Hong Kong Journal of Psychiatry

Publications
Investigated the cost-effectiveness of the first psychiatric long-stay care home in Hong Kong, which opened in 1990. This was a prospective cohort study of the first 43 patients (aged 21-79 yrs) discharged to the long-stay care home from Castle Peak Hospital, who were followed-up for 2 years. Patients had significantly improved social and community skills while remaining behaviourally and symptomatically stable. The long-stay care home provided a less restrictive environment than Castle Peak Hospital, and patients' satisfaction was high. The recurring costs for the long-stay care home were lower than for the hospital. The only statistically significant adverse finding was deterioration in personal health care skills 2 years after leaving the medical setting. This study provides the first scientific evidence in Hong Kong to show that the long-stay care home is a cost-effective means of successfully rehabilitating a group of long-stay mental hospital inpatients who do not qualify for halfway houses but require only minimal nursing care (less than 2.5 hours per week). (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Objectives: To examine the factor structure of the Automatic Thoughts Questionnaire-Malay and report its validity and reliability in Malaysia. Participants and Methods: One thousand and ninety patients from 4 different samples completed the Automatic Thoughts Questionnaire-Malay, as well as additional questionnaires which measured mood, cognition, and quality of life. Results: Exploratory factor analysis revealed a 2-factor solution and accounted for 51% of the total variance, and a subsequent confirmatory factor analysis confirmed the 2-factor solution was acceptable for the data. The 2 factors appeared to describe negative self-concept/negative expectation and personal maladjustment. The Cronbach's alpha coefficients ranged from 0.83 to 0.93. Evidence was also found to support the concurrent and discriminant validity of the Automatic Thoughts Questionnaire-Malay. Conclusions: This report shows that the Automatic Thoughts Questionnaire-Malay is a reliable and valid instrument for measuring negative automatic thoughts in the Malay population.
 
Memory deficits are commonly encountered in patients with schizophrenia, affecting everyday functioning and hindering rehabilitation efforts. To date, research has focused mainly on patients' ability to recall past information, or retrospective memory, but has neglected an important memory process known as prospective memory, or the ability to remember to perform actions in the future. Given its behavioural orientation, prospective memory is considered different from and more complex than the traditional construct of retrospective memory. Clinical experience has indicated that patients with schizophrenia experience some kind of prospective memory impairment but systematic research in this area is still lacking. Prospective memory is relevant to the management and rehabilitation of schizophrenia because prospective memory is essential for maintaining an organised daily routine and coping with social demands. For both theoretical and practical reasons, systematic investigation of the nature and extent of prospective memory impairment of patients with schizophrenia is clearly warranted. Research in this area will provide useful information for improving the assessment, management, and rehabilitation of prospective memory problems in schizophrenia. Furthermore, such research will advance our understanding of prospective memory processes and their relationship with frontal lobe functions.
 
The authors describe a female carrier of ring chromosome 13 with profound mental retardation and autistic symptoms, including a brief revision of the pertinent literature.
 
The history of psychiatry in Hong Kong covers only approximately 130 years. Psychiatry started as a specialty in 1875 with a temporary asylum, which was replaced by the European Lunatic Asylum in 1885. This era ended in 1928 when the term 'lunatic asylum' was substituted with 'mental hospital'. The hospital had 23 beds. In 1938, part of the staff quarters in High Street were converted to treat women at the mental hospital, increasing the number of beds to 84. The main function of the hospital was to provide custodial care for disturbed mental patients until their transfer to China or repatriation to their own countries. In 1948, Dr PM Yap was appointed the medical superintendent of the mental hospital and he started planning the development of psychiatric facilities and training of psychiatric personnel. The opening of Castle Peak Hospital in 1961 and the availability of efficacious psychotropic medications revolutionised psychiatric care. Rapid urbanisation and industrialisation from the 1950s to the 1970s gave rise to high density living and changes in socioeconomic and family structures, resulting in an increase in psychiatric morbidity and a range of problems in young and elderly people. These events, together with a high expectation of care from a more enlightened and affluent society, made demands for more sophisticated and specialised services. This paper describes the development from the start in 1875 to the range of facilities and services available in 1985, with reference to personal participation in treatment and planning.
 
The 21st century will see dramatic changes in medicine including psychiatry. Scientific advances and social development will definitely change the scenario of psychiatric rehabilitation and perhaps the public attitude towards mental patients in society. Mental health professionals should prepare themselves for such changes.
 
This paper reports an analysis of the characteristics of the first 354 outreach patients by the community psychiatric team at Kwai Chung Hospital. By categorising patients into 'new patient' and 'known patient' groups, the reasons for delay in intervention are studied. The diagnosis and violent and suicidal acts are correlated with the outcomes of the outreach service. Based on the findings, there are a number of important implications for future community psychiatric service development.
 
Using abused drugs is an expensive behaviour. Apart from causing health hazards to the users concerned, the associated physiological and psychological effects manifested when taking the drug(s) often induce abnormal behaviour, posing a threat to other people, damaging the abuser's financial situation, and jeopardising his or her social status. The government's efforts to steer the public, especially young people, away from abusing drugs have unfortunately been undermined by misleading information about the commonly abused drugs: a notable example being 'taking Ecstasy can help you keep slim'! Those unfounded myths are due to misunderstanding or lack of knowledge on the part of the drug users. In this paper, facts about certain commonly abused drugs and substances are discussed and myths that may have prompted curious individuals to experiment with them are also introduced.
 
