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Whether the first-degree relatives (FDRs) of patients with obsessive-compulsive disorder (OCD) have an increased risk of the major psychiatric disorders, namely schizophrenia, bipolar disorder, OCD, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), remains unclear.
Using the Taiwan National Health Insurance Research Database with the whole population sample size (n = 23 258 175), 89 500 FDRs, including parents, offspring, siblings, and twins, of patients with OCD were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with OCD.
FDRs of patients with OCD had higher RRs of major psychiatric disorders, namely OCD (RR 8.11, 95% confidence interval (CI) 7.68–8.57), bipolar disorder (RR 2.85, 95% CI 2.68–3.04), MDD (RR 2.67, 95% CI 2.58–2.76), ASD (RR 2.38, 95% CI 2.10–2.71), ADHD (RR 2.19, 95% CI 2.07–2.32), and schizophrenia (RR 1.97, 95% CI 1.86–2.09), compared with the total population. Different familial kinships of FDRs, such as parents, offspring, siblings, and twins consistently had increased risks for these disorders. In addition, a dose-dependent relationship was found between the numbers of OCD probands and the risk of each major psychiatric disorder.
The FDRs, including parents, offspring, siblings, and twins, of patients with OCD have a higher risk of OCD, schizophrenia, bipolar disorder, MDD, ADHD, and ASD. The familial co-aggregation of OCD with OCD and other major psychiatric disorders was existent in a dose-dependent manner. Given the increased risks of psychiatric disorders, medical practitioners should closely monitor the mental health of the FDRs of patients with OCD.
Major depressive disorder (MDD) is highly heterogeneous and can be classified as treatment-resistant depression (TRD) or antidepressant-responsive depression (non-TRD) based on patients' responses to antidepressant treatment. Methods for distinguishing between TRD and non-TRD are critical clinical concerns. Deficits of cortical inhibition (CI) have been reported to play an influential role in the pathophysiology of MDD. Whether TRD patients' CI is more impaired than that of non-TRD patients remains unclear.
Paired-pulse transcranial magnetic stimulation (ppTMS) was used to measure cortical inhibitory function including GABAA- and GABAB-receptor-related CI and cortical excitatory function including glutamate-receptor-related intracortical facilitation (ICF). We recruited 36 healthy controls (HC) and 36 patients with MDD (non-TRD, n = 16; TRD, n = 20). All participants received evaluations for depression severity and ppTMS examinations. Non-TRD patients received an additional ppTMS examination after 3 months of treatment with the SSRI escitalopram.
Patients with TRD exhibited reduced short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI), as shown by abnormally higher estimates, than those with non-TRD or HC (F = 11.030, p < 0.001; F = 10.309, p < 0.001, respectively). After an adequate trial of escitalopram treatment, the LICI of non-TRD reduced significantly (t = − 3.628, p < 0.001), whereas the ICF remained lower than that of HC and showed no difference from pretreatment non-TRD.
TRD was characterized by relatively reduced CI, including both GABAA- and GABAB-receptor-mediated neurons while non-TRD preserved partial CI. In non-TRD, SSRIs may mainly modulate GABAB-receptor-related LICI. Our findings revealed distinguishable features of CI in antidepressant-resistant and responsive major depression.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.
Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.
FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.
Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.
This paper develops an analytically tractable, two-country, two-traded-good dynamic general-equilibrium model of money to examine the long-run and short-run effects of a temporary change in the domestic inflation target on the trade pattern, the terms of trade, the foreign exchange rate, and the capital accumulation of each country and of the world economy. We find that such a temporary monetary innovation can generate permanent effects on the world distribution of capital and the pattern of trade, resulting in nonneutrality in an otherwise money-neutral cash-in-advance setting. This change also leads to very rich transitional dynamics that we fully characterize analytically. In particular, endogenous responses in transition can be monotone or nonmonotone and can exhibit over-shooting. Our analytic findings and quantitative results help explain some noticeable changes in the capital accumulation, output, and bilateral trade of several countries adopting inflation targeting. Since the permanent effects of a temporary change in the domestic inflation target on the pattern of international trade and the performance of the macroeconomy are driven by a new channel through the world distribution of capital, we add new insights to the literature.
Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.
To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.
Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.
ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).
ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.
