Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial
Psychological Medicine, 2022
Background Contrasting the well-described effects of early intervention (EI) services for youth-o... more Background Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [inte...
Gender differences in patients presenting with fi rst-episode psychosis in Hong Kong: a three-yea... more Gender differences in patients presenting with fi rst-episode psychosis in Hong Kong: a three-year follow up study
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2015
K e y M e s s a g e s 1. Psychotic patients who received early intervention had longer periods of... more K e y M e s s a g e s 1. Psychotic patients who received early intervention had longer periods of employment, fewer hospitalisations, more time in symptomatic remission, fewer suicidal attempts and violent acts, and lower mortality over a 10-year period. 2. Early intervention improved the longitudinal outcomes of psychosis. Nonetheless, symptomatic remission and recovery rate did not differ significantly at 10 years between patients with early intervention and patients with standard care. Early intervention did not alter the symptomatic trajectory of schizophreniaspectrum disorders. 3. Re-examination of the optimum duration of early
Possible olanzapine-induced hepatotoxicity in a young Chinese patient
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2009
We present a case of a 17-year-old man with first-episode schizophrenia who developed olanzapine-... more We present a case of a 17-year-old man with first-episode schizophrenia who developed olanzapine-induced hepatitis, cholestasis, and splenomegaly, all of which were reversed after ceasing olanzapine. Clinicians prescribing olanzapine should be aware of this possible hepatotoxicity. Patient education, vigilance from clinicians, and careful clinical examination can help detect this complication early.
The aim of this study was to evaluate an education programme on suicide prevention for nurses wor... more The aim of this study was to evaluate an education programme on suicide prevention for nurses working in general hospitals. A mixed method design that included a single group pretest-posttest analysis and focus group interviews was used. A convenient sample of 54 registered nurses was recruited from the medical and surgical units of two regional general hospitals. An 18-hour education programme on suicide prevention based on reflective learning principles was provided to the participants. The outcome measures used included participants' attitudes towards, knowledge of, competence in and stress levels arising from suicide prevention and management. Eighteen participants joined the focus group interviews. There were statistically significant positive changes in the pre- and post-test measures of participants' attitudes and competence levels. Qualitative data showed that participants had applied the new knowledge they acquired in clinical practice. They perceived themselves as ...
Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explore... more Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. Objective: To explore the relationship between DUP and long-term symptomatic remission. Methods: This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤ 30 days), medium (31-180 days) and long (N 180 days) DUP groups. Results: The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. Conclusion: The findings support the threshold theory that DUP longer than 30 days adversely impacts the longterm outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on longterm outcomes based on well-defined criteria and adequate statistical adjustment.
Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis
Schizophrenia Research, 2013
Relapse is common among patients with psychotic disorders. Identification of relapse predictors i... more 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. 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. 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. 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.
First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) ha... more First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.
To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia... more To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Methods: A randomized controlled trial was conducted. Seventy-three clients with a diagnosis of schizophrenia and their caregivers (n = 73) were recruited and randomized into a study (n = 36) and control group (n = 37). Ten psychoeducation sessions were provided to the study group. The outcomes were measured at the baseline, immediately after (post-1), six months (post-2), and 12 months after the intervention (post-3). Results: There were significant treatment effects across time for all client outcomes: adherence to medication (p < 0.01), mental status (p < 0.01), and insight into illness (p < 0.01). However, no significant differences were found between groups at the post-3 measures for all client outcomes. For the caregivers, significant group differences were only detected in self-efficacy at the post-1 (p = 0.007) and post-2 (p < 0.001) measures, the level of satisfaction at the post-1 (p = 0.033) and post-2 (p < 0.021) measures, and the perception of family burden at the post-2 measures (p = 0.043). Conclusion: A psychoeducation intervention had positive effects on Chinese clients and their caregivers. However, these effects might not be sustained 12 months after the intervention. Practice implications: To substantiate its effects, psychoeducation should be an ongoing intervention, with its outcomes constantly evaluated.
