Chi wing Law | The University of Hong Kong (original) (raw)

Papers by Chi wing Law

Research paper thumbnail of The prevalence and correlates of suicidal ideation in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong

European Neuropsychopharmacology

Research paper thumbnail of Gender Differences in Patients Presenting with First-Episode Psychosis in Hong Kong: A Three-Year Follow Up Study

Australian & New Zealand Journal of Psychiatry, 2011

Objective: The aim of the current study was to investigate gender differences with respect to pre... more Objective: The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. Methods: A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. Results: At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p...

Research paper thumbnail of The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews

Psychiatry Research

Introduction: With the start of the COVID-19 pandemic, the various social distancing policies imp... more Introduction: With the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. Aim: To evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. Method: This study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. Results: 90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. Conclusion: Symptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview. Abbreviations BPRS brief psychiatric rating scale C-SSRS Columbia suicide severity rating scale HAM-A Hamilton anxiety rating scale HDRS Hamilton depression rating scale ICC intraclass correlation coefficient ICD International statistical classification of diseases and related health problems IT information technology QMH Queen Mary Hospital YMRS Young Mania rating scale

Research paper thumbnail of Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial

Psychological Medicine

Background Contrasting the well-described effects of early intervention (EI) services for youth-o... more Background Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [inte...

Research paper thumbnail of Duration of untreated psychosis: Relationship with baseline characteristics and three-year outcome in first-episode psychosis

Psychiatry Research, 2012

First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) ha... more First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.

Research paper thumbnail of Outcome of An Early Intervention Programme for Psychosis (EASY): A Case Controlled Study

Research paper thumbnail of Self-stigma, stigma coping and functioning in remitted bipolar disorder

General Hospital Psychiatry

Research paper thumbnail of Study of quality of life in first-episode psychotic patients in the period of untreated psychosis

Research paper thumbnail of The Effect of Paternal Age on Relapse in First-Episode Schizophrenia

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015

Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. A... more Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. Advanced paternal age has been reported as a risk factor in schizophrenia. Whether this may affect schizophrenia outcome was not previously studied. We hypothesized that advanced paternal age may have a negative effect on the outcome of relapse in schizophrenia. We interviewed 191 patients with first-episode schizophrenia and their relatives for parental ages, sociodemographic factors at birth, birth rank, family history of psychotic disorders, and obstetric complications. The outcome measure was the presence of relapse at the end of the first year of treatment. In the 1-year follow-up period, 42 (22%) patients experienced 1 or more relapses. The mean paternal age was 34.62 years (SD 7.69). Patients who relapsed had significantly higher paternal age, poorer medication adherence, were female, and were hospitalized at onset, compared with patients who did not relapse. A multivariate regress...

Research paper thumbnail of Pathway to care for patients with first-episode psychosis in Hong Kong

Hong Kong Journal of Psychiatry

ABSTRACT

Research paper thumbnail of MRI Predicts Remission at 1 Year in First-Episode Schizophrenia in Females with Larger Striato-Thalamic Volumes

Neuropsychobiology, 2014

The Remission in Schizophrenia Working Group has defined remission as &amp;amp;amp;amp;amp;am... more The Remission in Schizophrenia Working Group has defined remission as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;a low-mild symptom intensity level, maintained for a minimum of 6 months, where such symptoms do not affect an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s behaviour&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; [Andreasen et al.: Am J Psychiatry 2005;162:441-449]. Since brain morphology relates to symptomatology, treatment and illness progression, MRI may assist in predicting remission. Thirty-nine patients newly diagnosed with DSM-IV schizophrenia underwent MRI brain scan prior to antipsychotic exposure. The Global Assessment of Functioning (GAF) score was entered into a voxel-based analysis to evaluate its relationship with cerebral grey matter volume from the baseline MRI. We entered age, total intracranial volume and intake GAF score as co-variates. Males and females were analysed separately because gender is a potent determinant of outcome. Males had lower GAF scores than females, both at intake and at 1 year. Males comprised only 40% (12 out of 39) of the early remission group. For females only, early remission was strongly and positively correlated with bilateral lentiform and striatal volumes. For males, there was no such relationship. Larger striato-thalamic volume correlated with early remission in females only. These baseline MRI findings were unlikely to be confounded by antipsychotic treatment and chronicity. These brain morphological markers show gender dimorphism and may assist in the prediction of early remission in newly diagnosed schizophrenia.

