Statin Use and the Risk of Dementia in Patients with Stroke: A Nationwide Population-Based Cohort Study.

BACKGROUND: Patients with stroke have an increased risk of dementia. Some studies have found that statin use might lower the risk of incident dementia; however, there is still a lack of data from patients with stroke. Therefore, the aim of our study was to investigate the impact of statin use on the risk of dementia in patients with stroke. METHODS: We used the National Health Insurance Research Database in Taiwan to identify 14,807 patients diagnosed with stroke from 1997 to 2005. These patients were classified as statin users and nonusers. Propensity score matching was performed to balance selected confounders between the statin users and nonusers. Cox proportional hazard regression models were used to evaluate the association between statin use and the risk of dementia. RESULTS: During the follow-up period (median, 7.5 years), 1895 patients were diagnosed with incident dementia. Statin use was associated with a significantly lower incidence of dementia (adjusted hazard ratio, .81; 95% confidence interval, .73-.89) than nonuse was. In particular, lipophilic and high-potency statins were associated with lower risk of dementia. Statin exposure duration was inversely related to the risk of dementia (P < .001 for the trend). No significant effect modification for the relationship between statin use and the risk of dementia was found for either age or sex. CONCLUSION: In this nationwide cohort study, statin use was associated with decreased risk of dementia among patients with stroke. The use of high-potency statins, lipophilic statins, and prolonged exposure to statins may be associated with greater benefits.

Comparison of agomelatine and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors in major depressive disorder: A meta-analysis of head-to-head randomized clinical trials.

OBJECTIVE: Agomelatine is a new antidepressant with unique melatonin receptor type 1A (MTNR1A) and 1B ( MTNR1B) agonism and serotonergic receptor 5-hydroxytryptamine receptor 2C (5-HT-2C) antagonism. Several studies of patients with major depressive disorder (MDD) have confirmed the superior efficacy and safety of agomelatine in comparison with established treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This meta-analysis comprehensively shows the efficacy, acceptability, and safety of agomelatine in comparison with SSRIs and SNRIs used as antidepressants in MDD. METHOD: Comprehensive electronic database searches were performed to identify reports of head-to-head randomized controlled trials that have compared agomelatine with SSRIs or SNRIs in terms of efficacy/effectiveness in treating MDD. Response and remission rates at both acute (6-12 weeks) and follow-up (24 weeks) phases, Clinical Global Impression-Improvement Scale response and remission rates, changes in depression scale scores, improvements in subjective sleep, dropout rates, and side effect rates were extracted and analysed. RESULTS: The meta-analysis included six head-to-head trials involving 1871 patients. In the acute phase, agomelatine had higher response rates (relative risk (RR) 1.08, 95% confidence interval (CI) 1.02-1.15) compared to SSRIs and SNRIs. In the remission analysis, only acute remission rates (RR 1.12, 95% CI 1.01-1.24) significantly differed. The action of agomelatine was superior on the Leeds Sleep Evaluation Questionnaire-Quality of Sleep score (mean difference 4.05, 95% CI 0.61-7.49). Discontinuation due to inefficacy did not differ between agomelatine and SSRIs/SNRIs (RR 0.74, 95% CI 0.42-1.28). Compared to SSRIs and SNRIs, however, agomelatine revealed a lower rate of discontinuation due to side effects (RR 0.38, 95% CI 0.25-0.57). CONCLUSIONS: Agomelatine has significantly higher efficacy and potential acceptability compared to SSRIs and SNRIs when treating MDD. However, the difference in efficacy is not considered clinically relevant. Because of its unique chronobiotic effects, agomelatine may be useful for the management of some MDD patients with circadian disturbance.

Subclinical alterations of resting state functional brain network for adjunctive bright light therapy in nonseasonal major depressive disorder: A double blind randomized controlled trial.

Introduction: The treatment effect of bright light therapy (BLT) on major depressive disorder (MDD) has been proven, but the underlying mechanism remains unclear. Neuroimaging biomarkers regarding disease alterations in MDD and treatment response are rarely focused on BLT. This study aimed to identify the modulatory mechanism of BLT in MDD using resting-state functional magnetic resonance imaging (rfMRI). Materials and methods: This double-blind, randomized controlled clinical trial included a dim red light (dRL) control group and a BLT experimental group. All participants received light therapy for 30 min every morning for 4 weeks. The assessment of the Hamilton Depression Rating Scale-24 (HAMD-24) and brain MRI exam were performed at the baseline and the 4-week endpoint. The four networks in interest, including the default mode network (DMN), frontoparietal network (FPN), salience network (SN), and sensorimotor network (SMN), were analyzed. Between-group differences of the change in these four networks were evaluated. Results: There were 22 and 21 participants in the BLT and dRL groups, respectively. Age, sex, years of education, baseline severity, and improvement in depressive symptoms were not significantly different between the two groups. The baseline rfMRI data did not show any significant functional connectivity differences within the DMN, FPN, SN, and SMN between the two groups. Compared with the dRL group, the BTL group showed significantly increased functional connectivity after treatment within the DMN, FPN, SN, and SMN. Graph analysis of the BLT group demonstrated an enhancement of betweenness centrality and global efficiency. Conclusion: BLT can enhance intra-network functional connectivity in the DMN, FPN, SN, and SMN for MDD patients. Furthermore, BLT improves the information processing of the whole brain. Clinical trial registration: The ClinicalTrials.gov identifier was NCT03941301.

