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Although studies have reported the effects of inadequate sleep on maternal health, few have examined the relationships of maternal sleep patterns with fetal health and early childhood development. This study investigated maternal sleep duration patterns from early pregnancy to 3-years postpartum and their effects on birth outcomes and child development. This study recruited pregnant women and their partners during prenatal visits at five selected hospitals in the Taipei area; follow-up lasted from July 2011 to April 2021. A total of 1178 parents completed self-reported assessments from early pregnancy until childbirth and 544 completed eight assessments up to 3-years postpartum. Generalized estimated equation models were used for analyses. Group-based trajectory modeling was used to identify four trajectories of sleep duration patterns. Although maternal sleep duration was not associated with birth outcomes, maternal "short decreasing" and "stably short" sleep patterns were associated with a higher risk of suspected overall developmental delay and language developmental delay, respectively. Furthermore, an "extremely long decreasing" pattern was associated with a higher risk of suspected overall developmental delay, [adjusted odds ratio (aOR) = 2.97, 95% confidence interval (CI):1.39–6.36)], gross motor delay, (aOR = 3.14, 95% CI: 1.42–6.99) and language developmental delay (aOR = 4.59, 95% CI:1.62–13.00). The results were significant for the children of multiparous women. We identified a U-shaped distribution of risk between offspring developmental delay and maternal prenatal sleep duration, with the highest risk levels on both ends of the maternal prenatal sleep duration pattern. Interventions for maternal sleep are relatively straightforward to implement and should thus be a key part of standard prenatal care. • Group-based trajectory modeling was used to classify prenatal sleep duration. • Prenatal sleep duration pattern is not associated with adverse birth outcomes. • Maternal prenatal sleep duration pattern is associated with toddlers' development. • Sleep beyond 6–10 h/night may represent a useful clinical guide for high-risk women. • Assessing maternal sleep, a modifiable factor, is essential in health promotion. [ABSTRACT FROM AUTHOR]

The major objective of this study was to investigate how smoking behavior mediates the relationship between life stress and depressive symptoms in adolescents. A descriptive correlational study was conducted from February to June 2017 at a vocational high school in northern Taiwan, and 226 students were recruited through convenience sampling. Results indicated that smoking behavior played a pivotal role by partially mediating the relationship between life stress and depressive symptoms in adolescents. Life stress in adolescents significantly increased the risk of experiencing depressive symptoms, and adolescents who smoked were also at a greater risk. Assessments between the objective and self‐reported smoking behavior were significantly correlated. Therefore, integrated methods for assessing life stress, smoking behavior, and depressive symptoms in adolescents are needed for teachers and clinical professionals. Implementing appropriate policies for discouraging tobacco use for adolescents experiencing life stress in order to decrease depressive symptoms in school settings is paramount. [ABSTRACT FROM AUTHOR]

Aim: Older patients with bipolar disorder (BD) are at a high risk of stroke. Silent stroke could be neglected in BD patients after middle age, particularly in those with illness onset at the young age. Therefore, we investigated the morbidity and related factors for stroke in older BD patients with typical‐onset age. Methods: Older patients with bipolar I disorder (age > 50 years) and their illness onset prior to the age of 40 years were recruited. After whole‐brain magnetic resonance imaging was conducted, the patients were divided into stroke and non‐stroke groups. Clinical data were obtained by reviewing all available medical records and directly interviewing the patients along with their reliable family members. Results: We recruited 62 patients with a mean age of 60.4 years and illness onset at the mean age of 28.4 years. Cerebral infarction or old stroke was observed in 24 (38.7%) patients, including 22 without any reported clinical history of stroke. That is, silent stroke (n = 22) was detected in 36.7% of 60 patients without clinical history of stroke. The stroke group had significantly higher mean numbers of lifetime mood episodes (P = 0.006) than the non‐stroke one. Logistic regression analysis showed that 10 or more prior mood episodes (odds ratio = 3.43, 95% confidence interval = 1.12–10.47, P < 0·04) was significantly associated with the occurrence of stroke. The two study groups did not exhibit any other differences in demographic and clinical variables, such as age, laboratory or physical measurements during the last acute psychiatric hospitalisation, body mass index, and substance use problems and concurrent medical diseases. Conclusions: High morbidity of stroke, particularly silent stroke, could be found in older bipolar patients with typical‐onset age. In addition to traditional risk factors, the number of recurrent mood episodes in a lifetime may increase the risk of stroke in older BD patients. [ABSTRACT FROM AUTHOR]

Objectives To determine whether periodontitis is a modifiable risk factor for dementia. Design Prospective cohort study. Setting National Health Insurance Research Database in Taiwan. Participants Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028). Measurements Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia. Periodontitis was defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9- CM) codes 523.3-5 diagnosed by dentists. To ensure diagnostic validity, only those who had concurrently received antibiotic therapies, periodontal treatment other than scaling, or scaling more than twice per year performed by certified dentists were included. Dementia was defined according to ICD-9- CM codes 290.0-290.4, 294.1, 331.0-331.2. Results After adjustment for confounding factors, the risk of developing dementia was calculated to be higher for participants with periodontitis (HR = 1.16, 95% confidence interval = 1.01-1.32, P = .03) than for those without. Conclusion Periodontitis is associated with greater risk of developing dementia. Periodontal infection is treatable, so it might be a modifiable risk factor for dementia. Clinicians must devote greater attention to this potential association in an effort to develop new preventive and therapeutic strategies for dementia. [ABSTRACT FROM AUTHOR]

Depression is one of the frequent complications following a mild traumatic brain injury (mTBI). Recent research indicated that abnormalities in the autonomic nervous system (ANS) can be evaluated by a noninvasive power spectral analysis of the heart rate variability (HRV). In this study, we investigated whether a frequency-domain analysis of HRV was correlated with late depression in mTBI patients. In total, 181 patients diagnosed with mTBI and 83 volunteers as healthy controls were recruited in 2010-2014. Beck Depression Inventory (BDI) scores were used to evaluate depression in the 1st week of assessment and at 1.5-, 3-, 6-, 12-, and 18-month follow-ups. Correlation and logistic regression analyses of the 1st week HRV parameters with BDI scores at 18 months were performed in individual female mTBI patients. Female mTBI patients were more vulnerable to depression accompanied by reduced HRV compared to healthy controls. Over time, depression was aggravated in female mTBI patients but was alleviated in male mTBI patients. A significantly lower parasympathetic proportion of the ANS was noted at 18 months with respect to the 1st week in female mTBI patients. In addition, depression in female mTBI patients at 18 months after injury was significantly correlated with a decrease in the parasympathetic proportion of the ANS in the 1st week (ρ = −0.411; p < .05). Dysautonomia resulted in higher risks of depression in female mTBI patients. We concluded that early dysautonomia following an mTBI contributes to late depression in female mTBI patients. [ABSTRACT FROM AUTHOR]

