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Loneliness is experienced by many older people and associated with depressive symptoms. Childhood adverse events have been found to be a predictor of loneliness in young adults. We would like to investigate whether childhood traumatic events are associated with loneliness in older people with depression. We also explored what kinds of traumatic events are more related to loneliness and whether family support will modify the association of interest.
Older adults (≧60 years) with history of major depressive disorder were enrolled from outpatient clinics. Participants cannot be diagnosed as dementia. They received a series of questionnaires, including cumulative illness rating scales, Hamilton depressive and anxiety rating scales (HDRS and HARS), Geriatric depression scale(GDS), Childhood Trauma Questionnaire(CTQ), Chinese version of the family adaptation, partnership, growth, affection and resolve(APGAR), and Mini-mental status examination.
Fifty-four participants were enrolled. The average age was 68.8 years and female predominance (83.7%) with mean educational year of 10.4. Univariate analysis was performed first using LS score as dependent variable, and only those variables with p value less than 0.2 were put into multiple linear regression. In the multiple regression model, age, gender, education, GDS, HDAS were entered as covariates and CTQ was treated as independent variable. The results showed that CTQ score was positively associated with LS (ß=0.565, p<0.001). The family support, presented as APGAR score, was not modified the results. In the explore analysis, physical neglect, emotional abuse, emotional neglect also showed positively associated with loneliness in the participants; however, physical abuse and sexual abuse did not have the same findings.
Childhood adverse events may be positively associated with loneliness in older people with depressive disorder after adjusting for confounders. We should pay more attention on the childhood traumatic events in these patients. In addition, physical neglect, emotional abuse, emotional neglect rather than physical abuse and sexual abuse seemed to have more impact on the loneliness in these participants. However, some limitations, such as small sample size, recall bias of childhood events, difficulty of recall physical and sexual abuse, and other latent confounders, should be considered before making a final conclusion.
Cognitive impairment is a growing problem with increasing burden in ageing global population. Older adults with major depressive disorder (MDD) have higher risk of dementia during ageing. Neurofilament light chain (NfL) has been proven as a potential biomarker related to dementia. The present study aims to assess the cognitive deficits in older adults with MDD and investigate their association with peripheral blood levels of NfL.
We enrolled 39 individuals with MDD and 15 individuals with mild neurocognitive disorder or major neurocognitive disorder, Alzheimer’s type. Both groups were over age 65 and with restricted 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 cognitive impairment in each domain.
In the MDD group, participants have higher rate of family psychiatry history and higher rate of current alcohol use habit compared with patients with neurocognitive disorders. In the neurocognitive disorders group, participants showed significantly lower score in total MMSE and higher plasma NfL levels. Part of the MDD patients presented cognitive deficits similar to 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.
We noted the negative correlation between NfL levels and cognitive performance in MDD patients whose cognitive manifestation were more similar to that of degenerative neurocognitive disorders. NfL might be a potential marker to predict patients with MDD to develop cognitive decline especially in domains typically found in Alzheimer’s disease. Further longitudinal studies are required to validate our findings for clinical implications.
Bipolar disorder is a chronic mental disorder related to cognitive deficits. Low serum vitamin D levels are significantly associated with compromised cognition in neuropsychiatric disorders. Although patients with bipolar disorder frequently exhibit hypovitaminosis D, the association between vitamin D and cognition in bipolar disorder, and their neuroaxonal integrity, is unclear.
To investigate the interaction effects between vitamin D and neurofilament light chain (NfL) levels on cognitive domains in bipolar disorder.
Serum vitamin D and NfL levels were determined in 100 euthymic patients with bipolar disorder in a cross-sectional study. Cognitive function was measured with the Brief Assessment of Cognition in Affective Disorders. We stratified by age groups and used general linear models to identify associations between vitamin D and NfL levels and their interaction effects on cognitive domains.
The mean vitamin D and NfL levels were 16.46 ng/nL and 11.10 pg/mL, respectively; 72% of patients were vitamin D deficient. In the older group, more frequent hospital admissions and lower physical activity were identified in the group with versus without vitamin D deficiency. The age-modified interaction effect of vitamin D and NfL was associated with composite neurocognitive scores and verbal fluency in both age groups, and with processing speed domain in the younger group.
We observed a high vitamin D deficiency prevalence in bipolar disorder. We identified the interaction of vitamin D and NfL on cognitive domains, and the effect was modified by age. Longitudinal or randomised controlled studies enrolling patients with various illness durations and mood statuses are required to validate our findings.
A proportion of patients with bipolar disorder (BD) manifests with only unipolar mania (UM). This study examined relevant clinical features and psychosocial characteristics in UM compared with depressive-manic (D-M) subgroups. Moreover, comorbidity patterns of physical conditions and psychiatric disorders were evaluated between the UM and D-M groups.
This clinical retrospective study (N = 1015) analyzed cases with an average of 10 years of illness duration and a nationwide population-based cohort (N = 8343) followed up for 10 years in the Taiwanese population. UM was defined as patients who did not experience depressive episodes and were not prescribed adequate antidepressant treatment during the disease course of BD. Logistic regression models adjusted for relevant covariates were used to evaluate the characteristics and lifetime comorbidities in the two groups.
The proportion of UM ranged from 12.91% to 14.87% in the two datasets. Compared with the D-M group, the UM group had more psychotic symptoms, fewer suicidal behaviors, a higher proportion of morningness chronotype, better sleep quality, higher extraversion, lower neuroticism, and less harm avoidance personality traits. Substantially different lifetime comorbidity patterns were observed between the two groups.
Patients with UM exhibited distinct clinical and psychosocial features compared with patients with the D-M subtype. In particular, a higher risk of comorbid cardiovascular diseases and anxiety disorders is apparent in patients with D-M. Further studies are warranted to investigate the underlying mechanisms for diverse presentations in subgroups of BDs.
This study presents an optimal design procedure including topology optimization and size–shape optimization methods to maximize mechanical advantage (which is defined as the ratio of output force to input force) of the synthesized compliant mechanism. The formulation of the topology optimization method to design compliant mechanisms with multiple output ports is presented. The topology-optimized result is used as the initial design domain for subsequent size–shape optimization process. The proposed optimal design procedure is used to synthesize an adaptive compliant gripper with high mechanical advantage. The proposed gripper is a monolithic two-finger design and is prototyped using silicon rubber. Experimental studies including mechanical advantage test, object grasping test, and payload test are carried out to evaluate the design. The results show that the proposed adaptive complaint gripper assembly can effectively grasp irregular objects up to 2.7 kg.
The sudden emergence of severe acute respiratory syndrome (SARS) caused international anxiety owing to its highly contagious and pandemic transmission. Health workers are vulnerable and are at high risk of infection.
To assess SARS-related stress and its immediate psychological impact and responses among health workers.
Health workers in a tertiary hospital affected by SARS were invited to complete a questionnaire designed to evaluate exposure experience, psychological impact and psychiatric morbidity. The risk and rates of psychiatric morbidity were estimated for exposure experience.
Altogether, 1257 health workers successfully completed the survey. In the initial phase of the outbreak, when the infection was spreading rapidly, feelings of extreme vulnerability, uncertainty and threat to life were perceived, dominated by somatic and cognitive symptoms of anxiety. During the ‘repair’ phase, when the infection was being brought under control, depression and avoidance were evident. The estimated prevalence of psychiatric morbidity measured by the Chinese Health Questionnaire was about 75%.
The outbreak of SARS could be regarded as an acute episode of a bio-disaster, leading to a significantly high rate of psychiatric morbidity.
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