Research paper thumbnail of Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia

Schizophrenia Research, 2006

Many studies have shown that schizophrenia is associated with a wide range of cognitive impairmen... more Many studies have shown that schizophrenia is associated with a wide range of cognitive impairments. Empirical findings suggest that patients with schizophrenia suffer from a bdysexecutive syndromeQ. However, the extent to which a general decline in neuropsychological function accounts for symptoms of executive dysfunction in schizophrenia is not clear. In this study, we examined further the nature and pattern of executive function in a sample of medication-naïve patients experiencing a firstepisode of schizophrenia with a set of tests capturing the specific components of executive function. We also compared the performance of this clinical group with healthy controls. A total of 78 medication-naïve patients with first episode schizophrenia were recruited from the Early Assessment Service for Young People with Psychosis (EASY). Another 60 healthy controls were recruited for comparison. All subjects participated in a comprehensive set of executive function tests assessing initiation, sustained attention, online updating, switching, attention allocation, inhibition, and non-executive function. The executive function of patients with first-episode schizophrenia was found to be compromised relative to healthy controls. However, unlike patients with established schizophrenia, first episode patients exhibited only a limited deficit in sustained attention. Moreover, the majority of executive function deficits did not correlate with intellectual functioning and memory impairment in a sub-group of first episode patients without intellectual impairment. These findings suggest that first-episode patients exhibit a specific pattern of executive dysfunction compared to healthy controls and patients with an established illness. This differential breakdown of executive function components is unlikely to be an artefact of general intellectual decline or memory impairment in schizophrenia. D

Research paper thumbnail of Predictors for relapse in a double-blind randomized placebo-controlled discontinuation study of remitted first-episode psychosis patients

Schizophrenia Research, 2008

Background: Clinical decisions about relapse prevention and maintenance therapy following a first... more Background: Clinical decisions about relapse prevention and maintenance therapy following a first/single psychotic episode can be enhanced if features that predict higher relapse risk can be identified. While naturalistic studies suggest that maintenance medication reduces relapse risks, it is important that other risk factors controlling for medication status can also be identified.

Research paper thumbnail of Impact of Untreated Psychosis on Quality of Life in Patients with First-episode Schizophrenia

Quality of Life Research, 2005

Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years,... more Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years, few studies have focused on the potential adverse effects of the illness on QOL during the period of untreated psychosis. Our study compares the QOL of patients with first-episode schizophrenia when they first presented to the psychiatric service with that of the normal population, and identifies possible relationships with various clinical parameters. One hundred and seventeen patients with schizophrenia (aged 14-28 years) who entered the Early Assessment Services for Young People with Psychosis (EASY) programme in Hong Kong

Research paper thumbnail of An instrument to assess mental patients? capacity to appraise and report subjective quality of life

Quality of Life Research, 2005

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment stu... more Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated.

Research paper thumbnail of Positive symptoms and white matter microstructure in never-medicated first episode schizophrenia

Psychological Medicine, 2011

BackgroundWe investigated cerebral structural connectivity and its relationship to symptoms in ne... more BackgroundWe investigated cerebral structural connectivity and its relationship to symptoms in never-medicated individuals with first-onset schizophrenia using diffusion tensor imaging (DTI).MethodWe recruited subjects with first episode DSM-IV schizophrenia who had never been exposed to antipsychotic medication (n=34) and age-matched healthy volunteers (n=32). All subjects received DTI and structural magnetic resonance imaging scans. Patients' symptoms were assessed on the Positive and Negative Syndrome Scale. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values significantly correlated with symptom scores.ResultsIn patients with first-episode schizophrenia, positive symptoms correlated positively with FA scores in white matter associated with the right frontal lobe, left anterior cingulate gyrus, left superior temporal gyrus, right middle temporal gyrus, right middle cingulate gyrus, and left cuneus. Importantly, FA in each of...