Objective: This study examined the psychometric properties of the Children's Impact of Event Scale-Revised. Participants and Methods: Sixty one children (aged 8 to 17 years) who attended the hospital accident and emergency service after road traffic accidents participated in the study. The Children's Impact of Event Scale-Revised, Children's Depression Inventory, and Revised Children's Manifest Anxiety Scale completed by the children 1 month after the road traffic accidents were studied. Results: A3-factor structure accounting for 72% of the variance was identified forthe 11-item Children's Impact of Event Scale-Revised. The test-retest reliability was satisfactory; the moderate correlations between the Children's Impact of Event Scale-Revised scores (i.e. intrusion, avoidance, and hyperarousal), Children's Depression Inventory, and Revised Children's Manifest Anxiety Scale supported the validity of the Children's Impact of Event Scale-Revised as a measure of post-traumatic stress in children. Results of the confirmatory factor analysis support generalisation of the post-traumatic stress disorder framework for the present sample of Chinese children. Conclusions: The 11-item Children's Impact of Event Scale-Revised has satisfactory psychometric properties as a screening instrument for stress responses after traumatic incidents.
 
Psychiatric symptoms in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome are rarely reported. We report a case of bipolar mood disorder, secondary to MELAS, in an adolescent female patient. To our knowledge, this is the first such report in the literature.
 
Significant brain regions activated on Chinese verbal fluency task (axial view of brain images; left side of image corresponds to left side of brain). 
Objective: To investigate the cerebral hemispheric representation of Chinese subjects employing functional magnetic resonance imaging during verbal fluency tasks. Patients and Methods: Healthy subjects were presented stimuli of the word categories animals, fruit, occupations. Each had to respond by saying aloud in Chinese any item which belonged to the category. Subjects' speech responses were recorded during functional magnetic resonance imaging. The blood oxygen level-dependent response was averaged and data analysed using statistical parametric mapping. Results: Verbal fluency tasks spoken in Chinese were associated with bilateral fronto-temporal lobe activation. Conclusion: These results provide preliminary support for bilateral cerebral hemispheric representation of Chinese speech.
 
Objectives: To selectively review longitudinal cohort studies examining the relationship of leisure activities to cognitive impairment in elders and to summarise proposed mechanisms of how such activities influence cognition. Methods: Studies were identified in Ovid MEDLINE-R (2003 to March 2007) using a set of key words in titles: 'activities', 'activity', 'exercises', 'exercise', or 'leisure'. The results were cross-matched with another set of key words: 'cognitive', 'cognition', 'dementia', 'Alzheimer', 'Alzheimer's', or 'AD'. This search produced 376 studies. A total of 13 longitudinal cohort studies examining the relation between leisure activities and cognitive impairment in elders were found. Results: Six of these studies focused on physical activities, one on cognitive activities, and the rest on general leisure activities. Cognitive activities showed more consistent beneficial effects on cognition, while the effects of physical and social activities were more inconsistent. The mixed and inconsistent results might be attributed to differences in study designs, measurements, definitions and operational criteria of both participation in activities and outcome measures. Difficulties encountered in conducting these studies were demonstrated. Conclusion: Further research is needed to elucidate the distinct effects of different activities on cognition, as well as to explore the necessary duration of such activity, evaluate the underlying mechanisms of benefit, and provide evidence upon which to base strategies to prevent cognitive impairment.
 
Objective: There is a significant correlation between stress and coronary artery disease when the stress is continuous and extreme. This study aims to determine the relationship between stress-related psychosocial factors, namely anxiety, depression, and life events, with ischaemic heart disease. Patients and Methods: Two sets of questionnaires - The Hospital Anxiety and Depression Scale and Rahe's Life Changes Stress Test - were administered to 3 groups comprising 36 patients with acute myocardial infarction or unstable angina, 38 outpatients from the Cardiology Clinic at the Universiti Kebangsaan Malaysia, and 25 healthy people from the community. All participants rated their feelings and reported any major lifestyle changes in the 6 months prior to interview. Results: The study group had significantly higher odds of having had mild anxiety and depression and moderate-risk life events when compared to the healthy participants. There was no significant difference between the case group and the outpatients. Conclusions: Psychosocial factors relating to stress is present in patients with acute ischaemic heart disease. Outpatients who have had long-term cardiac tribulation have the same odds for anxiety, depression, and life events as the patients with acute myocardial infarction.
 
Objective: This cross-sectional study was conducted to examine the difference in presenting symptoms among Malay, Chinese, and Indian patients with schizophrenia, who were admitted to the psychiatric wards of Hospital Kuala Lumpur, Malaysia. Participants and Methods: This study was conducted between 13 March 2004 and 13 June 2004. The Structured Clinical Interview for DSM-III-R (SCID) to generate DSM-IV diagnoses was used to diagnose schizophrenia, and Positive and Negative Syndrome Scale (PANSS) was used to compare differences in presenting symptoms among the 3 ethnic groups. A total of 97 patients were recruited; 49% were Malay, 28% Chinese, and 24% Indian. Results: There were no significant differences among the 3 ethnic groups with regard to the demographic factors except the level of education; more Malays had tertiary education than Chinese and Indians (p < 0.04). In this study, the PANSS score on emotional withdrawal was high among Indians (p < 0.03), and on passive / apathetic social withdrawal and stereotyped thinking were low among Malays (p < 0.002 and p < 0.001 respectively). The scores on tension and active social avoidance were also high among Indians as compared to the Malays (p < 0.02 in both). There was a significant reduction of the total PANSS score over 2 weeks, no difference was noted for the mean change of total PANSS score from baseline, i.e. 'on admission' to 'at week 2' among the 3 ethnic groups. A significant difference was observed in the mean PANSS positive scores, whereby reduction of the positive symptoms was greatest in Malays and least in Chinese (p < 0.004). Conclusion: There was no significant difference among the 3 ethnic groups in terms of positive symptoms, but there were significant differences among them for some negative symptoms.
 
