealand Journal of Psychiatry, Aug 29, 2016
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease involving cellu... more Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease involving cellular and humoral immunity. It is characterized by progressive symmetrical weakness or sensory loss in both proximal and distal muscles developing over a more than 8-week period (Vallat et al., 2010). Neuropsychiatric disorders related to CIDP rarely occur. Here, we report a case of CIDP with manic symptoms. A 66-year-old man was referred to our hospital with progressive weakness and numbness in all limbs over the past 2 years. One year prior to presentation, he developed irritable and labile mood and manic symptoms, including exaggerated sense of self-confidence, talkativeness, spending sprees, insomnia and increased energy. Laboratory investigation showed increased erythrocyte sedimentation rate (ESR: 39 mm/h). The nerve conduction velocity showed prolonged distal latency, a slowing of the conduction velocity and prolonged F-wave latency of the median, ulnar and peroneal nerves. Although he refused lumbar puncture, cerebrospinal fluid (CSF) studies are not mandatory according to the Inflammatory Neuropathy Cause and Treatment criteria for CIDP. A clinical diagnosis of CIDP was made. Intravenous methylprednisolone was given for 4 days and then shifted to oral prednisolone. His muscle weakness gradually improved after 1 week of steroid therapy. The mood symptoms improved with the initial Young Mania Rating Scale (YMRS) 22 and decreased to 13 after 3 weeks of steroid treatment. To our knowledge, no cases of bipolar disorder associated with CIDP have been previously documented. In acute inflammatory demyelinating polyneuropathy (AIDP), brief reactive psychosis, anxiety, depressive episodes and rapid eye movement (REM) sleep abnormalities were observed (Chan and Gold, 2007). The possible mechanism includes potential central nervous system (CNS) targets of the disease shown by lower CSF hypocretin-1 levels, inflammation and microglial activation in CNS, and proinflammatory cytokine-induced neurotransmitter dysfunction (Chan and Gold, 2007). Several reports have shown subclinical involvement and demyelination of the central pathways (Chan and Gold, 2007; Vallat et al., 2010). This is similar to another chronic inflammatory demyelinating disorder, multiple sclerosis (MS), which affects the CNS and could increase rates of depression and bipolar disorder that might be related to oxidative stress, autoimmunity and demyelination (Carta et al., 2014). Immune-mediated inflammation and cytokines may influence brain circuits as observed in MS and AIDP, and steroid treatment was effective for both CIDP and mania-like episode in our patient, suggesting that his manic symptoms could relate to the immunopathogenesis of CIDP. In conclusion, we report the first case of mania-like episode associated with CIDP. More studies are needed to clarify the associations between CIDP and manic-like episode.
Psychotic symptoms develop in 20–30% of patients with Parkinson’s disease (PD) who receive chroni... more Psychotic symptoms develop in 20–30% of patients with Parkinson’s disease (PD) who receive chronic antiparkinsonism medications. These symptoms disturb quality of life of both patients and their caregivers much more than motor disabilities [2]. Either reduction of dopaminomimetics or use of conventional antipsychotics alleviates psychotic symptoms associated with PD, but exacerbates parkinsonian motor symptoms [3]. Atypical antipsychotics, which control psychotic symptoms without compromising motor function, have now become primary treatment medications for PD psychosis [2,3]. Comparing to conventional antipsychotics, atypical agents have lower incidence of extrapyramidal side effects (EPS) and higher selectivity for mesolimbic rather than nigrostriatal dopamine (DA) receptors. They also have higher ratio of serotonin-2 (5-HT2) to DA-2 (D2) receptor blockade compared to the receptor affinity profile of conventional antipsychotics [3]. Previous publications regarding atypical antipscyhotics in the treatment of PD psychosis suggested that clozapine [7,8,10] and quetiapine [4,9] had the lowest risk of deleterious effects on parkinsonian symptoms [5], although other atypical agents such as risperidone and olanzapine have also been shown to be effective [2,3]. Ziprasidone is a relatively newer atypical antipsychotic with both 5-HT and DA antagonism. It rarely causes EPS in the treatment of patients with schizophrenia. To date, only one case report [1] showed the effectiveness of enteral ziprasidone in the treatment of PD psychosis. We present here another case of PD psychosis that was successfully treated with ziprasidone without exacerbation of his motor symptoms.