Crime victimization of persons with severe mental illness in Taiwan.

OBJECTIVE: Research in the West has shown that persons with severe mental illness are easy targets of criminals. The aim of the present study was to investigate the types, incidence, and prevalence of crime victimization and its demographic and clinical correlates among persons with severe mental illness in Taiwan. METHODS: Participants diagnosed with schizophrenia or major affective disorders were selected from the psychiatric service of a general hospital. They were asked about any crime perpetrated against them within the preceding year. Only crimes occurring after a psychiatric diagnosis had been made were included. The results of this survey were compared with crimes among the general population in 2000 as reported by the Taiwan Crime Victimization Survey of the Ministry of Justice. RESULTS: The 1 year prevalence of victimization in the study population was 16.8%, compared with 11.3% in the general population. After controlling for demographic and clinical variables it was found that those with affective disorders or a history of alcohol abuse were more likely to be victimized. CONCLUSION: In Taiwan, persons with severe mental illness are more vulnerable to crime victimization than the general population.

Controlled trial of problem-solving therapy and consultation-liaison for common mental disorders in general medical settings in Taiwan.

OBJECTIVE: Common mental disorders (CMD) are prevalent high-impact illnesses seen in general medical settings worldwide. There has been no investigation on the efficacy of enhanced care in Chinese societies. The aim of this study was to compare the outcome of three interventions for treating CMD: usual care (UC), problem-solving therapy plus UC (PST-UC), and psychiatric consultation plus UC (PC-UC). METHOD: The sample for this randomized controlled trial consisted of 254 patients with CMD being managed in general medical care settings. Clinical and functional assessments were done at baseline and at 16 weeks. RESULTS: Two hundred six patients had complete data at 16 weeks (66 in the UC group, 63 in the PST-UC group, 77 in the PC-UC group). All patients had significant improvement on all scales over time, with no significant differences among the three treatment groups. CONCLUSION: This trial failed to demonstrate the efficacy of enhanced care with consultation-liaison by mental health professionals for patients with CMD in general medical settings in Taiwan. Improved outcomes may require more integrated interventions.

Myocardial infarction risk and antipsychotics use revisited: a meta-analysis of 10 observational studies.

OBJECTIVE: Associations between antipsychotic agent (AP) use and myocardial infarction (MI) risk have been inconsistent and remain controversial. We therefore conducted a meta-analysis of observational studies to address this knowledge gap. METHOD: Detailed electronic database searches were performed to identify reports of observational studies that evaluated the association between AP use and the risk of MI. Pooled odds ratios (ORs) were calculated using random or fixed-effects models. RESULTS: In total, four case-control studies, two case-crossover studies, one case-case time control study, three cohort studies, and one self-controlled case series were included. The pooled OR (95% confidence interval (CI)) between any AP use and MI risk was 1.55 (1.33-1.79) compared with non-use: 1.39 (1.06-1.82) for atypical AP use and 1.57 (1.29-1.91) for typical AP use. Subgroup analyses indicated that male gender, schizophrenia diagnosis, and AP exposure periods ≤60 days were associated with higher risk of MI. CONCLUSION: Current evidence, based on 10 observational studies, suggested that AP use might be a potential risk factor of MI. However, we cannot conclude at this time due to significant heterogeneity among studies. We suggest that, instead of not using APs in fear of MI risk, careful cardiovascular monitoring before and during AP treatment in high-risk patients is needed. Additional high-quality prospective studies are required to evaluate the association between APs and the risk of MI.

Prevalence and detection of alcohol use disorders among general hospital inpatients in eastern Taiwan.

