published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Pathology congruent information-processing biases, the tendency for the information processing system to consistently favour materials whose content corresponds to the pathology’s symptoms and concerns, had been found to be implicated in the aetiology and maintenance of multiple clinical disorders, with ample research established in emotional disorders. Relatively, little work had been done on psychosis, in which research to date on biased interpretation mainly focused on interpretation of auditory hallucinations and the associated distress. The aim of the current study was to evaluate the effects of pathology congruent interpretation bias in paranoia on the prediction of psychosis proneness, the subclinical manifestation of psychosis phenotypes. Cross-sectional data on biased information processing and psychosis proneness were collected from 154 individuals recruited in the normal population via cognitive and self-report measures. A series of hierarchical regression analyses were performed and results suggest that negative information processing bias significantly contributes to the prediction of psychosis proneness. There is also evidence that interpretation bias plays a mediating role in the prediction of psychosis proneness only when the direction of bias was congruent to the pathology’s symptoms and concerns. The discerned mediating role of pathology congruent interpretation bias contributes to the understanding of the mechanisms underlying psychosis proneness. Its clinical implications in terms early identification and target for intervention are further discussed. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Thèse Médecine Paris, 1901, n°367.

Reproduction de : Thèse de doctorat : Psychologie : Lyon 2 : 2006. / Titre provenant de l'écran-titre. Bibliogr.

Aggressive behavior has been repeatedly observed in patients with schizophrenia and related psychotic disorders. However, there is little known about the underlying psychological mechanisms, especially the role of social cognition, in contributing to the exhibition of aggression. The aim of this study was to investigate whether aggression was associated with theory of mind (ToM) deficiency and the presence of hostility bias. Thirty individuals with a DSM-IV-TR diagnosis of schizophrenia or other psychotic disorders were asked to complete the Faux Pas Recognition Test, the Ambiguous Intentions Hostility Questionnaire, and the Conflict Tactic Scale. Results suggested that psychotic patients with predominately referential or persecutory delusions were more susceptible to theory of mind anomalies and hostility bias, and had a higher frequency of the demonstration of aggressive behavior relative to patients with auditory hallucination and remitted patients. Correlational analysis revealed significant associations among ToM, hostility bias, and aggression. Multiple regression analyses showed that hostility bias was neither a mediator nor a moderator in the relationship between ToM and aggression. The present study provided preliminary evidence that social cognition and social-cognitive attributional styles are related to the demonstration of aggressive behavior. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Objectives Medication adherence is one of the most important aspects of the treatment plan for successful recovery of patients with psychosis. Medication non-adherence leads to increased relapse rate, risk of violence, symptom severity, hospitalization, and suicide risk; reduced mental function and life satisfaction; as well as increased economic burden to society. The aim of this study was to examine the predictors of medication adherence for first-episode psychosis patients in a three-year retrospective cohort study. Methods The retrospective cohort study evaluated the potential predictors of medication adherence over 3 years in first-episode psychosis patients. Patients having a good adherence rating (1 or 2 on a 4-point scale) for 8 months or more were categorized into the good adherence group for that year. Patients having a poor adherence rating (3 or 4 on a 4-point scale) for 5 months or more were categorized into the poor adherence group for that year. Potential predictors for medication adherence were gender, age, years of education, migration, occupation impairment, premorbid functioning, duration of untreated psychosis, mode of onset, diagnosis, hospitalization at first presentation, positive, negative and depressive symptoms at 1 month, stressful life experiences, and early intervention. The dependent variable was medication adherence by the patient. Binary logistic regression analyses were performed to explore predictors for non-adherence at 1, 2 and 3 years. Results Among the 1400 patients recruited into the study, non-adherence rates were 15.7% (190/1208) at year 1, 15.3% (171/1115) at year 2, and 12.1% (125/1029) at year 3. From the logistic regression analyses, suicide attempt at baseline (p=0.027, OR=2.233) and mode of onset (p=0.035, OR=1.583) were found to be predictors of poor medication adherence at 3 years following the first episode. Common significant predictors were identified at year 1 and year 2. Standard care (p=0.000, OR=2.332), hospitalization at baseline (p=0.001, OR=2.095), stressful life event (p=0.015, OR=1.567), migration status (p=0.048, OR=1.472), more years of education (p=0.024, OR=1.084), lower positive symptom severity (p=0.001, OR=1.372) and paranoid schizophrenia (p=0.043, OR=1.444) were found to be predictors of poor medication adherence in the two years following the first episode. Conclusions It is clear from our study that early intervention comprising an individualized care plan enhanced medication adherence, but these benefits lasted only until the treatment ended. It is recommended that the early intervention service should be extended to 5 years and include patient-centred interventions for high-risk patients: an adjustment and adaptation programme for immigrants (specifically new immigrants to Hong Kong); a stigma reduction programme for teenagers; psychotherapy, group therapy and individual counseling for patients who have experienced stressful life events or attempted suicide; and sustained education on medication adherence for acute and sub-acute onset patients. These strategies of intervention tailored to the individual could be introduced to improve medication adherence in psychosis patients. Further studies on medication predictors including insight level, side effects of medication, social support level, level of premorbid intelligence and therapeutic relationships, could identify potential predictors of medication adherence, which can be targeted to reduce relapse, decrease hospitalization and reduce the cost to society. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Introduction: Patients of schizophrenia experienced a cluster of symptoms known as psychosis, which were concurrent phenomena presented across multiple psychopathological dimensions, among which hallucination was one of the principal features. Auditory verbal hallucination (AVH) was the most common among other modalities (i.e. visual, olfactory, gustatory and tactile) of hallucinations and was said to occur when audible voices were heard without presence of corresponding stimuli. There were two main neurocognitive hypotheses on the underlying mechanism of the occurrence of AVH, namely the inner speech hypothesis and the top down processing hypothesis. Existing descriptive psychopathology studies were not guided by any theoretical frameworks. This study was the groundwork to examine experiences of AVH as described by patients with psychosis and other psychiatric conditions based on these two major hypotheses. Method: This study was a retrospective case series. Comprehensive searches of AVH cases were done on biomedicine and psychology databases, in which case reports, case studies and studies with detailed descriptions of phenomenology of AVH with various aetiologies, a total of twenty cases, were selected. Four in-depth qualitative interviews were also conducted with psychosis patients for in-depth understandings of their AVH phenomena experiences. Result: Three specific features from the two neurocognitive hypotheses were identified. (1) Form of address, (2) linguistic complexity, and (3) command hallucinations were likely interpreted by inner speech hypothesis; whereas (1) single theme and repetitive contents, (2) relations with past experience/knowledge/perceptual expectations, and (3) congruent moods were likely interpreted by top down processing bias hypothesis. Discussion: This study has categorized AVH phenomena from twenty literature cases and four in-depth qualitative interview cases by specific features of the two mainstream hypotheses; and commented on each of the specific features on their relevancies to the two mainstream hypotheses. Conceptualisation of underlying neurocognitive mechanisms could made taxonomy easier, and as a result benefit clinical staging, better prediction of prognosis and better communications with patients and their families. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Hospitalization was one of the most important variables to study in patients of first-episode psychosis. Many literatures had done in the past to predict hospitalization in western countries, yet, little was done in Asian countries. In this study, the author aimed to examine the variables associated with hospitalization in seven hundred Chinese young people presented with first-episode psychosis to a specialized early intervention service in Hong Kong; the variables for examinations were mainly consisted of baseline characteristics and clinical variables such as socio-demographics, duration of untreated psychosis (DUP), age of onset, mode of onset, types of diagnosis and past history of suicide attempt. In comparison with patients who were admitted in the 3-year period EASY service, those who were never admitted during the service period were more likely to have higher educational attainment, older age at entry of the service, had insidious onset, longer DUP, unlikely to have suicide attempt history and were diagnosed with non-schizophrenia spectrum disorder. When comparing patients who were only admitted once during those three years with patients who were admitted more than once, patients admitted only once were more likely to be older age at entry of the service, have longer DUP and unlikely to have suicide attempt history. Regarding the 3-year outcome comparison between patients who were admitted voluntarily and compulsorily in the first month of the EASY program, voluntarily admitted patients were found to have more affective symptoms and shorter duration of initial admission; they were also found to have shorter duration of total hospitalization even after controlling patient’s age at onset, age at entry and length of initial admission. Results from the current study can shed some light on the predictors of hospitalization of first-episode psychosis patients in Hong Kong. Further researches are needed in order to have a more comprehensive picture regarding hospitalization. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Objectives: Public stigma has been identified as a major obstacle for the recovery process of persons suffering from psychosis. Psycho-education to the public is suggested to be effective in enhancing public knowledge and understanding of patients with psychosis. It claims to be an effective way to reduce discrimination against and the labelling effect on mentally ill patients. However, there is a lack of understanding on the relationship between knowledge and attitudes. The current study aims at evaluating the relationship between public knowledge and public attitudes on persons with psychosis; and at identifying how violence factor influences the public attitudes. The implications of the findings for planning a psycho-education programme are discussed. Method: Subjects (n=81) were recruited from public health talks on psychosis organized by the Jockey Club Early Psychosis Project (JECP). General knowledge about psychosis was assessed with a modified multiple-choice questionnaire, Knowledge about Schizophrenia Test (KAST). Two hypothetical descriptions of two patients with psychosis were designed, with one of the descriptions associated with violent behaviour and the other without. Subjects rated their willingness to interact with the hypothetical patients using a 19-item social distance scale. Other assessments included subjects’ previous contact with patients of psychosis and their history of working in the medical field. Results: The overall level of knowledge about psychosis of subjects was good. Subjects at an older age were associated with better knowledge of psychosis. No correlation was found between overall knowledge and attitudes. However, subjects having better knowledge in Cause of KAST were correlated with less rejecting attitudes towards patients of psychosis. The current study has identified that violence is a significant factor that influences the attitudes of subjects. Significant rejecting attitudes were found in violence vignette as compared to non-violence vignette. Female subjects were found having significantly higher rejecting attitudes towards patients of psychosis with violent behaivour. Previous contact with patients and history of working in the medical field found no correlation with attitudes in this study. Conclusion: The current study suggests that violence factor has a significant correlation with attitudes towards patients of psychosis. The rejecting attitudes influenced by the impression of violent behaviour of patients with psychosis are likely difficult to be removed. The labelling and stigmatizing effect on patients with psychosis through sensational description of violence by mass media is considered influential. Mass media should acknowledge their crucial role by stopping news reports using sensational, dramatic descriptions on violent incidences of mentally ill patients. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine