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The present study consisted of two phases: development and psychometric validation of a Chinese version of the Hooper Visual Organization Test (HVOT) using Rasch analysis and the provision of normative data on the basis of a representative sample of the Chinese-speaking population. The HVOT was administered to 1008 healthy adults aged 15-79 years, 60 patients with stroke, and 60 patients with schizophrenia. The results indicated that with 12 items removed, the resulting 18-item scale was found to be unidimensional, with satisfactory internal consistency and no evidence of differential item functioning or bias for age, sex and educational level. There were significant differences between each of the two patient groups and normal controls on the scores of the Rasch-developed measure. All test-retest coefficients exceeded 90 in patient samples. As performance on the Chinese version decreases with age and lower years of education, regression-based normative data that took age and education into account were established. A cut-off score of 21.5, out of an "x-y" range, the higher the better, resulted in a sensitivity of 0.86 and a specificity of 0.68. The normative data presented here will enable clinicians to determine different levels of visuosynthetic impairments more precisely.

The paper aims to analyze the hospital inpatient care use and medical fee of people with ID co-occurring with schizophrenia in Taiwan. A nationwide data were collected concerning hospital admission and medical expenditure of people with ID (n = 2565) among national health insurance beneficiaries in Taiwan. Multiple regression analyses were undertaken to determine the role of the explanatory variables to hospital psychiatric inpatient care and medical expenditure. We found that there were 2565 individuals with ID used hospital psychiatric inpatient care among people with ID in 2005, and 686 cases (26.7%) co-occurring with schizophrenia according to hospital discharge claims. Those ID patients co-occurring with schizophrenia consumed more annual inpatient fee than those without schizophrenia (251,346 vs. 126,666 NTD) (p less than 0.001). We found factors of female cases, longer hospital stay in chronic ward and general ward users among ID patients co-occurring with schizophrenia used more hospital inpatient care (R[superscript 2] = 0.417). Annual hospital inpatient days were significantly affected by factors of severe illness card holder, annual inpatient care fee, longer hospital stay in acute or chronic ward (R[superscript 2] = 0.746). Those factors of female cases, high inpatient care users, longer hospital stay in acute ward and general ward were consuming more medical care fee than their counterparts (R[superscript 2] = 0.620). The study highlights the future study should examine the efficacy of hospital inpatient care for people with ID and schizophrenia.

Subjective well-being is an increasingly common indicator of adequacy of psychiatric services. An easy-to-administer assessment tool of subjective well-being that is conceptually sound, valid, and reliable is needed for use in persons with schizophrenia. The purpose of this paper was to validate the 5-item Satisfaction with Life Scale (SWLS)-Taiwan version for persons with schizophrenia living in the community. Specifically, the internal consistency reliability, construct validity and criterion-related validity were examined. Data were obtained from a total of 443 patients with schizophrenia at multiple areas of Taiwan. Item analysis and confirmatory factor analysis were performed. The results revealed that the SWLS had good international consistency reliability and suggested a single-factor structure in life satisfaction among this patient group. The SWLS has good criterion-related validity with the brief World Health Organization Quality of Life Assessment (WHOQOL-BREF). It is concluded that the SWLS is a sound measurement to be used with persons with schizophrenia living in the community.

Objectives: There is an increasing incidence and prevalence of patients with chronic kidney disease (CKD) worldwide. Little is known the prevalence of CKD among older patients with schizophrenia. The purpose of this study was to investigate the prevalence of CKD and its risk factors in older adults with schizophrenia. Methods: In this cross-sectional study, a convenience sample of 240 patients with schizophrenia age 50 or older was recruited. In addition to demographic and clinical data, participants' estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease equation based on age, sex, ethnicity, and serum creatinine level determined from a blood sample taken from participants. Results: The overall prevalence of CKD was 11.3%. Those with CKD were older, had a longer duration of psychiatric illness, a higher body mass index (BMI), and diagnoses of hypertension compared to those in the non-CKD group. Independent of other risk factors, older age and BMI were significantly associated with CKD. Conclusions: This study found that the overall prevalence of CKD in older patients with schizophrenia was 11.3%. Independent risk factors for CKD in this population were older age and higher BMI. In addition to early identification and early treatment of CKD in older patients with schizophrenia, clinicians should actively manage the risk factors identified in this study. [ABSTRACT FROM AUTHOR]

Schizophrenia is highly comorbid with obsessive–compulsive disorder (OCD); both conditions share numerous pathophysiological etiologies. We, thus, examined the risk of mental disorders in the parents of probands with schizophrenia, OCD, or both conditions. Between 2001 and 2011, we enrolled a nationwide cohort of 69,813 patients with schizophrenia, OCD, or both. The control cohort included 698,130 individuals matched for demographics. Poisson regression models were employed to examine the risk of six mental disorders in their parents, including schizophrenia, bipolar disorder, depressive disorder, OCD, alcohol use disorder, and substance use disorder. We stratified patients into schizophrenia-only, OCD-only, and dual-diagnosis groups, and the dual-diagnosis group was further divided into schizophrenia-first, OCD-first, and simultaneously diagnosed groups. Compared with controls, the schizophrenia, OCD, and dual-diagnosis groups had higher risks for the six mental disorders in their parents (range of odds ratio [OR] 1.50–7.83). The sub-analysis of the dual-diagnosis group showed that the schizophrenia-first, OCD-first, and simultaneously diagnosed groups had higher odds for schizophrenia, bipolar disorder, depressive disorder, and OCD (range of OR 1.64–6.45) in their parents than the control group; the simultaneously diagnosed and OCD-first diagnosed groups had a higher odds of parental substance use disorder, while the schizophrenia-first diagnosed group had a higher odds of parental alcohol use disorder. The interrelationship between OCD and schizophrenia is linked to bipolar disorder, depressive disorder, alcohol use disorder, and substance use disorder. The results have implications for mental health policy and future research. [ABSTRACT FROM AUTHOR]

Background: The risks of sexually transmitted infections (STIs) and teenage pregnancy in the offspring of parents with schizophrenia remain unknown. Methods: From the Taiwan National Health Insurance Research Database, 5,850 individuals born between 1980 and 1999 having any parent with schizophrenia and 58,500 age-, sex-, income- and residence-matched controls without parents with severe mental disorders were enrolled in 1996 or on their birthdate and followed up to the end of 2011. Those who contracted any STI or became pregnant in adolescence during the follow-up period were identified. Results: Cox regression analyses demonstrated that offspring of parents with schizophrenia (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 1.02–1.44), especially daughters (HR: 1.30, 95% CI: 1.06–1.58), were more likely to contract any STI later in life than the control comparisons. In addition, daughters of parents with schizophrenia had an elevated risk of being pregnant in their adolescence (HR: 1.47, 95% CI: 1.29–1.67) compared with those having no parents with severe mental disorders. Discussion: The positive relationship between parental schizophrenia and offspring STIs and teenage pregnancy necessitates clinicians and public health officers to closely monitor the sexual health in the offspring of parents with schizophrenia so that optimal and prompt preventive measures can be taken in the at-risk group. [ABSTRACT FROM AUTHOR]

Background: Resilience, an increasingly important concept in the field of mental illness, refers to the active process by which individuals with mental illness positively adapt to adversity, facilitating their reintegration into society and return to the community. However, the recent pandemic has significantly impacted rehabilitation facility operations, affecting rehabilitation processes and personnel management. Thus, in the post-pandemic period, there is a need for empirical studies to revalidate the resilience of patients in halfway houses and the factors influencing it. Purpose: The aims of the study were to explore the resilience and important factors of influence in patients with schizophrenia residing in halfway houses. Methods: A cross-sectional survey design was employed, targeting individuals with schizophrenia residing in community rehabilitation homes in northern Taiwan. A convenience sampling method was used and 228 participants were enrolled. Research tools used in this study included measures of personal demographics, psychiatric symptoms, cognitive functions, attitudes towards medication, social support, and resilience. Results: The average resilience score was 21.87 (SD = 8.24), with 62.7% of the participants classified with low resilience. Resilience was found to correlate significantly with age group, educational level, ability to self-administer medication, participation in computer-based rehabilitation programs, cognitive functions, attitudes towards medication, and level of social support. However, the factors identified as statistically significant were limited to attitudes toward medication, ability to self-administer medication, and participation in computer-based rehabilitation programs. Conclusions/ Implications for Practice: A majority of the participants, patients with schizophrenia residing in community rehabilitation homes, exhibited low resilience. This highlights the need for community mental health case managers and rehabilitation home nursing staff to work closely with these patients to enhance their resilience. Particular attention should be paid to patients' ability to self-administer medication, their attitudes toward medication, and their participation in computer-based rehabilitation programs. [ABSTRACT FROM AUTHOR]