Objective: To examine the relationship between the menstrual cycle and deliberate self-harm. Participants and Methods: This was a case-control study on consecutive eligible female patients (n = 86) admitted to Hospital Kuala Lumpur following an episode of deliberate self-harm (defined by Hawton, 1999) and controls admitted for acute minor medical problems during the period March to June 2005. The Mini-International Neuropsychiatric Interview and Suicide Intent Scale were administered to diagnose psychiatric disorders and to assess suicidal intensity. Results: Patients with deliberate self-harm were associated with the age-group of 18 to 29 years (84%), being single (61%), and employed (78%). They were also significantly associated with being of Malay origin (p < 0.05), having a lower education level (p < 0.05), lacking a confiding relationship (p < 0.05), and having a depressive disorder (p < 0.05). The commonest method was self-poisoning (91%). More than half of the patients had medium suicidal intent. Deliberate self-harm was significantly associated with the follicular phase of the menstrual cycle (p < 0.05), later onset of menarche (p < 0.05), and shorter duration of menses (p < 0.05). Diagnoses of depressive disorders were not significantly different according to the phase of the menstrual cycle (p > 0.05). Conclusion: Menstrual factors may be significantly associated with deliberate self-harm. Further investigations are recommended to explore psychosocial and physiological factors associated with deliberate self-harm in young women.
 
Although primary prevention has been a concern among child mental health professionals for many years, progress in the field has been slow and is fraught with conceptual and methodological difficulties. The aim of this paper is to provide an overview of the topic, highlight some of the more consistent findings, and make suggestions about future development. While it is now generally agreed that intensive primary prevention programmes targeting high risk pre-school children and starting early in the child's life can be effective, much less is known about programmes targeting older children. There is also growing evidence that the participation of the child alone in these programmes - without changing the social context with which the child is in touch everyday - is insufficient to produce sustained improvements. Further development in the field should be guided by a better understanding of the risks and protective mechanisms, and how these affect the child's outcome. In Hong Kong, where child psychiatric morbidity is comparable to that of the West and there are only limited treatment resources, primary prevention needs to be systematically developed as a matter of urgency.
 
Objectives. To investigate subjective certainty regarding same-sex attraction and related psychosocial factors in youths. Participants and Methods. Questionnaire survey of 413 secondary school students (aged 12 to 21 years). Results. In all, 21% of the participants reported uncertainty about same-sex attraction and 4% reported definitely being same-sex attracted. Females were more likely than males to report uncertainty or certainty about same-sex attraction, and a higher level of perceived knowledge by peers on their sexual orientation. Males were more likely than females to report being not same-sex attracted. The level of satisfaction with one's gender identity was not significantly low for those who were certainly same-sex attracted, but participants who were unsure of same-sex attraction were less satisfied with their gender identity than those who were definitely not same-sex attracted. Participants who were same-sex attracted or unsure of same-sex attraction had lower perceived levels of acceptance and experienced more victimisation about their sexual orientation within their social environment, than those who reported they were not same-sex attracted. Conclusions. It is important not to have a preconception about the sexual orientation of individual youths in healthcare settings. Same-sex attraction is associated with subjective feelings of an unfavourable social environment.
 
People with learning disability have high rates of psychiatric disorder. Unlike disorders presenting in the general population, these problems are unfamiliar to many general psychiatrists. In the UK, specialist services have evolved to meet this need. These services are described, in terms of types of service, bed numbers, manpower, organisation, and educational function.
 
Drug abusers may attempt to conceal their drug intake by interfering with the clinical specimens sent to the laboratory for toxicology screening. This report describes a 27-year-old drug abuser who repeatedly submitted urine samples with abnormally low creatinine concentrations in order to invalidate drug screening. Adulteration by addition of ammonia-containing cleanser was suspected and eventually admitted by the patient. This case illustrates common features of urine adulteration. Various strategies for the prevention and detection of adulteration are also discussed.
 
Objectives: To investigate the functional and clinical status of a group of Chinese schizophrenic patients after treatment with individually tailored psychological treatment over a 9-month period. Patients and Methods: Thirty six 15- to 32-year-old Chinese schizophrenic patients were recruited into the study from 2001 to 2002. The patients were randomly assigned into treatment and waitlist groups. At baseline their pre-treatment clinical status, social functioning, and other clinically relevant parameters were assessed. The psychological treatments were conducted by 2 experienced clinical psychologists and assessed by face-to-face interviews. Results: After the treatment period, outcome measures supported the use of adjuvant psychotherapy in the routine treatment programme for subjects with schizophrenia; both positive and negative symptoms improved compared to baseline status (p < 0.001). Conclusions: The findings support the use of psychotherapeutic interventions to promote better adaptation to the psychotic disorder.
 
