Journal of Experimental & Clinical Medicine RSS feed: Current Issue. The Journal of Experimental and Clinical Medicine (JECM) aims to publish high quality scientific research in the field of experimental and clinical medicine, with the goal of promoting and disseminating medical science knowledge to improve global health. Articles on clinical, laboratory and social research in medicine and other related fields that are of interest to the medical profession are eligible for consideration. The JECM publishes review articles, original articles, case reports, short communications, and letters to the editor. The journal is published every 2 months, with a total of 6 issues a year. http://www.jecm-online.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Journal of Experimental & Clinical Medicine1878-331742April 2012 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.jecm-online.com/article/PIIS1878331712000319/abstract?rss=yesThe concept of having a special issue of the Journal of Experimental and Clinical Medicine (JECM) was the brainchild of Chuang C. Chiueh, the newly appointed Editor-in-Chief. He told me of the articles published in one special issue that had been contributed by speakers at a symposium on “Neurobiology of NO and OH,” producing a group of highly cited articles in the Annals of the New York Academy of Sciences. In the JECM (www.jecm-online.com), the first special issue was published on human motion analysis, and the second on oncology, these appearing in the October 2011 and December 2011 issues, respectively, of the JECM. This third special issue, published in April 2012, is on clinical psychiatry.What’s in Store in this Special Issue on Clinical Psychiatry: A PrefaceWinston W. Shen10.1016/j.jecm.2012.02.005Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-02Journal of Experimental & Clinical Medicine2012-03-0242S1878-3317(12)X0003-2Preface7576http://www.jecm-online.com/article/PIIS187833171200023X/abstract?rss=yesNatural disasters have caused millions of deaths worldwide, and hundreds of millions of people have suffered from various types of physical or mental traumas. Disasters change patterns of thinking and the concept of security among members of a community, which highlights the importance of mental rehabilitation in disaster psychiatry. Mental rehabilitation is not only a short-term intervention, but also involves long-term follow-up and referral of cases to regular psychiatric management. We used PubMed (http://www.ncbi.nlm.nih.gov/pubmed) to search for papers related to the Chi-Chi Earthquake and the Morakot Typhoon published between January 2001 and November 2011. We found that 33 articles are involved in seven topics. The most common disaster-related psychiatric diagnoses were major depressive episodes and posttraumatic stress disorder. The prevalence of posttraumatic stress disorder ranged from 8.0% to 34.3% in Taiwan after the 1999 Earthquake. However, lifetime and current prevalence for psychiatric disorders ranged from 1% to 74%, affecting women twice more than men. Because disasters are becoming increasingly common, it is vital to train a sufficient number of specialists with guidelines for standard clinical treatment, and to create a standard operating procedure for reducing traumatic conditions.Disaster Psychiatry in Taiwan: A Comprehensive ReviewHuei-Wen Angela Lo, Chao-Yueh Su, Frank Huang-Chih Chou10.1016/j.jecm.2012.01.005Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-24Journal of Experimental & Clinical Medicine2012-02-2442S1878-3317(12)X0003-2Review Articles7781http://www.jecm-online.com/article/PIIS1878331712000216/abstract?rss=yesUntil recently, mental health programs during and after disasters were considered to be controversial. A disaster exposes many people to extreme stresses and injury and illness. Especially in resource-poor countries, a disaster also brings a range of problems that erode protections, increase social injustice and inequality and entail human rights violations. There is a growing international consensus on the need for a range of mental health and social interventions integrated with existing systems. The mental health and psychosocial response programs increasingly integrated into humanitarian assistance programs can be seen as an opportunity to model the introduction of mental health centrally and explicitly in the public heath framework of a country. Mental health is a state of wellbeing in which a person can use their own abilities and cope with the normal stresses