Mong-Liang Lu

• MD, MS
• Professor (Full) at Taipei Medical University

Background Clozapine stands as the drug of choice for treating individuals with treatment-resistant schizophrenia (TRS). However, only 40% of patients with TRS respond to clozapine, forming a subgroup of clozapine- resistant patients. Recently, the neuropeptide orexin-A has emerged its relevance in the pathophysiology of schizophrenia (Chien et al....

Background Childhood trauma is associated with substance use disorders, including methamphetamine use disorder (MUD). Oxytocin, involved in social bonding, stress regulation, and reward processing, may influence addiction vulnerability and impulsivity in individuals with a history of childhood trauma. Aims & Objective To investigate the relationsh...

Background Prolactin elevation, resulting from dopamine D2 receptor antagonism, is a common side effect of antipsychotic medications. Olanzapine, an atypical antipsychotic drug, offers enhanced clinical efficacy and fewer side effects compared to typical antipsychotic drugs. Nevertheless, some studies suggest that olanzapine may still lead to an in...

Objective Therapeutic drug monitoring (TDM) indicators have been suggested to predict overall outcome responses to olanzapine (OLZ) treatments in terms of efficacy and metabolic syndrome. This study aimed to investigate whether paraoxonase-1 (PON-1) activity can be used to predict schizophrenia patient outcomes. Methods Schizophrenic patients ( N...

Objective Major depressive disorder (MDD) is an important psychiatric illness worldwide. We developed the Chen Depression Scale (CDS) based on the criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition . In this study, we intended to evaluate the psychometric properties of the CDS. Methods The sample consisted of 135...

Background Few previous studies have established Snaith–Hamilton Pleasure Scale (SHAPS) cut-off values using receiver operating characteristic curve analysis and applied these values to compare predictors of anhedonia between clinical and nonclinical groups. Aims To determine the optimal cut-off values for the SHAPS and use them to identify predic...

Childhood trauma has been linked to schizophrenia, but underlying biological mechanisms remain elusive. This study explored the potential role of plasma oxytocin as a mediator in the relationship between childhood trauma and the psychopathology of schizophrenia. 160 patients with schizophrenia and 80 age- and sex-matched healthy controls were asses...

The lymphocyte‐related ratios, neutrophil‐to‐lymphocyte ratio (NLR), monocyte‐to‐lymphocyte ratio (MLR) and platelet‐to‐lymphocyte ratio (PLR) are new measures of inflammation within the body. Few studies have investigated the inflammatory response of patients with methamphetamine‐induced psychotic disorder. Clinically, the psychotic symptoms and b...

Background Clozapine is the primary antipsychotic (APD) for treatment-resistant schizophrenia (TRS). However, only 40% of patients with TRS respond to clozapine, constituting a subgroup of clozapine-resistant patients. Recently, the neuropeptide orexin-A was shown to be involved in the pathophysiology of schizophrenia. This study evaluated the asso...

Objectives Risperidone, a dopamine and serotonin antagonist or a second-generation (atypical) antipsychotic drug, is commonly prescribed for various psychiatric disorders, including schizophrenia, bipolar disorder, and autism spectrum disorders. While effective, risperidone often leads to hyperprolactinemia, impacting about 40%–80% of patients. In...

Background Childhood trauma has been linked to increased risk of schizophrenia and social dysfunction, and oxytocin and its receptor gene have been implicated in regulating social behavior. This study investigated the potential role of oxytocin and oxytocin receptor gene (OXTR) in mediating the effects of childhood trauma on social functioning in s...

Objectives: To provide an updated systematic review of randomized controlled studies for the efficacy of cognitive behavioural therapy (CBT) in treating adults with attention-deficit/hyperactivity disorder (ADHD). Design: Meta-analysis. Methods: PROSPERO registration: CRD42021273633. The methods used aligned with the PRISMA guidelines. Databas...

Purpose Diabetes mellitus (DM) increases the risk of cardiovascular and all-cause mortality. The coexistence of depression and DM is associated with an increased risk of DM complications and functional morbidity. The independent effect of depression on mortality in patients with DM is unclear, and relevant Asian studies have provided inconsistent r...

Abstract Microbiota-gut-brain axis signaling plays a pivotal role in mood disorders. The communication between the host and the gut microbiota may involve complex regulatory networks. Previous evidence showed that host-fecal microRNAs (miRNAs) interactions partly shaped gut microbiota composition. We hypothesized that some miRNAs are correlated wit...