Objective: Although obstructive sleep apnea (OSA) is not a life-threatening disease, very few studies have compared differences in healthcare service utilization between patients with and those without OSA in an Asian population according to different age groups. This study attempted to investigate differences in healthcare service utilization between patients with and those without OSA in different age groups in Taiwan. Methods: Sampled subjects and data on their health service utilization were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included 568 patients with OSA and 2840 subjects without OSA. Each subject was followed for a 1-year period to evaluate their healthcare resource utilization. Wilcoxon-Mann-Whitney tests were performed to compare differences in healthcare utilization between patients with and those without OSA during the 1-year follow-up period. Results: As to all healthcare service utilization, patients with OSA had significantly more outpatient visits (30.3 vs. 18.6), outpatient costs (US$1231.2 vs. US$764.8), inpatient days (1.8 vs. 1.2), inpatient costs (US$563.6 vs. US$276.7), and total costs (US$1794.8 vs. US$1041.5) than comparison subjects during the 1-year follow-up period. Moreover, patients with OSA aged 40~49 and 50~59 years respectively incurred 2.11- and 2.02-fold higher total costs compared to patients without OSA. However, patients with OSA aged over 70 years did not have higher total costs compared to those without OSA. Conclusions: This study found that patients with OSA had greater healthcare service utilization than those without OSA. Additionally, patients with OSA in the 40~49- and 50~59-year age groups had about 2-fold higher total costs of healthcare services than those without OSA. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia, but low accessibility and relatively high cost limits the dissemination of the treatment. Several forms of digital CBT-I have been developed to increase the accessibility and shown to be effective; however, the treatment effect may be restricted by the lack of interaction within the treatment. The current study examines whether the therapeutic effects of self-help digital CBT-I could be enhanced by adding simple rule-based personalized feedback. Ninety-two young adults with self-reported insomnia were randomly assigned to three groups: a self-help group (SH, n = 31), who received an eight-session email-delivered CBT-I program; a feedback group (FB, n = 31), who went through the same CBT-I program with personalized feedback; and a waitlist group (WL, n = 30). The Insomnia Severity Index (ISI) was used as the primary outcome measure, and the 16-item version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), Sleep Hygiene Practice Scale (SHPS), and sleep diary were used as the secondary outcome measures. Treatment satisfaction and adherence were also compared between the treatment groups. Both the SH and FB groups showed significantly more improvements in insomnia severity, sleep-related beliefs, and sleep hygiene behaviors than the WL group. Sleep onset latency and sleep efficiency in the sleep diary were also significantly improved after treatment. None of these effects significantly differed between the two treatment groups. Nonetheless, participants in the FB group reported higher treatment satisfaction than those in the SH group. This study supports the effectiveness of email-delivered self-help CBT-I for young adults with insomnia. Furthermore, while adding simple personalized feedback may not have an additional effect on sleep per se, it can enhance treatment satisfaction. This simple intervention shows promise in addressing sleep disturbance in young adults. • Self-help CBT-I delivered via email is effective in reducing insomnia symptoms in young adults with sleep disturbance. • Adding rule-based personalized feedback was found to increase treatment satisfaction, but not to enhance treatment outcome. • Digital CBT-I combined with rule-based feedback can be implanted to increase the accessibility of CBT-I for youngsters. [ABSTRACT FROM AUTHOR]

Insomnia is a common complaint that can have significant daytime consequences. The prevalence of chronic insomnia may increase with age. The management of late-life insomnia can be complicated because aging is associated with normal changes in sleep structure, continuity, and timing, as well as a higher rate of medical and psychiatric disorders. A thorough evaluation and conceptualization of patients' problems should be conducted for effective treatment planning. Both non-pharmacological and pharmacological strategies have been proven effective in treating insomnia in elderly populations. Behavioral intervention and cognitive behavioral therapy for insomnia are recommended as first considerations. Light therapy may be administered for misalignment of the circadian phase. When necessary, hypnotic medications may be added with adequate safety precautions and consideration of comorbid conditions. [ABSTRACT FROM AUTHOR]

Abstract: This study investigated 6-year follow-up mortality rates and cause of death for persons younger than 45 years old with a history of hospitalisation for major psychiatric disorders after the introduction of the National Health Insurance (NHI). Linkage data combining death certificates with Taiwan NHI research claims data were used. The study cohort was comprised all patients under the age of 45 years, who had been hospitalised for major psychiatric disorders in 1998. Patients aged <45 years undergoing an appendectomy were selected as a control group. Cox proportional hazard regressions were performed to compute the adjusted 6-year hazard ratios. For patients with schizophrenia, major depression, or bipolar disorder, the adjusted risks of dying during the follow-up period were significantly 4.614, 3.707 and 3.866, respectively, times higher than that for appendectomy patients. The adjusted hazard ratios of non-natural dying during the follow-up period were significantly 16.316, 14.626 and 8.481 times for female patients with schizophrenia, major depression, and bipolar disorder, respectively, as high as for female appendectomy patients. The continuing excess mortality among psychiatric patients, from both natural and unnatural causes, still remains even after implementation of a NHI. [Copyright &y& Elsevier]

Abstract: Objective: To investigate pregnancy outcomes, including low birthweight, preterm births, and small-for-gestational-age (SGA) among women with bipolar disorder, schizophrenia compared with women with no history of mental illness using nationwide population-based data. Methods: This study linked the Taiwan National Health Insurance Research Dataset with the national birth certificate registry. A total of 528,398 singleton births between 2001 and 2003 were included; 337 were diagnosed with bipolar disorder. Multivariate logistic regression analyses were carried out to examine the relationship between maternal bipolar disorder, schizophrenia and the odds of low birthweight, preterm births, and SGA, after adjusting for characteristics of infant, mother and father. Results: It shows that pregnant women with bipolar disorder were more likely to have LBW infants (9.8% vs. 5.7%), preterm births (14.2% vs. 6.9%) and SGA (22.3% vs. 15.7%) than pregnant women with no history of mental illness. The adjusted odds of low birthweight for women with bipolar disorder was 1.66 times (95% CI, 1.16–2.38) that of women with no history of mental illness. In terms of preterm births and SGA, the adjusted odds ratios were 2.08 (95% CI, 1.53–2.83) and 1.47 (95% CI, 1.14–1.91) respectively, for women with bipolar disorder, compared to their counterparts with no history of mental illness. Conclusions: We conclude that women with bipolar disorder had increased risk of low birthweight, preterm births, and SGA than women without a history of mental illness. More active monitoring and early intervention to counter potential adverse pregnancy outcomes for pregnant women with bipolar disorder should be initiated. [Copyright &y& Elsevier]

Abstract: This study aimed to compare psychiatrists'' in-patient caseload volume with length of stay (LOS) and 30-day readmission rates in Taiwan. We hypothesized that high-volume psychiatrists would be associated with shorter LOS and lower 30-day readmission rates. The sample of 66,959 patients hospitalized for the first time for mental disorders was taken from Taiwan''s 2001–2003 National Health Insurance Research Database and categorized into four patient groups according to attending psychiatrists'' caseload volume. A total of 21,669 (32.4%) of the patients sampled were readmitted within a 30-day period, with the mean LOS being 24.0 (±19.5) days. As caseload volume increased, there was a corresponding increase in the adjusted odds ratio for 30-day readmission rates. The regression analysis reveals adjusted LOS for patients treated by psychiatrists with medium caseload volumes was 1.22 days shorter than that for patients treated by low caseload volume psychiatrists. The adjusted LOS for patients seeing high caseload volume psychiatrists was 2.03 days shorter than for those seeing psychiatrists with low caseload volumes; and for the very-high-volume group, it was 7.59 days shorter. Although the findings confirm our hypothesis regarding LOS, they do not support our hypothesis regarding the relationship between psychiatrists'' caseload volume and readmission rates. [Copyright &y& Elsevier]

