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Chen EYH, Zhao J, Ilomäki J, Sluggett JK, Bell JS, Wimmer BC, Hilmer SN, Blais JE, Wong ICK, Chan EW. Medication Regimen Complexity and Risk of Bleeding in People Who Initiate Oral Anticoagulants for Atrial Fibrillation: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2023; 78:470-478. [PMID: 36165226 DOI: 10.1093/gerona/glac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Oral anticoagulants (OACs) are high-risk medications often used in older people with complex medication regimens. This study was the first to assess the association between overall regimen complexity and bleeding in people with atrial fibrillation (AF) initiating OACs. METHODS Patients diagnosed with AF who initiated an OAC (warfarin, dabigatran, rivaroxaban, apixaban) between 2010 and 2016 were identified from the Hong Kong Clinical Database and Reporting System. Each patient's Medication Regimen Complexity Index (MRCI) score was computed. Baseline characteristics were balanced using inverse probability of treatment weighting. People were followed until a first hospitalization for bleeding (intracranial hemorrhage, gastrointestinal bleeding, or other bleeding) and censored at discontinuation of the index OAC, death, or end of the follow-up period, whichever occurred first. Cox regression was used to estimate hazard ratios (HR) between MRCI quartiles and bleeding during initiation and all follow-up. RESULTS There were 19 292 OAC initiators (n = 9 092 warfarin, n = 10 200 direct oral anticoagulants) with a mean (standard deviation) age at initiation of 73.9 (11.0) years. More complex medication regimens were associated with an increased risk of bleeding (MRCI > 14.0-22.00: aHR 1.17, 95% confidence interval [CI] 0.93-1.49; MRCI > 22.0-32.5: aHR 1.32, 95%CI 1.06-1.66; MRCI > 32.5: aHR 1.45, 95%CI 1.13-1.87, compared to MRCI ≤ 14). No significant association between MRCI and bleeding risk was observed during the initial 30, 60, or 90 days of treatment. CONCLUSION In this cohort study of people with AF initiating an OAC, a more complex medication regimen was associated with higher bleeding risk over periods longer than 90 days. Further prospective studies are needed to assess whether MRCI should be considered in OAC prescribing.
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Affiliation(s)
- Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Centre for Health Economics, Monash Business School, Monash University, Caulfield East, Victoria, Australia
| | - Jiaxi Zhao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Sluggett JK, Hughes GA, Ooi CE, Chen EYH, Corlis M, Hogan ME, Caporale T, Van Emden J, Bell JS. Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study. Int J Environ Res Public Health 2021; 18:ijerph18115778. [PMID: 34072223 PMCID: PMC8199013 DOI: 10.3390/ijerph18115778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/01/2023]
Abstract
Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs.
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Affiliation(s)
- Janet K. Sluggett
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Correspondence:
| | - Georgina A. Hughes
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Megan Corlis
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Michelle E. Hogan
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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3
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Dugré N, Bell JS, Hopkins RE, Ilomäki J, Chen EYH, Corlis M, Van Emden J, Hogan M, Sluggett JK. Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial. J Clin Med 2021; 10:jcm10051104. [PMID: 33800845 PMCID: PMC7961370 DOI: 10.3390/jcm10051104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53-2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38-0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50-0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.
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Affiliation(s)
- Nicolas Dugré
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Faculty of Pharmacy, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal, Clinique Universitaire de Médecine Familiale Sacré-Coeur, Montréal, QC H3M 3A9, Canada
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-9903-9533
| | - Ria E. Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- Helping Hand Aged Care, Adelaide, SA 5006, Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia; (N.D.); (R.E.H.); (J.I.); (E.Y.H.C.); (J.K.S.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, NSW 2077, Australia; (M.C.); (J.V.E.); (M.H.)
- UniSA Allied Health and Human Performance Unit, City East campus, University of South Australia, Adelaide, SA 5001, Australia
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4
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Chen EYH, Bell JS, Ilomäki J, Corlis M, Hogan ME, Caporale T, Van Emden J, Westbrook JI, Hilmer SN, Sluggett JK. Medication administration in Australian residential aged care: A time-and-motion study. J Eval Clin Pract 2021; 27:103-110. [PMID: 32285584 DOI: 10.1111/jep.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE/AIM Medication administration is a complex and time-consuming task in residential aged care facilities (RACFs). Understanding the time associated with each administration step may help identify opportunities to optimize medication management in RACFs. This study aimed to investigate the time taken to administer medications to residents, including those with complex care needs such as cognitive impairment and swallowing difficulties. METHOD A time-and-motion study was conducted in three South Australian RACFs. A representative sample of 57 scheduled medication administration rounds in 14 units were observed by a single investigator. The rounds were sampled to include different times of day, memory support units for residents living with dementia and standard units, and medication administration by registered and enrolled nurses. Medications were administered from pre-prepared medication strip packaging. The validated Work Observation Method By Activity Timing (WOMBAT) software was used to record observations. RESULTS Thirty nurses were observed. The average time spent on scheduled medication administration rounds was 5.2 h/unit of average 22 residents/day. The breakfast medication round had the longest duration (1.92 h/unit). Resident preparation, medication preparation and provision, documentation, transit, communication, and cleaning took an average of 5 minutes per resident per round. Medication preparation and provision comprised 60% of overall medication round time and took significantly longer in memory support than in standard units (66 vs 49 seconds per resident per round for preparation, 79 vs 58 for provision; P < .001 for both). Almost half (42%) of tablets/capsules were crushed in memory support units. The time taken for medication administration was not significantly different among registered and enrolled nurses. CONCLUSIONS Nurses took an average of 5 minutes to administer medications per resident per medication round. Medication administration in memory support units took an additional minute per resident per round, with almost half of tablets and capsules needing to be crushed.
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Affiliation(s)
- Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | | | | | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Helping Hand Aged Care, North Adelaide, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia.,Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, Australia
| | - Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Melbourne, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Sydney, Australia
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5
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Chang WC, Westbrook A, Strauss GP, Chu AOK, Chong CSY, Siu CMW, Chan SKW, Lee EHM, Hui CLM, Suen YM, Lo TL, Chen EYH. Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis. Psychol Med 2020; 50:2599-2609. [PMID: 31576787 DOI: 10.1017/s0033291719002769] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Abnormal effort-based decision-making represents a potential mechanism underlying motivational deficits (amotivation) in psychotic disorders. Previous research identified effort allocation impairment in chronic schizophrenia and focused mostly on physical effort modality. No study has investigated cognitive effort allocation in first-episode psychosis (FEP). METHOD Cognitive effort allocation was examined in 40 FEP patients and 44 demographically-matched healthy controls, using Cognitive Effort-Discounting (COGED) paradigm which quantified participants' willingness to expend cognitive effort in terms of explicit, continuous discounting of monetary rewards based on parametrically-varied cognitive demands (levels N of N-back task). Relationship between reward-discounting and amotivation was investigated. Group differences in reward-magnitude and effort-cost sensitivity, and differential associations of these sensitivity indices with amotivation were explored. RESULTS Patients displayed significantly greater reward-discounting than controls. In particular, such discounting was most pronounced in patients with high levels of amotivation even when N-back performance and reward base amount were taken into consideration. Moreover, patients exhibited reduced reward-benefit sensitivity and effort-cost sensitivity relative to controls, and that decreased sensitivity to reward-benefit but not effort-cost was correlated with diminished motivation. Reward-discounting and sensitivity indices were generally unrelated to other symptom dimensions, antipsychotic dose and cognitive deficits. CONCLUSION This study provides the first evidence of cognitive effort-based decision-making impairment in FEP, and indicates that decreased effort expenditure is associated with amotivation. Our findings further suggest that abnormal effort allocation and amotivation might primarily be related to blunted reward valuation. Prospective research is required to clarify the utility of effort-based measures in predicting amotivation and functional outcome in FEP.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - A Westbrook
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen 6525 EN, The Netherlands
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, Providence, RI02906, USA
| | - G P Strauss
- Department of Psychology, University of Georgia, Athens, GA30602, USA
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - C S Y Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - C M W Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Y M Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Chang WC, Wong CSM, Or PCF, Chu AOK, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Inter-relationships among psychopathology, premorbid adjustment, cognition and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychol Med 2020; 50:2019-2027. [PMID: 31451127 DOI: 10.1017/s0033291719002113] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP. METHOD This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses. RESULTS Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength. CONCLUSION Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - P C F Or
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - A O K Chu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - E M H Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Y N Suen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
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Hadar H, Zhang H, Phillips LJ, Amminger GP, Berger GE, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, McGorry PD, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma S, Yuen HP, Yung AR, Nelson B. Do schizotypal or borderline personality disorders predict onset of psychotic disorder or persistent attenuated psychotic symptoms in patients at high clinical risk? Schizophr Res 2020; 220:275-277. [PMID: 32305167 DOI: 10.1016/j.schres.2020.03.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- H Hadar
- Psychology Department, University of Otago, Dunedin, New Zealand
| | - H Zhang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - L J Phillips
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - G P Amminger
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - G E Berger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, Hong Kong
| | - L de Haan
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - J A Hartmann
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia
| | - S Lavoie
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - C Markulev
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - P D McGorry
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - D H Nieman
- Department of Psychiatry, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - M R Schäfer
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - M Schlögelhofer
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Vienna, Austria
| | - S Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - A Thompson
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - H P Yuen
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - A R Yung
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, United Kingdom
| | - B Nelson
- Centre for Youth Mental Health, The University of Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.
