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D'Avanzo B, Barbato A, Monzio Compagnoni M, Caggiu G, Allevi L, Carle F, Di Fiandra T, Ferrara L, Gaddini A, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Giordani C, Corrao G, Lora A. The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project. BMC Psychiatry 2023; 23:424. [PMID: 37312076 PMCID: PMC10261835 DOI: 10.1186/s12888-023-04921-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). METHODS Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. RESULTS 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26-1.44): 1.18 (1.07-1.29) in females, 1.60 (1.45-1.77) in males. Heterogeneity across areas was considerable in both cohorts. CONCLUSIONS We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
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Affiliation(s)
- Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy.
| | - Giulia Caggiu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Shen YC, Chen W, Tsai IJ, Wang JH, Lin SZ, Ding DC. Association of hysterectomy with bipolar disorder risk: A population-based cohort study. Depress Anxiety 2019; 36:543-551. [PMID: 31025812 DOI: 10.1002/da.22904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/17/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hormonal fluctuations may trigger the onset of bipolar disorder. We designed a longitudinal follow-up study to evaluate the association between hysterectomies and bipolar disorder risk. METHODS We conducted a large retrospective cohort study using Taiwan's National Health Insurance Research Database. A total of 4,337 women aged 30 to 50 years who underwent the hysterectomy during 2000-2013 were selected and 17,348 patients without hysterectomy were selected for comparison (1:4 match). Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). RESULTS During the follow-up of 7.93 years, 20 participants with hysterectomy and 28 without hysterectomy developed bipolar disorder. Receiving hysterectomy was associated with the risk of developing bipolar disorder (adjusted IRR = 2.80; 95% CI = 2.54-3.09). Women with hysterectomy had a higher risk of bipolar disorder in follow-up durations of <1 year (adjusted IRR = 2.18 with 95% CI = 1.94-1.45) and ≥1 year (adjusted IRR = 2.85 with 95% CI = 2.58-3.15). Endometriosis and Premarin use increased bipolar disorder incidence in the hysterectomy group (adjusted IRR = 3.17 [95% CI = 2.83-3.56] and 4.22 [95% CI = 3.71-4.80], respectively). CONCLUSION This study concluded that women with hysterectomy have an increased risk of bipolar disorder. Endometriosis and hormone therapy may add to the risk of bipolar disorder after hysterectomy. Knowledge about how surgical or natural hormonal withdrawal influences mood is fundamental and emphasizes the importance of coordinated psychiatric and gynecological care.
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Affiliation(s)
- Yu-Chih Shen
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Systemic autoimmune diseases are associated with an increased risk of bipolar disorder: A nationwide population-based cohort study. J Affect Disord 2018; 227:31-37. [PMID: 29049933 DOI: 10.1016/j.jad.2017.10.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/21/2017] [Accepted: 10/06/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Studies suggested autoimmunity plays a role in the etiology of bipolar disorder (BD). This study aimed to investigate the association between systemic autoimmune diseases (SADs) and the subsequent development of BD, and examine the potential risk factors for developing BD. METHODS Patients with SADs were identified in the Taiwan National Health Insurance Program (NHIP). A comparison cohort was created by matching patients without SADs with age. The SADs cohort consisted of 65,498 while the comparison cohort consisted of 261,992 patients. The incidence of BD was evaluated in both cohorts. RESULTS The major finding was the discovery of a higher incidence of subsequent BD among patients with SADs (adjusted hazard ratio: 1.98). Specifically, the risk of BD was observed to be significant increase in systemic lupus erythematosus, rheumatoid arthritis, autoimmune vasculitis, Sicca syndrome and Crohn's disease. Furthermore, our study revealed some potential risk factors for developing BD including female, younger age and patients who lived in eastern Taiwan. Also, some comorbidities including dyslipidemia, chronic obstructive pulmonary disease, diabetes mellitus, asthma, cerebrovascular disease, alcohol used disorder, liver cirrhosis, and malignancies were potential risk factors for incident BD. LIMITATIONS The diagnosis of SADs was based on the catastrophic illness certificate defined by Taiwanese NHIP. Thus, not every form of SADs was explored for subsequent developing BD. CONCLUSION This study confirms that SADs are associated with higher incidence of BD, suggesting that abnormal autoimmune process is associated with increased expression of psychiatric disturbances.
