Tainan, Taiwan
Tainan, Taiwan

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Chien J.,National Taiwan University | Chien J.,Chest Hospital | Chien J.,National Taiwan University Hospital | Chien S.,Chest Hospital | And 2 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: The safety of rifabutin replacing rifampicin among adults having rifampicin-related adverse reactions (ARs) during the treatment of tuberculosis remains unknown. Methods: From June 2006 to June 2010, a total of 2868 newly treated tuberculosis patients without HIV infection in a referral hospital were screened in this retrospective cohort study. Results: Among the screened patients, a total of 221 (8%) patients who received rifabutin replacing rifampicin were included. Of these patients, 158 (72%) tolerated rifabutin during treatment, but 47 (21%) and 16 (7%) experienced mild and severe rifabutin-related ARs (including neutropenia, severe hepatitis and uveitis), respectively, and needed to discontinue rifabutin. Those having previous rifampicin-related arthralgia, dermatological events and cholestasis had a higher AR recurrence rate (60%, 23% and 9%, respectively) than others (5% for hepatitis and gastrointestinal intolerance and 0% for flu-like syndrome, neutropenia and others; P<0.01). Multivariate logistic regression analysis showed that females (OR 3.35; 95% CI 1.06-10.56; P0.04) and patients with hepatitis virus B (HBV) or hepatitis C virus (HCV) coinfection (OR 3.72; 95% CI 1.19-11.67; P=0.02) were at a higher risk of rifabutin-related severe ARs. No development of new drug resistance and no relapse of tuberculosis were found during 2 years of follow-up. Conclusions: Rifabutin replacing rifampicin was well tolerated in most adults who had rifampicin-related ARs. Females and those with HCV or HBV coinfection were more prone to rifabutin-related severe ARs and required more cautious monitoring. © The Author 2013.


Tsu J.-H.,Jianan Mental Hospital | Kuo C.-C.,Jianan Mental Hospital DOH | Lin P.-E.,Jianan Mental Hospital DOH | Chang T.-J.,Catholic Mercy Hopital in Hsinchu
International Journal of Group Psychotherapy | Year: 2014

This study investigated the therapeutic effects of dynamic interpersonal group psychotherapy (DIGP) for the depressed in Taiwan. A 16-session DIGP was held weekly, and participants were evaluated with the Hamilton Depression Rating Scale, Taiwanese Depression Questionnaire, and World Health Organization Quality of Life-BREF before and after DIGP. Compared with control group, the patients treated with DIGP showed significant improvement in severity of their depression, especially in the somatic subscale and quality of life regarding psychological health. We found that focusing on repairing interpersonal interaction in DIGP would improve the social interaction problems of Chinese with depressive disorder.


Lee H.-Y.,Kaohsiung Medical University | Li J.-H.,Kaohsiung Medical University | Wu L.-T.,Duke University | Yen C.-F.,Kaohsiung Medical University | Tang H.-P.,Jianan Mental Hospital
Substance Abuse: Treatment, Prevention, and Policy | Year: 2012

Background: Although methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community.Methods: The study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged ≥ 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) ≥ 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined.Results: 128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP.Conclusions: The results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients. © 2012 Lee et al; licensee BioMed Central Ltd.


Chien I.-C.,Taoyuan Mental Hospital | Chien I.-C.,National Yang Ming University | Chang K.-C.,Jianan Mental Hospital | Lin C.-H.,Taichung Veteran General Hospital | And 2 more authors.
General Hospital Psychiatry | Year: 2010

Objective: We investigated the prevalence and correlates of diabetes in patients with bipolar disorder in Taiwan. Methods: The National Health Research Institute provided a database of 1,000,000 random subjects from which we selected a sample of 766,427 subjects aged 18 years and over. We identified study subjects who had at least one service claim during 2005, with a primary diagnosis of bipolar disorder or with a prescription for treatment of diabetes. Results: The prevalence of diabetes in patients with bipolar disorder was higher than in the general population (10.77% vs. 5.57%, OR, 2.01; 99% CI, 1.64-2.48). Compared with the general population, patients with bipolar disorder had a higher prevalence of diabetes in all age groups under 60 years; among females and males; among lower insurance amount groups; among those living in the northern, central and southern regions and among residents living in urban and rural areas. Antipsychotic use was associated with a higher prevalence of diabetes in persons with bipolar disorder. Conclusions: Patients with bipolar disorder had a higher prevalence of diabetes than the general population. Prevention, early detection and treatment of diabetes are important issues for patients with bipolar disorder. © 2010 Elsevier Inc.


