Papers by Ming-Shun Chung
Psychological Medicine, 2016
BackgroundAn association between low levels of physical activity and impaired cognitive performan... more BackgroundAn association between low levels of physical activity and impaired cognitive performance in schizophrenia has been proposed, but most studies have relied on self-report measures of activity. This study examined the association between actigraphy-derived physical activity and cognitive performance adjusting for multiple covariates in patients with schizophrenia.MethodPatients with schizophrenia (n= 199) were recruited from chronic psychiatric wards, and 60 age-, sex- and body mass index-matched comparison participants were recruited from the staff of two hospitals and universities. Physical activity was assessed objectively for 7 days using an ActiGraph. Cognitive performance was assessed with the Cognitrone test from the Vienna Test System and the Grooved Pegboard Test. Demographic variables, metabolic parameters, positive and negative symptoms, duration of illness and hospitalization, and medication use were included as covariates. Pearson correlations and multivariable ...
Background: Walking is the fundamental component of taking steps and is the main form of physical... more Background: Walking is the fundamental component of taking steps and is the main form of physical activity among individuals with schizophrenia; it also offers a range of health benefits. This study aimed to examine the associations between daily steps and cognitive function and further explored how many steps were related to better cognitive function among inpatients with schizophrenia. Methods: Inpatients with schizophrenia were recruited from long-stay psychiatric wards across two hospitals (n=199 at site 1 and n=195 at site 2). Daily steps were collected with an accelerometer for 7 days. Four cognitive domains (attention, processing speed, reaction time, and motor speed) were tested at site 1, and two cognitive domains (attention and processing speed) were tested at site 2. The associations of daily steps and levels of steps/day with cognitive function were tested using multivariable linear regressions separated by site. Covariates included demographic variables, weight status, metabolic parameters, and clinical state. Results: Participants took an average of 7445 (±3442) steps/day. More steps were related to better attention, processing speed, reaction time, and motor speed after multivariable adjustments. Compared with participants taking <5000 steps/day, those taking ≥5000 steps/day showed significantly better processing speed. Participants taking ≥7500 steps/day were associated with better attention, better reaction time, and better motor speed than those taking <5000 steps/day. Conclusion: Daily steps are associated with better cognitive function among inpatients with schizophrenia. The optimal benefit for cognitive function among this clinical population is achieving 7500 steps/day or more.
Quality of Life Research, 2007
We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophreni... more We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach's a = 0.92, 0.84). The test-retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r =-0.65 to-0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.
Journal of the Chinese Medical Association, 2011
International Journal of Psychiatry in Clinical Practice, 2009
Objectives. To validate the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese vers... more Objectives. To validate the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version with factor analysis. We also investigated factors influencing quality of life results. Method. One hundred patients with schizophrenia participated in this study. Experienced psychiatrists evaluated each patient's current psychological condition to assure intact judgment. Participants then filled out the quality of life questionnaire, SQLS-R4. We used principal component analysis to analyze SQLS-R4 with oblique rotation. We also collected demographic data, another subjective and objective quality of life questionnaire, and information about the functional status of the participants at the same time. Multiple linear regression was used to analyze collected factors which may influence the quality of life of schizophrenic patients. Results. We extracted seven factors that explained a 68.1% variance in the patients' quality of life. The factors were relationships with others, loneliness, exhaustion, depressed thinking, somatic concerns, vitality, and worry. Conclusion. We found that the SQLS-R4 factor analysis provided insights into the structure of the quality of life of patients with schizophrenia. We also found that subjective social participation, subjective health, and depression were quality-of-life-related factors. Whether other factors influence the quality of life in patients with schizophrenia requires further investigation.