This paper reports the clinical characteristics of patients with Turner's syndrome and mental disorder, as evidenced by 5 patients managed at the Tianjin Anding Hospital, along with 12 patients reported in the Chinese medical literature. Schizophreniform psychosis was the most common psychiatric diagnosis made, while presentation resembled bipolar affective disorder in a smaller number of patients. The aetiology, typology, and treatment of this disorder is outlined. The importance of recognising characteristic physical features of Turner's syndrome in the psychiatric clinic in order to reach a definitive diagnosis and implement appropriate psychiatric treatment is highlighted.
 
Linear regression analysis of different variables with affective temperament scores. Coefficients
Objective: Akiskal's view that a temperamental proneness lies in the roots of bipolarity has adequate empirical support from extensive clinical studies. This study was designed to investigate the relationship between affective temperaments and outcome in terms of polarity in bipolar I illness and to assess socio-occupational functioning in patients with these temperaments. Patients and Methods: 102 outpatients and inpatients meeting the Diagnostic and Statistical Manual of Mental Disorders-IV criteria for bipolar I disorder were recruited from consecutive patients admitted to hospital. Patients were evaluated when in a euthymic state using the Mont-gomery-Asberg Depression Rating Scale or the Bech-Refaelson Mania Rating Scale. The crite-ria developed by Akiskal and Mallya were used to assess the hyperthymic, depressive, cyclothymic, and irritable temperaments in a dimensional approach. The Socio-Occupational Functioning Assessment Scale was used to assess socio-occupational functioning. Results: Regression analysis indicated that the total number of episodes (manic and depressive) was significantly associated with the depressive score. Further, the total number of previous depressive episodes positively correlated with the depressive score and negatively correlated with the hyperthymic score. Patients who had had a recent manic episode had a hyperthymic score, while those who had the most recent depressive episode scored high on the depressive score. A significant impairment in socio-occupational functioning in patients with a depressive temperament was noted. Conclusions: These findings agree with the hypothesis that affective temperaments represent a putative stage in the clinical evolution of bipolar illness and reflect a trait-state continuum be-tween temperaments and affective episodes. Patients with depression were significantly im-paired in their socio-occupational functioning.
 
Objective: Agitation was common in patients suffering from moderate to severe dementia, for which music therapy is one of the commonly used non-pharmacological interventions. This preliminary report addresses the effectiveness of music therapy for demented patients residing in a local care setting for the elderly. Patients and Methods: This was a crossover study. Fourteen patients with dementia exhibiting at least one type of agitated behaviour were recruited and divided into 2 groups. For 3 weeks, 1 group received music therapy and the other usual care with no special intervention. Thereafter, the 2 groups were crossed over with respect to the active and control interventions for further 3 weeks. Behaviour disturbances were measured by the Neuropsychiatric Inventory and the Cohen-Mansfield Agitation Inventory. Assessments were conducted before attending (pre-music or pre-control therapy); just after completion of music or control therapy (end-music or end-control therapy) and 3 weeks after music therapy (post-music therapy). Results: There were significant reductions of total Neuropsychiatric Inventory and Cohen-Mansfield Agitation Inventory scores at the end-music therapy period (Wilcoxon signed rank tests, p < 0.001). Similar reductions were not found after usual care (end-control period). No lasting effects were observed after withdrawal of music therapy for 3 weeks (pre-music therapy vs post-music therapy; Wilcoxon signed rank tests, p = not significant). Conclusion: These preliminary results suggest that music therapy may have positive effects on behavioural disturbances manifested by demented elders. Although the effects were not persistent, music therapy may be considered for further research as a continuous means of reducing agitation in care settings for the older persons.
 
Objective: To assess the interaction patterns in families where the husband has alcohol dependence syndrome. Participants and Methods: The sample consisted of 30 spouses of men diagnosed with alcohol dependence syndrome and 30 spouses of men with no psychiatric diagnosis and / or alcohol dependence syndrome or any other substance addiction. Purposive sampling was used to select the samples. The Family Interaction Pattern Scale and General Health Questionnaire-12 were used for data collection. Results: A poorer pattern of family interaction was found in the domains of 'reinforcement', 'social support', 'role', 'communication', 'leadership', and Family Interaction Pattern Scale total score in spouses of patients with alcohol dependence compared to spouses of people with no alcohol dependence. Conclusion: There were significant differences in the family interaction patterns displayed by families where the spouse had alcohol dependence and those where the spouse did not have alcohol dependence.
 
Alzheimer's disease can either occur sporadically or be caused by inheritance of a gene mutation accompanying progressive loss of memory and general decline in cognition. The pathology of Alzheimer's disease is complex, but there are 2 hallmarks: the neuritic plaque consisting of β-amyloid derived from β-amyloid precursor proteins and the neurofibrillary tangles consisting of abnormally phosphorylated tau protein. Transgenic mice are used to reproduce these 2 hallmarks since they can reproduce many features of the disease. This review provides an overview of transgenic mouse models including familial Alzheimer's disease and non-hereditary Alzheimer's disease as well as emerging insights relevant to the pathogenesis and potential treatment strategies.
 
Objectives: To review existing literature on obesity and Alzheimer's disease and evaluate evidence of an association between them. Methods: A selected review of the epidemiologic studies published from 1987 to June 2007 from MEDLINE, EMBASE, PsychoINFO, and Cochrane Database about the relationship between obesity and Alzheimer's disease. Results: There was some evidence that obesity may increase the risk of Alzheimer's disease; the association was stronger for midlife than late-life obesity. Conclusions: Preliminary evidence indicates that obesity is a risk factor of Alzheimer's disease. Further large-scale, lifetime assessments are suggested to confirm the association and formulate effective measures to delay the onset of Alzheimer's disease.
 
