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Biomedical subjects

Ming-Been Lee

Publications and source records attributed to Ming-Been Lee.

16 recordsLinked to original sources
PubMed2006

Intermediate-term outcome of psychiatric inpatients with major depression.

BACKGROUND/PURPOSE: A wide range of recovery rates has been reported during the 1st year of follow-up inpatients with depression, and there is a lack of consensus regarding which clinical and psychosocial variables are associated with prognosis. This study investigated the outcome of inpatients with a major depressive episode at 10-22 months (mean +/- SD = 14.0 +/- 3.4 months) of follow-up and the associated psychosocial and clinical variables. METHODS: The demographic and clinical characteristics of 67 inpatients with a DSM-IV major depressive episode were assessed at admission, discharge and 1 year after the initial assessment. A logistic regression model was used to examine the predictive factors of depressive status at follow-up. RESULTS: At the 1-year follow-up, 12 patients could not be located, one refused further interview and one had committed suicide 1 month after discharge. Eighty percent of patients had follow-up examinations. Out of 67 patients, 31 (47%) underwent a DSM-IV diagnosis (29 with major depression and two with minor depression) and 22 (33%) recovered. Low socioeconomic status (p = 0.05), long duration of illness before admission (p = 0.03) and number of previous hospitalizations (p = 0.04) were predictive factors for a depressive morbidity at 10-22 months. CONCLUSION: At follow-up, almost half of the discharged depressive patients were still depressed. Screening for predictive factors of chronic depressive morbidity facilitates better outcome by considering the heterogeneity of psychopathology that can lead to failure in the treatment plan.

Adult↗
PubMed2006

A programme of symptom management for improving quality of life and drug adherence in AIDS/HIV patients.

AIM: This paper reports an evaluation of the effect of symptom management programmed on drug adherence, CD4 count and virus load and the quality of life of patients with HIV/AIDS. BACKGROUND: Patients with HIV/AIDS have to face the long-term side effects caused by highly active antiretroviral therapy regimens. There has been little research to evaluate the influence of drug intervention side effects on self-care. METHODS: Sixty-seven patients with HIV/AIDS were randomly assigned to one-on-one teaching, group teaching, or control groups. All those in the one-on-one and group teaching groups attended a symptom management programme once a week, followed by 3 weeks of continuity and telephone counselling. Those in the control group were offered experimental intervention at the conclusion of data collection. The Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and Quality of Life Index were used to evaluate the effectiveness of the symptom management programme before and at 3 months after the intervention. RESULTS: Median differences on the Customized Adherence Self-Report Questionnaire, CD4 count and virus load, and quality of life in both experimental groups were statistically significantly better than in the control group. CONCLUSIONS: The symptom management programme can increase self-care ability in managing medication side effects in patients with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2006

[The strategy and prospects of suicide prevention in Taiwan].

Suicide mortality rates have been steadily rising in Taiwan, and suicide has been among the top ten causes of death for the last consecutive eight years. In response to this situation, the Taiwan Department of Health assigned the Taiwan Association Against Depression the task of setting up the Taiwan Suicide Prevention Center. The mission of the Center, suicide prevention, is advanced by its establishment of efficient networks nationwide capable of delivering related care services. Suicide prevention strategies can be categorized, based on coverage, as universal, selective or indicated interventions. The Center also plans to standardize the national suicide report format and care delivery system, improve mental health service quality, and organize community support networks. It pursues an encompassing health care mechanism model, where clients are considered the first priority, the family a fundamental supporting unit, and the community a solid foundation. The Center will offer a helping hand for individuals who have attempted suicide by maintaining a spirit of positive values and achieving mutual benefits.

Community Networks↗
PubMed2005

Outcome of short-term hospitalization in a psychosomatic ward.

