Generalized Anxiety Disorder, Comorbid Major Depression and Heart Rate Variability: A Case-Control Study in Taiwan

Hsin-An Chang,Chuan-Chia Chang,Nian-Sheng Tzeng,Terry B. J. Kuo,Ru-Band Lu,San-Yuan Huang 대한신경정신의학회 2013 PSYCHIATRY INVESTIGATION Vol.10 No.4

Objective Decreased heart rate variability (HRV) has been reported in generalized anxiety disorder (GAD), but the results are mixed. Little is known about the impact of comorbid major depression (MD) on HRV in GAD patients. Both issues necessitate further investigation. Methods Twenty unmedicated, physically healthy GAD patients, 20 GAD patients with a secondary diagnosis of MD, 40 MD patients and 60 matched controls were recruited. We used the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale to assess anxiety and depression severity, respectively. Cardiac autonomic function was evaluated by measuring HRV parameters. Frequency-domain indices of HRV were obtained. Results Three patient groups had more anxiety and depression symptoms than control subjects, but heart rates (HRs) were significantly elevated only in GAD patients with comorbid depression. Relative to controls, GAD patients had reduced HRV while GAD patients with comorbid depression displayed the greatest reductions in HRV among three patients groups. Correlation analyses revealed anxiety/depression severity significantly associated with HRs, variance, LF-HRV and HF-HRV. However, separately analyzing among individual groups and adjusting for HRV-associated covariables rendered the correlations non-significant. Conclusion Our results suggest that reduction in HRV is a psychophysiological marker of GAD and individuals with comorbid GAD and MD may be distinguished based on psychophysiological correlates (for example, HF-HRV) from non-comorbid GAD patients. Taken into account that comorbid depression may confer increased risks for cardiovascular events in GAD patients, this subgroup of GAD patients may benefit better from cardiovascular risk reduction strategies.

7,8-Dihydroxyflavone, a Tropomyosin-Kinase Related Receptor B Agonist, Produces Fast-Onset Antidepressant-Like Effects in Rats Exposed to Chronic Mild Stress

Hsin-An Chang,Ying-Hsiu Wang,Che-Se Tung,Chin-Bin Yeh,Yia-Ping Liu 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.5

Objective Brain-derived neurotrophic factor (BDNF) and its specific receptor, tropomyosin-related kinase (TrkB), play important roles in treating depression. In this experiment, we examined whether 7,8-dihydroxyflavone, a novel potent TrkB agonist, could reverse the behavioral and biochemical abnormalities induced by the chronic mild stress (CMS) paradigm in rats. Methods SD rats were exposed to a battery of stressors for 56 days. 7,8-dihydroxyflavone (5 and 20 mg/kg) were administered intraperitoneally during the last 28 days of the CMS paradigm. Rats were tested in sucrose consumption test (SCT), forced-swimming test (FST) and elevated T-maze (ETM). Serum corticosterone levels and hippocampal BDNF levels of the rats were measured. Results Four-week CMS on the rats induced their depression-like behavior in SCT. The CMS-reduced sucrose consumption was reversed starting from 7 days after the 7,8-dihydroxyflavone (20 mg/kg) treatment and remained across the subsequent treatment regime. 7,8-dihydroxyflavone, when given at 5 mg/kg for 3 weeks, reduced the immobility time in the FST in the CMS-subjected rats. Additionally, the 4-week treatment with 7,8-dihydroxyflavone (20 mg/kg) attenuated the CMS-induced increase in anxiety-like behavior in the ETM. For the CMS-subjected rats, 7,8-dihydroxyflavone treatment dose-dependently reduced their serum corticosterone levels but increased their hippocampal BDNF levels only at 5 mg/kg. Conclusiona 7,8-dihydroxyflavone was beneficial for both depression and anxiety-like behaviors, and may exert fast-onset antidepressant effects. This provides a new insight into the pharmacological management of depression. ObjectiveaaBrain-derived neurotrophic factor (BDNF) and its specific receptor, tropomyosin-related kinase (TrkB), play important roles in treating depression. In this experiment, we examined whether 7,8-dihydroxyflavone, a novel potent TrkB agonist, could reverse the behavioral and biochemical abnormalities induced by the chronic mild stress (CMS) paradigm in rats. MethodsaaSD rats were exposed to a battery of stressors for 56 days. 7,8-dihydroxyflavone (5 and 20 mg/kg) were administered intraperitoneally during the last 28 days of the CMS paradigm. Rats were tested in sucrose consumption test (SCT), forced-swimming test (FST) and elevated T-maze (ETM). Serum corticosterone levels and hippocampal BDNF levels of the rats were measured. ResultsaaFour-week CMS on the rats induced their depression-like behavior in SCT. The CMS-reduced sucrose consumption was reversed starting from 7 days after the 7,8-dihydroxyflavone (20 mg/kg) treatment and remained across the subsequent treatment regime. 7,8-dihydroxyflavone, when given at 5 mg/kg for 3 weeks, reduced the immobility time in the FST in the CMS-subjected rats. Additionally, the 4-week treatment with 7,8-dihydroxyflavone (20 mg/kg) attenuated the CMS-induced increase in anxiety-like behavior in the ETM. For the CMS-subjected rats, 7,8-dihydroxyflavone treatment dose-dependently reduced their serum corticosterone levels but increased their hippocampal BDNF levels only at 5 mg/kg. Conclusion 7,8-dihydroxyflavone was beneficial for both depression and anxiety-like behaviors, and may exert fast-onset antidepressant effects. This provides a new insight into the pharmacological management of depression.

