Browsing by Author "Chiang, Wei-Shan"

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Cognitive enhancers associated with decreased risk of injury in patients with dementia: a nationwide cohort study in Taiwan
(2018-03-01)
Chao, Pei-Chun
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Chien, Wu-Chien
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Chung, Chi-Hsiang
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Chu, Ching-Wen
;
Yeh, Chin-Bin
This study aimed to investigate the associations among dementia, psychotropic medications and the risk of overall injuries. In this nationwide matched cohort study, a total of 144008 enrolled patients age of 50, with 36002 study subjects who suffered from dementia and 108006 controls matched for sex and age, from the Inpatient Dataset, for the period 2000-2010 in Taiwan were selected from the National Health Insurance Research Database, according to International Classification of Diseases, 9th Revision, Clinical Modification. When adjusting for the confounding factors, a Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 10 years of follow-up. Of the study subjects, 6701 (18.61%) suffered injury when compared with 20919 (19.37%) in the control group. The Cox regression analysis revealed that the study subjects were more likely to develop an injury (HR: 2.294, 95% CI=2.229 to 2.361, P<0.001) after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications in the subjects with dementia were associated with the risk of injury (adjusted HR=0.217, 95%CI: 0.206 to 0.228, P<0.001). Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, were associated with the risk of injury in the study subjects after being adjusted for all comorbidities and medications (adjusted HR=0.712(95% CI=0.512 to 0.925, P<0.01)). In conclusion, patients who suffered dementia had a higher risk of developing injury, and the cognitive enhancers were associated with the decreased risk of injury.
Fibromyalgia and Risk of Dementia - A Nationwide, Population-Based, Cohort Study
(2018-02-01)
Tzeng, Nian-Sheng
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Chung, Chi-Hsiang
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Liu, Feng-Cheng
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Chiu, Yu-Hsiang
;
Chang, Hsin-An
Background: Fibromyalgia is a syndrome of chronic pain and other symptoms and is associated with patient discomfort and other diseases. This nationwide matched-cohort population-based study aimed to investigate the association between fibromyalgia and the risk of developing dementia, and to clarify the association between fibromyalgia and dementia. Materials and Methods: A total of 41,612 patients of age >50 years with newly diagnosed fibromyalgia between January 1, and December 31, 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 124,836 controls matched for sex and age. After adjusting for any confounding factors, Fine and Gray competing risk analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Results: Of the study subjects, 1,704 from 41,612 fibromyalgia patients (21.23 per 1,000 person-years) developed dementia when compared to 4,419 from 124,836 controls (18.94 per 1,000 person-years). Fine and Gray competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio: 2.29, 95% CI: 2.16-2.42; P < 0.001). After adjusting for sex, age, monthly income, urbanization level, geographic region of residence and comorbidities the hazard ratio was 2.77 (95% CI: 2.61-2.95, P < 0.001). Fibromyalgia was associated with increased risk of all types of dementia in this study. Conclusion: The study subjects with fibromyalgia had a 2.77-fold risk of dementia in comparison to the control group. Therefore, further studies are needed to elucidate the underlying mechanisms of the association between fibromyalgia and the risk of dementia.
Forensic Evaluations for Offenders With Dementia in Taiwan's Criminal Courts
(2018-03-01)
Wang, Hui-Yi
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Chen, Jiun-Hsiung
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Huang, San-Yuan
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Yeh, Hui-Wen
;
Mao, Wei-Chung
Dementia is an increasing world-wide health problem, and the association between dementia and adjudication of crimes has rarely been studied. The data in this study are described and analyzed by gender, psychiatric diagnosis, type of crime, and the acceptance rate by the courts of opinions tendered by forensic psychiatric examiners. The source data are derived from the databank of the Judicial Yuan (Judicial Department) of the Republic of China Law and Regulations Retrieval System. There was a male predominance of 85.1 percent. Larceny (42.6%) was the most frequent crime. There was also a high judicial acceptance rate of 91.5 percent of the professional opinions received from forensic psychiatric evaluators who examined defendants at the request of the courts. Psychiatrists play an important role in providing their professional opinions for the Taiwanese courts with regard to adjudication of evaluees with dementia. Most courts accepted psychiatrists' professional opinions about offenders with dementia, and the rate of acceptance was reflected in the judicial rulings of criminal responsibility.