Aim. To evaluate the effect of an education programme on nurses’ knowledge, attitude and compete... more Aim. To evaluate the effect of an education programme on nurses’ knowledge, attitude and competence on suicide prevention and management for patients with suicide attempt or ideation and their family members; and to examine the strengths and weaknesses of the programme from the participants’ perspectives.Background. Providing care for patients with suicidal ideation or after suicidal acts in general hospitals often poses particular challenges for general nurses. Education programme may help these nurses acquire appropriate attitude, knowledge and competence in suicide prevention and intervention.Design. An 18‐hour education programme on suicide prevention and management was developed based on needs analysis and literature and was provided to the study group. Fifty‐four registered general nurses from the medical and surgical units of two general hospitals completed the education programme. Focus groups were used for process (n = 24) and outcome evaluation (n = 18).Results. Findin...
An Audit Study of Defaulters of Regular Psychiatric Outpatient Appointments in Hong Kong
International Journal of Social Psychiatry, 1995
This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. De... more This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. Defaulters were increased among those who were married, unem ployed, housewives, seen within one year, receiving medications and previously admitted to hospital. Clinical diagnoses (ICD-10 Axis-1) of the F1, F2, F3 and F7 groups were also associated with increased defaulting behaviour. However, fewer defaulters were found among those who were aged below 19, single, employed, students, and had diagnostic groups of F4 and F9. These results added new information on the non-attendance behavioral pattern of Chinese patients.
style described by McGorry (1). A statistical analysis of data was performed. Objetives Evaluate ... more style described by McGorry (1). A statistical analysis of data was performed. Objetives Evaluate the gender differences in the prodomal state and analyse the prognosis according to them. Results: 231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset. Conclusions: The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.
Effectiveness and optimal duration of early intervention treatment in adult-onset psychosis: a randomized clinical trial
Psychological Medicine, 2022
Background Contrasting the well-described effects of early intervention (EI) services for youth-o... more Background Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention. Methods 360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years. Results Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [inte...
Gender differences in patients presenting with fi rst-episode psychosis in Hong Kong: a three-yea... more Gender differences in patients presenting with fi rst-episode psychosis in Hong Kong: a three-year follow up study
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2015
K e y M e s s a g e s 1. Psychotic patients who received early intervention had longer periods of... more K e y M e s s a g e s 1. Psychotic patients who received early intervention had longer periods of employment, fewer hospitalisations, more time in symptomatic remission, fewer suicidal attempts and violent acts, and lower mortality over a 10-year period. 2. Early intervention improved the longitudinal outcomes of psychosis. Nonetheless, symptomatic remission and recovery rate did not differ significantly at 10 years between patients with early intervention and patients with standard care. Early intervention did not alter the symptomatic trajectory of schizophreniaspectrum disorders. 3. Re-examination of the optimum duration of early
Possible olanzapine-induced hepatotoxicity in a young Chinese patient
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2009
We present a case of a 17-year-old man with first-episode schizophrenia who developed olanzapine-... more We present a case of a 17-year-old man with first-episode schizophrenia who developed olanzapine-induced hepatitis, cholestasis, and splenomegaly, all of which were reversed after ceasing olanzapine. Clinicians prescribing olanzapine should be aware of this possible hepatotoxicity. Patient education, vigilance from clinicians, and careful clinical examination can help detect this complication early.
The aim of this study was to evaluate an education programme on suicide prevention for nurses wor... more The aim of this study was to evaluate an education programme on suicide prevention for nurses working in general hospitals. A mixed method design that included a single group pretest-posttest analysis and focus group interviews was used. A convenient sample of 54 registered nurses was recruited from the medical and surgical units of two regional general hospitals. An 18-hour education programme on suicide prevention based on reflective learning principles was provided to the participants. The outcome measures used included participants' attitudes towards, knowledge of, competence in and stress levels arising from suicide prevention and management. Eighteen participants joined the focus group interviews. There were statistically significant positive changes in the pre- and post-test measures of participants' attitudes and competence levels. Qualitative data showed that participants had applied the new knowledge they acquired in clinical practice. They perceived themselves as ...
Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explore... more Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP-outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. Objective: To explore the relationship between DUP and long-term symptomatic remission. Methods: This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤ 30 days), medium (31-180 days) and long (N 180 days) DUP groups. Results: The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. Conclusion: The findings support the threshold theory that DUP longer than 30 days adversely impacts the longterm outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on longterm outcomes based on well-defined criteria and adequate statistical adjustment.
Predicting 1-year risk for relapse in patients who have discontinued or continued quetiapine after remission from first-episode psychosis
Schizophrenia Research, 2013
Relapse is common among patients with psychotic disorders. Identification of relapse predictors i... more 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. 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. 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. 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.
First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) ha... more First-episode psychosis Outcome Employment Mode of onset Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds.
To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia... more To evaluate the effectiveness of a psychoeducation program for Chinese clients with schizophrenia and their family caregivers. Methods: A randomized controlled trial was conducted. Seventy-three clients with a diagnosis of schizophrenia and their caregivers (n = 73) were recruited and randomized into a study (n = 36) and control group (n = 37). Ten psychoeducation sessions were provided to the study group. The outcomes were measured at the baseline, immediately after (post-1), six months (post-2), and 12 months after the intervention (post-3). Results: There were significant treatment effects across time for all client outcomes: adherence to medication (p < 0.01), mental status (p < 0.01), and insight into illness (p < 0.01). However, no significant differences were found between groups at the post-3 measures for all client outcomes. For the caregivers, significant group differences were only detected in self-efficacy at the post-1 (p = 0.007) and post-2 (p < 0.001) measures, the level of satisfaction at the post-1 (p = 0.033) and post-2 (p < 0.021) measures, and the perception of family burden at the post-2 measures (p = 0.043). Conclusion: A psychoeducation intervention had positive effects on Chinese clients and their caregivers. However, these effects might not be sustained 12 months after the intervention. Practice implications: To substantiate its effects, psychoeducation should be an ongoing intervention, with its outcomes constantly evaluated.
Aim. To evaluate the effect of an education programme on nurses’ knowledge, attitude and compete... more Aim. To evaluate the effect of an education programme on nurses’ knowledge, attitude and competence on suicide prevention and management for patients with suicide attempt or ideation and their family members; and to examine the strengths and weaknesses of the programme from the participants’ perspectives.Background. Providing care for patients with suicidal ideation or after suicidal acts in general hospitals often poses particular challenges for general nurses. Education programme may help these nurses acquire appropriate attitude, knowledge and competence in suicide prevention and intervention.Design. An 18‐hour education programme on suicide prevention and management was developed based on needs analysis and literature and was provided to the study group. Fifty‐four registered general nurses from the medical and surgical units of two general hospitals completed the education programme. Focus groups were used for process (n = 24) and outcome evaluation (n = 18).Results. Findin...
An Audit Study of Defaulters of Regular Psychiatric Outpatient Appointments in Hong Kong
International Journal of Social Psychiatry, 1995
This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. De... more This paper describes an audit study of general psychiatric outpatient defaulters in Hong Kong. Defaulters were increased among those who were married, unem ployed, housewives, seen within one year, receiving medications and previously admitted to hospital. Clinical diagnoses (ICD-10 Axis-1) of the F1, F2, F3 and F7 groups were also associated with increased defaulting behaviour. However, fewer defaulters were found among those who were aged below 19, single, employed, students, and had diagnostic groups of F4 and F9. These results added new information on the non-attendance behavioral pattern of Chinese patients.
style described by McGorry (1). A statistical analysis of data was performed. Objetives Evaluate ... more style described by McGorry (1). A statistical analysis of data was performed. Objetives Evaluate the gender differences in the prodomal state and analyse the prognosis according to them. Results: 231 patients were included (32.5% women). The following symptoms were more frequent in men (p<0.05): isolation, odd behaviour, deterioration of cleanness, language vague, and lack of spontaneity. The outcome after 2 year was worse when patients had the following symptoms in the group of the men: lack of spontaneity, language vague and deterioration of cleanness. However, women have the same outcome independently of prodromal symptoms in the illness onset. Conclusions: The presence of prodromal symptoms could influence on outcome of men after two years. They have a worse outcome when they have some prodromal symptoms. The intervention on this phase could be an opportunity to improve the outcome of men with first psychosis episode.
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