BACKGROUND AND PURPOSE: This study investigated the short-term outcome of patients with common mental disorders (CMDs) admitted to a psychosomatic ward. Multidimensional outcome measurements were used, including psychological symptoms, global functioning, and service satisfaction. METHODS: A total of 56 consecutive patients with CMDs admitted to a 33-bed psychosomatic ward for crisis intervention or due to refractory conditions unresponsive to treatment at outpatient clinics were enrolled. Structured measurements including psychological symptoms, personality traits, family functioning and global functioning, at admission and discharge, were used to assess outcome. Baseline social functioning was measured at admission. Perspective on life satisfaction and satisfaction with therapy were assessed at discharge. Univariate analysis and multiple regression models that employed the stepwise method were used to determine the predictors of outcome. RESULTS: Psychological symptoms, global functioning and family function demonstrated significant improvement after hospitalization (p<0.05). Personality traits remained stable during hospitalization. Baseline social functioning, educational level, marital status, comorbid mental disorder, length of hospital stay, and neuroticism were significantly associated with psychological stress at discharge (adjusted R2=0.51). Higher educational level and male gender were significantly correlated with better global functioning at discharge (adjusted R2=0.18). Perspective on life satisfaction and improvement of family functioning predicted satisfaction with therapy during the index hospitalization (adjusted R2=0.19). CONCLUSIONS: This study demonstrated a significant improvement after short-term hospitalization in a psychosomatic ward. Demographic and clinical variables were able to predict the outcome measurement of symptoms, functioning and service satisfaction. This study also suggested that individual psychotherapy is a useful approach to the treatment of hospitalized patients with CMDs.

Adult↗
PubMed2005

Validity of the five-item Brief Symptom Rating Scale among subjects admitted for general health screening.

BACKGROUND AND PURPOSE: Hospital-based general health screening plays an important role in the early detection of mental disorders. The present study examined the validity of the 5-item Brief Symptom Rating Scale (BSRS-5) in subjects admitted for a 2-day general health screening program. METHODS: A cross-sectional survey with a modified 2-phase design was conducted at a medical center in Taipei. A total of 283 consecutive subjects who received health screening in a 1-month period completed the BSRS-5 in the first phase. There were 172 (60.8%) males and 111 (39.2%) females with a mean age of 54.4+/-12.0 years. 115 subjects received a standard psychiatric interview with the Mini International Neuropsychiatric Interview-Plus in the second phase. RESULTS: In this hospital-based sample, the internal consistency (Cronbach alpha) coefficient for the BSRS-5 was 0.84 and the area under the receiver-operating characteristic curve was 0.91 [95% confidence interval (CI), 0.86-0.95]. The optimal cut-off point was 5/6. The rate of accurate classification was 82.2% (82.6% sensitivity, 81.8% specificity, 81.9% positive predictive value, 82.5% negative predictive value). The estimated prevalence of minor psychiatric morbidity in this sample was 27.2% (95% CI, 22.2-32.4%). CONCLUSION: The BSRS-5 is an effective screening instrument for the identification of psychiatric morbidity in hospital-based health screening settings.

Adult↗
PubMed2004

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program.

OBJECTIVE: To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment. METHODS: One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (>/=20), subthreshold binge eaters (10-19), and nonbinge eaters (0-9). RESULTS: This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program. CONCLUSION: Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.

Adolescent↗
PubMed2004

A review of the legislative mechanisms available to protect the social participation rights of people with depression in the Asia Pacific region.

OBJECTIVE: To conduct a review of the legislative mechanisms potentially available to protect the social participation rights of people with depression in the Asia Pacific region. METHODS: Questions were sent to the SEBoD International Advisory Board and Internet and legal database searches were conducted to supplement responses from advisors. RESULTS: While it cannot be said that comprehensive antidiscrimination legislation in relation to disability exists in all countries in the Asia Pacific region, most countries have commenced the process. Many have implemented either human rights or antidiscrimination legislation and most have set up a Human Rights Commission to protect social participation rights and allow complaints to be lodged. CONCLUSIONS: This review highlighted the difference between legislation and practice. While many countries have enacted laws, insufficient resources have been committed to support the objectives to realise the protection of rights enshrined in legislation. Additionally, many people may not know that the laws exist or do not have the money or social supports to fight for their rights. Many countries, however, have commenced a concerted approach to tackling the larger issues and have developed comprehensive action plans to address the social participation rights of people with disability.

Asia, Southeastern↗
PubMed2004

Long-term outcome of bulimia nervosa in Taiwanese.

