Showing papers in "East Asian archives of psychiatry in 2012"

Acute mental disturbance caused by synthetic cannabinoid: a potential emerging substance of abuse in Hong Kong.

Abstract: Synthetic cannabinoids are hybrid herbal / chemical products which mimic the effects of cannabis. They are usually marketed as incense or 'herbal smoking blend', and best known by the brand names 'K2' and 'Spice'. Their popularity among recreational drug abusers has grown rapidly due to their easy availability, relatively low cost, non-detection by conventional drug tests, and ease of concealing their use from family and authorities. They took Europe and later North America by storm in the late 2000s, yet limited medical literature exists detailing their adverse effects. They began to emerge in the Hong Kong drug scene in 2009. We report on a man who developed acute mental disturbance after 4 weeks of daily K2 abuse. This is the first case report of mental disorder caused by synthetic cannabinoid abuse in a Chinese.

Body shape and eating attitudes among female nursing students in India

Abstract: OBJECTIVES. Eating disorders have been associated with body image disturbances, disordered eating attitudes, and other psychiatric difficulties. There is limited published literature on body shape and eating attitudes from non-western settings. This article presents the findings of a study of eating attitude and body shape concerns among female nursing students in India. METHODS. A cross-sectional observational study was conducted at a government nursing college associated with a tertiary-level multi-specialty hospital. Instruments used included semi-structured proforma, Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire (BSQ). Correlations of age and body mass index with EAT-26 and BSQ scores were carried out using Pearson's correlation statistics. The level of statistical significance was accepted at p < 0.05. RESULTS. A total of 97 nursing students returned the completed study questionnaire. There was a significant positive correlation between body mass index and BSQ score. However, body mass index was not found to be correlated with EAT-26 score. CONCLUSIONS. The findings from the current study bring some interesting insights into body shape and eating attitudes of female nursing students from India.

Schizophrenia and suicide.

Abstract: Objective: Schizophrenia is characterised by distorted thinking and perception and tends to run a chronic course. The World Health Organization reported that suicide accounts for almost 2% of the world's deaths. There is a close relationship between schizophrenia and suicide. Patients with schizophrenia experience personal distress and socio-occupational dysfunction and reduced life expectancy as a group. The current article presents a review of suicide in schizophrenia.

A questionnaire survey on attitudes and understanding towards mental disorders.

Abstract: OBJECTIVES. To obtain information about basic knowledge towards mental disorders and to evaluate public attitudes towards mental disorders in the Hong Kong Chinese population. METHODS. Questionnaires which collected basic demographic information, opinions about potential stigmas and myths, and knowledge on case vignettes depicting fictional characters with symptoms of mental illness were delivered to subjects in a secondary school, 2 homes for the elderly, a private housing estate, and a public housing estate in Hong Kong. RESULTS. Completed questionnaires were collected from 1035 subjects. In general, the participants' acceptance of mental illness was good. Regular contacts with such patients were associated with better knowledge (t = -2.71, p < 0.01) and better acceptance (t = 2.77, p < 0.01) of mental illness. Younger participants aged 15 to 19 years had a lower level of knowledge about mental health problems compared with other age-groups (p < 0.001). CONCLUSIONS. Personal contact with people with mental illness may help to improve knowledge and acceptance. Younger people in secondary school should be the target and prioritised group for mental health education. Apart from the delivery of mental health knowledge, strategies to increase social contact of the public with people having mental illness could be considered in the design and implementation of anti-stigma programmes.

Scale for positive aspects of caregiving experience: development, reliability, and factor structure.

Abstract: OBJECTIVE. To develop an instrument (Scale for Positive Aspects of Caregiving Experience [SPACE]) that evaluates positive caregiving experience and assess its psychometric properties. METHODS. Available scales which assess some aspects of positive caregiving experience were reviewed and a 50-item questionnaire with a 5-point rating was constructed. In all, 203 primary caregivers of patients with severe mental disorders were asked to complete the questionnaire. Internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity were evaluated. Principal component factor analysis was run to assess the factorial validity of the scale. RESULTS. The scale developed as part of the study was found to have good internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity. Principal component factor analysis yielded a 4-factor structure, which also had good test-retest reliability and cross-language reliability. There was a strong correlation between the 4 factors obtained. CONCLUSION. The SPACE developed as part of this study has good psychometric properties.

Prevalence and type of functional somatic complaints in patients with first-episode depression.

