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Tsai P.-S.,Taipei Medical University | Tsai P.-S.,Taipei Medical University Hospital | Liu I.-C.,Taipei Medical University | Chiu C.-H.,Taipei Medical University | And 3 more authors.
Journal of Affective Disorders | Year: 2016

Background Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder. Methods We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables. Results The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001). Limitation Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered. Conclusion Treating bipolar disorder with VPA increases the risk of dementia by 73-95%. © 2016 Elsevier B.V. All rights reserved.


Lee M.T.M.,Academia Sinica, Taiwan | Lee M.T.M.,China Medical University at Taichung | Chen C.H.,Academia Sinica, Taiwan | Chen C.H.,China Medical University at Taichung | And 36 more authors.
Molecular Psychiatry | Year: 2011

We report the first genome-wide association study in 1000 bipolar I patients and 1000 controls, with a replication of the top hits in another 409 cases and 1000 controls in the Han Chinese population. Four regions with most strongly associated single-nucleotide polymorphisms (SNPs) were detected, of which three were not found in previous GWA studies in the Caucasian populations. Among them, SNPs close to specificity protein 8 (SP8) and ST8 α-N-acetyl- neuraminide α-2,8-sialyltransferase (ST8SIA2) are associated with Bipolar I, with P-values of 4.87 × 10-7 (rs2709736) and 6.05 × 10-6 (rs8040009), respectively. We have also identified SNPs in potassium channel tetramerization domain containing 12 gene (KCTD12) (rs2073831, P9.74 × 10-6) and in CACNB2 (Calcium channel, voltage-dependent, Β-2 subunit) gene (rs11013860, P=5.15 × 10 -5), One SNP nearby the rs1938526 SNP of ANK3 gene and another SNP nearby the SNP rs11720452 in chromosome 3 reported in previous GWA studies also showed suggestive association in this study (P=6.55 × 10-5 and P=1.48 × 10-5, respectively). This may suggest that there are common and population-specific susceptibility genes for bipolar I disorder. © 2011 Macmillan Publishers Limited All rights reserved.


Tsai C.-W.,Taipei City Hospital | Tsai C.-W.,National Cheng Kung University | Gunnell D.,University of Bristol | Chou Y.-H.,Taipei Veterans General Hospital | And 8 more authors.
Journal of Affective Disorders | Year: 2011

Background: Marked increases in the incidence of charcoal burning suicide have contributed to Taiwan's rising suicide rate in the past decade. To assess possible opportunities for intervention, we have compared survivors of suicide attempts by charcoal burning with people who ingested poisons. Methods: We interviewed a consecutive series of suicide attempters by charcoal burning (n = 37) and self-poisoning (n = 38) admitted to Taipei Veterans General Hospital (TVGH) between January 2009 and March 2010. Interviews included the Structured Clinical Interview of DSMIV (SCID) and Beck Suicide Intent Scale. Results: Compared to people who ingested medicines/poisons, charcoal burning suicide attempters were less likely to have a pre-existing physical illness or contact with psychiatric services prior to the attempt and more likely to be employed. Charcoal burning suicide attempters had higher levels of suicide intent (mean score 20.1) compared to people ingesting poisons (mean score 13.5) (p < 0.001) and were considerably more likely to report that their choice of method was influenced by the media (87% vs. 8%), particularly the portrayal of the method as a peaceful way of dying. Charcoal burning suicides were less impulsive. Limitations: The study sample was limited to a single hospital. Conclusions: Survivors of suicide attempts by charcoal burning have high levels of intent and low levels of psychiatric contact indicating they may be more difficult to prevent than suicides by self-poisoning. Encouraging responsible media reporting of suicide and restricting the availability of charcoal may be the most promising approaches to preventing these deaths. © 2010 Elsevier B.V. All rights reserved.


Liu I.-C.,Taipei Medical University | Chiu C.-H.,Taipei Medical University | Chiu C.-H.,Taipei City Psychiatric Center | Tsai P.-S.,Taipei Medical University Hospital | Tsai P.-S.,Graduate Institute of Nursing
Quality of Life Research | Year: 2016

Purpose: The aims of the study were to adapt the Fatigue Severity Scale to Chinese conditions and assess the psychometric properties of the Chinese version in patients with major depressive disorder (MDD) and nondepressive people. Methods: A total of 101 patients with MDD and 94 nondepressive persons were included in this study. A forward and backward translation procedure was performed for developing a culturally acceptable Chinese version of the Fatigue Severity Scale (CFSS). Validity was assessed according to construct validity, internal consistency, concurrent validity, divergent validity, and contrasted-group validity. Results: The CFSS exhibited a one-factor structure in patients with MDD and the nondepressive participants. A 7-item version of CFSS and an 8-item version of the CFSS demonstrated better model fit than the original 9-item version in the patients with MDD and the nondepressive participants, respectively. In both participant groups, internal consistency values were within acceptable ranges. In addition, concurrent validity and divergent validity were confirmed in both groups. The average CFSS score of patients with MDD was significantly higher than that of the nondepressive participants. Conclusion: The 9-item CFSS is a valid instrument for assessing fatigue-related impairment in Chinese-speaking patients with MDD. However, the two reduced-item CFSS versions showed better psychometric properties than the original version in the patients with MDD and the nondepressive participants. © 2015, Springer International Publishing Switzerland.