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8
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Sluggett JK, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Keen C, Hopkins R, Ooi CE, Hilmer SN, Hughes GA, Luu A, Nguyen KH, Comans T, Edwards S, Quirke L, Patching A, Bell JS. Reducing the Burden of Complex Medication Regimens: SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2020; 21:1114-1120.e4. [PMID: 32179001 DOI: 10.1016/j.jamda.2020.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To assess the application of a structured process to consolidate the number of medication administration times for residents of aged care facilities. DESIGN A nonblinded, matched-pair, cluster randomized controlled trial. SETTING AND PARTICIPANTS Permanent residents who were English-speaking and taking at least 1 regular medication, recruited from 8 South Australian residential aged care facilities (RACFs). METHODS The intervention involved a clinical pharmacist applying a validated 5-step tool to identify opportunities to reduce medication complexity (eg, by administering medications at the same time or through use of longer-acting or combination formulations). Residents in the comparison group received routine care. The primary outcome at 4-month follow-up was the number of administration times per day for medications charted regularly. Resident satisfaction and quality of life were secondary outcomes. Harms included falls, medication incidents, hospitalizations, and mortality. The association between the intervention and primary outcome was estimated using linear mixed models. RESULTS Overall, 99 residents participated in the intervention arm and 143 in the comparison arm. At baseline, the mean resident age was 86 years, 74% were female, and medications were taken an average of 4 times daily. Medication simplification was possible for 62 (65%) residents in the intervention arm, with 57 (62%) of 92 simplification recommendations implemented at follow-up. The mean number of administration times at follow-up was reduced in the intervention arm in comparison to usual care (-0.36, 95% confidence interval -0.63 to -0.09, P = .01). No significant changes in secondary outcomes or harms were observed. CONCLUSIONS AND IMPLICATIONS One-off application of a structured tool to reduce regimen complexity is a low-risk intervention to reduce the burden of medication administration in RACFs and may enable staff to shift time to other resident care activities.
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Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Claire Keen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Ria Hopkins
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Georgina A Hughes
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Andrew Luu
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Kim-Huong Nguyen
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Tracy Comans
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Susan Edwards
- Drug & Therapeutics Information Service, GP Plus Marion, South Australia, Australia
| | - Lyntara Quirke
- Consumer Representative, Dementia Australia, Scullin, Australian Capital Territory, Australia
| | - Allan Patching
- Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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9
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Nelson B, Yuen HP, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, Mossaheb N, Nieman DH, Nordentoft M, Polari A, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Tedja A, Thompson A, Verma S, Yung AR, McGorry PD. Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
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Affiliation(s)
- B Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - H P Yuen
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G P Amminger
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C Markulev
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - A Polari
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - M R Schäfer
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Tedja
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Thompson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A R Yung
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - P D McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne
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10
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Youn S, Phillips LJ, Amminger GP, Berger G, Chen EYH, de Haan L, Hartmann JA, Hickie IB, Lavoie S, Markulev C, McGorry PD, Mossaheb N, Nieman DH, Nordentoft M, Riecher-Rössler A, Schäfer MR, Schlögelhofer M, Smesny S, Thompson A, Verma S, Yuen HP, Yung AR, Nelson B. Basic symptoms in young people at ultra-high risk of psychosis: Association with clinical characteristics and outcomes. Schizophr Res 2020; 216:255-261. [PMID: 31866077 DOI: 10.1016/j.schres.2019.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/06/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022]
Abstract
There has been limited research into the predictive value of basic symptoms and their relationship with other psychopathology in patients identified using the 'ultra high risk' (UHR) for psychosis approach. The current study investigated whether basic symptoms, specifically cognitive disturbances (COGDIS), were associated with a greater risk of transition to psychotic disorder and persistent attenuated psychotic symptoms (APS) at medium term follow-up (mean = 3.4 years) in UHR patients, as well as with general psychopathology at baseline. The sample included 304 UHR participants (mean age = 19.12 years) involved in an international multicenter trial of omega-3 fatty acids. UHR individuals who also met the COGDIS criteria (basic symptoms risk criteria) did not have a greater risk of transition than those who met the UHR criteria alone. However, meeting COGDIS risk criteria was associated with a greater likelihood of meeting the UHR attenuated psychotic symptoms risk group (i.e., having persistent attenuated psychotic symptoms) at 12-month follow-up (odds ratio = 1.85; 95% CI = 1.03, 3.32). Greater severity of cognitive basic symptoms was also independently associated with more severe general psychopathology at study entry. The findings do not support the notion that combined risk identification approaches (UHR and basic symptoms) aid in the identification of individuals at greatest risk of psychosis, although this interpretation is limited by the modest transition to psychosis rate (13%) and the time of follow up. However, the findings indicate that basic symptoms may be a clinically useful marker of more severe general psychopathology in UHR groups and risk for persistent attenuated psychotic symptoms.