Objective: To investigate the association of polymorphisms in the tumour necrosis factor receptor 2 (TNFR2) and tumour necrosis factor superfamily, member 6 (TNFRSF6, FAS) genes and the risk of Alzheimer's disease (AD) in a Chinese population. Patients and Methods: One hundred and fifty Chinese AD patients and 155 cognitively intact control subjects were recruited for the study. Genotypes of TNFR2+196, FAS-670, and FAS-1377 were investigated in this study by polymerase chain reaction-restriction fragment length polymorphisms. Results: The TNFR2+196 TT genotype was more prevalent in the AD group than in the controls. However, no significant difference in genotypic and allelic frequencies between AD and control groups (p = 0.68) was observed. Conclusion: We suggested that TNFR2+196, FAS-670, and FAS-1377 genotypes were not associated with the risk of AD in our Chinese population. However, evidence suggests involvement of tumour necrosis factor-alpha pathway in the pathogenesis of AD and a more comprehensive study may be required to identify the underlying associations.
 
Objective: Unlike cognitive function, clinical assessment of neurological deficits in Alzheimer's disease has received limited attention. This study aimed to determine the association between soft neurological signs and rate of clinical progression in Chinese people with Alzheimer's disease. Patients and Methods: 104 Chinese patients with late-onset Alzheimer's disease were followed up for an average of 22.5 months (SD, 5.2 months). Soft neurological signs were evaluated with the Cambridge Neurological Inventory. Outcome was determined by deterioration in Clinical Dementia Rating and mortality. Results: Motor coordination, sensory integration, and failure of suppression signs were more prevalent in participants with Alzheimer's disease than in controls without dementia (p < 0.001) and the scores for these signs were significantly correlated with most cognitive function tests (p < 0.05). Patients with stable Clinical Dementia Rating scores at follow-up had lower scores for parkinsonian signs (p < 0.005) than those who had died during the follow-up period. Conclusions: The findings suggest that cortical soft neurological signs such as motor coordination and sensory integration, which were highly associated with cognitive performance in patients with Alzheimer's disease, represent overlapping clinical dimensions. The presence of subcortical extrapyramidal signs may signify poorer prognosis.
 
Objective: To compare profiles of neuropsychological impairment in elderly Chinese patients with amnestic, multiple-domain mild cognitive impairment and patients with normal ageing and mild Alzheimer's disease. Patients and Methods: Patients with mild cognitive impairment were categorised into 2 groups: single-domain amnestic mild cognitive impairment (n = 54) and multiple-domain amnestic mild cognitive impairment (n = 93). The scores of neuropsychological tests of patients with mild cognitive impairment were compared with those of cognitively normal elderly controls (n = 78) and patients with mild Alzheimer's disease (n = 85). Results: The 2 groups of patients with mild cognitive impairment had performances in the neuropsychological tests intermediate between the normal controls and patients with mild Alzheimer's disease. Patients in the multiple-domain amnestic mild cognitive impairment group had different profiles of cognitive impairment from those in the single-domain amnestic mild cognitive impairment group, but there was no significant difference in tests on episodic memory and category verbal fluency between the 2 groups. Conclusion: Patients with mild cognitive impairment could be differentiated from cognitively normal controls, as well as from those with mild Alzheimer's disease, by neuropsychological measures.
 
Schizophrenia is equally prevalent in males and females but presents with different clinical course. Gender or sex chromosomes may be aetiologically related to schizophrenia. Genetic studies of schizophrenia have neither excluded nor supported linkage with X chromosome markers. We report a case of a schizophrenic patient with concurrent androgen insensitivity syndrome, which is an X-linked recessive disease. Her biological sister also has both androgen insensitivity syndrome and a psychotic disorder. The possible role of an X chromosome linkage in the aetiology of schizophrenia is discussed.
 
Objectives: To examine the relationship between antipsychotic use and obesity among patients with schizophrenia. Participants and Methods: This is a cross-sectional study. Patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders (4th edition) diagnosis of schizophrenia were included in this study. Demographic profiles and antipsychotic-related factors, including types of antipsychotic and concomitant drugs used, and duration of treatment, were obtained. Anthropometric measurements such as body mass index and waist circumference were measured and classified according to the body mass index and waist circumference classification for Asian populations proposed by the World Health Organization. Results: Sixty three (64.9%) and 34 (35.1%) patients were receiving atypical and conventional antipsychotics respectively. Twenty (20.6%) patients were being prescribed concomitant conventional depot antipsychotics. The prevalence of being overweight or obese (body mass index: > 23.0 kg/m2) was 71.4% (n = 45) for the atypical antipsychotics group and 79.4% (n = 27) for the conventional antipsychotics group. A large waist circumference was associated with treatment with atypical antipsychotics (p < 0.05) and concomitant conventional depot antipsychotics (p < 0.05). The duration of treatment with clozapine correlated inversely with patients' waist circumferences (r = -0.66, p = 0.04), and there was a positive correlation between duration of treatment and waist circumference in patients on olanzapine (r = 0.45, p = 0.03). Conclusion: Obesity is highly prevalent among patients with schizophrenia. A high waist circumference is related to the types of antipsychotic medications prescribed and concomitant use of conventional depot antipsychotics. These findings suggest schizophrenic patients are at higher risk of developing obesity-related physical illnesses.
 
