Increasing evidence has established a strong association between social anxiety disorder and suicidal behaviours, including suicidal ideation and suicide attempts. However, the association between social anxiety disorder and suicide mortality remains unclear.

This study analysed data from 15,776 patients with social anxiety disorder, extracted from a nationwide Taiwanese cohort between 2003 and 2017. Two unexposed groups without social anxiety disorder, matched by birth year and sex in 1:4 and 1:10 ratios, respectively, were used for comparison. Suicide deaths during the same period were examined. Psychiatric comorbidities commonly associated with social anxiety disorder, including schizophrenia, bipolar disorder, major depression, alcohol use disorder (AUD), substance use disorder (SUD), obsessive-compulsive disorder, autism, and attention deficit hyperactivity disorder, were identified.

Time-dependent Cox regression models, adjusted for demographic factors and psychiatric comorbidities, revealed that individuals with social anxiety disorder had an increased risk of suicide (hazard ratio: 3.49 in the 1:4 matched analysis and 2.84 in the 1:10 matched analysis) compared with those without the disorder. Comorbidities such as schizophrenia, bipolar disorder, major depression, AUD, and SUD further increased the risk of suicide in patients with social anxiety disorder.

Social anxiety disorder is an independent risk factor for suicide death. Additional psychiatric comorbidities, including schizophrenia, major affective disorders, and AUD, further increased social anxiety disorder-related suicide risk. Therefore, mental health officers and clinicians should develop targeted suicide prevention strategies for individuals with social anxiety disorder.

Panic disorder (PD) may increase the likelihood of suicidal ideation and behaviors because of psychiatric comorbidities such as major depressive disorder (MDD). However, research has yet to demonstrate a direct relationship between PD and suicide mortality.

Using data from Taiwan’s National Health Insurance Research Database, we identified 171,737 individuals with PD and 686,948 age- and sex-matched individuals without PD during 2003–2017. We assessed the risk of suicide within the same period. Psychiatric comorbidities such as schizophrenia, bipolar disorder, MDD, obsessive-compulsive disorder (OCD), autism, alcohol use disorder (AUD), and substance use disorder (SUD) were also evaluated. Time-dependent Cox regression models were used to compare the risk of suicide in different groups after adjustment for demographic data and psychiatric comorbidities.

Our Cox regression model revealed that PD was an independent risk factor for suicide (hazard ratio [HR] = 1.85, 95% confidence interval [CI] = 1.59–2.14), regardless of psychiatric comorbidities. Among all comorbidities, MDD with PD was associated with the highest risk of suicide (HR = 6.08, 95% CI = 5.48–6.74), followed by autism (HR = 4.52, 95% CI = 1.66–12.29), schizophrenia (HR = 3.34, 95% CI = 2.7–4.13), bipolar disorder (HR = 3.20, 95% CI = 2.71–3.79), AUD (HR = 2.99, 95% CI = 2.41–3.72), SUD (HR = 2.82, 95% CI = 2.28–3.47), and OCD (HR = 2.10, 95% CI = 1.64–2.67).

PD is an independent risk factor for suicide. Psychiatric comorbidities (i.e. schizophrenia, bipolar disorder, MDD, OCD, AUD, SUD, and autism) with PD increase the risk of suicide.

Research evidence has established an association of obsessive-compulsive disorder (OCD) with suicidal thoughts and suicide attempts. However, further investigation is required to determine whether individuals with OCD have higher risk of death by suicide compared with those without OCD.

Of the entire Taiwanese population, between 2003 and 2017, 56,977 individuals with OCD were identified; they were then matched at a 1:4 ratio with 227,908 non-OCD individuals on the basis of their birth year and sex. Suicide mortality was assessed between 2003 and 2017 for both groups. Time-dependent Cox regression models were used to investigate the difference in suicide risk between individuals with versus without OCD.

After adjustment for major psychiatric comorbidities (i.e., schizophrenia, bipolar disorder and major depressive disorder), the OCD group had higher risk of suicide (hazard ratio: 1.97, 95% confidence interval: 1.57–2.48) during the follow-up compared with the comparison group. Furthermore, OCD severity, as indicated by psychiatric hospitalizations due to OCD, was positively correlated with suicide risk.

Regardless of the existence of major psychiatric comorbidities, OCD was found to be an independent risk factor for death by suicide. A suicide prevention program specific to individuals with OCD may be developed in clinical practice in the future.

