Clm Hui

Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study

BACKGROUND Cognitive impairment is a core feature of schizophrenia. Its relationship with duration of untreated psychosis (DUP), a potentially malleable prognostic factor, has been less studied, with inconsistent findings being observed in the literature. Previous research investigating such a relationship was mostly cross-sectional and none of those prospective studies had a follow-up duration beyond 2 years. Method A total of 93 Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. DUP and pre-morbid adjustment were measured using a structured interview incorporating multiple sources of information. Psychopathological evaluation was administered at intake, after clinical stabilization of the first psychotic episode, and at 12, 24 and 36 months. Cognitive functions were measured at clinical stabilization, and at 12, 24 and 36 months. RESULTS DUP exerted differential effects on various cognitive domains, with memory deficits being the most related to DUP even when potential confounders including pre-morbid adjustment and sex were adjusted. Prolonged DUP was associated with more severe impairment in visual memory at clinical stabilization and verbal memory at 24 and 36 months. Further, patients with a long DUP were found to have worse outcomes on negative symptoms at 36 months. The effects of DUP on verbal memory remained significant even when negative symptoms were taken into consideration. CONCLUSIONS Our findings provided further supportive evidence that delayed treatment to first-episode psychosis is associated with poorer cognitive and clinical outcomes. In addition, DUP may specifically affect memory function and its adverse impact on verbal memory may only become evident at a later stage of the recovery process.

Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach

BACKGROUND Better understanding of the complex interplay among key determinants of functional outcome is crucial to promoting recovery in psychotic disorders. However, this is understudied in the early course of illness. We aimed to examine the relationships among negative symptoms, neurocognition, general self-efficacy and global functioning in first-episode psychosis (FEP) patients using structural equation modeling (SEM). METHOD Three hundred and twenty-one Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing symptom profiles, functioning, perceived general self-efficacy and a battery of neurocognitive tests were conducted. Negative symptom measurement was subdivided into amotivation and diminished expression (DE) domain scores based on the ratings in the Scale for the Assessment of Negative Symptoms. RESULTS An initial SEM model showed no significant association between functioning and DE which was removed from further analysis. A final trimmed model yielded very good model fit (χ2 = 15.48, p = 0.63; comparative fit index = 1.00; root mean square error of approximation <0.001) and demonstrated that amotivation, neurocognition and general self-efficacy had a direct effect on global functioning. Amotivation was also found to mediate a significant indirect effect of neurocognition and general self-efficacy on functioning. Neurocognition was not significantly related to general self-efficacy. CONCLUSION Our results indicate a critical intermediary role of amotivation in linking neurocognitive impairment to functioning in FEP. General self-efficacy may represent a promising treatment target for improvement of motivational deficits and functional outcome in the early illness stage.

Rich semantic networks applied to schizophrenia: A new framework ☆

The ‘loosening of associations’ is a core feature of language behavior in schizophrenia (Bleuler, 1911/1950). Most theories assume that words are arranged in a network which is disturbed due to a structural difference in their representation or activation. Despite considerable work using semantic priming and word association paradigms, critical issues remain unanswered, primarily because methodological limitations preclude the building of accuratemodels ofmeaning in themental lexicon, and the questionable relevance of only testing small parts of this lexicon. We introduce a framework sufficiently sensitive to investigate structural and dynamic processes in language production and how this is affected in serious mental illness. Our network-based proposal is influenced by Collins and Loftus (1975) but moves to a more realistic representation by removing experimenter bias and scaling it up to cover most words used in language. By representing a large variety of words (e.g., abstract or concrete, verbs, adjectives or nouns) it provides an alternative to the mental lexicon as a hierarchical taxonomic knowledge repository that typically focuses on concrete nouns. Instead, the lexicon also accounts for many thematic relations between words (De Deyne et al., 2015a, 2015b). Studying networks at this scale opens up a multi-level approach where both the global (macro), intermediate (meso) and detailed structure mutually constrain processes and potential representations (Baronchelli et al., 2013). Put differently, to understand the structure of the lexicon at the most detailed level depends on our understanding of higher level mesoor macroscopic levels as well. We argue that this novel approach is of particular use in the study of clinical disorders that affect language such as schizophrenia and we illustrate this with pilot data from a patient where we derived the macro, mesoand microscopic properties (see Fig. 1). A 20 year old female Cantonese speaking patient was tested onmultiple occasions while in an acute psychotic state. She was shown cue words and asked to generate as many associates as possible. These responses served as cues in subsequent testing sessions, thus gradually expanding in a snowball fashion (De Deyne et al., 2013). This approach is sensitive to capture the structure within basic level categories (e.g., birds) or entire domains (e.g., animals), but the wide scope contrasts with previous approacheswhich focus on a few categories or use spatial techniques to map the underlying structure (Elvevåg and Storms, 2003).