Abstract: Objective: Although a body of evidence indicates a link between psychiatric illnesses and allergies, no one has investigated the association between schizophrenia and atopic disorders. The objective of this nationwide population-based study was to examine the prevalence and risk of atopic disorders (asthma, allergic rhinitis, urticaria, and atopic dermatitis) among schizophrenia patients. Method: This study used data from the Taiwan National Health Insurance Research Database covering the years 2000 to 2002. A total of 44,187 patients diagnosed with schizophrenia in the year 2000 were included, together with 132,561 matched non-psychiatric controls. Follow up until the end of 2002 identified concurrent diagnoses of atopic disorders. Logistic regression analyses were performed after controlling for the covariates of socio-demographic characteristics. Results: Findings indicated high comorbidity, with 20.2% of schizophrenia patients (approximately one in five) experiencing concurrent atopic disorders. Moreover, schizophrenia in patients was independently associated with a 1.3-fold increased risk (95%CI=1.24–1.39) of concurrent asthma, after adjusting for socio-demographic characteristics. Yet the risk of diagnosed allergic rhinitis and urticaria was 23% (95%CI=0.74–0.81) and 26% (95%CI=0.72–0.77) lower, respectively, among schizophrenia patients compared to people without any psychiatric disease. Conclusion: Data suggests an increased risk of asthma and decreased risk of allergic rhinitis and urticaria among schizophrenia patients. Future studies on the identification of common etiologic pathways for schizophrenia and asthma could be significant for developing innovative treatments that target both illnesses concurrently. [Copyright &y& Elsevier]

Background: This study aims to estimate the risk of developing stroke within 5 years of discharge among young patients ages 18 to approximately 44 who were hospitalized for depressive disorders. Methods: Our study design features a study cohort and a comparison cohort. The study cohort included patients ages 18 to approximately 44 who were hospitalized with a principal diagnosis of depressive disorder (n = 827), whereas the comparison cohort consisted of 4,135 patients selected randomly (five for every depressed patient) and matched with the study group in terms of gender, age, and date of discharge. Each patient was tracked for 5 years after their discharge in 1998. Cox proportional hazard regressions were performed to compute the 5-year stroke-free survival rates after adjusting for possible confounding factors. Results: During the 5-year follow-up period, 50 depressed patients (6.05% of the study cohort) and 48 non-depressed subjects (1.16% of the comparison cohort) developed strokes. The adjusted hazard of stroke was 5.43 (95% confidence interval = 3.47–8.51, p < .001) times greater for depressed patients than for non-depressed subjects. Conclusions: Our findings show young patients ages 18 to approximately 44 who were hospitalized for depressive disorders were at over five times greater risk of developing stroke within 5 years of discharge compared with non-depressed age- and gender-matched subjects. [Copyright &y& Elsevier]

Questions about the seasonality of stroke remain controversial. Using a nationwide population-based dataset, this study presents a time series analysis of seasonal patterns in ischemic stroke occurrence, along with their association with climate in Taiwan. Using data from the Taiwan National Health Insurance Research Database, a total of 168,977 visits to emergency departments between 1998 and 2003 for ischemic stroke were identified for patients ranging between 20 and 84 yrs of age. Monthly stroke incidences were calculated for 72 months, by sex and stroke subtype, and for the age groups 20-54, 55-64, 65-74, and ≥75 yrs per 100,000 of the population. We performed auto-regressive integrated moving average (ARIMA) analysis to investigate the presence of seasonality and any association with climate for acute ischemic stroke events. We found no significant seasonal variation in the incidence of ischemic stroke for any age or sex groups. Furthermore, after adjusting for seasonality, month, and trend, the ARIMA regression model revealed only associations between ischemic stroke incidence and atmospheric pressure. We conclude that seasonality of ischemic stroke does not exist in Taiwan. Ischemic stroke incidence is, however, significantly related to atmospheric pressure. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To explore risk factors, such as characteristics of psychiatrist, patient and hospital at index hospitalization, associated with depressed patients who committed suicide within 3 months of discharge using a case-control design. Methods: By linking the Taiwanese nationwide mortality database and the National Health Insurance dataset, all hospitalized patients with major depression who committed suicide within a 90-day period post-discharge during the years 2002–2004 were selected as a study cohort (n =85). We randomly selected 425 cases (five for every case in the study cohort) that were matched with the study cohort in terms of age, gender and date of discharge as a control cohort. Cox proportional hazard regression was carried out to compute the adjusted 90-day survival rate after adjusting for other factors. Results: The majority of suicide occurred 30 days after discharge from hospitals, with a mean of 29.9 days. The adjusted hazard for committing suicide after hospital discharge for patients who left on their own initiative was 2.85 times (95% CI=1.387–5.856, p =0.004) greater than for those who were discharged with doctors'' approval. Furthermore, the adjusted hazard for patients who were discharged from medical centers was higher than for patients discharged from regional hospitals, by a multiple of 3.38 (95% CI=1.421–8.055, p =0.006). Limitations: Some patient-specific predictors of post-discharge suicide, such as suicidal ideation prior to admission, recent life events and social relationships with close relatives were not available. Conclusion: We conclude that, in addition to patient characteristics, hospital characteristics also constitute important risk factors for suicide within 90 days of discharge for depressed patients. [Copyright &y& Elsevier]

Early rehospitalization is common in schizophrenia. Given the impact on cost containment, there is an urgent need to identify the predictors of rehospitalization. This study aims to examine the association between the frequency of timely outpatient visits and the likelihood of early rehospitalization in schizophrenia patients. After adjusting for gender, age, substance use, and length of stay, patients failing to attend any outpatient appointments within 2 months after discharge had significantly higher rehospitalization rates than those attending at least I appointment. Thus, timely outpatient visits, shortly after discharge, may be associated with a decreased risk of rehospitalizations. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive impairment may interfere with psychosocial functioning in bipolar disorder (BD). There is limited information regarding the cognitive function of elderly bipolar patients with onset at a young age. The present study aimed to investigate the frequency and the determinants of cognitive impairment in elderly early-onset bipolar patients. Methods: Using the Clock-drawing Test (CDT), the Mini Mental State Examination (MMSE), and the Cognitive Abilities Screening Instrument (CASI), we examined euthymic patients with bipolar I disorder in Taiwan, aged 60 years and older. Clinical data were obtained by reviewing medical records and personal interviews with patients and their family members. The onset of BD prior to the age of 40 years is defined as ‘early-onset’. Results: Of the 52 early-onset patients, 42.3% were determined to have cognitive impairment by exhibiting either abnormal CDT or education-adjusted MMSE scores. In a multiple regression model, years of education and the age at the last manic/hypomanic (but not depressive) episode accounted for the greatest variance in both MMSE and CASI scores. While educational level and the age at the last manic/hypomanic episode were not considered in the regression model, onset with depressive syndrome and current age explained 21.5% of the variance in MMSE scores. Age at the first depressive episode, the first manic episode before the age of 40 years, and comorbid diabetes accounted for 16.7% of the variance in CASI scores. Conclusions: There appeared to be a sizable proportion of elderly early-onset bipolar patients having cognitive impairment. It is suggested that clinical manifestation of first-onset affective episode and impact of medical comorbidity affect the cognition of early-onset BD in later life. [ABSTRACT FROM AUTHOR]

Abstract: Hyperinsulinaemia, a pre-clinical condition which is considered to predict insulin resistance and metabolic syndrome, has not been sufficiently investigated in bipolar disorder, despite evidence to suggest that bipolar patients are at risk of developing insulin resistance. This study was set out to determine the alteration in fasting insulin levels and evaluate the factors associated with hyperinsulinaemia during manic episodes. Measurements were taken of the fasting plasma insulin and leptin levels, as well as the body mass index (BMI), amongst 42 physically healthy bipolar I manic (DSM-IV) patients aged ≤45 with Young Mania Rating Scale (YMRS) scores of ≥26. These were then compared with their values in subsequent remission (YMRS ≤12). A total of 14 patients (33.3%) in acute mania and 30 patients (71.4%) in subsequent remission met the Taiwanese criteria for hyperinsulinaemia of ≥8.7 μIU/ml for men, and ≥11.3 μIU/ml for women. Multiple analyses were then undertaken, without correction, as the exploratory analyses. The measurement, by logistic regression, of the use of propranolol in remission (odds ratio [OR]=10.04, 95% confidence interval [95% CI]=1.03–97.96) and the increase in BMI (OR=1.35, 95% CI=1.01–1.80) were found to have independent associations with hyperinsulinaemia in subsequent remission. Our results suggest that medicated bipolar manic patients are vulnerable to hyperinsulinaemia in early remission, particularly those gaining bodyweight or those using β-adrenoceptor antagonist (beta-blockers), irrespective of the types of mood stabilizers or antipsychotics used. [Copyright &y& Elsevier]

