Felice Lieh-Mak

Dopamine receptor D4 (DRD4) gene in Han Chinese children with Attention-Deficit/Hyperactivity Disorder (ADHD): Increased prevalence of the 2-repeat allele

There is an increased prevalence of the 7‐repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention‐deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate‐responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2‐repeat (2R) allele in this clinical sample (33%) compared to ethnically‐matched controls (20%) (χ2(1d.f.) = 5.90, P = 0.015). This approximately 1.65‐fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European‐ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European‐ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non‐4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.

No association between T102C polymorphism of serotonin-2A receptor gene and clinical phenotypes of Chinese schizophrenic patients.

Serotonin dysfunction has been implicated in the pathogenesis of schizophrenia. Previous studies have shown an association between the T102C polymorphism of the 5HT2a receptor gene and schizophrenia. However, negative findings have also been reported. One possible explanation for such discrepancy is disease heterogeneity due to the current limitations in the diagnosis of schizophrenia. We conducted a case-control study of the T102C polymorphism with detailed characterisation of the clinical phenotypes to investigate the possible association with schizophrenia not only at the diagnostic level, but also with reference to other clinical phenotypes potentially related to serotonin dysfunction. Four hundred and seventy-one biologically unrelated schizophrenic patients and 523 unrelated healthy controls of Han Chinese descent in Hong Kong were compared for genotypes and allele frequencies of the T102C polymorphism by PCR amplification and restriction analysis. No evidence of association was detected at the diagnostic level and various clinical phenotypes. However, we found a trend association with small effect size between genotype 102T/102C and patients with better verbal fluency and less motor co-ordination soft neurological signs. There is a need for future large-scale studies on the possible associations between genetic polymorphisms and neurocognitive function impairments in schizophrenia.

Language screening in preschool Chinese children

The incidence of language delay in Chinese preschool children was studied by a stratified proportional sampling of all 3 year olds in Hong Kong. The Developmental Language Screening Scale (DLSS) devised for use with Cantonese speaking children was used to identify children with language delay. Of 855 children sampled in the stage I screening procedure, 4%, 2.8% and 3.3% were identified as having delay in verbal comprehension, expression or both respectively. The stage II clinical diagnostic study included a randomly selected group of children screened in stage I with or without any associated behavioural problem. Among these, 3.4% were identified as having a language delay using the Reynell Language Developmental Scale (RDLS) with a criterion of language age of less than or equal to two-thirds of the chronological age; 3% had specific language delay using the criteria of language age less than or equal to two-thirds the chronological age and developmental age more than or equal to two-thirds the chronological age. More boys were found to have language delay, although this was not statistically significant.

Psychiatry as compared to other career choices: a survey of medical students in Hong Kong

Summary A questionnaire was administered to two groups of medical students, one preclinical and the other clinical, to assess their career choices, opinions of six specialties (including internal medicine, general practice, obstetrics and gynaecology, paediatrics and psychiatry as well as surgery) and anxieties about psychiatry. It was found that both groups of students conceptualized clinicians according to stereotypes which were modified but not abated by clinical exposure. Although the clinical students compared to preclinical students attributed more positive personality traits to psychiatrists, students interested in taking up careers in psychiatry were few in both groups. Compared to the preclinical class, clinical students were less worried about disturbed patients and emotional involvement with patients, but were more concerned about their deficiency in knowledge and skills relevant to psychiatry.

The pattern of coping in persons with spinal cord injuries

Purpose : To examine the modes of coping and adjustment of persons with spinal cord injuries (SCI) in Hong Kong. Method : A cross-sectional design was adopted. Structured questionnaires and semi-structured interviews on 66 persons with SCI were completed. Cluster analysis was performed to identify persons with SCI who are at risk for psychosocial morbidity. Results/Conclusion : The group at risk for developing psychological difficulties is characterized by high scores on external locus of control, inadequate coping modes, and low perceived social support. High levels of depression, social role dissatisfaction, care-giving burden, low levels of life satisfaction, and marital maladjustment are commonly noted. Rehabilitation of persons with SCI should also aim at promoting perceived personal control, acceptance of physical status, and realistic appraisal of stressful situations to facilitate better adjustment and coping with commonly identified stresses and difficulties. Counselling should be initiated at an early stage to reduce the development of distorted perceptions so that the needs and concerns of individuals with SCI may be better met and resolved. The frustrations due to unmet expectations may be prevented at an early stage through build-up of more realistic understandings related to the illness and living with the illness.