Forensic Psychiatric Evaluation for Military Absenteeism in Taiwan
(2016-09-01)
Tzeng, Nian-Sheng
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Chen, Chih-Kang
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Wang, Tzong-Shi
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Chang, Hsin-An
;
Kao, Yu-Chen
The relationship between military absenteeism and mental health problems has been noted; however, factors affecting military absenteeism by enlisted personnel have not been studied systematically. In a medical center in Taiwan, we performed a chart review of 26 forensic psychiatric evaluations of enlisted personnel who were absent without leave (AWOL) or deserted their service from 1994 to 2014. The findings showed that many of these recruits had a lower level of education (50.00% had just nine years of education), intellectual disability (46.15%), depressive disorders (30.76%), and suicidal ideation (53.85%). Depressive disorder was overrepresented in comparison with findings in a previous study. Further study is needed to confirm whether psychiatric screening before service enlistment and early psychiatric intervention for service members with mental illness or emotional disturbance could help in the prevention of desertion or going AWOL.
Increased Risk of Psychiatric Disorders in Allergic Diseases: A Nationwide, Population-Based, Cohort Study
(2018-04-24)
Tzeng, Nian-Sheng
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Chang, Hsin-An
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Chung, Chi-Hsiang
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Kao, Yu-Chen
;
Chang, Chuan-Chia
Background/objective: Allergic diseases, such as bronchial asthma, allergic rhinitis, atopic dermatitis, and psychiatric disorders, are major health issues. There have been reports that allergic diseases were associated with depression or anxiety disorders. This study aimed to investigate the association between these allergic diseases and the risk of developing overall psychiatric disorders in patients from Taiwan. Methods: This cohort study used the database of the Taiwan National Health Insurance Program. A total of 186,588 enrolled patients, with 46,647 study subjects who had suffered from allergic diseases, and 139,941 controls matched for sex and age, from the Longitudinal Health Insurance Dataset of 2000-2015, were selected from a sub-dataset of the National Health Insurance Research Database. Fine and Gray's competing risk model analysis was used to explore the hazard ratio (HR), and 95% confidence interval, for the risk of allergic diseases being associated with the risk of developing psychiatric disorders during the 15 years of follow-up. Results: Of the study subjects, 5,038 (10.8%) developed psychiatric disorders when compared to 9,376 (6.7%) in the control group, with significant difference (p < 0.001). Fine and Gray's competing risk model analysis revealed that the adjusted HR was 1.659 (95% Cl = 1.602-1.717, p < 0.001). In this study, we found that the groups of atopic dermatitis alone and the allergic rhinitis + atopic dermatitis were associated with a lower risk of psychiatric disorders, but all the other four groups, such as bronchial asthma alone, allergic rhinitis alone, bronchial asthma + allergic rhinitis, bronchial asthma + atopic dermatitis, and the combination of all these three allergic diseases, were associated with a higher risk of psychiatric disorders. Conclusion: Allergic diseases are therefore associated with a 1.66-fold increased hazard of psychiatric disorders in Taiwan.
Is Zolpidem Associated with Increased Risk of Fractures in the Elderly with Sleep Disorders? A Nationwide Case Cross-Over Study in Taiwan
(2015-12-30)
Tang, Yih-Jing
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Ho, Shinn-Ying
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Chu, Fang-Ying
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Chen, Hung-An
;
Yin, Yun-Ju
Background We conducted a study using a case-crossover design to clarify the risk of acute effects of zolpidem and benzodiazepine on all-sites of fractures in the elderly. Design of study Case-crossover design. Methods and Materials Elderly enrollees (n = 6010) in Taiwan's National Health Insurance Research Database with zolpidem or benzodiazepine use were analyzed for the risk of developing fractures. Results After adjusting for medications such as antipsychotics, antidepressants, and diuretics, or comorbidities such as hypertension, osteoarthritis, osteoporosis, rheumatoid arthritis and depression, neither zolpidem nor benzodiazepine was found to be associated with increased risk in all-sites fractures. Subjects without depression were found to have an increased risk of fractures. Diazepam is the only benzodiazepine with increased risk of fractures after adjusting for medications and comorbidities. Hip and spine were particular sites for increased fracture risk, but following adjustment for comorbidities, the associations were found to be insignificant. Conclusion Neither zolpidem nor benzodiazepine was associated with increased risk of all-site fractures in this case cross-over study after adjusting for medications or comorbidities in elderly individuals with insomnia. Clinicians should balance the benefits and risks for prescribing zolpidem or benzodiazepine in the elderly accordingly.