Abstract: Objective: Although seasonal influences on bipolar disorder admissions have long been observed, the issues of seasonality on different subtypes of mood episodes and the effects of associated climatic parameters remain controversial. This study sets out to examine seasonal variations in bipolar disorder admissions and the association with climate in Taiwan, a subtropical area with fairly constant weather conditions. Methods: This retrospective population-based study uses the Taiwan National Health Insurance Research Database for 1999–2003, identifying 15,060 admissions for bipolar disorder, comprising of 8631 manic, 2078 depressive and 4351 mixed/unspecified episodes. The auto-regressive integrated moving average model was applied to examine the presence of seasonality and the association with climate in each subtype of mood episodes. Results: Admission peaks were noted during spring/summer, early winter and early spring, for manic, depressive and mixed/unspecified episodes, respectively, while the associations with climatic parameters varied between the subtypes of mood episodes. Conclusions: Seasonality in bipolar disorder does exist for all subtypes of mood episodes. The distinct seasonal patterns and various associations with the climatic parameters imply different underlying mechanisms for the onset of each subtype of mood episodes. The association between admission rates and certain climatic variables found in this study is informative and could pave the way for future studies aimed at exploring the influence of climate on the psychopathology of bipolar patients as well as the underlying mechanisms. [Copyright &y& Elsevier]

Abstract: Background: Seasonality of suicide has been noted in several studies. A spring peak of suicide was observed, and associations between various climatic parameters and suicide have been suggested. This study sets out to verify seasonal patterns of suicide rates and to explore the association with climate in Taiwan. Method: The study used a nationwide mortality database in Taiwan from January 1997 to December 2003. An autoregressive integrated moving average model was applied to examine the presence of seasonality and the association of climate with suicidal death. Results: Seasonality with a spring peak was evident in suicidal death regardless of gender or age. Ambient temperature was positively associated with suicide after adjustment for trend and seasonality. Limitations: Misclassification and underreporting of suicidal death in the registry system might confound the results. Ecological fallacies might exist. Conclusions: The seasonal effect on suicide is significant in Taiwan. Suicide rates may be influenced by ambient temperatures. The findings are of research interest for future studies regarding mechanisms of suicidal behavior, and also of practical interest for better timing of suicide interventions and effective preventive strategies. [Copyright &y& Elsevier]

Objective: This study explores the association between psychiatrist case volumes and costs for hospitalized schizophrenia patients. Methods: The study uses the Taiwan National Health Insurance Research Database for 2003, identifying the study subjects from the database by ICD-9-CM principal diagnosis code 295. Our study sample comprises of 135,621 admissions treated by 787 psychiatrists in 181 hospitals, with the sample being divided equally into three psychiatrist volume groups: or=601 admissions (high volume). After adjusting for psychiatrist, patient and hospital characteristics, multiple regression analyses were performed to determine the association between psychiatrist case volume and hospitalization costs (total, drug, and non-drug). Results: The regression analyses showed that after adjusting for psychiatrist, patient and hospital characteristics, average treatment costs associated with hospitalized schizophrenia patients were inversely related to psychiatrist volume. The respective total costs, drug costs and non-drug costs of patients treated by high-volume psychiatrists were 369 US dollars (p<0.001), 26 US dollars (p<0.001) and 343 US dollars (p<0.001) lower than those of low-volume psychiatrists. The respective total costs, drug costs and non-drug costs for those treated by medium-volume psychiatrists were 248 US dollars (p<0.001), 22 US dollars (p<0.001) and 226 US dollars (p<0.001) lower than those of low-volume psychiatrists. Conclusions: We find that after adjusting for patient, psychiatrist and hospital characteristics, an inverse volume-cost relationship exists for psychiatrists treating schizophrenia patients. Further studies should aim to investigate the volume-quality relationship to ensure that incremental cost savings associated with increased patient volume are not achieved at the expense of quality of patient care. [ABSTRACT FROM AUTHOR]

Clara cell protein (CC16) and transferrin receptor (TfR) have been reported as possible biological markers for major depression and schizophrenia. However, the alternations of plasma TfR and CC16 levels and the influences of numerous clinical variables on them during bipolar mania are not sufficiently described. We investigated the immune function of 36 bipolar I, manic (DSM-IV) patients with Young Mania Rating Scale (YMRS) scores ⩾26 as well as during the subsequent remission (YMRS ⩽12) and age- and sex- matched healthy controls. The plasma TfR levels were increased during acute mania along with subsequent remission and were independent of medication status, individual variations, clinical and erythrocyte variables. Among inflammatory parameters and haematological variables, the plasma TfR levels merely had significant and negative relationship with the percentage of monocyte in circulating leukocyte counts despite of elevated plasma soluble interleukin-2 receptors levels during bipolar mania. The plasma levels of CC16 of bipolar patients did not significantly alter during acute mania, whereas smoking, body mass index, and co-existing psychotic features collectively contributed 42% of the plasma levels of CC16. We provide additional evidence to indicate the pathophysiological role of the immune systems in affective disorders. It is suggested that the elevation of plasma TfR levels might be a trait phenomenon in bipolar disorder. [Copyright &y& Elsevier]

Insomnia is a common sleep complaint among patients who had a stroke and has been recognized as an independent risk factor for cognitive impairment. However, the relationship between poststroke insomnia and cognitive impairment over time is under-researched. Therefore, we examined the association between poststroke insomnia and the risk of cognitive impairment. Stroke participants who had a stroke and were 20 years and older This multicenter hospital-based retrospective cohort study with a 13-year follow-up period (2004–2017). The diagnosis of stroke, insomnia, and cognitive impairment was based on the International Classification of Diseases. The study participants who experienced a stroke were divided into two cohorts: those who also had insomnia and those who did not have insomnia. A Cox proportional-hazards regression model was used. A total of 1,775 patients with a mean age of 67.6 years were included. Of these patients, 146 and 75 patients were diagnosed with insomnia and cognitive impairment during the follow-up period, respectively. The cumulative incidence of cognitive impairment in the stroke with insomnia cohort was significantly lower than that in the stroke without insomnia cohort (log-rank test, P <.001). The adjusted hazard ratio and 95% confidence interval (CI) of the stroke with insomnia cohort indicated a higher risk of cognitive impairment compared with the stroke without insomnia cohort (adjusted hazard ratio: 2.38; 95% CI: 1.41–4.03). Patients who had a stroke and were diagnosed with insomnia exhibited a substantial increased risk of cognitive impairment over time. [ABSTRACT FROM AUTHOR]