Bipolar disorder (BD) shows heterogeneous illness presentation both cross-sectionally and longitudinally. This phenotypic heterogeneity might reflect underlying genetic heterogeneity. At the same time, overlapping characteristics between BD and other psychiatric illnesses are observed at clinical and biomarker levels, which implies a shared biological mechanism between them. Incorporating these two issues in a single study design, this study investigated whether phenotypically heterogeneous subtypes of BD have a distinct polygenic basis shared with other psychiatric illnesses.

Six lifetime phenotype dimensions of BD identified in our previous study were used as target phenotypes. Associations between these phenotype dimensions and polygenic risk scores (PRSs) of major psychiatric illnesses from East Asian (EA) and other available populations were analyzed.

Each phenotype dimension showed a different association pattern with PRSs of mental illnesses. PRS for EA schizophrenia showed a significant negative association with the cyclicity dimension (p = 0.044) but a significant positive association with the psychotic/irritable mania dimension (p = 0.001). PRS of EA major depressive disorder demonstrated a significant negative association with the elation dimension (p = 0.003) but a significant positive association with the comorbidity dimension (p = 0.028).

This study demonstrates that well-defined phenotype dimensions of lifetime-basis in BD have distinct genetic risks shared with other major mental illnesses. This finding supports genetic heterogeneity in BD and suggests a pleiotropy among BD subtypes and other psychiatric disorders beyond BD. Further genomic analyses adopting deep phenotyping across mental illnesses in ancestrally diverse populations are warranted to clarify intra-diagnosis heterogeneity and inter-diagnoses commonality issues in psychiatry.

This study aimed to assess the actual burden of antibiotic use among end-of-life (EOL) patients in South Korea and to compare trends between cancer and non-cancer decedents.

Population-based mortality follow-back study.

Data from the Korean National Health Insurance Database, covering the period from January1, 2006, to December 31, 2018, provided for research by the National Health Insurance Service (NHIS), were used.

All decedents from 2006 to 2018 were included and categorized as cancer decedents or non-cancer decedents.

Annual antibiotic consumption rates and prescription rates were calculated, and Poisson regression was used to estimate their trends.

Overall antibiotic consumption rates decreased slightly among decedents in their final month with a less pronounced annual decrease rate among cancer decedents compared to non-cancer decedents (0.4% vs 2.3% per year, P <.001). Over the study period, although narrow spectrum antibiotics were used less, utilization and prescription of broad-spectrum antibiotics steadily increased, and prescription rates were higher in cancer decedents compared to non-cancer controls. Specifically, carbapenem prescription rates increased from 5.6% to 18.5%, (RR 1.087, 95% CI 1.085–1.088, P <.001) in cancer decedents and from 2.9% to 13.2% (RR 1.115, 95% CI 1.113–1.116, P <.001) in non-cancer decedents.

Our findings show that patients at the EOL, especially those with cancer, are increasingly and highly exposed to broad-spectrum antibiotics. Measures of antibiotic stewardship are required among this population.

Although various clinical indicators of suicide have been recorded, the previous suicide attempt is meaningful as one of the most robust risk factors predicting subsequent suicide attempts but there are lacking in biomarkers for evaluating suicide attempts. This study aimed to analyze the correlation of changes in oxygenated hemoglobin concentration with lifetime suicide attempt during verbal fluency test.

A total of 60 patients with major depressive disorder (MDD) were enrolled. Demographic, clinical, physical, and psychological evaluations were conducted. We evaluated the suicidal behaviors through MINI suicidality item. We indicated verbal fluency test to examine prefrontal activation during the cognitive execution while fNIRS was observed.

54 of enrolled patient with MDD (23 those with a lifetime history of suicide attempt; 31 those without a lifetime history of suicide attempt) are eligible for the subject. The patients were 35.19% of those with a lifetime history of suicide attempt. The values of the changes in oxygenated hemoglobin involving the entire regions of prefrontal cortex were smaller in those with a lifetime history of suicide attempt. The biggest difference is in right VMPFC, the mean score of those with a lifetime history of suicide attempt and those without a lifetime history of suicide attempt were 0.095(SD, 1.032) and 0.610(SD, 1.038) although the statistically non-significance. We discovered that a small value of changes in oxygenated hemoglobin was related to lifetime suicide attempt through multivariable logistic regression analysis. After adjusting for age, sex, years of education, and HAMD, there was a significant difference in the right VMPFC [OR = 0.491(95% CI=0.235~0.916), p = 0.036].