Tricyclic antidepressants have been the mainstay treatment modality of neuropathic pain. However, use of these agents has been limited by their significant side effects and potential cardiac adverse events, particularly in overdose. Newer antidepressants have been shown to have better safety profiles and tolerability. This article examines current evidence of the use of newer antidepressants in the treatment of neuropathic pain. The proposed mechanisms of action, clinical evidence and tolerability were reviewed. Although tricyclic antidepressants appear to be the most efficacious agents for neuropathic pain, there is inadequate evidence supporting their prolonged use. Paroxetine, trazodone, nefazodone, mirtazapine, and venlafaxine are potentially useful agents, but these drugs can also produce treatment-limiting side effects.
 
Objective: To compare two methods of calculating total antipsychotic drug dosage with a representative patient sample in Hong Kong. Methods: Antipsychotic prescription data from 8,620 inpatients and outpatients in the New Territories West Cluster hospitals of Hong Kong were collected. The total antipsychotic dose was calculated using the chlorpromazine equivalent method and the percentage of maximum recommended method. Results: There was 97.2% concordance between these two methods, with a Spearman's rank correlation of 0.92. High doses of antipsychotic medications were prescribed for 3.2% and 2.8% of the sample based on the chlorpromazine equivalent and percentage of maximum recommended methods, respectively. Conclusions: Total antipsychotic dose expressed as a percentage of the maximum recommended dose is easy to calculate and avoids the ambiguity associated with the chlorpromazine equivalent method, besides it helps to identify patients receiving high doses of antipsychotics, thus facilitating monitoring and adherence to current guidelines.
 
Objectives: To examine metabolic side-effects of year-long treatment with clozapine, risperidone, quetiapine, or olanzapine in comparison to treatment with haloperidol or perphenazine, among elderly individuals with long-term schizophrenia. Participants and Methods: In a retrospective chart review, clinical records of 228 psychiatric inpatients with persistent schizophrenia were examined to determine any differences in metabolic side-effects of typical versus atypical antipsychotic treatment. Results: There were no significant differences with respect to body mass index, body weight, blood glucose, and serum triglyceride, cholesterol, B12, and folic acid levels. Conclusions: Elderly psychogeriatric patients may be less susceptible to the metabolic side-effects associated with atypical antipsychotic agents than younger populations. This finding warrants further investigation in prospective randomised controlled trials.
 
Objective: This study used a randomised waitlist control design to examine the efficacy of cognitive-behavioural group therapy for Chinese people with social anxiety in Hong Kong. Patients and Methods: In total, 34 Chinese participants with social anxieties were randomly assigned into experimental and control groups. The participants in the experimental group received a 10-session cognitive-behavioural therapy group treatment, while participants of the control group did not. Outcome measures included The Liebowitz Social Anxiety Scale, Emotions Checklist, Coping Orientation to Problems Experienced Scale and Dysfunctional Attitude Scale. Results: Preliminary findings suggested that subjects receiving group cognitive-behavioural therapy showed significant decrease in social anxiety, dysfunctional rules and negative emotions and significant increase in adaptive coping skills and positive emotions compared with the control group. Conclusion: These findings provide initial evidence of the efficacy of group cognitive-behavioural therapy for Chinese people with social anxieties. Future research should use a larger sample and examine the longer term effect of group cognitive-behavioural therapy.
 
Of 138 patients who sought consultation for headache in a newly established headache clinic, migraine was found to be the commonest diagnosis (36.20%) followed by depression (23.20%). Overall, there was an over-representation of females in the group, but a higher proportion of males among patients with depression. The males were generally younger than the females. The male sex-role stereotype is discussed as a possible reason for the over-representation of young males with depression. Emphasis is placed on the need to identify and effectively treat such patients who may never see a psychiatrist since they may not admit to their depression or seek treatment for the symptoms.
 
Objectives: To examine the validity of the best-estimate method for making psychiatric diagnoses and determine potential psychosocial risk factors in a cohort of Hong Kong Chinese who attempted suicide. Participants and Methods: Seventy-one persons attempting suicide and their proxy-informants were interviewed separately to ascertain each patient's diagnosis (according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I diagnosis), psychosocial profile, and life circumstances surrounding the index suicide attempt. Results: There were substantial levels of agreement, high sensitivity and specificity on Axis I psychiatric diagnoses in subject-proxy pairs. Levels of subject-proxy agreement were substantial for other risk factor domains such as physical diagnoses, suicidal behaviour profile, social networking, and most life-event items. Fair-to-modest levels of agreement were observed in perceived well-being in general health, health service utilisation and life-events involving interpersonal conflicts within family and peer groups. Conclusions: Results support the validity of the best-estimate methodology for assessing psychosocial risk factors and making psychiatric diagnosis among Hong Kong Chinese who attempt suicide.
 
Patients with schizophrenia have been found to exhibit a cluster of symptoms collectively known as dysexecutive syndrome. However, neuropsychological studies of dysexecutive syndrome and their corresponding assessments are inherently difficult. Published studies of dysexecutive syndrome have predominantly considered English-speaking populations and, almost invariably, western cultural groups. As a consequence, the majority of assessment measures and checklists are standardised in English. The purpose of this paper is to discuss the current issues in the assessment of executive functions for schizophrenia in clinical practice in Hong Kong.
 