Highlights • This study aimed to evaluate the relationship between IBD and BD. • BD was found in 0.72% patients with IBD and in 0.34% comparison patients. • The adjusted odds ratio of BD for IBD patients was 2.10 than comparison group. Abstract Background To date, some experimental studies showed that inflammatory bowel disease (IBD) and bipolar disorder (BD) may share similar biological pathways. Nevertheless, only a few western studies have attempted to demonstrate the potential association between IBD and BD, and relevant findings are still conflicting. Therefore, this cross-sectional study aimed to evaluate the relationship between IBD and BD using a nationwide database in Taiwan. Method This study used data from the National Health Insurance Research Database. In total, 3590 patients with IBD and 14,360 propensity score-matched comparison patients without IBD were included in this study. Conditional logistic regressions were performed to evaluate the association between BD and IBD. Results Results showed that BD was found in 26 (0.72%) patients with IBD and in 49 (0.34%) matched comparison patients without IBD. After adjustment, the adjusted odds ratio (OR) of BD for IBD patients was 2.10 (95% confidence interval (CI): 1.30∼3.38) compared to the comparison group. Additionally, this study showed that adjusted OR of BD for ulcerative colitis patients were 2.23 (95% CI: 1.31∼3.82) compared to the comparison group. Limitations we could not precisely determine the causal association between BD and IBD. Conclusions We concluded that patients with IBD were more likely to have BD than those comparison patients without IBD. [ABSTRACT FROM AUTHOR]

Background: To date, some experimental studies showed that inflammatory bowel disease (IBD) and bipolar disorder (BD) may share similar biological pathways. Nevertheless, only a few western studies have attempted to demonstrate the potential association between IBD and BD, and relevant findings are still conflicting. Therefore, this cross-sectional study aimed to evaluate the relationship between IBD and BD using a nationwide database in Taiwan.Method: This study used data from the National Health Insurance Research Database. In total, 3590 patients with IBD and 14,360 propensity score-matched comparison patients without IBD were included in this study. Conditional logistic regressions were performed to evaluate the association between BD and IBD.Results: Results showed that BD was found in 26 (0.72%) patients with IBD and in 49 (0.34%) matched comparison patients without IBD. After adjustment, the adjusted odds ratio (OR) of BD for IBD patients was 2.10 (95% confidence interval (CI): 1.30∼3.38) compared to the comparison group. Additionally, this study showed that adjusted OR of BD for ulcerative colitis patients were 2.23 (95% CI: 1.31∼3.82) compared to the comparison group.Limitations: we could not precisely determine the causal association between BD and IBD.Conclusions: We concluded that patients with IBD were more likely to have BD than those comparison patients without IBD. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) with a low arousal threshold (low-ArTH) phenotype can cause minor respiratory events that exacerbate sleep fragmentation. Although anthropometric features may affect the risk of low-ArTH OSA, the associations and underlying mechanisms require further investigation. This study investigated the relationships of body fat and water distribution with polysomnography parameters by using data from a sleep center database. The derived data were classified as those for low-ArTH in accordance with criteria that considered oximetry and the frequency and type fraction of respiratory events and analyzed using mean comparison and regression approaches. The low-ArTH group members (n = 1850) were significantly older and had a higher visceral fat level, body fat percentage, trunk-to-limb fat ratio, and extracellular-to-intracellular (E–I) water ratio compared with the non-OSA group members (n = 368). Significant associations of body fat percentage (odds ratio [OR]: 1.58, 95% confident interval [CI]: 1.08 to 2.3, p < 0.05), trunk-to-limb fat ratio (OR: 1.22, 95% CI: 1.04 to 1.43, p < 0.05), and E–I water ratio (OR: 1.32, 95% CI: 1.08 to 1.62, p < 0.01) with the risk of low-ArTH OSA were noted after adjustments for sex, age, and body mass index. These observations suggest that increased truncal adiposity and extracellular water are associated with a higher risk of low-ArTH OSA. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a risk factor for neurodegenerative diseases. This study determined whether continuous positive airway pressure (CPAP), which can alleviate OSA symptoms, can reduce neurochemical biomarker levels. Thirty patients with OSA and normal cognitive function were recruited and divided into the control (n = 10) and CPAP (n = 20) groups. Next, we examined their in-lab sleep data (polysomnography and CPAP titration), sleep-related questionnaire outcomes, and neurochemical biomarker levels at baseline and the 3-month follow-up. The paired t-test and Wilcoxon signed-rank test were used to examine changes. Analysis of covariance (ANCOVA) was performed to increase the robustness of outcomes. The Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index scores were significantly decreased in the CPAP group. The mean levels of total tau (T-Tau), amyloid-beta-42 (Aβ42), and the product of the two (Aβ42 × T-Tau) increased considerably in the control group (ΔT-Tau: 2.31 pg/mL; ΔAβ42: 0.58 pg/mL; ΔAβ42 × T-Tau: 48.73 pg2/mL2), whereas the mean levels of T-Tau and the product of T-Tau and Aβ42 decreased considerably in the CPAP group (ΔT-Tau: −2.22 pg/mL; ΔAβ42 × T-Tau: −44.35 pg2/mL2). The results of ANCOVA with adjustment for age, sex, body mass index, baseline measurements, and apnea–hypopnea index demonstrated significant differences in neurochemical biomarker levels between the CPAP and control groups. The findings indicate that CPAP may reduce neurochemical biomarker levels by alleviating OSA symptoms. [ABSTRACT FROM AUTHOR]

Objective: Sleep disturbances are common in fibromyalgia, but the features of sleep disturbances are not well understood. We performed a systematic review and meta-analysis of case-control studies to compare the sleep outcomes of individuals with fibromyalgia and healthy controls.Methods: We systematically searched eight databases (PubMed, Ovid MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Airiti Library and Wanfang Data) for articles published before April 2016.Results: Twenty-five case-controlled studies and a total of 2086 participants were included in the meta-analysis. Sleep was assessed using polysomnography and the Pittsburgh Sleep Quality Index. When sleep was assessed using polysomnography (19 studies), significant differences were observed in wake time after sleep onset (g=0.81, 95% confidence interval [CI] 0.21-1.41), total sleep time (g=-0.78, 95% CI=-1.34 to -0.15), sleep efficiency (g=-0.78, 95% CI=-1.23 to -0.32), percentage of stage 1 sleep (g=0.55, 95% CI=0.15-0.95), and percentage of slow-wave sleep (g=-0.66, 95% CI=-1.21 to -0.12) between participants with fibromyalgia and healthy controls. When sleep was assessed using the Pittsburgh Sleep Quality Index (7 studies), significant differences were observed in global scores (g=2.19, 95% CI 1.58-2.79), sleep onset latency (g=1.75, 95% CI 0.80-2.70), and sleep efficiency (g=-1.08, 95% CI -1.65 to -0.51) between participants with fibromyalgia and healthy controls.Conclusion: Individuals with fibromyalgia experience lower sleep quality and sleep efficiency; longer wake time after sleep onset, short sleep duration, and light sleep when objectively assessed and more difficulty in initiating sleep when subjectively assessed. Sleep difficulties in fibromyalgia appear to be more when reported subjectively than when assessed objectively.Compliance With Ethical Standards: This study received no funding from any source. All authors declare that they have no conflict of interest. This article does not contain any studies with human participants performed by any of the authors. [ABSTRACT FROM AUTHOR]