背景：轉化症常表現神經學疾患之症狀但卻無法與神經學及其他身體病況相配。病因及復原機轉證據仍有限。本文以個案報告呈現自體心理學觀點中轉化症病人復原的可能機制。研究對象：一位三十一歲單身女性持續兩年... more 背景：轉化症常表現神經學疾患之症狀但卻無法與神經學及其他身體病況相配。病因及復原機轉證據仍有限。本文以個案報告呈現自體心理學觀點中轉化症病人復原的可能機制。研究對象：一位三十一歲單身女性持續兩年有癲癇發作且被診斷為轉化症。後續被轉介接受自體心理學導向的個別心理治療。治療過程及整合陳述：病人與治療者互動形成新的自體經驗，且整合過往自體經驗並增進自體一致性。十個月後，病人不再服用抗癲癇藥物且無癲癇發作。結論：藉由同理來形成自體客體，與被轉化症阻隔的情緒連結。個體進而能面對情緒，轉化症也不再出現。
We report the first genome-wide association study of a joint analysis using 795 Han Chinese indiv... more We report the first genome-wide association study of a joint analysis using 795 Han Chinese individuals with treatmentrefractory schizophrenia (TRS) and 806 controls. Three loci showed suggestive significant association with TRS were identified. These loci include: rs10218843 (P = 3.04610 27) and rs11265461 (P = 1.94610 27) are adjacent to signaling lymphocytic activation molecule family member 1 (SLAMF1); rs4699030 (P = 1.94610 26) and rs230529 (P = 1.74610 27) are located in the gene nuclear factor of kappa light polypeptide gene enhancer in B-cells 1 (NFKB1); and rs13049286 (P = 3.05610 25) and rs3827219 (P = 1.66610 25) fall in receptor-interacting serine/threonine-protein kinase 4 (RIPK4). One isolated single nucleotide polymorphism (SNP), rs739617 (P = 3.87610 25) was also identified to be associated with TRS. The-94delATTG allele (rs28362691) located in the promoter region of NFKB1 was identified by resequencing and was found to associate with TRS (P = 4.85610 26). The promoter assay demonstrated that the-94delATTG allele had a significant lower promoter activity than the-94insATTG allele in the SH-SY5Y cells. This study suggests that rs28362691 in NFKB1 might be involved in the development of TRS.
Taiwanese Journal of Psychiatry
Schizophrenia bulletin, May 23, 2016
Sedentary behavior (SB) is associated with poor cognitive performance in the general population. ... more Sedentary behavior (SB) is associated with poor cognitive performance in the general population. Although people with schizophrenia are highly sedentary and experience marked cognitive impairments, no study has investigated the relationship between SB and cognition in people with schizophrenia. A total of 199 inpatients with schizophrenia (mean [SD] age 44.0 [9.9] years, 61.3% male, mean [SD] illness duration 23.8 [6.5]) and 60 age and sex matched controls were recruited. Sedentary behavior and physical activity (PA) were captured for 7 consecutive days with an accelerometer. Cognitive performance was assessed using the Vienna Test System, and the Grooved Pegboard Test. Multivariate regression analyses adjusting for important confounders including positive and negative symptoms, illness duration, medication, and PA were conducted. The 199 patients with schizophrenia engaged in significantly more SB vs controls (581.1 (SD 127.6) vs 336.4 (SD 107.9) min per day, P < .001) and perfo...
Psychiatry Research, 2016
Sleep disorder is a risk factor for several systemic inflammation-related diseases and there are ... more Sleep disorder is a risk factor for several systemic inflammation-related diseases and there are extensive data showing that schizophrenia is associated with chronic low-grade systemic inflammation. This study investigated the associations between sleep quality and inflammatory markers in patients with schizophrenia, which has not been examined before. Sleep quality (total sleep time, sleep efficiency, sleep onset latency, total activity counts, wake after sleep onset, number of awakening, and average length of awakening) was measured using actigraphy in 199 schizophrenia inpatients. The state of inflammation was measured using blood concentration of white blood cells (WBC) and neutrophils, together with neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). The results showed that total sleep time was negatively associated with NLR and PLR, and sleep efficiency was negatively associated with neutrophil counts and NLR. Sleep onset latency, total activity counts, wake after sleep onset, and number of awakening were positively associated with WBC and neutrophil counts. The average length of awakening was positively associated with NLR and PLR. This is the first report to suggest that improving sleep quality may modulate the state of inflammation in patients with schizophrenia.
