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

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

Background Non-adherence at psychiatric out-patients clinics has serious impact on clinical and economic outcomes. It is costly to both health care systems and the patients. This study aimed to examine the predictors of treatment adherence in a group of patients with first episode psychosis in Hong Kong. Methods Thirty five patients with psychosis underwent assessment for prospective memory, insight and social support at baseline. Clinical symptoms were also measured. Linear regression was used to identify predictors of treatment adherence at baseline. Actual medication adherence was assessed three months later and multiple linear regression models were used to identify predictors of non-adherence. Results The effects of independent variables age, gender, number of psychiatric hospitalization, and prospective memory were no statistically significant to treatment adherence. But educational level, insight and social support were showed positive correlation with treatment adherence. Conclusions The study demonstrates that treatment adherence is associated with level of education, insight and social support system. These factors are important to assess when trying to estimate the degree of medication adherence and its relationship to clinical presentation. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Psychological distress aroused by stigma may lead to impairments in attentional functioning because it calls attention to the experience of stigma-related stress. Very few studies have actually considered whether stigma could disrupt attentional functioning by serving as distractors with emotional valence in the schizophrenia spectrum, given that there is a possible dysfunctional affective system in response to processing of emotional information. This research employed the paradigm of emotional Stroop task and attentional probe task to investigate how stigma impacts on the functioning of selective attention. The primary objective of this current study was to investigate how selective attention, as measured in terms of reaction time and accuracy, can be disturbed by stigma-related stimuli in schizophrenia patients. The secondary objective of this study was to test the assumption that schizophrenic patients with higher sensitivity towards stigmatization will demonstrate higher impairment of selective attention in relation to stigma-related stimuli, since they may display more intense negative emotions than patients with lower sensitivity. For emotional Stroop task, two categories of stimuli, including stigma-related words (emotional arousing to schizophrenic patients), furniture-related words (neutral stimuli) were shown in different colors and the subjects were instructed to name the color of words as fast and as accurate as possible. For attentional probe task, a stigma-related word was paired up with a furniture-related word in each trial. Participants had to respond as soon as they detect the dot in the position previously occupied by the words. Two groups of participants, healthy controls (N = 40) and patients with schizophrenia-related disorders (N = 40) were compared regarding their performances on emotional Stroop task and attentional probe task. The patients were further split into two groups; high-sensitivity towards stigma (N = 19) and low-sensitivity towards stigma(N = 18),for comparison on various variables, like level of symptoms, depression, medical adherence and awareness of mental disorders. Based on the group comparison of performance on emotional Stoop task, schizophrenic patients exhibited significant emotional interference with the presentations of stigma-related words when compared with the healthy controls. Although the group comparison of performance on attentional probe task did not provide a significant result, schizophrenic subjects obtained higher difference scores which indicated that they were in general displayed more attentional bias towards stigma-related stimuli as compared to furniture-related stimuli. Both emotional Stroop and attentional probe task results show that schizophrenia patients in high-sensitivity subgroup demonstrated the greatest effect of emotional interference with the presentations of stigma-related words. Level of emotional interference for stigma-related stimuli in schizophrenic patients was moderately correlated with the measure of positive symptoms severity, and patients in high-sensitivity group had a significantly higher mean depressive symptoms score than patients in low-sensitivity group. Such information might help to identify potential risk factors and lead to improved treatment and prevention strategies for psychotic patients. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Objectives: The study investigates the effects of different Chinese translations for psychosis on perceptions of youth service providers. The hypothesis is youth service providers believe that to have better understanding and acceptance in name si-jue-shi-tiao rather than others. Participants and methods: 100 youth service providers were recruited and interviewed with 34-item questionnaires. They were presented with a vignette describing a person with jing-shen-fen-lie-zheng/ si-jue-shi-tiao/ jing-shen-bin. Belief of cause, benevolence, separatism, stereotyping, restrictiveness, pessimistic prediction and stigmatization of different labeling were investigated. Results: The study found that si-jue-shi-tiao group has less stigmatization effect compared with jing-shen-fen-lie-zheng group and Jing-shen-bin group but the psychiatric labeling has no statistically significant effect on benevolence, separatism, stereotyping, restrictiveness, pessimistic prediction. Conclusion: The study supported renaming psychosis has an improvement on stigmatization, but not obviously seen to have improvement in the other attitudinal dimensions. People who have religious belief, profession in occupation, having previous contact with people (e.g. friend and client) who have mental illness indeed affected to have positive effect on their views towards person with psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Patients with psychosis comprise a high-risk group in terms of suicide behaviors especially in the early phases. Suicide ideation on the other hand acts as the starting point along the chain of suicide. However less is known about suicide ideation among patients at their first-episode psychosis (FEP). Present study investigated contributing factors in suicidal ideation among FEP patients in Hong Kong. FEP outpatients (N=20) and normal controls (N=20) were invited to complete a set of self-assessment questionnaires. These questionnaires measured a wide range of potential risk factors including hopelessness, impulsiveness, reasons for living, insight, drug-attitude and treatment satisfaction. Results showed that patients have a higher occurrence-rate of suicide ideation (45%) compared to patients without ideation. Ideators were significantly more hopeless, impulsive, more aware of their illness and having fewer survival & coping beliefs. Taken together, current study extended the stress-diathesis model in explaining suicidal behaviors among psychotic patients. We also demonstrated that insight in patients plays a role in interacting with suicide ideation. Further, since hopelessness appeared to be the strongest associative factor among all, this study has implications on prevention work focusing on hope maintenance. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