Abstract: Objective: To study the prevalence and type of functional somatic complaints in patients with firstepisode depression. Methods: A total of 164 patients attending the outpatient department of a general hospital psychiatric unit were evaluated using the Patient Health Questionnaire-15 (PHQ-15) and Hamilton Depression Rating Scale (HDRS). Results: More than half of the sample were male (n = 85; 52%) and most of the subjects were married (n = 128; 78%). The mean (standard deviation) HDRS score was 19.9 (5.4). All patients had at least 1 functional somatic complaint, and that the mean (range) number of functional somatic complaints per patient on the PHQ-15 was 8 (1-15). The most common functional somatic complaints included feeling tired or having little energy (93%); trouble sleeping (80%); nausea, gas and indigestion (68%); headache (68%); pain in arms, legs, or joints (66%); and feeling the heart racing (65%). Total PHQ-15 scores indicated the presence of moderate-to-severe severity of functional somatic complaints. Back pain, as well as pain in arms, legs, or joints, were found to be more common in females. The number and severity of functional somatic complaints did not differ significantly in relation to other socio-demographics (locality, marital status, age, education, income) and clinical variables (duration, physical co-morbidity, and atypical features). Conclusion: Functional somatic complaints are quite prevalent in subjects with first-episode depression. Hence, clinicians should routinely evaluate patients with depression for these symptoms.

Cognitive function, functional performance and severity of depression in Chinese older persons with late-onset depression.

Abstract: OBJECTIVES The relationship between cognitive status and depressive symptoms and their liability to cause functional decline are of clinical and public health importance as it appears to be common, frequently coexists, and may be treatable This study examined the relationship of depression severity and cognitive performance and the impact of such an interaction on functional ability in Chinese elderly subjects with late-onset depression METHODS A total of 105 non-demented elderly patients with late-onset depression were recruited Impairment in instrumental activities of daily living and severity of depression were respectively assessed with the Disability Assessment for Dementia scale and the 24-item Hamilton Depression Rating Scale Various cognitive domains were assessed including global cognitive function, delayed episodic memory, and executive functions The relationship between specific cognitive impairment and mood symptom severity was assessed The clinical correlates of functional performance were also examined RESULTS Increasingly severe depression was associated with lower scores in the Mini-Mental State Examination, delayed recall, and poorer performance in the Trail Making Test-Part A (after adjusting for the effect of age and education) The severity of apathy correlated negatively with the Mini-Mental State Examination scores only Among the depressed subjects, greater levels of depression and apathy, poorer performance in Trail Making Test-Part B, and mild parkinsonian signs were associated with lower functional scores CONCLUSIONS Lack of interest and motivation, depressive mood, compounded by behavioural abnormalities resulting from executive dysfunction, accounted for functional disability in elderly subjects with late-onset depression These relationships may provide the background for developing interventions targeting functional deficits associated with specific cognitive dysfunctions and depression

Mental health recovery for psychiatric inpatient services: perceived importance of the elements of recovery.

Abstract: OBJECTIVES. To develop a questionnaire for measuring the perceived importance of the elements of mental health recovery in psychiatric inpatients in Hong Kong and to test the psychometric properties of the questionnaire. METHODS. Thematic content analysis of identified literature on mental health recovery was performed to identify the elements related to mental health recovery. A questionnaire was developed to assess the perceived importance of the identified elements. An expert panel was set up to evaluate the content validity and patient focus group's face validity of the questionnaire. Participants were recruited from medium-stay and rehabilitation wards of Castle Peak Hospital. RESULTS. A total of 101 psychiatric inpatients completed the questionnaire, the majority of whom suffered from schizophrenia (75%). Having meaning in life was rated by 91% of the participants as an important element of recovery, followed by hope (86%) and general health and wellness (85%). Cronbach's alpha for internal consistency was 0.91. Explorative factor analysis yielded 7 factors and intraclass correlation coefficients revealed a fair-to-good test-retest reliability. CONCLUSIONS. The results supported the psychometric properties of the questionnaire for measurement of mental health recovery and serve as a basis for the future development of recovery-oriented services in the psychiatric inpatient settings in this locality.

Evolution of early psychosis intervention services in Singapore

Abstract: The alarmingly long duration of untreated psychosis in Singapore and probable severe consequences were the impetus for establishing the Early Psychosis Intervention Programme in 2001 In 2007, the Early Psychosis Intervention Programme became a part of the National Mental Health Blueprint This study analysed the Early Psychosis Intervention Programme's key outcomes according to the case management model, and shows how the programme has evolved and expanded into indicated prevention by establishment of the Support for Wellness Achievement Programme focusing on at-risk mental state The Early Psychosis Intervention Programme has incorporated an evaluation component into the clinical programme by administering regular structured assessments and generating operational statistics from the hospital's data systems Based on data analysis from a study on consecutive patients accepted into the Early Psychosis Intervention Programme over a 4-year period, we found that at the end of 2 years of follow-up, majority of patients (85%) scored >/- 61 on Global Assessment of Functioning (GAF) disability scale, while two-thirds (66%) met criteria for functional remission, which was defined as having a GAF disability score of ≥ 61 with engagement in age-appropriate vocation (gainfully employed or studying) There was also a significant decrease in the Positive and Negative Syndrome Scale for schizophrenia (t = 277, p < 005) and increase in GAF (t = 337, p < 005) mean scores from baseline at 2 years As a national programme, the Early Psychosis Intervention Programme has articulated processes and outcome indicators to the stakeholders, and a periodic report card on these outcomes ensures accountability to the funders, patients, and their families

Clinical characteristics of cough mixture abusers referred to three substance abuse clinics in Hong Kong: a retrospective study.