This study aimed to assess the impact of pay-for-performance (P4P) programmes on healthcare in Taiwan. This was a systematic review and meta-analysis. A systematic literature search was performed using the PubMed, Medline, Embase, Cochrane review, Scopus, Web of Science and PsycINFO databases up to July 2023. Meta-analysis of the available outcomes was conducted using a random-effects model. The search yielded 85 studies, of which 58 investigated the programme for diabetes mellitus (DM), eight looked at the programme for chronic kidney disease (CKD), and the remaining studies examined programmes for breast cancer, tuberculosis, schizophrenia and chronic obstructive pulmonary disease. The DM P4P programme was a cost-effective strategy associated with reduced hospitalisation and subsequent complications. The CKD P4P was associated with a lower risk of dialysis initiation. The P4P programme also improved outcomes in breast cancer, cure rates in tuberculosis, reduced admissions for schizophrenia and reduced acute exacerbation in chronic obstructive pulmonary disease. The meta-analysis revealed that the P4P programme for DM (odds ratio [OR] = 0.59; 95% confidence interval [CI] = 0.48–0.73) and CKD (OR = 0.73; 95% CI = 0.67–0.81) significantly reduced mortality risk. However, participation rate in the DM P4P programme was only 19% in 2014. P4P programmes in Taiwan improve quality of care. However, participation was voluntary and the participation rate was very low, raising the concern of selective enrolment of participants (i.e. 'cherry-picking' behaviour) by physicians. Future programme reforms should focus on well-designed features with the aim of reducing healthcare disparities. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the dyadic dynamics of benefit finding, stigma, and suicide risk on the depression severity of individuals with schizophrenia and their caregivers. Methods: We prospectively recruited a total of 72 individuals with schizophrenia and 72 caregivers of individuals with schizophrenia from a medical center in Taiwan between August 2022 and July 2023. Patients with schizophrenia and their caregivers were assessed using the Taiwanese Depression Questionnaire, Benefit Finding Scale, Explanatory Model Interview Catalogue, Suicide Assessment Scale, and Mini International Neuropsychiatric Interview. Results: The most prevalent psychiatric diagnoses in the caregivers were depressive disorders (29.2%). Using structural equation modeling, we found that patients' suicidal risk (β = 0.45, p < 0.001) may contribute to the severity of depression in individuals with schizophrenia. We also found that caregivers' BF degree (β = −0.25, p < 0.01) and suicidal risk (β = 0.64, p < 0.001) may contribute to the severity of depression in the caregivers of individuals with schizophrenia. Furthermore, we found that caregivers' suicidal risk (β = 0.28, p < 0.05) and caregivers' stigma (β = −0.31, p < 0.01) level may contribute to the severity of depression in individuals with schizophrenia. Discussion: Clinicians should actively manage caregivers' stigma and provide positive reinforcement for caregivers' BF, as this may help reduce depression in both caregivers and individuals with schizophrenia. Additionally, assessing suicide risk in both groups is essential for preventing suicides among individuals with schizophrenia and caregivers alike. [ABSTRACT FROM AUTHOR]

What is Known on the Subject?: People living with schizophrenia have reduced physical function and are more likely to experience loneliness than those without condition.Low physical function is associated with greater loneliness in people with psychosis. However, it is unclear whether social isolation and loneliness contribute to impaired physical function in this population.Loneliness is linked to an increased risk of physical function impairment among older individuals, but research on patients living with schizophrenia is limited. What This Paper Adds to Existing Knowledge?: This study is the first to evaluate the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia.It showed that more than one third of the participants experienced a decline in physical function over a 2‐year period.Loneliness, rather than social isolation, was associated with an increase in physical function impairment over 2 years among inpatients living with schizophrenia. What are the Implications for Practice?: Healthcare professionals should recognize loneliness as a potential risk factor for impaired physical function among inpatients diagnosed with schizophrenia.It is recommended that people living with schizophrenia are assessed for loneliness and that interventions are offered to alleviate their feelings of loneliness.Implementing interventions to reduce loneliness may help improve physical function and overall quality of life for individuals living with schizophrenia. Introduction: Patients living with schizophrenia often experience low physical function, which is associated with negative health outcomes. Therefore, investigating the risk factors for physical function is crucial in this population. Aim: This study examined the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia. Methods: Physical function was assessed using measures of activities daily living (ADL), instrumental activities daily living (IADL) and the combination scores of ADL/IADL. Social isolation was indexed with five types of social connection and loneliness was measured using UCLA Loneliness Scale. Results: Social isolation was not associated with the measures of physical function over 2 years. Loneliness exhibited an association with IADL and ADL/IADL at follow‐up, after adjustment for baseline levels of the outcomes. These associations remained when both social isolation and loneliness were simultaneously entered into the model. Discussion: Loneliness, rather than social isolation, was associated with increased physical function impairment over 2 years among inpatients living with schizophrenia. Implications for Practice: Healthcare professionals should consider loneliness as a potential risk factor for impaired physical function. It would be beneficial to assess patients for loneliness and implement interventions to reduce feelings of loneliness. [ABSTRACT FROM AUTHOR]

Background: Sepsis constitutes a condition that involves life-threatening organ dysfunction induced by severe infection. This nested case–control study investigated risk factors for severe sepsis and whether antipsychotic use is associated with severe sepsis risk in patients with schizophrenia, a topic that has not been comprehensively explored in previous studies. Methods: We selected 39,432 patients with schizophrenia aged between 15 and 65 years from Taiwan's Psychiatric Inpatient Medical Claims database for the period 2000–2012. The case group comprised patients with severe sepsis after their first psychiatric admission (n = 1382). The case and control groups were randomly matched (1:4) by age, sex and first psychiatric admission (year) and finally comprised 1382 and 5528 individuals, respectively. We employed multivariable conditional logistic regression to identify (1) risk factors (physical illnesses and nonpsychiatric medications) and (2) antipsychotic–severe sepsis associations. Results: Higher numbers of psychiatric admissions and physical illnesses such as delirium, cerebrovascular disease and cancer were significantly associated with a higher risk of severe sepsis. Furthermore, severe sepsis was associated with the use of antithrombotic agents, systemic corticosteroids and agents targeting the renin–angiotensin system. Clozapine (adjusted risk ratio = 1.65) and quetiapine (adjusted risk ratio = 1.59) use were associated with an increased risk of severe sepsis. The use of more than one antipsychotic drug could further increase this risk. Conclusion: Several physical illnesses and nonpsychiatric medications increase the risk of severe sepsis in patients with schizophrenia. Specifically, clozapine or quetiapine use significantly increased the risk of severe sepsis in these patients. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Parenting experiences are a great challenge but also a meaningful achievement for mothers diagnosed with schizophrenia (MDWSs).Most previous studies focused on the parenting experiences of Chinese mothers diagnosed with depression rather than those diagnosed with schizophrenia, who usually experience psychiatric symptoms. What this paper adds to existing knowledge?: Unlike in Western society, Chinese society is characterised by a family‐centred culture. This study insightfully explores MDWSs' parenting and family life experiences addressing their intrapersonal mindsets, interpersonal connections with family members across generations and extrapersonal roles such as traditional social expectations as a mother, wife and daughter‐in‐law.While Western studies have mainly focused on MDWSs' personal resilience, this study insightfully explored MDWSs' resilient dimensions including their personal, familial and cultural issues within the Chinese society. What are the implications for practice?: This study develops a comprehensive and professional understanding of the parenting experiences and family interactions of MDWSs who struggle to achieve their motherly role and re‐establish connections with intimate family members.The findings highlight the following important considerations when offering family‐based nursing cares: (1) assess power relationships, familial dynamics and cultural influences between MDWSs and their family members; (2) extend family members' involvement, such as parents‐in‐law, while offering psychoeducation to MDWSs and their family members. Introduction: In Chinese culture, raising the next generation is recognised as a crucial family matter involving intergenerational participation. Mothers diagnosed with schizophrenia (MDWSs) usually experience high stress due to psychiatric symptoms, different parenting values across generations and traditional expectations associated with motherly roles. MDWSs need urgent professional assistance. Aim: To explore MDWSs' parenting experiences and family life in Chinese cultural contexts. Method: In‐depth interviews were conducted with 20 MDWSs. Data were analysed using interpretative phenomenological analyses. Results: The superordinate theme was identified as 'You are not a qualified mother'. Three major themes were elicited: experiencing crises in parenting, family life and self‐stability; striving to be a good mother and wife under humiliation; and developing wisdom and courage to move forward. Discussion: A dehumanised attitude of family members in a paternalistic culture was found. While Western society focuses on personal resilience and family‐based nursing care for nuclear families, Chinese society intensively focuses on MDWSs' relationship with nuclear family members as well as extended family members such as parents‐in‐law. Implications for Practice: The results highlighted the significance of culturally sensitive nursing care for MDWSs and family‐centred psychoeducation that clarifies familial dynamics and improves effective communication between MDWSs and their family members. [ABSTRACT FROM AUTHOR]