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Affiliation(s)
- S Youn
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - L J Phillips
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - G P Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - J A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Australia
| | - S Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - C Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - P D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - M R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - M Schlögelhofer
- Department of Psychiatry, Medical University of Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - A Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - H P Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - A R Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - B Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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11
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Chen EYH, Wang KN, Sluggett JK, Ilomäki J, Hilmer SN, Corlis M, Bell JS. Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review. Australas J Ageing 2019; 38 Suppl 2:9-25. [DOI: 10.1111/ajag.12676] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/28/2019] [Accepted: 04/30/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Esa Y. H. Chen
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Kate N. Wang
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Kolling InstituteFaculty of Medicine and HealthThe University of Sydney and Royal North Shore Hospital St Leonards NSW Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Helping Hand Aged Care North Adelaide South Australia Australia
| | - J. Simon Bell
- Centre for Medicine Use and SafetyFaculty of Pharmacy and Pharmaceutical SciencesMonash University Parkville Victoria Australia
- NHMRC Cognitive Decline Partnership CentreUniversity of Sydney Sydney New South Wales Australia
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventative MedicineMonash University Melbourne Victoria Australia
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12
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Sluggett JK, Page AT, Chen EYH, Ilomäki J, Corlis M, Van Emden J, Hogan M, Caporale T, Angley M, Hilmer SN, Ooi CE, Bell JS. Protocol for a non-randomised pilot and feasibility study evaluating a multicomponent intervention to simplify medication regimens for people receiving community-based home care services. BMJ Open 2019; 9:e025345. [PMID: 31326924 PMCID: PMC6661559 DOI: 10.1136/bmjopen-2018-025345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Managing medication regimens is one of the most complex and burdensome tasks performed by older people, and can be prone to errors. People living with dementia may require medication administration assistance from formal and informal caregivers. Simplified medication regimens maintain the same therapeutic intent, but have less complex instructions and administration schedules. This protocol paper outlines a study to determine the feasibility of a multicomponent intervention to simplify medication regimens for people receiving community-based home care services. METHODS AND ANALYSIS This is a non-randomised pilot and feasibility study. Research nurses will recruit 50 people receiving community-based home care services. All participants will receive the intervention from a clinical pharmacist, who will undertake medication reconciliation, assess each participant's capacity to self-manage their medication regimen and apply a structured tool to identify opportunities for medication simplification. The pharmacist will communicate recommendations regarding medication simplification to registered nurses at the community-based home care provider organisation. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include the change in number of medication administration times per day, medication adherence, quality of life, participant satisfaction, medication incidents, falls and healthcare utilisation at 4 months. ETHICS AND DISSEMINATION Ethical approval was obtained from the Monash University Human Research Ethics Committee and the community-based home care provider organisation's ethical review panel. Research findings will be disseminated to consumers and caregivers, health professionals, researchers and healthcare providers through the National Health and Medical Research Council Cognitive Decline Partnership Centre and through conference presentations, lay summaries and peer-reviewed publications. This study will enable an improved understanding of medication management and administration among people receiving community-based home care services. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention. TRIAL REGISTRATION NUMBER ACTRN12618001130257; Pre-results.
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Affiliation(s)
- Janet Kathleen Sluggett
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Amy Theresa Page
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Jan Van Emden
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Michelle Hogan
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Research and Development, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Manya Angley
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah N Hilmer
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- National Health and Medical Research Council (NHMRC) Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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13
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Chang WC, Chan SKW, Lee EHM, Hui CLM, Chen EYH. Extended early intervention versus standard psychiatric care for adults with first-episode psychosis. Hong Kong Med J 2019; 25 Suppl 3:4-8. [PMID: 30792363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- W C Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - S K W Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - E H M Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - C L M Hui
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - E Y H Chen
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
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14
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Chen EYH, Chang WC, Hui CLM, Chan SKW, Lee EHM, Wong GHY. Duration of early intervention for psychosis: 2 years versus 3 years. Hong Kong Med J 2019; 25 Suppl 2:10-14. [PMID: 30674701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- E Y H Chen
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - W C Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - C L M Hui
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - S K W Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - E H M Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong
| | - G H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong
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15
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Yuen HP, Mackinnon A, Hartmann J, Amminger GP, Markulev C, Lavoie S, Schäfer MR, Polari A, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger G, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD, Nelson B. Dynamic prediction of transition to psychosis using joint modelling. Schizophr Res 2018; 202:333-340. [PMID: 30539771 DOI: 10.1016/j.schres.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 10/28/2022]
Abstract
Considerable research has been conducted seeking risk factors and constructing prediction models for transition to psychosis in individuals at ultra-high risk (UHR). Nearly all such research has only employed baseline predictors, i.e. data collected at the baseline time point, even though longitudinal data on relevant measures such as psychopathology have often been collected at various time points. Dynamic prediction, which is the updating of prediction at a post-baseline assessment using baseline and longitudinal data accumulated up to that assessment, has not been utilized in the UHR context. This study explored the use of dynamic prediction and determined if it could enhance the prediction of frank psychosis onset in UHR individuals. An emerging statistical methodology called joint modelling was used to implement the dynamic prediction. Data from the NEURAPRO study (n = 304 UHR individuals), an intervention study with transition to psychosis study as the primary outcome, were used to investigate dynamic predictors. Compared with the conventional approach of using only baseline predictors, dynamic prediction using joint modelling showed significantly better sensitivity, specificity and likelihood ratios. As dynamic prediction can provide an up-to-date prediction for each individual at each new assessment post entry, it can be a useful tool to help clinicians adjust their prognostic judgements based on the unfolding clinical symptomatology of the patients. This study has shown that a dynamic approach to psychosis prediction using joint modelling has the potential to aid clinicians in making decisions about the provision of timely and personalized treatment to patients concerned.
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Affiliation(s)
- H P Yuen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - A Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Black Dog Institute, New South Wales, Australia; University of New South Wales, New South Wales, Australia
| | - J Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - G P Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - C Markulev
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - M R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - A Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Orygen Youth Health, Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Austria
| | - M Schlögelhofer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Austria
| | - S Smesny
- University Hospital Jena, Germany
| | - I B Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, the Netherlands
| | - D H Nieman
- Academic Medical Center, Amsterdam, the Netherlands
| | - M Nordentoft
- Mental Health Centre Copenhagen, Mental Health Services in the Capital Region, Copenhagen University Hospital, Denmark
| | | | - S Verma
- Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - A Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, England, UK; North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, England, UK
| | - A R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, England, UK
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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16
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Chang WC, Lee HC, Chan SI, Chiu SY, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Negative symptom dimensions differentially impact on functioning in individuals at-risk for psychosis. Schizophr Res 2018; 202:310-315. [PMID: 29935882 DOI: 10.1016/j.schres.2018.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 04/20/2018] [Accepted: 06/14/2018] [Indexed: 12/24/2022]
Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
| | - H C Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S I Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Y Chiu
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - H M Lee
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K W Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - M C Wong
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - K L Chan
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - W S Yeung
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - L W Choy
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - S Y Chong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - M W Siu
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - T L Lo
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - W C Yan
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - M K Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - L T Poon
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - P F Pang
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - W C Lam
- Department of Psychiatry, United Christian Hospital, Hong Kong
| | - Y C Wong
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - W S Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - Y M Mo
- Department of Psychiatry, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - S Y Lui
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - L M Hui
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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17
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Chen EYH, Sluggett JK, Bell JS. What Steve Jobs knew about medicines. J Pharm Pract Res 2018. [DOI: 10.1002/jppr.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Esa Y. H. Chen
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Vic. Australia
- NHMRC Cognitive Decline Partnership Centre; Hornsby Ku-ring-gai Hospital; Hornsby NSW Australia
| | - Janet K. Sluggett
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Vic. Australia
- NHMRC Cognitive Decline Partnership Centre; Hornsby Ku-ring-gai Hospital; Hornsby NSW Australia
| | - J. Simon Bell
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne Vic. Australia
- NHMRC Cognitive Decline Partnership Centre; Hornsby Ku-ring-gai Hospital; Hornsby NSW Australia
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18
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Wang KN, Bell JS, Chen EYH, Gilmartin-Thomas JFM, Ilomäki J. Medications and Prescribing Patterns as Factors Associated with Hospitalizations from Long-Term Care Facilities: A Systematic Review. Drugs Aging 2018; 35:423-457. [PMID: 29582403 DOI: 10.1007/s40266-018-0537-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Residents of long-term care facilities (LTCFs) are at high risk of hospitalization. Medications are a potentially modifiable risk factor for hospitalizations. OBJECTIVE Our objective was to systematically review the association between medications or prescribing patterns and hospitalizations from LTCFs. METHODS We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and International Pharmaceutical Abstracts (IPA) from inception to August 2017 for longitudinal studies reporting associations between medications or prescribing patterns and hospitalizations. Two independent investigators completed the study selection, data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS Three randomized controlled trials (RCTs), 22 cohort studies, five case-control studies, one case-time-control study and one case-crossover study, investigating 13 different medication classes and two prescribing patterns were included. An RCT demonstrated that high-dose influenza vaccination reduced all-cause hospitalization compared with standard-dose vaccination (risk ratio [RR] 0.93; 95% confidence interval [CI] 0.88-0.98). Another RCT found no difference in hospitalization rates between oseltamivir as influenza treatment and oseltamivir as treatment plus prophylaxis (treatment = 4.7%, treatment and prophylaxis = 3.5%; p = 0.7). The third RCT found no difference between multivitamin/mineral supplementation and hospitalization (odds ratio [OR] 0.94; 95% CI 0.74-1.20) or emergency department visits (OR 1.05; 95% CI 0.76-1.47). Two cohort studies demonstrated influenza vaccination reduced hospitalization. Four studies suggested polypharmacy and potentially inappropriate medications (PIMs) increased all-cause hospitalization. However, associations between polypharmacy (two studies), PIMs (one study) and fall-related hospitalizations were inconsistent. Inconsistent associations were found between psychotropic medications with all-cause and cause-specific hospitalizations (11 studies). Warfarin, nonsteroidal anti-inflammatory drugs, pantoprazole and vinpocetine but not long-term acetylsalicylic acid (aspirin), statins, trimetazidine, digoxin or β-blockers were associated with all-cause or cause-specific hospitalizations in single studies of specific resident populations. Most cohort studies assessed prevalent rather than incident medication exposure, and no studies considered time-varying medication use. CONCLUSION High-quality evidence suggests influenza vaccination reduces hospitalization. Polypharmacy and PIMs are consistently associated with increased all-cause hospitalization.
