We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The study explored the origin of the age of acquisition (AoA) effect in second language (L2) using ERPs technique. We simulated L2 AoA by manipulating the order at which English pseudowords entered into training. Chinese-English bilinguals (mean age 22.04, range 18–28) learned English pseudowords matched with Chinese (L1) words, investigating the order of acquisition (OoA) effect of English pseudowords and its relationship with the matched L1 words’ AoA. OoA effects were observed in lexical decision, naming and semantic judgment tasks on N170, P200 and N400. Furthermore, OoA effects were modulated by L1 AoA in the semantic judgment task. These results suggested that OoA effects were independent at orthographic and phonological levels but modulated by L1 AoA at the semantic level. The interpretation of L2 AoA effects requires not only the integration of Semantic and Arbitrary Mapping Hypotheses, as well as consideration of the representation and activation characteristics of L2 words.
Individuals with schizophrenia face high mortality risks. The effects of lipid-modifying agents on this risk remain understudied.
Aim
This study was conducted to investigate the effects of lipid-modifying agents on mortality risk in people with schizophrenia.
Method
This nationwide cohort study collected the data of people with schizophrenia from Taiwan's National Health Insurance Research Database for the period between 1 January 2001 and 31 December 2019. Multivariable Cox proportional hazards regression with a time-dependent model was used to estimate the hazard ratio for mortality associated with each lipid-modifying agent.
Results
This study included 110 300 people with schizophrenia. Of them, 22 528 died (19 754 from natural causes and 1606 from suicide) during the study period, as confirmed using data from Taiwan's national mortality database. The use of lipid-modifying agents was associated with reduced risks of all-cause (adjusted hazard ratio [aHR]:0.37; P < 0.001) and natural (aHR:0.37; P < 0.001) mortality during a 5-year period. Among the lipid-modifying agents, statins and fibrates were associated with reduced risks of all-cause mortality (aHRs:0.37 and 0.39, respectively; P < 0.001 for both) and natural mortality (aHRs: 0.37 and 0.42, respectively; P < 0.001 for both). Notably, although our univariate analysis indicated an association between the use of lipid-modifying agents and a reduced risk of suicide mortality, the multivariate analysis revealed no significant association.
Conclusions
Lipid-modifying agents, particularly statins and fibrates, reduce the risk of mortality in people with schizophrenia. Appropriate use of lipid-modifying agents may bridge the mortality gap between these individuals and the general population.
The form of group training for prisoners near the end of their prison sentence are often taken in China to help them enhance their ability to adapt to the society after being released from prison, but this training may have shortcomings of weak pertinence and non-differentiation. A prisoner had turned to his supervisor for help due to the emotional anxiety two months before the end of his prison sentence, which caused the concern to the individual psychological state of the prisoner. In order to reduce the stress and abnormal psychological state of prisoners before their release, and help them to rebuild themselves after returning to society, psychological tests and questionnaires were conducted on prisoners whose remaining prison term was less than three months. The prisoners with psychological fluctuations were screened out for timely intervention.
Subjects and Methods
A prisoner, 23-year-old, male, complained of inattention, depression, tension, irritability and frequent insomnia, this phenomenon has been interrupted for a month. So, two months before his release from prison, he sought help from the prison Psychological Counseling Department. The psychological test result of the man is as follows: The Self Rating Anxiety Scale test (SAS) result is 67 points, which is higher than the norm, and SCL-90 Self-Rating Depression Scale (SCL-90) anxiety factor 2.6, higher than the norm. Through the use of cognitive therapy and relaxation training by the counselors, there was no anxiety state in the psychological test after four psychological consultations. The case aroused the concern about the psychological state of the criminals before their release from prison, and 30 criminals with the three months remaining in prison were given psychological tests and questionnaires to understand their psychological state. The questionnaire was conducted by self- filling method, the main contents included: criminal history, prison experience, self-evaluation of psychological state, planning after being released from prison, etc. The 30 criminals participated in SCL-90 test to understand their psychological status.
Results
Among the 30 prisoners who participated in the SCL-90 test, 8 had higher anxiety factors than the norm, and 6 of them were under the age of 35. According to the statistics of the questionnaire survey results of 30 prisoners near the end of their sentence, 25 people felt that their recent sleep status was average or poor; 20 people have no desire to talk with others and discuss the future. 16 people did not have any life plans after releasing from prison. Among the 30 prisoners who participated in the questionnaire survey, 10 hoped to get pre-release employment guidance from the prison, and 10 hoped to participate in classes to learn skills such as reading clubs, computer or finance courses organized by the prison.
Conclusions
Prisoners before their release, especially young prisoners under 35 years old, are more likely to have anxiety or irritability. Although the number of prisoners who are troubled with this psychological state and ask for help from supervisors is not large, and the number who take the initiative to plan their life before they are released from prison is also not large, most prisoners still hope to get care and help from the prison in their future life or have a job before they leave prison. Therefore, it is very important to pay more attention to the psychology of pre-release prisoners, especially the young people.