Australian & New Zealand Journal of Psychiatry, 2014
Delusional infestation is a relatively rare psychiatric condition characterized by the hypochondr... more Delusional infestation is a relatively rare psychiatric condition characterized by the hypochondriacal delusion that the patient is infested with insects despite objective evidence to the contrary. It can be categorized into a primary form without any underlying cause, and a secondary form considered to be related to mental illnesses, general medical conditions, organic brain diseases and drug use (Freudenmann and Lepping, 2009). We present a young man with delusional infestation caused by amphetamine use who was successfully treated with aripiprazole. A 26-year-old male with a six-year history of amphetamine abuse presented to our dermatology department for generalized pruritus caused by ‘bugs’ which he believed had been burrowing into his skin for several months. His most recent use of amphetamines was almost one month before this presentation. He believed the crawling sensation was caused by a ‘hexapod’ beneath his skin, and tried to dig them out with his fingernails and fingernail tools. New and resolving scattered excoriations on his elbows, face, waist, and legs were noted (Figure 1). A skin biopsy revealed chronic excoriated dermatitis with secondary fungal infection, but no evidence of an insect (Figure 2). Delusional infestation secondary to amphetamine use was suspected. We prescribed aripiprazole 2.5 mg/day and provided counseling for his amphetamine abuse. One week later, he reported that the itching sensation had decreased by almost 60% along with the frequency of his delusional behavior. His skin lesions also ameliorated under antifungal treatment with terbinafine 250 mg/day. Because of the great improvement of the symptoms, we maintained the treatment dosage of aripiprazole. Three weeks later, his delusion had dissipated and no adverse effects were noted. Although there are several case reports on amphetamine-related delusional parasitosis (Buscarino et al., 2012), our case is the first of amphetamine-induced delusional infestation treated with aripiprazole. Delusional infestations have also been Commentaries
Background The benefits of low-dose ketamine for patients with treatment-resistant depression (TR... more Background The benefits of low-dose ketamine for patients with treatment-resistant depression (TRD) and prominent suicidal ideation require further investigation. The effects of treatment refractoriness, the duration of the current depressive episode, and the number of prior antidepressant failures on ketamine efficacy also require clarification. Methods We recruited 84 outpatients with TRD and prominent suicidal ideation—defined as a score ≥4 on item 10 of the Montgomery–Åsberg Depression Rating Scale (MADRS)—and randomized them into 2 groups to receive 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. We assessed depressive and suicidal symptoms prior to infusion; 240 minutes post infusion; and 2, 3, 5, 7, and 14 days post infusion. Results According to the MADRS scores, the antidepressant effect (P = .035) was significantly noted in the ketamine group up to 14 days than in the midazolam group. However, the antisuicidal effect of ketamine, as measured by the Columbia-Suicide Severity R...
2017 13th International Conference on Natural Computation, Fuzzy Systems and Knowledge Discovery (ICNC-FSKD), 2017
Sleep is important for the restoration and renewal of the human body. Obstructive sleep apnea syn... more Sleep is important for the restoration and renewal of the human body. Obstructive sleep apnea syndrome (OSAS), which is caused by repetitive episodes of partial or complete upper airway obstruction during sleep, is the most common type of sleep apnea. The sleep electroencephalogram (EEG) analysis has been an important tool to investigate brain activity. In this study, we used the spectral analysis and fuzzy entropy to analyze the EEG signals collected from the OSAS patients and normal control. Results obtained from the EEG power spectrum and fuzzy entropy with and without principal component analysis (PCA) process were used as the features and fed into four different classifiers, namely, linear Support Vector Machines (SVM), Liner Discriminant Analysis (LDA), subspace k-nearest neighbor (k-NN) and subspace discriminant analysis, to differentiate these two groups. Our results demonstrated that the feature resulted from power spectrum with PCA process and subspace discriminate method using 5-fold cross-validation produces the superior classification rate which is 89 ± 3.74%.