Abstract: Objectives: Cough mixture is the third most commonly abused substance in patients attending the Prince of Wales Hospital Substance Abuse Clinic. The content of the local cough mixture is not well researched. Paranoid psychosis manifesting as persecutory delusions and derogatory hallucination, as well as mood symptoms, is common in these patients. The natural history and outcome of such psychoses associated with cough mixture abuse are not well known. This study aimed to address these questions. Methods: This was a retrospective study of cough mixture abuse in Hong Kong. Case records of cough mixture abusers currently receiving treatment at the 3 substance abuse clinics at the Prince of Wales Hospital, Alice Ho Miu Ling Nethersole Hospital, and the North District Hospital were retrieved for data collection. The patients' demographic data, duration and intake pattern of cough mixture, and use of any other drugs were documented. The presenting psychopathology, first urine toxicology results, diagnosis, treatment, number of hospitalisations, and course of the illness were also recorded. Results: A total of 63 patients with the diagnosis of cough mixture abuse were identified in the database; 89% were male. The mean +/- SD age of the patients was 34.4 +/- 6.2 years; 67% were single and 83% were unemployed. The mean +/- SD age of onset of cough mixture abuse was 20 +/- 5 years. Psychiatric symptoms developed a mean +/- SD of 7.6 +/- 6.0 years after onset of abuse. According to the ICD-10 Mental and Behavioural Disorders criteria, the top psychiatric diagnoses were substance-induced psychotic disorder (67%), schizophrenia (19%), depressive disorder (11%), and dysthymia (10%). The most common ingredients in the urine sample at first presentation were promethazine (75%), pseudoephedrine (67%), codeine (60%), ephedrine (57%), zopiclone (17%), and hydrocodone (16%). Additionally, 16% of patients were in the priority follow-up group. The mean +/- SD follow-up period was 6.2 +/- 7.1 years during which there were 3.2 +/- 3.7 episodes of hospitalisations, with a mean +/- SD length of stay in each admission of 25.0 +/- 40.9 days. Conclusions: Promethazine, ephedrine, pseudoephedrine, codeine, and hydrocodone are the most common ingredients of cough mixture abused in this locality. Psychotic disorders are the most frequent psychiatric diagnosis associated with cough mixture abuse.

Early intervention for first-episode psychosis in India.

Abstract: Objective: There have been very few studies of first-episode psychoses or early intervention programmes in India. This paper describes a pilot intervention programme for first-episode psychosis at the Schizophrenia Research Foundation, India.Methods: A total of 47 patients with the first episode of psychosis were followed up for 2 years. Based on the Positive and Negative Syndrome Scale for schizophrenia and Global Assessment of Functioning Scale scores, the data from 2 groups of patients, those who had remission and those who did not, were identified and compared. Assessments done at 3, 6, 12 and 24 months after recruitment enabled computation of time to achieve remission.Results: Complete data were available for 38 patients (28 patients in remission group and 10 patients in non-remission group) at 2 years. Baseline scores were not significantly different between the groups. In the remission group, more than 50% attained maximal improvement at 3 months, another 30% at 1 year, and the remaining 20% at 2 years. Maximal reduction in the mean Positive and Negative Syndrome Scale score was seen between 3 and 6 months after recruitment.Conclusions: With regular treatment, most patients with early psychosis achieve remission within 2 years. Negative symptoms persisting for longer than 6 months could be an indicator of long-term outcome. Early intervention is feasible and effective in developing countries.Key words: Early intervention (education); Psychotic disorders; Treatment outcome...(ProQuest: ... denotes non-US-ASCII text omitted.)IntroductionIndia was among the first countries in the developing world to formulate a National Mental Health Programme (NMHP), as early as 1982.1 The District Mental Health Programme (DMHP) was started under the NMHP and its implementation was integrated into the National Rural Health Mission providing services through Primary Health Centres. However, the absence of a separate budget for mental health until recently is a reflection on its low priority by policy-makers over the years.2 This has been addressed in the past few years with substantial budgetary allocations being made for the implementation of the DMHP. Shortage of trained mental health professionals has been another major impediment in providing mental health services in rural parts of the country.3,4 Apart from lack of access to affordable care, poor or faulty understanding of the concept of mental illness and limited acceptance of modern treatment options have also been responsible for inadequate service utilisation. This, to an extent, can explain the long duration of untreated psychosis (DUP) reported in several Indian studies over the years. When basic mental health needs are still not fully met, early intervention may not be viewed as a priority service and has not been actively sought by stakeholders. However, the effectiveness of early intervention in reducing long-term disability from severe mental illnesses has been noted. Clearly, more compelling evidence is needed before a policy on early intervention can be developed for India.5 A major part of the health care delivery in India is by the private sector. In the field of mental health, a few non-profit non-governmental organisations (NGOs) also play a role in service delivery. Developing an effective model of early intervention will enable scaling up of the service. This paper discusses the experience and feasibility of conducting a first-episode programme by the NGO Schizophrenia Research Foundation (SCARF).Being a non-profit organisation based in Chennai for > 25 years, the SCARF is a referral centre for rehabilitation of patients with severe mental disorders and an active research centre. The outpatient department is open in the morning for 5 days a week, and is manned by a multi-professional team. An average of 80 patients is seen weekly and there are facilities to admit about 140 patients.A first-episode psychosis programme was started at the SCARF in collaboration with the Prevention and Early Intervention Programme for Psychosis (PEPP), Montreal, Canada. …

Cognitive and functional impairment in Chinese elderly with late-onset depression.