BACKGROUND AND PURPOSE: Patients with bulimia nervosa (BN) often experience many associated psychiatric symptoms and behaviors other than disordered eating and body image disturbance. Follow-up studies showed a broad range of remission rates and few prognostic factors were consistently identified. This study examined the outcome of BN in Taiwanese patients using a broad scope of assessment methods. METHODS: From January 1985 to August 1999, a total of 68 consecutive patients with BN who visited the Department of Psychiatry at National Taiwan University Hospital were identified by chart review and invited to participate. Forty five patients (66.2%) agreed to participate in the study and were invited back for a follow-up assessment. The follow-up assessments used both semi-structured interview and self-rating questionnaires. RESULTS: The mean duration of follow-up was 4.7 +/- 2.9 (2 to 15) years. One patient died of gradual weight loss and malnutrition during the follow-up period. Forty four percent of the patients (n = 20) had no signs of eating disorder at follow-up, while 56% of the patients (n = 25) still met the criteria for diagnosis of an eating disorder (anorexia nervosa, BN, and eating disorders not otherwise specified). The rate of crossover from BN to anorexia nervosa was 6.6% (n = 3). The illness persisted for more than 2 years in most of the patients (84.5%). Purging subtype of BN was the only predictor of the presence of an eating disorder diagnosis at follow-up. CONCLUSIONS: This study found a high percentage of Taiwanese patients with BN failed to recover from eating disorders on long-term follow-up. The need for attention to the chronic nature of BN should be emphasized by medical professionals managing these patients.

Adult↗
PubMed2003

Development of a teaching style inventory for tutor evaluation in problem-based learning.

OBJECTIVE: To develop and validate a self-rating instrument to assess teaching styles among tutors in problem-based learning (PBL). METHODS: The development of the teaching style inventory (TSI) was based theoretically on four types of teaching behaviours: the assertive, suggestive, collaborative and facilitative styles, as proposed by Bibace et al. A 35-item questionnaire was generated and evaluated for content validity by a group of experienced tutors. The questionnaire was mailed to 196 tutors at the National Taiwan University College of Medicine. The results were submitted for item analysis, internal consistency testing and exploratory factor analysis. Longterm test-retest reliability was assessed by a sample of 50 tutors after a 6-month interval. RESULTS: Finally, 118 tutors returned the questionnaires. In the item reduction process, seven items were excluded due to low interscale correlation. Principle component factoring yielded a three-factor solution that accounted for 48.5% of the total variance. Internal consistency coefficients of the four hypothetical domains ranged from 0.73 to 0.83. All domains correlated to each other as expected. Assertive and facilitative styles, which are theoretically opposite teaching styles, showed a negative correlation with each other. Most of the items of each hypothetical domain correlated better with their own domain than with other domains. Longterm test-retest correlations of the four domains ranged from 0.54 to 0.81. CONCLUSION: The TSI demonstrated high internal consistency reliability, acceptable longterm test-retest reliability, and construct validity. Further psychometric testing should focus on applicability to other populations, predictive validity and short-term test-retest reliability. This instrument can be used by programme directors for the recruitment of tutors and can also be used to increase the self-awareness of tutors.

Adult↗
PubMed2003

Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity.

BACKGROUND AND PURPOSE: The accurate identification of minor mental disorders associated with depression and anxiety in non-psychiatric medical settings is an important component of mental health care. The present study aimed to develop a reliable and valid short screening tool to improve the identification of psychiatric morbidity. METHODS: Data from the 50-item Brief Symptom Rating Scale (BSRS-50) obtained from 721 medical inpatients were used to develop a short screening tool (BSRS-5) to identify psychiatric morbidity. The BSRS-5 comprises 5 symptom items, selected from the BSRS-50, each of which has the highest correlation with the corresponding subscale score of Anxiety, Depression, Hostility, Interpersonal Sensitivity and Additional Symptoms in the BSRS-50. Various types of reliability and validity of the BSRS-5 were assessed in different populations, including 253 human immunodeficiency virus-1 infected outpatients, 257 psychiatric outpatients, 56 psychiatric inpatients, 100 rehabilitation outpatients with chronic low back pain, 2915 university freshmen, and 1090 community members. RESULTS: Internal consistency (Cronbach alpha) coefficients of the BSRS-5 ranged from 0.77 to 0.90. The test-retest reliability coefficient was 0.82. Concurrent validity coefficients between the sum score of BSRS-5 and the General Severity Index of BSRS-50 ranged from 0.87 to 0.95. Choosing 6+ as the cut-off score for psychiatric cases, the rate of accurate classification of BSRS-5 was 76.3% (78.9% sensitivity, 74.3% specificity, 69.9% positive predictive value, 82.3% negative predictive value). The BSRS-5 could differentiate the severity of illness in psychiatric outpatients based on psychiatrist's ratings using the Clinical Global Impression scale, severity of psychopathology of psychiatric inpatients between admission and discharge, levels of pain indicated by 4 dimensions of the Dallas Pain Questionnaire for outpatients with chronic low back pain, and the severity of psychopathology between university students and community members with and without suicidal ideation. CONCLUSION: The BSRS-5 can be used to identify psychiatric morbidity in both medical practice and the community.