Objective: Previous studies suggest that ziprasidone may result in hypomania or mania. However, m... more Objective: Previous studies suggest that ziprasidone may result in hypomania or mania. However, most reported cases involved patients with mood disorders and only two schizophrenic patients developed mania during ziprasidone treatment. We describe a Taiwanese patient with schizophrenia who developed hypomanic symptoms following ziprasidone therapy. Case Report: A 37-year-old Taiwanese man who was hospitalized due to acute exacerbation of chronic schizophrenia was treated with 160mg per day of ziprasidone. Ten days after starting ziprasidone therapy, he developed hypomanic symptoms including expansive and euphoric mood, inflated self-esteem, decreased sleep desire, overtalkativeness, and hyperactivity. His mood symptoms resolved after switching from ziprasidone to risperidone therapy. However, his schizophrenic symptoms including persecutory delusions and auditory hallucinations relapsed after the switch in treatment. Due to the relapse of schizophrenic symptoms, his risperidone trea...
Whether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, a... more Whether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, and anti-inflammatory effects of the first low-dose ketamine infusion remains unclear. A total of 78 patients with medication-resistant depression were allocated to receive two ketamine infusions (n = 30; days 1 and 4), a single ketamine infusion (n = 24; only day 1), or normal saline placebo infusion (n = 24; only day 1). The Montgomery-Asberg Depression Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HDRS) were administered before and at 40 min, 240 min, day 2, day 4, day 5, and day 7 after infusion. Serum concentrations of interleukin (IL)-2 and tumor necrosis factor (TNF)-α were assessed. Two ketamine infusions improved the overall depressive symptoms (p < 0.001) and melancholic symptoms (p < 0.001) than a single ketamine or placebo infusion. The antisuicidal effect did not differ between the ketamine treatment groups. Two ketamine infusions increased TNF-α levels compared with a single ketamine or placebo infusion (p = 0.015). A single ketamine infusion improved the TNF-α-to-IL-2 ratio, an index of average anti-inflammatory effect, than two ketamine infusions or a single placebo infusion (p = 0.027). Repeated low-dose ketamine infusions improved the antidepressant effect, but not the antisuicidal effect, compared with a single infusion. However, repeated ketamine infusions may exert a lesser anti-inflammatory effect than a single infusion.
Human Psychopharmacology: Clinical and Experimental, 2021
BACKGROUND Whether a single low-dose ketamine infusion may have rapid antidepressant and antisuic... more BACKGROUND Whether a single low-dose ketamine infusion may have rapid antidepressant and antisuicidal effects in patients with treatment-resistant double depression remains unclear. METHODS This study enrolled 35 patients with treatment-resistant double depression, 12 of whom received 0.5 mg/kg ketamine, 11 received 0.2 mg/kg ketamine, and 12 received normal saline as a placebo. The patients were assessed using the 17-item Hamilton Rating Scale for Depression (HDRS) prior to the initiation of infusions, at 40 and 240 min post-infusion, and sequentially on Days 2-7 and on Day 14 after ketamine or placebo infusions. RESULTS A single 0.5 mg/kg ketamine infusion had rapid antidepressant (p = 0.031, measured by the HDRS) and antisuicidal (p = 0.033, measured by the HDRS item 3 scores) effects in patients with treatment-resistant double depression. However, 0.2 mg/kg ketamine was insufficient to exert rapid antidepressant and antisuicidal effects in this patient population with severe and chronic illness. DISCUSSION In this patient population, the commonly used dose of 0.5 mg/kg was sufficient. Additional studies are required to investigate whether repeated infusions of low-dose ketamine may also maintain antidepressant and antisuicidal effects in patients with treatment-resistant double depression.
BACKGROUNDS Whether the antidepressant effects of low-dose ketamine infusion and the therapeutic ... more BACKGROUNDS Whether the antidepressant effects of low-dose ketamine infusion and the therapeutic impact of Val66Met brain-derived neurotrophic factor (BDNF) polymorphism vary across different depression symptom domains, namely affective, cognitive, and somatic, remains unclear. METHODS We-reanalyzed the data of Adjunctive Ketamine Study of Taiwanese Patients with Treatment-Resistant Depression (TRD). A total of 71 patients with TRD were randomized to three infusion groups: 0.5 and 0.2 mg/kg ketamine groups and the normal saline placebo group. The Beck Depression Inventory-II (BDI-II) was used to obtain self-reported scores prior to infusion and 240 min after infusion and sequentially on days 3, 7, and 14 after infusion. The three-factor model of cognitive, somatic, and affective depressive symptoms that is based on the BDI-II and proposed by Beck et al. was applied in the current study. The Val66Met BDNF polymorphism was genotyped. RESULTS Ketamine infusion exerted rapid and sustained antidepressant effects on the affective (p = 0.014) and cognitive (p = 0.005) depression symptom domains but not on the somatic (p = 0.085) depression symptom domain. Only patients with TRD harboring any Val allele at the BDNF rs6265 polymorphism were more likely to respond (p = 0.011) to low-dose ketamine infusion. DISCUSSION Additional studies should elucidate different mechanisms underlying the effects of ketamine infusion on cognitive, affective, and somatic depression symptom domains in patients with TRD.