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Affiliation(s)
- Kate N Wang
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.
| | - J Simon Bell
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Esa Y H Chen
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW, Australia
| | - Julia F M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Jenni Ilomäki
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville Campus, 381 Royal Parade, Parkville, VIC, 3052, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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19
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Nelson B, Amminger GP, Yuen HP, Markulev C, Lavoie S, Schäfer MR, Hartmann JA, Mossaheb N, Schlögelhofer M, Smesny S, Hickie IB, Berger G, Chen EYH, de Haan L, Nieman DH, Nordentoft M, Riecher-Rössler A, Verma S, Thompson A, Yung AR, McGorry PD. NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders-medium-term follow-up and clinical course. NPJ Schizophr 2018; 4:11. [PMID: 29941938 PMCID: PMC6018097 DOI: 10.1038/s41537-018-0052-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 11/09/2022]
Abstract
This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6-12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11-13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.
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Affiliation(s)
- B Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | - G P Amminger
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - H P Yuen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - C Markulev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - S Lavoie
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M R Schäfer
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - J A Hartmann
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - N Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University of Vienna, Vienna, Austria
| | - M Schlögelhofer
- Department of Psychiatry, Medical University of Vienna, Vienna, Austria
| | - S Smesny
- University Hospital Jena, Jena, Germany
| | - I B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - G Berger
- Child and Adolescent Psychiatric Service of the Canton of Zurich, Zurich, Switzerland
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Pokfulam, Hong Kong
| | - L de Haan
- Academic Medical Center, Amsterdam, The Netherlands
| | - D H Nieman
- Academic Medical Center, Amsterdam, The Netherlands
| | - M Nordentoft
- Psychiatric Centre Bispebjerg, Copenhagen, Denmark
| | | | - S Verma
- Institute of Mental Health, Singapore, Singapore
| | - A Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, Coventry, UK
| | - A R Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - P D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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20
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Sluggett JK, Chen EYH, Ilomäki J, Corlis M, Hilmer SN, Van Emden J, Ooi CE, Nguyen KH, Comans T, Hogan M, Caporale T, Edwards S, Quirke L, Patching A, Bell JS. SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER): study protocol for a cluster randomised controlled trial. Trials 2018; 19:37. [PMID: 29329559 PMCID: PMC5767065 DOI: 10.1186/s13063-017-2417-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/16/2017] [Indexed: 12/25/2022] Open
Abstract
Background Complex medication regimens are highly prevalent in residential aged care facilities (RACFs). Strategies to reduce unnecessary complexity may be valuable because complex medication regimens can be burdensome for residents and are costly in terms of nursing time. The aim of this study is to investigate application of a structured process to simplify medication administration in RACFs. Methods SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) is a non-blinded, matched-pair, cluster randomised controlled trial of a single multidisciplinary intervention to simplify medication regimens. Trained study nurses will recruit English-speaking, permanent residents from eight South Australian RACFs. Medications taken by residents in the intervention arm will be assessed once using a structured tool (the Medication Regimen Simplification Guide for Residential Aged CarE) to identify opportunities to reduce medication regimen complexity (e.g. by administering medications at the same time, or through the use of longer-acting or combination formulations). Residents in the comparison group will receive routine care. Participants will be followed for up to 36 months after study entry. The primary outcome measure will be the total number of charted medication administration times at 4 months after study entry. Secondary outcome measures will include time spent administering medications, medication incidents, resident satisfaction, quality of life, falls, hospitalisation and mortality. Individual-level analyses that account for clustering will be undertaken to determine the impact of the intervention on the study outcomes. Discussion Ethical approval has been obtained from the Monash University Human Research Ethics Committee and the aged care provider organisation. Research findings will be disseminated through conference presentations and peer-reviewed publications. SIMPLER will enable an improved understanding of the burden of medication use in RACFs and quantify the impact of regimen simplification on a range of outcomes important to residents and care providers. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617001060336. Retrospectively registered on 20 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-017-2417-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janet K Sluggett
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia. .,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
| | - Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Megan Corlis
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, Northern Clinical School, School of Medicine, University of Sydney, New South Wales, Australia
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
| | - Kim-Huong Nguyen
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Tracy Comans
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Woolloogabba, Queensland, Australia
| | - Michelle Hogan
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - Susan Edwards
- Drug & Therapeutics Information Service, Repatriation General Hospital, Daw Park, South Australia, Australia
| | - Lyntara Quirke
- Consumer representative, Alzheimer's Australia, Scullin, Australian Capital Territory, Australia
| | - Allan Patching
- Helping Hand Consumer and Carer Reference Group, Helping Hand Aged Care, North Adelaide, South Australia, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.,NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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21
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Chang WC, Kwong VWY, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach. Psychol Med 2017; 47:755-765. [PMID: 27869058 DOI: 10.1017/s0033291716003044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM). METHOD Three hundred and twenty-one Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms. RESULTS An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy. CONCLUSION Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.
