Effects of cognitive stimulus therapy on middle-aged and elderly institutionalized patients with chronic schizophrenia with declined cognition.

PURPOSE: This study investigates whether using group Cognitive Stimulation Therapy (CST) effectively improves functioning among middle-aged and elderly patients with chronic schizophrenia and a below-normal cognitive range. METHODS: The study included an experimental group (N = 24), which was divided into two sub-groups to receive group CST, and a control group (N = 24), who received treatment as usual (TAU). We assessed cognitive functions using the Mini-Mental Status Examination (MMSE). We evaluated the emotional status, psychotic symptoms, and quality of life using the Geriatric Depression Scale short-form 15 (GDS-15), the Brief Psychiatric Rating Scale (BPRS), and the Dementia-Quality of Life (D-QoL) instrument. We performed all measures at three-time points: pre-CST, post-CST, and 3-month follow-up. RESULTS: We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up. RESULTS: We found group CST can significantly improve cognitive performance, especially the ability to use new information, after group CST intervention. However, the experimental group did not maintain this effect at the 3-month follow-up. CONCLUSION: This study supports group CST can delay the degradation of some cognitive functions in long-term hospitalized patients with chronic schizophrenia for the duration of the intervention. This finding has important clinical implications for long-term institutionalized middle-aged and elderly chronic schizophrenic patients with a below-normal cognitive range in an aging society.

Risk and protective factors for suicide mortality among patients with alcohol dependence.

OBJECTIVE: People with alcohol dependence suffer from poor health outcomes, including excessive suicide mortality. This study estimated the suicide rate and explored the risk and protective factors for suicide in a large-scale Asian population. METHOD: We enrolled patients with alcohol dependence (ICD-9 code 303**) consecutively admitted to a psychiatric center in northern Taiwan from January 1, 1985, through December 31, 2008 (N = 2,793). Using patient linkage to the national mortality database (1985-2008), we determined that 960 patients died during the study period. Of those deaths, 65 patients died of suicide. On the basis of risk-set sampling for the selection of controls, we conducted a nested case-control study and collected the information by means of a standardized chart review process. We estimated the standardized mortality ratio (SMR) for suicide mortality. Conditional logistic regression was employed for exploring the risk and protective factors for suicide. RESULTS: The study subjects had excessive suicide and all-cause deaths, with SMRs of 21.2 and 12.7, respectively. We pinpointed auditory hallucination (adjusted risk ratio [aRR] = 1.80, P = .04) and attempted suicide (aRR = 7.52, P = .001) as the risk factors associated with suicide. In contrast, protective factors included financial independence (aRR = 0.11, P = .005) and being married (aRR = 0.16, P = .02). Intriguingly, those with physical illnesses had a lower risk of suicide (aRR = 0.15, P = .01). CONCLUSIONS: Compared with the general population, those with alcohol dependence faced excessive suicide mortality. For a comprehensive approach to suicide prevention, recognizing and improving the protective factors could have equal importance in mitigating the risk of suicide.

Risk factors for sudden cardiac death among patients with schizophrenia.

INTRODUCTION: Patients with schizophrenia suffer from excessive premature mortality, and sudden cardiac death (SCD) is receiving growing attention as a potential cause. AIM: The present study investigated the incidence of SCD and its risk factors in a large schizophrenia cohort. METHODS: We enrolled a consecutive series of 8264 patients diagnosed with schizophrenia (according to DSM-III-R and DSM-IV criteria) who were admitted to a psychiatric center in northern Taiwan from January 1, 1985 through December 31, 2008. By linking with national mortality database, 64 cases of SCD were identified. The standardized mortality ratio (SMR) for SCD was estimated. The cases were matched with controls randomly selected using risk-set sampling in a 1:2 ratio. A standardized chart review process was used to collect socio-demographic and clinical characteristics and the prescribed drugs for each study subject. Multivariate conditional logistic regression analysis was used to identify correlates of SCD at the index admission and the latest admission. RESULTS: The SMR for SCD was 4.5. For the clinical profiles at the index admission, physical disease (adjusted risk ratio [aRR]=2.91, P<.01) and aggressive behaviors (aRR=3.99, P<.01) were associated with the risk of SCD. Regarding the latest admission, electrocardiographic abnormalities (aRR=5.46, P<.05) and administration of first-generation antipsychotics (aRR=5.13, P<.01) elevated the risk for SCD. Consistently, aggressive behaviors (aRR=3.26, P<.05) were associated with increased risk as well. CONCLUSIONS: Apart from cardiovascular profiles and antipsychotics, physical aggression is a crucial risk factor that deserves ongoing work for clarifying the mechanisms mediating SCD in schizophrenia.

Excessive suicide mortality and risk factors for suicide among patients with heroin dependence.

BACKGROUND: The mortality risk is high among individuals dependent on heroin, and suicide is a severe consequence of long-term heroin use. We estimated the incidence of suicide mortality and its risk factors in a large Asian cohort with heroin dependence. METHODS: A consecutive series of 2750 inpatients dependent on heroin admitted to a psychiatric center in northern Taiwan between 1990 and 2010 were retrospectively enrolled as the study cohort. These patients were linked to the Taiwan National Mortality Database to obtain each mortality event. We determined the Standardized Mortality Ratio (SMR) for each cause of death. Among the deceased, 69 deaths were due to suicide (cases); 138 controls were randomly selected using risk-set density sampling based on a nested case-control design. We collected clinical information from subjects' medical records. Multivariate conditional logistic regression was employed to explore the correlates of suicide mortality. RESULTS: The findings showed a 7.9-fold SMR for all-cause mortality among heroin users compared to the general population while the SMR for suicide mortality was 16.2. Multivariate analysis showed that suicide attempt as the reason for the index admission (adjusted risk ratio [RR] = 4.29, p = 0.035) and depressive syndrome anytime during life (adjusted RR = 2.61, p = 0.019) were associated with the risk of suicide mortality. CONCLUSIONS: Individuals dependent on heroin are more likely to die of suicide compared to the general population. We recommend that clinical psychiatric staff carefully gather information related to the identified risk factors to prevent suicide among heroin users.