Objectives: This was a pilot study exploring the psychometric performance of the Chinese version of the Assessment of Capacity for Everyday Decision-Making questionnaire in financial management among Chinese psychogeriatric patients. Participants and Methods: The English version of the Assessment of Capacity for Everyday Decision-Making questionnaire was translated into Chinese. Its potential applicability was assessed by 2 focus groups. Eighteen Chinese psychogeriatric patients were recruited. Subjects were administered the Chinese instrument and assessed by independent clinician ratings based on the definition in the United Kingdom Mental Capacity Act 2005. Results: In the assessment of inter-rater reliability, the intraclass correlation coefficient showed satisfactory reliability for the ability scores of understanding (0.99), appreciation (0.97), reasoning (0.99) and expressing a choice (0.85). The internal consistency, as measured by Cronbach's alpha, was 0.83 for understanding and 0.86 for reasoning. The ability scores of understanding and reasoning correlated with the clinician ratings. Conclusion: For this pilot study, the reliability of the Assessment of Capacity for Everyday Decision-Making Ability questionnaire for Chinese older patients was satisfactory. This instrument warrants further evaluation for its validity and applicability in other Chinese populations.
 
Objective: To investigate the association between the tryptophan hydroxylase-2 (TPH2) gene (G1463A) polymorphism and unipolar depression in a southern Chinese Han population. Participants and Methods: The allelic and genotypic frequencies of TPH2 gene G1463A polymorphism were examined with the amplification refractory mutation system–polymerase chain reaction technique in 123 unipolar depressive patients and 122 healthy individuals. Patients and healthy controls were all from the Guangdong Han population in southern China. Results: No subjects among the cases or controls were found to carry any TPH2 1463A allele. Conclusion: There is no association identified between the TPH2 G1463A polymorphism and unipolar depression in the southern Chinese Han population.
 
Objective: To examine the rate of choking incidents and the associated factors among Chinese psychiatric patients in Hong Kong over a 12-year period. Methods: All choking incidents recorded in a large psychiatric unit in Hong Kong during the inclusive period January 1996 to December 2007 were retrospectively analysed with respect to demographic and clinical variables, and circumstantial factors at the time of the incident. Results: Nineteen choking incidents involving 17 patients were identified. In psychiatric inpatients, the mortality rate due to choking was 8-fold higher than that of the general population. Different age-groups exhibited different clinical characteristics related to the incidents. Medication side-effects and poor eating habits were implicated as contributory causes. Conclusion: Mental health professionals should have a high awareness of the increased risk from choking in psychiatric patients, identify those at high risk, and implement effective preventive measures.
 
Background: The issue of suicide attempts by jumping from height is a serious problem in Hong Kong. This study explores the characteristics of survived suicidal jumpers and the suicide attempts. Methods: This is a retrospective data collection study, reviewing the psychiatric consultation notes of 79 jumpers who survived their attempts at suicide. Results: The jumpers attempting suicide were mostly Chinese men aged 21 to 50 years who were sober and drug-free at the time of the incident. More than three quarters of them were living with relatives or friends. Approximately half were employed full time or were housewives, but more than one quarter were unemployed. Three quarters of attempts occurred at their residences or familiar places. The jumpers did not usually leave suicide hints or notes, and nearly 50% of suicidal acts were done under impulse. One quarter of them were suffering from functional psychoses and one quarter from major depressive illness. Half of the attempts were triggered by psychosocial life events. Conclusion: Although half of the jumpers attempting suicide were suffering from either psychotic illness or major depressive disorder, mental illness itself could not account for all suicide attempts by jumping from height. A cognitive-behavioural model is postulated to account for the suicidal behaviour.
 
Objective: To report attitudes to psychiatry before and after their psychiatric posting, among final-year medical students of a Nigerian University using the 30-item Attitude To Psychiatry questionnaire. Participants and Methods: A total of 126 students participated pre-clerkship, while 135 students participated in the post-clerkship phase of the study. Results: Approximately 54% of the students scored above the Attitude To Psychiatry questionnaire midpoint (90) at the pre-clerkship assessment, while 41% of the students scored higher than 90 at the post-clerkship phase. The mean (± standard deviation) score also decreased significantly (p = 0.03) from 90.6 (± 9.4) pre-posting to 88.2 (± 8.2) at the end. Facets that showed appreciable decline were those that evaluated the teaching of the subject, symptom worry being made worse by treatment, and perceived job satisfaction of psychiatrists by the students. Conclusion: The general attitude to psychiatry of this group of medical students witnessed an unfavourable trend after psychiatric exposure. Some of the areas that need to be improved upon undergraduate teaching in psychiatry.
 
Objectives: To explore the characteristics of dysfunctional attitudes among Chinese depressed persons. Participants and Methods: Semi-structured interviews were conducted on 20 Chinese depressed participants, with dysfunctional attitudes pertaining to themes concerning: 'vulnerability', 'need for approval', 'role performance within family hierarchy', 'familial harmony', 'relational harmony', 'imperatives', 'fate', 'face', 'fairness', and 'success- perfectionism'. Results: Themes related to interpersonal and family issues were dominant in their profile of dysfunctional attitudes. New themes such as 'face' and 'fate' were identified. Cultural influences contributing to these dysfunctional attitude characteristics were discussed. Conclusion: To enhance the treatment effectiveness and rehabilitation from cognitive behavioural programmes in Chinese subjects suffering from depression, culturally sensitive attitudes should be attended to.
 