Chang S.-S.,National Taiwan University | Chang S.-S.,University of Hong Kong | Kwok S.S.M.,University of Sydney | Cheng Q.,University of Hong Kong | And 4 more authors.
Social Psychiatry and Psychiatric Epidemiology | Year: 2015

Purpose: Some East/Southeast Asian countries have experienced a rapid increase in suicide by charcoal burning over the past decade. Media reporting and Internet use were thought to contribute to the epidemic. We investigated the association between method-specific suicide incidence and both Internet search volume and newspaper reporting in Taiwan. Method: Weekly data for suicide, suicide-related Google search volume, and the number of articles reporting suicide in four major newspapers in Taiwan during 2008–2011 were obtained. Poisson autoregressive regression models were used to examine the associations between these variables. Results: In the fully adjusted models, every 10 % increase in Google searches was associated with a 4.3 % [95 % confidence interval (CI) 1.1–7.6 %] increase in charcoal-burning suicide incidence in the same week, and a 3.8 % (95 % CI 0.4–7.2 %) increase in the following week. A one-article increase in the United Daily was associated with a 3.6 % (95 % CI 1.5–5.8 %) increase in charcoal-burning suicide in the same week. By contrast, non-charcoal-burning suicide was not associated with Google search volume, but was associated with the Apple Daily’s reporting in the preceding week. Conclusions: We found that increased Internet searches for charcoal-burning suicide appeared to be associated with a subsequent increase in suicide by this method. The prevention of suicide using emerging methods may include monitoring and regulating online information that provides details of these methods as well as encouraging Internet service providers to provide help-seeking information. © 2015, Springer-Verlag Berlin Heidelberg.


Cheng W.-J.,China Medical University at Taichung | Huang M.-C.,Taipei City Psychiatric Center | Huang M.-C.,Taipei Medical University | Cheng Y.,National Taiwan University | And 2 more authors.
Alcohol and Alcoholism | Year: 2015

Aims: Alcoholic energy drinks (AEDs) have been popular among Taiwanese manual workers. Study results concerning increased health risks of AED consumption relative to alcohol alone have been inconsistent, and the risk for potential work-related injury or disease has not been studied. Our study goal was to evaluate the association between AED consumption and work-related injury or disease in manual workers in Taiwan. Methods: National survey data of the working population in 2007 was utilized. A total of 1192 manual workers, who drank alcohol more than once per week, were divided into AED-drinkers and non-AED drinkers. We compared AED drinking behaviors and risk of work-related injury or disease between the two groups. Results: AED drinkers had a higher risk of work-related injury or disease, with an odds ratio of 1.48 (95% CI: 1.14-1.93), after controlling demographic, smoking and drinking characteristics. The presence of problem drinking (defined by CAGE score equal to or higher than two) was another risk factor of having work-related injury or disease. Compared to non-AED counterparts, AED drinkers had a significantly higher prevalence of work-related injury or disease in the strata of CAGE score of 1 and 2. Conclusion: AED consumers presented increased risks of work-related injury or disease compared with non-AED drinkers among manual workers in Taiwan. In order to conduct an effective intervention program to protect Taiwanese manual workers from potential risks, the reasons for this increased risk among AED drinkers need to be further studied. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.


PubMed | National Taiwan University and Taipei City Psychiatric Center
Type: Journal Article | Journal: Forensic science review | Year: 2015

Substance abuse is an increasingly important medical and legal problem in Taiwan. This article reviews limited studies in Taiwan on the prevalence of substance abuse and psychiatric co-morbidity, and assessment of substance use disorder, with emphasis on their relation to forensic psychiatry. Complicated interaction exists among substance abuse, criminal behavior, and various mental disorders (including antisocial personality disorder). Forensic psychiatry can play an important role in both treatment and research aimed at overcoming the problems of substance abuse. Also discussed are the necessity in merging genetic analysis methods with forensic psychiatric assessment, and the implementation of treatment and rehabilitation programs for criminal offenders co-morbid with psychiatric illness.