Importance: Prenatal exposure to benzodiazepines is reported to be associated with neurodevelopmental disorders among children, but associations of maternal genetic confounding with neurodevelopmental disorders among children have not been taken into consideration. Objective: To ascertain whether prenatal benzodiazepine exposure was associated w...

Some personality traits, especially neuroticism, has been found to be associated with suicide attempt (SA) in mood disorder patients. The present study explored the association between personality traits and SA using polygenic risk scores (PRS) for personality among patients with mood disorders. We also investigated the effects of a variety of psyc...

Social dysfunction, manifested by impaired social cognition, is contributing to poorer prognosis of patients with schizophrenia. Growing evidence indicates that oxytocin acts as a neurotransmitter in the regulation of social cognition. It still lacks a thorough understanding of how oxytocin is linked with deficits in social cognition and social fun...

Theta-burst stimulation is a non-invasive brain stimulation technique that was introduced as a potential augmentation treatment for patients with schizophrenia. The purpose of this meta-analysis was to investigate the therapeutic efficacy and safety of intermittent theta-burst stimulation in patients with schizophrenia. Following the PRISMA guideli...

Inadequate levels of 5-methyltetrahydrofolate (5-MTHF) and the T variant of MTHFR C677T have been suggested to be associated with an increased risk of developing mental illness, whereas the PON1 SNP variant provides a protective role. However, reports validating the methodology for plasma 5-MTHF levels in schizophrenia patients are limited. A sensi...

The high prevalence of metabolic syndrome in persons with schizophrenia has spurred investigational efforts to study the mechanism beneath its pathophysiology. Early psychosis dysfunction is present across multiple organ systems. On this account, schizophrenia may be a multisystem disorder in which one organ system is predominantly affected and whe...

Objective This study aimed to investigate the relationship between eveningness preference and poor sleep quality and eventually examine the moderation effect of stress susceptibility. Methods Individuals with non-acute major depressive disorder or bipolar affective disorder and healthy participants were recruited. The Composite Scale of Morningnes...

Background/Purpose Orexin-A levels are reportedly increased in antipsychotic (APD)-treated patients with schizophrenia compared to healthy controls and have been associated with metabolic abnormalities. It is not clear whether the orexin-A elevation is related specifically to the drug (APDs) effect, which should be clarified by including a drug-fre...

Background Antipsychotic drug (APD) treatment has been associated with metabolic abnormalities. Brown adipose tissue (BAT) is the main site of adaptive thermogenesis and secretes various metabolism-improving factors known as batokines. We explored the association of BAT activity with APD treatment and metabolic abnormalities in patients with schizo...

Backgrounds A proportion of patients with bipolar disorder (BD) manifests with only unipolar mania (UM). This study examined relevant clinical features and psychosocial characteristics in UM compared with depressive-manic (D-M) subgroups. Moreover, comorbidity patterns of physical conditions and psychiatric disorders were evaluated between the UM a...

Schizophrenia is one of the most stigmatized mental disorders. In 2014, schizophrenia was renamed in Mandarin in Taiwan, from the old name of “mind-splitting disease” to new name “disorder with dysfunction of thought and perception”, in an attempt to reduce the stigmatization of schizophrenia. This cross-sectional study aimed to investigate the eff...

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe cutaneous drug hypersensitivity reaction. Delays in making a diagnosis of DRESS syndrome and lack of timely treatment may result in morbidity and mortality. However, the presentation can be misinterpreted as other pathologies because of a broad spectrum of clini...

Purpose Studies have reported a strong link between asthma and panic disorder. We conducted a 17-year community-based large cohort study to examine the relationship between asthma, early smoking initiation, and panic disorder during adolescence and early adulthood. Methods A total of 162,766 participants aged 11–16 years were categorized into asth...

Background: Subgrouping patients with major depressive disorder is a promising solution for the issue of heterogeneity. However, the link between available subtypes and distinct pathological mechanisms is weak and yields disappointing results in clinical application. Aim: To develop a novel approach for classification of patients with time-depen...

The one-carbon metabolism pathway is a suitable candidate for studying the genetic and epigenetic factors contributing to metabolic abnormalities in patients with schizophrenia. We recruited 232 patients with schizophrenia and analyzed their serum folate, vitamin B12, and homocysteine levels and metabolic parameters to investigate the associations...

Recent studies have suggested that gut–brain axis may be one of the mechanisms of major depression disorder (MDD). The current study aimed to investigate the effects of Lactobacillus plantarum PS128 (PS128) on psychophysiology in patients with MDD. We recruited 11 patients with MDD and gave them PS128 for 8 weeks. We compared depression symptoms, s...

