Quality of life and its associated factors among patients with two common types of chronic mental illness living in Kaohsiung City.

AIM: This study explored the associations of personal, disease, family, and social factors with quality of life (QoL) in patients with two common types of chronic mental illness (CMI) living in Kaohsiung City, Taiwan. METHODS: Using a convenience sample and a cross-sectional design, 714 patients (50.1% male, 49.9% female) with CMI (72.1% schizophrenia and 27.9% affective disorder) and their caregivers were recruited. Demographic information was collected via the following questionnaires: 12-Item Short-Form Health Survey (SF-12), five-item Brief Symptom Rating Scale (BSRS-5), Caregiver Burden Scale, and Clinical Global Impressions (CGI-S) Scale. Pearson correlations and hierarchical regression analyses were used to predict QoL. RESULTS: Disease factors accounted for 17-50% of the change in variance. Predictors of low mental subscale scores included the following: high psychological distress and high family burden as well as a history of suicide attempts, negative caregiver attitudes, and living away from home. Disease factors also explained the greatest variance in the physical subscales. Predictors of low physical subscale scores included the following: high psychological distress, age, unemployment, a history of suicide attempts, high family burden, and living alone. CONCLUSIONS: Disease factors were the most important predictors of QoL in patients with CMI. Family factors were more important than social factors on the mental subscales. Differential relationships were also found for the other two dimensions. Together, these results indicate that a wide range of factors improve the QoL in patients with CMI.

Early prediction of clinical response in schizophrenia patients receiving the atypical antipsychotic zotepine.

OBJECTIVE: Prior early prediction models for antipsychotic treatment response demonstrate good specificity but poor sensitivity (i.e., high false-negative rates). The purpose of this study was to refine the early prediction model in schizophrenia patients taking an atypical antipsychotic agent, zotepine. METHOD: 135 acutely ill inpatients with DSM-IV-defined schizophrenia received 4 weeks of 150 mg/day zotepine treatment. Psychopathology severity was assessed weekly with the Brief Psychiatric Rating Scale (BPRS) and subscales for positive, negative, and general symptoms. Clinical response was defined as a reduction of 20% or more in the BPRS total score at week 4. A logistic regression model was used to obtain early predictors. The receiver operating characteristic curve was employed to determine the optimal cutoff points of the variables for predicting response. The study was conducted from June 2004 to April 2005. RESULTS: The most significant early predictors for ultimate response at week 4 were BPRS positive subscale score changes at week 1 and, better, at week 2 (p < .001 at both timepoints). At week 1, a BPRS positive score reduction of 4 appeared to be the optimal cutoff point for predicting eventual response, providing a sensitivity of 0.77 and specificity of 0.77. At week 2, a BPRS positive score reduction of 6 was the best for prediction, with a sensitivity of 0.83 and specificity of 0.91. CONCLUSIONS: These findings suggest that using the first 2 weeks' improvement in positive symptoms to predict the fourth week's treatment response is favorable in terms of both specificity and sensitivity. Further studies are needed. Moreover, whether this model could be applied to establish a prediction system for other antipsychotics or other psychotropics also deserves research.

The relationship between quality of life and posttraumatic stress disorder or major depression for firefighters in Kaohsiung, Taiwan.

OBJECTIVE: The work of firefighters involves the risk of exposure to the harmful effects of toxic substances as well as the possibility of enormous emotional shock from disasters, which may result in psychiatric impairments and a lower quality of life. Therefore, we examined quality of life, prevalence of posttraumatic stress disorder (PTSD) and major depression, and the related risk factors for firefighters in Kaohsiung, Taiwan. METHODS: This is a two-stage survey study. During the first stage, we used the 36-item Short-Form Health Survey (SF-36) and the Disaster-Related Psychological Screening Test (DRPST) to assess quality of life, probable PTSD, probable major depression, and the related risk factors for 410 firefighters. During the second stage, psychiatrists categorized these probable cases according to self-reported questionnaires against DSM-IV into PTSD or major depression group, subclinical group, and health group. All the data were analyzed with SPSS 10.0 Chinese version. RESULTS: The estimated current prevalence rates for major depression and PTSD were 5.4% (22/410) and 10.5% (43/410), respectively. The firefighters with estimated PTSD or major depression scored significantly lower on quality of life measures than subclinical PTSD/major depression and mentally healthy groups, which was evident in eight concepts and two domains of the SF-36. The major predictors of poor quality of life and PTSD/major depression were mental status, psychosocial stressors, or perceived physical condition. CONCLUSION: Firefighters have a higher estimated rate of PTSD, and the risk factors that affect quality of life and PTSD/major depression should encourage intervention from mental health professionals.