Venous thromboembolism (VTE) is a life‐threatening disease, and some studies reported that benzod... more Venous thromboembolism (VTE) is a life‐threatening disease, and some studies reported that benzodiazepine receptor agonist (BZRA) use could increase the risk of VTE, but this association lacks population‐based evidence.
1. Yahav D, Farbman L, Leibovici L, et al. Colistin: new lessons on an old antibiotic. Clin Micro... more 1. Yahav D, Farbman L, Leibovici L, et al. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect. 2012;18:18–29. 2. Zavascki AP. Polymyxins for the treatment of extensivelydrug-resistant Gram-negative bacteria: from pharmacokinetics to bedside. Expert Rev Anti Infect Ther. 2014;12:531–533. 3. Tuon FF, Rigatto MH, Lopes CK, et al. Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium. Int J Antimicrob Agents. 2014;43:349–352. 4. Layeux B, Taccone FS, Fagnoul D, et al. Amikacin monotherapy for sepsis caused by panresistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2010;54:4939– 4941. 5. Roger C, Nucci B, Molinari N, et al. Standard dosing of amikacin and gentamicin in critically ill patients results in variable and subtherapeutic concentrations. Int J Antimicrob Agents. 2015;46:21–27. 6. Bagshaw SM, George C, Bellomo R, et al. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transpl. 2008;23:1569– 1574. 7. Ming K, Rosenbaum PR. Substantial gains in bias reduction from matching with a variable number of controls. Biometrics. 2000;56:118–124. 8. Tuon FF, Aragao BZ, Santos TA, et al. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond). 2016; 48:3. 9. Rigatto MH, Oliveira MS, Perdigão-Neto LV, et al. Multicenter prospective cohort study of renal failure in patients treated with colistin versus polymyxin B. Antimicrob Agents Chemother. 2016;60:2443–2449. 10. Kwon KH, Oh JY, Yoon YS, et al. Colistin treatment in carbapenem-resistant Acinetobacter baumannii pneumonia patients: incidence of nephrotoxicity and outcomes. Int J Antimicrob Agents. 2015;45:605–609.
STUDY OBJECTIVES To examine the risk of hospitalization for motor vehicle accident injury (MVAI) ... more STUDY OBJECTIVES To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy. METHODS This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810-E819) plus injury codes (ICD-9-CM codes: 800.xx-999.xx) due to MVAI following hospitalization were used for the study outcome. The type of injury, causes, intentionality, and the effects of stimulant use on patients with narcolepsy were also assessed. RESULTS A total of 1,316 participants were enrolled, including 329 participants with narcolepsy and 987 participants without narcolepsy. During a 14-year follow-up period, a total of 104 participants had MVAI, of whom 47 (1,559.54 per 100,000 person-years) belonged to the narcolepsy cohort and 57 (556.21 per 100,000 person-years) to the non-narcolepsy cohort. After adjusting for covariates, the risk of hospitalization for MVAI among participants with narcolepsy was still significantly higher than those without narcolepsy (adjusted hazard ratio = 6.725; 95% confidence interval = 4.421-10.231; P < .001). The use of modafinil or methylphenidate, as monotherapy or combined treatment, was associated with a lower risk of MVAI in the narcolepsy cohort. CONCLUSIONS Patients with narcolepsy may have a higher risk of hospitalization for MVAI and stimulant use could mitigate such risk.