The present study investigated the age of acquisition (AoA) effect in processing second language (L2) words and how it is related to the AoA of the corresponding first language (L1) words. We adopted a lexical decision task in three experiments. The filler words were orthographically illegal in Experiment 1 to elicit more word form processing, while Experiment 2 used legal fillers to shift the bias toward semantic processing. In Experiment 3, we used a larger amount of stimuli containing more longer words with legal fillers. Our results showed that L2 AoA has a weak effect at the orthographical processing level and a stable effect at the semantic processing level. The L1 AoA modulates the L2 AoA effect at the semantic processing level, which is more likely to appear in long words. These results suggest that it is important to take bilingual representation and activation into consideration to explain the L2 AoA effect.
Bipolar disorder is a chronic mental disorder related to cognitive deficits. Low serum vitamin D levels are significantly associated with compromised cognition in neuropsychiatric disorders. Although patients with bipolar disorder frequently exhibit hypovitaminosis D, the association between vitamin D and cognition in bipolar disorder, and their neuroaxonal integrity, is unclear.
Aims
To investigate the interaction effects between vitamin D and neurofilament light chain (NfL) levels on cognitive domains in bipolar disorder.
Method
Serum vitamin D and NfL levels were determined in 100 euthymic patients with bipolar disorder in a cross-sectional study. Cognitive function was measured with the Brief Assessment of Cognition in Affective Disorders. We stratified by age groups and used general linear models to identify associations between vitamin D and NfL levels and their interaction effects on cognitive domains.
Results
The mean vitamin D and NfL levels were 16.46 ng/nL and 11.10 pg/mL, respectively; 72% of patients were vitamin D deficient. In the older group, more frequent hospital admissions and lower physical activity were identified in the group with versus without vitamin D deficiency. The age-modified interaction effect of vitamin D and NfL was associated with composite neurocognitive scores and verbal fluency in both age groups, and with processing speed domain in the younger group.
Conclusions
We observed a high vitamin D deficiency prevalence in bipolar disorder. We identified the interaction of vitamin D and NfL on cognitive domains, and the effect was modified by age. Longitudinal or randomised controlled studies enrolling patients with various illness durations and mood statuses are required to validate our findings.
This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.
Methods
From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.
Results
Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.
Conclusions
The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.
Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity.
Methods
Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case–control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities.
Results
Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls.
Conclusions
Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.
Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.
For each recollement of triangulated categories, there is an epivalence between the middle category and the comma category associated with a triangle functor from the category on the right to the category on the left. For a morphic enhancement of a triangulated category $\mathcal {T}$, there are three explicit ideals of the enhancing category, whose corresponding factor categories are all equivalent to the module category over $\mathcal {T}$. Examples related to inflation categories and weighted projective lines are discussed.
Research on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.
Aims
In this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder.
Method
Data for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case–crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.
Results
Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.
Conclusions
Use of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.
The role of the cerebellum in obsessive-compulsive disorder (OCD) has drawn increasing attention. However, the functional connectivity between the cerebellum and the cerebral cortex has not been investigated in OCD, nor has the relationship between such functional connectivity and clinical symptoms.
Methods
A total of 27 patients with OCD and 21 healthy controls (HCs) matched on age, sex and education underwent magnetic resonance imaging (MRI). Seed-based connectivity analyses were performed to examine differences in cerebellar-cerebral connectivity in patients with OCD compared with HCs. Associations between functional connectivity and clinical features in OCD were analyzed.
Results
Compared with HCs, OCD patients showed significantly decreased cerebellar-cerebral functional connectivity in executive control and emotion processing networks. Within the OCD group, decreased functional connectivity in an executive network spanning the right cerebellar Crus I and the inferior parietal lobule was positively correlated with symptom severity, and decreased connectivity in an emotion processing network spanning the left cerebellar lobule VI and the lingual gyrus was negatively correlated with illness duration.
Conclusions
Altered functional connectivity between the cerebellum and cerebral networks involved in cognitive-affective processing in patients with OCD provides further evidence for the involvement of the cerebellum in the pathophysiology of OCD, and is consistent with impairment in executive control and emotion regulation in this condition.
Psychiatric disorders such as schizophrenia and major depressive disorder
(MDD) are likely to be caused by multiple susceptibility genes, each with
small effects in increasing the risk of illness. Identifying DNA variants
associated with schizophrenia and MDD is a crucial step in understanding
the pathophysiology of these disorders.
Aims
To investigate whether the SP4 gene plays a significant
role in schizophrenia or MDD in the Han Chinese population.
Method
We focused on nine single nucleotide polymorphisms (SNPs) harbouring the
SP4 gene and carried out case–control studies in 1235
patients with schizophrenia, 1045 patients with MDD and 1235 healthy
controls recruited from the Han Chinese population.
Results
We found that rs40245 was significantly associated with schizophrenia in
both allele and genotype distributions (Pallele = 0.0005, Pallele = 0.004 after Bonferroni correction; Pgenotype = 0.0023, Pgenotype = 0.0184 after Bonferroni correction). The rs6461563
SNP was significantly associated with schizophrenia in the allele
distributions (Pallele = 0.0033, Pallele = 0.0264 after Bonferroni correction).
