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Background: This paper reviews the development of Bipolar II disorder, defining the development of diagnosis and the current state of the art in treatment. Methods: Through his training and working in psychiatry, the author recounted the early days when Bipolar II disorder was conceptualized and developed as a separate clinical entity at the Department of Psychiatry at Washington University, US National Institute of Mental Health, and New York State Psychiatric Institute/Columbia University. The author also participated in the process leading to the inclusion of Bipolar II in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) in 1994. In this review, the author presents his recollections how bipolar II disorder came about and entered the diagnostic criteria that we now use in psychiatry. Results: The diagnostic criteria of Bipolar II disorder in DSM-IV and DSM-5 were reviewed. Then, the author stressed the importance of differentiating Bipolar II disorder clinically, how to make the diagnosis of Bipolar II disorder, differentiating mania from hypomania, differentiating hypomania from unipolar depression (i.e., major depressive disorder), and provided useful clinical tips related to ascertaining this diagnosis. Then, he reviewed and raised some issues in treating Bipolar II disorder. The neuroscience-based nomenclatures were given for all drugs used in treating Bipolar II disorder in this review. Conclusion: Bipolar II disorder has come a long way to be accepted as a valid clinical entity. The author believes that more clinical knowledge can further improve the diagnosis and treatment for patients with Bipolar II disorder.

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Background: Eating disorder (ED) is a disease entity with substantial physical and psychosocial morbidity, while it has remained underdetected by clinicians in Taiwan. To improve the detection and treatment of EDs by health-care professionals in Taiwan, we reviewed ED studies in Taiwan, including epidemiology, measurements, correlates, comorbidities, and health-care use. Methods: A literature review was done using PubMed. The main inclusion criteria were studies that focused on EDs and disordered eating attitudes/behaviors and were done in Taiwan. Results: Several frequently used ED measurements had well-established Mandarin Chinese versions, and they all had sound psychometric properties. Disordered eating attitudes/behaviors have been prevalent in Taiwanese adolescents and college students, but EDs were detected at an older age compared to that in Western countries. Having a diagnosis of ED and higher ED symptom severity are associated with increased comorbidity burden. All patients with anorexia nervosa (AN) and bulimia nervosa (BN) have sought treatment for physical problems while less than half have sought treatment for mental health problems. Studies have also shown a 2–4-fold higher total costs in patients with AN/BN than individuals without EDs. Conclusion: More effort is needed to detect individuals with AN and BN at a younger age in Taiwan. Programs targeting at the influence of family, peers, and media on the body image of children/adolescents and young adults await establishment. We also need to build more educational programs to improve ED literacy in both health-care professionals and the general public for early detection and timely treatments of EDs by mental health professionals.

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Objectives: Preliminary studies suggested that the high rates of stress are increasingly prevalent in students in tertiary education in the Arabian Gulf countries and that their emotional eating is often triggered by stress. Nevertheless, there is a dearth of studies on this topic and Oman is no exception. In this study, we intended to examine the prevalence of emotional eating and perceived stress in Omani college students and to clarify the relationship between their emotional eating and sociodemographic and risk factors among the population in the college students in Oman. Methods: We used Salzburg Emotional Eating Scale and Perceived Stress Scale to assess emotional eating and variations in perceived stress, respectively. We also study their sociodemographic and risk factors. Results: A total of 422 students took part in the study, with the age of 20.6 ± 1.8 (mean ± standard deviation) years. Of all students, 85.8% (n = 362) were reported to have emotional eating and 78.7% of the sample were reported to experience stress. The multivariate logistic analysis showed that body mass index (BMI) and the student's major subjects were the significant risk factors. Students who majored in science/engineering/agriculture (odds ratio [OR] = 0.926, p < 0.001) and arts/business/law were 3.1 times (OR = 3.115, p < 0.05) and 2.3 times (OR = 2.347, p < 0.05) were significantly engaged in emotional eating as compared to those majoring in medicine/nursing. Students who are underweight (BMI < 18) were 3.9 times (OR = 3.984, p < 0.05) were also significantly more to engage in emotional eating than those students who were overweight/obese (BMI 25+). Conclusion: In this study, we found that both rates of emotional eating and stress were high among college students in Oman. Contrary to international trends, underweight students (BMI < 18) were more prone to engaging in emotional eating than overweight/obese students (BMI 25+) in our study sample. This suggests that there is likely to be subcultural diversity or artifacts that are intimately tied to emotional eating. More studies on this discrepant finding are warranted.

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Objectives: In this study, the author compared the psychodynamics of three patient groups before the termination of individual psychotherapy to understand how the patients differed in related themes and their dysfunction levels, conflicts and modes of conflict processing, defense immaturity level, and disintegration levels of some aspects of the psychodynamic structure. Methods: I used detailed process notes of 97 adult psychotherapy patients treated by a psychotherapist in a Taiwan psychiatric hospital. The study patients were divided into three groups: the treatment completers, premature terminators with prior information (informers), and premature terminators without prior information (non-informers), according to their completion of the treatment protocol and offering premature termination (PT) information in advance. I also used the core scheme of Operationalized Psychodynamic Diagosis-2 to evaluate the psychodynamics of the last two sessions before ending therapy. Results: Three groups of patients were not different in primary relational themes and total dysfunctional level of relations, also in conflict significance and mode of conflict processing. The completers and informers were not different in conflict types, but the completers presented themselves higher frequency of “individuation-dependency” conflict and a lower frequency of “Oedipal” and “un-notable” conflicts than noninformers. The completers showed less disintegrated “internal communication” and “external world communication” than informers and noninformers. Conclusion: Premature terminators less communicated internally and externally with the therapist than therapy completers, and non-informers depend less on dyad therapeutic relationships than informers and completers. Psychodynamics represented in preterminate therapy sessions can provide insight into predicting patients' inclination to PT with or without advance information that is difficult to detect in another way.