Ouyang W.-C.,Jianan Mental Hospital | Ouyang W.-C.,Chung Hwa University of Medical Technology | Hsu M.-C.,I - Shou University | Yeh I.-N.,St Joseph Hospital | Kuo C.-C.,Jianan Mental Hospital
International Journal of Psychiatry in Clinical Practice | Year: 2012

Objective. The current study evaluated the efficacy and safety of risperidone and haloperidol as an adjunctive agent in combination with divalproate in patients with an episode of acute mania. Methods. This 6-week randomized, single-blind study was conducted in psychiatric wards of a mental hospital. A total of 41 patients were randomly assigned to the risperidone (risperidone plus divalproate) or haloperidol groups (haloperidol plus divalproate). Efficacy was assessed by changes in symptom rating scales [Young Mania Rating Scale (YMRS), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impression (CGI) scores]. Safety and tolerability were assessed by monitoring the Extrapyramidal Symptom Rating Scale (ESRS) and Hamilton Rating Scale for depression. Results. Mean doses at baseline, and at weeks 4 and 6 were 3.77, 4.95 and 5.00 mg/day of risperidone and 5.89, 9.95 and 8.58 mg/day of haloperidol, respectively. Risperidone was shown to have significant anti-manic effects which was observed as early as week 1, following start of treatment. The BPRS scores were in favor of risperidone at week 2. Patients receiving risperidone exhibited significant greater global improvement on the CGI, as early as week 2 and over the entire treatment period, than haloperidol after 4 weeks of treatment. The ESRS at endpoint were significantly higher in the haloperidol patients. Conclusions. Risperidone plus divalproate was more efficacious than haloperidol plus divalproate for treatment of acute mania, and was well tolerated due to its evidence showing rapid anti-manic action, effective and sustained control of manic and psychotic symptoms and a favorable safety and tolerability profile in acute mania. © 2012 Informa Healthcare.


Lin Y.-C.,Jianan Mental Hospital | Lin Y.-C.,China Medical University at Taichung | Wynn J.K.,VA Greater Los Angeles Healthcare System | Wynn J.K.,University of California at Los Angeles | And 3 more authors.
Schizophrenia Research | Year: 2012

Social cognition, which includes emotional intelligence, is impaired in schizophrenia. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) is a widely-used assessment of emotional intelligence, with a four-factor structure in healthy individual. However, a recent factor analysis in schizophrenia patients revealed a two-factor structure of the MSCEIT. The current study aimed to replicate this finding in a larger, more diverse, schizophrenia sample (n = 194). Our findings revealed an identical two-factor structure as in the previously-reported study, indicating that emotional intelligence is organized in a different manner in schizophrenia than it is in healthy controls. © 2012 .


Yeh Y.-C.,Kaohsiung Medical University | Ouyang W.-C.,Jianan Mental Hospital | Ouyang W.-C.,Chung Hwa University of Medical Technology
Kaohsiung Journal of Medical Sciences | Year: 2012

Behavioral and psychological symptoms of dementia (BPSD) are common and debilitating problems, but current treatments are limited. Antipsychotic agents show some efficacy on BPSD, but their use is limited by the associated risk of cerebrovascular events and mortality. Reports have shown the efficacy of mood stabilizers on BPSD, but systemic reviews on this issue are scant. This article aims to review studies of the efficacy of mood stabilizers on BPSD, and the quality of the available evidence. We searched for articles published in English during the period 1990 to 2010 and included in the PubMed database that concerned treatment of BPSD with mood stabilizers, such as carbamazepine, valproate, gabapentin, topiramate, lamotrigine, oxcarbazepine and lithium. The quality of the studies was assessed by considering the trial designs, analyses, subjects and results. We found one meta-analysis and three randomized controlled trials (RCTs) supporting the efficacy of carbamazepine in managing global BPSD, particularly aggression and hostility. With regard to valproate, current evidence from one meta-analysis and five RCTs did not strongly support its efficacy for global BPSD, including agitation and aggression. Only open trials or case series showed some efficacy of gabapentin, topiramate and lamotrigine in controlling BPSD. The single RCT investigating the effect of oxcarbazepine on agitation and aggression showed negative results. Case series reports on lithium tended to show it to be ineffective. Thus far, among mood stabilizers, carbamazepine has the most robust evidence of efficacy on BPSD. More RCTs are needed to strengthen evidence regarding the efficacy of gabapentin, topiramate and lamotrigine. Valproate, oxcarbazepine and lithium showed low or no evidence of efficacy. Large and well designed RCTs focusing on specific symptoms of BPSD are needed to deal with the issue. Copyright © 2012, Elsevier Taiwan LLC. All rights reserved.