The Virtue Existential Career Model (VEC) is a Chinese career development model based on the Classic of Changes. It is designed to supplement the person-environment fit paradigm of Taiwan's 12-Year Basic Education for junior high school students. We adopted an action research approach with two parts, reflection-on-action and critical-emancipatory. An easy-to-use VEC career curriculum and a career information system (Career Genesis; CG) were developed by a team of staff members from government agencies (Tainan Department of Education and Student Counseling Centers), junior high schools, and the Chinese Career Research Center of National Changhua University of Education, Taiwan. The outcome of this project was strong on fostering interconnectedness. Implementing our VEC curriculum and CG to 30 junior high school students received statistically significant immediate increases in resilience, adaptation, and liking of career decision. The feedback and reflections suggest that mandating, attracting, and simplifying are useful strategies to promote our VEC model as well as to facilitate social change and create a multiple-win situation for all parties involved. This approach also follows the tao (道) of the Classic of Changes to provide new knowledge.
Previous evidence has shown positive associations between post-traumatic
stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes
mellitus, which are all risk factors for stroke, but the role of PTSD in
the subsequent development of stroke is still unknown.
To investigate the temporal association between PTSD and the development
Identified from the Taiwan National Health Insurance Research Database,
5217 individuals aged 18 years, with PTSD but with no history of stroke,
and 20 868 age- and gender-matched controls were enrolled between 2002
and 2009, and followed up until the end of 2011 to identify the
development of stroke.
Individuals with PTSD had an increased risk of developing any stroke
(hazard ratio (HR) 3.37, 95% CI 2.44–4.67) and ischaemic stroke (HR =
3.47, 95% CI 2.23–5.39) after adjusting for demographic data and medical
comorbidities. Sensitivity tests showed consistent findings (any stroke
HR = 3.02, 95% CI 2.13–4.28; ischaemic stroke HR = 2.89, 95% CI
1.79–4.66) after excluding the first year of observation.
Individuals with PTSD have an increased risk of developing any stroke and
ischaemic stroke. Further studies are required to investigate the
This study presents a numerical solution to the three-dimensional solute transport in heterogeneous media by using a layer-integrated approach. Omitting vertical spatial variation of soil and hydraulic properties within each layer, a three-dimensional solute transport can be simplified as a quasi-three-dimensional solute transport which couples a horizontal two-dimensional simulation and a vertical one-dimensional computation. The finite analytic numerical method was used to discretize the derived two-dimensional governing equation. A quadratic function was used to approximate the vertical one-dimensional concentration distribution in the layer to ensure the continuity of concentration and flux at the interface between the adjacent layers. By integration over each layer, a set of system of equations can be generated for a single column of vertical cells and solved numerically to give the vertical solute concentration profile. The solute concentration field was then obtained by solving all columns of vertical cells to achieve convergence with the iterative solution procedure. The proposed model was verified through examples from the published literatures including four verifications in terms of analytical and experimental cases. Comparison of simulation results indicates that the proposed model satisfies the solute concentration profiles obtained from experiments in time and space.
To challenge the Taiwan Ministry of Education's (TMOE) dominant enforcement of a person-environment fit model, the Chinese Career Research Center incorporated yin-yang alternation principles from the Classic of Changes (I Ching, Yi Jing or 易經) to develop the model of career development touching the sky yet grounded (TSG) and corresponding practice guidelines, a career website (CCN), and four career service projects. Using Lewin's (1946) cyclical-spiral process of action research, CCN and TSG service projects were promoted to complement the TMOE's fit model, and feedback was utilised to revise our TSG model and its applications. Yin-yang alternation principles and the four stages of chien (the creative) from the Classic of Changes were applied to develop social action strategies. Social change was indicated by counsellors’ and students’ changes in their career views, as well as the TMOE's direct financial support for TSG service projects. This progress is encouraging for whoever is interested in developing culture-inclusive indigenous psychology with practical outcomes.
This study identified possible risk factors for newly diagnosed mood disorders, including depressive and bipolar disorders, in prostate cancer patients.
From 2000 to 2006, two cohorts were evaluated on the occurrence of mood disorder diagnosis and treatment. For the first cohort, data of patients diagnosed with prostate cancer was obtained from the Taiwan National Health Insurance (NHI) Research Database. As the second cohort, a cancer-free comparison group was matched for age, comorbidities, geographic region, and socioeconomic status.
