Effect of acceleration and deceleration distance on the walking speed of people with chronic stroke

published_or_final_versio

Pathway of psychiatric care in Hong Kong

published_or_final_versio

Acceleration and deceleration distances for measuring walking speed in stroke rehabilitation

Conference Theme: From Science to Societ

The incidence and characteristics of clozapine-induced fever in a local psychiatric unit in Hong Kong

Objective: To determine the incidence, characteristics, and predictors of clozapine-induced fever in a sample of patients in a local psychiatric unit. Method: A retrospective review of case notes of 227 inpatients newly started on clozapine from March 2003 to December 2006 was conducted. Demographic characteristics, presence of fever, investigations carried out, fever characteristics, and complications of fever were recorded and analyzed. Patients with clozapine-induced fever were compared with their fever-free counterparts on demographic and clinical factors. Multivariate logistic regression was performed to identify predictors of clozapine-induced fever. Results: Thirty-one out of 227 patients (13.7%) developed clozapine-induced fever. The means for day of onset of clozapine-induced fever after clozapine initiation and duration of fever were 13.7 and 4.7 days, respectively. The mean highest body temperature was 38.8°C. Fever resolved within 48 hours after clozapine discontinuation in 79% of the patients with clozapine-induced fever. One out of 7 patients (14.3%) had fever on re-challenge. Clozapine-induced fever was associated with rate of titration more than 50 mg/wk (OR 18.9; 95% CI 5.3 to 66.7; P < 0.01), concomitant use of valproate (OR 3.6; 95% CI 1.5 to 8.9; P = 0.01), and presence of physical illnesses (OR 3.2; 95% CI 1.2 to 8.3; P = 0.02). Conclusion: Clozapine-induced fever is common. Temporary withdrawal of clozapine may result in resolution of fever, and clozapine re-challenge may be considered after fever subsides. Slower rate of clozapine titration may be helpful in patients with underlying physical illness and concomitant valproate treatment.link_to_subscribed_fulltex

A 3-year prospective study of neurological soft signs in first-episode schizophrenia

Neurological soft signs are biological traits that underlie schizophrenia and are found to occur at higher levels in at-risk individuals. The expression of neurological soft signs may be modifiable during the onset of the first psychotic episode and the subsequent evolution of the illness and its treatment. This study investigates neurological soft signs in 138 patients with first-episode schizophrenia and tracks the expression of motor soft signs in the following 3 years. For the 93 patients who have completed the 3-year follow-up, we find that neurological soft signs are stable in the 3 years that follow the first psychotic episode, and that neurological soft signs are already elevated at the presentation of first-episode psychosis in medication-naïve subjects. The level of neurological soft signs at clinical stabilization is lower for patients with a shorter duration of untreated psychosis. Although the quantity of neurological soft signs does not significantly change in the 3 years that follow the first episode, the relationship between neurological soft signs and negative symptoms does not become apparent until 1 year after the initial episode. A higher level of neurological soft signs is related to a lower educational level and an older age at onset, but the level of neurological soft signs does not predict the outcome in terms of relapse or occupational functioning. © 2004 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex

A prospective 3-year longitudinal study of cognitive predictors of relapse in first-episode schizophrenic patients

Background: Cognitive predictors of relapse have been extensively explored only in few long term longitudinal studies of first-episode schizophrenia. Method: This study prospectively followed 93 patients with first-episode schizophrenia, schizophreniform disorder, and schizoaffective disorder for 3 years after their first-episode illness. Cognitive domains including verbal intelligence, verbal and visual memory, verbal fluency, and Wisconsin Card Sorting Test performance were investigated as potential predictors of relapse. Results: We found that by the first year 21% patients had relapsed, by the second year 33% had relapsed, and by the third year 40% had relapsed. There was a significant difference in the relapse rate between patients with good adherence and patients with poor adherence to medication regimes. A multiple logistic regression analysis revealed that after controlling for medication adherence, perseverative error in the Wisconsin Card Sorting Test was the only cognitive function that significantly predict relapse with an odds ratio of 2.4. Conclusions: Cognitive flexibility in set shifting is related to tendency towards relapse in first-episode schizophrenic patients. Other cognitive factors appear not to be related to relapse. Possible mechanisms included the link between prefrontal dysfunction and sub-cortical dopamine system stability, as well as the effects of executive dysfunction on insight impairment and adherence behavior. © 2005 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex

Normalization of semantic categorization deficit in first-episode schizophrenia patients following symptomatic recovery: a three-year prospective longitudinal study