Abstract: OBJECTIVES. To investigate cognitive and functional impairment in Chinese elderly subjects with late-onset depression. METHODS. Subjects with late-onset depression and who were clinically non-demented were recruited. Their cognitive and functional scores were compared with those of cognitively normal elderly controls and elderly persons with mild cognitive impairment. Functional ability was assessed by the Disability Assessment for Dementia score. Various cognitive domains were assessed including global cognitive function, delayed episodic memory, working memory, and categorical verbal fluency test. RESULTS. A total of 105 depressed subjects and 324 non-depressed controls (149 normal elderly controls and 175 with mild cognitive impairment) were recruited. The depression group had significantly poorer performance in all cognitive assessments compared to the normal elderly control group. The depression group had a similar cognitive profile to those with mild cognitive impairment, except that its subjects had slightly better performance in the Categorical Verbal Fluency Test, delayed recall testing, and the Chinese version of the Alzheimer's Disease Assessment Scale-Cognitive subscale test. Depressed subjects had significantly lower functional scores in instrumental activities of daily living than the non-depressed, normal elderly controls, and those with mild cognitive impairment. CONCLUSIONS. Our results demonstrate that Chinese elderly with late-onset depression had cognitive impairments in multiple domains similar to those encountered in the age- and sex-matched non-depressed controls with mild cognitive impairment. However, their functional performance was significantly poorer than that in these controls. This study provided extensive characterisation of the range and depth of cognitive and functional impairments in elderly patients with late-onset depression.

Identification of vulnerability among first-degree relatives of patients with schizophrenia.

Abstract: Objectives: To evaluate the status of schizotypy, neurological soft signs, and cognitive functions as vulnerability markers for schizophrenia and to investigate the potential value of their combination for early identification of people at high risk for schizophrenia.

Factors related to choosing psychiatry as a future medical career among medical students at the Faculty of Medicine of the University of Indonesia.

Abstract: Objective: To identify factors related to choosing psychiatry as a future medical career and attitude towards psychiatry among medical students of the International Class Programme of the Faculty of Medicine, The University of Indonesia. Methods: This was a cross-sectional design which included 225 data sets from first to sixth year medical students (n = 188) as well as the freshly graduated medical doctors (n = 37). The Attitude Towards Psychiatry-30 questionnaire (ATP-30) was adopted. Data including demographics, past experience in psychiatry, inclination to work in psychiatry, and 3 specialty choices for future medical career were collected. Independent t test and logistic regression were used in data analysis. Results: The mean ATP-30 score from the fresh graduates was slightly higher compared with the medical students. Inclination to work in the field of psychiatry, past experience in psychiatry, and the ATP-30 score were significantly correlated and contributed 57% to the prediction of choosing psychiatry as a future medical career (p Conclusion: The greater inclination to work in the field of psychiatry, as well as a better attitude towards psychiatry can predict the choice of psychiatry as a future medical career. Therefore, it is very important to increase the quality of psychiatry teaching and to motivate medical students who show a high level of interest in psychiatry. Key words: Career choice; Questionnaires; Students, medical ... (ProQuest: ... denotes non-US-ASCII text omitted.) Introduction The Faculty of Medicine of The University of Indonesia (FMUI) announced the International Class Programme in 2000, using English as the basic medium of instruction. It aims to train up medical doctors who can compete with those from other countries and possess internationally recognised competencies. The system of teaching and learning is mostly student-based and problem-based. From the first to the sixth semester the curriculum consists of medical science education, integrated basic medical science, and basic clinical skills. Students are exposed to neuropsychiatry in the Neuroscience module, psychosocial development in the Growth and Development module, and finally they go to the Neurology and Psychiatry module for 6 weeks. During that period, students do not have any exposure to patients. After finishing the third year, they are sent to the University of Melbourne, Australia for research activities for a year. During the fifth and sixth years, they are posted to undertake clinical practice in several departments. Clinical practice in the Department of Psychiatry is run over a 3-week period. They work with inpatient and outpatient clinics and finally have to record their case and present it at an oral examination. Research on the attitude of medical students towards psychiatry was extensively documented many years ago. The aim of this research was to determine what difficulties there were in recruiting medical graduates to specialise in psychiatry.1,2 The study from Al-Ansari and Alsadadi3 showed that the first, fourth, and seventh year medical students' exposure to psychiatry did not improve their Attitude Towards Psychiatry-30 (ATP-30) score. In addition, few reports demonstrated any positive attitudinal change towards psychiatry among medical students following exposure to the psychiatry teaching programme.4,5 Several studies showed that the number of people with mental disorders has been increasing worldwide, nevertheless only a small proportion of medical graduates were willing to pursue this specialty.6,7 Notably, the number of international medical graduates with the intention of choosing psychiatry as their future medical specialty decreased from approximately 10% in the 1960s, to only about 2 to 5% in the last decade.8-11 A study in Ireland6 also reported that only 4% of interns considered psychiatry as a career choice. …

