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

Cost of Community Care in for Dementia and Cognitive Impairment in Hong Kong Chinese: Social and Informal Care Time Analysis

Parallel Session 6 - Health Economics and Dementia Policy : no. OC032Background: Social care and informal care constitutes the largest amount of economic cost in the care of dementia. Using data from a comprehensive health and functioning assessment tool for community-dwelling elders in Hong Kong and staff time measurement, this study aims to investigate the cost of care for dementia in terms of care time, to inform rational social care resources allocation to support persons with dementia and their caregivers in the community. Method: The sample consists of 298 frail elders using community care service users aged 60 years or above in Hong Kong. Participants were interviewed using the interRAI Home Care 9.1 assessment form between May and August 2014. Data on the types and volume (in time) of formal social care and informal care used over 4 weeks were collected. Cognitive impairment was divided into seven levels according to the interRAI Cognitive Performance Scale. Availability of a dementia diagnosis was also recorded. Results: The sample had a mean age of 81 years. Total daily care time and the corresponding annual care cost increases from 2.5 ± 2.8 hours and HK$51,728 (US$6,632) among cognitively intact participants to 8.9 ± 3.1 hours and HK$187,145 (US$23,993) among those who are very severely impaired. One-third (35%) have a diagnosis of dementia, 14% have moderate cognitive impairment without a dementia diagnosis, and the remaining half (51%) having mild to no cognitive impairment. The three diagnostic groups used on average 5.8, 6.5, and 2.4 hours of social and informal care per day, respectively. Participants diagnosed with dementia used more formal care provided by supportive care workers than the other two groups ([F(5,288)=22.5, p=0.00; adjusted R2=0.27). The use of professional formal care services was comparable among the three groups. Discussion: Care time and costs increased more than three times with increasing levels of cognitive impairment. Frail elders with moderate cognitive impairment with or without a dementia diagnosis used comparable informal care, which is significantly higher than frail elders with mild or no cognitive impairment. Formal non-professional care may be more available to those with a diagnosis. Resources allocation to support community care of frail elders should take into account the substantial informal care cost for cognitive impairment regardless of dementia diagnosis

Effectiveness of Participatory Arts in Improving Cognition, Mood, and Psychological Well-being in Older Adults with or without Dementia: A systematic review

Poster Abstract - Non-Pharmacological Interventions: no. P027Objective: To conduct a systematic review of the efficacy participatory arts interventions on cognition, mood, and wellbeing in older adults with or without dementia. This study aims to provide insight on the potential benefits of different art forms on multiple mental health outcome domains to inform future application and intervention design. Design: Systematic review on randomized controlled trials and quasi-experiments of the effects of participatory arts on cognitive, mood, or psychological well-being in older adults (defined as age >60 yeas) with or without dementia. Method: We searched PsycINFO, PubMed, SpringerLink, JSTORE, Frontier, SAGE, Taylor and Francis, and Science Direct and identified 1,087 papers. A total of 20 studies were fulfilling our criteria were included in the analysis. Results: A wide range of participatory arts forms have been studied with different intervention design and outcome measurements. Dance appeared to improve attention and reaction. Theatre arts may benefit language-related word recall, reaction, and problem solving. Music showed an impact on memory and reaction. Participatory arts in general appeared to improve mood, although their effects on general psychological wellbeing is less robust. Conclusion: Participatory arts improve mood in older adults with or without dementia. Different art forms may have different cognitive benefits, possibly delivered through different mechanisms of change. These findings can be further developed into research studies and practices of targeted participatory arts interventions

Differential role of age, education, and lifestyle on cognition in late life

Parallel Session 13 - Risk Reduction and Risk Factors - no. OC073Background and Objectives: The reported risk reduction effect of higher education and more active lifestyle on cognitive decline has been hypothesized to reflect better cognitive reserve (CR). This study examined the association between age, education, lifestyle, and global cognition in community-dwelling elderly in Hong Kong, and further investigated whether and how the two proxies of CR, namely education and lifestyle, affected the elderly’s cognitive performance differently. Methods: One thousand eight hundred and twenty participants aged 65 and above, not clinically demented at the time of data collection, were recruited using age-stratification random sampling method through 11 public rental housing estates in Hong Kong. Participants’ basic demographic information including age, gender and years of education was collected; their engagement in physical, mental, and social activities was assessed; and their cognitive abilities were measured by the validated Cantonese Chinese Montreal Cognitive Assessment (MoCA). Hierarchical regression model and moderation analysis were performed to evaluate the association between age, education, lifestyle and cognition. Results: Age was negatively associated with cognitive performance (r =-.48, adjusted R2 =2.33, p < .001), while both higher education (r = .41, R2 change = .075, p < .001) and more active participation in social, physical, and mental stimulating activities (r = .11, R2 change =.01, p < .001) were positively associated with more favorable cognitive performance after controlling for age. There was a weak moderation effect of age on the relationship between education and cognition (R2 change =.01, p < .05) after controlling other independent variables, but not on that between lifestyle and cognition. Conclusions: Age, education, and lifestyle are all significant predictors of cognition among elderly over the age of 65 in Hong Kong. Higher education and more active lifestyle as proxies of better CR associate with better cognitive performance, and could potentially delay the onset of dementia. Age appears to have a modulating effect between early-life education and later-life cognition, but it does not affect the relationship between lifestyle and cognition in late life

Relationship of premorbid functioning with negative symptoms and cognition in first-episode schizophrenia: a three-year prospective follow-up study