Research paper thumbnail of Anti-psychotics adherence among out-patients with schizophrenia in Hong Kong

The Keio Journal of Medicine, 2006

Objective: Adherence to antipsychotic treatment is an important aspect of long term management of... more Objective: Adherence to antipsychotic treatment is an important aspect of long term management of schizophrenia and other related psychotic disorders. The evaluation of adherence is often difficult in clinical settings. This study compared patients self-reports and clinician judgment of adherence behavior and explored their relationship with attitudes toward taking medication. Methods: Clinician rated questionnaire and matching patient self rated questionnaires were administered to 508 consecutive outpatients and their clinicians in four hospital clinic sites in Hong Kong. Items in the questionnaires address adherence behaviors as well as attitudes toward medication. In addition, clinicians also estimate the presence of factors unfavorable to adherence such as substance abuse, cognitive impairments etc. Results: Non-adherence was reported in at least 26% of patients. Clinician's detection of non-adherence behaviors achieved relative high specificity (0.84) but has low sensitivity (0.33). A logistic regression analysis on patients' decision to stop medication revealed that significant predictors include patients' reported lack of perception from the benefits of medication, patients' reported negative feelings associated with regular medication and younger age. Conclusion: Non-adherence is a widespread phenomenon affecting a significant proportion of outpatients under treatment. Clinicians have relatively low sensitivity in detecting which patients are non-adherent. Non-adherence behavior is predicted by level of awareness of illness, perceived benefits of medication, negative feelings toward medication and age. (Keio J Med 55 (1): 9-14, March 2006)

Research paper thumbnail of What Does Recovery From Schizophrenia Mean? Perceptions of Long-Term Patients

International Journal of Social Psychiatry, 2008

The study investigated the meaning of recovery to eight people with chronic schizophrenia. A qual... more The study investigated the meaning of recovery to eight people with chronic schizophrenia. A qualitative methodology was used based on a 3-hour focus group. The material was transcribed and analysed into 18 subcategories and 4 categories; namely recovery as a multi-dimensional construct, the relationship of medication to recovery, a sense of hopelessness and helplessness about recovery, factors that promoted recovery. Respondents believed that full recovery could not be said to have been achieved until they stopped medication and had a steady job. The support and care of family and friends were also vital, although sometimes problematic. Independent living has a different meaning in Chinese culture. Further research directions are suggested as well as ways to change attitudes to the inclusion of medication in recovery.

Research paper thumbnail of What does recovery from psychosis mean? Perceptions of young first-episode patients

International Journal of Social Psychiatry, 2011

This study explored the experience of first-episode psychosis from the patients&amp;amp;amp;a... more This study explored the experience of first-episode psychosis from the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspective and the meanings they attach to the illness and their recovery. A qualitative methodology was used based on a focus group. Audio tapes were transcribed verbatim and three researchers participated in a content analysis that identified four major themes: the meaning of psychosis and psychotic experience; the meaning of recovery; stigma; and having an optimistic view of recovery. Participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; view of recovery was broader than that often held by psychiatrists, extending beyond symptom control and medication compliance, and they identified positive features that the experience of illness had brought. Their concerns included the side effects of medication and the fear of their illness being disclosed (to employers, university authorities, acquaintances, etc.) in the face of societal stigma. Ideas about what constitutes recovery need to take account of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views and experience in order to emphasize therapeutic optimism rather than pessimism, and to inform treatment contexts and the views of medical staff.