Australian and New Zealand Journal of Psychiatry, Aug 29, 2016
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease involving cellu... more Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease involving cellular and humoral immunity. It is characterized by progressive symmetrical weakness or sensory loss in both proximal and distal muscles developing over a more than 8-week period (Vallat et al., 2010). Neuropsychiatric disorders related to CIDP rarely occur. Here, we report a case of CIDP with manic symptoms. A 66-year-old man was referred to our hospital with progressive weakness and numbness in all limbs over the past 2 years. One year prior to presentation, he developed irritable and labile mood and manic symptoms, including exaggerated sense of self-confidence, talkativeness, spending sprees, insomnia and increased energy. Laboratory investigation showed increased erythrocyte sedimentation rate (ESR: 39 mm/h). The nerve conduction velocity showed prolonged distal latency, a slowing of the conduction velocity and prolonged F-wave latency of the median, ulnar and peroneal nerves. Although he refused lumbar puncture, cerebrospinal fluid (CSF) studies are not mandatory according to the Inflammatory Neuropathy Cause and Treatment criteria for CIDP. A clinical diagnosis of CIDP was made. Intravenous methylprednisolone was given for 4 days and then shifted to oral prednisolone. His muscle weakness gradually improved after 1 week of steroid therapy. The mood symptoms improved with the initial Young Mania Rating Scale (YMRS) 22 and decreased to 13 after 3 weeks of steroid treatment. To our knowledge, no cases of bipolar disorder associated with CIDP have been previously documented. In acute inflammatory demyelinating polyneuropathy (AIDP), brief reactive psychosis, anxiety, depressive episodes and rapid eye movement (REM) sleep abnormalities were observed (Chan and Gold, 2007). The possible mechanism includes potential central nervous system (CNS) targets of the disease shown by lower CSF hypocretin-1 levels, inflammation and microglial activation in CNS, and proinflammatory cytokine-induced neurotransmitter dysfunction (Chan and Gold, 2007). Several reports have shown subclinical involvement and demyelination of the central pathways (Chan and Gold, 2007; Vallat et al., 2010). This is similar to another chronic inflammatory demyelinating disorder, multiple sclerosis (MS), which affects the CNS and could increase rates of depression and bipolar disorder that might be related to oxidative stress, autoimmunity and demyelination (Carta et al., 2014). Immune-mediated inflammation and cytokines may influence brain circuits as observed in MS and AIDP, and steroid treatment was effective for both CIDP and mania-like episode in our patient, suggesting that his manic symptoms could relate to the immunopathogenesis of CIDP. In conclusion, we report the first case of mania-like episode associated with CIDP. More studies are needed to clarify the associations between CIDP and manic-like episode.
Psychotic symptoms develop in 20–30% of patients with Parkinson’s disease (PD) who receive chroni... more Psychotic symptoms develop in 20–30% of patients with Parkinson’s disease (PD) who receive chronic antiparkinsonism medications. These symptoms disturb quality of life of both patients and their caregivers much more than motor disabilities [2]. Either reduction of dopaminomimetics or use of conventional antipsychotics alleviates psychotic symptoms associated with PD, but exacerbates parkinsonian motor symptoms [3]. Atypical antipsychotics, which control psychotic symptoms without compromising motor function, have now become primary treatment medications for PD psychosis [2,3]. Comparing to conventional antipsychotics, atypical agents have lower incidence of extrapyramidal side effects (EPS) and higher selectivity for mesolimbic rather than nigrostriatal dopamine (DA) receptors. They also have higher ratio of serotonin-2 (5-HT2) to DA-2 (D2) receptor blockade compared to the receptor affinity profile of conventional antipsychotics [3]. Previous publications regarding atypical antipscyhotics in the treatment of PD psychosis suggested that clozapine [7,8,10] and quetiapine [4,9] had the lowest risk of deleterious effects on parkinsonian symptoms [5], although other atypical agents such as risperidone and olanzapine have also been shown to be effective [2,3]. Ziprasidone is a relatively newer atypical antipsychotic with both 5-HT and DA antagonism. It rarely causes EPS in the treatment of patients with schizophrenia. To date, only one case report [1] showed the effectiveness of enteral ziprasidone in the treatment of PD psychosis. We present here another case of PD psychosis that was successfully treated with ziprasidone without exacerbation of his motor symptoms.