Linking an Anxiety-Related Personality Trait to Cardiac Autonomic Regulation in Well-Defined Healthy Adults: Harm Avoidance and Resting Heart Rate Variability

Lien-Cheng Kao,Yu-Wen Liu,Nian-Sheng Tzeng,Terry B. J. Kuo,San-Yuan Huang,Chuan-Chia Chang,Hsin-An Chang 대한신경정신의학회 2016 PSYCHIATRY INVESTIGATION Vol.13 No.4

ObjectiveaaAnxiety trait, anxiety and depression states have all been reported to increase risks for cardiovascular disease (CVD), possibly through altering cardiac autonomic regulation. Our aim was to investigate whether the relationship between harm avoidance (HA, an anxiety-related personality trait) and cardiac autonomic regulation is independent of anxiety and depression states in healthy adults. MethodsaaWe recruited 535 physically and mentally healthy volunteers. Participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Tri-dimensional Personality Questionnaire. Participants were divided into high or low HA groups as discriminated by the quartile value. Cardiac autonomic function was evaluated by measuring heart rate variability (HRV). We obtained the time and frequency-domain indices of HRV including variance (total HRV), the low-frequency power (LF; 0.05–0.15 Hz), which may reflect baroreflex function, the high-frequency power (HF; 0.15–0.40 Hz), which reflects cardiac parasympathetic activity, as well as the LF/HF ratio. ResultsaaThe BDI and HA scores showed associations with HRV parameters. After adjustment for the BDI scores and other control variables, HA is still associated with reduced variance, LF and HF power. Compared with the participants with low HA, those with high HA displayed significant reductions in variance, LF and HF power and a significant increase in their LF/HF ratio. ConclusionaaThis study highlights the independent role of HA in contributing to decreased autonomic cardiac regulation in healthy adults and provides a potential underlying mechanism for anxiety trait to confer increased risk for CVD.

Utilizing Design Thinking in the Development and Evaluation of a Pre-loaded Diluent and Medication Syringe

Zu-Chun Lin,Hsin-Ling Hsieh,Wen-Ting Chang,Nian-An Liu,Li-Ren Chen 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): Design Thinking is a human-centered problem-solving solution. It seeks innovative solutions for different issues by starting from human needs. The process includes empathizing, defining, ideating, prototyping, and testing. Innovation is a new trend for nursing education and talent training, but nursing-related research that combines design thinking with innovative research and development is lacking. In this study, cross-disciplinary instructors used design thinking to lead a team of nursing students in innovating on a Pre-loaded Diluent and Medication Syringe. The completed pilot test provides implementation and research directions for innovation education. Method(s): The researchers created 15 questions regarding ease of operation, safe use, environmental friendliness, and economic benefits for their self-developed Pre-loaded Diluent and Medication Syringe. The research team then demonstrated the device to 40 invited nursing students with registered nurse licenses, who were then asked to complete the questionnaire, thus allowing score-based comparisons between this innovative syringe and traditional syringes used in drug administration. The data was analyzed using descriptive and inferential statistics. Result(s): The results of the research showed that there was no significant difference on the “applicable to all types of wards” question for ease of operation, but the other 14 items all showed significant differences (P<.05). The reason for that insignificant difference may be due to unmet needs for micro-administration of special drugs and reuse of pediatric surplus; this prompted the research team to carry out develop on a Drug-mixing Syringe Feasible for Multiple Administrations. Conclusion(s): Based on the evaluation results, the research team developed a syringe more optimized to meet clinical needs. The study provides cross-disciplinary guidance to students in the process of nursing innovation, and narrows research gaps in related fields.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan. (Intest Res 2017;15:266-284)