Research paper thumbnail of A double-blind randomized placebo-controlled relapse prevention study in remitted first-episode psychosis patients following one year of maintanence therapy

European Psychiatry, 2008

Research paper thumbnail of The prevalence and correlates of suicidal ideation in Chinese psychiatric patients during the fifth wave of COVID-19 in Hong Kong

European Neuropsychopharmacology

Research paper thumbnail of Gender Differences in Patients Presenting with First-Episode Psychosis in Hong Kong: A Three-Year Follow Up Study

Australian & New Zealand Journal of Psychiatry, 2011

Objective: The aim of the current study was to investigate gender differences with respect to pre... more Objective: The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. Methods: A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. Results: At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p...

Research paper thumbnail of The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews

Psychiatry Research

Introduction: With the start of the COVID-19 pandemic, the various social distancing policies imp... more Introduction: With the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. Aim: To evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. Method: This study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. Results: 90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. Conclusion: Symptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview. Abbreviations BPRS brief psychiatric rating scale C-SSRS Columbia suicide severity rating scale HAM-A Hamilton anxiety rating scale HDRS Hamilton depression rating scale ICC intraclass correlation coefficient ICD International statistical classification of diseases and related health problems IT information technology QMH Queen Mary Hospital YMRS Young Mania rating scale

Research paper thumbnail of Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial

Psychological Medicine

Background Contrasting the well-described effects of early intervention (EI) services for youth-o... more Background Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [inte...

Research paper thumbnail of Duration of untreated psychosis: Relationship with baseline characteristics and three-year outcome in first-episode psychosis

Psychiatry Research, 2012

First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) ha... more First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.

Research paper thumbnail of Outcome of An Early Intervention Programme for Psychosis (EASY): A Case Controlled Study

Research paper thumbnail of Self-stigma, stigma coping and functioning in remitted bipolar disorder

General Hospital Psychiatry

Research paper thumbnail of Study of quality of life in first-episode psychotic patients in the period of untreated psychosis

Research paper thumbnail of The Effect of Paternal Age on Relapse in First-Episode Schizophrenia

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2015

Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. A... more Multiple etiological and prognostic factors have been implied in schizophrenia and its outcome. Advanced paternal age has been reported as a risk factor in schizophrenia. Whether this may affect schizophrenia outcome was not previously studied. We hypothesized that advanced paternal age may have a negative effect on the outcome of relapse in schizophrenia. We interviewed 191 patients with first-episode schizophrenia and their relatives for parental ages, sociodemographic factors at birth, birth rank, family history of psychotic disorders, and obstetric complications. The outcome measure was the presence of relapse at the end of the first year of treatment. In the 1-year follow-up period, 42 (22%) patients experienced 1 or more relapses. The mean paternal age was 34.62 years (SD 7.69). Patients who relapsed had significantly higher paternal age, poorer medication adherence, were female, and were hospitalized at onset, compared with patients who did not relapse. A multivariate regress...

Research paper thumbnail of Pathway to care for patients with first-episode psychosis in Hong Kong

Hong Kong Journal of Psychiatry

ABSTRACT

Research paper thumbnail of MRI Predicts Remission at 1 Year in First-Episode Schizophrenia in Females with Larger Striato-Thalamic Volumes

Neuropsychobiology, 2014

The Remission in Schizophrenia Working Group has defined remission as &amp;amp;amp;amp;amp;am... more The Remission in Schizophrenia Working Group has defined remission as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;a low-mild symptom intensity level, maintained for a minimum of 6 months, where such symptoms do not affect an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s behaviour&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; [Andreasen et al.: Am J Psychiatry 2005;162:441-449]. Since brain morphology relates to symptomatology, treatment and illness progression, MRI may assist in predicting remission. Thirty-nine patients newly diagnosed with DSM-IV schizophrenia underwent MRI brain scan prior to antipsychotic exposure. The Global Assessment of Functioning (GAF) score was entered into a voxel-based analysis to evaluate its relationship with cerebral grey matter volume from the baseline MRI. We entered age, total intracranial volume and intake GAF score as co-variates. Males and females were analysed separately because gender is a potent determinant of outcome. Males had lower GAF scores than females, both at intake and at 1 year. Males comprised only 40% (12 out of 39) of the early remission group. For females only, early remission was strongly and positively correlated with bilateral lentiform and striatal volumes. For males, there was no such relationship. Larger striato-thalamic volume correlated with early remission in females only. These baseline MRI findings were unlikely to be confounded by antipsychotic treatment and chronicity. These brain morphological markers show gender dimorphism and may assist in the prediction of early remission in newly diagnosed schizophrenia.