Vietnamese refugee children in camps in Hong Kong

Vietnamese refugee children staying in an open camp in Hong Kong were interviewed to find out the nature of their war experience. The effects of war and refugee experience on their fears about being hurt or killed were assessed. Most of the Vietnamese children in the present sample travelled to Hong Kong with their family and had little experience of separation, death or injury of close family members. However, about two-thirds of them had witnessed violence and one-third reported experience of being assaulted. Children exposed to unpleasant war experience were more likely to report a fear of being hurt than those not exposed to similar negative events. However, there was no consistent finding relating other types of fear to war experience. The family and the cohesiveness of the community in which they lived may have protected them against adverse psychological reactions.

Brain morphological abnormality in schizophrenia is independent of country of origin

Objective: The disorder schizophrenia has a worldwide prevalence of 1% and is generally associated with lateral cerebral ventricular enlargement. Whether there is a relationship between these two findings is unclear but has aetiological relevance.

The 15-year outcome of Chinese patients with schizophrenia in Hong Kong.

Objective: To explore the differential outcome of schizophrenia in developed and developing countries. The 15–year outcome of patients with schizophrenia in Hong Kong is reported. Method: In a 15-year retrospective outcome study, 100 patients with first-onset schizophrenia in 1977–1978 were randomly selected for outcome assessment from a pool of 797 patient files. The patterns of outcome were assessed by the same set of instruments and methodology as in other centres, since Hong Kong is 1 of the World Health Organization (WHO) centres for the International Study of Schizophrenia (ISoS). Results: Nineteen subjects were untraceable, and 10 subjects committed suicide. More than one-half of the subjects had a good symptomatic outcome, while about 20% of the subjects were rated as having a good psychosocial adjustment. Over the entire 15-year period, 96% of the subjects were maintained on medications, and 79% were living with family members. Conclusion: Despite Hong Kongs developed economy, its schizophrenia outcome is similar to that in developing countries. The existence of good family support and active follow-up treatment may be important contributory factors to better outcome.

The test-retest reliability and screening efficiency of DISC Predictive Scales-version 4.32 (DPS-4.32) with Chinese children/youths

IntroductionThe DISC Predictive Scales-4.32 (DPS-4.32) were short-forms of the Diagnostic Interview Schedule for Children-IV (DISC-IV).MethodThe psychometric properties of DPS-4.32 were tested on two Chinese samples: a clinic sample of 83 children/youths, and a community sample of 541 youths.ResultsBoth Parent and Youth DPS-4.32 exhibited good-to-excellent test-retest reliability. Their screening efficiency was examined respectively against DSM-IV diagnoses of the full-length Parent and Youth DISC-IV. Results indicated large AUCs (Area under Receiver—Operating Charateristic Curve), as well as high sensitivity, specificity, and negative predictive values, supporting the capability of DPS-4.32 to differentiate cases from noncases.ConclusionDPS-4.32 held promise as efficient short-forms of DISC-IV, screening DSM-IV diagnoses. They were also applicable to the Chinese population, demonstrating their cross-cultural applicability.

A comparison between male and female parasuicides in Hong Kong

SummaryThe epidemiological, social and clinical characteristics of 259 male and 475 female parasuicides in Hong Kong were compared. The majority are young adults, with an overall female: male ratio of 1.83. Compared to male subjects, females are more likely to be married or cohabiting, of higher social-economic status, born in places in the Far East apart from Mainland China, and of lower educational level. Their parasuicidal acts are more often motivated by interpersonal difficulties, especially with spouses or friends of the opposite sex, and take the form of self-poisoning. Male subjects on the other hand are more often single, immigrants from Mainland China, and of lower socio-economic status. Their problems are more often personal, and they are more likely to employ physical methods in their parasuicidal acts. In both sexes, age specific parasuicidal rates showed a second peak in senescence. Both the overall prevalence of psychiatric disorders and the rate of repeated parasuicide 2 years following the index admissions were low. The implications of these findings are explored.