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Affiliation(s)
- W C Chang
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - V W Y Kwong
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - C L M Hui
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - S K W Chan
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E H M Lee
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
| | - E Y H Chen
- Department of Psychiatry,The University of Hong Kong,Queen Mary Hospital,Pokfulam,Hong Kong
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22
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Chang WC, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis. Eur Psychiatry 2017; 41:37-41. [PMID: 28049079 DOI: 10.1016/j.eurpsy.2016.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/22/2016] [Accepted: 09/28/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments. RESULTS Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation. CONCLUSION Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong.
| | - V W Y Kwong
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - G H K Chan
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - O T T Jim
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E S K Lau
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C L M Hui
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - S K W Chan
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
| | - E H M Lee
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong, Hong Kong
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De Deyne S, Elvevåg B, Hui CLM, Poon VWY, Chen EYH. Rich semantic networks applied to schizophrenia: A new framework. Schizophr Res 2016; 176:454-455. [PMID: 27245710 DOI: 10.1016/j.schres.2016.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 05/10/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- S De Deyne
- Computational Cognitive Science Lab, School of Psychology, University of Adelaide, Australia.
| | - B Elvevåg
- Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway; Norwegian Centre for eHealth Research, University Hospital of North Norway, Tromsø, Norway.
| | - C L M Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - V W Y Poon
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
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Hui CLM, Li YK, Li AWY, Lee EHM, Chang WC, Chan SKW, Lam SY, Thornton AE, Sham P, Honer WG, Chen EYH. Visual working memory deterioration preceding relapse in psychosis. Psychol Med 2016; 46:2435-2444. [PMID: 27305830 DOI: 10.1017/s0033291716000751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Relapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration. METHOD Visual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter-Number span test) working memory and stressful life events were assessed monthly. RESULTS Remitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19-7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20-3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08-14.62, P = 0.001). CONCLUSIONS Visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.
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Affiliation(s)
- C L M Hui
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - Y K Li
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - A W Y Li
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - E H M Lee
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - W C Chang
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - S K W Chan
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - S Y Lam
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - A E Thornton
- Department of Psychology,Simon Fraser University,Burnaby,BC,Canada
| | - P Sham
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - W G Honer
- Department of Psychiatry,University of British Columbia,Vancouver,BC,Canada
| | - E Y H Chen
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
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25
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Lee EHM, Hui CLM, Chang WC, Chan SKW, Lin J, Chen EYH. Letter to the Editor: Comparison of cognitive functions, pre-morbid conditions and clinical characteristics between brief psychotic disorder and schizophrenia. Psychol Med 2016; 46:2011-2013. [PMID: 27181416 DOI: 10.1017/s0033291716000623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- E H M Lee
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - C L M Hui
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - W C Chang
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - S K W Chan
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - J Lin
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
| | - E Y H Chen
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,People's Republic of China
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Hui CLM, Lee EHM, Chang WC, Chan SKW, Chen EYH. Letter to the Editor: Comparing delusional disorder and schizophrenia: a comment on Hui et al. (2015)-–a reply. Psychol Med 2016; 46:1561-1562. [PMID: 26691196 DOI: 10.1017/s0033291715002810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chen EYH, Diug B, Bell JS, Mc Namara KP, Dooley MJ, Kirkpatrick CM, McNeil JJ, Caughey GE, Ilomäki J. Spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. Ther Adv Drug Saf 2016; 7:4-10. [PMID: 26834958 DOI: 10.1177/2042098615618171] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The objective of our study was to describe spontaneously reported haemorrhagic adverse events associated with rivaroxaban and dabigatran in Australia. METHODS Data were sourced from the Australian Therapeutic Goods Administration (TGA) Database of Adverse Event Notifications between June 2009 and May 2014. Records of haemorrhagic adverse events in which rivaroxaban or dabigatran was considered as a potential cause were analysed. RESULTS There were 240 haemorrhagic adverse events associated with rivaroxaban and 504 associated with dabigatran. Age was specified for 164 (68%) haemorrhages associated with rivaroxaban, of which 101 occurred in people aged ⩾75 years. Age was specified for 437 (87%) haemorrhages associated with dabigatran, of which 300 occurred in people aged ⩾75 years. Time from treatment initiation to haemorrhage was specified for 122 (51%) haemorrhages associated with rivaroxaban, with 69 (57%) haemorrhages occurring within 30 days of rivaroxaban initiation. Time from treatment initiation to haemorrhage was specified for 253 (50%) haemorrhages associated with dabigatran, with 123 (49%) haemorrhages occurring within 30 days of dabigatran initiation. Gastrointestinal (GI) haemorrhages were the most frequent type of haemorrhages associated with both rivaroxaban (n = 105, 44%) and dabigatran (n = 302, 60%). Data were available on the severity of haemorrhage for 101 (42%) haemorrhages associated with rivaroxaban, with haemorrhage leading to death in 17 people. The severity of haemorrhage was specified for 384 (76%) haemorrhages associated with dabigatran, with haemorrhage leading to death in 61 people. CONCLUSIONS Our study highlights the need for research on the haemorrhagic complications of anticoagulation in clinical care. A considerable proportion of reported haemorrhagic events occurred within 30 days of rivaroxaban and dabigatran initiation. This highlights the importance of considering bleeding risk at the time of treatment initiation.
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Affiliation(s)
- Esa Y H Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Basia Diug
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, and Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Kevin P Mc Namara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, and Greater Green Triangle University Department of Rural Health, Flinders University, SA, and Deakin University, Burwood, Victoria, Australia
| | - Michael J Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, and Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Carl M Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gillian E Caughey
- Sansom Institute for Health Research, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
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Hui CLM, Lee EHM, Chang WC, Chan SKW, Lin J, Xu JQ, Chen EYH. Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients. Psychol Med 2015; 45:3085-3095. [PMID: 26036591 DOI: 10.1017/s0033291715001051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample. METHOD We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements. RESULTS Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning. CONCLUSIONS Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.
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Affiliation(s)
- C L M Hui
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - E H M Lee
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - W C Chang
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - S K W Chan
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - J Lin
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - J Q Xu
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - E Y H Chen
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
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Chan SKW, Chen EYH, Tang JYM, Chiu CPY, Lam MML, Chung DWS, Tso S, Hung SF, Yip KC, Dunn ELW. Early intervention versus standard care for psychosis in Hong Kong: a 10-year study. Hong Kong Med J 2015; 21 Suppl 2:19-22. [PMID: 25852097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- S K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - J Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - C P Y Chiu
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - M M L Lam
- Department of Psychiatry, Queen Mary Hospital, Hong Kong
| | - D W S Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - S Tso
- Department of Psychiatry, Castle Peak Hospital, Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - K C Yip
- Department of Psychiatry, Kowloon Hospital, Hong Kong
| | - E L W Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
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30
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Chen EYH, Chang WC, Chan SKW, Lam MML, Hung SF, Chung DWS, Hui CLM, Wong GHY, Au Yang WS, Tang JYM. Three-year community case management for early psychosis: a randomised controlled study. Hong Kong Med J 2015; 21 Suppl 2:23-26. [PMID: 25852098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- E Y H Chen
- Department of Psychiatry, The University of Hong Kong
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong
| | - M M L Lam
- Department of Psychiatry, The University of Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - D W S Chung
- Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong
| | - G H Y Wong
- Department of Psychiatry, The University of Hong Kong
| | - W S Au Yang
- Department of Psychiatry, The University of Hong Kong
| | - J Y M Tang
- Department of Psychiatry, The University of Hong Kong
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31
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Chan SKW, So HC, Hui CLM, Chang WC, Lee EHM, Chung DWS, Tso S, Hung SF, Yip KC, Dunn E, Chen EYH. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med 2015; 45:1181-1193. [PMID: 25233868 DOI: 10.1017/s0033291714002220] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design. METHOD Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed. RESULTS Results suggested that EI patients had reduced suicide rate (χ2 (1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR -0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery. CONCLUSIONS The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.