Final analyses involved 12,872 men with prostate cancer and 12,872 matched patients. Increased incidence of both depressive (IRR 1.52, 95% CI 1.30–1.79, P <0.001) and bipolar disorder (IRR 1.84, 95% CI 1.25–2.74, P = 0.001) was observed among patients diagnosed with prostate cancer. Multivariate matched regression models show that cerebrovascular disease (CVD) and radiotherapy treatment could be independent risk factors for developing subsequent depressive and bipolar disorders.
We observed that the risk of developing newly diagnosed depressive and bipolar disorders is higher among Taiwanese prostate cancer patients. Clinicians should be aware of the possibility of increased depressive and bipolar disorders among prostate cancer patients in Taiwan. A prospective study is necessary to confirm these findings.
We propose and study the feasibility of a THz GaN/AlGaN quantum cascade laser (QCL) consisting of only five periods with confinement provided by a spoof surface plasmon (SSP) waveguide for room temperature operation. The QCL design takes advantages of the large optical phonon energy and the ultrafast phonon scattering in GaN that allow for engineering favorable laser state lifetimes, and the SSP waveguide provides the optical confinement for the ultrathin QCL. Our analysis has shown that the waveguide loss is sufficiently low for the QCL to reach its threshold at the injection current density around 6 kA/cm2 at room temperature.
The language history questionnaire (LHQ) is an important tool for assessing the linguistic background of bilinguals or second language learners and for generating self-reported proficiency in multiple languages. Previously we developed a generic LHQ based on the most commonly asked questions in published studies (Li, Sepanski & Zhao, 2006). Here we report a new web-based interface (LHQ 2.0) that has more flexibility in functionality, more accuracy in data recording, and more privacy for users and data. LHQ 2.0 achieves flexibility, accuracy, and privacy by using dynamic web-design features for enhanced data collection. It allows investigators to dynamically construct individualized LHQs on the fly and allows participants to complete the LHQ online in multiple languages. Investigators can download and delete the LHQ results and update their user and experiment information on the web. Privacy issues are handled through the online assignment of a unique ID number for each study and password-protected access to data.
Background: The caregiver burden on foreign paid caregivers (FPCs) is currently not well understood. This study identified predictors and differences in caregiver burden between FPCs and family caregivers who provided care for patients with dementia.
Methods: We recruited 489 patients with dementia (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition) and used the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) Scale to assess their neuropsychiatric behavioral problems and severity of dementia. All caregivers [FPCs (n = 42) and family caregivers with (n = 42) and without (n = 447) FPCs] completed three questionnaires: the Zarit Burden Interview (ZBI), the Center for Epidemiological Studies–Depression Scale (CES-D), and caregivers’ knowledge of dementia (KD). To understand caregiver burden, we analyzed the correlations between ZBI and other variables and investigated the differences between family caregivers and FPCs.
Results: NPI and CDR scores were higher among patients assisted by FPCs than among those whose families did not employ FPCs. Burdens were greater among family caregivers assisted by FPCs than among FPCs and family caregivers who were not assisted by FPCs. Family caregivers had greater knowledge of dementia than did FPCs. For family caregivers, CES-D scores (Spearman's r = 0.650; p < 0.01) and patients’ NPI scores (Spearman's r = 0.471; p < 0.01) were correlated with caregiver burden. For FPCs, only CES-D scores (Spearman's r = 0.511; p < 0.01) were correlated with caregiver burden. A linear regression model showed that CES-D scores contributed most to caregiver burden in all groups [β = 0.560 (family caregivers without FPCs), 0.546 (family caregivers with FPCs), and 0.583 (FPCs); p < 0.005].
Conclusion: Both family caregivers and FPCs need emotional support. Adequate treatment to reduce the neuropsychiatric symptoms of patients with dementia might reduce the burden on family caregivers.
To examine the effect of taking an elective psychiatry and literature
course during the first year of medical school on performance in the
later mandatory general psychiatry curriculum. Class members were
surveyed for baseline characteristics at the time of their admission to
medical school. Following completion of their fourth year, average grades
in psychiatry were calculated and results compared for those who did and
those who did not take the course. Multiple regression analysis was used
to assess the effects of baseline characteristics that were significantly
different between the groups.