(a) Objective: Obstructive sleep apnea syndrome (OSAS) is typically diagnosed through polysomnography (PSG). However, PSG incurs high medical costs. This study developed new models for screening the risk of moderate-to-severe OSAS (apnea-hypopnea index, AHI ≥15) and severe OSAS (AHI ≥30) in various age groups and sexes by using anthropometric features in the Taiwan population. (b) Participants: Data were derived from 10,391 northern Taiwan patients who underwent PSG. (c) Methods: Patients' characteristics – namely age, sex, body mass index (BMI), neck circumference, and waist circumference – was obtained. To develop an age- and sex-independent model, various approaches – namely logistic regression, k-nearest neighbor, naive Bayes, random forest (RF), and support vector machine – were trained for four groups based on sex and age (men or women; aged <50 or ≥50 years). Dataset was separated independently (training:70%; validation: 10%; testing: 20%) and Cross-validated grid search was applied for model optimization. Models demonstrating the highest overall accuracy in validation outcomes for the four groups were used to predict the testing dataset. (d) Results: The RF models showed the highest overall accuracy. BMI was the most influential parameter in both types of OSAS severity screening models. (e) Conclusion: The established models can be applied to screen OSAS risk in the Taiwan population and those with similar craniofacial features. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a global health concern and is typically diagnosed using in-laboratory polysomnography (PSG). However, PSG is highly time-consuming and labor-intensive. We, therefore, developed machine learning models based on easily accessed anthropometric features to screen for the risk of moderate to severe and severe OSA. We enrolled 3503 patients from Taiwan and determined their PSG parameters and anthropometric features. Subsequently, we compared the mean values among patients with different OSA severity and considered correlations among all participants. We developed models based on the following machine learning approaches: logistic regression, k-nearest neighbors, naïve Bayes, random forest (RF), support vector machine, and XGBoost. Collected data were first independently split into two data sets (training and validation: 80%; testing: 20%). Thereafter, we adopted the model with the highest accuracy in the training and validation stage to predict the testing set. We explored the importance of each feature in the OSA risk screening by calculating the Shapley values of each input variable. The RF model achieved the highest accuracy for moderate to severe (84.74%) and severe (72.61%) OSA. The level of visceral fat was found to be a predominant feature in the risk screening models of OSA with the aforementioned levels of severity. Our machine learning models can be employed to screen for OSA risk in the populations in Taiwan and in those with similar craniofacial structures. [ABSTRACT FROM AUTHOR]

While sleep-disordered breathing (SDB), high blood pressure (BP) and air pollution exposure have separately been associated with increased risk of cardiopulmonary mortality, the association linking air pollution exposure to BP among patients with sleep-disordered breathing is still unclear. We collected 3762 participants' data from the Taipei Medical University Hospital's Sleep Center and air pollution data from the Taiwan Environmental Protection Administration. Associations of 1-year mean criteria air pollutants [particulate matter with aerodynamic diameters ≤ 10 μm (PM 10 ), particulate matter with aerodynamic diameters ≤ 2.5 μm (PM 2.5 ), nitrogen dioxide (NO 2 ) and ozone (O 3 )] with systolic BP (SBP) and diastolic BP (DBP) were investigated by generalized additive models. After controlling for age, sex, body mass index (BMI), temperature and relative humidity, we observed that increases in air pollution levels were associated with decreased SBP and increased DBP. We also found that patients with apnea–hypopnea index (AHI) ≥ 30 showed a stronger BP response to increased levels of air pollution exposure than those with AHI < 30. Stronger effects of air pollution exposure on BP were found in overweight participants than in participants with normal BMI. We concluded that annual exposure to air pollution was associated with change of BP among patients with sleep-disordered breathing. The association between annual air pollution exposure and BP could be modified by AHI and BMI. [ABSTRACT FROM AUTHOR]

While long-term hypnotic use is very common in clinical practice, the associated factors have been understudied. This study aims to explore the cognitive factors that might influence the long-term use of hypnotics based on the theory of planned behavior (TPB), and examines the moderating effect of craving between cognitive intention and actual hypnotic-use behavior at follow-up. A total of 139 insomnia patients completed a self-constructed TPB questionnaire to measure their attitude, subjective norm, perceived behavioral control, and behavioral intention of hypnotic use, as well as the Hypnotic-Use Urge Scale (HUS) to measure their craving for hypnotics. They were then contacted through phone approximately three months later to assess their hypnotic use. Hierarchical regression showed that perceived behavioral control was the most significant determinant for behavioral intention of hypnotic use. Behavioral intention, in turn, can predict the frequency of hypnotic use after three months. However, this association was moderated by hypnotic craving. The association was lower among the participants with higher cravings for hypnotic use. The findings suggest that the patients' beliefs about their control over sleep and daily life situations, and their craving for hypnotics should be taken into consideration in the management of hypnotic use. [ABSTRACT FROM AUTHOR]

Background: Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database. Methods: Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy. Results: Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient’s sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02–2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08–2.41) for patients who underwent cholecystectomy compared to those who did not. Conclusions: There is an association between cholecystectomy and subsequent risk of DD among females, but not in males. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To assess the risks that maternal panic disorder (PD) during pregnancy contribute to adverse pregnancy outcomes, with the effects further specifically differentiated into mothers who experienced a panic attack during pregnancy and those who did not. Method: This study linked two nationwide population-based datasets: the birth certificate registry and the Taiwan National Health Insurance Research Dataset. We identified a total of 371 women who gave birth from 2001 to 2003, who had been diagnosed with PD within 2 years prior to the index delivery, together with 1585 matched women without this chronic disease as a comparison cohort. Multivariate logistic regression analyses were performed to estimate odds ratios. Results: Results indicated that compared to women without chronic disease, PD mothers who experienced panic manifestations during pregnancy and those who did not were independently associated with respective 2.29- (95% confidence interval (CI)=1.14–4.60) and 1.45-fold (95% CI=1.03–2.04) increased risks of having small-for-gestational-age infants. Further, for PD mothers who experienced a panic attack during gestation, the adjusted odds ratio for having a preterm delivery was 2.54 (95% CI=1.09–5.93), whereas no significant difference was identified between PD women who did not have a panic attack during pregnancy and women without PD. Limitation: Our study was unable to investigate the effects of such risk factors as dietary habits, cigarette smoking, and alcohol use in the regression model. Conclusion: We conclude that prenatal PD, particularly the occurrence of panic attacks during pregnancy, was associated with adverse birth outcomes. [Copyright &y& Elsevier]

Abstract: Background: Young adults aged from 18 to 44 years comprise a large portion of the population suffering from depression. Yet few studies have compared the likelihood of dying of natural causes or by suicide among depressed patients. This study uses a case–control approach to compare the likelihood of dying of natural causes and by suicide for depressed and non-depressed patients based on a representative national sample in Taiwan. Method: A retrospective case–control study design was used to analyze two nationwide population-based datasets: the National Health Insurance Research Database (NHIRD) and the official Cause of Death data file in Taiwan. The study cohort consisted of 827 patients from 18 to 44 years old who were hospitalized with a primary diagnosis of depressive disorder from 1998–2003. A comparison cohort of patients hospitalized for appendectomies was matched with the study sample in terms of age and gender (N =2481). Results: After adjusting for the age and comorbid medical disorders, the hazard of dying during the five-year follow-up period was 1.72 times greater for depressed patients than for appendectomy patients. Depressed patients were more likely to die by suicide during the follow-up period, as no significant difference in odds of dying from natural causes was observed between these two cohorts. Conclusion: Further studies should be initiated to identify specific risk factors for suicide among younger adults, while prevention strategies might focus on stresses associated with particular life stages, taking age and gender patterns into account. [Copyright &y& Elsevier]