Adult↗
PubMed2003

Brain tumor presenting as anorexia nervosa in a 19-year-old man.

Slow-growing brain tumors can produce disturbances of food intake and endocrine dysfunction. We report a case of slow-growing midline brain tumor in a patient with clinical presentation of anorexia nervosa (AN). A 19-year-old man was referred from a general practitioner to a psychiatric clinic due to illness behavior and psychopathological characteristics of AN. His body weight had decreased from 52 kg to 40 kg within 6 months. Laboratory tests showed hypernatremia (160 mmol/L), adrenal insufficiency (adrenocorticotrophic hormone, 11.4 pg/mL; 8 am cortisol, 1.4 microg/dL; 4 pm cortisol, 11.4 microg/dL) and hypogonadotropic hypogonadism (testosterone < 0.5 ng/mL, follicle-stimulating hormone < 0.1 mIU/mL, luteinizing hormone < 0.7 mIU/mL). Brain magnetic resonance imaging showed an extensive mass lesion at suprasellar, hypothalamic region, third ventricle, pineal region, lateral ventricle, and corpus callosum. Owing to central herniation during physical assessment, he died of unknown intracranial pathology. This case suggests that an intracranial tumor near the hypothalamus should be included in the differential diagnosis of AN. Any male adolescent with the clinical impression of AN should receive periodic re-evaluation, including neurological, endocrinological and, if necessary, neuroimaging study.

Adrenal Insufficiency↗
PubMed2002

Association of psychological distress with psychological factors in rescue workers within two months after a major earthquake.

BACKGROUND AND PURPOSE: Studies of the health of rescue workers after a major disaster have frequently focused on posttraumatic stress disorder. This study aimed to determine the characteristics of psychological distress and its psychosocial predictors in rescue workers within a 2-month period after an earthquake that struck central Taiwan on September 21, 1999. METHODS: A total of 1,104 rescue workers serving in the earthquake were enrolled in the study. Psychological distress was measured using the Brief Symptom Rating Scale (BSRS), personality traits using the Maudsley Personality Inventory (MPI), and family function using APGAR (adaptability, partnership, growth, affection, and resolve) indexes. These measurements were performed within 2 months of the earthquake. Univariate and multivariate analyses were applied to examine the association between psychological distress and various psychosocial factors. RESULTS: BSRS assessment revealed severe psychological distress in 137 (16.4%) subjects. The most common symptom dimension was phobic-anxiety (18.7%), followed by hostility (17.6%), obsessive-compulsive symptoms (16.2%), depression (14.9%), paranoid ideation (14.2%), interpersonal sensitivity (13.3%), psychoticism (11.9%), anxiety (10.8%), additional symptoms (8.5%), and somatization (6.2%). Pre-disaster major life events (R2 = 0.03) and most of the factor scores of the MPI (including moodiness, anxiety-prone, outgoing, conscientiousness, activity, and sociability factors; R2 = 0.25) predicted the severity of psychological distress. Time of arrival at the scene, previous exposure, age, and family function had no or trivial predictive power. CONCLUSION: The results of this study indicated that prevalence of general psychological distress is high among rescue workers in the first 2 months after a major earthquake. Personality traits and pre-disaster life adjustment had a dominant predictive power for psychological distress. Immediate psychosocial intervention should be considered to ameliorate the distress related to disaster rescue work.

