Chronic alcoholism can result in severe liver conditions such as fatty liver disease and cirrhosis, potentially leading to life-threatening complications and premature death.

This study investigated the age-sex distribution of patients with alcohol addiction and aimed to identify differences in clinic department preferences based on their principal and additional diagnoses in Taiwan, in 2022.

We conducted a comprehensive analysis of the diagnostic patterns of 334 patients with alcohol addiction from the Taoyuan General Hospital, Ministry of Health and Welfare.

Figure 1 depicts patient demographics, highlighting 297 male and 37 female patients with alcohol-related disorders. Males aged 41-60 years were particularly dominant, as shown in Figure 2. Principal diagnoses, including alcoholic liver disease and acute pancreatitis, are detailed in Table 1. Additional diagnoses, such as chronic pancreatitis and esophageal varices, are presented in Table 2. For departmental preferences, Table 3 reveals the Gastrointestinal (GI) department as the top choice, followed by Kidney, Neurological, and Cardiovascular/Chest.Table 1.

Top 5 Principal Diagnoses of Alcohol Addiction Patients.

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The study revealed that patients with alcohol addiction often delay seeking psychiatric help instead of presenting for medical care only after liver or gastrointestinal complications occur. This underscores the crucial need for better health education regarding the relationship between alcohol addiction and liver disease. Prompt recognition and early intervention for substance addiction can significantly reduce these risks and improve patient outcomes.

None Declared

The COVID-19 pandemic has stressed global healthcare systems, with Taiwan’s National Health Insurance (NHI) playing a crucial role in prevention and treatment. Like other countries, Taiwan grappled with managing the virus alongside regular healthcare services, resulting in notable financial strain on hospitals after COVID-19 pandemic.

This study explores the financial implications of the psychiatric department at a medical center in Taiwan, highlighting the changing dynamics of healthcare costs and revenue during this period.

Data were collected monthly between January 2020 and September 2022, including the number of outpatient visits, inpatient patient-days, medical revenue, medical costs, and gross medical profit. Multivariate linear regression analysis confirmed the assumptions of the model and validated the findings.

Regression analysis revealed a significant correlation between the number of patients and financial indicators (USD1). Medical revenue (Table. 1), grew by 82 USD for each outpatient visit(p<0.001, 95% CI:41–122), and grew by 70 USD for each inpatient-days(p=0.001, 95% CI:31–108). Medical costs (Table. 2), increased by 59 USD for every inpatient-days (p=0.01, 95% CI:15–102). Finally, the gross medical profits (Table. 3) increased by 72 USD for each outpatient visit (p=0.003, 95% CI:27–117).Table 1.

Multiple linear regression analysis of the impact of medical service on medical revenue.

During the COVID-19 outbreak, healthcare systems, including those in Taiwan, were tested for unparalleled service challenges. This study found that while outpatient services boosted profits, rising inpatient admissions strained finances, given their higher costs and staffing needs. After the pandemic, psychiatric departments should reconsider resource allocation to balance expenses and revenues. Effective management is crucial for patient outcomes, emphasizing the need for quality care and fiscal control. Future research must focus on fortifying healthcare resilience.

None Declared

According to CEOWORLD Magazine‘s 2019 “Health Care Indicators” rating of 89 countries in the world, Taiwan ranks first in the world. The coverage of the National Health Insurance covers all necessary medical treatment, including outpatient, hospitalization, and prescription drugs etc. The psychiatrist was wondering which item with the highest service cost–performance (CP) ratio of the psychiatrist performance in a general hospital and used proportion of PPF as performance indicator. He used allocation to distribute the hours across job activities.

The purpose of this study is to investigate items allocation proportion for outpatient and inpatient ward in a specific month, examining the distribution of performance and figure out an appropriate model to optimal medical service.

Demographic data were collected through PPF projects included 15 outpatient items and 19 inpatient ward items from the third-month of the psychiatrist’s employment in the general hospital, as shown in Table 1. Items related to physiological examination has been excluded. The performance is calculated by combining outpatient and inpatient wards.

Demographic data analysis found that proportion of inpatient ward PPF (67.01%) was significantly greater than proportion of outpatient PPF (32.99%) (Figure 1). The inpatient ward performance was 2 times the outpatient performance. This result showed that most performance came from inpatient ward. Among all items of the proportion of PPF unit, the highest two for inpatient ward items were general hospital bed inpatient consultation (32.58%) and special treatment for psychiatric inpatients (14.35%), and for outpatient, the highest was psychiatric outpatient consultation - more than two (11.31%) (Table 1).

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National Health Insurance is an important system to assist in epidemic prevention during the COVID-19 period. The most PPF of psychiatrist service in a general hospital came from the service of inpatient ward items, including the general hospital bed inpatient consultation with the highest CP ratio. These findings may suggest that the inpatient service could offer psychiatrists fair PPF, and the hospital environment could be favorable for recruitment.

None Declared

TDuring COVID-19 pandemic, it was noticed that it was students who were mostly affected by the changes that aroused because of the pandemic. The interesting part is whether students’ well-being could be associated with their fields of study as well as coping strategies.

In this study, we aimed to assess 1) the mental health of students from nine countries with a particular focus on depression, anxiety, and stress levels and their fields of study, 2) the major coping strategies of students after one year of the COVID-19 pandemic.

We conducted an anonymous online cross-sectional survey on 12th April – 1st June 2021 that was distributed among the students from Poland, Mexico, Egypt, India, Pakistan, China, Vietnam, Philippines, and Bangladesh. To measure the emotional distress, we used the Depression, Anxiety, and Stress Scale-21 (DASS-21), and to identify the major coping strategies of students - the Brief-COPE.

We gathered 7219 responses from students studying five major studies: medical studies (N=2821), social sciences (N=1471), technical sciences (N=891), artistic/humanistic studies (N=1094), sciences (N=942). The greatest intensity of depression (M=18.29±13.83; moderate intensity), anxiety (M=13.13±11.37; moderate intensity ), and stress (M=17.86±12.94; mild intensity) was observed among sciences students. Medical students presented the lowest intensity of all three components - depression (M=13.31±12.45; mild intensity), anxiety (M=10.37±10.57; moderate intensity), and stress (M=13.65±11.94; mild intensity). Students of all fields primarily used acceptance and self-distraction as their coping mechanisms, while the least commonly used were self-blame, denial, and substance use. The group of coping mechanisms the most frequently used was ‘emotional focus’. Medical students statistically less often used avoidant coping strategies compared to other fields of study. Substance use was only one coping mechanism that did not statistically differ between students of different fields of study. Behavioral disengagement presented the highest correlation with depression (r=0.54), anxiety (r=0.48), and stress (r=0.47) while religion presented the lowest positive correlation with depression (r=0.07), anxiety (r=0.14), and stress (r=0.11).

1) The greatest intensity of depression, anxiety, and stress was observed among sciences students, while the lowest intensity of those components was found among students studying medicine.

2) Not using avoidant coping strategies might be associated with lower intensity of all DASS components among students.

3) Behavioral disengagement might be strongly associated with greater intensity of depression, anxiety, and stress among students.

4) There was no coping mechanism that provided the alleviation of emotional distress in all the fields of studies of students.

None Declared

Major Depressive Disorder (MDD) is one of the most common mental illnesses worldwide and is strongly associated with suicidality. Commonly used treatments for MDD with suicidality include crisis intervention, oral antidepressants (although risk of suicidal behavior is high among non-responders and during the first 10-14 days of the treatment) benzodiazepines and lithium. Although several interventions addressing suicidality exist, only few studies have characterized in detail patients with MDD and suicidality, including treatment, clinical course and outcomes. Patient Characteristics, Validity of Clinical Diagnoses and Outcomes Associated with Suicidality in Inpatients with Symptoms of Depression (OASIS-D)-study is an investigator-initiated trial funded by Janssen-Cilag GmbH.

For population 1 out of 3 OASIS-D populations, to assess the sub-population of patients with suicidality and its correlates in hospitalized individuals with MDD.

The ongoing OASIS-D study consecutively examines hospitalized patients at 8 German psychiatric university hospitals treated as part of routine clinical care. A sub-group of patients with persistent suicidality after >48 hours post-hospitalization are assessed in detail and a sub-group of those are followed for 6 months to assess course and treatment of suicidality associated with MDD. The present analysis focuses on a preplanned interim analysis of the overall hospitalized population with MDD.

Of 2,049 inpatients (age=42.5±15.9 years, females=53.2%), 68.0% had severe MDD without psychosis and 21.2% had moderately severe MDD, with 16.7% having treatment-resistant MDD. Most inpatients referred themselves (49.4%), followed by referrals by outpatient care providers (14.6%), inpatient care providers (9.0%), family/friends (8.5%), and ambulance (6.8%). Of these admissions, 43.1% represented a psychiatric emergency, with suicidality being the reason in 35.9%. Altogether, 72.4% had at least current passive suicidal ideation (SI, lifetime=87.2%), including passive SI (25.1%), active SI without plan (15.5%), active SI with plan (14.2%), and active SI with plan+intent (14.1%), while 11.5% had attempted suicide ≤2 weeks before admission (lifetime=28.7%). Drug-induced mental and behavioral disorders (19.6%) were the most frequent comorbid disorders, followed by personality disorders (8.2%). Upon admission, 64.5% were receiving psychiatric medications, including antidepressants (46.7%), second-generation antipsychotics (23.0%), anxiolytics (11.4%) antiepileptics (6.0%), and lithium (2.8%). Altogether, 9.8% reported nonadherence to medications within 6 months of admission.

In adults admitted for MDD, suicidality was common, representing a psychiatric emergency in 35.9% of patients. Usual-care treatments and outcomes of suicidality in hospitalized adults with MDD require further study.

None Declared

In Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.

This study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.

Demographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.

Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.

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In the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.

None Declared

Olanzapine (OLA) is a common first-prescribed antipsychotic and has shown favorable efficacy in acutely exacerbated patients with schizophrenia. The mixed receptor activity of OLA and its greater affinity for serotonin 5-HT2A rather than dopamine D2 receptors are similar to those of clozapine. Pharmacokinetically, OLA is metabolized mainly by hepatic cytochrome enzyme P450 1A2 (CYP1A2). Because risks of antipsychotic polypharmacy include increased drug-drug interactions, pharmacokinetic considerations are important for selection of antipsychotics to be combined. Due to its pharmacological characteristics, amisulpride (AMI), another atypical antipsychotic with proven efficacy, is a promising adjuvant agent of special interest. AMI is unlikely to interact with other drugs due to the low plasma protein binding and metabolism and does not affect the activity of the CYP system. Furthermore, AMI is highly selective for dopamine D2/D3 receptors; has minimal or no affinity for D1, D4, or D5 receptors. Despite the potential benefits of the combination of OLA and AMI, only a few open-label studies have been conducted, and no randomized clinical trial has been performed to date to examine the efficacy and tolerability of the combination. Hence, the goals of this study were to test the hypothesis that AMI augmentation would improve psychotic symptoms and be well tolerated in schizophrenic patients who showed poor response to OLA monotherapy.

The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy.

The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks.

The changes in PANSS total score and PANSS-positive subscale score were significantly different (p < 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant.

AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.

W.-M. Bahk Grant / Research support from: Handok Pharmaceuticals, Seoul, Korea, Y. S. Woo: None Declared, S.-Y. Park: None Declared, B.-H. Yoon: None Declared, S.-M. Wang: None Declared, M.-D. Kim: None Declared

This study aimed to compare the pre- and post-operative vestibular and equilibrium functions of patients with cholesteatoma-induced labyrinthine fistulas who underwent different management methods.

Data from 49 patients with cholesteatoma-induced labyrinthine fistulas who underwent one of three surgical procedures were retrospectively analysed. The three management options were fistula repair, obliteration and canal occlusion.

Patients underwent fistula repair (n = 8), canal occlusion (n = 18) or obliteration procedures (n = 23). Patients in the fistula repair and canal occlusion groups suffered from post-operative vertigo and imbalance, which persisted for longer than in those in the obliteration group. Despite receiving different management strategies, all patients achieved complete recovery of equilibrium functions through persistent efforts in rehabilitation exercises.

Complete removal of the cholesteatoma matrix overlying the fistula is reliable for preventing iatrogenic hearing deterioration due to unremitting labyrinthitis. Thus, among the three fistula treatments, obliteration is the optimal method for preserving post-operative vestibular functions.

Abnormal reward functioning is central to anhedonia and amotivation symptoms of schizophrenia (SCZ). Reward processing encompasses a series of psychological components. This systematic review and meta-analysis examined the brain dysfunction related to reward processing of individuals with SCZ spectrum disorders and risks, covering multiple reward components.

After a systematic literature search, 37 neuroimaging studies were identified and divided into four groups based on their target psychology components (i.e. reward anticipation, reward consumption, reward learning, effort computation). Whole-brain Seed-based d Mapping (SDM) meta-analyses were conducted for all included studies and each component.

The meta-analysis for all reward-related studies revealed reduced functional activation across the SCZ spectrum in the striatum, orbital frontal cortex, cingulate cortex, and cerebellar areas. Meanwhile, distinct abnormal patterns were found for reward anticipation (decreased activation of the cingulate cortex and striatum), reward consumption (decreased activation of cerebellum IV/V areas, insula and inferior frontal gyri), and reward learning processing (decreased activation of the striatum, thalamus, cerebellar Crus I, cingulate cortex, orbitofrontal cortex, and parietal and occipital areas). Lastly, our qualitative review suggested that decreased activation of the ventral striatum and anterior cingulate cortex was also involved in effort computation.

These results provide deep insights on the component-based neuro-psychopathological mechanisms for anhedonia and amotivation symptoms of the SCZ spectrum.