Management of Crohn`s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Crohn`s disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan. (Intest Res 2017;15:285-310)

Hypomania Induced by Bifrontal Transcranial Direct Current Stimulation in a Patient with Bipolar Depression

Pei-Chun Chao,Chuan-Chia Chang,Hsin-An Chang 대한신경정신의학회 2018 PSYCHIATRY INVESTIGATION Vol.15 No.9

Transcranial direct current stimulation (tDCS), a non-invasive neuromodulation technique, has been increasingly used to treat bipolar depression. Researchers recently noticed the risk of tDCS-emergent mania/hypomania in depressed patients and started to evaluate this risk by launching a meta-analysis. Here we present a female with bipolar II depression who rapidly developed hypomanic switching during bifrontal tDCS.

Effect of Food Processing and Formulation Procedures on the Immunoregulatory Activity of Six Mushroom Proteins

Wen-I Chuang,Man-Hua Tung,Hui-Hsin Chang,An-Ju Chang,Fuu Sheu 한국원예학회 2006 한국원예학회 기타간행물 Vol.- No.-

Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity

Po-Han Chou,Yen-Feng Lin,Ming-Kuei Lu,Hsin-An Chang,Che-Sheng Chu,Wei Hung Chang,Taishiro Kishimoto,Alexander T. Sack,Kuan-Pin Su 대한정신약물학회 2021 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.19 No.2

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are evidenced-based treatments for patients with major depressive disorder (MDD) who fail to respond to standard first-line therapies. However, although various TMS protocols have been proven to be clinically effective, the response rate varies across clinical applications due to the heterogeneity of real-world psychiatric comorbidities, such as generalized anxiety dis-order, posttraumatic stress disorder, panic disorder, or substance use disorder, which are often observed in patients with MDD. Therefore, individualized treatment approaches are important to increase treatment response by assigning a given patient to the most optimal TMS treatment protocol based on his or her individual profile. This literature review summarizes different rTMS or TBS protocols that have been applied in researches investigating MDD patients with certain psychiatric comorbidities and discusses biomarkers that may be used to predict rTMS treatment response. Furthermore, we highlight the need for the validation of neuroimaging and electrophysiological biomarkers associated with rTMS treatment responses. Finally, we discuss on which directions future efforts should focus for developing the personalization of the treatment of depression with rTMS or iTBS.

Distinct Inflammation Biomarkers in Healthy Individuals and Patients with Schizophrenia: A Reliability Testing of Multiplex Cytokine Immunoassay by Bland-Altman Analysis

Ta-Chuan Yeh,Hsuan-Te Chu,Chia-Kuang Tsai,Hsin-An Chang,Fu-Chi Yang,San-Yuan Huang,Chih-Sung Liang 대한신경정신의학회 2019 PSYCHIATRY INVESTIGATION Vol.16 No.8

Objective Since the inflammatory process has been implicated in the pathophysiology of psychiatric disorder, an important issue emerging is to assess the test-retest reliability of cytokine measurement in healthy individuals and patients with schizophrenia. The objective of the present study was to investigate the test-retest reliability of bead-based multiplex immunoassay technology (BMIT) for cytokine measurement by using a Bland-Altman plot (BAP). Methods Twenty healthy individuals and twenty patients with schizophrenia were enrolled, and a 17-plex cytokine assay was used to measure inflammatory biomarkers at baseline and two weeks later. The test-retest reliability was examined by BAP, 95% limits of agreement (LOA), intraclass correlation coefficient (ICC), and coefficient of repeatability (CoR). Results In the healthy controls, only interleukin (IL)-2, IL-13, IL-10, IL-17, and macrophage inflammatory protein-1β showed excellent ICC. The BAP with 95% LOA determined that 13 cytokines showed acceptable 95% LOA for a 2-week test-retest reliability, and only IL-1β, IL-12 and tumor necrosis factor (TNF)-α had significant test-retest bias. The CoR of cytokines varied significantly, ranging from 1.72 to 218.1. Compared with healthy controls, patients with schizophrenia showed significantly higher levels of IL-5, IL-13, and TNF-α and significantly lower levels of IL-4, IL-12, and interferon-gamma (IFN-γ). Of these six cytokines, IL-12 and TNF-α were considered suboptimal reliability. Conclusion The findings from ICC and CoR implied that the test-retest reliability of BMIT for cytokine measurement were suboptimal. However, the BAP with 95% LOA confirmed that BMIT can reliably distinguish schizophrenia from healthy individuals in cytokine measurement, while significant within-subject variation and between-group overlapping were evident in cytokine expression.