Clozapine is indicated as the last-line agent for the treatment of refractory schizophrenia due to its side effects. This study included an Asian schizophrenia population and investigated the effect of clozapine on the risks of all-cause, natural, and suicide mortality. This study included a large-scale schizophrenia inpatient cohort derived from the National Health Insurance Research Database from January 1, 2001, to December 31, 2019 (n = 43,025). Of them, we selected those who received clozapine (clozapine cohort, n = 5800). From those who never used clozapine, we selected two individuals for each patient in the clozapine cohort by matching by age, sex, and the year of the index date (ratio: 1:2, control cohort, n = 11,583). The clozapine and nonclozapine control cohorts together were defined as the study cohort (n = 17,383). Multivariate Cox proportional-hazards regression with a time-dependent model was performed to investigate the effect of individual antipsychotic agents on mortality. All individual first-generation antipsychotics were not associated with mortality risk. However, most individual second-generation antipsychotics exerted protective effects against all-cause and natural mortality. Furthermore, only clozapine and risperidone were significantly associated with a low risk of suicide mortality. Only clozapine exhibited a dose-dependent relationship with all-cause, natural, and suicide mortality. This study provides robust evidence supporting the strong protective effect of clozapine on all-cause, suicide, and natural mortality risks in an Asian population. Under close monitoring, clozapine use can be advantageous in patients with schizophrenia who are at a high risk of suicide. [ABSTRACT FROM AUTHOR]

Background: Congenital cleft lip and palate (CCLP) may be associated with major psychiatric disorders, including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), schizophrenia, bipolar disorder, and major depressive disorder. Methods: From the Taiwan National Health Insurance Research Database, 1,158 children and adolescents with CCLP and 11,580 age/sex-matched controls without CCLP were included in this study between 2001 and 2010; they were followed up until the end of 2011 to identify the aforementioned major psychiatric disorders. Results: After adjustment for age, sex, income, residence, and family history, the Cox regression model revealed a positive relationship of CCLP with subsequent schizophrenia (hazard ratio [HR]: 7.60, 95% confidence interval [CI]: 2.03–28.54), ASD (HR: 6.03, 95% CI: 1.76–20.61), and ADHD (HR: 7.33, 95% CI: 5.01–10.73). Discussion: These findings suggest that clinicians should be attentive to the presence or emergence of mental health conditions in patients with CCLP. Further studies are necessary to investigate the pathogenesis between CCLP and major psychiatric disorders. [ABSTRACT FROM AUTHOR]

Case management (CM)-based community therapy for patients with schizophrenia had little effect on reducing suicide mortality. We investigate the long-term suicide mortality outcome and associated risk factors in patients with schizophrenia receiving homecare (CM) in Taiwan. We enrolled a nationwide cohort of patients with schizophrenia who newly received homecare CM intervention (n = 13 317) between January 1, 2001, and December 31, 2015; their data were derived from Taiwan's National Health Insurance Research Database. We calculated the incidence rate of suicide methods. We examined the demographic and medical utilization profile for suicide and then performed a nested case–control study and multivariate regression to identify independent risk factors for suicide mortality. Among the 13 317 patients who received homecare CM intervention, 1766 died during the study period, of whom 213 died by suicide, which is the leading cause of unnatural death. Jumping from a high place, self-poisoning, and hanging were the top 3 suicide methods. Increased medical utilization was noted for both psychiatric and non-psychiatric services within 3 months of suicide mortality. Comorbidities of depressive disorder, nonspecific heart diseases, pneumonia, and gastrointestinal ulcers were identified as independent risk factors for suicide mortality. Suicide was the leading cause of unnatural mortality in patients with schizophrenia receiving homecare CM intervention in Taiwan. We noted the preferred suicide methods, high medical utilization, and comorbidities before suicide. Thus, we suggest that the CM team should assess lethal methods for suicide and ensure that patients adhere to psychiatry treatment for improving the current care model for this specified population. [ABSTRACT FROM AUTHOR]

Our study employs machine learning to predict serum valproic acid (VPA) concentrations, aiming to contribute to the development of non-invasive assays for therapeutic drug monitoring. Medical records from 2002 to 2019 were obtained from the Taiwan Chang Gung Research Database. Using various machine learning algorithms, we developed predictive models to classify serum VPA concentrations into two categories (1–50 μg/ml or 51–100 μg/ml) and predicted the exact concentration value. The models were trained on 5142 samples and tested on 644 independent samples. Accuracy was the main metric used to evaluate model performance, with a tolerance of 20 μg/ml for continuous variables. Furthermore, we identified important features and developed simplified models with fewer features. The models achieved an average accuracy of 0.80–0.86 for binary outcomes and 0.72–0.88 for continuous outcome. Ten top features associated with higher serum VPA levels included higher VPA last and daily doses, bipolar disorder or schizophrenia spectrum disorder diagnoses, elevated levels of serum albumin, calcium, and creatinine, low platelet count, low percentage of segmented white blood cells, and low red cell distribution width-coefficient of variation. The simplified models had an average accuracy of 0.82–0.86 for binary outcome and 0.70–0.86 for continuous outcome. The study's predictive model lacked external test data from outside the hospital for validation. Machine learning models have the potential to integrate real-world data and predict VPA concentrations, providing a promising tool for reducing the need for frequent monitoring of serum levels in clinical practice. • Use machine learning to predict serum valproic acid concentration from real-world data. • Models achieved 0.72–0.88 accuracy for various binary and continuous outcomes. • Higher serum albumin is one of the key features influencing higher serum valproic acid concentrations. [ABSTRACT FROM AUTHOR]

People with schizophrenia are at a greater risk of poor physical health than the general population. This study investigated the annual incidence of physical illnesses after a new schizophrenia diagnosis, which has rarely been investigated in the literature. The authors collected data from Taiwan's National Health Insurance Research Database from January 1, 1996, to December 31, 2013, and enrolled 1910 patients with newly diagnosed schizophrenia cases aged 10–40 years and 7640 age- and sex-matched controls from the general population. They estimated the 1-year prevalence and annual incidence rate ratio (IRR) of specified physical diseases across 3 years in the schizophrenia group compared with the controls. Several physical illnesses were prevalent within 1 year of schizophrenia diagnosis. Regarding incident physical illnesses, patients had a moderate to strong risk of numerous physical illnesses (IRR > 3.0: ischemic heart disease, cerebrovascular disease, diabetes mellitus, and cancer; IRR 1.8–3.0: other forms of heart disease, vein and lymphatic diseases, pneumonia, chronic hepatic disease, and ulcer disease) within the first year after schizophrenia diagnosis. The IRRs of most physical illnesses declined over 3 years, except for that of cerebrovascular disease, which significantly increased (IRR > 3.0) over the 3 years after schizophrenia diagnosis. Cerebrovascular disease had a significant incidence risk (IRR > 3) persistently across the 3 years. Various comorbid physical illnesses can occur in the early stages of schizophrenia. Clinicians should consider these vulnerabilities to physical illnesses during the evaluation of patients with newly diagnosed schizophrenia by attempting to prevent, screen for, and manage them. [ABSTRACT FROM AUTHOR]

