Kaohsiung Municipal Kai-Syuan Psychiatric Hospital

BackgroundLong-acting injectable antipsychotics (LAIs) are reimbursed under Taiwan’s National Health Insurance (NHI) but are underutilized due to budget constraints. To enhance LAI usage, the NHI launched the LAI-dedicated budget policy (LAI-DBP) in January 2022 with NT$2.7 billion in funding. Its real-world impact has not yet been studied.Aims & ObjectivesTo assess the impact of the LAI-DBP on prescription rates for first- and second-generation (FGA/SGA) LAIs in patients with schizophrenia/schizoaffective disorder.​​​​MethodPrescription data for 18–65-year-olds with schizophrenia/schizoaffective disorder were obtained from Kaohsiung Municipal Kai-Syuan Psychiatric Hospital electronic medical records between October 2005–September 2024. An interrupted time-series design and Prais-Winsten regression model were used to estimate changes before and after LAI-DBP implementation. The impact of NHI reimbursement for SGA paliperidone palmitate once-monthly/3-monthly (R-PP1M/R-PP3M) on prescribing was also assessed.ResultsBetween October 2005 and R-PP1M, overall LAI prescriptions decreased by -0.03 percentage points per month (pp/m) (P<0.0001). R-PP1M and R-PP3M were followed by significant increases of 0.08 pp/m. After LAI-DBP implementation, overall LAI prescriptions increased by 0.19 pp/m, increasing the proportion of LAIs to 33.2% of all antipsychotic prescriptions by September 2024. In parallel, FGA-LAI prescriptions decreased over time, with significant trend changes following R-PP1M (-0.06 pp/m) and LAI-DBP implementation (-0.15 pp/m). SGA-LAI prescriptions rose 0.2% pp/m to account for 27.8% of all antipsychotic prescriptions by September 2024, with significant trend changes after R-PP1M (0.02 pp/m), R-PP3M (0.11 pp/m), and LAI-DBP implementation (0.35 pp/m). The model predicted that LAI-DBP resulted in a 24.0% increase in all LAI prescriptions (-40.3% for FGA-LAI, +68.1% for SGA-LAI).Discussion & ConclusionsThe LAI-DBP significantly increased the proportion of antipsychotic prescriptions using any LAI and SGA-LAIs and had a greater impact than R-PP1M and R-PP3M. LAI prescriptions account for approximately one-third of all antipsychotic prescriptions, suggesting that, in addition to financial support, other strategies may be needed to overcome obstacles to their uptake.

Surface electromyography (sEMG) is a non-invasive technique widely used to assess muscle activation and function. This study was aimed to investigate the relationship between sEMG signal features and hand grip strength in healthy individuals across different ages and genders. A total of 280 participants (122 males, 158 females), aged 20 years and above, were categorized into six age groups. Grip strength was measured using a digital hand dynamometer, and sEMG signals of four upper-limb muscles, biceps brachii, triceps brachii, brachioradialis, and flexor carpi ulnaris, were recorded at the same time. Root mean square (RMS) features were extracted from the sEMG signals to represent muscle activation. Pearson correlations were performed to analyze the relationship between RMS values and grip force. Results show a strong positive correlation between sEMG features and grip strength. These findings suggest that RMS-based sEMG analysis may provide a reliable, non-invasive indicator of grip strength and could aid in early detection of muscular decline in clinical or aging populations.

BackgroundThe rate of vaccination is lower in patients with schizophrenia than in the general population, and therefore, further investigation into the psychosocial impact of COVID-19 on these patients and their vaccine attitudes is warranted. In this study, we investigated factors influencing vaccine attitudes in patients with schizophrenia and explored the interactions among these factors.MethodsCross-sectional, self-report surveys were conducted among Taiwanese patients with schizophrenia to collect data on vaccine attitudes and associated variables. Our sample was drawn from the largest psychiatric specialty hospital in Taiwan. As of December 1, 2022, 88% of the Taiwanese population had received at least two doses of the COVID-19 vaccine. Factors influencing vaccine attitudes and potential moderators were investigated through correlation analyses, hierarchical regression, and Hayes’ Process Macro.ResultsThis study included 457 patients. Our results revealed that social anxiety and social desirability were respectively positively and negatively correlated with vaccine attitudes. Positive thinking moderated the overall effect of social influence on vaccine attitudes. Low levels of positive thinking intensified the effect of social influence on vaccine hesitancy.ConclusionThis study clarified the association of social influence with vaccine attitudes and the moderating effect of positive thinking on this association. Reputable medical centers can enhance patients’ confidence in vaccination policies and foster positive thinking to increase vaccine acceptance among patients with schizophrenia.

