Early intervention for psychotic disorders: Real-life implementation in Hong Kong

Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education. © 2012 Elsevier B.V.postprin

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

Emergency department triage: an ethical analysis

<p>Abstract</p> <p>Background</p> <p>Emergency departments across the globe follow a triage system in order to cope with overcrowding. The intention behind triage is to improve the emergency care and to prioritize cases in terms of clinical urgency.</p> <p>Discussion</p> <p>In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a <it>comprehensive </it>ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.</p> <p>Summary</p> <p>We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.</p

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

Attitudes, knowledge, and actions with regard to organ donation among Hong Kong medical students

Objective: To study attitudes, knowledge, and actions of local medical students with regard to organ donation and self-perceived confidence and competence in approaching potential organ donors. Design: Cross-sectional questionnaire survey. Setting: Faculty of Medicine, The University of Hong Kong, Hong Kong. Participants: Medical students, years 1-5. Main outcome measures: Knowledge on various aspects of organ donation was assessed, and students' self-evaluated competence and confidence about counselling for organ donation was evaluated. Factors influencing attitudes and actions were determined. Results: The response rate was 94% (655/694). A majority (85%) had a 'positive' attitude, but only a small proportion (23%) had signed the organ donation card. Inconvenience and lack of knowledge about organ donor registration, and concerns about premature termination of medical treatment accounted for such discrepancies. Socio-cultural factors such as the traditional Chinese belief in preservation of an intact body after death, unease discussing death-related issues, and family objections to organ donation were significantly associated with a 'negative' attitude. Knowledge and action increased with medical education yet only a small proportion of medical students felt competent and confident in counselling patients on organ donation. Conclusions: The medical curriculum should increase medical students' awareness of the organ shortage problem. The donor registration system should be made more convenient and public education is recommended to correct misconceptions.published_or_final_versio

Gender differences in patients presented with first-episode psychosis in Hong Kong

Poster 232BACKGROUND: Gender differences have been observed in psychotic disorders in terms of premorbid adjustment, illness onset, symptomatology, course and outcome. Most studies focused on schizophrenia and the samples examined were mainly recruited from subjects with chronic illness in inpatient setting. Few studies have evaluated gender differences of functional psychosis encompassing various diagnostic categories at its early illness stage in a representative sample. Thus, the aim of this study was to investigate gender differences in a treated sample of patients with first-episode psychosis. METHODS: Seven hundred (male, n = 360; female, n = 340) subjects aged 15-30 years consecutively enrolled in a territory-wide first-episode psychosis treatment program in Hong Kong from 1st July 2001 to 31st August 2003 were studied. Socio-demographic data, baseline and follow-up clinical variables, and treatment and service utilization characteristics were collected via systematic medical records review. CGI severity of illness (positive, negative and affective symptoms) and SOFAS (social functioning) were retrospectively employed on case notes in each month across the whole three-year follow-up period. Gender differences at entry and outcome were examined. RESULTS: At service entry, females had significantly longer median duration of untreated psychosis (p < 0.001). achieved higher educational level (p < 0.01) and were less likely to be a smoker (p < 0.001). Males experienced more negative symptoms (CGI, p = 0.01) and lower level of affective symptoms (CGI, p < 0.01) at baseline. No gender difference was observed in age at first presentation, age at onset of psychosis, mode of onset, baseline functioning, pre-service substance abuse and suicidal attempt. In three-year follow-up period, males had significantly more severe negative symptoms (CGI, p < 0.001) and less affective symptoms (CGI, p < 0.01), and were more likely to commit violence (p < 0.01) and to have comorbid substance abuse (p < 0.01). Females had significantly better functioning than males in follow-up interval (SOFAS, p < 0.001) and more females than males were employed in second (p < 0.01) and third year (p < 0.01) of follow-up. There was no gender difference noted in numbers and total length of psychiatric hospitalizations, numbers of relapses, service disengagement, suicidal attempt and severity of positive symptoms. DISCUSSION: Gender differences were evident in the early phase of functional psychosis since the illness onset. Males were found to have lower premorbid educational attainment, more prominent negative symptoms and less severe affective symptoms at baseline and along the course of illness, less favourable outcome with poorer psychosocial functioning and more comorbid substance abuse than females in first-episode psychosis sample. More research should be conducted to better elucidate the interplay between biological and psychosocial factors contributing to gender differences of psychotic disorders with respect to illness manifestation and trajectory. Clinically, differential needs between men and women and gender-specific therapeutic strategies need to be considered in early intervention service for first-episode psychosis