Students who took the course had statistically significant
(t = −3.34, P <0.001) higher
grades in fourth year psychiatry. They had lower admission interview
scores (t = −2.15, P <0.05) and
reported less academic stress (t = −9.55,
P <0.01) before taking the course.
Literature is an effective medium through which to teach medical students
psychiatry as it can lead to a greater understanding of the topic.
Hydrogenated amorphous silicon (a-Si:H) thin films were deposited on pre-oxidized Si wafers by electron cyclotron resonance chemical vapor deposition (ECRCVD). The rapid thermal annealing (RTA) treatments were applied to the as-grown samples in nitrogen atmosphere, and the temperature range for the RTA process is from 450 to 950 °C. The crystallization and grain growth behaviors of the annealed films were investigated by Raman spectroscopy, X-ray diffraction (XRD) and transmission electron microscopy (TEM). The onset temperature for the crystallization and grain growth is around 625 ∼ 650°C. The crystalline fraction of annealed a-Si:H films can reach ∼80%, and a grain size up to 17 nm could be obtained from the RTA treatment at 700 °C. We found that the crystallization continues when the grain growth has stopped.
ZnO films were grown on (0001) sapphire substrates by atomic layer deposition (ALD) using diethylzinc (DeZn) and nitrous oxide (N2O) in an inductively heated reactor operated at atmospheric pressure. Low-temperature (LT) ZnO buffer layers having various thicknesses were deposited at 400¢J followed by subsequent growth of ZnO films at 600¢J. Some of the ZnO films were then post-annealed at 1000¢J in the N2O flow. Under certain growth conditions, ZnO nanowires were formed on the post-annealed ZnO samples. Room temperature (RT) photoluminescence (PL) spectra of the ZnO nanowires show strong ultraviolet (UV) near band edge emissions at 3.27 eV with a typical full width at half-maximum ( FWHM ) of ~130 meV and quenched defect luminescence at 2.8 eV. 10 K PL spectra of the post-annealed ZnO all exhibit sharp excitonic emissions with the dominant emission being located at 3.36 eV having a FWHM of 4.6 meV.
Objectives: Magnetic resonance imaging (MRI) and computerized tomography (CT) scanners are high-tech equipment with the highest utilizations and expenditures in Taiwan. This study investigates the factors that affect MRI and CT utilization, such as whether supply-side factors have more impact than demand-side factors, and the effect of utilization control policies.
Methods: This study used the nationwide CT and MRI claim data for the years 1998 to 2001 from the Bureau of National Health Insurance (BNHI) in Taiwan. Multiple regression analysis was the statistical method used to determine the relative factors that influence CT and MRI utilization.
Results: CT : population ratio, hospital-based physician : population ratio, female ratio, pediatric (≤14 years) : population ratio, and family income significantly influenced CT utilization. MRI : population ratio and hospital-based physician : population ratio, female ratio, and family income significantly influenced MRI utilization. However, the proportion of the aged (≥65 years of age) did not significantly influence CT or MRI utilization after controlling for other factors. The rates of CT and MRI utilization for the outpatient and inpatient settings and the repeated uses of CT or MRI have decreased significantly after a utilization review was implemented by BNHI, which suggests that CT and MRI have been overused.
Conclusions: Increases in supply-side factors significantly increase CT/MRI utilization, and supply-side factors impact CT/MRI utilization more than demand-side factors. The results show that the utilization instant report policy effectively decreases repeated uses of CT/MRI.
Transmittance loops upon thermal cycling of VO2 thin films were found to change among films with different fabrication conditions that lead to different transition temperatures (Tts) from that of a strain-free VO2 single crystal, 68 °C. The residual stresses in the films quantitatively determined from x-ray diffractometry were used to explain this variation. Electron spectroscopy for chemical analysis spectra showed that the difference in the binding energy of core electrons 2p1/2 and 2p3/2 of the vanadium atom are affected by residual stress and proportional to Tts of the films. The bond length between vanadium and oxygen atoms at room temperature varies with different residual stresses and, furthermore, affects the movements of both atoms during phase change (and hence the Tt of VO2 thin films). Residual stresses also affect the hysteresis span of the transmittance loop. The relationship between the residual stress of as-deposited VO2 films and the relative positions between vanadium and oxygen atoms are also delineated in detail.