This study used a nationwide population-based dataset to explore the variation among the days of week of stroke onset within population subgroups defined by age, sex, and stroke type. We used ambulatory care data from the 2002 Taiwan National Health Insurance Research Database, focusing on 42,779 emergency room (ER) visits for stroke that year. All analyses were stratified by sex, age (<60 and ≥60 yrs), and type of stroke. Auto-Regressive Integrated Moving Average (ARIMA) was performed to investigate the relationship between daily number of stroke events and holidays and days of the week after adjusting for the effects of seasonality and trends. One-way ANOVA revealed significant differences in stroke ER admissions according to day of week according to age <60 (p<0.01), age ≥60 (p<0.001), male (p<0.001), female (p<0.001), ischemic stroke (IS) (p<0.001), and unspecified stroke (UNSP) (p<0.001). However, the analysis by type—subarachnoid hemorrhage and intracerebral hemorrhage—did not show significant relationships between daily emergency room stroke admissions, holidays, or day of the week. The ARIMA regression analyses also showed that Mondays had the highest rate of emergency room admissions for stroke regardless of sex, age, or IS and UNSP types of stroke, after adjusting for seasonality and trends. We conclude that stroke occurs more frequently on Mondays than on the other days of the week, which might be associated with short-term changes in lifestyle or due to the sudden return of stress on the first working day of the week, and on holidays. [ABSTRACT FROM AUTHOR]

Serum lipids have been found to play important roles in the pathophysiology of mood disorders. The aim of the present study was therefore to investigate the relationship between symptom dimensions and serum cholesterol and triglyceride levels, and to explore correlates of lipid levels during acute mood episodes of bipolar I disorder in Taiwan. Measurements were taken of the serum cholesterol and triglyceride levels in patients with bipolar I disorder hospitalized for acute mood episodes (68 manic, eight depressive, and six mixed). The relationships between serum lipids levels and various clinical variables were examined. The mean serum levels of cholesterol (4.54 mmol/L) and triglycerides (1.16 mmol/L) of sampled patients were comparable to those of the general population in the same age segment. Severe depressive symptoms and comorbid atopic diseases were associated with higher serum cholesterol levels. A negative association was noted between serum triglyceride levels and overall psychiatric symptoms. Compared with previous studies on Western populations, racial differences may exist in lipids profiles of bipolar disorder patients during acute mood episodes. Increased serum cholesterol levels may have greater relevance to immunomodulatory system and depressive symptoms, in comparison with manic symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Background: Despite cerebrovascular diseases having been reported as one of the major causes of death among patients with bipolar disorder, there is scant information on the risk of stroke among this patient population. This study estimated the relative risk of developing stroke among patients with bipolar disorder in 6 years following hospitalization for an acute mood episode compared with patients undergoing appendectomy. Methods: Two study cohorts were identified from the Taiwan National Health Insurance Research Database for the year 1998: patients hospitalized with bipolar disorder, and patients undergoing an appendectomy. Follow-up was undertaken to determine whether sampled patients had utilized emergency medical services for the management of any type of stroke in the period 1998–2003. Results: Stroke occurred among 2.97% of patients with bipolar disorder and 1.50% of patients undergoing appendectomy between 1998 and 2003. The adjusted odds ratio of developing stroke, by cohort, shows that after adjusting for demographic characteristics, comorbid medical disorder, and substance or alcohol dependence, patients with bipolar disorder were more likely to develop stroke (OR=2.05; 95% CI=1.73–3.54). Limitations: The validity of diagnoses, lacking of information on smoking, body mass index, and socioeconomic status, and possible selection bias might compromise the findings. Conclusions: During the six-year follow-up period, the likelihood of developing stroke was twice as great amongst patients with bipolar disorder as patients undergoing an appendectomy. A requirement exists for the initiation of research providing an understanding of the pathophysiological mechanisms of the association between stroke and bipolar disorder. [Copyright &y& Elsevier]

Background: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. Methods: People with major depressive disorder (n = 25) and controls (n = 25) underwent task-based electro-encephalogram recording. We studied late event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. Results: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. Limitations: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. Conclusion: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression. [ABSTRACT FROM AUTHOR]

• Changes to the GABA- and glutamatergic systems are thought to occur in depression. • Previous MRS studies have suggested that the occipital cortex is one region where this occurs. • We conducted an MRS study and a meta-analysis of the previous literature to confirm this effect. • Instead, no difference in MRS measures of these transmitters between patients with depression and controls was found. The neurotransmitters GABA and glutamate have been suggested to play a role in Major Depressive Disorder (MDD) through an imbalance between cortical inhibition and excitation. This effect has been highlighted in higher brain areas, such as the prefrontal cortex, but has also been posited in basic sensory cortices. Based on this, magnetic resonance spectroscopy (MRS) was used to investigate potential changes to GABA+ and glutamate+glutamine (Glx) concentrations within the occipital cortex in MDD patients (n = 25) and healthy controls (n = 25). No difference in occipital GABA+ or Glx concentrations, nor in the GABA+/Glx ratio, was found between groups. An analysis of an extended MDD patient and unmatched control dataset (n = 90) found no correlation between metabolite concentrations and depressive symptoms. These results were integrated with prior studies through metabolite-specific meta-analyses, revealing no difference in occipital GABA and Glx concentrations between patients and controls. An effect of publication year on GABA group differences was found, suggesting that previously reported results may have been artifacts of measurement accuracy. Taken together, our results suggest that, contrary to some prior reports, MRS measurements of occipital GABA and Glx do not differ between MDD patients and controls. [ABSTRACT FROM AUTHOR]

The brain's intrinsic activity plays a fundamental role in its function. In normal conditions this activity is responsive to behavioural context, changing as an individual switches between directed tasks and task‐free conditions. A key feature of such changes is the movement of the brain between corresponding critical and sub‐critical states, with these dynamics supporting efficient cognitive processing. Breakdowns in processing efficiency can occur, however, in brain disorders such as depression. It was therefore hypothesised that depressive symptoms would be related to reduced intrinsic activity responsiveness to changes in behavioural state. This was tested in a mixed group of major depressive disorder patients (n = 26) and healthy participants (n = 37) by measuring intrinsic EEG activity temporal structure, quantified with detrended fluctuation analysis (DFA), in eyes‐closed (EC) and eyes‐open task‐free states and contrasting between the conditions. The degree to which DFA values changed between the states was found to correlate negatively with depressive symptoms. DFA values did not differ between states in those with higher symptom levels, meaning that the brain remained in a less flexible sub‐critical condition. This sub‐critical condition in the EC state was further found to correlate with levels of maladaptive rumination. This may reflect a general cognitive inflexibility resulting from a lack in neural activity reactivity that may predispose people to overly engage in self‐directed attention. These results provide an initial link between intrinsic activity reactivity and psychological features found in psychiatric disorders. [ABSTRACT FROM AUTHOR]

Abstract: This study sets out to assess the relationship between in-hospital mortality rates and physician acute myocardial infarction (AMI) volume, along with an examination of the impact of physician specialty on in-hospital mortality rates in Taiwan. Analysis was undertaken on a total of 19,086 patients hospitalized for AMI, following the division of the sample patients into four roughly equivalent groups. Within each physician specialty, the AMI patients were also subsequently grouped into four roughly equivalent groups based upon physician volume. After adjusting for other factors, the likelihood of in-hospital mortality among patients treated by low-volume physicians was 2.141 (p <0.001) times as high as that for patients treated by high-volume physicians, and 2.410 (p <0.001) times as high as that for patients treated by very high-volume physicians. However, while such an inverse relationship was found to persist for those physicians specializing in general internal medicine and ‘others’, this was not the case for cardiologists. [Copyright &y& Elsevier]