Poster no. 259BACKGROUND: Semantic memory dysfunction has been suggested in schizophrenia using the categorization task. However, data were largely inconsistent and the longitudinal trajectory of the deficit was unknown. Current study aimed to explore the 3-year longitudinal course of semantic memory deficits in first-episode schizophrenia patients. METHODS: First-episode schizophrenia patients (DSM-IV) were assessed prospectively at the point of first contact (A1), after clinical stabilization (A2), and each year for the following 3 years (Y1, Y2, Y3) using the categorization task. Patients are required to make decision (yes or no) on whether a 'word' belonged to a 'category'. 40 pairs of words were divided into 4 categories: fruits, furniture, drinks and clothing. Each category (e.g., furniture) was subdivided into five degrees of semantic relatedness: (1) typical word of the category (e.g., table), (2) atypical of the category (e.g., bookcase), (3) borderline word (e.g., clock), (4) related but outside the category (e.g., painting) and (5) unrelated and outside the category (e.g., sun). Data on both reaction time and proportion of yes response were analyzed. Normal participants were assessed once. RESULTS: 37 first-episode schizophrenia patients and 37 normal were recruited (matched for gender, age and education). Five ANOVAs were carried out to detect the difference in the five semantic relatedness conditions between patients and control at each of the 5 timepoints. In the first ANOVA which compared patients at A1 and control, reaction times in all conditions were slower in patients compared with control (F(1, 72)=7.83, p=.007). Significant main effect of semantic relatedness condition (F(4, 288)=12.30, p<.001) and interaction effect were also found (F(4, 288)=4.88, p=.001). Post-hoc pairwise comparisons found the two groups were different with regard to typical (p=.006), related (p=.036), and unrelated condition (p<.001). Interestingly, the remaining ANOVAs produced the same results. Significant main effect of condition (p=.015, p<.001, p<.001, p<.001, respectively) was observed in patients at A2, Y1, Y2 and Y3 as compared with control. Besides, pairwise comparisons had suggested significant difference in all conditions (all with p<.001). Likewise, ANOVA was carried out in the yes response data and similar results were identified. Main effect of group was found at A1 only (F(1, 72)=7.10, P=.009) but not the other timepoints. DISCUSSION: The data clearly show semantic memory abnormalities (slower reaction time and more error, i.e., more yes response in the outside the category condition) in first-episode schizophrenia as compared with normal. Intriguingly, they largely normalized following symptomatic recovery and remained stable for up to the first three years of the disorder, suggesting a state effect rather than a trait effect.The 2nd Biennial Schizophrenia International Research Conference, Florence, Italy, 10-14 April 2010. In Schizophrenia Research, 2010, v. 117 n. 2-3, p. 292-29

Relapse predictors in frist-episode schizophrenia: a 3-year longitudinal study

The relapsing nature of schizophrenia poses great challenge in terms of treatment and recovery. Identification of relapse predictors would be of utmost importance and relevance in the management of schizophrenia. In this naturalistic study, potential relapse predictors in terms of demographics, clinical symptomatology and cognition were investigated. 153 consecutive patients with first-episode psychosis were recruited, of which 138 fulfilled DSM-IV criteria for schizophrenia, schizophreniform disorder or schizoaffective disorder upon review at 3 years. Of the 138 eligible subjects, 93 completed the study at 3 years. They were 42 men and 51 women with a mean age of 31.2 (S.D.= 9.6), mean duration of untreated psychosis of 474 days (S.D.= 768), and mean educational attainment of 10.54 years (S.D.=2.9). 55 patients (605) experienced no relapse at 3 years, 25 (27%) had one relapse and 12 (13%) had 2 or more relapses. Those who relapsed have significantly poorer medication adherence (year 1: t=-3.4, p=0.002; year 2: t=-3.6, p=0.001; year 3: t=-3.4, p=0.002) and lower age at presentation (t=3.27, p=0.002). They also tended to have more life events prior to onset (t=-1.687, p=0.097) and more years of education (t=-1.99, p=0.049). No significant effect was found with regard to pre-morbid personality and gender. Our findings suggest that medication adherence and younger age at presentation are significant predictors of the number of relapses in first-episode schizophrenia patients in the first three years. Efforts should target at enhancing medication adherence and engagement of patients, especially those of younger age

Predictors of short-term functional outcome following first-episode psychosis

Poster Presentation: 20. Neuropsychology H. Miscellaneous studiesThis journal issue entitled: Biennial Winter Workshop on Schizophreni

Motor soft neurological signs in first episode schizophrenia: a two year longitudinal study

This journal suppl. entitled: Abstracts of the 9th International Congress on Schizophrenia Researc