K.W. Chan

Medication adherence, knowledge about psychosis, and insight among patients with a schizophrenia-spectrum disorder.

Abstract This study aimed to explore the relationship between knowledge about psychosis, insight, and medication adherence among patients at an early stage of a schizophrenia-spectrum disorder. Eighty patients were recruited from a specialized outpatient clinic. Knowledge was assessed with the modified Knowledge About Schizophrenia Test (KAST). Medication adherence was determined with the Chinese abridged Medication Adherence Ratings Scale. Insight was measured with the abridged Scale to Assess Unawareness of Mental Disorder (SUMD). The KAST total score was correlated with the SUMD. A trend correlation between KAST subscores of cause and SUMD was found. The nonadherence rate was 43.8%. The medication-adherent patients had lower SUMD (z = −4.338, p < 0.0001) and higher KAST subscore of cause (z = −2.767, p = 0.006). These two variables explained 38.9% of the variance in adherence behavior, with SUMD being the mediator. This study highlights the importance of patients’ understanding of etiology of the illness and its relationship with insight and medication adherence.

Perceived risk of relapse and role of medication: comparison between patients with psychosis and their caregivers

PurposeStudies have suggested that appraisal of relapse risk and knowledge of medications in relapse prevention may shape one’s reactions towards an illness and treatment, and influence the illness outcome. The aim of this study is to explore patients’ and caregivers’ knowledge of medications, perceived chances of relapse and its predictors, as well as their relations with medication adherence.MethodsEighty patient–caregiver dyads participated in the study. Their knowledge about psychosis, specific knowledge about medications and course of illness of their own and their relatives, medication adherence and symptomatology of patients were assessed. Differences in knowledge between patients and caregivers were compared. The link between adherence with perceived relapse risk and consequences of stopping medication were explored. Multinomial regression analyses were performed to examine predictors of perceived relapse risk.ResultsMore patients underestimated their chance of relapse and were unaware that stopping medication may lead to relapse. The lack of understanding about the effect of stopping medication of both caregivers and patients was related to poor medication adherence of patients. Patients perceived of having higher chance of relapse had more severe positive symptoms. Positive symptoms of patients and greater knowledge about psychosis of caregivers were related to higher caregivers’ perceived relapse risk of their relative.ConclusionsThis study explored the views of patients and their caregivers on the perceived risk of relapse and role of medication in preventing relapse, and the potential significance. Specific interventions addressing these areas should be considered in developing relapse prevention programs.

THE IMPACTS OF YOGA AND AEROBIC EXERCISE ON NEURO-COGNITION AND BRAIN STRUCTURE IN EARLY PSYCHOSIS – A PRELIMINARY ANALYSIS OF THE RANDOMIZED CONTROLLED CLINICAL TRIAL

This journal suppl. entitled: Abstracts of the 3rd Biennial Schizophrenia International Research Conference

The Impacts of Yoga On Cortical Thickness, Neural Connectivity and Cognitive Function in Early Psychosis: Preliminary Results From a Randomized Controlled Clinical Trial

Background Impairments of attention and memory are evident in early psychosis, and often lead to severe, longstanding functional disability. Effective non-pharmacological interventions are needed due to the unsuccessful results of pharmacological interventions. Aims To determine whether yoga is effective for cognitive impairments, and the neural mechanism underlying these effects. Methods It was a randomized controlled study of 12-week of yoga and aerobic exercise (walking and cycling) intervention vs wait-list control for female early psychotic patients. Memory was measured with Hong Kong List Learning Test and Digit Span test, and attention was measured with Letter Cancellation test. Cognitive data analysis was based on the Intention-to-Treat method using a mixed-model analysis. Seed based functional connectivity was applied using posterior cingulate cortex (PCC) as seed with AFNI. Cortical thickness analyses were performed using FreeSurfer. Results from yoga and control groups were presented. Results A total of 140 women were recruited and randomized into three groups. 95 completed the study, and 115 were included for cognitive data analysis. For imaging data, 42 participants were used for cortical thickness analyses; and 60 were included for neural connectivity analyses. Yoga group demonstrated significant improvements in working memory, verbal acquisition and attention (P=.01). Cortical thickness increased in the postcentral gyrus (P Conclusions Yoga has been found to be effective for memory and attention in early psychotic patients. The increases of thickness and neural connectivity indicate the possible neural mechanisms underlying the improvements of cognition.

