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Lee CC, Chui WWH, Wong SL, Wong TCB, Lau SPF, Kwong PK, Hung SF, Yau SSW. Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification. East Asian Arch Psychiatry 2020; 30:12-19. [PMID: 32229642 DOI: 10.12809/eaap1848] [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] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. METHODS Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. RESULTS Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. CONCLUSIONS Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.
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Affiliation(s)
- C C Lee
- Kwai Chung Hospital, Hong Kong
| | | | | | - T C B Wong
- New Life Psychiatric Rehabilitation Association, Hong Kong
| | | | | | - S F Hung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - S S W Yau
- New Life Psychiatric Rehabilitation Association, Hong Kong
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Abstract
Objective: We examined adulthood diagnostic, functioning, and social outcomes of childhood ADHD in a Hong Kong Chinese clinical sample. Method: We identified from the central registry 499 Chinese adults clinically diagnosed with ADHD aged 6 to 12 in 2002-2005 in four Hong Kong child psychiatric centers. Assessments included ADHD Clinical Diagnostic Scale (ACDS), Structured Clinical Interview for DSM Disorders (SCID), and World Health Organization Disability Assessment Schedule (WHO-DAS). Results: Eligible participants = 499. One hundred forty-five completed assessments, two deceased, six incarcerated, 100 had invalid contact, 83 declined, 34 emigrated, and 129 unable to attend. Mean follow-up duration = 14.9 years. Nonrespondents were slightly younger (19.78 vs. 20.53, p < .001). In all, 83.1% of all participants currently met Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD criteria (36.8% inattentive subtype (IA), 43% combined, 3.3% hyperactive/impulsive subtype (H/I) ). One third of persistent ADHD participants currently received care. ADHD persistence was associated with significantly increased psychiatric comorbidity (49.5% vs. 22.7%, p = .02) and poor academic and social outcomes. ADHD persistence and comorbidity independently predicted impairment. Conclusion: Adulthood-persistence of clinically presented childhood ADHD is common and impairing in Hong Kong Chinese.
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Affiliation(s)
| | | | | | | | - Kelly Lai
- The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Sheila Wong
- The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Patrick Leung
- The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - S F Hung
- The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Linda C W Lam
- The Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Sing Lee
- The Chinese University of Hong Kong, Tai Po, Hong Kong
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3
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Tang CP, Hung SF, Lee CC, Ho TP, Leung PWL. 15-year computer-record study of adolescents exposed to peer suicide. Hong Kong Med J 2019; 25 Suppl 3:11-12. [PMID: 30792365] [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)
| | | | | | - T P Ho
- Department of Psychiatry, The University of Hong Kong
| | - P W L Leung
- Department of Psychology, The Chinese University of Hong Kong
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Chan WC, Wong CS, Chen EY, Ng RM, Hung SF, Cheung EF, Sham PC, Chiu HF, Lam M, Chang WC, Lee EH, Chiang TP, Lau JT, van Os J, Lewis G, Bebbington P, Lam LC. Validation of the Chinese Version of the Revised Clinical Interview Schedule: Findings from Hong Kong Mental Morbidity Survey. East Asian Arch Psychiatry 2017; 27:3-10. [PMID: 28387207] [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: 06/07/2023]
Abstract
This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version.