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Background: Temperament is a relatively stable individual characteristic. Temperament predicts many consequential outcomes throughout life. Different dimensions of temperament lead to different patterns of responses to external stimuli. Dimensions such as activity level and negative emotionality are related to risk-promoting behavior like substance use in adolescents. Methods: In this cross-sectional study, we included 35 adolescents in the age group of 10–17 years. We included adolescents attending outpatient clinics and inpatient services who were diagnosed with mental disorders due to substance use according to ICD-10 diagnostic criteria. We also included 35 healthy controls. All study participants in the case and control groups were assessed using the Early Adolescent Temperament Questionnaire-Revised (EATQ-R) scale. Results: When temperament was assessed using the EATQ-R, the mean scores were highest for frustration, aggression, surgency, and depressed mood, but were lowest for shyness in the study group. While comparing temperament between the study group and the control group, significant differences were found between activation control (p < 0.05), aggression (p < 0.001), attention (p < 0.001), depressed mood (p < 0.05), fear (p < 0.001), inhibitory control (p < 0.001), shyness (p < 0.001), and surgency (p < 0.001). Conclusion: Temperament plays a significant rôle in adolescent substance use. Person-specific treatment can be designed to provide better care and management of patients in taking temperament into account.

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Objectives: Earlier studies suggest that self-esteem is an important predisposing factor to substance use among young adults. In this study, we intended to determine the risk, patterns of substance use, and the association between self-esteem and substance use among undergraduate students. Methods: This is a cross-sectional study in a state university in Nigeria. The study university students completed a copy of sociodemographic questionnaire inquiring about their substance use and an assessment with the Rosenberg Self-Esteem Scale. Results: A sum of 448 students took part in the study. Among them, the odds ratio (OR) (95% confidence interval) of 198 (44.2%) students was found to be 0.442 (0.395–0.489) for a lifetime history of any substance use while OR (95% confident interval) of 141 (31.5%) students was found to be 0.315 (0.272–0.360) to have a history of current use of any substance. We also found that 182 students, i.e., 0.406 (0.360–0.453) and 118 students, i.e., 0.263 (0.223–0.307) had lifetime and current use of alcohol, respectively. This was followed by nicotine, tramadol, and cannabis. Participants who were 21 years and above, male, in third year and above, and who were not satisfied with their finances were significantly more to have a lifetime and current history of substance use (p < 0.05). There was no significant association between self-esteem and either lifetime or current substance use. Conclusion: The patterns of substance use in this study were similar to those obtained in the general population, however, with a relatively higher rate of alcohol use. Students with substance use were more likely to be males, older, have some financial difficulties, and low to normal self-esteem.

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Background: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has emerged as one of the biggest health threats of our generation. Since its outbreak, COVID-19 has been showing many typical and some atypical manifestations. One of the common complications in COVID-19 is delirium. Delirium should be detected at the earliest to reduce mortality in COVID-19. Methods: We prospectively studied hospitalized adult (age ≥ 18 years) patients with confirmed COVID-19 from May 1 to May 31, 2021, at GMERS Medical College and Civil Hospital, Sola, Ahmedabad, India. We included all patients suffering from COVID-19 and diagnosed with delirium in the study. Delirium was assessed using the Confusion Assessment Method and Richmond Agitation Sedation Scale. Follow-up was done for delirium patients on days 0, 5, 10, and 30. Results: We included 1,233 patients in the analysis. The incidence of delirium was found 2.43% in which 63.3% were hypoactive delirium while 36.7% were hypoactive delirium presentation. The mean age ± standard deviation of delirium patients was 68.33 ± 14.67 years (range = 46-92) years, and 20 (66.7%) were male and 10 (33.3%) were female. The result of the study also showed statistical significance between deaths in patients of confirmed cases of COVID-19 with delirium (93.33%) than patients of confirmed cases of COVID-19 without delirium (12.38%, p < 0.001). Conclusion: The presence of delirium was associated with increased risk of mortality in hospitalized adults with COVID-19.

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Objectives: Many nurses feel anxious before starting to work during SARS-CoV- 2 omicron pandemic. How to reduce prework anxiety level in nurses is an important issue. In this study, we intended to explore the effect of a 10-minute music intervention on prework anxiety in nurses during the Omicron COVID-19 pandemic. Methods: A randomized controlled trial was conducted to measure the anxiety level of 60 nurse participants at a hospital before starting to work. We randomized 60 study participating nurses into three groups who listened to no music, fast-tempo music, and slow-tempo music for 10 min each day before going to work. Results: Nurses who listened to 10-min music, whether fast or slow, before work had significantly lower anxiety level than those who experienced no music in this study (p < 0.05). Conclusion: This 10-min music intervention designed for nurses is a feasible and time-saving method during the omicron COVID-19 epidemic.

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