K C Yip

Hong Kong Hospital Authority, Hong Kong, Hong Kong

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Publications (13)27.07 Total impact


  • No preview · Article · Apr 2015 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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    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.
    No preview · Article · Sep 2014 · Psychological Medicine
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    ABSTRACT: Although phase-specific early intervention for first-episode psychosis has been implemented in many different parts of the world, limited medium-term outcome data are available in non-Western populations with relatively low mental health resources. The study aimed to determine the effectiveness of phase-specific early intervention in first-episode psychosis. In this cohort study, we compared the 3-year outcome of 700 first-episode psychosis patients who received phase-specific early intervention with that of 700 patients matched for age, sex and diagnosis who received standard psychiatric care prior to early intervention. Using a structured data acquisition procedure, we determined functional outcome, symptom levels, relapse, recovery, suicidal behaviour and service utilization from clinical records. Patients in the early intervention group had longer full-time employment or study (P<0.001), fewer days of hospitalization (P<0.001), less severe positive symptoms (P=0.006), less severe negative symptoms (P =0.001), fewer suicides (P=0.009) and fewer disengagements (P=0.002) than the historical control group. Additionally, more patients in the early intervention group experienced a period of recovery (P=0.001), but the two groups had similar rates of relapse (P=0.08) and durations of untreated psychosis (P=0.72). The 3-year outcome in phase-specific early intervention compared favourably with that of standard psychiatric care, particularly with respect to functional outcome and reduction in hospitalizations, suicides and disengagements. However, intervention did not appear to reduce the rate of relapse.
    No preview · Article · Jul 2011 · Early Intervention in Psychiatry
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    ABSTRACT: Most studies showed that patients would first go to their primary care physicians (PCPs) when depressed. This choice is probably due to PCP being the entry point into the health care system. We studied the general population's initial choice of mental care in Hong Kong, where patients were unclear about family medicine and free to choose doctors of any specialty. A combined qualitative and quantitative approach was adopted. We held focus groups with participants recruited from community centers and a telephone survey with adults ages 18 or above randomly selected from the domestic telephone directory. Of 1,647 adults successfully interviewed, 49.0% would seek help from their regular PCP, 19.3% from psychiatrists, 4.8% from any doctors, 16.5% from non-medical resources; 6.9% would not seek any help, and 3.5% were uncertain of what to do. Those who did not seek any help were more likely to be male or without regular doctors. The focus group participants highlighted the stigmatizing effect of consulting psychiatrists and expressed strong expectation of empathic relationship, time, and communication skills from their care providers. Some participants were not aware that PCP could manage mental illness. Given free choice of health care service, most people would first consult their regular doctors for treatment of depression specifically because of better relationship and no stigmatization. To draw depressed patients to seek help, especially from primary care, public education of the PCPs role in mental health should be promoted, and the PCPs could demonstrate their empathy and listening skills to patients.
    Full-text · Article · May 2011 · Family medicine
  • Lung Kit Hui · Roger M K Ng · Lui Pau · K C Yip
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    ABSTRACT: The aim of this study was to explore and describe the subjective experiences of agoraphobia in Hong Kong Chinese. This was a cross-sectional descriptive study, using a combined qualitative-quantitative approach. In the qualitative part, two focus groups were held with nine participants suffering from DSM-IV panic disorder with agoraphobia, followed up in a regional hospital in Hong Kong. The audiotaped was transcribed and analysed into four main categories and 13 subcategories based on a grounded theory approach. One subcategory ('Fear of making others worried and being a burden to others') was identified as a novel, culture-specific concept in agoraphobia that was not reported in Western literature. In the quantitative part, this subcategory was redefined and measured by a two-item, self-rated questionnaire survey in another 35 participants suffering from DSM-IV defined panic disorder with agoraphobia. Qualitative data showed that the clinical manifestations of agoraphobia were specifically related to the underlying corresponding catastrophic cognitions. An individual's agoraphobic cognitions and symptoms were highly related to the identity of the surrounding people during panic attacks in agoraphobic situations, which reflected the characteristic structure of the Chinese interpersonal network. Participants preferred reliance on self to cope with the anxiety first, then turned to their family members for help due to higher interpersonal trust. Participants also expressed fear of affecting others due to their illness. A new sub-theme of agoraphobia ('Fear of making others worried and being a burden to others') was extracted from the qualitative data. Its validity was confirmed by the quantitative description of this new theme using a self-rated questionnaire as a methodological triangulation. The central theme to emerge from the qualitative data was that agoraphobia is a clinical condition that has a close relationship to Chinese cultural factors. 'Fear of making others worried and being a burden to others' is a new concept in agoraphobia worthy of further study.
