Early intervention in schizophrenia patients: rationale for its implementation and practice

This review examines the clinical and theoretical evidence justifying early intervention in individuals with schizophrenia. Potential reasons for the previous lack of emphasis on early intervention are discussed. Interventions that target psychosis are distinguished from those that work on prodromal symptoms. It is suggested that early intervention programmes should try to reduce the duration of untreated psychosis. The relationship between this and outcome is discussed. Improving service accessibility alone may not be sufficient, and education and destigmatisation input may be required. Once a patient is identified, vigorous pharmacological and psychosocial interventions are important to improve the long-term clinical outcome. An effective early intervention programme for psychosis provides a basis for the future development of a prodrome intervention programme.published_or_final_versio

Transformation of a Metaphor: Semantic Shift in a Cantonese Term 'Chi Sin' Denoting Insanity

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Psychological Distance of Semantic Categorization in Schizophrenia

Organized as a Joint Meeting with the German Society of Neuropsychology (GNP)This study aimed to examine the psychological distance of categorization in schizophrenia. A cross-sectional design was adopted with a total of 187 patients with schizophrenia and 98 normal controls. Participants were asked to generate as many exemplars from within a semantic category as they could in 3 minutes. The categories selected for this study were “Animal”, “Means of Transport”, “Food” and “Furniture”. Analysis using the Rasch Model was undertaken. The findings indicated that the psychological distance, in terms of logits unit, was not at an equal interval within each category across the 3-min interval in both patients and healthy controls. The psychological distances between different categories were also found to be inconsistent in both groups. These preliminary findings suggest that we should not simply equate different category scores when we study semantic categorization. Such a simple “count” of categories may not sufficiently reflect the actual psychological distance perceived by patients and healthy controls. Future study should further examine a more representative and accurate measurement of semantic categorization.published_or_final_versio

Motor programs: an artificial neural network approach

It is commonly assumed that, during learning, the brain creates “motor programs” which store all the information essential to performing a motor skill. Yet there is still no consensus on what constitutes a motor program. In this study, a Multilayer Perceptron (MLP) network with one hidden layer, trained using the backpropagation rule, was used in an attempt to identify motor programs. Nine healthy subjects were asked to use their left hand to make fast and accurate movements in a tracking task of 75 identical steps, by either wrist flexion and extension, or the precision grip. The electromyogram (EMG) activity of 8 finger and hand muscles were simultaneously recorded by standard techniques. Onset timing of muscle activities were quantified from the digitized EMG signals, and were then used as the inputs to the MLP network. Reaction time was also measured, providing the desired output of the network. The trained network captured salient features of the relationship between EMG onset times and reaction time.published_or_final_versio

Coping with Illness Experiences in Patients with Schizophrenia: The Role of Peacefulness

Background: The relationship between spirituality and schizophrenia is a largely unexplored, yet important area of research in psychiatry given its role in recovery from mental illness and in long-term care. Peacefulness, as one of the primary consequences of spirituality, was found to be most prominently associated with the emotional well-beings. This analysis aims to explore the concept of peacefulness among schizophrenic patients and its effect on their illness experiences. Methods: Eighteen early-stage schizophrenic patients were recruited from the outpatient clinic of a hospital in Hong Kong for an in-depth individual interview. Data were analyzed with grounded theory techniques. Results: Peacefulness has an emotional component and a cognitive component. The participants described peacefulness as a carefree state of mind that consisted of an inner sense of tranquility (the emotional component) and perceived freedom (the cognitive component). Their illness experiences were a vicious circle that was formed and maintained by distress (negative emotions) and preoccupation (distorted cognition). They believed that an inner sense of tranquility (the emotional component) facilitated the regulation of their distress, leaving them more cognitive resources to stabilize their chaotic minds, whereas perceived freedom (cognitive component) created an intra psychic moment and space with no stress to free the patients from their preoccupation. Conclusion: Peacefulness is able to break the vicious circle of patient’s illness experiences by moderating distress and preoccupation. In addition, it may help promote patients’ personal resilience and self-efficacy, which are important for coping with residual symptoms, maintaining the patients’ mental health and preventing relapse.published_or_final_versio

Concepts of ‘self’ in delusion resolution

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Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study

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Cognitive and affective perspectives on formation and maintenance of grandiose delusions of a patient with schizophrenia

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Mild Reinforcement Learning Deficits in Patients With First-Episode Psychosis

Numerous studies have identified reinforcement learning (RL) deficits in schizophrenia. Most have focused on chronic patients with longstanding antipsychotic treatment, however, and studies of RL in early-illness patients have produced mixed results, particularly regarding gradual/procedural learning. No study has directly contrasted both rapid and gradual RL in first-episode psychosis (FEP) samples. We examined probabilistic RL in 34 FEP patients and 36 controls, using Go/NoGo (GNG) and Gain vs Loss-Avoidance (GLA) paradigms. Our results were mixed, with FEP patients exhibiting greater impairment in the ability to use positive, as opposed to negative, feedback to drive rapid RL on the GLA, but not the GNG. By contrast, patients and controls showed similar improvement across the acquisition. Finally, we found no significant between-group differences in the postacquisition expression of value-based preference in both tasks. Negative symptoms were modestly associated with RL measures, while the overall bias to engage in Go-responding correlated significantly with psychosis severity in FEP patients, consistent with striatal hyperdopaminergia. Taken together, FEP patients demonstrated more circumscribed RL impairments than previous studies have documented in chronic samples, possibly reflecting differential symptom profiles between first-episode and chronic samples. Our finding of relatively preserved gradual/procedural RL, in briefly medicated FEP patients, might suggest spared or restored basal ganglia function. Our findings of preserved abilities to use representations of expected value to guide decision making, and our mixed results regarding rapid RL, may reflect a lesser degree of prefrontal cortical functional impairment in FEP than in chronic samples. Further longitudinal research, in larger samples, is required.postprin

Subjective recovery in patients with first-episode psychosis in Hong Kong

Poster PresentationINTRODUCTION: The concept of recovery can be organized into two types: objective and subjective (1). Objective recovery is defined as the remission of clinical symptoms and improved everyday functioning, while subjective recovery is a personal understanding of recovery that varies individually. Understanding subjective recovery facilitates treatment adherence. The study aims to investigate the subjective determinants of perceived non-recovery to patients with first-episode psychosis in Chinese sample and the factors affecting subjective recovery ...published_or_final_versio