of life. It is promoted by effective public health and social interventions. Mental health and physical health and behavior are closely interconnected. These connections are important after a disaster. Resilience refers to a person’s relative resistance to, or the overcoming of, stress or adversity. Mental health and resilience depend on interactions between personal and wider social factors, such as safety and access to education and work. Effective interventions to promote mental health and resilience after a disaster focus on self-efficacy and community participation. Interventions occur at several levels, and alongside help provided to those with mental illnesses. They include social policies such as rebuilding housing and opening schools. They also include activities closer to the person, such as livelihood support to women and girls. A challenge now is to evaluate and refine programs and good practice after a disaster: monitoring the effects on mental health of activities in nonhealth sectors; and monitoring the effects on broader health and function of activities designed primarily to promote mental health.Promoting Mental Health and Resilience after a DisasterHelen Herrman10.1016/j.jecm.2012.01.003Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-22Journal of Experimental & Clinical Medicine2012-02-2242S1878-3317(12)X0003-2Review Articles8287http://www.jecm-online.com/article/PIIS1878331712000241/abstract?rss=yesGeneralized anxiety disorder (GAD) is characterized by a pervasive cognitive dysfunction with a focus on threats and risks toward the individual or his/her immediate family. It goes with tension, worry, muscle pain, disturbed sleep, and irritability that all together impair work capacity, relations, and leisure activities. By its chronic course, GAD increases direct and indirect costs for the individual, the family, the health care services, and at work or in education. Among patients with cardiovascular or cerebrovascular disease, pulmonary disease, diabetes, and neurological diseases, GAD is a risk factor for somatic complications and for lowered adherence to somatic treatments. GAD can be treated with cognitive behavioral therapy, and/or with medications.Generalized Anxiety Disorder: A Review of Recent FindingsChrister Allgulander10.1016/j.jecm.2012.01.006Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-22Journal of Experimental & Clinical Medicine2012-02-2242S1878-3317(12)X0003-2Review Articles8891http://www.jecm-online.com/article/PIIS1878331712000277/abstract?rss=yesStuttering is a speech disorder defined by frequent prolongations, repetitions, or blocks of spoken sounds and/or syllables, as well as anxiety and cognitive avoidance. Stuttering is a very common disorder, and research now indicates that it is likely a multifactorial process with a physiologic etiology. Recent advances in the field of stuttering now provide insight into novel treatment strategies to help guide the practicing clinician. In addition to considering the upcoming revision to the Diagnostic and Statistical Manual of Mental Disorders criteria, comprehensive treatment should address all aspects of this disorder, as the optimal treatment of stuttering involves a multidisciplinary approach.Overview of the Diagnosis and Treatment of StutteringGerald A. Maguire, Christopher Y. Yeh, Brandon S. Ito10.1016/j.jecm.2012.02.001Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-05Journal of Experimental & Clinical Medicine2012-03-0542S1878-3317(12)X0003-2Review Articles9297http://www.jecm-online.com/article/PIIS1878331712000290/abstract?rss=yesThe concept of “resistant schizophrenia” is linked to the development of antipsychotic drugs. Although there were previous attempts, the first definition acknowledged in the scientific literature, was closely linked to the development of clozapine in dichotomic terms of response/no response to previous drug. This article reviews the influence of the psychopharmacologic treatment of schizophrenia on the evolving definition of treatment-resistance. It also addresses other concepts of interest, such as remission and recovery, as well as definitions of schizophrenia in which deterioration is an integral part of the psychopathology, thereby implicitly ruling out the possibility of a complete remission of symptoms. Instead of treatment-resistance, we are suggesting the term “lack of adequate response,” which is closer to operational dimensional models that integrate the idea of a continuum with response levels related to