Yeuk-Lun Chau

Medical conditions and medications as risk factors of falls in the inpatient older people: a case–control study

The majority of inpatient falls are older people who have various medical conditions and are on several medications. The purpose of this study was to examine the association between medical conditions and medications and falls in older people in hospital.

Increased risk of developing dementia in patients with bipolar disorder: a nested matched case-control study.

The association between bipolar disorder and subsequent dementia risk is not well established. The objective of this study was to investigate whether patients with bipolar disorder were at an increased risk for developing dementia.

Psychotropic drugs and risk of motor vehicle accidents: a population-based case-control study

AIM To examine comprehensively the relationship between exposure to four classes of psychotropic drugs including antipsychotics, antidepressants, benzodiazepines (BZDs) and Z-drugs, and motor vehicle accidents (MVAs). METHOD The authors conducted a matched case-control study of 5183 subjects with MVAs and 31 093 matched controls, identified from the claims records of outpatient service visits during the period from 2000 to 2009. Inclusion criteria were defined as subjects aged equal to or more than 18 years and involved in MVAs. Conditional logistic regressions with covariates adjustment (including urbanity, psychiatric and non-psychiatric outpatient visits and Charlson comorbidity score) were applied to examine the effect of four classes of psychotropic drugs on MVAs. RESULTS Significant increased risk of MVAs was found in subjects taking antidepressants within 1 month (adjusted odds ratio (AOR) 1.73, 95% confidence interval (CI) 1.34, 2.22), 1 week (AOR 1.71, 95% CI 1.29, 2.26), and 1 day (AOR 1.70, 95% CI 1.26, 2.29) before MVAs occurred. Similar results were observed in subjects taking benzodiazepines (BZDs) (AOR 1.56, 95% CI 1.38, 1.75 for 1 month; AOR 1.64, 95% CI 1.43, 1.88 for 1 week, and AOR 1.62, 95% CI 1.39, 1.88 for 1 day) and Z-drugs (AOR 1.42, 95% CI 1.14, 1.76 for 1 month, AOR 1.37, 95% CI 1.06, 1.75 for 1 week, AOR 1.34, 95% CI 1.03, 1.75 for 1 day), but not antipsychotics. Moreover, significant dose effects of antidepressants (equal to or more than 0.6-1.0 DDD), BZDs (equal to or more than 0.1-0.5 DDD) and Z-drugs (more than 1 DDD) were observed, respectively, on the risk of experiencing an MVA. CONCLUSION Taken together, subjects taking antidepressants, BZDs and Z-drugs, separately, should be particularly cautioned for their increasing risk of MVAs.

Transient Ischemic Attack and Incidence of Depression in Old Age: Evidence From a Population-Based Analysis in Taiwan

OBJECTIVES The association between transient ischemic attack (TIA) and depression has not been investigated previously. This study was aimed to examine the relationship between TIA and depression in old age in Taiwan. METHOD This cross-sectional analysis was performed using data from the nationwide 2002 Health Promotion Knowledge, Attitude, Performance Survey in Taiwan. Depressive symptoms were categorized using the Taiwanese Depression Questionnaire with a cutoff point of 18 of 19, and TIA was defined as the sudden or rapid onset of focal neurologic deficit that had fully resolved within 24 hours. Cerebrovascular risk factors (CVRFs) including age, cardiovascular disease, diabetes mellitus, hypertension, antihypertensive drugs, and smoking were used as covariates. RESULTS Of the total 3,613 subjects aged 65 years and older, 8.2% had previously experienced a TIA. Subjects with depressive symptoms were significantly more likely to have a previous TIA than those without depressive symptoms (17.1%:7.4%, odds ratio [OR] = 2.6, 95% confidence interval [CI] = 1.8-3.8). After controlling of sex, education, functional disability, and CVRFs, TIA was still significantly associated with depression in old age (Adjusted OR = 2.1, 95% CI = 1.4-3.2). CONCLUSION Previous TIA was significantly increased risk of depression which cannot be explained by functional disability or CVRFs. This result supported the hypothesis of vascular depression.