Australian & New Zealand Journal of Psychiatry, 2014
Delusional infestation is a relatively rare psychiatric condition characterized by the hypochondr... more Delusional infestation is a relatively rare psychiatric condition characterized by the hypochondriacal delusion that the patient is infested with insects despite objective evidence to the contrary. It can be categorized into a primary form without any underlying cause, and a secondary form considered to be related to mental illnesses, general medical conditions, organic brain diseases and drug use (Freudenmann and Lepping, 2009). We present a young man with delusional infestation caused by amphetamine use who was successfully treated with aripiprazole. A 26-year-old male with a six-year history of amphetamine abuse presented to our dermatology department for generalized pruritus caused by ‘bugs’ which he believed had been burrowing into his skin for several months. His most recent use of amphetamines was almost one month before this presentation. He believed the crawling sensation was caused by a ‘hexapod’ beneath his skin, and tried to dig them out with his fingernails and fingernail tools. New and resolving scattered excoriations on his elbows, face, waist, and legs were noted (Figure 1). A skin biopsy revealed chronic excoriated dermatitis with secondary fungal infection, but no evidence of an insect (Figure 2). Delusional infestation secondary to amphetamine use was suspected. We prescribed aripiprazole 2.5 mg/day and provided counseling for his amphetamine abuse. One week later, he reported that the itching sensation had decreased by almost 60% along with the frequency of his delusional behavior. His skin lesions also ameliorated under antifungal treatment with terbinafine 250 mg/day. Because of the great improvement of the symptoms, we maintained the treatment dosage of aripiprazole. Three weeks later, his delusion had dissipated and no adverse effects were noted. Although there are several case reports on amphetamine-related delusional parasitosis (Buscarino et al., 2012), our case is the first of amphetamine-induced delusional infestation treated with aripiprazole. Delusional infestations have also been Commentaries
Background The benefits of low-dose ketamine for patients with treatment-resistant depression (TR... more Background The benefits of low-dose ketamine for patients with treatment-resistant depression (TRD) and prominent suicidal ideation require further investigation. The effects of treatment refractoriness, the duration of the current depressive episode, and the number of prior antidepressant failures on ketamine efficacy also require clarification. Methods We recruited 84 outpatients with TRD and prominent suicidal ideation—defined as a score ≥4 on item 10 of the Montgomery–Åsberg Depression Rating Scale (MADRS)—and randomized them into 2 groups to receive 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. We assessed depressive and suicidal symptoms prior to infusion; 240 minutes post infusion; and 2, 3, 5, 7, and 14 days post infusion. Results According to the MADRS scores, the antidepressant effect (P = .035) was significantly noted in the ketamine group up to 14 days than in the midazolam group. However, the antisuicidal effect of ketamine, as measured by the Columbia-Suicide Severity R...
2017 13th International Conference on Natural Computation, Fuzzy Systems and Knowledge Discovery (ICNC-FSKD), 2017
Sleep is important for the restoration and renewal of the human body. Obstructive sleep apnea syn... more Sleep is important for the restoration and renewal of the human body. Obstructive sleep apnea syndrome (OSAS), which is caused by repetitive episodes of partial or complete upper airway obstruction during sleep, is the most common type of sleep apnea. The sleep electroencephalogram (EEG) analysis has been an important tool to investigate brain activity. In this study, we used the spectral analysis and fuzzy entropy to analyze the EEG signals collected from the OSAS patients and normal control. Results obtained from the EEG power spectrum and fuzzy entropy with and without principal component analysis (PCA) process were used as the features and fed into four different classifiers, namely, linear Support Vector Machines (SVM), Liner Discriminant Analysis (LDA), subspace k-nearest neighbor (k-NN) and subspace discriminant analysis, to differentiate these two groups. Our results demonstrated that the feature resulted from power spectrum with PCA process and subspace discriminate method using 5-fold cross-validation produces the superior classification rate which is 89 ± 3.74%.
Objective: Previous studies suggest that ziprasidone may result in hypomania or mania. However, m... more Objective: Previous studies suggest that ziprasidone may result in hypomania or mania. However, most reported cases involved patients with mood disorders and only two schizophrenic patients developed mania during ziprasidone treatment. We describe a Taiwanese patient with schizophrenia who developed hypomanic symptoms following ziprasidone therapy. Case Report: A 37-year-old Taiwanese man who was hospitalized due to acute exacerbation of chronic schizophrenia was treated with 160mg per day of ziprasidone. Ten days after starting ziprasidone therapy, he developed hypomanic symptoms including expansive and euphoric mood, inflated self-esteem, decreased sleep desire, overtalkativeness, and hyperactivity. His mood symptoms resolved after switching from ziprasidone to risperidone therapy. However, his schizophrenic symptoms including persecutory delusions and auditory hallucinations relapsed after the switch in treatment. Due to the relapse of schizophrenic symptoms, his risperidone trea...