The Journal of Clinical Psychiatry
Background: Inflammatory responses from chronic infection might affect the brain and increase the... more Background: Inflammatory responses from chronic infection might affect the brain and increase the risk of depressive disorder. However, the temporal association between chronic infection (eg, tuberculosis [TB]) and incident depressive disorder has not been prospectively evaluated. Objective: To determine the association of pulmonary tuberculosis (PTB) and anti-TB drugs with incident depressive disorder (ICD-9-CM codes 296.2x-296.3x, 300.4, and 311.x). Method: From January 1, 2000, we identified adult patients with PTB from the Taiwan National Health Insurance Research Database. A control cohort without PTB, matched for age (± 5 years), sex, comorbidities, and income level, was selected for comparison. The 2 cohorts were followed until December 31, 2011, and observed for occurrence of depressive disorder. Results: Of the 23,145 patients (4,629 study patients and 18,516 matched controls), 302 (1.3%) had depressive disorder during a mean follow-up period of 6.53 years, including 79 study patients (1.71%) and 223 controls (1.20%). After adjusting for age, sex, comorbidities, and income level in the Cox proportional hazards model, PTB was found to be an independent risk factor of incident depressive disorder (adjusted hazard ratio [HR], 1.74; 95% CI, 1.35-2.25). The risk of incident depressive disorder was significantly higher (adjusted HR, 2.54; 95% CI, 1.19-5.45) in patients with TB who received more than 60 defined daily doses (DDDs) of ethambutol, and the effect was dose-dependent. Conclusions: PTB patients had a higher risk of incident depressive disorder, particular in those with an ethambutol dose of more than 60 DDDs. Depressive disorder should be sought in patients following tuberculosis.
International Journal of Group Psychotherapy
This study investigated the therapeutic effects of dynamic interpersonal group psychotherapy (DIG... more This study investigated the therapeutic effects of dynamic interpersonal group psychotherapy (DIGP) for the depressed in Taiwan. A 16-session DIGP was held weekly, and participants were evaluated with the Hamilton Depression Rating Scale, Taiwanese Depression Questionnaire, and World Health Organization Quality of Life-BREF before and after DIGP. Compared with control group, the patients treated with DIGP showed significant improvement in severity of their depression, especially in the somatic subscale and quality of life regarding psychological health. We found that focusing on repairing interpersonal interaction in DIGP would improve the social interaction problems of Chinese with depressive disorder.
Objective: We aimed to develop a Screening Test for Suicide Risk (STSR) in 10-15-year-old school ... more Objective: We aimed to develop a Screening Test for Suicide Risk (STSR) in 10-15-year-old school children as a tool for people-centered public health. Methods: 607 students filled out the Taiwanese Depression Questionnaire (TDQ) for assessing suicide risk and multiple ...
Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists, 2014
The aim of this study is to investigate the association among depressive disorder, adjustment dis... more The aim of this study is to investigate the association among depressive disorder, adjustment disorder, sleep disturbance, and suicidal ideation in Taiwanese adolescent. We recruited 607 students (grades 5-9) to fill out the investigation of basic data and sleep disturbance. Psychiatrists then used the Mini International Neuropsychiatric Interview-Kid to interview these students to assess their suicidal ideation and psychiatric diagnosis. Multiple logistic regression with forward conditionals was used to find the risk factors for multivariate analysis. Female, age, depressive disorder, adjustment disorder, and poor sleep all contributed to adolescent suicidal ideation in univariate analysis. However, poor sleep became non-significant under the control of depressive disorder and adjustment disorder. We found that both depressive disorder and adjustment disorder play important roles in sleep and adolescent suicidal ideation. After controlling both depressive disorder and adjustment di...
Psychiatry Research, 2013
Schizophrenia has been associated with autonomic dysregulation and increased cardiovascular co-mo... more Schizophrenia has been associated with autonomic dysregulation and increased cardiovascular co-morbidity. We hypothesised that autonomic dysregulation in patients with schizophrenia is associated with psychopathology and metabolic profiles. In this study, we aimed to evaluate psychopathology, comprehensive metabolic profiles and cardiac autonomic function using heart-rate variability (HRV) analysis in patients with schizophrenia. A total of 94 patients with schizophrenia and 51 healthy controls were recruited. Each patient underwent a physical examination, laboratory tests and rating scale evaluation, and all subjects underwent a 1-h electrocardiogram monitoring. Analysis of variance was used to compare demographic and HRV variables between control and patient groups. We applied multiple regression analysis with backward selection to examine the association between HRV indices and demographic, metabolic and psychopathology profiles. A decreased HRV was found in patient groups, compared to controls. Reduced vagal-related and complexity domain of HRV indices in patient groups were correlated with increased body mass indices, diastolic pressure, triglycerides, high- and low-density lipoprotein and severity of psychosis mainly in the negative symptom domain. This study provides evidence that altered autonomic function is associated with both psychopathology and metabolic profiles in patients with schizophrenia. These findings may warrant future research in using HRV as objective markers to monitor cardiovascular health and the severity of psychosis in patients with schizophrenia.
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Papers by Ming-Shun Chung