Clinical practice at a multi-dimensional treatment centre for individuals with early psychosis in Japan

Abstract: Early intervention for psychosis in Japan has lagged behind that in western countries, but has rapidly begun to attract attention in recent years. As part of a worldwide trend, a multi-dimensional treatment centre for early psychosis consisting of a Youth Clinic, which specialises in young individuals with an at-risk mental state for psychosis, and Il Bosco, a special day-care service for individuals with early psychosis, was initiated at the Toho University Omori Medical Center in Japan in 2007. The treatment centre aims to provide early intervention to prevent the development of full-blown psychosis in patients with an at-risk mental state and intensive rehabilitation to enable first-episode schizophrenia patients to return to the community. We presently provide the same programmes for both groups at Il Bosco. However, different approaches may need to be considered for patients with an at-risk mental state and for those with firstepisode schizophrenia. More phase-specific and need-specific services will be indispensable for early psychiatric interventions in the future.

Obesity in multiracial schizophrenia patients receiving outpatient treatment in a regional tertiary hospital in Malaysia

Abstract: OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data. METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records. RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug. CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.

Serum prolactin levels and the acute-phase efficacy in drug-naïve schizophrenia treated with ziprasidone and olanzapine (translated version).

Abstract: OBJECTIVES. To study the efficacy and associated serum prolactin levels of ziprasidone and olanzapine treatment in drug-naive schizophrenia patients. METHODS. All 78 inpatients with drug-naive schizophrenia were recruited from the Department of Psychology, The Third Affiliated Hospital of Sun Yat-sen University. They were divided into either olanzapine group (n = 49 [24 men, 25 women]; mean [standard deviation] age, 24 [6] years) or ziprasidone group (n = 29 [14 men, 15 women]; mean [standard deviation] age, 23 [7] years), all of whom were treated for 4 weeks. The serum prolactin level, the Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Improvement scores were measured before and at the end of treatment. RESULTS. In the olanzapine group, the respective mean (standard deviation) PANSS and CGI-S scores after the treatment (62 ± 15 and 3 ± 1) were significantly lower than those before the treatment (104 ± 14 and 6 ± 1) [p < 0.01]. In the ziprasidone group, the corresponding scores after the treatment (75 ± 20 and 4 ± 1) were also significantly lower than those before the treatment (104 ± 17 and 6 ± 1) [p < 0.01]. The decreases in mean (standard deviation) PANSS total (42 ± 17) and PANSS positive scores (12 ± 6) in the olanzapine group were significantly higher than those in the ziprasidone group (29 ± 12 and 6 ± 4, respectively) [p < 0.01]. The increase of serum prolactin in the ziprasidone female group (47 ± 51 µg/L) was significantly higher than that in the ziprasidone male group (17 ± 11 µg/L), the olanzapine male group (5 ± 16 µg/L), and the olanzapine female group (21 ± 34 µg/L) [p < 0.05]. CONCLUSIONS. Both ziprasidone and olanzapine are effective for treating drug-naive acute schizophrenia, but olanzapine was superior to ziprasidone in terms of positive and general psychopathological symptoms. In women, ziprasidone was associated with greater changes in prolactin level than olanzapine.

Psychiatric morbidity in Chinese patients with chronic hepatitis B infection in a local infectious disease clinic.