The lymphocyte‐related ratios, neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR) and platelet‐to‐lymphocyte ratio (PLR) are new measures of inflammation within the body. Few studies have investigated the inflammatory response of patients with methamphetamine‐induced psychotic disorder. Clinically, the psychotic symptoms and behavioural manifestation of methamphetamine‐induced psychotic disorder are often indistinguishable from paranoid schizophrenia. We aimed to determine the differences in these inflammatory markers between patients with methamphetamine‐induced psychotic disorder, patients with schizophrenia and healthy individuals. A total of 905 individuals were recruited. The NLR and MLR were found to be higher in both patients with methamphetamine‐induced psychotic disorders and patients with schizophrenia compared with healthy controls. There was no significant difference between the three groups in PLR. When compared with the control group, the methamphetamine‐induced psychotic disorder group was significantly higher in NLR 27% (95%CI = 11 to 46%, p = 0.001), MLR 16% (95%CI = 3% to 31%, p = 0.013) and PLR 16% (95%CI = 5% to 28%, p = 0.005). NLR of the group with methamphetamine‐induced psychotic disorder was 17% (95%CI = 73% to 94%, p = 0.004) less than the group with schizophrenia, while MLR and PLR did not differ significantly between the two groups. This is the first study that investigated the lymphocyte‐related ratios in methamphetamine‐induced psychotic disorder when compared with patients with schizophrenia and healthy individuals. The results showed that both patients with methamphetamine‐induced psychotic disorder and patients with schizophrenia had stronger inflammatory responses than the healthy control. Our finding also indicated that the inflammatory response of methamphetamine‐induced psychotic disorder was between those of patients with schizophrenia and healthy individuals. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia have a high mortality risk, and the role of antipsychotic medications remains inconclusive. In an aging society, older patients with schizophrenia warrant increased attention. This study investigated the association of antipsychotic medication dosages with mortality in patients with schizophrenia by using data from Taiwan's National Health Insurance Research Database from 2010 to 2014. This study included 102,964 patients with schizophrenia and a subgroup of 6433 older patients in addition to an age- and sex-matched control group. The findings revealed that among patients with schizophrenia, the no antipsychotic exposure group had the highest mortality risk (3.61- and 3.37-fold higher risk for overall and cardiovascular mortality, respectively) in the age- and sex-adjusted model, followed by the high, low, and moderate exposure groups. A similar pattern was observed in the older patients with schizophrenia. High exposure to antipsychotics was associated with the highest risks of overall and cardiovascular mortality (3.01- and 2.95-fold higher risk, respectively). In conclusion, the use of antipsychotics can be beneficial for patients with schizophrenia with recommended exposure levels being low to moderate. In older patients, high antipsychotic exposure was associated with the highest mortality risk, indicating that clinicians should be cautious when administering antipsychotic medications to such patients. [ABSTRACT FROM AUTHOR]

Aim: The study investigated the relationship between chronic diseases and health problems, emotional health status, health literacy, health self‐management attitude, and health management self‐efficacy in older patients with schizophrenia. It is expected to provide multiple health perspectives in the care of older patients with schizophrenia and improve their health literacy and self‐management. Design: A cross‐sectional study. Methods: Data collection from 2020/09 to 2021/10, the study of older patients with schizophrenia who were diagnosed with schizophrenia and were over 50 years, live in residential mental rehabilitation institutions in eastern Taiwan as older people. Data were collected on demographic variables, chronic diseases, health problems, health literacy, healthy management self‐efficacy, and attitudes. Results: The study results show 61.49 years (SD = 6.57), the gender, health literacy, and health management self‐efficacy can effectively explain the variance of health self‐management state by 18.5% (F(3,116) = 10.01, p < 0.000), in which health literacy (β = 0.28, t = 3.07, p = 0.003) and health management self‐efficacy (β = 0.19, t = 2.03, p = 0.04) that in the analysis of predictors, emotional health status, and health literacy not only have significant explanatory power on health management self‐efficacy and the performance of physical functions but are also important factors affecting the quality of life among the elderly; the important influencing factor of health management self‐efficacy and health self‐management behaviour is health literacy. Therefore, health literacy is crucial to the health attitudes of older patients with schizophrenia. Conclusion: This study found that increased health literacy among older patients with schizophrenia can enhance their attitude and ability to manage their health. Implications for the Profession and No Patient or Public Contribution: Nursing can provide nursing measures related to individual health literacy to help patients improve their health literacy, maintain the health of chronic older patients with schizophrenia, reduce elderly schizophrenia disability, enhance patients' ability to manage their self‐efficacy and health self‐management attitude, and improving the health and quality of life of patients. [ABSTRACT FROM AUTHOR]

The use of single-item measures of self-rated mental health (SRMH) has been increasingly valued in epidemiologic research. However, little is known about the reliability and mental health correlates of SRMH in Chinese populations. This study examined the reliability and mental health correlates of SRMH in three Chinese samples. We analyzed data collected from two convenience samples of Chinese adults from Hong Kong and/or Taiwan (Sample 1: N = 205; Sample 2: N = 377), and a random sample of Taiwan psychiatric inpatients (Sample 3: N = 100). Our results showed that the single-item measure of SRMH had moderate to good test–retest reliability (intraclass correlation [ICC] = 0.75) in Sample 1 and acceptable reliability between the self-report and interviewer-administered versions (ICC = 0.58) in Sample 3. It had a high positive correlation with self-esteem and a moderately high negative correlation with depression. It also had a consistently negative correlation with borderline personality disorder symptoms and post-traumatic stress disorder symptoms. The SRMH score was also associated with psychiatric service usage. These findings contribute to the body of knowledge regarding the use of a single-item measure of SRMH to assess overall self-perceived mental health in Chinese communities. [ABSTRACT FROM AUTHOR]

Patients with serious mental illness have a higher risk of hepatitis C virus (HCV) infection but suboptimal HCV care. The current study aimed to facilitate HCV treatment uptake by implementing an integrated outreach care model. Multidisciplinary outreach screening followed by HCV reflex testing and onsite treatment for schizophrenia patients was accomplished through the coordination of nongovernmental organizations, remote specialists, and local care providers. The objective was microelimination effectiveness, defined as the multiplication of the rates of anti‐HCV antibodies screening, accurate HCV RNA diagnosis, treatment allocation, treatment completion, and sustained virological response (SVR12; no detectable HCV RNA throughout 12 weeks in the post‐treatment follow‐up period). A total of 1478 of the 2300 (64.3%) psychiatric patients received HCV mass screening. Seventy‐three (4.9%) individuals were seropositive for anti‐HCV antibodies. Of the 73 anti‐HCV seropositive patients, all (100%) received HCV reflex testing, and 29 (37.7%) patients had HCV viremia. Eight patients (34.8%) had advanced liver disease, including 3 with liver cirrhosis and 2 with newly diagnosed hepatocellular carcinoma. Twenty‐three of the 24 (95.8%) patients who stayed in the healthcare system received and completed 8 weeks of glecaprevir/pibrentasvir treatment and post‐treatment follow‐up without significant DDIs or adverse events. The SVR12 rate was 100%. The microelimination effectiveness in the current study was 61.6%. Individuals with serious mental illness are underserved and suffer from diagnostic delays. This patient‐centered and integrated outreach program facilitated HCV care in this marginalized population. [ABSTRACT FROM AUTHOR]

To establish a clinically applicable neuroimaging-guided diagnostic support system that uses near-infrared spectroscopy (NIRS) for differential diagnosis at the individual level among major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SZ). A total of 192 participants were recruited, including 40 patients with MDD, 38 patients with BPD, 65 patients with SZ, and 49 healthy individuals. We analyzed the spatiotemporal characteristics of hemodynamic responses in the frontotemporal cortex during a verbal fluency test (VFT) measured by NIRS to assess the accuracy of single-subject classification for differential diagnosis among the three psychiatric disorders. The optimal threshold of the frontal centroid value (54 seconds) was utilized on the basis of the findings of the Japanese study. The application of the optimal threshold of the frontal centroid value (54 seconds) allowed for the accurate differentiation of patients with unipolar MDD (72.5%) from BPD (78.9%) or SZ (84.6%). These results suggest that the NIRS-aided differential diagnosis of major psychiatric disorders can be a promising biomarker in Taiwan. Future multi-site studies are needed to validate our findings. • We used NIRS signals for differential diagnosis among major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SZ). • NIRS could accurately differentiate patients with MDD (72.5%) from BPD (78.9%) or SZ (84.6%). • Our results indicated that NIRS could be a promising biomarker in psychiatric clinical practice. [ABSTRACT FROM AUTHOR]

Our study aimed to determine whether mothers with bipolar disorder, major depressive disorder, schizophrenia, or schizoaffective disorder affected the risk of type 1 diabetes (T1D) in their offspring.Methods: We conducted a nationwide cohort study by using data from Taiwan's National Health Insurance Research Database and the Maternal and Child Health Database from 2004 to 2018. A total of 2,556,640 mother-child pairs were identified. Cox proportional hazards models were used to compare the risk of T1D between children born to mothers with mood disorders and schizophrenia and those without.Results: No significant difference in risk of T1D was observed between the offspring of mothers with major psychiatric disorders and those without (adjusted hazard ratio (aHR) of 0.86 with a 95% confidence interval (CI) of 0.58– 1.24). In subgroup analysis, we found an aHR of 1.81 with a 95% CI of 0.83– 3.82 in the maternal bipolar disorder on the risk of T1D in offspring and an aHR of 0.87 (95% CI: 0.59– 1.25) in maternal major depressive disorder. In the schizophrenia/schizoaffective disorder group, aHR cannot be obtained due to lesser than three events in the analysis.Conclusion: The risk of T1D in offspring of mothers with mood disorders and schizophrenia was not significant. However, children born to mothers with bipolar disorder may have a tendency to develop T1D. The relationship between maternal psychiatric disorders and the risk of T1D in offspring warrants further investigation in studies with longer follow-up periods. [ABSTRACT FROM AUTHOR]