an individual's life expectations, and which allow different pharmacological approaches to be integrated.Evolution of the Concept of Treatment-resistant Schizophrenia: Toward a Reformulation for Lack of an Adequate ResponseJuan D. Molina, Ana B. Jiménez-González, Francisco López-Muñoz, Fernando Cañas10.1016/j.jecm.2012.02.003Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-14Journal of Experimental & Clinical Medicine2012-03-1442S1878-3317(12)X0003-2Review Articles98102http://www.jecm-online.com/article/PIIS1878331712000253/abstract?rss=yesMetabolic disturbances and cardiovascular disease are important causes of morbidity and mortality in patients with severe mental illnesses. Antipsychotic medications are the drug of the choice for patients with schizophrenia. However, some antipsychotic drugs have a high tendency to cause weight gain and metabolic abnormalities, therefore increasing the risk of obesity, metabolic syndrome, type 2 diabetes mellitus, and cardiovascular disease. These findings have led to an increased interest in looking into the relationships between schizophrenia, antipsychotic drugs, metabolic dysregulation, and cardiovascular disease. Although some neurotransmitter receptor-binding affinities are correlated with specific metabolic abnormalities, the exact mechanisms underlying antipsychotic-induced adverse metabolic effects are still unclear. The receptor affinity of antipsychotic drugs for histamine H1, serotonin 5-HT2C and 5-HT1A, muscarinic M3, dopamine D2, and adrenergic receptors might be involved in causing metabolic dysregulation. Low-potency first-generation antipsychotic drugs are associated with a higher potential to cause weight gain and metabolic disturbance than are high-potency first-generation antipsychotics. Second-generation antipsychotic drugs carry different risks of causing weight gain and metabolic dysregulation: clozapine and olanzapine have the highest risk; quetiapine and risperidone a moderate risk; and aripiprazole, amisulpride, and ziprasidone the lowest risk. The psychiatric literature has recommended follow-up for metabolic and cardiovascular risk factors, but many antipsychotic-treated patients have not received the recommended regular monitoring for these risk factors. Psychiatrists need to educate and motivate this group of patients to make healthy lifestyle changes. If these lifestyle changes fail, these patients need to receive drug interventions. Adding medications (such as metformin, topiramate, and amantadine) or switching to another antipsychotic drug should be considered to decrease the risk of antipsychotic-induced weight gain and metabolic abnormalities. In conclusion, this review is intended to describe the adverse metabolic and cardiovascular effects related to antipsychotic medications, to explore their possible underlying mechanisms, and to recommend how to monitor and manage those iatrogenic side effects.Metabolic and Cardiovascular Adverse Effects Associated with Treatment with Antipsychotic DrugsShen-Chieh Chang, Mong-Liang Lu10.1016/j.jecm.2012.01.007Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-05Journal of Experimental & Clinical Medicine2012-03-0542S1878-3317(12)X0003-2Review Articles103107http://www.jecm-online.com/article/PIIS1878331712000228/abstract?rss=yesAlcohol-related problems cause a tremendous social and public health burden worldwide. Alcohol dependence (AD) is a common, chronic and relapsing psychiatric disorder, with prevalence varying among different ethnic populations, and determined by a combination of genetic and environmental factors. The heritability of AD is estimated roughly as 50%–60%. Until recently, the only genes established to affect the risk AD, were those encoding several alcohol metabolizing enzymes such as ADH1B and ALDH2. However, we are still in the early stages of understanding the physiology of other risk gene loci. Both ADH1B*2 and ALDH2*2, found more frequently in Asians compared to Caucasians, are considered as protective alleles, potentially explaining a lower prevalence of AD in Taiwanese people. Alcohol intake produces a long-lasting neuroadaptation, which is involved in developing and maintaining AD. Toxicity, such as oxidative damage associated with chronic alcohol consumption, also contributes to the addiction process. Emerging evidenceprovides an insight into the understanding of the mechanisms of how alcohol disrupts the synergistic homeostasis of bodily systems, and results in behavioral and physiological dysfunction.Alcohol