Utilization of Psychopharmacological Treatment Among Patients With Newly Diagnosed Bipolar Disorder From 2001 to 2010.

Objective The aim of the study was to examine utilization and patterns of psychopharmacological treatment during a 1-year follow-up period among patients with newly diagnosed bipolar disorder from 2001 to 2010. Methods Patients with newly diagnosed bipolar disorder from 2001 to 2010 were identified from the National Health Insurance Research Database in Taiwan. We assessed prescription records related to 4 kinds of psychopharmacological medication, including antipsychotics (APs), antidepressants, mood stabilizers, and benzodiazepines, as well as health care utilization in a 1-year follow-up period among the study subjects. In addition, logistic regressions were applied to test the trends for utilization of psychopharmacological treatment during the 10-year study period. Results A total of 2703 patients newly diagnosed with bipolar disorder were enrolled. The ratio of good adherence, defined as medications possession ratio greater than 0.8, for use of the examined psychopharmacological medication was relatively low during the study period. The use of first-generation APs, selective serotonin reuptake inhibitors, tricyclic antidepressants, lithium, carbamazepine, and benzodiazepines has declined; however, the use of second-generation APs, serotonin and norepinephrine reuptake inhibitors, lamotrigine, and valproate has risen markedly during the 10-year period. Conclusions This study presents patterns of pharmacological treatment in patients with newly diagnosed bipolar disorder in Taiwan for a 10-year study period. It would be of importance to further investigate causes and outcomes for polytherapy and nonadherence to psychotropic medications among patients with bipolar disorder.

Validity and clinical utilization of the Chinese version of the Gotland Male Depression Scale at a men’s health polyclinic

Introduction Symptoms of depression in males, such as aggression and irritability, are different from those in females. However, there are no adequate scales for detecting possible diagnoses in the Chinese population. The aim of this study was to assess whether the Chinese version of the Gotland Male Depression Scale (CV-GMDS) could identify male depression as effectively as the English version. Materials and methods A total of 231 male outpatients were sampled from a men’s health polyclinic. We used questionnaires to evaluate the characteristics and mood status of participants, including the CV-GMDS, the Chinese version of the Beck Depressive Inventory II (CV-BDI-II), and the Chinese version of the Aging Males’ Symptoms (CV-AMS) scale. Cronbach’s α-coefficient and Levene’s test were used to investigate internal consistency and homogeneity, respectively. External validity was evaluated using Spearman’s correlation coefficient. A factor analysis was conducted to evaluate the conceptual structure of the CV-GMDS, and a regression analysis was used to determine the relationship of the CV-AMS scale with the CV-GMDS and CV-BDI-II. Results The mean age of the 231 participants was 46.1 years (standard deviation 11.0). Of the participants, 36.8% (n=85) were found to have depression according to the CV-GMDS and 34.6% (n=80) according to the CV-BDI-II. The internal consistency of the CV-GMDS was demonstrated by a Cronbach’s α of 0.933, and the test of homogeneity revealed a P-value of 0.762. The external validity for the CV-GDMS and CV-BDI-II was demonstrated by an intercorrelation of 0.835. The third and fourth items of the GMDS differed from the others, and the CV-GMDS showed a better relationship (R2=0.616) with the CV-AMS scale than the CV-BDI-II did. Conclusion The CV-GMDS is a satisfactory and suitable psychometric questionnaire for detecting depression among a Chinese-speaking middle-aged or older male population. The results of this study could be used as a basis for investigating specific male depression and aging symptoms.

The impact of depression on self-care activities and health care utilization among people with diabetes in Taiwan.

Using cross-sectional analyses of a nationally representative community sample (n=1260), we found that in people with diabetes, depression was associated with lower rates of reducing or quitting smoking and alcohol, less exercise, less regular lifestyle, but more health care utilization and a higher rate of foot care.

Psychotropic drugs and risk of burn injury in individuals with mental illness: a 10-year population-based case–control study

We aimed to investigate the association between psychotropic treatment and risk of burn injury in individuals with mental illness.