Background Some schizophrenia patients treated with clozapine experience an inadequate response and adherence problems. The purpose of this study was to compare time to rehospitalization within 6 months in schizophrenia patients discharged on 3 clozapine regimens. Additionally, the temporal trend of prescription rate in each group was also explored. Methods Schizophrenia patients discharged from the study hospital from January 1, 2006, to December 31, 2021, (n = 3271) were included in the analysis. The type of clozapine prescribed at discharge was divided into 3 groups: clozapine plus long-acting injectable antipsychotics (clozapine + LAIs), clozapine plus other oral antipsychotics (clozapine + OAPs), and clozapine monotherapy. Survival analysis was used to compare time to rehospitalization within 6 months after discharge among the 3 groups. The temporal trend in the prescription rate of each group was analyzed using the Cochran-Armitage Trend test. Results Patients discharged on clozapine + LAIs had a significantly longer time to rehospitalization than those on clozapine + OAPs or clozapine monotherapy. The prescription rates of clozapine + LAIs and clozapine + OAPs significantly increased over time, whereas the prescription rates of clozapine monotherapy significantly decreased. Conclusions Compared with the clozapine + OAPs group, the clozapine + LAIs group had a lower risk of rehospitalization and a lower dose of clozapine prescribed. Therefore, if a second antipsychotic is required for patients who are taking clozapine alone, LAIs should be considered earlier. [ABSTRACT FROM AUTHOR]

The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan. A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol. A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60. Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. Height and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ). The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness. Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness. [ABSTRACT FROM AUTHOR]

Objectives: Studies on cancer incidence and mortality in patients with schizophrenia have reported inconsistent findings. In this study, we simultaneously investigated cancer incidence and mortality in patients with schizophrenia and evaluated the cancer mortality‐to‐incidence ratio (MIR), which is rare in the literature. Methods: From the Taiwan National Health Insurance Database, we collected the data of 107,489 patients who received a diagnosis of schizophrenia between 2000 and 2019. Data regarding cancer incidence and mortality were obtained from the Taiwan Cancer Registry and National Mortality Database, respectively. In total, 3881 incident cancer cases and 2288 cancer mortality cases were identified. Standardized incidence ratios (SIRs), mortality rate ratios (MRRs), and MIRs were compared between patients with schizophrenia and the general population. Results: The overall rate of cancer incidence was slightly lower (SIR: 0.95; 95% confidence interval [CI]: 0.92–0.98; p < 0.001) and that of cancer mortality was higher (MRR: 1.29; 95% CI: 1.23–1.3; p < 0.001) in patients with schizophrenia than in the general population. The MIR for overall cancer was significantly higher in the patients with schizophrenia. The relative MIR (MIR of patients with schizophrenia divided by that of the general population) was 1.36 (95% CI: 1.30–1.42). Conclusion: The MIR was significantly higher in the patients with schizophrenia than in the general population, indicating the possible presence of healthcare disparities. Additional studies are required to investigate the potential association between the significantly higher MIR in patients with schizophrenia and healthcare disparities. [ABSTRACT FROM AUTHOR]

Objectives: Risperidone, a dopamine and serotonin antagonist or a second-generation (atypical) antipsychotic drug, is commonly prescribed for various psychiatric disorders, including schizophrenia, bipolar disorder, and autism spectrum disorders. While effective, risperidone often leads to hyperprolactinemia, impacting about 40%–80% of patients. In this study, we intended to examine the prevalence of hyperprolactinemia in Taiwanese patients with schizophrenia who received risperidone medication and to analyze potential links between prolactin blood levels and clinical variables. Methods: Patients with schizophrenia receiving risperidone monotherapy were included in this cross-sectional study. Blood levels of prolactin and metabolic parameters were measured. Results: A total of 176 participants diagnosed with schizophrenia, including 87 women and 89 men, were enrolled in our study. The prevalence of hyperprolactinemia and metabolic syndrome was 75.6% and 31.8%, respectively. Patients with hyperprolactinemia showed significantly higher insulin blood levels (p < 0.05) and significantly higher homeostasis model assessment for insulin resistance (HOMA-IR) indexes (p < 0.05) than those without hyperprolactinemia. The results of multivariate linear regression analysis showed that female sex (p = 0.001), HOMA-IR index (p < 0.01), and risperidone daily dosage (p < 0.05) were significantly associated with prolactin blood level. Conclusion: This study adds to the existing knowledge concerning risperidone-induced hyperprolactinemia in Taiwanese patients with schizophrenia. Hyperprolactinemia and metabolic syndrome are prevalent in patients with schizophrenia treated with risperidone. Clinicians are advised to be aware of these problems and monitor them regularly with their patients who receive treatment with risperidone. [ABSTRACT FROM AUTHOR]

This paper focuses on a migrant worker with schizophrenia including auditory hallucinations and violent behavior. The worker had returned to Taiwan to quarantine and accept medical treatment. The nursing period was from December 16th, 2020 to January 27th, 2021. The author collect data through case history and discussion which was analyzed with five perspectives of psychiatry, and confirmed nursing problems involving a deficiency in self-care, resistance to following instructions, violent behavior, and perceptual alterations. Given the case was in quarantine, and the nature of the disease, an across-team cooperative nursing plan was started. For instance, insure the cleanliness of the body, comply to quarantine measures, build up therapeutic relationship with the case and provide a safe environment to avoid violence, escape, and any problem situations. Additionally, an attempt was made to teach the case to observe mental states to help separate reality and hallucinations to cope with auditory hallucination. Thus, patient education in Filipino was given to increase medicine-taking obedience. Finally, in order to continue the medical treatment after return to Philippines, video calls was made to contact the case's brother in Philippines. [ABSTRACT FROM AUTHOR]

Background: Relatively few studies have explored the differential contributions of the accumulative dosage of psychotropic medications on mortality in patients with schizophrenia. Methods: We aimed to explore the effects of the exposure dosage of psychotropic medications on mortality during a follow-up period of 5 years with a national cohort of individuals with schizophrenia in 2010. Causes of death were linked through Taiwan's National Mortality Registry. The mean defined daily dose of antipsychotics, antidepressants, mood stabilizers, and sedative-hypnotics, were calculated and survival analyses were conducted. Results: A total of 102 964 individuals (54 151 men, 52.59%) with schizophrenia were included. Compared to patients with no exposure to antipsychotics, those with antipsychotic exposure had better survival outcomes, regardless of antipsychotic dosage. Antidepressant exposure, in low and moderate dosage, was associated with decreased all-cause mortality; exposure to mood stabilizers appeared to be associated with an increase in all-cause mortality. Although 89.7% of the patients had been prescribed sedative-hypnotics, exposure to sedative-hypnotics was associated with dose-related increased mortality risk [hazard ratio (HR) in low dose group: 1.16, 95% confidence interval (CI) 1.07–1.27; HR in moderate dose: 1.32, 95% CI 1.21–1.44; HR in high dose: 1.83, 95% CI 1.67–2.01)]. Conclusions: The results indicate that in the treatment of schizophrenia, antipsychotics and antidepressants are associated with lower mortality when using adequate dosages and mood stabilizers and sedative-hypnotics with higher mortality compared with no use. Furthermore, exposure to sedative-hypnotics is associated with a dose-related increased mortality risk which warrants clinical attention and further study. [ABSTRACT FROM AUTHOR]

Introduction: Family functioning, particularly among primary family caregivers for patients with schizophrenia, is a global concern that poses unprecedented challenges. The family unit is a pivotal agent for the preservation of the integrity of individual members. Little attention has been paid to the changes in family functioning and their predictors in primary family caregivers. This study aimed to examine the changes in and the correlates of family functioning in primary family caregivers of individuals with schizophrenia over a 6‐month post‐discharge period. Design: A prospective, longitudinal study was conducted. Methods: A total of 58 primary family caregivers of patients with schizophrenia were recruited from two psychiatric hospitals in Taiwan. Data were collected four times, including 1 week before hospital discharge and at 1‐, 3‐, and 6‐month intervals post‐discharge. Demographic and clinical questionnaires, the Affiliate Stigma Scale, the Family Empowerment Scale, and the General Functioning subscale were used to collect data. Generalized Estimating Equations were applied for data analysis. Results: Approximately 59.6%–77.6% of primary family caregivers presented unhealthy family functioning during the 6‐month post‐discharge period. Significant reductions in family functioning of primary family caregivers were noted in the group with unhealthy family functioning; however, family functioning of primary family caregivers remained unchanged in the group with healthy family functioning over 6 months. Affiliate stigma and family empowerment significantly accounted for the changes in family functioning of primary family caregivers in the groups with unhealthy and healthy family functioning, respectively. Conclusion: This study highlights affiliate stigma and family empowerment as long‐term predictors of changes in family functioning for primary family caregivers and as pivotal targets of mental health care. Clinical Relevance: Family‐centered interventions with a focus on ameliorating affiliate stigma and enhancing family empowerment are recommended to improve family functioning for primary family caregivers of patients with schizophrenia at different periods after hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is associated with poor functional recovery. Internalized stigma is one of the factors related to the functioning of individuals with schizophrenia. We aimed to investigate whether internalized stigma was associated with subjective and objective recovery-related outcomes after controlling for neurocognition and other important confounders in individuals with schizophrenia. Method: We assessed the socio demographic background, psychopathology, neurocognition, internalized stigma, psychosocial functioning, and quality of life of 86 patients who had schizophrenia. Correlation analyses and multiple linear regression were used to investigate the association of internalized stigma and other variables with recovery-related outcomes. Results: We found that the negative symptom scores of the Positive and Negative Syndrome Scale but not internalized stigma was associated with psychosocial functioning as measured by the Personal and Social Performance global score. In contrast, internalized stigma was associated with the Psychological, Social relationships, and Environment scores of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). Depression was also associated with the Physical health, Psychological, and Social relationships sores of the WHOQOL-BREF. Conclusions: While internalized stigma was associated with several domains of quality of life, it was not associated with clinician-rated psychosocial functioning. The effects of internalized stigma on the subjective and objective recovery-related outcomes of individuals with schizophrenia might be divergent. [ABSTRACT FROM AUTHOR]