Metabolic disturbances and obesity are major cardiovascular risk factors in patients with schizophrenia, resulting in a higher mortality rate and shorter life expectancy compared with those in the general population. Although schizophrenia and metabolic disturbances may share certain genetic or pathobiological risks, antipsychotics, particularly th...

Importance Most previous genome-wide association studies (GWAS) of depression have used data from individuals of European descent. This limits the understanding of the underlying biology of depression and raises questions about the transferability of findings between populations. Objective To investigate the genetics of depression among individual...

The stigma associated with serious mental illnesses causes a huge burden on patients, their families, and society. In October 2012, in Taiwan, schizophrenia was renamed to reduce the stigma associated with this disease. The aim of this study was to compare the differences of public stigma, self-stigma, and social distance associated with schizophre...

To determine whether exposure to antidepressants (ATDs) results in improved overall survival (OS) of patients with gastric cancer (GC) after surgery, we conducted a large cohort study and considered confounding factors that might affect the research outcomes. Patients who received a new diagnosis of GC and received surgery and chemotherapy between...

Evidence has demonstrated the association between childhood trauma and criminality in adulthood, however, less is known about how best to explain the route from childhood trauma to adulthood aggression. Results from both human and animal studies have generated the hypothesis that dysfunction of the oxytocinergic system may correlate with pathologic...

The aim of the study was to assess the relationship between prolactin levels and sexual dysfunction in patients with schizophrenia who use olanzapine medication. The potential risk factors of hyperprolactinemia and sexual dysfunction were also investigated. Patients with schizophrenia undergoing olanzapine monotherapy were invited to participate in...

Introduction Efforts have been made in assessing efficacy and tolerability to various antidepressants, but understanding personalized chances of stability to medication switching sequence is still inconclusive. This study aimed to identify naturalistic switching patterns of medication in stratifying MDD patients. Methods MDD patients were stratifi...

Background Increased traumatic brain injury (TBI) risk was found in patients with bipolar disorder (BPD). Whether the medications for BPD and dosage moderate the risk of TBI is not clear. Aim This study aimed to determine whether an association exists between BPD and TBI and whether the prescription of psychotropics moderates TBI risk. Methods A...

Purpose This study aimed to elucidate the various co-occurring patterns of depressive symptomatology and sleep-wake-related disturbances (SWRDs) in patients with mood disorders. Patients and Methods Individuals in non-acute states of major depressive disorder or bipolar disorder were recruited. The Beck Depression Inventory II (BDI-II) was utilize...

Background Several monotherapy and augmentation strategies have been introduced to improve the treatment of schizophrenia. The benefits of omega-3 polyunsaturated fatty acids in patients with mental disorders is becoming increasingly acknowledged. However, its role in the treatment of schizophrenia raises complex considerations about which there ha...

Background Global pandemic resulted from the coronavirus disease-19 (COVID-19) demands mental health concerns on the affected population. We examine the time-course shift of psychological burden among suspected and confirmed COVID-19 patients. Methods Participants with suspected or confirmed COVID-19 were included in the cohort. Consecutive survey...

Antipsychotic-induced metabolic disturbance is a common adverse event occurring in patients treated with antipsychotic drugs. The mechanisms underlying metabolic dysregulation are complex, involving various neurochemical and hormonal systems, the interaction of genetic and lifestyle risk factors, and the antipsychotic drug prescribed. Recently, the...

Background Dysfunction of the N-methyl- D-aspartate glutamate receptor is involved in the putative pathology of schizophrenia. There is growing interest in the potential of N-methyl- D-aspartate receptor modulators to improve the symptoms of schizophrenia, but the evidence for the use of glutamatergic agents for augmenting schizophrenia remains inc...

Nontuberculous mycobacteria (NTM) infection may interfere in the diagnosis and treatment of tuberculosis (TB) in TB-endemic regions. However, the population-based incidence of NTM disease and NTM–TB coinfection remains unclear. We used Taiwan's National Health Insurance Research Database to identify new diagnoses of NTM disease and TB from 2005 to...

Background Research has proposed that selective serotonin reuptake inhibitors (SSRIs) were associated with a reduction of the risk of hepatocellular carcinoma (HCC). The objective of this study is to investigate whether SSRIs use is associated with decreased risk of HCC in patients with alcohol use disorder (AUD). Patients and methods We conducted...