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Affiliation(s)
- W C Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - C Sm Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Yh Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - R Mk Ng
- Department of Psychiatry, Kowloon Hospital, Hong Kong SAR, China
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong SAR, China
| | - E Fc Cheung
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - P C Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - H Fk Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M Lam
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - W C Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - E Hm Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - T P Chiang
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - J Tf Lau
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - P Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - L Cw Lam
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
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5
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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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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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Chan WC, Chow PPL, Lam LCW, Hung SF, Cheung EFC, Dunn ELW, Ng RMK, Fu JCK. Pathway of psychiatric care in Hong Kong. Hong Kong Med J 2015; 21 Suppl 2:41-44. [PMID: 25852102] [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)
- W C Chan
- Department of Psychiatry, The University of Hong Kong
| | - P P L Chow
- Department of Old Age Psychiatry, Castle Peak Hospital
| | - L C W Lam
- Department of Psychiatry, The Chinese University of Hong Kong
| | - S F Hung
- Department of Psychiatry, Kwai Chung Hospital
| | - E F C Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital
| | - E L W Dunn
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital
| | - R M K Ng
- Department of Psychiatry, Kowloon Hospital
| | - J C K Fu
- Department of General Adult Psychiatry, Castle Peak Hospital
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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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Kuo YH, Chang KC, Wang JH, Tsai PS, Hung SF, Hung CH, Lu SN. Changing serum levels of quantitative hepatitis B surface antigen and hepatitis B virus DNA in hepatitis B virus surface antigen carriers: a follow-up study of an elderly cohort. Kaohsiung J Med Sci 2014; 31:102-7. [PMID: 25645989 DOI: 10.1016/j.kjms.2014.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 12/16/2022] Open
Abstract
This study was to elucidate longitudinally quantitative changes of hepatitis B virus (HBV) surface antigen (HBsAg) and HBV DNA in elder HBsAg carriers in a community. Among 1002 residents screened for HBsAg in 2005, 405 responded to this follow-up study in 2010. Fifty-nine (14.6%) were HBsAg carriers in 2005; HBsAg quantification and HBV DNA were measured. HBsAg quantification (cutoff 1600 IU/mL) and HBV DNA (cutoff 2000 IU/mL) were combined to stratify the participants between two screens. A total of 30 men and 29 women with a mean age of 63.9 ± 7.9 years were enrolled. Quantitative levels of HBsAg and HBV DNA were significantly correlated in 2005 (r = 0.509, p < 0.001) and 2010 (r = 0.777, p < 0.001). Concentrations of HBsAg (IU/mL) significantly decreased from 2.2 ± 1.0 log in 2005 to 1.7 ± 1.5 log in 2010 (p < 0.001). The level of HBsAg was decreased in 48 (81.4%) individuals and HBsAg was undetectable in eight (13.6%). The annual incidence of HBsAg clearance was 2.7%. These 59 HBsAg carriers in 2005 were divided into four groups: low HBsAg low HBV DNA (n = 32), high HBsAg low HBV DNA (n = 5), low HBsAg high HBV DNA (n = 12) and high HBsAg high HBV DNA (n = 10). All 32 individuals in the low HBsAg low HBV DNA group were still in that group in 2010, whereas only two of the high HBsAg high HBV DNA group became inactive. As with a younger cohort in hospital, HBsAg quantification was still well correlated with HBV DNA in elderly HBsAg carriers in the community. Lower levels of both HBsAg and HBV DNA might represent an inactive HBV infection.
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Affiliation(s)
- Yuan-Hung Kuo
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Ching Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Houng Wang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Shan Tsai
- Health Center of Zihguan Township, Kaohsiung, Taiwan
| | - Shu-Feng Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Hung Hung
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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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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Hui CLM, Wong GHY, Tang JYM, Chang WC, Chan SKW, Lee EHM, Lam MML, Chiu CPY, Law CW, Chung DWS, Tso S, Pang EPF, Chan KT, Wong YC, Mo FYM, Chan KPM, Hung SF, Honer WG, Chen EYH. Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis. Schizophr Res 2013; 150:297-302. [PMID: 23993865 DOI: 10.1016/j.schres.2013.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 05/20/2013] [Revised: 07/23/2013] [Accepted: 08/10/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Relapse is common among patients with psychotic disorders. Identification of relapse predictors is important for decision regarding maintenance medication. Naturalistic studies often identify medication non-adherence as a dominant predictor. There are relatively few studies for predictors where adherence is already known. It is this situation i.e., discontinuation of medication that predictors will be most useful. We identify predictors for relapse in situations of (i) discontinuation and (ii) continuation of maintenance medication. METHOD Analysis of relapse predictors is based on a randomized controlled study (n=178) comparing relapse rates between patients who discontinued or continued medication for at least 1 year following first-episode psychosis. Demographic, clinical and neurocognitive variables were assessed at baseline as predictors of relapse within 1 year. RESULTS Risk of relapse was 79% in the discontinuation group and 41% in the maintenance group. Predictors in the discontinuation group were diagnosis of schizophrenia, poorer semantic fluency performance, and higher blink rate. Predictors in the continuation group were disinhibition soft signs and more general psychopathology symptoms. CONCLUSION Different predictors of relapse were identified for first episode psychosis patients who discontinued and continued maintenance medication. Neurocognitive dysfunctions are important predictors for both groups. While signs of frontal dysfunction and dopamine hyperactivity predict relapse in the discontinuation group, sign of cognitive disinhibition predicts relapse in the continuation group.
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Affiliation(s)
- Christy L M Hui
- Department of Psychiatry, University of Hong Kong, Hong Kong, 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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13
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Wong GHY, Hui CLM, Tang JYM, Chang WC, Chan SKW, Xu JQ, Lin JJX, Lai DC, Tam W, Kok J, Chung D, Hung SF, Chen EYH. Early intervention for psychotic disorders: Real-life implementation in Hong Kong. Asian J Psychiatr 2012; 5:68-72. [PMID: 26878952 DOI: 10.1016/j.ajp.2012.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/11/2012] [Indexed: 11/16/2022]
Abstract
Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.