Objectives: To examine the attitudes of healthcare professionals towards psychiatric patients in a general hospital in Hong Kong, and explore what contributions these attitudes may have on their management. Participants and Methods: A survey was carried out on healthcare professionals working in a general hospital in Hong Kong. A newly devised questionnaire with a case vignette was used. Each subject received a case depicting either a psychiatric patient (case group) or a diabetes mellitus patient (control group) randomly. Results: A total of 1200 questionnaires were distributed with a response rate of 36.1%. A case vignette depicting a psychiatric patient elicited responses that reveal a statistical significant contribution towards the expression of negative opinions; about two-thirds of the statements contained negative connotations. Increase in social exposure to psychiatric patients led to a decrease in negative attitude, whilst negative experience with psychiatric patients led to an increase in negative attitude. Conclusion: Stigma towards psychiatric patients exists to a certain degree among the healthcare professionals in the general hospital we investigated. More clinical research is needed in this area to have a more in-depth understanding of the issue.
 
For more than 30 years, a measure of the family environment termed expressed emotion has enhanced our understanding of how family psychosocial factors influence psychiatric relapse. This article reviews research addressing relatives' causal attributions, expressed emotion, and patient relapse, which support a model in which relatives' attributions are causally related to expressed emotion. A mediational model of attribution-expressed emotion outcome is evaluated as a theoretical framework to understand how attributions and expressed emotion contribute to patient relapse. Research addressing this topic in China, where relatives' behaviours towards patients differ greatly from their western counterparts, is reviewed. Relatives of patients with schizophrenia in China demonstrated a more situational attribution bias than relatives of patients from western cultures, yet Chinese relatives' controllable and personal attributions still related to high expressed emotion types of criticism and hostility. Expressed emotion partially mediated controllability attributions in predicting relapse. Contrary to expectations, personal attributions, particularly relatives' causal beliefs of 'xiao xin yan' ('narrow-mindedness'), protected against relapse in a manner unexplained by expressed emotion. These results further support the hypothesised causal relation between attributions and expressed emotion, and provide a new pathway to explore how relatives' behaviours ameliorate patient illness course. Future directions for research utilising attributions and expressed emotion in Chinese societies are provided.
 
Multiple sclerosis, a common demyelinating disorder, has been associated with mood symptoms for years. There are very few reports in which the psychiatric symptoms are either the presenting signs of multiple sclerosis or present simultaneously with neurological signs and symptoms. We present a case where the patient presented with overwhelmingly psychiatric manifestations- delusional parasitosis. The patient gave detailed descriptions of the shape, colour, and types of offending parasites: crawling, biting, burrowing. In such cases, therapy with antipsychotic medication is necessary. Despite treatment with antipsychotics, the patient's delusions persisted and detailed investigations led to a diagnosis of multiple sclerosis as the cause of her psychosis. The authors recommend that clinicians have a high index of suspicion and, after exploring all the common possibilities, should look for neurological causes in a patient with psychosis. Multiple sclerosis is one such condition, where the patient can present with psychotic symptoms even in the absence of neurological deficits.
 
Objectives: To investigate the prevalence of violence among psychiatric patients in Hong Kong and its associated risk factors. Participants and Methods: Retrospective case notes analysis of patients admitted to the psychiatric units of the New Territories East Cluster of Hong Kong within the period from 1 January to 31 March 2005. Patients were divided into those with and without violent behaviour. The 2 groups were compared for socio-demographic and psychopathological variables. Results: Case notes of 515 patients, aged between 18 and 64 years, with diagnosable psychiatric disorders were studied. The prevalence of violent behaviour within 4 weeks of the index admission was 18.6%. Violence was particularly associated with older patients diagnosed with psychotic disorders and having persecutory delusion and agitation. Conclusion: The prevalence of violent behaviour was comparable to what has been reported in similar studies from western countries. Associated risk factors were identified for which preventive measures should be implemented accordingly.
 
Objective: Despite extensive research in cognitive-behavioural therapy (CBT) for psychosis in the United Kingdom and the United States, there are very limited data about its efficacy in other parts of the world. This pilot study aimed to investigate the efficacy of CBT by novice therapists (mainly social workers) for regularly supervised community hostel residents with treatment-resistant psychotic symptoms. Participants and Methods: Ten novice CBT therapists with a social work background provided weekly individual CBT to a group of hostel residents, who had an ICD-10 diagnosis of schizophrenia and with persistent psychotic symptoms despite adequate medication. Before the commencement of CBT, the severity of psychotic symptoms, emotions associated with psychosis (depression, anger, and anxiety), insight, and self-esteem were measured. The measurements were repeated after 6 months of CBT Results: At the end of the sixth month, there was a reduction in the severity of psychotic symptoms (as measured by the Positive and Negative Syndrome Scale, and Psychotic Symptom Rating Scale) and improvement in self-esteem. However mood symptoms and insight level remained relatively unchanged. Conclusion: Cognitive-behavioural therapy conducted by novice therapists under regular supervision may be useful in reducing symptoms and distress in a group of supervised community hostel residents in Hong Kong. Due to the small sample size and other methodological limitations, this conclusion is only tentative. A randomised controlled trial is warranted to confirm these preliminary finding.
 
Top-cited authors
Eric Chen
  • The University of Hong Kong
Irene WK Kam
  • Hong Kong Hospital Authority
Wai Sau Dicky Chung
  • The Chinese University of Hong Kong
Baba Awoye Issa
  • University of Ilorin
Ronald Y L Chen
  • The University of Hong Kong