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Lin CY, Chang FW, Yang JJ, Chang CH, Yeh CL, Lei WT, Huang CF, Liu JM, Hsu RJ. Increased risk of bipolar disorder in patients with scabies: A nationwide population-based matched-cohort study. Psychiatry Res 2017; 257:14-20. [PMID: 28709117 DOI: 10.1016/j.psychres.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/17/2017] [Accepted: 07/04/2017] [Indexed: 02/09/2023]
Abstract
Both scabies and bipolar disorder (BD) are common and troublesome disorders. There are several similarities in both diseases: pruritus, a higher prevalence in crowded environments, and cytokine-mediated inflammatory processes in the pathophysiology. We conducted this nationwide population-based study to investigate the possible relationship between scabies and BD. Based on the National Health Insurance Research Database (NHIRD) of Taiwan, a total of 7096 patients with scabies were identified as a study group and 28,375 matched patients as a control. We tracked the patients in both groups for a 7-year period to identify those newly diagnosed with BD. The demographic characteristics and comorbidities of the patients were analyzed, and Cox proportional hazard regressions were performed to calculate the hazard ratio (HR) of BD. Of the 35,471 patients in this study, 183 (0.5%) patients with newly diagnosed BD were identified, with 58 (0.8%) from the scabies group and 125 (0.4%) from the control group. The patients with scabies had a higher risk of subsequent BD, with a crude hazard ratio of 1.86 and an adjusted hazard ratio of 1.55 (95% confidence interval: 1.12-2.09, P < 0.05). This study shows there is an increased risk for BD among patients with scabies. Immunopathology may contribute to this association.
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Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Division of Infection and Pathway Medicine, College of Medicine and Veterinary Medicine, the University of Edinburgh, Scotland, UK.
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Jing-Jung Yang
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
| | - Chia-Lun Yeh
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Chun-Fa Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Nursing, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Barbato A, Vallarino M, Rapisarda F, Lora A, Parabiaghi A, D'Avanzo B, Lesage A. Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. Int J Soc Psychiatry 2016; 62:334-44. [PMID: 26896028 DOI: 10.1177/0020764016631368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. AIMS This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. METHOD Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. RESULTS A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. CONCLUSION Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy
| | - Martine Vallarino
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- Mental Health Department, Lecco Hospital, Lecco, Italy
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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Wang CH, Chen KC, Hsu WY, Lee IH, Chiu NY, Chen PS, Yang YK. Sleep complaints and memory in psychotropic drug-free euthymic patients with bipolar disorder. J Formos Med Assoc 2014; 113:298-302. [DOI: 10.1016/j.jfma.2012.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 11/28/2022] Open
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Tsai KY, Chung TC, Lee CC, Chou YM, Su CY, Shen SP, Lin CH, Chou FHC. Is low individual socioeconomic status (SES) in high-SES areas the same as low individual SES in low-SES areas: a 10-year follow-up schizophrenia study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:89-96. [PMID: 23728232 DOI: 10.1007/s00127-013-0716-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study investigates the relationship between individual and neighborhood socioeconomic status (SES) and mortality among patients with schizophrenia. METHODS A study population was identified from the National Health Insurance Research Database (NHIRD) prior to the end of 1999 that included 60,402 patients with schizophrenia. Each patient was tracked until death or to the end of 2009. Individual SESs were defined by enrollee category. Neighborhood SES was defined by enrollee category (as a proxy for occupation) and education, which were classified according to the conventions of Hollingshead. Neighborhoods were also grouped into advantaged and disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rate between the different SES groups after adjusting for possible confounding factors and risk factors. RESULTS During the 10-year follow-up period, the mortality rates among high, moderate, and low individual SES groups were 12.22, 14.75, and 18.48%, respectively (P < 0.001). Schizophrenia patients with low individual SESs in disadvantaged neighborhoods had a risk of death that was 18-22% higher than that of those with high individual SES in advantaged neighborhoods. The analysis of the combined effect of individual SES and neighborhood SES revealed that the death rates were highest among those with low individual SES and low neighborhood SES (P < 0.001). CONCLUSIONS Schizophrenia patients with low individual SES in disadvantaged neighborhoods have the highest risk of mortality despite a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
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Affiliation(s)
- Kuan-Yi Tsai
- Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd, Lingya District, Kaohsiung City, Taiwan
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Chien IC, Lin CH, Chou YJ, Chou P. Risk of hypertension in patients with bipolar disorder in Taiwan: a population-based study. Compr Psychiatry 2013; 54:687-93. [PMID: 23433221 DOI: 10.1016/j.comppsych.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/13/2013] [Accepted: 01/13/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To examine the prevalence, incidence, and risk factors of hypertension in patients with bipolar disorder in Taiwan. METHOD The National Health Research Institute provided a database of 1,000,000 random subjects for study in Taiwan. Study subjects ≥ 18 years or older had at least one service claim during 2005 for either outpatient or inpatient care, with a primary or secondary diagnosis of hypertension combined with antihypertensive drug treatment were identified. We also compared the incidence of hypertension in patients with bipolar disorder and the general population from 2006 through 2010. RESULTS The 1-year prevalence of hypertension in patients with bipolar disorder was higher than the general population (18.13% vs. 13.22%, odds ratio, 1.43; 95% confidence interval, 1.25-1.64) in Taiwan. Compared with the general population, patients with bipolar disorder had a higher prevalence of hypertension among 18- to 39-year-olds and 40- to 59-year-olds, in both sexes, and in the group with lower socioeconomic status. The average annual incidence of hypertension in patients with bipolar disorder from 2006 to 2010 was higher than the general population (2.83% vs. 1.99%, risk ratio, 1.40; 95% confidence interval, 1.20-1.62). Patients with bipolar disorder had a higher incidence of hypertension among 18- to 39-year-olds and 40- to 59-year-olds and in both sexes compared with the general population. CONCLUSIONS Patients with bipolar disorder had a higher prevalence and a higher incidence of hypertension than those in the general population. Prevention, early detection, and comprehensive treatment of hypertension are important issues for patients with bipolar disorder.