Background Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) concentrations were reported to decrease in patients with advanced cancer. However, the clinical significance of DHEA and DHEAS concentrations in patients with NSCLC receiving chemotherapy (CT) has not been sufficiently documented. Objective To evaluate the correlation between menta...

Objectives: Firefighters are exposed to repeated traumatic events while the robustness of cumulative effects of repeated exposure to trauma on psychological distress among them are inconsistent. Considering the length of service and seniority are risk factors, the purpose of this study was to examine the effects of the interaction between age and...

Aims Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD. Method Data...

Background Little is known about methylphenidate (MPH) use and mortality outcomes. Aims To investigate the association between MPH use and mortality among children with an attention-deficit hyperactivity disorder (ADHD) diagnosis. Method This population-based cohort study analysed data from Taiwan's National Health Insurance Research Database (NH...

Background: The potential of old drugs in novel indications is being greatly valued. We propose a triple-model study involving population-based, cell, and animal studies to investigate the effects of risperidone, a type of second-generation antipsychotic (SGA) drug, on colorectal cancer. Methods: We used data from Taiwan’s National Health Insurance...

Background: Past studies suggest mixed associations between selective serotonin reuptake inhibitor (SSRI) prescription and carcinogenic risk. There is no epidemiological study reporting on the association between SSRI use and the incidence of bladder cancer. The aim of this study is to determine whether SSRI use influences the risk of bladder canc...

Purpose This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM). Patients and Methods Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 an...

Differences in cognitive function have been suggested in people with late-life depression between those with early- (EOD) and late-onset (LOD), possibly reflecting different etiologies. However, depressive symptoms at the time of disorder are important confounders. The study aimed to compare cognitive function in older people with EOD and LOD in th...

Objective: This study investigates the association between mental disorders and interferon nontreatment in patients with chronic hepatitis C virus (HCV) infection in a large national sample. Methods: Using the National Health Insurance Research Database of Taiwan, we conducted a nationwide population-based study. Each case was matched to five co...

Background The present study aimed to develop a new scale to evaluate the level of difficulty in treating major depressive disorder with antidepressants based on the lifetime treatment profile. Methods In addition to evaluating the difficulty of treatment with antidepressants (A subscale), the Treatment Resistance to Antidepressants Evaluation Sca...

Background Clozapine has been used in treatment-resistant patients with schizophrenia. However, only 40% of patients with treatment-resistant schizophrenia have response to clozapine. Many augmentation strategies have been proposed to treat those clozapine-resistant patients, but the results are inconclusive. In this review, we intended to review p...

In this narrative review, we intended to summarize the evidence of pharmacological and somatic treatment choices for treatment-resistant depression (TRD). There are several types of therapeutic strategies to improve inadequate response to antidepressant treament. The first step for patients with TRD is to optimize the dosage and duration of antidep...

Background Ghrelin is a peptide hormone that mediates glucose homeostasis and lipid metabolism. Acylated ghrelin (AG) and desacylated ghrelin (DAG) are the two main forms of ghrelin, which have opposing roles in energy homeostasis. The AG/DAG ratio has been proposed to be associated with metabolic syndrome (MetS) in the general population. This stu...

Background: The aim of this study was to investigate the risk and peak time of post-traumatic hydrocephalus (PTH) in traumatic brain injury (TBI) patients with traumatic subarachnoid hemorrhage (SAH), compared to TBI patients without traumatic SAH. Methods: In this retrospective population-based cohort study, the data was extracted from Longitud...

Accumulating data show that probiotics may be beneficial in reducing depressive symptoms. We conducted an updated meta-analysis and evaluated the effects of probiotics on depressive symptoms. A systematic search of six databases was performed, and the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analy...

Importance Few studies have investigated levels of mortality in patients with attention-deficit/hyperactivity disorder (ADHD), and findings have been inconsistent and lacking information on specific causes of deaths. Objective To investigate the association between ADHD and causes of death in Taiwan. Design, Setting, and Participants A nationwide...

Context The effect of antidepressants (ATDs) use on mortality in patients with diabetes mellitus (DM) has not yet been sufficiently studied although co-morbid depression is common in this population. Objective To explore the impact of ATDs on mortality among DM patients. Design A retrospective cohort study in a national database. Setting This po...

Objective: The association between antipsychotic use and gastric cancer risk remains unclear. Therefore, this study aimed to determine the association between antipsychotic exposure and the incidence of gastric cancer. Methods: Using a nested case-control design, a total of 34 470 gastric cancer patients and 163 430 nongastric cancer controls we...