Background: Premorbid adjustment is an important prognostic factor of schizophrenia. Numerous previous studies examined premorbid functioning as a unitary construct without further delineation into its sub-domains. Relatively few studies focused on first-episode population and the follow up periods were mostly within 1 to 2 years. We aimed to investigate the differential relationships of premorbid social and academic domains with symptoms and cognitions in first-episode schizophrenia-spectrum disorder over 3 years utilizing a prospective design. Methods: Ninety-three Hong Kong Chinese aged 18 to 55 years presenting with first-episode DSM-IV schizophrenia, schizophreniform disorder or schizoaffective disorder were examined using Premorbid Adjustment Scale (PAS), IRAOS, PANSS, HEN1 and a battery of cognitive assessments. Psychopathological and cognitive evaluations were conducted at baseline, clinical stabilization after first-episode, 12, 24 and 36 months. Subjects were categorized into three groups based on the classification method of Haas & Sweeny (1992). Following the same procedure, yet due to small size of deteriorating group, subjects were divided into two groups, namely good and poor premorbid groups (combining stable-poor & deteriorating groups) with respect to academic and social premorbid functioning. Results: There was no significant difference among PAS groups in sociodemographics, duration of untreated psychosis (DUP), baseline symptomatology and cognitive functions, and treatment characteristics. Repeatedmeasures ANOVAs (5 time points × 3 PAS groups) revealed significant between-subject main effect of premorbid adjustment typology on total negative symptom score (HEN total score; F=4.1, p<0.05) and HEN Diminished-Expression2 (DE, F=4.4, p<0.05), but not HEN Avolition-Asociality (AA)2 scores and cognitions over 3 years. Concerning social functional dimension, repeated-measures ANOVAs (5×2 groups) showed that poor-premorbid group had significantly higher HEN total (F=5.2, p<0.05), DE (F=4.5, p<0.05) and AA (F=5.5, p<0.05) scores than goodpremorbid group, and the results remained significant even when DUP was added as covariate for further analysis. No significant differences between two groups in cognitions were observed. Regarding academic dimension, good-premorbid group was associated with female sex (chi-sqaure=5.1, p<0.05), higher educational attainment (t=1.7, p<0.01), and superior performnace on verbal fluency (F=3.9, p=0.05), logical memory (F=4.2, p<0.05) and WCST perseverative error (F=5.8, p<0.05) over 3 years as revealed by repeated-measures ANOVAs (5×2 groups). Results on WCST perseverative error remained significant when sex, educational level and DUP were controlled for. No significant difference on negative symptom level between two groups was noted. Discussion: In a Chinese cohort of first-episode schizophrenia-spectrum disorder, we found that premorbid social functioning was associated with severity of negative symptoms while poorer academic adjustment was related to male sex, lower scholatsic achievement and worse cognitive functioning. The current findings thus lend support to the differential patterns between social and academic dimensions of premorbid functioning in relation to demographics, symptom manifestations and cognitive impairment in the initial 3 years of first-episode schizophrenia

Predictors of relapse in early psychosis: a 3-year retrospective chort study in Hong Kong

Congress Theme: Yin and Yang of Mental Health in Asia - Balancing PolaritieRegular Symposium 2.2 – Early Psychosis: no. RS2.2.3OBJECTIVE: Relapse prevention is one of the most important and challenging targets in the treatment of psychotic disorders. However, apart from medication discontinuation, consistent relapse predictor has not been identified. We aimed to investigate relapse predictors in a large cohort of patients with first-episode psychosis. METHOD: This was a retrospective cohort study designed to evaluate relapses in first-episode psychosis patients in 3 years. A total of 1,400 patients’ case records were retrieved from a hospital database. Potential relapse predictors including demographic variables, baseline clinical measures, medication adherence, and residual positive symptoms upon clinical stabilisation were collected. RESULTS: The cumulative relapse rates were 19.3% by year 1, 38.4% by year 2, and 48.1% by year 3. Multivariate Cox-proportional hazards regression analysis revealed that medication non-adherence, smoking, schizophrenia diagnosis, younger age, and shorter baseline hospitalization were associated with an increased risk of relapse in 3 years. CONCLUSIONS: Nearly half of the patients relapsed after 3 years following their first-episode psychosis. Smoking as a predictor of relapse is an intriguing new finding supportive of a link between nicotinic receptors and the dopamine system. Their relationship deserves further investigations with potential clinical implications for relapse prevention in psychosis.link_to_OA_fulltex

Predictors of help-seeking duration in adult-onset psychosis in Hong Kong

Purpose: Delay in receiving treatment in psychosis may lead to adverse consequences. We examined the predictors for help-seeking duration in adult-onset psychosis Chinese patients in Hong Kong. We hypothesized that factors which are more related to the illness manifestation would be predictive of waiting time before any help-seeking initiation, and factors which are more related to one's knowledge about mental health services would be predictive of help-seeking duration. Methods: First-episode patients with psychosis were recruited from the Jockey Club Early Psychosis project. They were asked to report retrospectively all help-seeking behaviors involved since their first occurrence of psychotic symptoms until receipt of effective psychiatric treatment. Baseline characteristics, pre-morbid functioning and traits, and mode of illness onset were assessed. Results: Help-seeking pattern was analyzed in 360 patients who had subsequently reached the psychiatric services. They had an average of 2.5 help-seeking contacts. Nearly half of the first help-seeking process was initiated by family members. Only 1 % approached priests or traditional healers as the first step in help-seeking. Whereas a gradual mode of onset was significantly associated with longer waiting time to first help-seeking initiation, more premorbid schizoid and schizotypal traits and a migrant status were related to longer help-seeking duration. Conclusions: Current findings suggested that family members were the key decision makers in initiating help-seeking. Longer help-seeking duration in migrants has significant implications to both local and global mental health policy. © 2013 Springer-Verlag Berlin Heidelberg.link_to_subscribed_fulltex