Gender differences in patients presenting with first-episode psychosis in Hong Kong: A three-year follow up study

Objective: The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. Methods: A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. Results: At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p < 0.001), fewer affective symptoms (p < 0.01), more violent behaviour and forensic records (p < 0.01), and higher rate of substance abuse (p < 0.01). Women achieved higher levels of functioning than men (Social Occupational Functioning Assessment Scale (SOFAS), p < 0.001) and a significantly higher proportion of women than men engaged in full-time employment or study for at least 12 consecutive months (p < 0.001) in the initial three years after psychiatric treatment. Conclusion: Notable gender differences in clinical profiles, illness trajectory and functional outcome were demonstrated in Chinese young people suffering from first-episode psychosis. Differential needs between men and women and hence gender-specific therapeutic strategies should be considered in early intervention service. © 2011 The Royal Australian and New Zealand College of Psychiatrists.link_to_subscribed_fulltex

Duration of untreated psychosis: Relationship with baseline characteristics and three-year outcome in first-episode psychosis

Duration of untreated psychosis (DUP) has been considered as one of the few potentially malleable prognostic factors in psychotic illness. The literature demonstrated that prolonged DUP predicted the level of positive symptoms, but its relationships with negative symptoms and functional outcome were less clear-cut. Thus far, most first-episode studies have been conducted in western countries. Yet, it is known that illness outcome might be modified by socio-cultural factors. In this study, we aimed to examine the impact of DUP on baseline characteristics, clinical and vocational outcomes over 3 years in 700 Chinese young people who presented with first-episode psychosis to a specialized early intervention service in Hong Kong. Our results showed that prolonged DUP was associated with male sex, younger age of onset, schizophrenia-spectrum diagnosis, insidious development of psychosis, fewer baseline positive symptoms and less likelihood of hospitalization at intake. Regression analyses revealed that prolonged DUP was significantly predictive of outcome on positive symptoms, recovery and sustained full-time employment in our first-episode psychosis cohort. Taken together, our study provided further supportive evidence regarding the prognostic value of DUP on illness outcome. Additionally, it suggested that an adverse impact of treatment delay for psychosis may likely be applied across regions of various ethno-cultural backgrounds. © 2012 Elsevier Ltd.link_to_subscribed_fulltex

Outcome of an early intervention programme for psychosis (EASY)

This journal suppl. entitled: Special Issue: 6th International Conference on Early PsychosisConference Theme: Early Intervention - The Next WavePoster abstract: no. PO169Early Intervention Services for Psychosis (EI) is an increasingly adopted approach to improve the outcome for psychotic disorders. The EASY (Early Assessment Service for Young People with Psychosis) programme in Hong Kong is one of the first in Asia. Comparison to a matched control group under standard care showed that EI patients had fewer days in hospital, better functional outcome, lower likelihood of disengagement from service, and less aggressive behaviour, completed suicides or suicide attempts. No significant difference was found for relapses and the duration of untreated psychosis (DUP) suggesting that in Hong Kong, the improved outcome was not mediated by these two variables. The present study suggests that early psychosis programme in Hong Kong is successful in improving the 3-year outcome of psychotic disorders. The effect appears to be attributable to improved intervention rather than to a reduction of DUP, relapses or atypical medication