Tsai H.-C.,National Cheng Kung University | Lu M.-K.,Jianan Mental Hospital | Yang Y.-K.,National Cheng Kung University | Huang M.-C.,Taipei City Hospital | And 5 more authors.
Journal of Affective Disorders | Year: 2012

Objective: Bipolar-I disorder (BPI) often co-occurred with anxiety (ANX) and substance use disorders (SUD), which poses challenges in public health and clinical treatment, and adds complexity in searching for relevant etiologic factors. The present study sought to identify subgroups of BPI patients using comorbidity patterns with ANX and SUD. Methods: Clinical patients (N = 306) diagnosed with BPI were recruited and interviewed using the Composite International Diagnostic Interview to collect data on demographics and clinical features, including episodic information, impairments, and lifetime diagnoses of ANX (panic, agoraphobia, generalized anxiety disorder, specific and social phobia) and SUD (nicotine dependence, alcohol use and drug use disorder). We applied latent class analysis to empirically derive classes of BPI. A number of exogenous variables were examined for each class. Results: A three-class model provides excellent discriminability for subgrouping BPI patients with different comorbidity patterns. The BPI-LOW class (83.99%) had more pure mania without most lifetime comorbidity, higher numbers of last year mania episodes, and less suicidality and impairments. The BPI-ANX class (3.60%) was female predominant, tended to comorbid with multiple anxiety disorders but no SUD, and had early onset age. The BPI-SUD class (12.42%) was male predominant, had high prevalence of lifetime SUD and frequent mood episodes in the last year. Both the BPI-ANX and BPI-SUD classes had severe functional impairments and suicidal behaviors. Limitations: Clinical information was retrospectively collected. Besides, we did not comprehensively access lifetime comorbidity for all psychiatric disorders. Conclusion: The three empirically identified subgroups of BPI patients exhibited distinguished comorbidity patterns and clinical features, including suicidal behaviors, frequent mood episodes and functional impairments. Our findings have clinical implication in intervention and treatment as well as to explore their different underlying mechanisms. © 2011 Elsevier B.V.


Lo Y.-T.,St Joseph Hospital | Wang J.-J.,National Cheng Kung University | Liu L.-F.,National Cheng Kung University | Wang C.-N.,Jianan Mental Hospital
Journal of the American Medical Directors Association | Year: 2010

Objectives: To report the prevalence of Do-Not-Resuscitate (DNR) directives and to explore the factors associated with the presence of DNR directives among nursing home residents in Taiwan. Design: A cross-sectional, correlation study. Setting: Seven nursing homes in southern Taiwan. Participants: Nursing home residents and their family surrogates. Measurements: Data were collected using chart abstraction and a questionnaire survey. We used multivariate logistic regression to analyze the associations between resident, family surrogate, and facility characteristics and the presence of DNR directives. Results: Among the 201 nursing home residents, 33 (16.4%) had DNR directives and 91% of the directives had been put in place by family surrogates. Our data revealed that resident's age (OR = 1.06, 95% CI = 1.01-1.12), cognitive function score (OR = 0.91, 95% CI = 0.85-0.97), prior DNR discussion between physician and family surrogate (OR = 4.09, 95% CI = 1.53-10.96), and nursing home with DNR policy (OR = 17.71, 95% CI = 5.87-53.46) were independently and associated with the presence of a DNR directive. Conclusions: The prevalence of DNR directives among Taiwanese nursing home residents was lower than that in other countries. Our results point out the lack of DNR policy in most Taiwanese nursing homes and highlight the need for policy makers to implement further regulations. Meanwhile, education about advance directives is warranted to increase public and professional awareness and to facilitate empowerment of the increasing number of frail elderly nursing home residents in Taiwan. © 2010 American Medical Directors Association.


PubMed | National Cheng Kung University, Jianan Mental Hospital and Kaohsiung Veterans General Hospital Tainan Branch
Type: | Journal: Sleep & breathing = Schlaf & Atmung | Year: 2016

The symptoms of sleep apnea, such as sleep fragmentation and oxygen desaturation, might be risk factors for subsequent mood disorder (MD), but associations between sleep apnea and MD remain unclear. This nationwide population-based study thus aimed to identify the risk of MD in patients with vs. without sleep apnea.This cohort study used data from the National Health Insurance database. In total, 5415 patients diagnosed with sleep apnea between 2000 and 2010 were evaluated, and 27,075 matched non-sleep apnea enrollees were included as a comparison cohort. All subjects were followed until 2011. The Cox proportional hazard ratio (HR) was used to investigate the relationship between MD and sleep apnea while controlling covariates and comorbidities of sleep apnea.Of 5415, 154 patients with sleep apnea (2.84%) were diagnosed with MD during the follow-up period in comparison with 306 of 27,075 individuals (1.13%) without antecedent sleep apnea. After adjusting for the selected factors and comorbidities, we found that patients with sleep apnea were from 1.82- to 2.07-fold greater risk of MD than the comparisons. Of the three subcategories of MD (major depressive disorder, bipolar disorder, and unspecified MD), sleep apnea had the highest predisposing risk with respect to major depressive disorder (adjusted HR from 1.82 to 2.07) and bipolar disorder (adjusted HR from 2.15 to 3.24).There is a greater likelihood of MD manifesting in patients with a history of sleep apnea. Health professionals are thus advised to carefully monitor the psychological impacts of sleep apnea.

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