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Affiliation(s)
- I-Chia Chien
- Department of Health, Taoyuan Mental Hospital, Taoyuan, Taiwan.
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Sung TI, Chen MJ, Su HJ. A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 2013; 48:295-302. [PMID: 22763494 DOI: 10.1007/s00127-012-0542-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/15/2012] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study characterizes the positive relationship between daily temperature and bipolar disorder in a cohort of Taiwanese psychiatric inpatients. METHODS Meteorological data, provided by the Central Weather Bureau (CWB) of Taiwan, were interpolated to create representative estimates of mean diurnal temperatures for 352 townships. Psychiatric inpatient admissions enrolled in the national health-care insurance system were retrieved from the 1996-2007 Psychiatric Inpatient Medical Claim (PIMC) dataset. The generalized linear mixed models with Poisson distribution were used to evaluate the relative risks of mean diurnal temperature with respect to increased admissions for bipolar disorder, while adjusting for internal correlations and demographic covariates. RESULTS Increased relative risks of bipolar disorder admissions were associated with the increasing trends of temperature over 24.0 °C (50th ‰), especially for adults and females. The highest daily diurnal temperatures above 30.7 °C (99th ‰) had the greatest risks of bipolar hospitalizations. CONCLUSION Understanding the increase of bipolar disorder admissions occurring in extreme heat is important in the preparation and prevention of massive recurrences of bipolar episodes.
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Affiliation(s)
- Tzu-I Sung
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Rd, Tainan 704, Taiwan
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Hwang DK, Chou YJ, Pu CY, Chou P. Epidemiology of Uveitis among the Chinese Population in Taiwan. Ophthalmology 2012; 119:2371-6. [DOI: 10.1016/j.ophtha.2012.05.026] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 05/14/2012] [Accepted: 05/14/2012] [Indexed: 01/14/2023] Open
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Tsai KY, Lee CC, Chou YM, Su CY, Chou FHC. The incidence and relative risk of stroke in patients with schizophrenia: a five-year follow-up study. Schizophr Res 2012; 138:41-7. [PMID: 22386734 DOI: 10.1016/j.schres.2012.02.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/31/2012] [Accepted: 02/10/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. METHODS This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. RESULTS Over five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05-1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06-1.41; P=0.0052). CONCLUSIONS During a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.
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Affiliation(s)
- Kuan-Yi Tsai
- Department of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung City, Taiwan
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Chou FHC, Tsai KY, Su CY, Lee CC. The incidence and relative risk factors for developing cancer among patients with schizophrenia: a nine-year follow-up study. Schizophr Res 2011; 129:97-103. [PMID: 21458957 DOI: 10.1016/j.schres.2011.02.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 02/17/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the incidence and relative risk of developing cancer as well as the mortality rate after cancer diagnosis for patients with schizophrenia compared with the general population. METHODS Our population for this study was identified before the end of 1999. The study included 59,257 patients with schizophrenia and 178,156 age- and gender-matched individuals without schizophrenia as controls, who were selected from the 23,981,020 subjects in the National Health Insurance Research Database (NHIRD), which consists of 96% of the entire Taiwanese population. From the 2000 to 2008 NHIRD, we calculated the cancer incidence and survival time after cancer diagnosis in each of the two groups. Based on the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), the cancers were divided into nine groups. RESULTS During the nine-year follow-up period, 1145 (1.93%) of the patients with schizophrenia and 5294 (2.97%) of the control group developed cancer. The patients with schizophrenia had a significantly lower cancer incidence than those in the control group in both the male (OR=0.50, 95% CI, 0.46-0.55) and female (OR=0.81, 95% CI, 0.74-0.88) populations. Patients with schizophrenia were less likely to develop cancer than individuals in the control group for every cancer type except breast and cervical/uterine cancer. After adjustment using the Cox regression model, patients with schizophrenia had an overall decreased cancer risk (adjusted hazard ratio 0.71, 95% CI, 0.66-0.76) compared to the control population. For all cancer patients, the mortality adjusted hazard ratio for patients with schizophrenia versus the control group was 1.36 (95% CI, 1.24-1.50) after adjusting for other variables. CONCLUSIONS Although the likelihood of developing cancer among patients with schizophrenia (0.64) was less than that of the non-schizophrenia group, the mortality rate among patients with schizophrenia was higher than that of the control group.