Abstract: [TEXT NOT REPRODUCIBLE IN ASCII] Introduction Hepatitis B virus (HBV) infection is a major global health problem, and is one of the commonest infections in the world. The virus can cause both acute and chronic infections in humans. Chronic hepatitis B (CHB) infection is defined as chronic necroinflammatory disease of the liver caused by persistent HBV infection for more than 6 months. Approximately 120 million people living in China have CHB. (1) The prevalence of CHB is more than 10% in South China, including Hong Kong. (2) Most patients with CHB in this region acquired the infection in the perinatal period or during childhood. (3) As newborns are considered to be 'immune tolerant', 90% of infected newborns will develop CHB, whereas less than 5% of infected adults will develop CHB. (4-7) Patients with CHB have been found to have significant reductions in both physical and mental health-related functioning. (8) If CHB is not well treated, 15 to 40% of patients will develop serious sequelae. (9) Antiviral drugs are prescribed for suppression of HBV replication and remission of liver disease, with the ultimate goal of prevention of cirrhosis, liver failure, and hepatocellular carcinoma (HCC). (10) There have been many studies of psychiatric morbidity in patients with hepatitis C infection in western countries, where it is far more prevalent than hepatitis B infection, while studies for CHB are relatively few. The prevalence rate for psychiatric morbidity is as high as 44.7% for patients with CHB. (8) Major depressive disorder is the commonest diagnosis among CHB patients, of which the point prevalence is up to 14%. (11) Psychiatric morbidity in CHB patients might encourage other behaviours hazardous to health such as smoking, which may further affect health functioning for these patients. (12) Moreover, it has been found that the anxiety state of patients with CHB is negatively correlated with CD4+ and CD4+/CD8+, which would affect the immune function of patients. (13) Chronic hepatitis B is prevalent in Chinese societies, but the prevalence of associated psychiatric morbidity has not been adequately investigated. The study aimed to explore the prevalence of psychiatric morbidity in Chinese HBV-infected patients attending a local specialist infectious disease (ID) clinic. The correlates of current psychiatric disorders, current depressive disorders, and current anxiety disorders were also examined. This is also the first local study to examine the psychiatric morbidity of Chinese patients with CHB infection in Hong Kong. Methods Study Design This was a cross-sectional study conducted in a public specialist outpatient ID clinic at the Princess Margaret Hospital (PMH) of the Hospital Authority in Hong Kong from October 2008 to June 2009. The clinic acts as a major local centre for the management and isolation of patients with ID. Providing treatment for patients with viral hepatitis is one of its major roles. Patients with complications of cirrhosis or HCC are referred to other hepatology clinics. Approval for conducting the present study was obtained from the hospital's Clinical Research Ethics Committee. Patients Patients who attended the ID clinic from September 2007 to September 2008 with a confirmed diagnosis of HBV infection, and without other viral hepatitis virus or human immunodeficiency virus co-infection were included in the randomised sampling. According to the prevalence rate for major depressive disorders found in a previous study, (11) 160 patients were needed for the study. Each patient was assigned a number, and a computerised random number generator was used to generate 160 samples out of 1144 patients. They were recruited on the day when they attended the ID clinic for routine clinical follow-up. Patients were excluded if they were not Chinese, unable to understand Cantonese, or illiterate. Patients with dementia, mental retardation, or communication difficulties who were unable to give informed consent were also excluded. …

Violence among psychiatric inpatients: a victim's perspective.

Abstract: OBJECTIVE. Violence in psychiatric wards results in serious consequences and there is need for research to assess it in various settings to enable improvements in safety within psychiatric facilities. This study aimed to assess the inpatient violence from victims' perspective, in settings where family members accompanied patients during inpatient stay and played a significant role in caregiving. METHODS. A total of 100 consecutive incidents of inpatient violence were examined. Family members present at the time of the incident were interviewed to assess putative causes and behaviour prior to the incident. RESULTS. Bipolar spectrum disorder was the most common diagnosis. Family members were the targets of violence in 70% of the incidents and 81% were provoked episodes. Also, 76% of the patients were identified by family member to be irritable just prior to the episode. As preventive measures, family members suggested a need for more staff, more sedation, and improved communication. CONCLUSIONS. The capability of family members to identify behaviour patterns of patients prior to the episode might help decrease the severity and consequence of violence. It is essential to provide culture-specific interventions to the family, which could enable them in handling violence and give better care for the patient.

Development of an early psychosis intervention system in Korea: focus on the continuing care system for first-episode psychosis treatment in Seoul.

Abstract: Providing intensive psychosocial intervention within the 5-year critical period following the first psychotic episode is important for both symptomatic and functional recovery. Recently, community mental health centres in Korea have begun to shift their main roles from care of those with chronic schizophrenia to early detection of and interventions for those with first-episode psychosis. This pioneering approach was initiated by the Seoul Mental Health Center, which established a community network, formed a clinical consortium with hospitals and clinics, and developed guidelines for early psychosis detection and management and for the Social Treatment for Early Psychosis (STEP) programme. The One-STEP programme, provided during hospitalisation, has been especially efficient in obtaining a high acceptance rate for community services. Several key issues are discussed with regard to the successful establishment of the close partnership between community mental health centres and hospitals / clinics.

Developments in early intervention for psychosis in Hong Kong.

Abstract: The year 2011 marked the 10-year milestone of early intervention for psychosis in Hong Kong. Since 2001, the landscape of early psychosis services has changed markedly in Hong Kong. Substantial progress has been made in the areas of early intervention service implementation, knowledge generation, and public awareness promotion. Favourable outcomes attributable to the early intervention service are supported by solid evidence from local clinical research studies; early intervention service users showed improved functioning, ameliorated symptoms, and decreased hospitalisation and suicide rates. Continued development of early intervention in Hong Kong over the decade includes the introduction and maturation of several key platforms, such as the Hospital Authority Early Assessment Service for Young People with Psychosis programme, the Psychosis Studies and Intervention Unit by the University of Hong Kong, the Hong Kong Early Psychosis Intervention Society, the Jockey Club Early Psychosis Project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. In this paper, we reviewed some of the major milestones in local service development with reference to features of the Hong Kong mental health system. We describe chronologically the implementation and consolidation of public early intervention services as well as recent progresses in public awareness work that are tied in with knowledge generation and transfer, and outline the prospects for early intervention in the next decade and those that follow.