Study result indicated that the values of the changes in oxygenated hemoglobin were smaller in who attempted suicide before during cognitive execution. The adjusted regression analysis was presented significant result in right VMPFC. Therefore, the changes in oxygenated hemoglobin measured by fNIRS can be applied as a biomarker for suicidal behavior such as lifetime suicide attempt.

Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback.

Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the StateTrait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases.

A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback

VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.

Virtual Reality (VR)-based Biofeedback (BF), a relatively new intervention, is rapidly increasing for the treatment of mood disorders. However, research on whether VR-based BF is more effective than traditional BF is still lacking.

A total of 131 adults from the community enrolled in the study. Participants scored ≥10 on Patient Health Questionnaire-9 (PHQ-9) or ≥9 on Panic Disorder Severity Scale (PDSS) were randomly assigned to VR or BF group. Those who have not met the criteria of PHQ-9 and PDSS were classified as the control group. All participants visited three times across 3 months and received either VR-based or conventional BF intervention. The control group received the same treatment as the VR group. Also, on each visit, the participants completed Montgomery-Asberg Depression Rating Scale (MADRS), State-Trait Anxiety Inventory (STAI), and Visual Analogue Scale (VAS).

The analysis included 118 participants in total (VR: 40, BF: 38, Control: 40). There was no significant difference in demographic variables among the 3 groups. After the treatment, VR and BF groups exhibited significant decreases in MADRS, PHQ-9, STAI, and VAS compared to the baseline within each group (p<0.005). Importantly, compared to the BF group, the VR group showed a significantly greater decrease in STAI (p<0.05). Further analyses revealed that scores of MADRD, PHQ-9, STAI, and VAS also significantly decreased in highly stressed group compared to the control group.

Findings suggest that the application of VR-based BF was effective in reducing anxiety and depressive symptoms in highly stressed people. Compared to conventional BF, VR-based BF can be a cost-effective treatment option especially for relieving anxiety.

Although people who attempted suicide tend to repeat suicide attempts, there is a lack of evidence on the association between psychiatric service factors and suicide reattempt among them.

We used a nationwide, population-based medical record database of South Korea to investigate the use of psychiatric services before and after the index suicide attempt and the association between psychiatric service factors after the index suicide attempt with the risk of suicide reattempt.

Among 5,874 people who had attempted suicide, the all-cause mortality within 3 months after the suicide attempt was 11.6%. Among all subjects who attempted suicide, 30.6% of them had used psychiatric services within 6 months before the suicide attempt; 43.7% of them had used psychiatric services within 3 months after the suicide attempt. Among individuals who had visited clinics following attempted suicide, the cumulative incidence of suicide reattempt over a mean follow-up period of 5.1 years was 3.4%. About half of suicide reattempts occurred within 1 year after the index suicide attempt. Referral to psychiatric services within 7 days was associated with a decreased risk of suicide reattempt (adjusted hazard ratio, 0.51; 95% confidence intervals, 0.29-0.89).

An early psychiatric referral within 1 week after a suicide attempt was associated with a decreased risk of suicide reattempt.

The “Fast track” protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD.

We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled “Fast track” protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays.

The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0–169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031).

Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.

Evidence suggests a familial coaggregation of major psychiatric disorders, including schizophrenia, bipolar disorder, major depression (MDD), autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). Those disorders are further related to suicide and accidental death. However, whether death by suicide may coaggregate with accidental death and major psychiatric disorders within families remains unclear.

To clarify the familial coaggregation of deaths by suicide with accidental death and five major psychiatric disorders.

Using a database linked to the entire Taiwanese population, 68 214 first-degree relatives of individuals who died by suicide between 2003 and 2017 and 272 856 age- and gender-matched controls were assessed for the risks of death by suicide, accidental death and major psychiatric disorders.

A Poisson regression model showed that the first-degree relatives of individuals who died by suicide were more likely to die by suicide (relative risk RR = 4.61, 95% CI 4.02–5.29) or accident (RR = 1.62, 95% CI 1.43–1.84) or to be diagnosed with schizophrenia (RR = 1.53, 95% CI 1.40–1.66), bipolar disorder (RR = 1.99, 95% CI 1.83–2.16), MDD (RR = 1.98, 95% CI 1.89–2.08) or ADHD (RR = 1.34, 95% CI 1.24–1.44).

Our findings identified a familial coaggregation of death by suicide with accidental death, schizophrenia, major affective disorders and ADHD. Further studies would be required to elucidate the pathological mechanisms underlying this coaggregation.