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Affiliation(s)
- Gloria H Y Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jia-Qi Xu
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Jessie J X Lin
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Dik-Chee Lai
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Wendy Tam
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | - Joy Kok
- Hong Kong Early Psychosis Intervention Society, Hong Kong
| | - Dicky Chung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Tai Po Hospital, Hong Kong
| | - S F Hung
- Hong Kong Early Psychosis Intervention Society, Hong Kong; Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; Hong Kong Early Psychosis Intervention Society, Hong Kong
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Chang WC, Tang JYM, Hui CLM, Chiu CPY, Lam MML, Wong GHY, Chung DWS, Law CW, Tso S, Chan KPM, Hung SF, Chen EYH. Gender differences in patients presenting with first-episode psychosis in Hong Kong: a three-year follow up study. Aust N Z J Psychiatry 2011; 45:199-205. [PMID: 21261552 DOI: 10.3109/00048674.2010.547841] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. METHODS A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. RESULTS At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p < 0.001), fewer affective symptoms (p < 0.01), more violent behaviour and forensic records (p < 0.01), and higher rate of substance abuse (p < 0.01). Women achieved higher levels of functioning than men (Social Occupational Functioning Assessment Scale (SOFAS), p < 0.001) and a significantly higher proportion of women than men engaged in full-time employment or study for at least 12 consecutive months (p < 0.001) in the initial three years after psychiatric treatment. CONCLUSION Notable gender differences in clinical profiles, illness trajectory and functional outcome were demonstrated in Chinese young people suffering from first-episode psychosis. Differential needs between men and women and hence gender-specific therapeutic strategies should be considered in early intervention service.
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Leung SSL, Leung C, Lam TH, Hung SF, Chan R, Yeung T, Miao M, Cheng S, Leung SH, Lau A, Lee DTS. Outcome of a postnatal depression screening programme using the Edinburgh Postnatal Depression Scale: a randomized controlled trial. J Public Health (Oxf) 2010; 33:292-301. [PMID: 20884642 DOI: 10.1093/pubmed/fdq075] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a lack of evidence on the effectiveness of postnatal depression (PND) screening programmes in reducing morbidity. The aim of this study was to evaluate the effectiveness of a PND screening programme using Edinburgh Postnatal Depression Scale (EPDS) in improving maternal mental health. METHODS The randomized controlled trial design was used. Participants were 462 Chinese mothers with 2-month-old babies visiting Maternal and Child Health Centres in Hong Kong. Participants in the intervention group were screened for PND using the EPDS, whereas those in the control group were screened by clinical assessment. In both groups, participants identified with PND were offered follow-up management according to protocol. RESULTS Participants in the intervention group had better maternal mental health outcome as assessed by EPDS at 6 months (risk ratio: 0.59; 95% confidence interval: 0.39-0.89). The number needed to screen was 25. CONCLUSIONS A PND screening programme comprising the use of EPDS as the screening tool and the provision of follow-up care had resulted in an improvement in maternal mental health at 6 months.
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Affiliation(s)
- Shirley S L Leung
- Family Health Service, Department of Health, Room 1308, 13/F, Guardian House, 32 Oi Kwan Road, Wanchai, Hong Kong, China.
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16
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Chen EYH, Hui CLM, Lam MML, Chiu CPY, Law CW, Chung DWS, Tso S, Pang EPF, Chan KT, Wong YC, Mo FYM, Chan KPM, Yao TJ, Hung SF, Honer WG. Maintenance treatment with quetiapine versus discontinuation after one year of treatment in patients with remitted first episode psychosis: randomised controlled trial. BMJ 2010; 341:c4024. [PMID: 20724402 PMCID: PMC2924475 DOI: 10.1136/bmj.c4024] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment. DESIGN 12 month randomised, double blind, placebo controlled trial. SETTING Early psychosis outpatient clinics in Hong Kong. PARTICIPANTS 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis. INTERVENTIONS Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred. MAIN OUTCOME MEASURE Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds. RESULTS 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; chi(2)=3.20, df=1; P=0.07). CONCLUSION In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year. Trial registration Clinical trials NCT00334035.
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Affiliation(s)
- Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong.