Research paper thumbnail of Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia

Schizophrenia Research, 2006

Many studies have shown that schizophrenia is associated with a wide range of cognitive impairmen... more Many studies have shown that schizophrenia is associated with a wide range of cognitive impairments. Empirical findings suggest that patients with schizophrenia suffer from a bdysexecutive syndromeQ. However, the extent to which a general decline in neuropsychological function accounts for symptoms of executive dysfunction in schizophrenia is not clear. In this study, we examined further the nature and pattern of executive function in a sample of medication-naïve patients experiencing a firstepisode of schizophrenia with a set of tests capturing the specific components of executive function. We also compared the performance of this clinical group with healthy controls. A total of 78 medication-naïve patients with first episode schizophrenia were recruited from the Early Assessment Service for Young People with Psychosis (EASY). Another 60 healthy controls were recruited for comparison. All subjects participated in a comprehensive set of executive function tests assessing initiation, sustained attention, online updating, switching, attention allocation, inhibition, and non-executive function. The executive function of patients with first-episode schizophrenia was found to be compromised relative to healthy controls. However, unlike patients with established schizophrenia, first episode patients exhibited only a limited deficit in sustained attention. Moreover, the majority of executive function deficits did not correlate with intellectual functioning and memory impairment in a sub-group of first episode patients without intellectual impairment. These findings suggest that first-episode patients exhibit a specific pattern of executive dysfunction compared to healthy controls and patients with an established illness. This differential breakdown of executive function components is unlikely to be an artefact of general intellectual decline or memory impairment in schizophrenia. D

Research paper thumbnail of Predictors for relapse in a double-blind randomized placebo-controlled discontinuation study of remitted first-episode psychosis patients

Schizophrenia Research, 2008

Background: Clinical decisions about relapse prevention and maintenance therapy following a first... more Background: Clinical decisions about relapse prevention and maintenance therapy following a first/single psychotic episode can be enhanced if features that predict higher relapse risk can be identified. While naturalistic studies suggest that maintenance medication reduces relapse risks, it is important that other risk factors controlling for medication status can also be identified.

Research paper thumbnail of Impact of Untreated Psychosis on Quality of Life in Patients with First-episode Schizophrenia

Quality of Life Research, 2005

Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years,... more Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years, few studies have focused on the potential adverse effects of the illness on QOL during the period of untreated psychosis. Our study compares the QOL of patients with first-episode schizophrenia when they first presented to the psychiatric service with that of the normal population, and identifies possible relationships with various clinical parameters. One hundred and seventeen patients with schizophrenia (aged 14-28 years) who entered the Early Assessment Services for Young People with Psychosis (EASY) programme in Hong Kong

Research paper thumbnail of An instrument to assess mental patients? capacity to appraise and report subjective quality of life

Quality of Life Research, 2005

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment stu... more Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated.

Research paper thumbnail of Positive symptoms and white matter microstructure in never-medicated first episode schizophrenia

Psychological Medicine, 2011

BackgroundWe investigated cerebral structural connectivity and its relationship to symptoms in ne... more BackgroundWe investigated cerebral structural connectivity and its relationship to symptoms in never-medicated individuals with first-onset schizophrenia using diffusion tensor imaging (DTI).MethodWe recruited subjects with first episode DSM-IV schizophrenia who had never been exposed to antipsychotic medication (n=34) and age-matched healthy volunteers (n=32). All subjects received DTI and structural magnetic resonance imaging scans. Patients' symptoms were assessed on the Positive and Negative Syndrome Scale. Voxel-based analysis was performed to investigate brain regions where fractional anisotropy (FA) values significantly correlated with symptom scores.ResultsIn patients with first-episode schizophrenia, positive symptoms correlated positively with FA scores in white matter associated with the right frontal lobe, left anterior cingulate gyrus, left superior temporal gyrus, right middle temporal gyrus, right middle cingulate gyrus, and left cuneus. Importantly, FA in each of...