published_or_final_version / Mental Health / Master / Master of Social Sciences

Background Early interventions (EI) for psychosis are predicted to have an effect in reducing suicidal attempts and self harms for first episode psychosis (FEP) patients. However there is little evidence to reveal that early intervention has a long term effect in reducing suicidal behaviors. Also, the longitudinal patterns of suicidal behavior of patients under EI and standard care (SC) programme were remained unclear. Therefore, this study was performed to explore the longitudinal pattern of suicidal behaviors for EI and SC patients. The long term effect of EI in reducing suicidal attempts and self harms and possible predictors for suicide were also explored and analysed. Method A secondary analysis was performed with data retrieved from medical data in different hospitals. The data are matched up for SC patients and EI patients based on their demographic information. Data related to suicidal behaviors are collected. Longitudinal patterns of suicidal behaviors were analysis with generalized linear model (GENLIN) and descriptive analysis. Univariate regression was also performed to investigate predictors for suicide. Results EI has a significant effect in reducing the total number of suicidal attempts (X^2=5.779, p=0.016) and deliberate self harm (X2=7.817, 0.005) over 10 years but no effect on suicidal attempts in the first three year when effect was expected. However, data indicated EI has an effect of reducing the number of complete suicide. Patients do not receive EI is a significant predictor for increase in the suicidal attempts and younger age is a predictor for latter deliberate self harm behaviors. Conclusion The result demonstrated that EI has a long term effect in reducing suicidal behavior rather only short term and non-lasting effect as suggested by other researches. However, EI treatment might have a short term negative effect on suicidal ideations as suggested by the increase of suicidal attempts in the second and third years. EI services do not only improve in symptoms and quality of life but a long term effects in reducing the number suicidal behaviors. Although, there is a possible negative effect on suicidal attempts, it might be beneficial if EI programme can be apply to all psychotic patients. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

Objective: The aim of the current study was to investigate the differences in baseline characteristics and three-year outcomes between two diagnostic categories with presentation of first-episode psychosis: bipolar affective disorder (mania with psychotic features) and schizophrenia. The comparison was based on pre-treatment characteristics, clinical presentation, symptomatic and functional outcomes, and engagement in risk behaviours. Methods:461 schizophrenic patients and 54 bipolar affective disorder (BAD) patients between the ages of 15 to 25 years from a local first-episode psychosis treatment program within the years2001 to 2003 were studied. Researchers collected detailed data on baseline and three-year follow up variables from systematic medical file review for statistical analyses. Results: At service entry, compared to schizophrenic patients, bipolar affective disorder(BAD)patients exhibited more prominent positive symptoms (p = 0.01), were younger at first presentation and had a higher unemployment rate (p < 0.01), were more likely to have acute onset of psychosis, shorter duration of untreated psychosis (DUP), a higher rate of hospital admission within first month after initial contact, and lower pre-treatment functioning (Social and Occupational Functioning Assessment Scale (SOFAS), p < 0.001). There was no significant difference in gender, education level, age of onset and pre-treatment risk taking behaviours. After applying univariate analysis of variance (ANCOVA)by controlling baseline variables that showed significant differences, the three year follow up reveals that schizophrenic patients displayed fewer numbers of hospitalization (p <0.01)with no difference in the total length (days) of hospitalization, more prominent positive symptoms(p < 0.01), poorer functioning at year 3 (p <0.05), and consistently significant lower employment rate at 12 month (p < 0.001), 24 month (p < 0.001) and 36 month (p < 0.01). Finally, more schizophrenic patients received social benefits (p < 0.05). Conclusion: The outstanding baseline poorer functioning level of bipolar affective disorder patients have progressively made a modest improvement in functional outcomes at the end of three-year follow up. BAD patients also displayed a marked improvement with fewer positive symptoms in the follow up. The results suggest a differentiation in symptomatology and the course of illness between bipolar affective disorder and schizophrenia with first-episode psychosis. In coherence with other scholastic literature, duration of untreated psychosis (DUP) associates with remission(Crumlish et al., 2009;Chang et al., 2012a), positive symptoms(Barnes et.al., 2008; Chang et.al., 2012b; Clarke et al., 2006; Crumlish et.al., 2009;), and functional outcomes(Barnes et al., 2008; Chang et al., 2012b; Clarke et.al., 2006; Crumlish et.al, 2009; Fusar-Poli et al., 2009). Moreover, further exploration about the diagnostic-specific therapeutic window for early intervention, symptoms management, and rehabilitation strategies in occupational training are in demand. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine