ABSTRACT
The 6-year mortality rate of a nation-wide cohort of Taiwanese psychiatric inpatients admitted during the 1-year period from 1987 to 1988 was examined via record linkage. The psychiatric care system in Taiwan is mainly hospital-based. Of the 13,385 patients studied (9309 men and 4076 women), 2039 (1720 men and 319 women) had died by the end of 1993. The standardized mortality ratio (SMR) in this sample (3.10 for men and 4.83 for women) was as high as those reported in western industrialized countries during the pre-deinstitutionalization era. We also examined the relationship between the excess mortality of patients and age, sex, causes of death, diagnostic categories, and length of hospital stay. In general, the SMR was greatest for the youngest age group, women, unnatural deaths, substance use disorders, and in the first year after admission. Although the main cause for the excess mortality was unnatural deaths, there was also an excess mortality due to natural causes across all diagnostic categories. Several recommendations for the improvement of psychiatric care in Taiwan are made on the basis of these findings.
Subject(s)
Cross-Cultural Comparison , Developing Countries , Mental Disorders/mortality , Adolescent , Adult , Aged , Cause of Death , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Risk Factors , Sex Ratio , Survival Analysis , Taiwan/epidemiologyABSTRACT
Schizophrenic patients have been shown to have a moderate excess of winter births in the areas where seasonal variations in weather are large. In this report, we examined the seasonality of schizophrenic births in Taiwan, which has a subtropical climate. Using nationwide hospitalization data (2429 male and 1320 female schizophrenic patients), we applied the life table method to compare the risk of schizophrenia among 12 cohorts of month-of-birth for males and females, respectively. Differences among the risks of the 12 cohorts were tested using the logrank test. The samples were further stratified by family history and age at onset. There was a significant association between the risk of being admitted as a schizophrenic and month of birth for both males and females. The cohorts born in November and January had the highest risks. After stratification, the association was significant only for non-familial, male, and early onset schizophrenic patients. The results indicate that seasonally varying factors might increase the risk of schizophrenia, especially in those without a family history of the disease. Men are more vulnerable to such factors than women, and the schizophrenics resulting from such insults tend to be early onset.
Subject(s)
Schizophrenia/epidemiology , Schizophrenic Psychology , Seasons , Adolescent , Adult , Age Factors , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Life Tables , Male , Pregnancy , Prenatal Exposure Delayed Effects , Risk Factors , Schizophrenia/diagnosis , Schizophrenia/genetics , Sex Factors , Taiwan/epidemiologyABSTRACT
While researching concepts of neurasthenia as described by patients and physicians of various backgrounds, it was found that there is a great discrepancy between the two groups. In this study, questionnaires were administered to 70 psychiatric patients, 6 Chinese medicine men, 44 general physicians and 35 neuropsychiatrists, to inquire into the reasons for positive or negative attitudes toward neurasthenia. Half of the clinical patients believed that they were suffering from neurasthenia. Neurasthenia is a predominate term used for various types of distress arising mainly from psychiatric diseases. Chinese medicine men are aware that this term is a medical diagnosis introduced from the West. Through experience they regard neurasthenia as a kind of deficit of nerve. Apparently, the concept of neurasthenia has been integrated into the Chinese medical system, a fact substantiated by its longstanding, nosological use by the public. Younger generation physicians within both general and neuropsychiatric disciplines on the whole reject neurasthenia as a diagnostic term. However, one-third of neuropsychiatrists and 40% of general physicians use this term in their practice in order to improve the treatment of and to establish good communication and rapport with the patients whom they treat. Most of them, however, do not use the term in their formal diagnosis. The concept of the illness, neurasthenia, is historically rooted and today presents a nosological dilemma. It will eventually be transformed conceptually and disappear from the public mind.
