The Effect of Paternal Age on Relapse in First-Episode Schizophrenia

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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

Positive symptoms and white matter microstructure in never-medicated first episode schizophrenia

Author name used in this publication: V. Cheung2010-2011 > Academic research: refereed > Publication in refereed journalVersion of RecordPublishe

Yoga and aerobic exercise in early psychosis: neurocognitive effects and brain changes of a novel clinical strategy

Session: Cognitive neuroscience: FC-09 Free Communications: no. FC-09-006OBJECTIVE: The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive functioning and clinical symptoms for female patients in the early phase of psychosis. We further propose to investigate potential mechanism underlying the clinical consequences. METHOD: 120 female early psychosis patients were recruited from three hospital/clinic sites and randomized into integrated yoga, aerobic exercise, and control groups. 82 patients completed the 12-week study (29 in yoga group, 25 in exercise group, and 28 in control group). Both interventions were held three times weekly, with each session lasted for an hour. All ...postprin

The impacts of yoga and aerobic exercise on neuro-cognition and brain structure in early psychosis: a preliminary analysis of the randomized controlled clinical trial

This journal suppl. entitled: Abstracts of the 3rd Biennial Schizophrenia International Research ConferenceCognitive impairment was detectable in early psychosis together with a decreased hippocampal volume (Wright et al., 2000). These cognitive deficits of attention and memory often result in severe and longstanding functional impairment. Reducing cognitive impairment with pharmacological intervention has not been universally successful (Addington, 2007). The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive functioning and brain structure for female patients in the early phase of psychosis. We further propose to investigate potential differential effects of these two forms of exercise. 61 female early psychosis patients were recruited from two hospital/clinic sites and randomized into aerobic ...postprin

Social anxiety and ideas/delusions of reference in early psychosis

Background: Social anxiety disorder (SAD) is increasingly recognized as a comorbid condition in early psychosis. Putative explanations include SAD as a psychological response emerging during recovery, a component per se or vulnerability marker for psychosis. Alternatively, it could also be an epiphenomenon of conceptually related symptoms, such as subthreshold suspiciousness and ideas/delusions of reference (I/DOR). This study describes the relationships between SAD and psychotic symptoms in stable patients. Methods: A consecutive sample of 137 outpatients with early psychosis was interviewed using the Liebowitz Social Anxiety Scale (LSAS) and an I/DOR scale validated in Hong Kong Chinese. General symptoms were rated by patients' attending psychiatrists using the Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia and Scale to Assess Unawareness of Mental Disorder. SAD was defined using LSAS cutoff as previously described. Results: SAD was found in 45.3% of outpatients. Compared with patients in remission (defined using PANSS criteria, n = 106), SAD is more prevalent (39.6% vs. 64.5%) and severe (LSAS 28.7 vs. 44.1, both p = 0.01) in symptomatic patients (n = 31). LSAS correlated with all dimensions of the I/DOR scale. Patients with existing I/DOR are more likely to be socially anxious (OR 3.8, p = 0.00) and scored higher on LSAS (mean, 42.2) than those who no longer (28.3) or have never experienced I/DOR (26.9). Specific positive symptoms associated with social anxiety are PANSS suspiciousness (r = 0.28) and SAPS I/DOR (r = 0.31, both p < 0.01) but not other delusions or hallucinations. Insight is not associated with SAD. Conclusions: SAD is more common and severe in symptomatic than remitted outpatients. It covariates with I/DOR, and is not affected by insight. Results suggest that SAD could be understood as closely related to I/DOR. Whether this relationship is correlational or epiphenomenological will require further exploration

Ideas/delusions of reference: development and validation of a new rating scale

Background: Recent emphasis on a symptom dimension and continuum approach in understanding psychosis has resulted in a need for more refined description of common psychotic symptoms. While Ideas/delusions of reference (I/DOR) were reported in two-thirds of schizophrenic patients, not much is known beyond this earlier observation. This descriptive study provides more details. Methods: Structured interviews were conducted in a consecutive sample of 137 outpatients with early psychosis by trained raters using an I/DOR scale validated in Hong Kong Chinese. General symptoms were rated by patients' psychiatrists using Positive and Negative Syndrome Scale (PANSS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia and Scale to Assess Unawareness of Mental Disorder. Results: During the study period, I/DOR was present in 43 cases and subsided in 47, giving a point prevalence of 31.4% and a prevalence of 65.7%. It is equally represented in both sexes, across diagnoses and sociodemographic factors. I/DOR is associated with auditory hallucination, persecutory delusions and circumstantiality in SAPS (r = 0.39, 0.28 and 0.34), impersistence at work/school and inability to feel intimacy and closeness in SANS (r = 0.26 and 0.25), and depression (r = 0.24; all p < 0.01). Insight was not affected. The most commonly reported themes were “being talked/laughed at” (73% of I/DOR cases), “being followed” (30%), “being gazed upon” (29%) and “being depicted in mass media” (28%). Of note, 17% (18/106) of remitted patients (defined using PANSS criteria) were currently experiencing IOR. Conclusions: Our study confirmed previous prevalence findings. I/DOR is a common experience in early psychosis, unexplained by individual patient characteristics. It covariates with a number of positive and negative symptoms, but does not affect insight. Patterns of association between individual I/DOR themes and psychotic symptoms are explored. This study suggests possible directions for future pathogenesis studies. Implications of subthreshold I/DOR in remitted patients despite otherwise adequate disease control also call for attention