A case-controlled study on the outcome of an early intervention programme for psychosis (EASY)

This journal suppl. entitled: Abstracts for the 12th International Congress on Schizophrenia Research (ICOSR)

Agreement between clinically assessed and self-rated medication adherence with schizophrenia in Hong Kong

This is the Special Issue: Abstracts of the 20th International Congress on Schizophrenia Research 2005This journal issue entitled: Special Issue: Abstracts of the XX International Congress on Schizophrenia Research

The effect of media reporting of a homicide committed by a patient with schizophrenia on the public stigma and knowledge of psychosis among the general population of Hong Kong

PurposeThis study aimed to investigate the effects of media reporting of a homicide committed by a patient with schizophrenia on the knowledge about and stigma regarding psychosis among the general Hong Kong population. The effects of using the term ‘schizophrenia (jing-shen-fen-lei)’ in the news on the perceptions of the new Chinese term ‘psychosis (si-jue-shi-tiao)’ were explored.MethodsRandom telephone surveys of the general Hong Kong population were conducted in April 2009 (1 month before the incident) and June 2009 (1 week after the incident). Stigma was measured with the Link’s Perceived Discrimination-Devaluation Scale (LPDDS). Knowledge about the symptoms, treatment and belief of dangerousness of psychosis were assessed. The emotional reaction of the public to the news was explored, and its effects on knowledge and stigma were studied.ResultsOverall, 1016 and 506 participants completed the two surveys. More participants in the post-incident survey agreed that people with psychosis are dangerous to the public (χ2 = 4.934, p = 0.026). However, no significant differences were observed in the LPDDS scores. Participants who reported a high level of distress related to the news were more likely to perceive people with psychosis as dangerous to the public (χ2 = 6.738, p = 0.009). Women and older people reported greater distress.ConclusionsThese findings suggest that media reporting of violent incidents involving people with schizophrenia increases the public belief in the dangerousness of people with psychosis but not the overall stigma. Further studies of the differential effects of violence reporting on public perceptions about people with psychosis and schizophrenia are warranted.

Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

BACKGROUND Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI). METHODS One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments. RESULTS Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation. CONCLUSION Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.

Determinants of subjective quality of life in first-episode psychosis patients receiving specialized early intervention service in Hong Kong

IEPA 10th International Conference on Early Intervention in Mental Health – “Looking Back, Moving Forward” Milan, Italy, 20th – 22nd October 2016

Prevalence of psychiatric comorbidity and its associations with clinical, cognitive and functional variables in individuals with at-risk mental state for psychosis in Hong Kong

IEPA 10th International Conference on Early Intervention in Mental Health – “Looking Back, Moving Forward” Milan, Italy, 20th – 22nd October 2016

Predictive factors of physical and mental health quality of life among a 10-year outcome study of early intervention program for psychosis

IEPA 10th International Conference on Early Intervention in Mental Health – “Looking Back, Moving Forward” Milan, Italy, 20th – 22nd October 2016