Magnesium oxide use and reduced risk of dementia: a retrospective, nationwide cohort study in Taiwan
(2018-01-01)
Tzeng, Nian-Sheng
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Chung, Chi-Hsiang
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Lin, Fu-Huang
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Huang, Ching-Feng
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Yeh, Chin-Bin
Objective: Dietary magnesium may be associated with a lower risk of dementia; however, the impact of magnesium oxide (MgO), a common laxative, on dementia has yet to be elucidated. This study aimed to investigate the association between the usage of MgO and the risk of developing dementia. Methods: We used a dataset from the National Health Research Institute Database (NHRID) of Taiwan containing one million randomly sampled subjects to identify patients aged >= 50 years with no history of MgO usage. A total of 1547 patients who had used MgO were enrolled, along with 4641 controls who had not used the MgO propensity score matched by age, gender and comorbidity, at a ratio of 1:3. After adjusting for confounding risk factors, a Cox proportional hazards model was used to compare the risk of developing dementia during a 10 year follow-up period. Results: Of the enrolled patients, 44 (2.84%) developed dementia, when compared to 199 (4.28%) in the control group. The Cox proportional hazards regression analysis revealed that the patients who had used MgO were less likely to develop dementia with a crude hazard ratio of 0.617 (95% CI, 0.445-0.856, p=.004). After adjusting for age, gender, comorbidity, geographical area and urbanization level of residence, and monthly income, the adjusted hazard ratio was 0.517 (95% CI, 0.412-0.793, p=.001). Conclusions: The patients who used MgO had a decreased risk of developing dementia. Further studies on the effects of MgO in reducing the risk of dementia are therefore warranted.
Obstructive Sleep Apnea in Children and Adolescents and the Risk of Major Adverse Cardiovascular Events: A Nationwide Cohort Study in Taiwan
(2019-01-01)
Tzeng, Nian-Sheng
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Chung, Chi-Hsiang
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Chang, Hsin-An
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Chang, Chuan-Chia
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Lu, Ru-Band
Study Objectives: This study has investigated the risk of major adverse cardiovascular events (MACEs), including acute myocardial infarction, coronary artery disease, peripheral artery disease, and acute stroke, among children and adolescents (age younger than 20 years) with obstructive sleep apnea (OSA). Methods: In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients in whom OSA had been first diagnosed between 2000 and 2015. Children and adolescents with OSA (n = 6,535) were included with 1:3 ratio by age, sex, and index year of control participants without OSA (n = 19,605). The Cox proportional regression model was used to evaluate the risk of MACEs in this cohort study. Results: After a 15-year follow-up, the incidence rate of MACEs was higher in the OSA cohort when compared with the non-OSA control cohort (15.97 and 8.20 per 100,000 person-years, respectively). After adjusting for covariates, the risk of MACEs among children and adolescents with OSA was still significantly higher (hazard ratio = 2.050; 95% confidence interval = 1.312-3.107; P = .010). No MACEs were found in the children and adolescents with OSA who received continuous airway positive pressure treatment or pharyngeal surgery. Conclusions: This study found a significantly higher risk of MACEs in children and adolescents with OSA. These findings strongly suggest that clinicians should provide careful follow-up and medical treatment for children and adolescents with OSA.