Objective: Alterations in psychomotor dimension cut across different psychiatric disorders, such as schizophrenia (SCZ) and bipolar disorder (BD). This preliminary study aimed to investigate the organization of intrinsic brain activity in the subcortical-cortical sensorimotor system in SCZ (and BD) as characterized according to psychomotor dimension.Method: In this resting-state functional magnetic resonance imaging (fMRI) study, functional connectivity (FC) between thalamus and sensorimotor network (SMN), along with FC from substantia nigra (SN) and raphe nuclei (RN) to basal ganglia (BG) and thalamic regions, were investigated by using an a-priori-driven and dimensional approach. This was done in two datasets: SCZ patients showing inhibited psychomotricity (n = 18) vs. controls (n = 19); SCZ patients showing excited psychomotricity (n = 20) vs. controls (n = 108). Data from a third dataset of BD in inhibited depressive or manic phases (reflecting inhibited or excited psychomotricity) were used as control.Results: SCZ patients suffering from psychomotor inhibition showed decreased thalamus-SMN FC toward around-zero values paralleled by a concomitant reduction of SN-BG/thalamus FC and RN-BG/thalamus FC (as BD patients in inhibited depression). By contrast, SCZ patients suffering from psychomotor excitation exhibited increased thalamus-SMN FC toward positive values paralleled by a concomitant reduction of RN-BG/thalamus FC (as BD patients in mania).Conclusions: These findings suggest that patients exhibiting low or high levels of psychomotor activity show distinct patterns of thalamus-SMN coupling, which could be traced to specific deficit in SN- or RN-related connectivity. Notably, this was independent from the diagnosis of SCZ or BD, supporting an RDoC-like dimensional approach to psychomotricity. [ABSTRACT FROM AUTHOR]

Delirium is a common neuropsychiatric syndrome that is often overlooked in clinical settings. The most accurate instrument for screening delirium has not been established. This study aimed to compare the diagnostic accuracy of the 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) in detecting delirium among older adults in clinical settings. These assessment tools feature concise item sets and straightforward administration procedures. Five electronic databases were systematically searched from their inception to September 7, 2022. Studies evaluating the sensitivity and specificity of the 4AT, Nu-DESC, and CAM against the Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases as the reference standard were included. Bivariate random effects model was used to summarize the sensitivity and specificity results. A total of 38 studies involving 7378 patients were included. The 4AT, Nu-DESC, and CAM had comparable sensitivity in detecting delirium (0.76, 0.78, and 0.80, respectively). However, the specificity of the CAM was higher than that of the 4AT (0.98 vs 0.89, P =.01) and Nu-DESC 0.99 vs 0.90, P =.003). Diagnostic accuracy was moderated by the percentage of women, acute care setting, sample size, and assessors. The three tools exhibit comparable sensitivity, and the CAM has the highest specificity. Based on the feasibility of the tools, nurses and clinical staffs could employ the Nu-DESC and the 4AT on screening out positive delirium cases and integrate these tools into daily practice. Further investigations are warranted to verify our findings. • The 4 'A's Test (4AT), Nursing Delirium Screening Scale (Nu-DESC), and Confusion Assessment Method (CAM) are commonly used for delirium detection. • The 4AT, Nu-DESC, and CAM had comparable pooled sensitivity in screening delirium (0.76, 0.78, and 0.80, respectively). • The CAM had the optimal ability to exclude patients without delirium. • Nu-DESC is suitable for screening delirium among older adults through daily nursing practice in few minutes. [ABSTRACT FROM AUTHOR]

While the efficacy of cognitive behavior therapy for insomnia (CBT-I) has been established with well-controlled studies, its effectiveness in typical clinical practice remains to be determined. We examined the effect of CBT-I combined with usual medication on night-time sleep, daytime functioning, and the discontinuation of hypnotic drugs. The study recruited 103 patients with insomnia, who were divided into three groups: CBT-I only (CBT-I, N = 30), CBT-I combined with usual medication (COM, N = 48), and usual medication only (TAU, N = 25). A six-session CBT-I program was delivered in the CBT and COM groups, and patients in the COM and TAU groups continued to take the medication prescribed by their physicians. All groups showed significant improvements in the Insomnia Severity Inventory. The CBT-I and COM groups showed significant improvements on two subscales (vitality and physical role functioning) of the 36-item Short Form Health Survey. There was no significant improvement in the daytime functioning of the TAU group. Moreover, significantly more participants in the COM group discontinued their use of hypnotics. CBT-I in addition to regular medication is an effective treatment option in clinical settings. It can improve not only night-time sleep, but also daytime functioning. Furthermore, it can be helpful in facilitating the discontinuation of medication. Our results support the utility of CBT-I in clinical settings, and it can be integrated into the patients' usual treatment protocol. [ABSTRACT FROM AUTHOR]

Hypnotic dependence is a major concern for long-term hypnotic use, but is not consistently reported in empirical studies. The inconsistent findings may be in part due to individual differences in the psychological processes of hypnotic use. To further the understanding of this issue, the current study developed the Hypnotic-Use Urge Scale (HUS) to measure the urge to take hypnotics at bedtime. Insomnia patients with a history of hypnotic use (n = 202; mean age = 46.4 years) were included in the study. Participant's agreement with 37 statements regarding anticipation, desire, and feelings about hypnotic use at bedtime was rated using Likert-type scales. An exploratory factor analysis identified 20 statements to be included as items of the HUS, which were categorized into three subscales: Factor 1—anticipated effects of hypnotic use; Factor 2—compelling desire to use hypnotics; and Factor 3—preoccupation and pleasurable feelings from hypnotic use. The total scale and subscales demonstrated good internal consistency and test-retest reliability. The scale scores correlated significantly with the frequency of hypnotic use. Intriguingly, although Factor 1 accounted for the highest portion of the total variance, Factor 2 was identified to be the best predictor for the frequency of hypnotic use. The results support the use of the HUS as a valid and reliable measure to assess the urge to use hypnotic at bedtime. It could be used to measure the psychological processes associated with hypnotic dependence in both research and clinical settings. [ABSTRACT FROM AUTHOR]

Aims: We conducted a cohort study utilizing a nationwide health insurance database to assess the European Medicines Agency's restrictions on using metoclopramide and its association with the risk of parkinsonism. Methods: New oral metoclopramide users aged ≥20 years, and age‐ and gender‐matched non‐users were recruited between 2001 and 2011. Users were divided into high‐exposure (dose >30 mg day–1 and/or duration >5 days) and standard‐exposure (dose ≤30 mg day–1 and duration ≤5 days) groups. The adjusted hazard ratio (aHR) with 95% confidence interval (CI) estimated the risk of parkinsonism. Results: During a 1‐year period, 122 of 218 931 (0.06%) users of metoclopramide vs. 56 of 218 931 (0.03%) non‐users developed parkinsonism (P < 0.001). Among the 122 cases of parkinsonism in users, 64 (0.04%) were from 168 566 standard‐exposure users and 58 (0.12%) from 50 365 high‐exposure users. Compared with non‐users, the risk of parkinsonism was higher in users (aHR 2.16; 95% CI 1.54, 3.02), including standard‐exposure (aHR 1.73; 95% CI 1.11, 2.70), and high‐exposure (aHR 3.15; 95% CI 1.78, 5.57) users. High‐exposure users had a higher risk of parkinsonism than standard‐exposure users (aHR 1.83; 95% CI 1.28, 2.63). Within the high‐exposure group, 45 233 of 50 365 (89.81%) users and 55 of 58 (94.83%) parkinsonism were from long‐duration exposure; 5 132 of 50 365 (10.19%) users and 3 of 58 (5.17%) parkinsonism were from high‐dose exposure and long‐duration + high‐dose exposure. Conclusions: The risk of parkinsonism in metoclopramide users, although extremely low (0.06%), is 2.16‐fold greater than in non‐users. High‐exposure users have a 1.83‐fold higher risk than standard‐exposure users. As users in high‐exposure group had a higher risk of parkinsonism than in standard‐exposure group, and the majority of users and parkinsonism in high‐exposure group were from long‐duration exposure; thus, physician are advised to avoid prescribing metoclopramide for >5 days, even if the daily dose is ≤30 mg. [ABSTRACT FROM AUTHOR]