Research paper thumbnail of Anti-psychotics adherence among out-patients with schizophrenia in Hong Kong

The Keio Journal of Medicine, 2006

Objective: Adherence to antipsychotic treatment is an important aspect of long term management of... more Objective: Adherence to antipsychotic treatment is an important aspect of long term management of schizophrenia and other related psychotic disorders. The evaluation of adherence is often difficult in clinical settings. This study compared patients self-reports and clinician judgment of adherence behavior and explored their relationship with attitudes toward taking medication. Methods: Clinician rated questionnaire and matching patient self rated questionnaires were administered to 508 consecutive outpatients and their clinicians in four hospital clinic sites in Hong Kong. Items in the questionnaires address adherence behaviors as well as attitudes toward medication. In addition, clinicians also estimate the presence of factors unfavorable to adherence such as substance abuse, cognitive impairments etc. Results: Non-adherence was reported in at least 26% of patients. Clinician's detection of non-adherence behaviors achieved relative high specificity (0.84) but has low sensitivity (0.33). A logistic regression analysis on patients' decision to stop medication revealed that significant predictors include patients' reported lack of perception from the benefits of medication, patients' reported negative feelings associated with regular medication and younger age. Conclusion: Non-adherence is a widespread phenomenon affecting a significant proportion of outpatients under treatment. Clinicians have relatively low sensitivity in detecting which patients are non-adherent. Non-adherence behavior is predicted by level of awareness of illness, perceived benefits of medication, negative feelings toward medication and age. (Keio J Med 55 (1): 9-14, March 2006)

Research paper thumbnail of What Does Recovery From Schizophrenia Mean? Perceptions of Long-Term Patients

International Journal of Social Psychiatry, 2008

The study investigated the meaning of recovery to eight people with chronic schizophrenia. A qual... more The study investigated the meaning of recovery to eight people with chronic schizophrenia. A qualitative methodology was used based on a 3-hour focus group. The material was transcribed and analysed into 18 subcategories and 4 categories; namely recovery as a multi-dimensional construct, the relationship of medication to recovery, a sense of hopelessness and helplessness about recovery, factors that promoted recovery. Respondents believed that full recovery could not be said to have been achieved until they stopped medication and had a steady job. The support and care of family and friends were also vital, although sometimes problematic. Independent living has a different meaning in Chinese culture. Further research directions are suggested as well as ways to change attitudes to the inclusion of medication in recovery.

Research paper thumbnail of What does recovery from psychosis mean? Perceptions of young first-episode patients

International Journal of Social Psychiatry, 2011

This study explored the experience of first-episode psychosis from the patients&amp;amp;amp;a... more This study explored the experience of first-episode psychosis from the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perspective and the meanings they attach to the illness and their recovery. A qualitative methodology was used based on a focus group. Audio tapes were transcribed verbatim and three researchers participated in a content analysis that identified four major themes: the meaning of psychosis and psychotic experience; the meaning of recovery; stigma; and having an optimistic view of recovery. Participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; view of recovery was broader than that often held by psychiatrists, extending beyond symptom control and medication compliance, and they identified positive features that the experience of illness had brought. Their concerns included the side effects of medication and the fear of their illness being disclosed (to employers, university authorities, acquaintances, etc.) in the face of societal stigma. Ideas about what constitutes recovery need to take account of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; views and experience in order to emphasize therapeutic optimism rather than pessimism, and to inform treatment contexts and the views of medical staff.

Research paper thumbnail of A double-blind randomized placebo-controlled relapse prevention study in remitted first-episode psychosis patients following one year of maintanence therapy

European Psychiatry, 2008