Whether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, a... more Whether a second ketamine infusion in the first week improves the antidepressant, antisuicidal, and anti-inflammatory effects of the first low-dose ketamine infusion remains unclear. A total of 78 patients with medication-resistant depression were allocated to receive two ketamine infusions (n = 30; days 1 and 4), a single ketamine infusion (n = 24; only day 1), or normal saline placebo infusion (n = 24; only day 1). The Montgomery-Asberg Depression Scale (MADRS) and 17-item Hamilton Rating Scale for Depression (HDRS) were administered before and at 40 min, 240 min, day 2, day 4, day 5, and day 7 after infusion. Serum concentrations of interleukin (IL)-2 and tumor necrosis factor (TNF)-α were assessed. Two ketamine infusions improved the overall depressive symptoms (p < 0.001) and melancholic symptoms (p < 0.001) than a single ketamine or placebo infusion. The antisuicidal effect did not differ between the ketamine treatment groups. Two ketamine infusions increased TNF-α levels compared with a single ketamine or placebo infusion (p = 0.015). A single ketamine infusion improved the TNF-α-to-IL-2 ratio, an index of average anti-inflammatory effect, than two ketamine infusions or a single placebo infusion (p = 0.027). Repeated low-dose ketamine infusions improved the antidepressant effect, but not the antisuicidal effect, compared with a single infusion. However, repeated ketamine infusions may exert a lesser anti-inflammatory effect than a single infusion.
Human Psychopharmacology: Clinical and Experimental, 2021
BACKGROUND Whether a single low-dose ketamine infusion may have rapid antidepressant and antisuic... more BACKGROUND Whether a single low-dose ketamine infusion may have rapid antidepressant and antisuicidal effects in patients with treatment-resistant double depression remains unclear. METHODS This study enrolled 35 patients with treatment-resistant double depression, 12 of whom received 0.5 mg/kg ketamine, 11 received 0.2 mg/kg ketamine, and 12 received normal saline as a placebo. The patients were assessed using the 17-item Hamilton Rating Scale for Depression (HDRS) prior to the initiation of infusions, at 40 and 240 min post-infusion, and sequentially on Days 2-7 and on Day 14 after ketamine or placebo infusions. RESULTS A single 0.5 mg/kg ketamine infusion had rapid antidepressant (p = 0.031, measured by the HDRS) and antisuicidal (p = 0.033, measured by the HDRS item 3 scores) effects in patients with treatment-resistant double depression. However, 0.2 mg/kg ketamine was insufficient to exert rapid antidepressant and antisuicidal effects in this patient population with severe and chronic illness. DISCUSSION In this patient population, the commonly used dose of 0.5 mg/kg was sufficient. Additional studies are required to investigate whether repeated infusions of low-dose ketamine may also maintain antidepressant and antisuicidal effects in patients with treatment-resistant double depression.
BACKGROUNDS Whether the antidepressant effects of low-dose ketamine infusion and the therapeutic ... more BACKGROUNDS Whether the antidepressant effects of low-dose ketamine infusion and the therapeutic impact of Val66Met brain-derived neurotrophic factor (BDNF) polymorphism vary across different depression symptom domains, namely affective, cognitive, and somatic, remains unclear. METHODS We-reanalyzed the data of Adjunctive Ketamine Study of Taiwanese Patients with Treatment-Resistant Depression (TRD). A total of 71 patients with TRD were randomized to three infusion groups: 0.5 and 0.2 mg/kg ketamine groups and the normal saline placebo group. The Beck Depression Inventory-II (BDI-II) was used to obtain self-reported scores prior to infusion and 240 min after infusion and sequentially on days 3, 7, and 14 after infusion. The three-factor model of cognitive, somatic, and affective depressive symptoms that is based on the BDI-II and proposed by Beck et al. was applied in the current study. The Val66Met BDNF polymorphism was genotyped. RESULTS Ketamine infusion exerted rapid and sustained antidepressant effects on the affective (p = 0.014) and cognitive (p = 0.005) depression symptom domains but not on the somatic (p = 0.085) depression symptom domain. Only patients with TRD harboring any Val allele at the BDNF rs6265 polymorphism were more likely to respond (p = 0.011) to low-dose ketamine infusion. DISCUSSION Additional studies should elucidate different mechanisms underlying the effects of ketamine infusion on cognitive, affective, and somatic depression symptom domains in patients with TRD.
