Early intervention for psychosis in Hong Kong - the EASY programme

Aim: This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. Methods: In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. Results: An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. Conclusions: The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed. © 2010 Blackwell Publishing Asia Pty Ltd.postprin

Diagnostic stability of functional psychosis: A systematic review

Objective: Stability of diagnosis is one measure of predictive validity for psychiatric syndromes. It is an under-studied area despite its clinical and research implications. This report aimed to critically review the literature concerning diagnostic stability in functional psychosis. Methods: Articles concerned with evaluating the diagnostic stability of functional psychosis and factors associated with diagnostic change were reviewed. Results: Despite methodological variation, schizophrenia was found to be the most stable diagnosis followed by affective psychosis. Other psychotic disorders were diagnostically unstable overtime. Around one-fifth of patients with first-onset psychosis had their diagnoses revised at follow-up. Diagnostic change occurred early in the course of the psychotic illness. The major pattern of diagnostic shift was towards schizophrenia spectrum disorders, particularly schizophrenia. Few variables were identified as predictors of such diagnostic conversion and the evidence established thus far is inconclusive. Conclusions: The present analysis indicates that diagnostic uncertainty and temporal instability is common in the early phase of psychosis especially in less prevalent diagnostic categories. It also highlights the limitations of the contemporary nosological classification in functional psychosis. In the absence of biological markers, a diagnostic process taking into account longitudinal observations across consecutive episodes should be a major requirement for making a definitive diagnosis. © 2009 Hong Kong College of Psychiatrists.link_to_subscribed_fulltex

Five-year stability of ICD-10 diagnoses among Chinese patients presented with first-episode psychosis in Hong Kong

Background: Diagnostic stability is one measure of predictive validity for psychiatric syndromes. It is an under-studied area in functional psychosis despite its clinical and research implications. We aimed at evaluating the stability of ICD-10 diagnoses in a sample of young people with first-episode psychosis. Method: One hundred and sixty-six Hong Kong Chinese enrolled in a regional first-episode psychosis treatment program were studied. Subjects' baseline and final 5-year consensus diagnoses were established via systematic medical records' review to determine diagnostic stability and to identify predictors of diagnostic shift towards schizophrenia spectrum. Results: The overall diagnostic consistency was 80.7%. Bipolar affective disorder and schizophrenia were the most stable diagnostic categories over 5 years with prospective consistency of 100% and 95.8% respectively. The least stable baseline diagnoses were unspecified non-organic psychosis, acute and transient psychotic disorders and delusional disorder. Around one-fifth (19.3%) of subjects had diagnostic revision in 5 years. The predominant pattern of diagnostic shift was towards schizophrenia spectrum disorder. Family history of psychosis and longer duration of untreated psychosis were associated with diagnostic transition towards schizophrenia spectrum. Conclusions: Schizophrenia and bipolar affective disorder were diagnostically stable and could be reliably classified at intake in a Chinese first-episode psychosis sample using the ICD-10 criteria. Diagnostic instability in the least prevalent categories of functional psychosis highlights the limitations of current taxonomies and calls for ongoing revision of diagnostic criteria. In the absence of biological marker, longitudinal validation across consecutive episodes is necessary for accurate diagnostic ascertainment. © 2009 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex

Efficacy of a brief intervention for carers of people with first-episode psychosis: A waiting list controlled study

Objectives: While family psycho-education for schizophrenia is well-supported, the efficacy of family intervention for first-episode psychosis is less studied. This waiting list controlled study set out to evaluate the effectiveness of a 6-week intervention for carers of people with first-episode psychosis. Participants and Methods: Carers were randomised into experimental or waiting list categories. Study 1 compared various outcome measures in the 2 categories. Study 2 evaluated the treatment effects. Results: After the intervention, carers showed increased knowledge about psychosis and a reduction in negative ways of coping. The improvement in knowledge was maintained at 6-month follow-up, and trends towards improved caregiving burden and coping were also evident. Conclusions: A brief intervention programme can be effective in improving important variables such as knowledge, coping, and caregiving burden. The implications for selecting 'core components' for an effective intervention were discussed. © 2006 Hong Kong College of Psychiatrists.link_to_subscribed_fulltex

A novel KIF5B-ALK variant in nonsmall cell lung cancer

BACKGROUND: The anaplastic lymphoma kinase (ALK) gene is involved frequently in chromosomal translocations, resulting in fusion genes with different partners found in various lymphoproliferative conditions. It was recently reported in nonsmall cell lung cancer (NSCLC) that the fusion protein encoded by echinoderm microtubule-associated protein-like 4-ALK (EML4-ALK) fusion gene conferred oncogenic properties. The objective of the current study was to identify other possible ALK fusion genes in NSCLC. METHODS: Immunohistochemical analysis was used to screen for aberrant ALK expression in primary NSCLC. The authors used 5′ rapid amplification of complementary DNA ends to screen for potential, novel 5′ fusion partners of ALK other than EML4-ALK. Reverse transcriptase-polymerase chain reaction and fluorescence in situ hybridization analyses were used to confirm the identity of 5′ fusion partners. The genomic breakpoint was verified using genomic sequencing. Overexpression of the novel ALK fusion gene and variants 3a and 3b of EML4-ALK was performed to assess downstream signaling and functional effects. RESULTS: The authors identified a novel gene resulting from the fusion of kinesin family member 5B (KIF5B) exon 15 to ALK exon 20 in a primary lung adenocarcinoma. Western blot analysis of clinical tumor tissues revealed the expression of a protein whose size correlated with that of the predicted KIF5B-ALK. Overexpression of KIF5B-ALK in mammalian cells led to the activation of signal transducer and activator of transcription 3 and protein kinase B and to enhanced cell proliferation, migration, and invasion. CONCLUSIONS: The discovery of the novel KIF5B-ALK variant further consolidated the role of aberrant ALK signaling in lung carcinogenesis. Copyright © 2011 American Cancer Society.link_to_subscribed_fulltex

Naming psychosis: The Hong Kong experience

Aim: Schizophrenia translates in Chinese as 'Mind Split Disease' which is heavily stigmatizing. The narrow conceptualization for schizophrenia alone was insufficient, in the context of early detection and intervention for psychosis. The need for an effective Chinese translation for psychotic disorders was imminent upon the launch of the Early Assessment Service for Young People with Psychosis in Hong Kong, where public awareness strategies had to be built upon effective communication of the disorder.Methods: 'Si Jue Shi Tiao', the new term for psychosis, described 'thought and perceptual dysregulation'. This new terminology and concept was strategically introduced to the local community.Results: The term 'Si Jue Shi Tiao' was taken up well locally and had demonstrated interactions within the Chinese and East Asian communities. The public has taken in the broader concept of psychosis, in contrary to the previous concept of schizophrenia per se.Conclusions: In Hong Kong, the restrictive view of perceiving psychotic disorders as schizophrenia was broadened upon the introduction of a more embracing, less stigmatizing term 'Si Jue Shi Tiao'. Effective establishment of this term to the local vocabulary allowed a basis for communication as well as public education work. Further evaluation is necessary to determine the effectiveness of the naming and to guide further public awareness strategies. © 2010 Blackwell Publishing Asia Pty Ltd.link_to_subscribed_fulltex