While vocational training may offer financial and health benefits for patients with schizophrenia (PwS), further empirical research is required to investigate the effectiveness of this intervention for PwS, as well as the factors influencing their employability. This study aimed to (i) identify the factors affecting the employability of PwS who had participated in vocational training and (ii) examine the effectiveness of vocational training. This prospective cohort study was conducted in a community rehabilitation center attached to a psychiatric hospital in southern Taiwan that provides vocational training. The participants completed two questionnaires: (i) a pre-test that served as the study's baseline; (ii) a post-test during a follow-up 12 months later. The questionnaire was divided into three parts: (i) participants' basic information, (ii) the work performance scale, and (iii) the mental state measure. The participants included 35 males and 30 females, with the average age being 45.85 years. The significant factors affecting their employability were social support, work behavior, thinking disorder, and cognitive impairment. In other words, participants with better social support, work behavior, and fewer thought disorders and cognitive impairment were more employable. Their work attitude and ability were found to have significantly improved after having participated in vocational training for 12 months. In conclusion, when conducting vocational training in the future, it is necessary to pay attention to individual participants' social support and work behavior and reduce thinking disorders and cognitive impairments. This may help improve the employability of PwS. [ABSTRACT FROM AUTHOR]

This study investigated mindfulness in relation to self-defeatist beliefs and negative symptoms, with the hypothesis that mindfulness has a moderating effect. Three hundred and thirty-one patients with schizophrenia were recruited from a public mental health hospital. All were interviewed by experienced research assistants and completed self-report questionnaires after giving informed consent. Self-defeatist beliefs, negative symptoms, and mindfulness were measured, and descriptive analyses and hierarchical regression analysis were conducted. Our results demonstrated that self-defeatist beliefs were highly related to avolition, affective flattening, and apathy of negative symptoms related to diminished experience, while no significant relationships were found between self-defeatist beliefs, alogia, and attentional impairment. We also confirmed the effect of mindfulness on negative symptoms, but unexpectedly, the moderating effect of mindfulness could not be supported in the present study. Emotional regulation and dysfunctional beliefs could be important for the development of negative symptoms. The effect of social cognitive deficits on self-defeatist beliefs, mindfulness, and negative symptoms, as well as the differential effects of mindfulness-based interventions and cognitive behavioral therapy on negative symptoms, should be investigated further in the future. [ABSTRACT FROM AUTHOR]

Introduction: Drug‐induced extrapyramidal syndrome (EPS) remains a major problem in clinical psychiatry. This study aimed to examine the factor structure of drug‐induced extrapyramidal symptoms observed in patients with schizophrenia and assessed using the Drug‐Induced Extrapyramidal Symptoms Scale (DIEPSS). Methods: The participants were 1478 patients with a diagnosis of schizophrenia whose EPS was assessed using the DIEPSS in India, Indonesia, Japan, Malaysia, and Taiwan in the 2016 REAP AP‐4 study. The records of the participants were randomly divided into two subgroups: the first for exploratory factor analysis of the eight DIEPSS items, and the second for confirmatory factor analysis. Results: The factor analysis identified three factors: F1 (gait and bradykinesia), F2 (muscle rigidity and tremor), and F3 (sialorrhea, akathisia, dystonia, and dyskinesia). Conclusion: The results suggest that the eight individual items of the DIEPSS could be composed of three different mechanisms: acute parkinsonism observed during action (F1), acute parkinsonism observed at rest (F2), and central dopaminergic mechanisms with pathophysiology other than acute parkinsonism (F3). [ABSTRACT FROM AUTHOR]

Background: Homicidal offenders with schizophrenia who went through psychiatric evaluations are a small but significant group during a criminal appeal. Aim: Our aims are to explore whether the types of crime, such as homicide or not, would be related to the verdicts for the alleged offenders with schizophrenia in Taiwan. Our hypothesis was that homicide cases, rather than other alleged offenses, would be more likely to be regarded as no responsibility (legal insanity) or diminished responsibility for those defendants in the forensic psychiatric evaluation opinions or the court verdicts. Methods: A retrospective comparison of the homicide offenders with the nonhomicide offenders with schizophrenia, registered between December 2000 and November 2009, was conducted in the web-based, national, open-access court verdict databank. Results: There were 33 (3.4%) in 9691 criminal homicide offenders that had a diagnosis of schizophrenia. There were 33 in the homicide group and 22 in the nonhomicide group. Among these defendants in the homicide group, 3 (9.1%) were regarded as legal insanity, and 21 (63.6%) were regarded as diminished responsibility in comparison to the zero (0%) as legal insanity and nine (40.9%) as diminished responsibility in the nonhomicide group (P = 0.029). In addition, the group with multiple evaluations tended to receive forensic psychiatric opinions as legal insanity (N = 3; 33.3%), and the group with single evaluation tended to receive forensic psychiatric opinions as diminished responsibility (N = 16; 66.67%) (P = 0.017). The group with multiple evaluations tended to be ruled as legal insanity in the court (P = 0.001). Conclusion: Homicide cases would be more likely to be regarded as legal insanity or diminished responsibility for the defendants with schizophrenia in the forensic psychiatric evaluation opinions or the court verdicts. [ABSTRACT FROM AUTHOR]

Background: To investigate the risk of poor prognosis regarding schizophrenic disorders, psychotic disorders, suicide, self-inflicted injury, and mortality after adult violence from 2000 to 2015 in Taiwan. Methods: This study used data from National Health Insurance Research Database (NHIRD) on outpatient, emergency, and inpatient visits for two million people enrolled in the National Health Insurance (NHI) from 2000 to 2015. The case study defined ICD-9 diagnosis code N code 995.8 (abused adult) or E code E960-E969 (homicide and intentional injury of another). It analyzed first-time violence in adults aged 18–64 years (study group). 1:4 ratio was matched with injury and non-violent patients (control group). The paired variables were sex, age (± 1 year), pre-exposure to the Charlson comorbidity index, and year of medical treatment. Statistical analysis was conducted using SAS 9.4 and Cox regression for data analysis. Results: In total, 8,726 individuals experienced violence (case group) while34,904 did not experienced violence (control group) over 15 years. The prevalence of poor prognosis among victims of violence was 25.4/104, 31.3/104, 10.5/10,4 and 104.6/104 for schizophrenic disorders, psychotic disorders, suicide or self-inflicted injury and mortality, respectively. Among adults, the risks of suicide or self-inflicted injury, schizophrenic disorders, psychotic disorders, and mortality after exposure to violence (average 9 years) were 6.87-, 5.63-, 4.10-, and 2.50-times (p < 0.01), respectively, compared with those without violence. Among males, the risks were 5.66-, 3.85-, 3.59- and 2.51-times higher, respectively, than those without violence (p < 0.01), and they were 21.93-, 5.57-, 4.60- and 2.46-times higher than those without violence (p < 0.01) among females. Conclusion: The risk of poor prognosis regarding schizophrenic disorders, psychotic disorders, suicide, or self-inflicted injury and mortality after adult violence was higher than in those who have not experienced a violent injury. Adults at the highest risk for violent suicide or self-inflicted injuries due to exposure to violent injuries —males were at risk for schizophrenia and females were at risk for suicide or self-inflicted injuries. Therefore, it is necessary for social workers and medical personnel to pay attention to the psychological status of victims of violence. [ABSTRACT FROM AUTHOR]