Venous thromboembolism (VTE) is a life‐threatening disease, and some studies reported that benzod... more Venous thromboembolism (VTE) is a life‐threatening disease, and some studies reported that benzodiazepine receptor agonist (BZRA) use could increase the risk of VTE, but this association lacks population‐based evidence.
1. Yahav D, Farbman L, Leibovici L, et al. Colistin: new lessons on an old antibiotic. Clin Micro... more 1. Yahav D, Farbman L, Leibovici L, et al. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect. 2012;18:18–29. 2. Zavascki AP. Polymyxins for the treatment of extensivelydrug-resistant Gram-negative bacteria: from pharmacokinetics to bedside. Expert Rev Anti Infect Ther. 2014;12:531–533. 3. Tuon FF, Rigatto MH, Lopes CK, et al. Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium. Int J Antimicrob Agents. 2014;43:349–352. 4. Layeux B, Taccone FS, Fagnoul D, et al. Amikacin monotherapy for sepsis caused by panresistant Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2010;54:4939– 4941. 5. Roger C, Nucci B, Molinari N, et al. Standard dosing of amikacin and gentamicin in critically ill patients results in variable and subtherapeutic concentrations. Int J Antimicrob Agents. 2015;46:21–27. 6. Bagshaw SM, George C, Bellomo R, et al. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transpl. 2008;23:1569– 1574. 7. Ming K, Rosenbaum PR. Substantial gains in bias reduction from matching with a variable number of controls. Biometrics. 2000;56:118–124. 8. Tuon FF, Aragao BZ, Santos TA, et al. Acute kidney injury in patients using amikacin in an era of carbapenem-resistant bacteria. Infect Dis (Lond). 2016; 48:3. 9. Rigatto MH, Oliveira MS, Perdigão-Neto LV, et al. Multicenter prospective cohort study of renal failure in patients treated with colistin versus polymyxin B. Antimicrob Agents Chemother. 2016;60:2443–2449. 10. Kwon KH, Oh JY, Yoon YS, et al. Colistin treatment in carbapenem-resistant Acinetobacter baumannii pneumonia patients: incidence of nephrotoxicity and outcomes. Int J Antimicrob Agents. 2015;45:605–609.
STUDY OBJECTIVES To examine the risk of hospitalization for motor vehicle accident injury (MVAI) ... more STUDY OBJECTIVES To examine the risk of hospitalization for motor vehicle accident injury (MVAI) in patients with narcolepsy and the effects of stimulant use on MVAI occurrence in patients with narcolepsy. METHODS This is a population-based, retrospective cohort study using Taiwan's National Health Insurance Research Database between 2000 and 2013. We included patients with narcolepsy based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, 347. The case and matched control participants were selected in a ratio of 1:3, and the traffic accident (ICD-9-CM codes: E810-E819) plus injury codes (ICD-9-CM codes: 800.xx-999.xx) due to MVAI following hospitalization were used for the study outcome. The type of injury, causes, intentionality, and the effects of stimulant use on patients with narcolepsy were also assessed. RESULTS A total of 1,316 participants were enrolled, including 329 participants with narcolepsy and 987 participants without narcolepsy. During a 14-year follow-up period, a total of 104 participants had MVAI, of whom 47 (1,559.54 per 100,000 person-years) belonged to the narcolepsy cohort and 57 (556.21 per 100,000 person-years) to the non-narcolepsy cohort. After adjusting for covariates, the risk of hospitalization for MVAI among participants with narcolepsy was still significantly higher than those without narcolepsy (adjusted hazard ratio = 6.725; 95% confidence interval = 4.421-10.231; P < .001). The use of modafinil or methylphenidate, as monotherapy or combined treatment, was associated with a lower risk of MVAI in the narcolepsy cohort. CONCLUSIONS Patients with narcolepsy may have a higher risk of hospitalization for MVAI and stimulant use could mitigate such risk.
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