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Tang JYM, Wong GHY, Hui CLM, Lam MML, Chiu CPY, Chan SKW, Chung DWS, Tso S, Chan KPM, Yip KC, Hung SF, Chen EYH. Early intervention for psychosis in Hong Kong--the EASY programme. Early Interv Psychiatry 2010; 4:214-9. [PMID: 20712726 DOI: 10.1111/j.1751-7893.2010.00193.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. METHODS In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. RESULTS An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. CONCLUSIONS The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed.
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Affiliation(s)
- Jennifer Y M Tang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
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18
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Leung PWL, Kwong SL, Tang CP, Ho TP, Hung SF, Lee CC, Hong SL, Chiu CM, Liu WS. Test-retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR. J Child Psychol Psychiatry 2006; 47:970-3. [PMID: 16930392 DOI: 10.1111/j.1469-7610.2005.01570.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [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] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity. METHODS Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR. RESULTS The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better. CONCLUSIONS Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.
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Affiliation(s)
- Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
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19
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Leung PWL, Lee CC, Hung SF, Ho TP, Tang CP, Kwong SL, Leung SY, Yuen ST, Lieh-Mak F, Oosterlaan J, Grady D, Harxhi A, Ding YC, Chi HC, Flodman P, Schuck S, Spence MA, Moyzis R, Swanson J. Dopamine receptor D4 (DRD4) gene in Han Chinese children with attention-deficit/hyperactivity disorder (ADHD): increased prevalence of the 2-repeat allele. Am J Med Genet B Neuropsychiatr Genet 2005; 133B:54-6. [PMID: 15578612 DOI: 10.1002/ajmg.b.30129] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.
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Affiliation(s)
- Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
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20
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Chan KP, Hung SF, Yip PS. Suicide in response to changing societies. Child Adolesc Psychiatr Clin N Am 2001; 10:777-95. [PMID: 11588803] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The "medical model" is an insufficient explanation for the high suicide rates, but it does not mean that suicide is a different phenomenon in China. A multidimensional model (Fig. 6) is proposed to appreciate better the complexity of the problem, which can be applied to other countries. As in Figure 6, suicide and suicide attempts are conceptualized as a continuum of behaviors. The suicide method may modify the boundaries (i.e., the availability and choice of a lethal method may expand the size of completed suicides and vice versa). The spectrum of behaviors is also under the influence of individual factors, such as psychiatric disorders and personality, and local factors, such as local cultural norms, resources, and familial problems. All of these factors are subject to the influence of greater social forces. For example, psychiatric disorder increases the risk of suicide but is shaped by global forces. In the case of China, the importing of Western values influences the way Chinese people present their idioms of distress. Chinese people who tend to somatize start to psychologize more, [figure: see text] which in turn affects the rates of depression and subsequently the risk of suicide. The various factors also interact with one another. The diagnosis of disruptive and antisocial disorder illustrates how local factors modulate that of the individual. In Diagnostic and Statistical Manual of Mental Disorders, conduct disorder is defined by a series of "socially unacceptable behaviors," including aggression, destruction of property, theft, and violation of rules. Because biologic validity is lacking, the diagnosis (an individual factor) may vary widely in different cultural settings (a local factor). In China, conformity, self-control, and discipline are emphasized; subthreshold cases in the West already may be unacceptable in the Chinese setting and be labeled "disruptive." On the other hand, the cultural emphasis on conformity in the upbringing may reduce the display of such behaviors and lead to a lower prevalence of disruptive and antisocial disorders in China. With globalization, however, the "Chinese" values are more closely identified with the global culture, and a rising trend of personality disorders has been witnessed. The media are some of the powerful agents in transmitting these forces. The medical model of explaining the phenomenon of suicide with psychiatric disorders is not entirely satisfactory. The association of a high suicide rate with a low prevalence of psychiatric disorders in China challenges this conventional view. Rather than refuting this conventional model, the dynamic interaction with local sociocultural factors and global forces is emphasized. Empirical evidence is lacking, however, and should be the focus for future suicide research.
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Affiliation(s)
- K P Chan
- Department of Psychiatry, Chinese University of Hong Kong, Kwai Chung Hospital, Hong Kong, China.