Background and aims: Alcohol‐related mental health burden and suicidality impose heavy burdens on global public health. This study measured the sex‐specific incidence and risk profiles of suicide mortality in individuals with alcohol dependence in a non‐western context. Design: In this prospective cohort study, individuals with alcohol dependence who were enrollees in Taiwan's National Health Insurance Research database were followed‐up over an almost 15‐year period. Their data were linked to the national mortality registration database. Setting: Taiwan. Participants: In total, 278 345 patients with alcohol dependence were enrolled and followed‐up from 1 January 2001 to 31 December 2016. Measurements We calculated the incidence and standardized mortality ratio (SMR) of suicide in the cohort and stratified the suicide methods by sex. Sex‐specific risk profiles (based on demographic characteristics and physical and psychiatric comorbidities) were generated through Cox proportional hazards regression. Findings The suicide rates of men and women were 173.5 and 158.9 per 100 000 person‐years, respectively (P = 0.097). The SMR of suicide mortality was more than two times higher in women than in men (6.6 versus 15.0). Women and men adopted different suicide methods. A multivariable Cox proportional hazards regression with a time‐varying model revealed that depressive disorder was a common risk factor for suicide in both men and women [adjusted hazard ratio (aHR) = 3.03, 95% confidence interval (CI) = 2.77‐3.31 versus aHR = 5.46, 95% CI = 4.65‐6.40]. For men, receiving a diagnosis of alcohol dependence between the ages of 25 and 44 years, being unemployed and having schizophrenia, drug‐induced mental disorder or sleep disorder were risk factors for suicide. Conclusion: In Taiwan, the incidence of suicide in patients with alcohol dependence is substantially higher than that of the general population. The standardized mortality ratio of suicide in women with alcohol dependence is more than twice that of men with alcohol dependence. [ABSTRACT FROM AUTHOR]

Stigma attached to schizophrenia among patients is a global concern to mental health advocates. The extent of internalized stigma experienced by consumers with schizophrenia living in the community and its correlates have not been fully explored. This study aimed to examine the prevalence of high internalized stigma and its association with sociodemographic and clinical characteristics, personality traits and aspects of health‐related quality of life among community‐dwelling consumers with schizophrenia. A descriptive, correlational study with a cross‐sectional design was conducted with 149 consumers from outpatient psychiatric clinics of two hospitals in Taiwan. Face‐to‐face interviews with structured questionnaires were adopted. Data were analysed with descriptive statistics, chi‐squares tests, independent t‐tests and a binary logistic regression analysis. Approximately 41.6% of consumers with schizophrenia experienced high internalized stigma. In the subscales, a high experience of discrimination experience (43.6%) was reported, followed by alienation (34.2%), social withdrawal (28.2%), stereotype endorsement (24.8%) and stigma resistance (20.8%). Being younger at the onset of schizophrenia, attaining lower education, having a history of suicidality, fewer positive personality traits and poor aspects of health‐related quality of life were significantly associated with high internalized stigma. Personality traits in the domains of emotional stability and conscientiousness and social and environmental aspects of health‐related quality of life appeared to be the most relevant to risk of high internalized stigma. Anti‐stigma initiatives coupled with personality‐traits modules and modifications of health‐related quality of life are suggested for mental health professionals and policy makers to ameliorate internalized stigma among community‐dwelling consumers with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: The overlapping symptoms of schizophrenia and dissociation have been increasingly recognized. This paper explains why it is reasonable to expect that there would be a substantial subgroup of patients diagnosed with schizophrenia spectrum disorders (SSDs) who suffer from pathological dissociation. Objective: As little is known about the prevalence of dissociative disorders and symptoms among patients with SSDs, we investigated the prevalence of dissociative disorders and symptoms among patients with SSDs. Method: We used both self-report measures and structured interviews to examine dissociative disorders and symptoms in a randomly recruited sample of inpatients with a clinical diagnosis of SSDs in Taiwan (N = 100). Results: Over 60% of participants exhibited pathological dissociation, and 54% had a dissociative disorder according to structured interview data; three participants met the DSM-5 diagnostic criteria for dissociative identity disorder. The concurrent validity of pathological dissociation in this sample was similar to that of depression among patients with schizophrenia reported in the literature. Participants with a dissociative disorder were more likely to report high-betrayal traumas and meet DSM-5 criteria for post-traumatic stress disorder; they also reported more psychotic symptoms than those without a dissociative disorder. Conclusions: This was one of very few studies that used structured interviews to examine pathological dissociation in patients with SSDs. The results indicate that pathological dissociation in SSDs is not uncommon. Clinical assessment should include measures of dissociation to facilitate early identification. Patients with dissociative disorders are often diagnosed with a psychotic disorder. Our study found that unrecognized dissociation is common in a sample of Taiwan inpatients with schizophrenia. Patients with schizophrenia spectrum disorders should be screened for dissociation. Trauma and dissociation are not rare among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan. [ABSTRACT FROM AUTHOR]

The aim of this study was to clarify the association between various antipsychotic formulations-oral-daily antipsychotics (OAPs), long-acting injectable antipsychotics (LAIs), and their combination-and the risk of sudden cardiac death (SCD). We conducted a nationwide population-based case-control study using data from 2011 to 2020 from the National Health Insurance Research Database and multiple-cause-of-death data from Taiwan. The study included patients with a new diagnosis of schizophrenia who were followed for SCD occurrence until 2020. Cases and controls were frequency-matched at a 1:4 ratio by age, sex, and year of new schizophrenia diagnosis. Compared with the use of OAP monotherapy, the use of LAI and OAP combination (OR = 1.91) and LAI monotherapy (OR = 1.45) were associated with an increased risk of SCD. Additionally, cardiovascular comorbidities (adjusted OR = 11.15) were identified as a significant risk factor for SCD. This study revealed the following hierarchy of SCD risk associated with antipsychotic formulations (listed from lowest to highest risk): nonuse of antipsychotics, OAP monotherapy, LAI monotherapy, and their combination. These findings underscore the importance of assessing cardiovascular disease history before LAIs are prescribed to patients with schizophrenia and indicate that physicians should avoid prescribing combined antipsychotics when using LAIs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: To examine a screen model for detecting undergraduates with higher risk for developing psychosis (HRDP). Design and Methods: A cross‐sectional design with convenience sampling was used. The screen model included exploration stage by self‐report scales and confirmation stage by face‐to‐face interviews. Findings: A total of 273 students were detected from 4744 surveys during 4 years. Of them, 120 students with HRDP were identified and 7 had been diagnosed as schizophrenia or bipolar disorders at 12‐month follow‐up. Practice Implications: This screen model can be used in early detection for undergraduates with HRDP from large general samples. [ABSTRACT FROM AUTHOR]

Objective: The stigma and prejudice of the public regarding psychiatric disorders are a long‐standing social problem. However, health professionals are more likely to have negative attitudes and label people with mental health conditions. This study aimed to investigate how self‐rated familiarity and literacy about schizophrenia are related to social distancing towards schizophrenia patients among health professionals in Taiwan. Method: This study used a cross‐sectional questionnaire survey and invited respondents to complete the survey either electronically or in a pencil/paper format. Respondents included health professionals in different disciplines and students under medical placements. The survey instrument consists of three parts: sociodemographic information, the 18‐item Social Distance Scale for schizophrenia, and the 19‐item Schizophrenia Experience and Knowledge Questionnaires. Data were analyzed using linear regression models to explore sociodemographic factors, self‐rated familiarity, and literacy total scores about social distance, attitude, and opinions towards schizophrenia. Result: In total, 420 health professionals completed the questionnaire, of which 24.5% were physicians, 36.0% nurses, 6.7% pharmacists, and 28.6% interns. The majority of respondents (n = 360, 85.7%) had contact experience with schizophrenia patients, and approximately 60% rated their experience as a positive impression. Although 62.9% of respondents had received psychiatric education or training, 86% believed that such education/training was insufficient. Moreover, over half of the respondents did not have confidence in their knowledge of schizophrenia. Older age, being married, and having more working experience were associated with high social distance, a negative attitude, and high prejudice. More familiarity with schizophrenia was associated with low social distance, a positive attitude, and less prejudice. A high literacy score was associated with a positive attitude and less prejudice, but no significant correlation was observed with social distance (β ± SE = −0.26 ± 0.14, p =.057). Among respondents who rated their past contact experiences as negative, neither familiarity nor literacy was associated with social distance. Conclusion: High levels of self‐rated familiarity and high literacy about schizophrenia were associated with low social distance, a positive attitude, and less prejudice towards schizophrenia among health professionals. Therefore, sufficient education and training are imperative to increase familiarity and knowledge of schizophrenia. Appropriate education could be implemented from different perspectives, including communication skills, resources of social support, and topics to reduce stigma and prejudice. [ABSTRACT FROM AUTHOR]