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Affiliation(s)
- Frank Huang-Chih Chou
- Department of Community Psychiatry, Kai-Suan Psychiatric Hospital, Kaohsiung City, Taiwan
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Chien IC, Bih SH, Lin CH, Chou YJ, Lee WG, Lee CH, Chou P. Correlates and psychiatric disorders associated with psychotropic drug use in Taiwan. Soc Psychiatry Psychiatr Epidemiol 2011; 46:77-84. [PMID: 19924363 DOI: 10.1007/s00127-009-0169-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 11/03/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE We used the population-based National Health Insurance database to investigate correlates and psychiatric disorders associated with psychotropic drug use in Taiwan. METHODS The National Health Research Institute provided a database of 200,000 random subjects for study. We obtained a random sample of 145,304 subjects aged 18 years or older in 2004. Study subjects who had made at least two psychotropic drug prescriptions during this year were identified. We detected factors associated with psychotropic drug use. In addition, we examined the prevalence of antipsychotic, antidepressant, mood stabilizer, sedative-hypnotic-anxiolytic (SHA) agent, and any psychotropic drug use according to psychiatric disorders. RESULTS Higher prevalence of any psychotropic drug use was found in the 25-44, 45-64, and 65 or older age groups, females, aborigine, with a lower premium, with disability, and among those who lived in central region, suburban or rural area. Among those subjects with any major psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent, and any psychotropic drug use were 59.3, 49.7, 17.9, 78.6, and 92.0%, respectively. Among those subjects with any minor psychiatric disorders, the prevalence of antipsychotic, antidepressant, mood stabilizer, SHA agent and any psychotropic drug use were 17.5, 41.8, 4.0, 85.5, and 89.4%, respectively. CONCLUSIONS Thus, those subjects with any psychiatric disorders had a high percentage of any psychotropic drug use in National Health Insurance program in Taiwan. Future studies should focus on the outcome evaluation and correlates associated with individual psychotropic use.
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Affiliation(s)
- I-Chia Chien
- Jianan Mental Hospital, No. 80, Lane 870, Jhongshan Road, Rende Township, Tainan, Tainan County, 71742, Taiwan.
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Chien IC, Chang KC, Lin CH, Chou YJ, Chou P. Prevalence of diabetes in patients with bipolar disorder in Taiwan: a population-based national health insurance study. Gen Hosp Psychiatry 2010; 32:577-82. [PMID: 21112448 DOI: 10.1016/j.genhosppsych.2010.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/08/2010] [Accepted: 09/10/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We investigated the prevalence and correlates of diabetes in patients with bipolar disorder in Taiwan. METHODS The National Health Research Institute provided a database of 1,000,000 random subjects from which we selected a sample of 766,427 subjects aged 18 years and over. We identified study subjects who had at least one service claim during 2005, with a primary diagnosis of bipolar disorder or with a prescription for treatment of diabetes. RESULTS The prevalence of diabetes in patients with bipolar disorder was higher than in the general population (10.77% vs. 5.57%, OR, 2.01; 99% CI, 1.64-2.48). Compared with the general population, patients with bipolar disorder had a higher prevalence of diabetes in all age groups under 60 years; among females and males; among lower insurance amount groups; among those living in the northern, central and southern regions and among residents living in urban and rural areas. Antipsychotic use was associated with a higher prevalence of diabetes in persons with bipolar disorder. CONCLUSIONS Patients with bipolar disorder had a higher prevalence of diabetes than the general population. Prevention, early detection and treatment of diabetes are important issues for patients with bipolar disorder.
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Affiliation(s)
- I-Chia Chien
- Department of Health, Taoyuan Mental Hospital, Taoyuan City, Taoyuan County 33058, Taiwan.
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