Dependence in Taiwan: From Epidemiology to BiomedicineMing-Chyi Huang, Chiao-Chicy Chen10.1016/j.jecm.2012.01.004Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-14Journal of Experimental & Clinical Medicine2012-03-1442S1878-3317(12)X0003-2Review Articles108112http://www.jecm-online.com/article/PIIS1878331712000307/abstract?rss=yesObjective: Benzodiazepines with a unique chemical structure of three-ring diabenzine can induce the benzodiazepine-gamma aminobutyric acid A receptor complex to produce sedative, anxiolytic, muscle-relaxant, and anticonvulsant effects. But they have serious side effects such as tolerance and withdrawal, memory and performance impairments, and complex behaviors associated with amnesia.Method: We searched zolpidem-related published papers from Taiwan from 2003 to 2011. All bibliographical data of original clinical reports were studied. We focused only on complex behaviors related to zolpidem and not on the symptoms of zolpidem-related addiction, tolerance, and withdrawal.Results: The search in PubMed with the keyword “zolpidem” yielded 729 articles published from 2003 to 2011. Of these, 20 articles were written by Taiwanese author(s). There were 15 case reports and five clinical studies. Besides the symptoms of addiction, tolerance, and withdrawal, these papers describe complex behavioral disturbances, such as performance impairments, behavioral impairment with amnesia, sleepwalking, sleep-related eating disorder, and hallucination and sensory distortion.Conclusion: We have summarized the case reports and clinical studies of zolpidem-related adverse effects published from Taiwan and reviewed concerns about zolpidem’s safety that international researchers have been voicing out in recent years. The incidence of those zolpidem-induced complex behaviors is similar to that found in Western countries. Clinicians should therefore use more antidepressants to treat the underlying diseases that present with insomnia (such as major depressive disorder or generalized anxiety disorder).Complex Behaviors Related to Zolpidem: An Analysis of Published Clinical Cases from TaiwanAna Isabel Wu-Chou, Winston W. Shen10.1016/j.jecm.2012.02.004Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-29Journal of Experimental & Clinical Medicine2012-02-2942S1878-3317(12)X0003-2Original Articles113118http://www.jecm-online.com/article/PIIS1878331712000289/abstract?rss=yesIntroduction: Studies have shown reduced levels of brain-derived neurotrophic factor (BDNF) in patients with schizophrenia, but the effects of antipsychotic agents on BDNF levels have been inconsistent. The current study aimed to examine (1) whether the levels of peripheral BDNF in patients with schizophrenia change after antipsychotic treatment, and (2) whether the effect differs among antipsychotic drugs.Methods: Meta-analyses were performed using the random effects model. The results from 10 studies with 399 subjects were synthesized applying the random effects model.Results: Overall, the study showed that the BDNF levels were mildly increased after antipsychotic treatment [standardized mean difference (SMD)=0.171, 95% confidence interval (CI)=0.008–0.334, p=0.040]. When categorizing the subjects based on the antipsychotic drugs they used, BDNF levels were only significantly increased with olanzapine treatment (SMD=0.635, 95% CI=0.323–0.948, p=0.0001), but not with risperidone (SMD=0.005, 95% CI=−0.176 to 0.185, p=0.612).Discussion: These results suggested a differential effect of antipsychotic agents on BDNF levels in patients with schizophrenia. Peripheral BDNF may play a role in the disease process of a subset of patients, related to the use of antipsychotic agents.Increase in Brain-derived Neurotrophic Factor in Patients with Schizophrenia Treated with Olanzapine: A Systemic Review and Meta-analysisPao-Yen Lin10.1016/j.jecm.2012.02.002Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-05Journal of Experimental & Clinical Medicine2012-03-0542S1878-3317(12)X0003-2Original Articles119124http://www.jecm-online.com/article/PIIS1878331712000198/abstract?rss=yesBackground: Some specific findings from the psychiatric evaluation of 90 living relative donors and the recipients before kidney transplantation in Taiwan during the mid 1970s to the early 1980s are reported. We highlight the attitude of the parental donors, their decision-making process, and the emotional turmoil at the time of family crisis in the context of cultural background.Method: As a required routine