Hung G.C.-L.,Taipei City Psychiatric Center | Hung G.C.-L.,Human Development and Health | Huang M.-C.,Taipei City Psychiatric Center | Huang M.-C.,Taipei Medical University | And 4 more authors.
Journal of Studies on Alcohol and Drugs | Year: 2013

Objective: Alcohol dependence is frequently associated with suicide attempts. A history of adverse childhood experiences (ACEs) increases the risk of emotional and behavioral problems in adulthood. Child abuse is reported to increase suicide risk among alcohol-dependent patients. However, other types of ACEs, including ACEs related to family dysfunction that may have exceptional impact among the Chinese, are rarely explored. Method: The contribution of a broad spectrum of ACEs to lifetime risk of suicide attempts among alcoholic inpatients in Taiwan was examined. Family Health History Questionnaires were used to assess ACEs among 194 male alcohol-dependent inpatients admitted for alcohol detoxification. Logistic regression analysis was applied to examine the prediction of ACEs for lifetime risk of suicide attempts. Results: The rate of attempted suicide in this cohort was 27.4%. The prevalence of ACEs was high, with around 90% of participants reporting at least one type of ACE. In the regression analysis, after adjusting for lifetime depression, illicit drug use, and severity of alcohol dependence, having had a battered mother (odds ratio [OR] = 3.99, 95% CI [1.40, 11.34]) and having parents who were separated/divorced (OR = 7.35, 95% CI [1.56, 34.72]) were associated with the risk of suicide attempts, but having experienced physical and sexual abuse were not. A 1-unit increase in childhood adversity raised the likelihood of a suicide attempt by 61% (OR = 1.61, 95% CI [1.16, 2.25]). Conclusions: There is a direct and graded relationship between childhood adversities and lifetime risk of suicide attempts among male alcoholic patients. In Chinese societies, adversities related to parental separation, divorce, and interparental violence may have a specifi c effect in aggravating suicide risk.


Huang M.-C.,Taipei Medical University | Huang M.-C.,Taipei City Psychiatric Center | Chen C.-C.,Taipei Medical University | Pan C.-H.,Taipei City Psychiatric Center | And 2 more authors.
Alcoholism: Clinical and Experimental Research | Year: 2014

Background: Chronic and excessive alcohol consumption increases oxidative stress. We previously found that levels of 8-hydroxy-2′-deoxyguanosine (8-OHdG), a marker of oxidative DNA damage, are elevated in alcohol-dependent patients without delirium tremens (DTs). The aim of this study was to compare serum 8-OHdG levels between alcohol-dependent patients with and without DTs. Methods: We recruited 16 alcohol-dependent patients with DTs (DTs group) and 58 patients without DTs (non-DTs group). Alcohol withdrawal severity was evaluated using the Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C) every 8 hours. Serum levels of 8-OHdG and other biological indices were assayed at baseline and after 1 week of detoxification. Results: The mean 8-OHdG level in the DTs group was significantly higher than that in the non-DTs group (0.50 vs. 0.34 ng/ml, p < 0.001). A significant correlation was found between the highest CIWA-Ar-C scores and serum 8-OHdG levels (β = 0.43, p = 0.001) in the non-DTs group, but not in the DTs group (β = 0.34, p = 0.19). An area under receiver operating characteristic curve of 0.83 suggests that 8-OHdG levels potentially differentiate patients with DTs from those without DTs. After dividing the patients into quartiles by 8-OHdG level, we found that compared to the patients in the third and fourth quartiles, the patients in the highest quartile had an odds ratio of 24.1 (p < 0.001) to have DTs, while those in the second highest quartile had an odds ratio of 3.5 (p = 0.19). Serum 8-OHdG levels did not significantly change after 1 week of detoxification in either group. Conclusions: Alcohol-dependent patients with DTs have higher serum 8-OHdG levels than those without DTs, suggesting that higher oxidative stress carries a greater risk of the occurrence of DTs. © 2014 by the Research Society on Alcoholism.


PubMed | Taipei City Psychiatric Center
Type: Journal Article | Journal: Journal of studies on alcohol and drugs | Year: 2013

Alcohol dependence is frequently associated with suicide attempts. A history of adverse childhood experiences (ACEs) increases the risk of emotional and behavioral problems in adulthood. Child abuse is reported to increase suicide risk among alcohol-dependent patients. However, other types of ACEs, including ACEs related to family dysfunction that may have exceptional impact among the Chinese, are rarely explored.The contribution of a broad spectrum of ACEs to lifetime risk of suicide attempts among alcoholic inpatients in Taiwan was examined. Family Health History Questionnaires were used to assess ACEs among 194 male alcohol-dependent inpatients admitted for alcohol detoxification. Logistic regression analysis was applied to examine the prediction of ACEs for lifetime risk of suicide attempts.The rate of attempted suicide in this cohort was 27.4%. The prevalence of ACEs was high, with around 90% of participants reporting at least one type of ACE. In the regression analysis, after adjusting for lifetime depression, illicit drug use, and severity of alcohol dependence, having had a battered mother (odds ratio [OR] = 3.99, 95% CI [1.40, 11.34]) and having parents who were separated/divorced (OR = 7.35, 95% CI [1.56, 34.72]) were associated with the risk of suicide attempts, but having experienced physical and sexual abuse were not. A 1-unit increase in childhood adversity raised the likelihood of a suicide attempt by 61% (OR = 1.61, 95% CI [1.16, 2.25]).There is a direct and graded relationship between childhood adversities and lifetime risk of suicide attempts among male alcoholic patients. In Chinese societies, adversities related to parental separation, divorce, and interparental violence may have a specific effect in aggravating suicide risk.

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