Background: Psychiatric patients with Type 2 diabetes often experience suboptimal care and poor health outcomes.Aims: This study is aimed at investigating the impact of a diabetes pay-for-performance (P4P) program on glycemic control in psychiatric patients with diabetes by comparing two regional psychiatric hospitals, one with the P4P program and one without.Methods: We conducted a retrospective quasiexperimental study. A total of 149 psychiatric outpatients with Type 2 diabetes were enrolled in the P4P group, and 129 patients were in the non-P4P group. Hemoglobin A1c (HbA1c) values in the fourth quarter of 2018 served as baseline (before P4P implementation in either hospital). Follow-up HbA1c levels were collected at 3, 6, 9, and 12 months in 2019. Propensity score matching was performed based on baseline HbA1c to create comparable groups. Changes in HbA1c over 1 year were analyzed using paired and independent t-tests and a generalized estimating equation (GEE) model.Result: The mean HbA1c level in the P4P group decreased progressively over 12 months (from 6.97% at baseline to 6.60%), whereas the non-P4P group showed an increase (from 7.00% to 7.12%). By the fourth quarter, the P4P group had a significantly lower mean HbA1c than the non-P4P group (p < 0.05). Subgroup analysis showed a greater HbA1c reduction in P4P participants who were male or had schizophrenia (p = 0.01 and p = 0.04, respectively).Conclusions: The P4P program was associated with significantly improved glycemic control in psychiatric patients with diabetes compared to usual care. This integrated care model may be an effective strategy to improve diabetes outcomes in psychiatric populations.

Breast cancer is one of the most prevalent and serious types of cancer globally. Previous literature has shown that women with mental illness may have an increased risk of breast cancer, however whether this risk is associated with the use of psychotropic drugs has yet to be elucidated. This study aimed to assess such risk among women with major depressive disorder (MDD) and bipolar disorder (BD). A nested case–control study design was used with data obtained from the Taiwan National Health Insurance Research Database. Logistic regression analysis with adjustments for demographic characteristics, medical and mental comorbidities, and all-cause clinical visits was performed to estimate the risk of breast cancer according to the cumulative defined daily dose (cDDD) of psychotropic drugs. The study included 1564 women with MDD or BD who had breast cancer, and 15,540 women with MDD or BD who did not have breast cancer. After adjusting for important confounders, the long-term use of valproic acid (odds ratio, 95% confidence interval: 0.58, 0.39–0.56, cDDD ≥ 365), citalopram (0.58, 0.37–0.91, cDDD 180–365), and sertraline (0.77, 0.61–0.91, cDDD ≥ 365) was associated with a lower risk of breast cancer compared to a cDDD < 30. The short-term use of fluvoxamine (0.82, 0.69–0.96, cDDD 30–180), olanzapine (0.54, 0.33–0.89, cDDD 30–179), risperidone (0.7, 0.51–0.98, cDDD 30–179), and chlorpromazine (0.48, 0.25–0.90, cDDD 30–179) was associated with a lower risk of breast cancer. We found no evidence of an increased risk of breast cancer in patients with MDD or BD receiving psychotropic drugs.

The coronavirus disease 2019 (COVID-19) pandemic has had an impact on patients with substance use disorder (SUD). We aimed to investigate factors associated with confidence and adherence to governmental policies against COVID-19 (social desirability) among patients with SUD. This cross-sectional study was conducted during 2020 to 2021. Patients with SUD and healthy controls were recruited. The severity of sleep disturbance, social desirability, drug dependence, vaccine worries, other psychological burdens and demographic variables were collected through self-administrated questionnaires. Differences between the SUD and control groups were estimated. Hierarchical regression analysis was used to identify significant relationships between social desirability and other factors. In total, 58 of patients with SUD and 47 healthy controls were recruited. The patients with SUD had a lower level of social desirability and more severe sleep disturbance than the control group. Older age, more severe sleep disturbance, lower level of drug dependence, and lower level of vaccine worries were significantly associated with a higher level of social desirability among the patients with SUD. Our results show the importance of timely interventions for drug dependence and to address vaccine worries in patients with SUD.