Objective: Augmentation strategies are commonly applied when an individual is unresponsive to antidepressant monotherapy. Lamotrigine is currently considered at best only as second line augmentation for treatment-resistant unipolar depression while its clinical efficacy and safety profiles remain inconclusive. We intended to assess the therapeutic...

Bipolar disorder (BD) is highly heritable and well known for its recurrent manic and depressive episodes. The present study focused on manic episode in BD patients and aimed to investigate state-specific transcriptome alterations between acute episode and remission, including messenger RNAs (mRNAs), long noncoding RNAs (lncRNAs), and micro-RNAs (mi...

Objectives The association between older‐age bipolar disorder and cognitive impairments may be mediated by vascular burden. The aim of the study was to examine the difference of cognitive function between older people with late‐onset bipolar disorder (LOBD) and early‐onset bipolar disorder (EOBD) by considering rigorous vascular risk burden evaluat...

High comorbidity of obsessive-compulsive disorder (OCD)has been reported in patients with schizophrenia. The sequence of OCD and schizophrenia onset might clarify the underlying pathophysiological relationships between these two disorders, but available evidence is limited. In this study, we used a population-based cohort to investigate the risk of...

Growing evidence suggests the link between gut microbiota and mood regulation. The current study aimed to identify microbiota targets for major depressive disorder (MDD) and mood-related traits in Taiwanese samples, while taking into account the influence of dietary patterns. We recruited 36 MDD patients and 37 healthy controls for 16S rRNA gene se...

Background: Using data from the National Health Insurance (NHI) of Taiwan, we conducted a nationwide population-based cohort study to investigate the association between antidepressant (ATD) use and the risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) who had received interferon (IFN) therapy. Methods: This study i...

Background: High sedative use in a major depressive episode may imply specific clinical features. This study aims to examine the correlation between sedative use and clinical severity indicators in the initial treatment phase of first-onset major depressive disorder. Methods: A study cohort in the first episode of major depressive disorder was used...

Obsessive-compulsive symptoms (OCS) occur in a substantial portion of schizophrenia patients and have significant impacts on clinical course. This study was intended to investigate the relationships of OCS with pharmacological parameters of olanzapine, psychopathology, and quality of life. Totally 151 schizophrenia patients were recruited, and rate...

Background: Seasonal Pattern (SP) was reported in depressive patients of both Bipolar Disorder (BD) and Major Depressive Disorder (MDD). In this study, we aimed to investigate genetic contributions of seasonal pattern of major depressive episodes in both BD and MDD patients, including genes in relevant biological pathways indicated in previous stud...

Objectives: Patients with eating disorder (ED) have been associated with some risk factors for cancer, including nutritional deficiency, chaotic life styles, alcohol or tobacco use, dysfunctional immune system, and impaired organ functions. In this study, we intended to study the risk of cancer in ED patients. Methods: During the period of January...

It has been encouraged to use large existing data like insurance claims data to investigate the new indications of old drugs. New strategies of research are warranted to identify feasible drugs. We conducted a dual research model with a population‐based case–control study using Taiwan's National Health Insurance Research Database and an in vitro st...

Background: The role of orexin-A in regulating metabolic homeostasis has been recognized, but its association with antipsychotic-induced metabolic abnormalities remains unclear. We investigated the association between orexin-A levels and metabolic syndrome in patients with schizophrenia treated with clozapine or less obesogenic antipsychotics comp...

Background and aims: Delay and impairment in Speech and language are common developmental problems in younger populations. Hitherto, there has been minimal study of the association between common childhood infections (e.g. enterovirus [EV]) and speech and language. The impetus for evaluating this association is provided by evidence linking inflamm...

Rationale: The World Health Organization reports that, by 2030, depression is expected to be the largest contributor to disease burden. Only small proportion of patients with major depressive disorder (MDD) achieves remission and the majority of them do not achieve long-term functional recovery. One of the neuropsychological domains that have been...

Objective: Weight gain is one of the most challenging issues in patients with schizophrenia treated with antipsychotics. Several meta-analyses have been conducted to review the efficacy of topiramate in reducing weight, however, several issues regarding the methodology had arisen of which make the results remain ambiguous. Methods: We conducted a m...

Objective: Leptin and adiponectin are adipokines which have opposing roles in the development of insulin resistance and metabolic syndrome (MetS). Leptin/adiponectin ratio (L/A ratio) has been proposed as a good biomarker for MetS in general population. This study aimed to compare the strength of association between MetS and leptin, adiponectin an...

[This corrects the article DOI: 10.1371/journal.pone.0168347.].