Methadone prescribing in the general hospital

Purpose – The purpose of this paper is to evaluate the clinical practice for management of opiate dependence in a general hospital in‐patient population based on agreed standards and changes of clinical practice after the introduction of a guideline.Design/methodology/approach – A complete cycle of audit was carried out based on the agreed guideline, which was introduced after the first cycle. Data were obtained, using a standardized audit form, over two one‐year periods, by cross‐sectional analysis of case notes for patients identified as having been dispensed methadone whilst an in‐patient.Findings – There were significant increases in: referral to the specialist service whilst an in‐patient (p=0.01); referral to the addiction services on discharge (p<0.001) and providing information about the addiction diagnosis to GP (p<0.001). However, there was no improvement in the documented history and examination related to aspects of addiction, some of which were consistently low. Of most concern were significa...

T250. CLINICAL CORRELATES OF SUBJECTIVE QUALITY OF LIFE IN INDIVIDUALS WITH AT-RISK MENTAL STATE FOR PSYCHOSIS IN HONG KONG

Abstract Background Subjective quality of life (SQoL) is an important outcome domain in individuals with at-risk mental state (ARMS) for psychosis. In an effort to better understand and maximize SQoL in ARMS populations, an increasing number of research has been conducted to investigate factors determining SQoL. This study aimed to examine clinical, functional and cognitive correlates of SQoL in Chinese young people presenting with ARMS in Hong Kong. Methods This is a naturalistic prospective study examining the longitudinal course of ARMS and prediction of psychosis in Hong Kong. In total, 110 Chinese participants aged 15 to 40 years presenting with ARMS were recruited from a territory-wide specialized early intervention service for psychosis. ARMS status was verified using Comprehensive Assessment for At-Risk Mental State (CAARMS). Assessments encompassing symptom profiles (Positive and Negative Syndrome Scale, PANSS; Montgomery-Asberg Depression Rating Scale, MADRS; Brief Negative Symptom Scale, BNSS), functioning (Social and Occupational Functioning Rating Scale, SOFAS) and a brief battery of cognitive tests was conducted. A validated Chinese version of SF12 questionnaire was used to measure SQoL. The current analysis focused on data collected at baseline. Results Of 110 ARMS participants, 48.2% were male. The mean age and educational level of the sample was 20.9 years (S.D.=6.7) and 11.4 years (S.D.=2.6), respectively. Correlation analyses revealed that SF12 mental health score was correlated with MADRS total score, BNSS total score and SOFAS score, while SF12 physical health score was correlated with PANSS positive symptom score only (p<0.05). Multiple linear regression analysis showed that only MADRS total score was independently associated with SF12 mental health score (p<0.001). SQoL measures were not correlated with any cognitive functions. Discussion Our results were consistent with the literature which indicates that psychological domain of SQoL is significantly related to depressive symptoms in ARMS individuals. Further analysis on the longitudinal data regarding our prospective ARMS cohort will clarify variables predictive of SQoL at follow-up.

T62. COMPARISON OF NEUROCOGNITIVE FUNCTIONS IN FIRST-EPISODE SCHIZOPHRENIA PATIENTS, NON-PSYCHOTIC SIBLINGS, AND INDIVIDUALS AT CLINICAL HIGH-RISK FOR PSYCHOSIS