Factors affecting time to rehospitalization for patients with major depressive disorder.

Major depressive disorder is a common psychiatric condition. Hospitalization is usually indicated for patients with more severe symptoms and severe functional impairment. Rehospitalization is known as the re-emergence of significant depressive symptoms. The purpose of the present study was to investigate the risk factors affecting time to rehospitalization. Rehospitalization status was monitored for all patients with major depressive disorder discharged from Kai-Suan Psychiatric Hospital between 1 January 2002 and 31 December 2003. Patients were followed up with respect to rehospitalization until 31 December 2004. The Kaplan-Meier method was used to calculate the median time to rehospitalization. Risk factors associated with rehospitalization were examined on Cox proportional hazards regression. Three hundred patients were recruited. Median time to readmission was 174 days (SD = 37). Comorbid alcohol abuse/dependence (hazard ratio [HR] = 1.841, 95% confidence interval [CI] = 1.229-2.758, P < 0.01), comorbid personality disorders (HR = 1.530, 95%CI = 1.053-2.223, P < 0.05), and the number of previous hospitalizations (HR = 1.121, 95%CI = 1.056-1.190, P < 0.001) were found to be predictors of the shorter time to rehospitalization over the 360-day study. Further research should be carried out to test risk factors in a prospective study, and to study the cost-effectiveness of interventions to reduce risk factors and rehospitalizations.

Effects of Asian dust storm events on daily stroke admissions in Taipei, Taiwan.

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of ADS on the hospital stroke admissions of residents in Taipei, Taiwan, during the period from 1996 to 2001. We identified 54 dust storm episodes, which were classified as index days. Daily stroke admissions on the index days were compared with admissions on the comparison days. We selected two comparison days for each index day, 7 days before the index days and 7 days after the index days. The study results indicated a statistically significant association between ADS events and daily primary intracerebral hemorrhagic stroke admissions 3 days after the event (relative risk of 1.15; 95% CI, 1.01-10.10). We also found a positive but nonsignificant association between ADS events and ischemic stroke admissions 3 days following the dust storms. This was due mainly to PM(10). We conclude that more attention be given to ADS events and health in the future.

Effects of Asian dust storm events on daily hospital admissions for cardiovascular disease in Taipei, Taiwan.

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible effects of ADS on the hospital cardiovascular disease (CVD) admissions of residents in Taipei, Taiwan, during the period from 1996 to 2001. Fifty-four dust storm episodes, which were classified as index days, were identified. Daily CVD admissions on index days were compared with admissions on comparison days. Two comparison days were selected for each index day, 7 d before the index day and 7 d after the index day. The effects of dust storms on CVD were prominent 1 d after the event (3.65% increase). However, the association was not statistically significant. Nonetheless, it may be worthwhile to focus more on the potential adverse effects of ADS events in the future.

The attitude toward truth telling of cancer in Taiwan.