Pinworm infections associated with risk of psychiatric disorders-A nationwide cohort study in Taiwan Pinworm infections and psychiatric disorders
(2019-08-01)
Chao, Pei-Chun
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Chien, Wu-Chien
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Chung, Chi-Hsiang
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Chu, Ching-Wen
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Yeh, Chin-Bin
Aim: This study aimed to investigate the association between males with pinworm infections and the risk of developing psychiatric disorders. Method: A total of 2044 enrolled patients, with 511 pinworm subjects and 1533 unexposed subjects (1:3) matched for sex, age and index year, from Taiwan's Longitudinal Health Insurance Database (LHID) from 2000 to 2015, selected from the National Health Insurance Research Database (NHIRD). After adjusting for confounding factors, the Cox regression model was used to compare the risk of developing psychiatric disorders during the 15 years of follow-up. Results: Of all the enrollees. 24 in the pinworm cohort and 18 in the unexposed cohort (343.10 vs 84.96 per 100,000 person-year) developed psychiatric disorders. The Cox regression model revealed that, after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 4.581 (95% CI: 2.214-9.480, p < .001, p < .001). Pinworm infections were associated with the increased risk in anxiety disorders, depressive disorders, and sleep disorders, respectively. Conclusion: Patients who suffered from pinworm infections have a higher risk of developing psychiatric disorders, and this finding should be considered as a timely reminder for the clinicians to provide much more attention for these patients because of their mental health issues. (C) 2019 Published by Elsevier Inc.
Risk of Dementia in Adults With ADHD: A Nationwide, Population-Based Cohort Study in Taiwan
(2019-07-01)
Tzeng, Nian-Sheng
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Chung, Chi-Hsiang
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Lin, Fu-Huang
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Yeh, Chin-Bin
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Huang, San-Yuan
Objective:This study aimed to investigate the association between adults with ADHD and the risk of developing dementia. Method: Utilizing National Health Insurance Research Database of Taiwan, ADHD patients were identified and compared with age- and gender-matched controls (1:3). Results: Of the study participants, 37 (5.48%) developed dementia compared with 81 (4.0%) in the control group. Cox proportional hazards regression analysis revealed that the study participants were more likely to develop dementia. The crude hazard ratio (HR) is 3.418 (95% confidence interval [CI] = [2.289, 5.106], p < .001), and adjusted HR is 4.008 (95% CI = [2.526, 6.361], p < .001) in risk of developing dementia after adjusted for age, gender, comorbidities, geographical area of residence, urbanization level of residence, and monthly income. Conclusion: Adults with ADHD have a 3.4-fold risk of developing dementia, and other large or national data sets should be explored to support the current findings.
Risk of psychiatric disorders in Guillain-Barre syndrome: A nationwide, population-based, cohort study
(2017-10-15)
Tzeng, Nian-Sheng
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Chang, Hsin-An
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Chung, Chi-Hsiang
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Lin, Fu-Huang
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Yeh, Chin-Bin
Background Guillain-Barre syndrome (GBS) is a rare immune-related neurological disorder with high mortality and morbidity, but the comorbid psychiatric disorders garnered little attention in the GBS patients. This study aimed to investigate the association between GBS and the risk of developing psychiatric disorders. Methods: A total of 18,192 enrolled patients, with 4548 study subjects who had suffered GBS, and 13,644 controls matched for gender and age, from the Inpatient Dataset of 2000-2013 in Taiwan, and selected from the National Health Insurance Research Database (NHIRD). After adjusting for confounding factors, Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 13 years of follow-up. Results: Of the study subjects, 471 (10.35%) developed psychiatric disorders when compared to 1023 (7.50%) in the control group. Fine and Gray's competing risk model analysis revealed that the study subjects were more likely to develop psychiatric disorders (crude hazard ratio [HR]: 4.281 (95% CI = 3.819-4.798, p < 0.001). After adjusting for gender, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 4.320 (95% CI = 3.852-4.842, p < 0.001). Dementia, depressive disorders, sleep disorders, and psychotic disorders predominate in these psychiatric disorders. Mechanical ventilation and hemodialysis are associated with a lower risk of dementia when compared to the control groups. Conclusions: Patients who suffered from GBS had a higher risk of developing psychiatric disorders, and this finding should act as a reminder to the clinicians that a regular psychiatric follow-up might well be needed for those patients.