Abstract Background Neurocognitive impairment is a core feature of schizophrenia, and has been observed among healthy non-psychotic siblings of schizophrenia patients as well as individuals at clinical high-risk (CHR) for psychosis. Thus far, few studies have directly contrasted neurocognitive performance between non-psychotic siblings and CHR samples. Potential differential patterns of neurocognitive deficits among schizophrenia patients, familial high-risk and CHR samples remain to be clarified. This study aimed to compare neurocognitive functions among first-episode schizophrenia (FES) patients, their non-psychotic siblings, CHR individuals, and healthy controls. Methods FES patients (n=69, mean age=25.3) and CHR individuals (n=97, mean age=21.1) without family history of psychosis were recruited from a territory-wide specialized early intervention service for psychosis in Hong Kong. A group of non-psychotic siblings of FES patients (n=50, mean age=25.4) and healthy controls (HC) (n=68, mean age=24.5) were also recruited. A standardized battery of neurocognitive tests encompassing working memory, processing speed, executive function, visual memory, verbal learning, and sustained attention was administered. Group differences were examined using analysis of covariance (ACOVA) with Bonferroni correction applied for statistical significance (P<0.008), controlling for age and years of education. Results Compared with HC, FES patients exhibited significantly poorer performance across all neurocognitive domains (Hedges g ranged: 0.48–1.73), while CHR individuals demonstrated significantly worse neurocognitive functioning in all domains (Hedges g ranged: 0.53–1.15) but sustained attention. Non-psychotic performed significantly worse than HC in executive function (Hedges g=0.63, p<0.001), visual memory (Hedges g=0.57, p=0.002), verbal learning (Hedges g=0.52, p=0.001), and working memory (Hedges g=0.37, p=0.003). Among four groups, FES patients displayed the most severe neurocognitive impairment. The pattern of neurocognitive dysfunction was similar between CHR and non-psychotic sibling groups, except for processing speed, of which CHR individuals demonstrated greater degree of impairment than siblings in digit symbol coding test (p<0.001). Discussion Our results indicate a gradient of neurocognitive impairment across FES, CHR and non-psychotic sibling samples, reflecting differential degrees of psychosis liability. Processing speed, as measured by digit symbol coding test, demonstrated the highest discriminant utility in discriminating CHR from familial high-risk individuals. Our findings thus confirm the critical role of neurocognitive dysfunction as a reliable risk indicator and an endophenotype for schizophrenia and related psychoses.

S122. 3-YEAR NEGATIVE SYMPTOM TRAJECTORY AND ITS RELATIONSHIP WITH SYMPTOM AND FUNCTIONAL OUTCOMES IN FIRST-EPISODE NON-AFFECTIVE PSYCHOSIS: A PROSPECTIVE 13-YEAR FOLLOW-UP STUDY

Abstract Background Negative symptoms are a core feature of schizophrenia and are a major determinant of functional impairment. Few studies have been conducted to examine patterns of longitudinal course of negative symptoms in the early stage of illness. Differential relationships of negative symptom trajectories with long-term clinical and functional outcomes remain to be clarified. This study aimed to investigate patterns of negative symptom trajectories over 3 years, utilizing latent class growth analysis (LCGA), in patients presenting with first-episode non-affective psychosis. Predictive capacity of symptom trajectories on 13-year functional and negative symptom outcomes was also examined. Methods One hundred thirty-six Chinese patients aged 18–55 years presenting with DSM-IV first-episode schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder or delusional disorder were assessed at clinical stabilization for first psychotic episode (baseline), 1, 2, 3 and 13 years of follow-up. Assessments encompassing premorbid adjustment, baseline symptom and cognitive profiles and functional levels were conducted. Negative symptoms were measured by High Royds Evaluation of Negativity (HEN) Scale. Individual class membership of negative symptoms derived from LCGA was based on HEN ratings at baseline, 1, 2 and 3-year follow-up. Results Three distinct negative symptom trajectories were identified including low-stable (59.6%, n=81), moderate-stable (29.4%, n=40) and high-increasing (11.0%, n=15) trajectories. Multinomial regression analysis revealed that poorer premorbid adjustment, lower baseline cognitive composite scores and more severe baseline depression predicted high-increasing trajectory membership (Nagelkerke pseudo R2=0.339, Model χ2=277.96, p<0.01). At 13 years, 88 patients (64.7%) completed follow-up assessment, with attrition analysis indicating lack of significant differences in demographic, premorbid and baseline characteristics between completers and non-completers. Analysis of covariance (controlling for premorbid adjustment, baseline cognition and depression) followed by post-hoc comparison analyses found that high-increasing trajectory was significantly associated with poorer global functional outcome and higher negative symptom levels at 13-year follow-up. Discussion Our results indicate that 11% of first-episode non-affective psychosis patients displayed persistently high levels of negative symptoms with gradual symptom worsening over 3-year follow-up. This trajectory membership was predictive of poorer negative symptom and functional outcomes 13 years after presentation. High-increasing negative symptom trajectory identified in the initial 3 years of treatment for first-episode psychosis may represent a subgroup of patients having markedly elevated risk of developing deficit syndrome in the later course of illness.