    No preview · Article · Feb 2011 · International Journal of Social Psychiatry
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    YT Wun · Tai Pong Lam · K F Lam · D Goldberg · D K T Li · K C Yip
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    ABSTRACT: The health care systems in many countries are focused on specialist care. In those countries that have recently changed to a primary care-based system, some doctors and patients were dissatisfied with the change. To explore the opinions of the general public and the doctors on the change to a family medicine (FM)-based health care system. Qualitative study with focus groups of doctors working in different practice settings. Quantitative study with questionnaires sent to all doctors registered in Hong Kong and a telephone survey targeting the general public aged ≥18. Doctors in the focus groups generally supported a FM-based health care system. They were concerned that there were not enough family doctors for such a system and the patients' current free choice of any doctor for primary care would impede its success. Thousand six hundred and forty-seven adults took part in the telephone survey (response rate 67.6%) and 2310 doctors (22.8%) responded to the questionnaire. Nearly 95% of the general public respondents agreed to the FM system though only 66.3% of them had ever heard of the term family doctor. About 65% of the doctors supported this system but only 33% agreed that the system would work. The specialist-doctors were less supportive of mandatory referral than the non-specialists, while the public was equally divided on this issue. The public accepts the FM-based system but needs education on the benefits of primary health care. Direct access to the specialist would be the greatest barrier. Government involvements are essential for the reform.
    Preview · Article · Feb 2011 · Family Practice
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    Y T Wun · T P Lam · K F Lam · D K T Li · K C Yip
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    ABSTRACT: To study the local medical profession's opinions on the training requirements for the specialty of family medicine. This was to serve as a reference for future planning of the health care system. Cross-sectional study. All registered doctors in Hong Kong. Doctors' ratings on the importance of vocational training, professional assessment, job nature, and experience to become suitably qualified as a family doctor, and their opinions on the length of necessary vocational training. A total of 2310 doctors (23% of doctors in the local register) responded. Professional assessment was mostly agreed as a qualification, followed by vocational training, clinical experience, and job nature. Over 70% agreed on a training period of 4 years or less. Non-family doctors were more likely to opt for professional assessment as the qualification and also opt for a longer training period. Vocational training was considered important as a qualification for the specialty of family medicine. The length of training was mostly agreed to be 4 years or less, not the 6 years currently required by the Hong Kong Academy of Medicine. The vocational training programme for family medicine might require re-examination.
    Full-text · Article · Feb 2011 · Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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    ABSTRACT: A recent trend in health care system is to provide more choices to the patients. This study surveyed the general public's choices for primary care in Hong Kong which has the setting of free choices for private or public service and also direct access to specialists. We used a combined qualitative and quantitative approach. We held five focus group interviews with participants of different socio-economic categories. Information from the focus groups helped to design a questionnaire for random telephone interviews with members of the public aged 18 or above. There were 37 participants in the focus groups and 1647 respondents in the telephone survey. The most important factor for choosing a doctor was proximity to home or workplace, followed by quick relief from the illness. Once continuity of care had been established, distance was of less importance but comprehensive care was valued. Nearly 70% of the public had regular doctors. About 93% of the public would consult specialists directly when they thought they needed a specialist's opinion. Nearly 30% chose specialists for any medical care and 38% preferred specialists to also look after their primary care problems. Convenient accessibility was the most important factor for the initial choice of primary care doctors by the general public. The perceived clinical proficiency of the doctor determined future continuity of care. Patients liked to have direct access to specialists. Though some chose to see the specialists even for primary care problems, most people had regular doctors who were likely to have the attributes of family doctors.
    No preview · Article · Dec 2010 · Journal of Evaluation in Clinical Practice
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    ABSTRACT: This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. 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. 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. 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.
    No preview · Article · Aug 2010 · Early Intervention in Psychiatry
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    ABSTRACT: Elevated serum levels of homocysteine have been shown to be associated with schizophrenia in some studies, but the evidence is still limited and mixed. The aim of the present study was therefore to evaluate the serum homocysteine level in Chinese in schizophrenia patients and assess its association with clinical phenotypes of the disease. A total of 250 inpatients and 250 healthy controls were identified at Kowloon Hospital and the Red Cross Blood Donation Centre, respectively. Each subject was evaluated with a structured diagnostic interview. Demographic data were collected and blood was analysed for homocysteine level. The Positive and Negative Syndrome Scale was used to grade clinical symptoms of schizophrenia. Confounding factors affecting homocysteine levels were controlled by strict exclusion criteria or statistical methods. Serum homocysteine level was elevated in Chinese schizophrenia patients. Both male (mean, 12.26 micromol L(-1); control, 11.40 micromol L(-1), p = 0.026) and female (mean, 9.61 micromol L(-1); control, 8.33 micromol L(-1), p < 0.001) patients had a higher serum homocysteine level than the healthy controls, and these differences persisted after controlling for age. There was no significant association between serum homocysteine level and duration of illness, clinical symptoms or age of onset of schizophrenia. The serum homocysteine levels were elevated in both male and female Chinese schizophrenia patients. The levels were not apparently related to other clinical parameters.