Risk of psychiatric disorders in overactive bladder syndrome: a nationwide cohort study in Taiwan
(2019-02-01)
Tzeng, Nian-Sheng
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Chang, Hsin-An
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Chung, Chi-Hsiang
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Kao, Yu-Chen
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Yeh, Hui-Wen
Population-based cohort study investigating the risk of depression and other psychiatric disorders for patients with overactive bladder (OAB) syndrome is unavailable. This study investigated the subsequent risk of psychiatric disorders among patients with OAB in an Asian population. Using data from the National Health Insurance Research Database of Taiwan, we established a cohort with 811 patients in an exposed group with OAB between January 1, 2000 and December 31, 2000, and a nonexposed group, without OAB, of 2433 patients without OAB matched by age and year of diagnosis. The occurrence of psychiatric disorders and Cox regression model measured adjusted HRs (aHR) were monitored until the end of 2013. The overall incidence of psychiatric disorders was 41.7% higher in the exposed group with OAB than in the non-exposed group without OAB (14.2% vs 10.1%, p<0.001), with an aHR of 1.34 (95% CI 1.12 to 1.80, p<0.001) for the OAB cohort. OAB was associated with the increased risk of dementia, anxiety, depressive, sleep, and psychotic disorders, with aHRs as 1.53 (p= 0.040), 1.61 (p<0.001), 2.10 (p<0.001), 1.43 (p<0.001), and 2.49 (p= 0.002), respectively. The risk of psychiatric disorders, including depression and anxiety, is significantly higher in patients with OAB than in those without OAB. Evaluation of psychiatric status in patients with OAB is strongly recommended.
Risk of Psychiatric Morbidity in Psychosexual Disorders in Male Patients: A Nationwide, Cohort Study in Taiwan
(2019-04-11)
Tzeng, Nian-Sheng
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Yeh, Hui-Wen
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Chung, Chi-Hsiang
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Chang, Hsin-An
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Kao, Yu-Chen
This study aimed to investigate the association between males with psychosexual disorders (PSDs) and the risk of developing psychiatric disorders. A total of 34,972 enrolled patients, with 8,743 subjects who had suffered from PSD and 26,229 controls (1:3) matched for age and index year, from Taiwan's Longitudinal Health Insurance Database (LHID) from 2000 to 2015, selected from the National Health Insurance Research Database (NHIRD). After adjusting all the confounding factors, the multivariate Cox regression model was used to compare the risk of developing psychiatric disorders, between the PSD and non-PSD groups, during the 15 years of follow-up. Of the all enrollees, 1,113 in the PSD cohort and 2,611 in the non-PSD cohort (1,180.96 vs. 954.68 per 100,000 person-year) developed psychiatric disorders. Multivariate Cox regression model survival analysis revealed that, after adjusting for gender, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted hazard ratio (HR) was 2.448 (95% CI [2.227, 2.633], p < .001). PSD has been associated with the increased risk in anxiety disorders, depressive disorders, bipolar disorders, sleep disorders, and psychotic disorders, respectively. Sexual dysfunctions, paraphilia, and gender identity disorders were associated with the overall psychiatric disorders with adjusted HRs as 1.990 (p < .001), 11.622 (p < .001), and 5.472 (p < .001), respectively. Male patients who suffered from PSD have a higher risk of developing psychiatric disorders, and this finding should be considered as a timely reminder for the clinicians to provide much more attention for these patients because of their mental health issues.
Stress, Sleep and Depressive Symptoms in Active Duty Military Personnel
(2016-08)
Chou, Han-Wei
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Tzeng, Wen-Chii
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Chou, Yu-Ching
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Yeh, Hui-Wen
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Chang, Hsin-An
Background: The military is a unique occupational group and, because of this, military personnel face different kinds of stress than civilian populations. Sleep problems are an example. The purpose of this study was to investigate the relationship between sleep problems, depression level and coping strategies among military personnel. Materials and Methods: In this cross-sectional study, military personnel completed the Beck Depression Inventory, the Pittsburgh Sleep Quality Index and the Jalowiec Coping Scale. Results: An evaluation of the test scores showed that officers had better sleep quality and fewer depressive symptoms than enlisted personnel. Military personnel with higher educational levels and less physical illness also had fewer depressive symptoms. Officers and noncommissioned officers preferred problem-focused strategies. Those with higher Beck Depression Inventory and Pittsburgh Sleep Quality Index scores and those who drank alcohol frequently preferred affective-focused strategies. conclusions: Our results revealed that sleep quality, physical illness and alcohol consumption were associated with the mental health of military personnel. Treating these factors may improve the mental health of military personnel and enhance effective coping strategies.