Conclusions
Our results suggest that common risk factors in the SP4
gene are associated with schizophrenia, although not with MDD, in the Han
Chinese population.
Cancer is a serious public health problem worldwide, and its relationship
with affective disorders is not clear.
Aims
To investigate alcohol- and tobacco-related cancer risk among patients
with affective disorders in a large Taiwanese cohort.
Method
Records of newly admitted patients with affective disorders from January
1997 through December 2002 were retrieved from the Psychiatric Inpatient
Medical Claims database in Taiwan. Cancers were stratified by site and
grouped into tobacco- or alcohol-related cancers. Standardised incidence
ratios (SIRs) were calculated to compare the risk of cancer between those
with affective disorders and the general population.
Results
Some 10 207 patients with bipolar disorder and 9826 with major depression
were included. The risk of cancer was higher in patients with major
depression (SIR = 2.01, 95% CI 1.85–2.19) than in those with bipolar
disorder (SIR 1.39, 95% CI 1.26–1.53). The elevated cancer risk among
individuals ever admitted to hospital for affective disorders was more
pronounced in tobacco- and/or alcohol-related cancers.
Conclusions
Elevated cancer risk was found in patients who had received in-patient
care for affective disorders. They require holistic approaches to
lifestyle behaviours and associated cancer risks.
Repeat self-harm is an important risk factor for suicide. Few studies have explored risk factors for non-fatal repeat self-harm in Asia.
Aims
To investigate the risk of non-fatal repeat self-harm in a large cohort of patients presenting to hospital in Taipei City, Taiwan.
Method
Prospective cohort study of 7601 patients with self-harm presenting to emergency departments (January 2004–December 2006). Survival analysis was used to examine the rates, timing and factors associated with repeat self-harm.
Results
In total 778 (10.2%) patients presented to hospital with one or more further episodes of self-harm. The cumulative risk of non-fatal repetition within 1 year of a self-harm episode was 9.3% (95% CI 8.7–10.1). The median time to repetition within 1 year was 105 days. Females had a higher incidence of repeat self-harm than males (adjusted hazard ratio 1.25, 95% CI 1.05–1.48) but males had shorter median time to repetition (107 v. 80 days). Other independent risk factors for repeat self-harm within 1 year of an index episode were: young age, self-harm by medicine overdose and increasing number of repeat episodes of self-harm.
Conclusions
The risk of non-fatal repeat self-harm in Taipei City is lower than that seen in the West. Risk factors for repeat non-fatal self-harm differ from those for fatal self-harm. The first 3 months after self-harm is a crucial period for intervention.
Common psychiatric disorders are highly heritable, indicating that genetic factors play an important role in their aetiology. The CACNA1C gene, which codes for subunit alpha-1C of the Cav1.2 voltage-dependent L-type calcium channel, has been consistently found to be the shared risk gene for several kinds of mental disorder.
Aims
To investigate whether CACNA1C is a susceptibility gene for schizophrenia and major depressive disorder in the Han Chinese population.
Method
We carried out a case–control study of 1235 patients with schizophrenia, 1045 with major depressive disorder and 1235 healthy controls. A tag single nucleotide polymorphism (SNP) rs1006737 along with another 10 tag SNPs in the CACNA1C gene were genotyped in all samples.
Results
We found that rs1006737 was associated with both schizophrenia (Pallele = 0.0014, Pgenotype = 0.006, odds ratio (OR) = 1.384, 95% CI 1.134–1.690) and major depressive disorder (Pallele = 0.0007, Pgenotype = 0.003, OR = 1.425, 95% CI 1.160–1.752).
Conclusions
Our findings support CACNA1C being a risk gene for both schizophrenia and major depressive disorder in the Han Chinese population.
Most previous studies of long-term mortality risk following self-harm
have been conducted in Western countries with few studies from Asia.
Aims
To investigate suicide and non-suicide mortality after non-fatal
self-harm in Taipei City, Taiwan.
Method
Prospective cohort study (median follow-up 3.3 years) of 7601 individuals
presenting to hospital with self-harm (January 2004 to December 2006).
Standardised mortality ratios (SMRs) for suicide and non-suicide
mortality were calculated.
Results
Suicide risk in the year following self-harm was over 100 times higher
than in the general population (SMR = 119.6, 95% CI 99.6–142.5). Males
and middle-aged and older adults had the highest subsequent risk of
suicide. Compared with people who took an overdose, individuals who used
hanging or charcoal burning in their index episode had the highest risk
of suicide. For non-suicide mortality the SMRs were 6.7 (95% CI 5.7–7.8)
in the first year and 4.4 (95% CI 3.9–4.9) during the whole follow-up
period.
Conclusions
Patterns of increased all-cause and suicide mortality following an
episode of self-harm are similar in Taipei City to those seen in Western
countries. Designing better aftercare following non-fatal self-harm,
particularly for those with underlying physical disorders or who have
used lethal self-harm methods, should be a priority for suicide
prevention programmes in Asia.