T252. TREATMENT DELAY AND OUTCOME COMPARISON OF EXTENDED EARLY INTERVENTION SERVICE AND STANDARD PSYCHIATRIC CARE FOR ADULTS PRESENTING WITH FIRST-EPISODE PSYCHOSIS IN HONG KONG

Abstract Background A territory-wide specialized early intervention (EI) service for psychosis (EASY) has been implemented in Hong Kong since 2001, providing 2-year phase-specific early assessment and clinical care to young people aged 15–25 years presenting with first-episode psychosis (FEP). Previous evaluation demonstrated superiority of EASY programme over standard care in outcome improvement in FEP. Recently, EASY has been extended to provide 3-year EI service to FEP patients aged 15 to 64 years. However, effectiveness of EI on adult FEP populations has not been well examined. Methods This study adopted case versus historical-control design, comparing patients received 3-year EASY treatment (EI group) with those managed by standard psychiatric care (SC group) prior to implementation of EASY extension in terms of treatment delay and outcomes in symptom and functioning. In total, 320 Chinese adult FEP patients aged 26–55 years (160 in EI group, 160 in SC group) were included in the study. Retrospective record review detailing service utilization over 3-year treatment period was conducted. Follow-up interview assessment (on average 48.3 months after service entry) encompassing premorbid adjustment, duration of untreated psychosis (DUP), clinical (Positive and Negative Syndrome Scale, PANSS; Calgary Depression Scale, CDS), functional (Role Functioning Scale, RFS) and treatment profiles was administered. Comparison analyses on DUP and service utilization were based on record review data of 320 patients. Clinical and functional outcome analyses focused on data collected from follow-up interview assessment (251 patients completed follow-up assessment, 130 from EI and 121 from SC groups). Results EI and SC groups were comparable regarding demographics, premorbid and baseline characteristics, except the use of second-generation antipsychotic (SGA) treatment (EI patients were more likely to receive SGA than SC patients). EI patients had significantly shorter DUP than SC counterparts (p=0.015). Regarding follow-up outcomes, EI patients displayed lower levels of negative (p=0.044) and depressive symptoms (p=0.055), higher scores in RFS immediate social network (p=0.027) and lower rates of service disengagement (p=0.048) than SC patients even when SGA use and DUP were adjusted as covariates in analysis of covariance for comparison. There were no significant group differences in admission and suicide rates. Discussion Our results indicate that extended EASY service achieve favorable outcomes in adult FEP patients on shortening of treatment delay and improvement in negative symptoms and social functioning, and service disengagement reduction. Further evaluation is required to assess the sustainability of positive effects.

Prevalence and correlates of antipsychotic polypharmacy in Hong Kong

BACKGROUND Antipsychotic polypharmacy (APP) remains a common practice despite inconclusive empirical evidence of additional efficacy and potential exacerbation of side effects. Previous studies suggest APP rate is notably high in East Asia. This paper aims to investigate the prevalence and correlates of APP in Hong Kong. METHOD This was a cross-sectional study of 728 patients with psychosis. The demographics and clinical information, including age, gender, diagnosis, hospitalization history, and medication were collected. Chi-square tests and logistic regression analyses were used to study correlates of APP. RESULTS The APP rate for psychosis was 24.2% (n = 728) and that for schizophrenia was 26.0% (n = 611), both considerably lower than our previous local data and that from East Asian regions. The most widely used APP prescription fell within the atypical/atypical combination (i.e., Amisulpride/Clozapine and Paliperidone/Olanzapine), and Olanzapine was the most commonly prescribed antipsychotic. At least 75% of APP patients with psychosis took at least one type of atypical antipsychotics in their medical regimen. Typical/typical polypharmacy was associated with older age and use of antiparkinson drugs. Typical/atypical polypharmacy was associated with the use of antiparkinson drugs and anxiolytics, as well as inpatient status. Atypical/atypical polypharmacy was associated with younger age, inpatient status, and the use of mood stabilizers. CONCLUSION Overall, our study highlights a relatively low APP rate in Hong Kong when compared to other countries in East Asia. Age, inpatient status and use of antiparkinson drugs, anxiolytics and mood stabilizers were associated with use of APP.