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Affiliation(s)
- S K W Chan
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - H C So
- Department of Psychiatry,Queen Mary Hospital,Hong Kong
| | - C L M Hui
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - W C Chang
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - E H M Lee
- Department of Psychiatry,The University of Hong Kong,Hong Kong
| | - D W S Chung
- Department of Psychiatry,Tai Po Hospital,Hong Kong
| | - S Tso
- Department of Psychiatry,Castle Peak Hospital,Hong Kong
| | - S F Hung
- Department of Psychiatry,Kwai Chung Hospital,Hong Kong
| | - K C Yip
- Department of Psychiatry,Kowloon Hospital,Hong Kong
| | - E Dunn
- Department of Psychiatry,Pamela Youde Nethersole Eastern Hospital
| | - E Y H Chen
- Department of Psychiatry,The University of Hong Kong,Hong Kong
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Ng JYW, Chen EYH. Transformation of a metaphor: semantic shift in a Cantonese term 'Chi Sin' denoting insanity. East Asian Arch Psychiatry 2015; 25:16-20. [PMID: 25829101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The historical evolution of the existing terms used to describe insanity may be able to shed light on the formation of stigma towards psychosis patients. In Hong Kong, a widely used Cantonese term for insanity 'Chi Sin' provides a unique example because of its neutral original sense, as it literally means misconnection in a network circuit. We attempt to trace the origin and subsequent evolution of the term 'Chi Sin' from its early use to the present day to understand how local Hong Kong people have attached increasingly negative connotations to this scientific term since the mid-20th century. METHODS We sampled as many newspapers and magazines published in Hong Kong from 1939 to June 2014 as possible, and sampled 7 popular local movies from the 1950s and 1960s. We also searched all the newspapers published in Hong Kong, Macau, Taiwan, and Mainland China from January 1998 to June 2014, and searched several other local historical resources. RESULTS In one early use of 'Chi Sin' in 1939, the term was only used in a technical sense to describe 'short circuiting'. We found that the development of the telephone system, the Strowger system, in Hong Kong is closely related to the evolution of the semantics of the term 'Chi Sin'. CONCLUSIONS The original meaning of short circuitry of the term 'Chi Sin' is no longer used, and it has become a dead metaphor through repeated use with negative emotional connotations. This illustrates some of the factors facilitating the emergence of a metaphor with subsequent semantic drift.
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Affiliation(s)
- J Y W Ng
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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Ching EYN, Lee EHM, Hui CLM, Lin JX, Chang WC, Chan SKW, Chen EYH. Prodromal psychosis: a case series of ten symptomatic patients. East Asian Arch Psychiatry 2015; 25:35-41. [PMID: 25829104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This case series provides an account of 10 patients with prodromal psychosis in Hong Kong over the course of 12 months between 2012 and 2014. Patterns of symptoms and functioning levels were noted each month and overall presentation was classified into 4 categories. Four patients' conditions were classified as fluctuating, 3 patients as improved, 2 patients as no change, and 1 patient as transition into psychosis. The noted observations were compared to the current conceptualisation of prodromal psychosis according to the clinical staging model of McGorry and colleagues. This case series provides insights into the condition in an Asian population and provides background data to inform future clinical research and mental health services.
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Affiliation(s)
- E Y N Ching
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - J X Lin
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - S K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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34
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Lam LCW, Chan WC, Wong CSM, Chen EYH, Ng RMK, Lee EHM, Chang WC, Hung SF, Cheung EFC, Sham PC, Chiu HFK, Lam M, Chiang TP, van Os J, Lau JTF, Lewis G, Bebbington P. The Hong Kong mental morbidity survey: background and study design. East Asian Arch Psychiatry 2014; 24:30-36. [PMID: 24676485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mental disorders are highly prevalent conditions with immense disease burden. To inform health and social services policy formulation, local psychiatric epidemiological data are required. The Hong Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong.
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Affiliation(s)
- L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C S M Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R M K Ng
- Kowloon Hospital, Hong Kong SAR, China
| | - E H M Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - S F Hung
- Kwai Chung Hospital, Hong Kong SAR, China
| | | | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H F K Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Castle Peak Hospital, Hong Kong SAR, China
| | - T P Chiang
- Castle Peak Hospital, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J T F Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G Lewis
- Academic Unit of Psychiatry, University of Bristol, Bristol, England
| | - P Bebbington
- Department of Mental Health Sciences, University College London, London, England
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Lai DC, Chang WC, Tam WWY, Hui CLM, Chen EYH. Cognitive and affective perspectives on formation and maintenance of grandiose delusions of a patient with schizophrenia. East Asian Arch Psychiatry 2013; 23:160-163. [PMID: 24374488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report on a woman with first-episode schizophrenia with grandiose delusions. She developed a bizarre delusion that she was 'Jesus', who had special powers to talk to animals and predict the future. The grandiose delusions were maintained by her positive emotions, positive imagery of becoming an extraordinary person, and cognitive biases. With the application of cognitive and affective model for formulation of an intervention plan, it was found that the patient had improvement in lowered shamefulness about herself and skills of setting appropriate expectations. The assessment and treatment process of this patient shows the value of applying theory to case formulation and making a care plan for the case management service for patients with first-episode psychosis. This report has clear limitations in that it is a discussion of a single patient, and the case formulation is speculative at this time. The formation and maintenance of grandiose delusions are discussed from the cognitive and affective perspectives.
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Affiliation(s)
- D C Lai
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
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Chang WC, Hui CLM, Tang JYM, Wong GHY, Chan SKW, Lee EHM, Chen EYH. Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study. Psychol Med 2013; 43:1883-1893. [PMID: 23217676 DOI: 10.1017/s0033291712002838] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive impairment is a core feature of schizophrenia. Its relationship with duration of untreated psychosis (DUP), a potentially malleable prognostic factor, has been less studied, with inconsistent findings being observed in the literature. Previous research investigating such a relationship was mostly cross-sectional and none of those prospective studies had a follow-up duration beyond 2 years. Method A total of 93 Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. DUP and pre-morbid adjustment were measured using a structured interview incorporating multiple sources of information. Psychopathological evaluation was administered at intake, after clinical stabilization of the first psychotic episode, and at 12, 24 and 36 months. Cognitive functions were measured at clinical stabilization, and at 12, 24 and 36 months. RESULTS DUP exerted differential effects on various cognitive domains, with memory deficits being the most related to DUP even when potential confounders including pre-morbid adjustment and sex were adjusted. Prolonged DUP was associated with more severe impairment in visual memory at clinical stabilization and verbal memory at 24 and 36 months. Further, patients with a long DUP were found to have worse outcomes on negative symptoms at 36 months. The effects of DUP on verbal memory remained significant even when negative symptoms were taken into consideration. CONCLUSIONS Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes. In addition, DUP may specifically affect memory function and its adverse impact on verbal memory may only become evident at a later stage of the recovery process.
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Affiliation(s)
- W C Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
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Chen EYH, Tang JYM, Hui CLM, Chan SKW, Chang WC, Lee EHM, Chiu CPY, Lam MML, Law CW, Yew CWS, Wong GHY, Chung DWS, Tso S, Chan KPM, Yip KC, Fung SF, Honer WG. Three-year outcome of phase-specific early intervention for first-episode psychosis: a cohort study in Hong Kong. Hong Kong Med J 2012; 18 Suppl 6:7-13. [PMID: 23249845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- E Y H Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
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Wong GHY, Hui CLM, Wong DY, Tang JYM, Chang WC, Chan SKW, Lee EHM, Xu JQ, Lin JJX, Lai DC, Tam W, Kok J, Chung DWS, Hung SF, Chen EYH. Developments in early intervention for psychosis in Hong Kong. East Asian Arch Psychiatry 2012; 22:100-104. [PMID: 23019282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The year 2011 marked the 10-year milestone of early intervention for psychosis in Hong Kong. Since 2001, the landscape of early psychosis services has changed markedly in Hong Kong. Substantial progress has been made in the areas of early intervention service implementation, knowledge generation, and public awareness promotion. Favourable outcomes attributable to the early intervention service are supported by solid evidence from local clinical research studies; early intervention service users showed improved functioning, ameliorated symptoms, and decreased hospitalisation and suicide rates. Continued development of early intervention in Hong Kong over the decade includes the introduction and maturation of several key platforms, such as the Hospital Authority Early Assessment Service for Young People with Psychosis programme, the Psychosis Studies and Intervention Unit by the University of Hong Kong, the Hong Kong Early Psychosis Intervention Society, the Jockey Club Early Psychosis Project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. In this paper, we reviewed some of the major milestones in local service development with reference to features of the Hong Kong mental health system. We describe chronologically the implementation and consolidation of public early intervention services as well as recent progresses in public awareness work that are tied in with knowledge generation and transfer, and outline the prospects for early intervention in the next decade and those that follow.