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21
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Ho TP, Leung PW, Hung SF, Lee CC, Tang CP. The mental health of the peers of suicide completers and attempters. J Child Psychol Psychiatry 2000; 41:301-8. [PMID: 10784077] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
This study examined the prevalence and risk of psychiatric disturbances and suicidal behaviours among the peers of suicide attempters and completers. The subjects were selected from high schools with and without history of student suicides in the past 3 years. The psychiatric disturbances (as measured by the YSR and CBCL), suicidal behaviours, drug use, and a wide range of potential risk factors were measured. About a quarter of the peers of suicide completers and attempters were probable psychiatric cases and 15-21% of them reported suicidal acts. The increased risk of psychiatric disturbances and suicidal behaviours were still evident after controlling for age, sex, and potential risk factors. The presence of psychiatric disturbances could not wholly account for the increased odds of suicidal behaviours. Peers of suicide attempters carried a higher risk than peers of suicide completers. The close friends of suicide completers were particularly at risk of internalising problems, whereas the close friends of suicide attempters were at high risk of externalising problems. The peers of suicide completers and attempters represent a high-risk group for psychiatric disturbances and suicidal behaviours. The specific association of different types of psychiatric disturbances in the peers of suicide completers and attempters suggested that different risk mechanisms might be in operation within these peer groups.
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Affiliation(s)
- T P Ho
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
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22
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Ho TP, Hung SF. The prevention of youth suicide: research and services. Hong Kong Med J 1998; 4:195-202. [PMID: 11832573] [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: 02/23/2023] Open
Abstract
In parallel with the escalating concern about youth suicides in the 1970s in the West, came an increase in suicide prevention efforts. The production of research data in the past 20 years enables us to evaluate the rationale and effectiveness of these suicide prevention programmes. Effective prevention programmes for youth suicide depend on our knowledge of the scope of the problem, factors associated with its occurrence, and an evaluation of the existing prevention strategies. The aim of this article is to review the main body of knowledge on the prevalence of and risk factors for youth suicide (both completed and attempted suicides) and use these to assess various prevention programmes.
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Affiliation(s)
- T P Ho
- Department of Psychiatry, Queen Mary Hospital, Pokfulam, Hong Kong
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23
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Abstract
BACKGROUND Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking. METHOD The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews. RESULTS Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r = 0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder. CONCLUSIONS Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clinical research.
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Affiliation(s)
- J M Rey
- Department of Psychological Medicine, University of Sydney, New South Wales
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Chang CL, Tsai YC, Niu CS, Hung SF, Cheng JT. Inhibitory effect of propofol on sympathetic neurotransmission results in changes of plasma neuropeptide Y in rats. J Auton Pharmacol 1996; 16:29-33. [PMID: 8736428 DOI: 10.1111/j.1474-8673.1996.tb00353.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
1. The effects of propofol on sympathetic neurotransmission and changes of plasma level of neuropeptide Y-like immunoreactivity (NPY-ir) were investigated in rats. 2. Intraperitoneal injection of propofol into rats lowered the systemic blood pressure and plasma NPY-ir in a dose-dependent manner. 3. Decrease of plasma NPY-ir induced by propofol was not modified in adrenalectomized rats. In the activation of adrenergic neurotransmission by a ganglionic nicotinic agonist, elevation of plasma NPY-ir was also reduced by propofol indicating the direct effect on peripheral adrenergic nerve terminals. 4. Plasma level of NPY-ir reversed in parallel with the recovery of anaesthesia induced by propofol. After an intracerebroventricular injection of propofol into the rats, both the lowering of plasma NPY-ir and the induction of anaesthesia were observed. Thus, a central nervous system effect of propofol can also be considered in its effect on plasma NPY-ir. 5. The data suggest that propofol has the ability to lower plasma NPY-ir in rats through an inhibition of adrenergic neurotransmission via central nervous pathway and/or peripheral nerve terminal blockade.
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Affiliation(s)
- C L Chang
- Department of Anesthesiology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan, Republic of China
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Abstract
This paper explores the intrapersonal and sociocultural factors behind youth suicide in Hong Kong. The coroner's court reports of consecutive population-based youth suicide (below age of 25 years, n = 303) cases from 1986 to 1992 were reviewed. Compared with other countries, Hong Kong had low male but high female youth suicide rates. The number of undetermined deaths did not significantly affect the estimated suicide rates. Cross-cultural differences in youth suicide rates may be understood from a differential distribution of risk factors and cultural attitudes towards role behaviours and suicide. Youth suicides in Hong Kong were characterised by a high prevalence of psychiatric disturbances and age-normative precipitants; both findings bear great resemblances to samples studied elsewhere. The results were evaluated in light of studies in different sociocultural backgrounds and highlighted the universality and specificity of youth suicide in Hong Kong.
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Affiliation(s)
- T P Ho
- Department of Psychiatry, University of Hong Kong, Queen Mary Hospital, Pokfulam
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Affiliation(s)
- L C Lam
- Kwai Chung Hospital, Hong Kong
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