    No preview · Article · Sep 2009 · Australian and New Zealand Journal of Psychiatry
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    ABSTRACT: In 2001, an initiative was taken in Hong Kong to reduce delay in presentation and improve intervention for early psychosis. This has resulted in the launch of the Early Assessment Service for Young people with psychosis (EASY) programme. This article outlines the main issues in developing and implementing the programme, describes its characteristics, and presents early data on the service outcome. Patients managed by the programme appear to have improved occupational functioning, reducing hospitalization, and suicide rate, without increasing medical costs. In the Hong Kong context, key factors in service success include public education, destigmatization by renaming ‘psychosis’, increased service accessibility, hotline screening assessment, and protocol-based phase-specific case management.
    Full-text · Article · Jan 2008
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    ABSTRACT: Adherence to antipsychotic treatment is an important aspect of the long-term management of schizophrenia. The evaluation of adherence is often difficult in the clinical setting. This study compared patient self-reporting and clinician judgment of adherence behaviour in patients with early and chronic schizophrenia. Clinician-rated questionnaires and parallel patient self-rated questionnaires were administered to 229 patients with early schizophrenia (illness duration < 5 years) and 255 patients with chronic schizophrenia. Items in the questionnaires addressed two forms of adherence behaviour (forgetting to take medication and deciding to stop medication) as well as attitudes toward medication. Significant non-adherent behaviour was reported by patients, particularly in the early schizophrenia group. Non-adherent behaviour was related to feelings of embarrassment about taking medication. Both non-adherence and embarrassment were under-recognized by clinicians. Starting from a prior probability of 0.24, knowledge of the patients' attitudes increased the posterior probability to 0.33, whereas clinicians' detection of non-adherence (deciding to stop medication) improved the posterior probability to 0.65. When both clinicians' evaluations and patients' attitudes were known, the posterior probability improved to 0.68. Non-adherence is a widespread phenomenon in early schizophrenia. Increasing clinicians' sensitivity to patients' feelings of embarrassment may be an important factor in the detection of non-adherence. When taking a base rate of non-adherence into consideration, clinicians' evaluations appeared to be more effective in detecting non-adherence than simple information obtained from patients on their attitudes toward medication. Pragmatic real-life estimation of non-adherence has important implications for the possibility of intervention.
    No preview · Article · Jun 2006 · Australian and New Zealand Journal of Psychiatry
  • CLM Hui · EYH Chen · CS Kan · KC Yip · CW Law · CPY Chiu
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    ABSTRACT: Objective: Adherence to antipsychotic treatment is an important aspect of the long-term management of schizophrenia. The evaluation of adherence is often difficult in the clinical setting. This study compared patient self-reporting and clinician judgment of adherence behaviour in patients with early and chronic schizophrenia. Method: Clinician-rated questionnaires and parallel patient self-rated questionnaires were administered to 229 patients with early schizophrenia (illness duration < 5 years) and 255 patients with chronic schizophrenia. Items in the questionnaires addressed two forms of adherence behaviour (forgetting to take medication and deciding to stop medication) as well as attitudes toward medication. Results: Significant non-adherent behaviour was reported by patients, particularly in the early schizophrenia group. Non-adherent behaviour was related to feelings of embarrassment about taking medication. Both non-adherence and embarrassment were under-recognized by clinicians. Starting from a prior probability of 0.24, knowledge of the patients' attitudes increased the posterior probability to 0.33, whereas clinicians' detection of non-adherence (deciding to stop medication) improved the posterior probability to 0.65. When both clinicians' evaluations and patients' attitudes were known, the posterior probability improved to 0.68. Conclusion: Non-adherence is a widespread phenomenon in early schizophrenia. Increasing clinicians' sensitivity to patients' feelings of embarrassment may be an important factor in the detection of non-adherence. When taking a base rate of non-adherence into consideration, clinicians' evaluations appeared to be more effective in detecting non-adherence than simple information obtained from patients on their attitudes toward medication. Pragmatic real-life estimation of non-adherence has important implications for the possibility of intervention.
    No preview · Article · May 2006 · Australian and New Zealand Journal of Psychiatry