Early Psychosis Declaration for Asia by the Asian Network of Early Psychosis

Abstract: In line with the Early Psychosis Declaration issued by the World Health Organization and the International Early Psychosis Association, as well as the International Clinical Practice Guidelines for early psychosis by the latter in 2005, increasing interest in early intervention programmes is evident throughout Asia. Experience sharing and close collaboration that take into account the unique Asian context are needed to facilitate development of early psychosis services, education, and research in the region. The Asian Network of Early Psychosis has defined a set of Asian-specific principles to guide best practice in mental health care delivery for psychotic disorders in Asia. These principles are outlined in this paper.

The gradation of psychopathology: for better or for worse.

Abstract: Lately, there has been a growing interest in the dimensional concept of psychiatric diagnosis, along with a tendency to replace the categorical concept by the dimensional one. Before favouring either of these concepts, more light should be shed on the specifics of the categorical and dimensional approach to diagnosing mental disorders. A comparison of the main features of the categorical and dimensional concepts of psychiatric diagnosis has been made. The strengths of the categorical concept are weaknesses of the dimensional one, and vice versa. The clinical utility of the categorical concept over-rates the dimensional model, whereas the dimensional concept provides more information about the respective individual. Usefulness of the categorical concept is the major reason why it is going to stay as a cornerstone of psychiatric diagnostics.

Early intervention for psychosis in Asia.

Abstract: It is now just over a decade since the first early intervention for psychosis programmes were established in Asia and, in the intervening years, a number of programmes have been developed in various Asian cities. There is growing interest in early intervention in the Asian region, as evidenced by the Early Psychosis Declaration for Asia formulated by the Asian Network for Early Psychosis and published in this issue of the East Asian Archives of Psychiatry. (1) The overarching aim of the Declaration is to guide good clinical practice in mental health care delivery for psychotic disorders in the Asian context, with 4 broad aims specifically endorsed by the Declaration: first, to facilitate close collaboration between researchers, clinicians, and policymakers in order to inform service planning and increase resources for effective early psychosis intervention; second, to develop a set of Asian-specific clinical practice guidelines for the management of psychosis; third, to raise the level of awareness and understanding of psychosis through public education campaigns from an Oriental perspective; and finally, to consolidate an Asian-specific evidence base for psychotic disorders and facilitate collaboration in the region. It is inspiring that so many pioneering Asian psychiatrists have recognised that prevention and early intervention are key potential strategies in the struggle to reduce the burden of mental illness in our rapidly changing societies. Quite apart from the human cost, the economic impact of untreated or poorly treated mental disorders is a major threat to happiness and prosperity worldwide. In its 2011 report on the impact of non-communicable diseases, the World Economic Forum has shown that mental illness will equal cardiovascular disease as the major threat to gross domestic product both in developed and developing economies over the next 2 decades. (2) This is because mental disorders are chronic diseases of young people, with 75% of onsets occurring before the age of 25 years, and most occur between puberty and the mid-twenties. (3) Obviously, this hits hardest in developing countries with their predominantly young populations. In the western world, despite compelling logic and a substantial emerging evidence base which almost uniformly indicates that the early intervention paradigm is as valid in mental health as it is in physical health, timely and appropriate early intervention remains aspirational for the average patient experiencing the onset of a mental illness. This is in part a reflection of the inequity that people living with mental ill health around the world still experience, but also a reflection of a certain degree of lack of confidence and maturity within the mental health community. Despite 2 decades of indicative evidence, and the early intervention field having been led by an international array of academic clinicians deeply committed to evidence-based medicine, there has been not only excessive conservatism, but also an attempt by a small group of academics to use the evidence-based paradigm selectively to introduce doubt and undermine reform. (4) Scepticism is central to science and is necessary, but a double standard is at work here, since similar doubts have not been fuelled in relation to any aspect of the status quo of traditional mental health care. Fortunately, the dichotomy between early intervention and decent long-term care is demonstrably false, since investment in early intervention has been shown to be cost-effective, especially in relation to psychosis, where 5 studies all point to substantial savings that can be channelled into enhancing care programmes for the substantial and cumulative minority whose recovery is prolonged or elusive. (5-9) Many, although admittedly not all, of those who come to need such programmes do so precisely because they have received late, desultory, or poor-quality intervention from pessimistic and poorly resourced cultures of care, despite the best efforts of dedicated clinicians desperately propping up the latter. …