examination in kidney transplantation, we interviewed 90 prospective donors referred by the kidney transplantation team before and after the surgery. The interview was conducted in a semistructured and open-ended fashion.Results: Unless medically unfit or strongly opposed by the other family members, a great majority of the parents, particularly the mothers, first volunteered to donate a kidney. Significantly, the sons had more opportunities to receive a kidney from either parent than daughters regardless of marital status. Although the decision-making for donation by the parents was instantaneous and occurred in the early stage, the rates of giving-up decision for donation was significantly lower than that of donation by siblings or other relatives. They were not or did not want to be well informed about kidney transplantation; they even gave many reasons to justify their decision to donate a kidney and to rationalize their anxiety over the results of the transplantation surgery. The process in decision-making and the donor selection often provoked the underlying intrafamily conflict, and led to giving up transplantation surgery. Denial, compensation, rationalization, and displacement were the commonly observed defense mechanisms against anxiety, guilt feelings, or hostility. Anxiety and depression were common among those donors.Conclusion: The importance of psychiatric evaluation before transplantation surgery and the specific need for long-term care for the donors after operation are emphasized.Donating a Kidney in Taiwan: A Study of 90 Relative Living DonorsEng-Kung Yeh, Hai-Gwo Hwu, Agnes C.C. Wu10.1016/j.jecm.2012.01.001Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-23Journal of Experimental & Clinical Medicine2012-02-2342S1878-3317(12)X0003-2Original Articles125129http://www.jecm-online.com/article/PIIS1878331712000204/abstract?rss=yesCreutzfeldt-Jakob disease (CJD) has various clinical presentations in cognitive, behavior, sensory or motor dysfunction. A male patient (80 years old) presented himself with forgetfulness, personality change and sleep disorder initially. Afterwards, he started to show many other neurological symptoms such as visual manifestation, dyspraxia, dysarthria, and myoclonic jerks. Magnetic resonance imaging (MRI) of the brain revealed the findings of cortical ribbon sign as well as basal nuclear hyperintensity lesion in both fluid attenuated inversion recovery images (FLAIR) and diffusion-weighted images (DWI). The results of electroencephalography (EEG) showed bi-lateral periodic sharp wave complexes. Deterioration in the clinical condition was rapid and relentless, progressing to a completely dependent state within 2 months. In this case report, we have illustrated clinical, laboratory, neurophysiologic, and imaging findings and details of the diagnostic procedures of the condition. We suggest that making the diagnosis of CJD is difficult early in the course of CJD.Creutzfeldt-Jakob Disease: A Case Report Emphasizing the Differential DiagnosisShu-Ping Chao, Yu-Hsuan Han10.1016/j.jecm.2012.01.002Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-02-27Journal of Experimental & Clinical Medicine2012-02-2742S1878-3317(12)X0003-2Case Report130132http://www.jecm-online.com/article/PIIS1878331712000320/abstract?rss=yesDr Edwin L. Cooper was the founding Editor-in-Chief of Evidence-based Complimentary and Alternative Medicine (eCAM), which was established in 2004. He was appointed by Wen-Ta Chiu, former president of Taipei Medical University (TMU), to serve as Editor-in-Chief of the Journal of Experimental and Clinical Medicine (JECM) in 2008 (TMU holds the copyrights of JECM-published articles). Under Cooper’s guidance and the editorial assistance provided by Kenneth K. S. Yeh, the former executive editor, JECM published bimonthly 55 and 69 original and/or review articles in 2009 and 2010, respectively. Dr Cooper’s contributions to the growth of the journal are significant since the citation number was increased from 16 in 1999 to 40 in 2000. The JECM citations under his tenure were 0.1 in January 2011 and 0.37 in February 2012; the scientific impact of JECM was improving, but not as great as that of eCAM (2.96).Thank You Note for the Emeritus Editor-in-Chief, Edwin L. Cooper: Honoring the Past and Imaging for the FutureChuang C. Chiueh10.1016/j.jecm.2012.02.006Journal of Experimental & Clinical Medicine 4, 2 (2012)2012-03-19Journal of Experimental & Clinical Medicine2012-03-1942S1878-3317(12)X0003-2Editorial Note133133