The issue of antipsychotic (dis)continuation has been a long-standing clinical dilemma. While the routine usage of antipsychotic is associated with side effects and stigma, short-term evidence ...suggest that the risk of relapse is heightened following antipsychotics withdrawal. Clinical guidelines therefore propose a one to two years duration of maintenance treatment upon remission in first episode psychosis (FEP), but guidance beyond which remains unclear. Only two controlled studies have addressed the long-term consequences of antipsychotic discontinuation. While Wunderink et al. concluded that dose reduction is associated with a higher rate of recovery, Hui et al. found discontinuation to be associated with better clinical outcomes. Data from Hui et al.’s study further suggests that treatment should be maintained for at least the first three years upon remission in FEP in order reduce the risk of relapse, as well as subsequent poor long-term outcome. It is noted that the two studies not only differ in outcome measures, but also in their strategies of “antipsychotic discontinuation”. Considering that discontinuation is a more compelling option to most patients, it may therefore be more clinically relevant. More long-term follow-up discontinuation studies are needed to provide further evidence in the development of treatment guidelines for FEP.
There have been few studies performed to examine the pathophysiological differences between different types of psychosis, such as between delusional disorder (DD) and schizophrenia (SZ). Notably, ...despite the different clinical characteristics of DD and schizophrenia (SZ), antipsychotics are deemed equally effective pharmaceutical treatments for both conditions. In this context, dopamine dysregulation may be transdiagnostic of the pathophysiology of psychotic disorders such as DD and SZ. In this study, an examination is made of the dopamine synthesis capacity (DSC) of patients with SZ, DD, other psychotic disorders, and the DSC of healthy subjects. Fifty-four subjects were recruited to the study, comprising 35 subjects with first-episode psychosis (11 DD, 12 SZ, 12 other psychotic disorders) and 19 healthy controls. All received an
F-DOPA positron emission tomography (PET)/magnetic resonance (MR) scan to measure DSC (K
value) within 1 month of starting antipsychotic treatment. Clinical assessments were also made, which included Positive and Negative Syndrome Scale (PANSS) measurements. The mean K
was significantly greater in the caudate region of subjects in the DD group (ES = 0.83, corrected p = 0.048), the SZ group (ES = 1.40, corrected p = 0.003) and the other psychotic disorder group (ES = 1.34, corrected p = 0.0045), compared to that of the control group. These data indicate that DD, SZ, and other psychotic disorders have similar dysregulated mechanisms of dopamine synthesis, which supports the utility of abnormal dopamine synthesis in transdiagnoses of these psychotic conditions.
Aim
Young people in Hong Kong have been facing numerous population‐level events over the past year, including social unrest and the COVID‐19 pandemic. Representative data concerning the mental health ...of youths, however, is limited. The Hong Kong Youth Epidemiological Study of Mental Health (HK‐YES) is commissioned to provide the first representative prevalence estimates and correlates of mental disorders among young people in Hong Kong. It will also examine the help‐seeking behaviours, treatment rates, quality of life, and functional outcomes of the young people. More importantly, the direct and indirect economic costs of mental disorders in youths will be estimated.
Methods
A total of 4500 community‐dwelling participants aged 15–24 years from Hong Kong will be surveyed. Participants will be selected using a multistage stratified sampling design to provide representative estimates of the youth population in Hong Kong. All interviews will be conducted using computer‐assisted personal interviewing methods for assessments covering areas of psychiatric diagnoses, symptomatology, functioning, quality of life, disability, service utilization, health economic costs of mental disorders, and sociodemographic and lifestyle characteristics. A population‐weighted prevalence will be estimated using survey weights. Methods such as multivariate logistic and linear regression analyses will be used to calculate the risks and odds of factors that might be associated with different mental disorders.
Conclusion
As the first population‐based youth study in Hong Kong, HK‐YES collects extensive and representative data on different mental conditions and their associated factors among young people. The information gathered will be important for future planning on youth mental health services in Hong Kong and will offer the opportunity for a more meaningful comparison of data with other youth populations.
Aims
Psychotic‐like experiences (PLEs) or subclinical psychotic experiences have received increased attention as some studies have suggested continuity between PLEs and psychotic disorders. However, ...epidemiological and correlational studies of PLEs showed mixed findings – it is observed that different studies use a wide variety of definitions of PLEs, as well as different assessment tools that are designed to capture such described experiences. The differences in definitions and assessment tools adopted could contribute to the discrepancy of findings. The current review aims to examine the definitions and assessment tools adopted in the studies of PLEs.
Methods
Literature search was conducted between October 2013 and February 2014 using three search engines: Medline, Web of Science and PubMed.
Results
A total of 76 papers met the selection criteria and were included in the current review. It is found that the majority of papers reviewed defined PLEs quantitatively using assessment tools and do not have a specific phenomenological definition, whereas assessment tools adopted have a wide variety. Furthermore, phenomenological studies of PLEs were rare.
Conclusions
The variations in definitions and assessment tools of PLEs might contribute to mixed findings in researches. Reaching to a consensus through the study of phenomenology of PLEs is essential to further advancement of the research in this area.
Negative symptoms are an important symptom dimension in schizophrenia that are often least responsive to antipsychotic medications. We revisit the current practice of identifying 'primary' negative ...symptoms and suggest that its concept would benefit from a further elaboration of their timing of emergence in relation to the dynamic neurobiological changes to enhance their utility in clinical decision-making and research.
Abstract
Background
The development of a valid and simple-to-use self-administered tool in Asian adolescents for clinical screening and intervention remains limited. The present study assessed the ...psychometric characteristics and validity of the Generalised Anxiety Disorder Scale-7 (GAD-7) among adolescents in Hong Kong.
Methods
Epidemiological data from 3,261 Hong Kong adolescents aged 15 - 24 years were analysed for the construct validity, criterion validity, concurrent validity, and Rasch Model. All analyses were age- and gender-weighted according to the distributions of Hong Kong’s general population.
Results
The GAD-7 showed high internal consistency and strong fit to the one-factor structure. The best cut-off value was set at 7 or more. Regression models found that the total scores of the scale were positively associated with symptoms of depression and hypomania, schizotypal personality and alcohol dependence. Rasch model analysis found that the separation index was 2.18 and 16.51 for the respondents and items, respectively and all residual pairs had small correlation coefficients (i.e., < 0.3).
Conclusions
All psychometric findings presented in this study support the use of the GAD-7 as a legitimate measure of anxiety severity. A cut-off score of 7 should indicate a potential diagnosable condition in Asian adolescents, which requires our attention but should not be used as a formal diagnostic screening tool. The findings revealed the local dependence of the items of the GAD-7 and that the scale can separate respondents into at least two groups and items into numerous groups according to the separation index.
Background:
Ethnic minorities (EMs) typically underutilise mental health services (EMs) with issues that are not shared by the local population. Understanding the underlying perceived factors could ...help reduce their mental health disparities.
Aims:
This is a qualitative study aiming to examine the barriers that prevent EMs from seeking mental health services in Hong Kong.
Methods:
Six semistructured focus groups with 31 EMs who resided in Hong Kong were conducted from May 31 to June 26, 2021. The outcome measures were the themes and subthemes of perspectives on mental health service use.
Results:
Among 31 adults (20 64.5% women, 11 35.5% men; 17 54.8% aged 25–39 years) who participated, most participants self-identified as Indian (13 41.95) or Pakistani (10 32.3). There were 16 individuals (51.6%) who reported severe or higher levels of anxiety or depressive symptoms, while 12 individuals (38.7%) reported moderate levels. Three emerging themes identified for the barriers to help-seeking for psychiatric intervention were (1) preexisting problems, (2) psychaitric service lacks cultural sensitivity and (3) personal or family limitation, while that for the recommendations to improve help-seeking had six themes: (1) improve cultural sensitivity, (2) make EM mental health practitioners available, (3) improve professional conduct, (4) improve on-site support, (5) improve financial support and (6) improve mental health promotion in schools.
Conclusion:
This study found that EMs in Hong Kong experience double stigma, which keeps them away from seeking professional mental health care. There were also disparities in the use of mental health services by ethnicity. The study also made recommendations for promoting EM help-seeking at the individual, governmental and community levels.
Background:
Self-discrepancy is associated with poorer mental health, yet its mechanism is understudied. A recent study found that resilience plays a moderating role in the relationship between ...self-discrepancy and depressive symptoms in adults. The current study investigated whether there were any similar relationships among young people aged 15 to 24 years.
Methods:
As part of the ongoing Hong Kong Epidemiological Study of Mental Health (HK-YES) project, the current study analysed data from 1,144 participants who provided complete data on ideal-actual selfdiscrepancy, psychiatric conditions, resilience level and recent stressful life events (SLEs).
Results:
Ideal-actual self-discrepancies were associated with increased depressive and anxiety symptoms, as well as odds of 12-month major depressive episodes (MDEs) and generalised anxiety disorder (GAD). All these associations became nonsignificant after adjusting for resilience. Separate models found resilience mediating rather than moderating the relationship. According to four-way decomposition, the pure indirect effect explained most of the total effects of self-discrepancy on mental health conditions. The mediation effects on symptom severity were recently revealed to be more prominent among individuals with substantial exposure to SLE.
Conclusions:
Resilience functions mainly as a mediator in the relationship between self-discrepancy and mental health conditions, and its effect is weakened by the exposure of SLEs. Important implications are discussed regarding the use of resilience-focused interventions and the consideration of recent adversity.
Abstract
Objectives
Patients with schizophrenia have a significant risk of self-harm. We aimed to explore the dynamic relationship between symptomatology, functioning and deliberate self-harm (DSH) ...and evaluate the feasibility of developing a self-harm risk prediction tool for patients with first-episode schizophrenia (FES).
Methods
Patients with FES (n = 1234) were followed up for 36 months. Symptomatology, functioning, treatment adherence and self-harm information were obtained monthly over the follow-up period. A time-varying vector autoregressive (VAR) model was used to study the contribution of clinical variables to self-harm over the 36th month. Random forest models for self-harm were established to classify the individuals with self-harm and predict future self-harm events.
Results
Over a 36-month period, 187 patients with FES had one or more self-harm events. The depressive symptoms contributed the most to self-harm prediction during the first year, while the importance of positive psychotic symptoms increased from the second year onwards. The random forest model with all static information and symptom instability achieved a good area under the receiver operating characteristic curve (AUROC = 0.77 ± 0.023) for identifying patients with DSH. With a sliding window analysis, the averaged AUROC of predicting a self-event was 0.65 ± 0.102 (ranging from 0.54 to 0.78) with the best model being 6-month predicted future 6-month self-harm for month 11–23 (AUROC = 0.7).
Conclusions
Results highlight the importance of the dynamic relationship of depressive and positive psychotic symptoms with self-harm and the possibility of self-harm prediction in FES with longitudinal clinical data.
Background:
Exercise offers improvement to physical and mental health symptoms as well and cognitive function in patients with psychosis. However, patients with psychosis are often less ready to ...benefit from exercise intervention because of the difficulties in motivation. This study aimed to examine the effectiveness of adjunctive motivational coaching on exercise intervention in women with psychosis in Hong Kong.
Methods:
From a community mental health programme for women, patients with a diagnosis of psychotic disorder (within 5 years of first onset) were randomly allocated to receive 12 30-minute sessions of motivational coaching or psychoeducation in a group format. Both groups additionally received exercise intervention sessions consisting of yoga, stretching and high-intensity interval training. Primary outcome was the total physical activity level measured by the International Physical Activity Questionnaire.
Results:
Fifty-seven patients (mean SD age, 34.47 12.44 years) were randomised into motivational coaching (n = 30) or psychoeducation (n = 27) treatment groups. The motivational coaching group had a significantly higher total physical activity level (4601.67 686.59 vs 2524.82 723.73 metabolic equivalent task-min/week, r2 = 0.473, p = 0.04) after the intervention and at 6 months post-intervention. Moderate and light physical activity levels were significantly higher in the motivational coaching group after intervention and at 6 months, respectively. Additionally, symptoms of bizarre behaviour were improved in the motivational coaching group at 6 months. Younger, unemployed, unmarried and those with longer durations of untreated psychosis generally showed larger improvements in the motivational coaching group.
Conclusion:
Motivational coaching may augment the effects of exercise interventions, as reflected by higher physical activity participation. Motivational coaching augmentation has the potential to further improve exercise intervention outcomes.
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