The purposes of this study were to develop a new measure, the Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (FBPAS-MI) and to validate the psychometrics. This study included two phases. In Phase I, a literature review and five focus groups were conducted to develop an item bank. Then, expert consultation and cognitive interviews were used for content validity. In Phase II, 147 participants with severe mental illness were recruited from 10 community-based psychiatric rehabilitation centers in Taiwan to examine the psychometrics. Principal axis factoring method with direct oblique rotation was used to identify the underlying constructs of FBPAS-MI. Concurrent validity, internal consistency and test-retest reliability were examined. The results revealed five domains in the facilitator subscale (15 items) and two domains in the barrier subscale (11 items). Both subscales showed satisfactory internal consistency (all Cronbach's α >0.80); the concurrent validity and test-retest reliability were established. This study confirmed that the FBPAS-MI is a valid and reliable scale to understand perceived facilitators and barriers to physical activity for severe mental illness. The FBPAS-MI can provide useful information in the development of individualized health promotion program for this population. The Facilitators and Barriers to Physical Activity Scale for People with Mental Illness (i.e., FBPAS-MI) is a valid and reliable assessment to examine key factors affecting physical activity participation among people with severe mental illness. Psychiatric rehabilitation practitioners could use the FBPAS-MI to help develop and tailor individualized physical activity promotion programs based on identified facilitators and barriers to activity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term efficacy and safety of three-monthly paliperidone palmitate (PP3M) in Asian patients with stable schizophrenia in a naturalistic setting. Methods: Asian patients recruited between May 2016 and March 2018 from the prospective, single-arm, non-randomized, open-label, multi-national REMISSIO study were analyzed. Patients received PP3M over 12 months following = 4 months of treatment with one-monthly paliperidone palmitate. The primary efficacy endpoint was the proportion of patients who achieved symptomatic remission. Other endpoints were changes in Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) total scores, hospitalization rates, and safety. Results: A total of 71 patients (23.3%) were Asian (South Korea: 33, Malaysia: 21, Taiwan: 17); 95.8% of patients completed the study. At LOCF, 71% of Asian patients achieved symptomatic remission compared to the overall population (n = 172/303, 56.8%). Improvements in mean (standard deviation) PANSS and PSP total scores from baseline to LOCF in Asian patients and overall population were clinically significant. A lower proportion of Asian patients had = 1 psychiatric hospitalization after PP3M treatment (n = 1/70, 1.4%) than during the 12 months before (n = 12/70, 17.1%); compared with patients in the overall population after (n = 8/303, 2.6%) and before PP3M treatment (n = 37/303, 12.2%). The overall incidence of treatment-emergent adverse events across Asian patients was 62.9% compared to 53.1% in the overall population. Safety findings were consistent with the known safety profile of PP3M. Conclusion: Our findings confirm existing evidence on the efficacy and tolerability of PP3M in Asian patients with stable schizophrenia over 12 months of treatment. [ABSTRACT FROM AUTHOR]

Caregiving for patients with schizophrenia is often challenging and may increase the risk of psychiatric morbidity among primary family caregivers. However, the associated factors of psychiatric morbidity among caregivers have not been fully investigated. This study aimed to screen psychiatric morbidity and its correlates among primary family caregivers of persons with schizophrenia receiving inpatient psychiatric rehabilitation services. A cross-sectional, correlational design was used. A total of 184 Taiwanese primary family caregivers in inpatient psychiatric rehabilitation units participated in the study. Descriptive statistics, Chi-square tests, independent t-tests, and a stepwise binary logistic regression analysis were performed to examine the association among primary family caregivers' psychiatric morbidity and primary family caregivers' sociodemographic characteristics and mutuality and patients' sociodemographic and clinical characteristics. The prevalence of psychiatric morbidity among primary family caregivers was 48.4%. Unemployment, lower mutuality, additional dependents in need of care, and caring for patients with more psychiatric hospitalizations were the most significant factors for psychiatric morbidity among primary family caregivers. Mental healthcare professionals should recognize patients and their primary family caregivers as a unit of care. Primary family caregivers must receive increased assistance, including supportive resources and therapeutic interventions, to reduce psychiatric morbidity. [ABSTRACT FROM AUTHOR]

Background: Family coaggregation of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD) and schizophrenia have been presented in previous studies. The shared genetic and environmental factors among psychiatric disorders remain elusive. Methods: This nationwide population-based study examined familial coaggregation of major psychiatric disorders in first-degree relatives (FDRs) of individuals with ASD. Taiwan's National Health Insurance Research Database was used to identify 26 667 individuals with ASD and 67 998 FDRs of individuals with ASD. The cohort was matched in 1:4 ratio to 271 992 controls. The relative risks (RRs) and 95% confidence intervals (CI) of ADHD, ASD, BD, MDD and schizophrenia were assessed among FDRs of individuals with ASD and ASD with intellectual disability (ASD-ID). Results: FDRs of individuals with ASD have higher RRs of major psychiatric disorders compared with controls: ASD 17.46 (CI 15.50–19.67), ADHD 3.94 (CI 3.72–4.17), schizophrenia 3.05 (CI 2.74–3.40), BD 2.22 (CI 1.98–2.48) and MDD 1.88 (CI 1.76–2.00). Higher RRs of schizophrenia (4.47, CI 3.95–5.06) and ASD (18.54, CI 16.18–21.23) were observed in FDRs of individuals with both ASD-ID, compared with ASD only. Conclusions: The risk for major psychiatric disorders was consistently elevated across all types of FDRs of individuals with ASD. FDRs of individuals with ASD-ID are at further higher risk for ASD and schizophrenia. Our results provide leads for future investigation of shared etiologic pathways of ASD, ID and major psychiatric disorders and highlight the importance of mental health care delivered to at-risk families for early diagnoses and interventions. [ABSTRACT FROM AUTHOR]

Background: Increased medication adherence improves patient outcomes and lowers the overall cost of care by preventing disease relapse and hospital readmission. Several systematic reviews have identified that insight, therapeutic alliance, and attitude towards medication affect medication adherence in patients with schizophrenia; however, no study has examined all the aforementioned variables together nor has discussed the chains of these mediators. Purpose: To examine the insight–medication adherence relationship among community-dwelling schizophrenia patients through a serial multiple mediation model of therapeutic alliance and medication attitude. Patients and Methods: This study with a cross-sectional correlational design included a convenience sample of community-dwelling schizophrenia patients from Taiwan (n = 229). From January 2017 to January 2018, data were collected by trained nurses using questionnaires. The PROCESS tool was used to analyse fine-grained chains. Results: In serial multiple mediation, the indirect effect of insight on medication adherence through therapeutic alliance and, subsequently, alteration of medication attitude was significant. However, the direct effect changed from significant to non-significant, indicating a complete mediating effect. Conclusion: In community-dwelling schizophrenia patients, the effects of therapeutic alliance and medication attitude on medication adherence are greater than that of insight. We recommend revising the strategy of community home visits by different psychiatrists or nurses in alternating shifts. Therapeutic alliance is the first step required to promote medication adherence. Based on this alliance, altering the patients' medication attitude may be more effective in improving medication adherence than merely enhancing insight. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effects of a brief family strengths‐oriented therapeutic conversation (FAM‐SOTC) intervention on symptom severity of patients with schizophrenia and family coping and caregiver burden for family caregivers. Design: A quasi‐experimental research design with repeated measures. Methods: A convenience sample of 72 dyads of patient‐family caregivers was recruited from randomized inpatient psychiatric rehabilitation units in a psychiatric hospital in Taiwan. Sixty‐one patient‐family caregiver dyads that comprised the intervention group (n = 29) and control group (n = 32) completed questionnaires at four time points (baseline, immediate, one‐ and three‐months post‐intervention). Demographic questionnaires and clinical information, Brief Psychiatric Rating Scale, Family Crisis‐Orientation Personal Evaluation Scales, and Zarit Burden Interview were used to collect data. Generalized estimating equations were used to assess the differences in symptom severity, family coping, and caregiver burden between the two groups. Findings: As compared to the control group, the intervention group showed statistically significant improvements over three months in symptom severity as well as family coping, especially acquiring social support, reframing, and mobilizing social support for family caregivers. Caregiver burden in the intervention group was ameliorated immediately and one month after the intervention rather than a three‐month post‐intervention. Conclusions: A brief FAM‐SOTC intervention proved to be favorable for alleviating psychiatric symptoms of patients coupled with an improvement in family coping and burden in family caregivers encountering schizophrenia. Clinical relevance: Integration of a brief family therapeutic conversation intervention into the routine psychiatric rehabilitation services delivery is recommended to help patients and their family caregivers effectively manage schizophrenia. [ABSTRACT FROM AUTHOR]