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Affiliation(s)
- G H Y Wong
- Department of Psychiatry, The University of Hong Kong; Hong Kong Early Psychosis Intervention Society (EPISO), Hong Kong SAR, China
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Wong MMC, Chen EYH, Lui SSY, Tso S. Medication adherence and subjective weight perception in patients with first-episode psychotic disorder. ACTA ACUST UNITED AC 2011; 5:135-41. [PMID: 21983497 DOI: 10.3371/csrp.5.3.3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Medication adherence is critical to the management of psychotic disorder. Different factors associated with medication adherence have been investigated in previous studies. However, the association with subjective weight perception, which is related to the weight gain side effect of antipsychotics, has not been thoroughly investigated. Subjective weight perception may not equal objective weight status. This study tests the hypothesis that medication adherence is related to subjective weight perception in a group of patients with first-episode psychotic disorder who have taken antipsychotics for one year. METHODS This study recruited 160 participants with one-year histories of first-episode psychotic disorder and measured their actual and perceived weights, amount of weight gain in the past year, body size satisfaction and medication adherence levels. The associations between medication adherence and both the actual and perceived weight status were analyzed controlling for other confounding factors including insight, drug attitude, illness severity and other medication side effects. RESULTS Stepwise multiple regression analysis found that the participants' perceived weight status, negative attitude toward their drugs and insight were the major factors associated with poor medication adherence. Of the participants who perceived themselves as being overweight, 86% believed that antipsychotics were responsible. Among those who had such beliefs, 72% had reduced their antipsychotic dosages on their own. About half of the participants had gained more than 7% of their baseline weight and 43.1% of the participants were found to be overweight after one year of treatment with antipsychotics. CONCLUSIONS The results of this study indicate that medication adherence is associated with perceived weight status. Healthcare professionals should be aware of this relationship and address this issue early in the management of patients. Apart from weight management programs, education on a correct weight perception should be carried out with the promotion of proper drug attitudes and better insight for the improvement of medication adherence in the early course of psychotic disorder.
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Chan KKS, Hui CLM, Lam MML, Tang JYM, Wong GHY, Chan SKW, Chen EYH. A three-year prospective study of spontaneous eye-blink rate in first-episode schizophrenia: relationship with relapse and neurocognitive function. East Asian Arch Psychiatry 2010; 20:174-179. [PMID: 22348926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To examine the spontaneous blink rate over a 3-year period and its clinical and cognitive correlates among patients with first-episode schizophrenia. METHODS This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform and schizoaffective disorders for 3 years. Patients were longitudinally assessed for blink rate, their positive and negative symptoms, and a range of cognitive features including verbal fluency, verbal memory, visual memory, and the Wisconsin Card Sorting Test performance. RESULTS. When compared with a matched control group, there was a significantly higher blink rate at their 3-year follow-up but not at initial presentation. The increase in blink rate over time correlated positively with the number of relapses. It also correlated with logical memory, verbal fluency, categories completed, and perseverative errors in the Wisconsin Card Sorting Test. The increased blink rate also correlated with pre-morbid schizoid and schizotypal traits. All these correlations were statistically significant. CONCLUSION The change in the blink rate over time may reflect underlying involvement of the dopaminergic system in mediating relapse and cognitive functions.
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Affiliation(s)
- K K S Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
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Chan RCK, Wang YN, Cao XY, Chen EYH. Contribution of working memory components to the performance of the tower of hanoi in schizophrenia. East Asian Arch Psychiatry 2010; 20:69-75. [PMID: 22351812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To examine the underlying structure of neuropsychological tests involving working memory components and those not involving working memory components that contribute to the performance of the Tower of Hanoi task in schizophrenic patients. PARTICIPANTS AND METHODS A total of 90 patients with residual schizophrenia received a comprehensive cognitive assessment. Working memory was assessed with Letter-Number Span and Visual Patterns tests. Executive function was assessed by the Tower of Hanoi task. Stepwise multiple linear regressions were performed including age, education, duration of illness, and all cognitive functions. RESULTS Principal component analysis was conducted and yielded a 4-factor solution: auditory working memory, visual working memory, verbal working memory, and verbal fluency. Subsequent stepwise regression indicated that only visual working memory components and auditory working memory components were retained in the final model accounting, which explained 23.5% of the variance. CONCLUSIONS These findings emphasise the importance of memory components, particularly those involving visual- and auditory-based working memory, when conceptualising the performance of the Tower of Hanoi task in residual schizophrenia.
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Affiliation(s)
- R C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory; Key Laboratory of Mental Health; Institute of Psychology, Chinese Academy of Sciences, 4A Datun Road, Beijing, China.
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Chua SE, Deng Y, Chen EYH, Law CW, Chiu CPY, Cheung C, Wong JCH, Lienenkaëmper N, Cheung V, Suckling J, McAlonan GM. Early striatal hypertrophy in first-episode psychosis within 3 weeks of initiating antipsychotic drug treatment. Psychol Med 2009; 39:793-800. [PMID: 18713487 DOI: 10.1017/s0033291708004212] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We and others have reported that patients experiencing their first episode of psychosis already have significant structural brain abnormalities. Antipsychotics seem to reverse subcortical volume deficits after months of treatment. However, the early impact of medication on brain morphology is not known. METHOD Forty-eight individuals in their first episode of psychosis underwent magnetic resonance imaging (MRI) brain scanning. Twenty-six were antipsychotic naive and 22 were newly treated with antipsychotic medication for a median period of 3 weeks. In each group, 80% of subjects received a diagnosis of schizophrenia. The two groups were balanced for age, sex, handedness, ethnicity, height, years of education, paternal socio-economic status (SES) and Positive and Negative Syndrome Scale (PANSS) score. Group differences in whole-brain grey matter were compared voxel by voxel, using Brain Activation and Morphological Mapping (BAMM) software. We also conducted testing of group differences with region-of-interest (ROI) measurements of the caudate nucleus. RESULTS Relative to the untreated group, those receiving antipsychotic medication for 3-4 weeks had significantly greater grey-matter volumes in the bilateral caudate and cingulate gyri, extending to the left medial frontal gyrus. ROI analysis confirmed that, in treated patients, the right and left caudate nuclei were significantly larger by 10% (p<0.039, two-tailed) and 9% (p<0.048, two-tailed) respectively. CONCLUSIONS Early striatal grey-matter enlargement may occur within the first 3-4 weeks of antipsychotic treatment. Possible reasons for putative striatal hypertrophy and its implications are discussed.
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Affiliation(s)
- S E Chua
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, S.A.R. China
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Abstract
OBJECTIVE To explore the frequency and risk factors of homelessness among a previously identified cohort of patients with schizophrenia in rural China. METHOD A 10-year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. RESULTS Thirty-nine patients (7.8%) experienced homelessness during the follow-up period. The rate of homelessness was 0.9 per 100 person-years during the 10-year follow-up period. Four significant predictors of homelessness remained in the final logistic regression model: living in shabby or unstable house or shelter, positive family history of mental disorders, without income of the patient, and unmarried, divorced, or separated. Risk of homelessness increased substantially with exposure to multiple risk factors. CONCLUSION Substantial numbers of homeless patients with schizophrenia are challenges for mental health care and public health. Appropriate community-based services, especially housing services, should be crucial for prevention of homelessness in patients with schizophrenia.