OBJECTIVE: This study examined a group of Taiwanese subjects at a medical university hospital regarding their attitudes toward truth telling of cancer. METHOD: Self-report survey with convenience sampling of 195 participants admitted for a 3-day comprehensive health examination in a medical university hospital in Taiwan. Three instruments used to collect the data included the Brief Psychiatric Symptom Rating Scale (BPSRS), Chinese Health Questionnaire (CHQ), and the Attitude Toward Truth Telling of Cancer List. RESULTS: Once diagnosed with cancer, 92.3% of the participants preferred being told the truth about their diagnosis and 7.7% did not. Age, education, and employment were found to differ between disclosure and nondisclosure groups. The latter group also tended to have higher depression and hostility scores on the BPSRS and higher minor psychiatric morbidity scores. A total of 62.6% of the participants preferred that doctors tell a relative the truth about their cancer diagnosis, while 37.4% preferred that doctors not tell a relative the truth. The distributions of demographic data and mental status did not significantly differ between disclosure and nondisclosure groups if a relative was to be the cancer victim. CONCLUSIONS: A majority of subjects in Taiwan would prefer to know the truth if victimized by a cancer disease, despite the supposed influence of Chinese culture. Furthermore, attitudes toward truth telling of cancer differed between relatives of patients and the patients themselves. Relatives of cancer patients were more likely to follow to the principle of beneficence, whereas the patients themselves were more likely to follow to the principle of autonomy.

Effects of Asian dust storm events on daily mortality in Taipei, Taiwan.

In spring, windblown dust storms originating in the deserts of Mongolia and China make their way to Taipei City. These occurrences are known as Asian dust storm events. The objective of this study was to assess the possible effects of Asian dust storms on the mortality of residents in Taipei, Taiwan, during the period from 1995 to 2000. We identified 39 dust storm episodes, which were classified as index days. Daily deaths on the index days were compared with deaths on the comparison days. We selected two comparison days for each index day, 7 days before the index day and 7 days after the index day. The strongest estimated effects of dust storms were increases of 7.66% in risk for respiratory disease 1 day after the event, 4.92% for total deaths 2 days following the dust storms and 2.59% for circulatory diseases 2 days following the dust storms. However, none of these effects were statistically significant. This study found greater specificity for associations with respiratory deaths, and this increases the likelihood that the association between dust events and daily mortality represents a causal relationship.

Relationship between ambient air pollution and hospital admissions for cardiovascular diseases in kaohsiung, taiwan.

This study was undertaken to determine whether there is an association between air pollutants levels and increased number of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions records for CVD and ambient air contaminant data collected from monitoring station in Kaohsiung were obtained for the period 1997-2000. The relative risk of hospital admission for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant model, on warm days (> or =25 degrees C) statistically significant positive associations were found between levels of particular matter of < 10 microm aerodynamic diameter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). On cool days (< 25 degrees C), all pollutants except O3 were significantly associated with increased CVD admissions. For the two-pollutant model, CO and O3 were both significant in combination with each of the other four contaminants on warm days. PM10 and NO2 remained significantly associated with elevated CVD admissions on warm days. On cool days, CO and NO2 remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient contaminants, particularly CO, increase the risk of increased hospital admissions for CVD.

Depression in chronic haemodialysed patients.

From April 2000 to April 2001, a total of 108 chronic stable haemodialysed patients (34 males aged 57.76 +/- 12.68 years under haemodialysis treatment for 31.41 +/- 24.71 months and 74 females aged 54.99 +/- 12.87 years under haemodialysis for 41.47 +/- 33.47 months) were studied for signs of clinical depression. Depression was measured by using 'The Taiwanese Depression Questionnaire (TDQ)'. After analysing various possible factors, we chose to study three dimensions: affective change, somatic complaint and cognitive disturbance. Thirty-six (33.4%) of the patients were found to have TDQ scores above 19; our cut-off value. Diabetic patients were also found to have higher depression scores and affective change scores than those without diabetes. The elderly suffered more from somatic complaints, and patients without jobs also tended to have higher depression scores. We compared the nutrition indexes and uraemic toxin removal indexes of those with higher depression scores (score > or =19) with those with normal scores (score <19), and we found no differences between the two groups. We found that an underlying disease and job status were the major differences found in the two groups. Therefore, our findings suggest that the depression found in our chronic haemodialysed patients was not a result of the physical conditions, but a result of psychosocial problems indicating a need for psychosocial support for these patients.