Multiple Factors Associated With Child Abuse Perpetration: A Nationwide Population-Based Retrospective Study.

Differences in child abuse perpetration between individuals with and without mental disorders remain obscure. This study compared the risk difference and further investigated the association between the category of mental disorders and child abuse perpetration. A total of 681,970 adults from the 2002 to 2013 Taiwan National Health Insurance Research Database were analyzed, including 340,985 patients with psychiatric disorders (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 290.x-319.x) and 340,985 sex- and age-matched individuals without psychiatric disorders. Child abuse perpetration (ICD-9-CM N-codes 995.5x and E-code E967) was the outcome variable. Matched analyses indicated that the risk of child abuse among patients with psychiatric disorders (0.25%) was significantly higher than that among those without psychiatric disorders (0.16%; odds ratio [OR] = 1.464, p < .0001). Among the six categories of mental disorders, the prevalence rates of committing child abuse were significantly higher for personality disorders, substance use, and affective disorders (0.56%, 0.45%, and 0.40%, respectively; p < .0001). Compared with anxiety disorders, substance use disorders were significantly associated with higher odds of child abuse perpetration (OR = 2.032, p < .05), especially physical abuse (OR = 2.018, p < .0001). Psychiatric morbidity was associated with higher odds of child abuse, with substance use determined as the major risk category. Screening high-risk families by using the associated factors is crucial.

Association between Thioridazine Use and Cancer Risk in Adult Patients with Schizophrenia-A Population-Based Study.

OBJECTIVE: Several cell line studies have demonstrated thioridazine's anticancer, multidrug resistance-reversing and apoptosis-inducing properties in various tumors. We conducted this nationwide population-based study to investigate the association between thioridazine use and cancer risk among adult patients with schizophrenia. METHODS: Based on the Psychiatric Inpatient Medical Claim of the National Health Insurance Research Database of Taiwan, a total of 185,689 insured psychiatric patients during 2000 to 2005 were identified. After excluding patients with prior history of schizophrenia, only 42,273 newly diagnosed patients were included. Among them, 1,631 patients ever receiving thioridazine for more than 30 days within 6 months were selected and paired with 6,256 randomly selected non-thioridazine controls. These patients were traced till 2012/12/31 to see if they have any malignancy. RESULTS: The incidence rates of hypertension and cerebrovascular disease were higher among cases than among matched controls. The incidence of hyperlipidemia, coronary artery disease and chronic pulmonary disease did not differ between the two groups. By using Cox proportional hazard model for cancer incidence, the crude hazard ratio was significantly higher in age, hypertension, hyperlipidemia, cerebrovascular disease, coronary artery disease and chronic pulmornary disease. However, after adjusting for other covariates, only age and hypertension remained significant. Thioridazine use in adult patients with schizophrenia had no significant association with cancer. CONCLUSION: Despite our finding that thioridazine use had no prevention in cancer in adult patients with schizophrenia. Based on the biological activity, thioridazine is a potential anticancer drug and further investigation in human with cancer is warranted.

Risk of First Onset Stroke in SSRI-Exposed Adult Subjects: Survival Analysis and Examination of Age and Time Effects.

OBJECTIVE: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. METHODS: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). RESULTS: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P < .001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. CONCLUSIONS: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.