Healing Trauma: A Professional Guide

Abstract: Healing Trauma: a Professional Guide Editors: Kitty K. Wu, Catherine S. Tang, Eugenie Y. Leung Hong Kong University Press USD 29.00; pp379; ISBN 978-9888028979 People feel overwhelmed, frightened, and beyond control in traumatic experiences. Apart from physical, interpersonal and sexual violence, these also include accidents, natural and man-made disasters. Traumatic experiences can fundamentally change not only the way of life of the victims, but also their psychological outlook. It is not uncommon in our clinical practice to encounter cases related to trauma. Healing Trauma offers a systematic examination in the interpretation of trauma psychology and management of trauma cases in Hong Kong. Not only does it emphasise empirical evidence from international and local research, it also captures the experience of local experts in dealing with a range of trauma under a unique cultural context. This book is divided into 7 parts. It begins with an introduction, assessment and intervention of trauma. It is followed by examining interpersonal trauma, medical trauma, mass trauma and disaster. In conclusion, the prospect of professional training and reflections of psychological trauma are discussed. The first section is about research and practice in trauma assessment, as well as the psychological and psychopharmacological management of trauma. It summarises the psychometric properties and previous findings of assessment tools for traumatic stress that have been translated into Chinese, and their limitations. Current influential theories about traumatic stress and salient risk factors in post-traumatic stress disorder (PTSD) are examined. The controversy and evidence behind the effectiveness of critical incident stress debriefing is discussed. There is an overview on the cognitive model of persistent PTSD, and its therapeutic implications on cognitive behaviour therapy. I found one of the most interesting parts was about the concept of resilience and post-traumatic growth. While some individuals may suffer chronic psychopathology after trauma, others recover and show a lack of negative reactions, and some will even report beneficiary effects. The latter 2 post-trauma outcomes are usually referred to as resilience and post-traumatic growth, respectively. Positive explanatory style, such as meaning-making and optimism towards positive events, is used to explain the underlying cognitive mechanisms of post-traumatic growth. …

Recent developments in dementia: from new diagnostic criteria to a new name.

Abstract: In the past decade, there have been significant advances in the understanding of the pathophysiology of various forms of dementia. In particular, there have been remarkable developments in the use of biomarkers for the diagnosis of Alzheimer's disease (AD). In the past, AD was viewed as a clinicopathological condition, with underlying AD pathology in the brain and a clinical manifestation of dementia. With the advances in technology, including biomarkers based on cerebrospinal fluid (CSF) and neuroimaging, it is now possible to detect AD pathology in the brain years before the onset of clinical symptoms. It is postulated that amyloid biomarkers are abnormal 10 to 20 years before the onset of clinical symptoms, whereas abnormalities in biomarkers of neurodegeneration occur later. (1) The revised criteria for AD by the National Institute on Aging-Alzheimer's Association (NIA-AA), published in 2011, represent a major paradigm shift in the diagnosis of AD. (1) These criteria are intended to replace the one by McKhann et al (2) that have been in use since 1984. Major changes in the criteria are the incorporation of biomarkers into the diagnostic criteria, and the differentiation of AD into 3 stages of disease--preclinical AD, mild cognitive impairment (MCI) due to AD, and AD dementia. (1,3-5) With the use of biomarkers, it is now possible to diagnose AD at a very early stage, even at a preclinical stage when there is AD neuropathology but no clinical symptoms. Currently, the better-validated biomarkers include (6): 1. Biomarkers of brain [beta]-amyloidosis, which are evidenced by either increased uptake of amyloid on amyloid imaging (e.g. positron emission tomographic [PET] scan with Pittsburgh compound B), or decreased CSF amyloid [beta]42. 2. Biomarkers of neuronal degeneration or injury, evidenced by temporoparietal hypometabolism on fluorodeoxyglucose PET scan or temporoparietal hypoperfusion on single photon emission computed tomography, medial temporal atrophy on structural imaging, or increased CSF tau or phospho-tau. These new criteria are very useful for recruiting individuals at a very early stage of AD for research purposes, and may increase the diagnostic certainty that a patient's cognitive impairment is due to AD. Indeed, these new criteria are greeted with great enthusiasm both by researchers and by clinicians. However, potential problems in the use of these criteria in routine clinical practice have also been raised. These include: (1) the lack of standardisation of various biomarkers and poor reproducibility across centres, so that optimal cut-off scores are not established; (2) the uncertain predictive value of these new criteria, e.g. whether preclinical AD will progress to MCI or dementia; (3) practical difficulties in operationalising these criteria; (4) the clinical utility of a preclinical diagnosis of AD in the absence of effective disease-modifying treatment; and (5) ethical concerns about how the very early diagnosis of AD, e.g. preclinical AD or MCI due to AD, will affect the person in various aspects of their lives, including job opportunities, insurance, and driving. (6,7) Turning to Hong Kong, there are additional problems in applying the new diagnostic criteria in the local setting. For instance, the waiting time for a new case appointment in the psychogeriatric outpatient clinics varies from several months to over a year. In certain clusters under the Hospital Authority (HA), the waiting time for a computed tomographic scan is 1 year. The costs of checking for the presence of the AD biomarkers are very high, and affordability is a major factor that will limit the widespread use of these biomarkers. With the stretched resources in the HA, the situation is unlikely to improve drastically in the near future. We are of the view that the new criteria for AD diagnosis are a major advance in the field of dementia, and are very useful for research, as well as for the diagnosis of difficult cases in tertiary centres, but they are not suitable for routine clinical use in Hong Kong currently. …

Sexual dysfunction in men (advances in psychotherapy - evidence-based practice) [Book Review]

Abstract: Review(s) of: Sexual dysfunction in men (advances in psychotherapy - evidence-based practice), by David L. Rowland, Hogrefe Publishing, USD 29.80; pp108; ASIN B009HNL54Q.