Adult↗
PubMed2002

Psychobehavioral response and weight loss prediction in a hospital-based weight reduction program.

BACKGROUND AND PURPOSE: Depression and binge eating are common adverse psychologic responses associated with weight loss in overweight and obese adults. This study aimed to assess the effects of different degrees of weight loss on psychologic functioning and the relationship between mood change and weight reduction, and to identify predictors of short-term weight loss among subjects in a hospital-based weight reduction program. METHODS: A total of 189 obese subjects who participated in a hospital-based weight-reduction program during a 12-week interval were enrolled in this study. They ranged in age from 18 to 67 years (mean, 40.5 +/- 12.3 yr) with female predominance (87.8%). Mean body weight was 79.3 +/- 13.9 kg and mean body mass index was 31.1 +/- 3.8 kg/m2 on entry into the program. Body weight was periodically measured and subjects were asked to complete two self-administered questionnaires including the Brief Symptom Rating Scale (BSRS) and the Bulimic Investigatory Test, Edinburgh (BITE), pre- and post-treatment. RESULTS: Using the last observation carried forward method of analysis, the average weight loss for all participants was 5.6 +/- 3.7 kg. For subjects who completed the 12-week program, weight loss was 6.6 +/- 3.6 kg. Subjects who completed the program (n = 115, 60.8%) had significantly reduced BITE as well as all BSRS subscale scores at the end of the program. There was no linear relationship between mood change and weight loss by correlation analysis, but subjects with higher degrees of weight loss had improvement in more dimensions of psychologic functioning. Initial mood and binge-eating status predicted neither compliance nor weight reduction. Two biologic factors (initial weight loss, initial body weight) and one behavioral factor (attendance rate) were identified as significant predictors of short-term weight loss for all subjects. CONCLUSIONS: There was no evidence that weight loss made mood or eating pathology worse among those who completed the weight loss program. Beneficial effects on general psychologic functioning and eating pathology were demonstrated for subjects with a minimal weight loss of 5% of initial weight and who completed the program. Psychologic assessments at the start of the program did not predict weight loss at the end of participation in this hospital-based weight loss program.

Adolescent↗
PubMedDate not supplied

Hyperleptinemia in subjects with persistent partial posttraumatic stress disorder after a major earthquake.

OBJECTIVE: Leptin, a peptide hormone derived from adipose tissue, regulates food intake and controls weight. Serum leptin levels may be elevated in critically ill patients and in cases of physical stress. Our aim was to examine the relationship between postdisaster psychiatric symptoms and serum leptin levels. METHODS: We recruited 92 subjects who visited emergency medical stations immediately after the giant earthquake seized middle Taiwan on September 21, 1999. Of these cases, 43 met the criteria for subsyndromal acute stress disorder. Eighteen months later, we measured serum leptin levels and performed in-depth psychiatric assessments using the posttraumatic stress disorder subset in the Mini International Neuropsychiatric Instrument and the Brief Symptom Rating Scale short form. RESULTS: After we adjusted for age, gender, and body mass index, serum leptin levels were significantly higher in the persistent subsyndromal group (N = 15; estimated marginal mean, 9.641; 95% confidence interval, 7.673-11.610) than in others (estimated marginal means, 4.775-6.368). A hyperaroused state predicted a higher adjusted leptin level. On the Brief Symptom Rating Scale, general severity index, paranoid tendency, anxiety symptoms, and depressive symptoms were positively correlated with adjusted leptin levels. CONCLUSIONS: We found a direct relationship between stress-related psychopathologic symptoms and serum leptin levels. Subjects with persistent subsyndromal posttraumatic stress disorder and hyperarousal had significantly higher serum leptin levels. Therefore, leptin may be a valid neuroendocrinologic marker for the hypervigilant state of vulnerable people who have faced tremendous danger and uncertainty. Further studies are needed to examine the correlation between leptin levels and hypothalamic-pituitary-adrenal axis function, particularly the inverted diurnal serum leptin levels in hyperaroused subjects.

Adult↗