OBJECTIVE: To examine (1) the prevalence of alcohol use disorders (AUD) and its various correlates, and (2) the detection rate of AUD by nonpsychiatric physicians and its related factors associated with increased chances of detection among inpatients in a general hospital in rural eastern Taiwan. METHODS: A well-trained psychiatrist interviewed all adult patients admitted during a 1-month period using the Alcohol Inventory and reviewed all medical records for alcohol-related diagnoses. RESULTS: A total of 303 inpatients aged 18 to 93 years were evaluated, of whom 78 (25.7%) were diagnosed by the psychiatrist as having AUD within the past year. Males, aborigines, middle-aged, current smokers and betel quid chewers had a significantly higher odds ratio for AUD. Nonpsychiatric physicians detected only 14.1% patients with recent AUD. Internists identified AUD nearly four times as often as surgeons. Better detection was associated with higher level of alcohol intake. CONCLUSIONS: This study demonstrates the high prevalence of AUD among hospitalized patients in eastern Taiwan and the frequent failure of physicians to identify the disorder. These findings suggest that more effort should be directed toward increasing medical professionals' awareness of AUD in general hospital settings, especially among high-risk groups.

Bidirectional association between obstructive sleep apnea and depression: A population-based longitudinal study.

An association may exist between obstructive sleep apnea (OSA) and depression. However, results regarding this association are inconsistent, and the direction of the association between OSA and depression remains unknown. Therefore, we used the Taiwan National Health Insurance Research Database to investigate the bidirectional association between OSA and depression.A total of 6427 OSA patients and 32,135 age and sex-matched control subjects were enrolled to analyze the risk of depression among patients with OSA, where 27,073 patients with depression and 135,365 control subjects were enrolled to address the risk of OSA among patients with depression. All subjects were followed to identify their outcomes of interest from January 1, 1997 to December 31, 2012.Cox proportional-hazards models, after adjusting for potential confounders, demonstrated that patients with OSA had an increased risk (adjusted hazard ratio 2.48, 95% confidence interval 2.20-2.79) of developing depression, whereas those with depression were associated with an increased risk of future OSA (adjusted hazard ratio 2.30, 95% confidence interval 2.11-2.50).Our results suggested that a strong bidirectional relationship exists between OSA and depression, with each disease influencing the development of the other. Health providers are recommended to ensure the early detection and management of depression among patients with OSA and vice versa.

Resting respiratory sinus arrhythmia is related to longer hospitalization in mood-disordered repetitive suicide attempters.

OBJECTIVES: Our aims were (1) to measure respiratory sinus arrhythmia (RSA), a high-frequency spectrum component of heart rate variability (HRV) in mood-disordered suicide attempters and (2) to investigate the relationship of RSA to symptoms and length of hospitalization. METHODS: Forty-nine female repetitive-suicide attempters with depressive disorder or bipolar disorder were recruited in a general hospital setting. Manic or psychotic patients were excluded. Resting RSA values were calculated from electrocardiogram data, and severity of clinical presentation shortly after admission and length of hospital stay were assessed. RESULTS: RSA was positively associated with a higher Beck Scale for Suicidal Ideation score (r = 0.33 P = 0.019). Stepwise multiple regression analysis showed a significant correlation between RSA and hospitalization length after adjusting other variables (beta coefficient = 3.00; P = 0.030). Patients with a higher resting RSA had more prolonged hospitalizations (hospitalization beyond 30 days) after controlling for other variables (odds ratio = 5.08, P = 0.017). CONCLUSIONS: Interaction between the environment and the autonomic nervous system is complex. Further and more comprehensive research is needed.

Randomized controlled trial of a brief intervention for unhealthy alcohol use in hospitalized Taiwanese men.

AIMS: To evaluate the effectiveness of a brief intervention in hospitalized Taiwanese men to reduce unhealthy alcohol consumption. DESIGN: Randomized controlled trial. SETTING: Medical/surgical wards of a medical centre in Taipei, Taiwan. PARTICIPANTS: Of 3669 consecutive adult male in-patients, 616 were identified as unhealthy alcohol users (>14 drinks/week) and assigned randomly to either usual care (n = 308) or a brief intervention (n = 308). MEASUREMENTS: Primary outcomes were changes in alcohol consumption at 4, 9 and 12 months, including self-reported weekly alcohol consumption, drinking days and heavy drinking episodes assessed by 7-day time-line follow-back. Secondary outcomes were (i) self-reported alcohol problems, (ii) health-care utilization (hospital days and emergency department visits), (iii) self-reported seeking of speciality treatment for alcohol problems and (iv) 3-month Quick Drinking Screen. FINDINGS: Based on intention-to-treat analyses, the intervention group consumed significantly less alcohol than the control group among both unhealthy drinkers and the subgroup of alcohol-dependent participants over 12 months, on both 7-day and 3-month assessments. Adjunctive analyses of only those who completed all assessments found that total drinks consumed did not remain significant. Significantly more participants with alcohol use disorders in the intervention than in the control group (8.3%, 19 of 230 versus 2.1%, four of 189) consulted specialists by 12 months (P = 0.01). However, alcohol-related problems and health-care utilization did not differ significantly in the two groups during follow-up. CONCLUSIONS: Data from Taiwan confirm that brief in-hospital intervention can result in a reduction in alcohol intake by men who drink heavily or are diagnosed with an alcohol use disorder.