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Affiliation(s)
- M S Ran
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong, China.
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Oknina LB, Wild-Wall N, Oades RD, Juran SA, Röpcke B, Pfueller U, Weisbrod M, Chan E, Chen EYH. Frontal and temporal sources of mismatch negativity in healthy controls, patients at onset of schizophrenia in adolescence and others at 15 years after onset. Schizophr Res 2005; 76:25-41. [PMID: 15927796 DOI: 10.1016/j.schres.2004.10.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 09/23/2004] [Accepted: 10/04/2004] [Indexed: 11/28/2022]
Abstract
Mismatch negativity (MMN) is an event-related potential measure of auditory change detection. It is widely reported to be smaller in patients with schizophrenia and may not improve along with otherwise successful clinical treatment. The main aim of this report is to explore ways of measuring and presenting four features of frequency-deviant MMN dipole sources (dipole moment, peak latency, brain location and orientation) and to relate these to the processes of psychopathology and illness progression. Data from early onset patients (EOS) at the start of the illness in adolescence, and others who had their first break in adolescence 15 years ago (S-15Y) were compared with two groups of age-matched healthy controls (C-EOS, C-15Y). A four-source model fitted the MMN waveform recorded from all four groups, whether MMN amplitude was more (EOS) or less (S-15Y) reduced. The locations were in the left superior temporal and anterior cingulate gyri, right superior temporal and inferior/mid frontal cortices. Dipole latencies confirmed a bottom-up sequence of processing and dipole moments were larger in the temporal lobes and on the left. Patients showed small dipole location changes that were more marked in the S-15Y than the EOS group (more rostral for the left anterior cingulate, more caudal for the right mid-frontal dipole) consistent with illness progression. The modelling of MMN dipole sources on brain atlas and anatomical images suggests that there is a degree of dissociation during illness between small progressive anatomical changes and some functional recovery indexed by scalp recordings from patients with an onset in adolescence 15 years before compared to adolescents in their first episode.
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Affiliation(s)
- L B Oknina
- Institute of Higher Nervous Activity and Neurophysiology, Burdenco Neurosurgery Institute, Moscow, Russia
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Chan RCK, Chen EYH, Cheung EFC, Cheung HK. Executive dysfunctions in schizophrenia. Relationships to clinical manifestation. Eur Arch Psychiatry Clin Neurosci 2004; 254:256-62. [PMID: 15309397 DOI: 10.1007/s00406-004-0492-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 01/15/2004] [Indexed: 10/26/2022]
Abstract
Studies suggest that executive functions in patients with schizophrenia are markedly impaired as compared with normal controls. Most previous studies employed tests of executive functions adopted from frontal lobe neuropsychological paradigms based on lesion studies. This study employed several more recently developed theory-driven tests of executive functions addressing the construct of the supervisory attentional system. We explore the pattern of executive function impairment using factor analysis and subsequently investigate the relationships between these executive function factors and the clinical features in a sample of chronic schizophrenic patients. A total of 51 patients with chronic schizophrenia were recruited. The Sustained Attention Response to Task (SART), Six Elements Test (SET) and Hayling Sentence Completion Test (HSC) were used to assess executive functions. Three factors were identified within the executive function tests: 1) The "semantic inhibition factor" comprised items in the HSC, 2) the "action/attention inhibition" factor comprised the SART commission error and the SET rule-breaking score and 3) the "output generation factor" comprised the SET raw score and the correct SART response. Significant relationships were found between these derived factors and clinical features after partialling out the confounding effect of age, education and illness duration. The three theory-based tests of executive function were shown to have good construct validity among the group of chronic schizophrenic patients.
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Affiliation(s)
- R C K Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, ROC.
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Chan RCK, Chen EYH, Cheung EFC, Chen RYL, Cheung HK. Problem-solving ability in chronic schizophrenia. A comparison study of patients with traumatic brain injury. Eur Arch Psychiatry Clin Neurosci 2004; 254:236-41. [PMID: 15309393 DOI: 10.1007/s00406-004-0486-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 12/04/2003] [Indexed: 12/01/2022]
Abstract
We tested the hypothesis that patients with schizophrenia are more prone to impairment in planning and problem-solving as compared with normal controls and patients with traumatic brain injury (TBI) by administering the Tower of Hanoi (TOH) task. A total of one hundred and fifty-three participants (51 in each group) were recruited. The performance of the patient groups was markedly worse than normal controls in terms of profile score, number of rule-breaking behaviour, and mean execution time. Two-way 3 (group) x 6 (complexity) ANOVAs indicated that significant main effects of group and complexity were observed in the number of moves, planning time to initiate the first move and subsequent execution time. The general performance of TOH in the schizophrenia group was very similar to that of the TBI group. Subsequent comparison of sub-groups of frontal and posterior lobe damage indicated the pattern of performance in schizophrenia patients lie between them. Taken together, these findings suggest that neither focal frontal nor temporal lobe damage is a sufficient explanation for the problem-solving deficits in patients with schizophrenia.
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Affiliation(s)
- R C K Chan
- Department of Psychology, Sun Yat Sen University, Guangzhou, China.
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Chan RCK, Chen EYH, Cheung EFC, Chen RYL, Cheung HK. A Study of Sensitivity of the Sustained Attention to Response Task in Patients With Schizophrenia. Clin Neuropsychol 2004; 18:114-21. [PMID: 15595363 DOI: 10.1080/13854040490507208] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The sustained attention to response task (SART), a measure of sustained attention created by Robertson, Manly, Andrade, Baddeley, and Yiend (1997), was administered to 51 patients with schizophrenia and 51 normal controls to provide information on the sensitivity of the measure in this clinical group. Patients with schizophrenia performed significantly worse than the normal controls in correct response, reaction time for correct response, and efficiency estimate of taking account of both the accuracy and speed of movement. Moreover, the patient group was more often correctly classified as defective on the basis of efficiency estimate than the normal controls. These data provide further evidence of the sensitivity of the SART to patients with schizophrenia.
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Affiliation(s)
- R C K Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China.
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Chua SE, Lam IWS, Tai KS, Cheung C, Tang WN, Chen EYH, Lee PWH, Chan FL, Lieh-Mak F, McKenna PJ. Brain morphological abnormality in schizophrenia is independent of country of origin. Acta Psychiatr Scand 2003; 108:269-75. [PMID: 12956827 DOI: 10.1034/j.1600-0447.2003.00134.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The disorder schizophrenia has a worldwide prevalence of 1% and is generally associated with lateral cerebral ventricular enlargement. Whether there is a relationship between these two findings is unclear but has aetiological relevance. METHOD Consecutively admitted Chinese patients (n = 19) with first episode of schizophrenia and healthy community volunteers (n = 29) underwent magnetic resonance imaging brain scan. The groups were balanced for age, sex, best social class and handedness. These patients were similar on clinical and socio-demographic indices to those who declined participation (n = 15). Semi-automated volumetric analysis of whole brain volume, cortical grey matter, cerebrospinal fluid, sulci and lateral ventricles was performed. RESULTS Chinese patients in their first episode of schizophrenia have significant enlargement of lateral ventricles. CONCLUSION Brain morphological abnormality in schizophrenia is present regardless of the country of origin. The importance of genes in driving normal brain development and stable prevalence suggests that aetiology may favour genes over environment.
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Affiliation(s)
- S E Chua
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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