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Hui CLM, Chan EWT, Hui PWM, Tao TJ, Ho ECN, Lam BST, Wah See SH, Suen YN, Chang WC, Wa SK, Lee EHM, Chen EYH. Functional and clinical outcomes of delusional disorder and schizophrenia patients after first episode psychosis: a 4-year follow-up study. BMC Psychiatry 2023; 23:676. [PMID: 37723482 PMCID: PMC10506281 DOI: 10.1186/s12888-023-05175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/09/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years. METHODS 71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years. RESULTS At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients. CONCLUSIONS Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.
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Affiliation(s)
- Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
| | - Evie Wai Ting Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Priscilla Wing Man Hui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Tiffany Junchen Tao
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Elise Chun Ning Ho
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Bertha Sze Ting Lam
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Sally Hiu Wah See
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Hong Kong
| | - Sherry Kit Wa
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Hong Kong
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Li XY, Liu Q, Chen P, Ruan J, Gong X, Luo D, Zhou Y, Yin C, Wang XQ, Liu L, Yang BX. Predictors of Professional Help-Seeking Intention Toward Depression Among Community-Dwelling Populations: A Structural Equation Modeling Analysis. Front Psychiatry 2022; 13:801231. [PMID: 35280177 PMCID: PMC8907597 DOI: 10.3389/fpsyt.2022.801231] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background A low intention of professional help seeking hinders the effective treatment of depression. The factors are from the perspectives of the social, family, and individual; however, an understanding of how they interact to predict professional help-seeking intention (PHSI) is not clear. Objectives The objectives of the study was to investigate PHSI toward depression in a Chinese community-dwelling population and construct a predictive model of the PHSI to explore the various factors involved. Methods Stratified random sampling and Kish table methods were used to identify 2,000 community residents. Participants completed a series of questionnaires to measure general characteristics, PHSI, professional help-seeking attitude, depression stigma, depression knowledge, family function, and depression symptoms. Analyses included descriptive statistics and Pearson correlation analysis using SPSS 26.0 and a Structural Equation Model using Amos 22.0. Results The score of the PHSI was 14.92 ± 9.574. Professional help-seeking attitude (r = 0.291, p < 0.001) and depression knowledge (r = 0.077, p = 0.002) were positively related to PHSI, while a negative correlation was found between stigma (r = -0.149, p < 0.001) and PHSI. The model of the PHSI indicated a good fit with a CMIN/DF = 2.740 and RESEA = 0.032. The total effect of the influencing factors on the PHSI was listed in the following order: professional help-seeking attitude (0.676) > stigma (-0.143) > depression knowledge (0.088) > depression symptoms (-0.009) > family function (0.005). The total effect of depression knowledge on PHSI included a direct negative effect (Beta = -0.266, p < 0.001) and an indirect positive effect (0.354) through professional help-seeking attitude and stigma. Also, depression knowledge was negatively associated with stigma (Beta = -0.153, p < 0.001). Depression symptoms were negatively associated with family function (Beta = -0.282, p < 0.001), depression knowledge (Beta = -0.252, p < 0.001), and stigma (Beta = -0.102, p < 0.001), indicating that people with less severe depression symptoms had good family function, depression knowledge, and higher stigma. Family function contributed a positive effect on depression knowledge directly (Beta = 0.145, p < 0.001) and a totally positive effect (0.033) on stigma. Conclusion The PHSI toward depression is low among Chinese community residents. Professional help-seeking attitude, depression knowledge, and family functioning were facilitators of PHSI, and stigma and the severity of depression symptoms were barriers to PHSI. This study provides reference for the development of policies and guidelines to promote community residents to actively seek professional mental health help. Future policies can focus on multicollaboration among the government, mental health services, and families to increase the mental health resources, improve family functioning, enhance mental health literacy (MHL) of the public, and reduce depression stigma to ease the burden of this mental health issue.
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Affiliation(s)
- Xin Yi Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Qian Liu
- School of Nursing, Wuhan University, Wuhan, China
| | - Pan Chen
- School of Nursing, Wuhan University, Wuhan, China
| | - Juan Ruan
- Wuhan Mental Health Center, Wuhan, China
| | - Xuan Gong
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Luo
- School of Nursing, Wuhan University, Wuhan, China
| | - Yang Zhou
- Wuhan Mental Health Center, Wuhan, China
| | - Cong Yin
- Wuhan Mental Health Center, Wuhan, China
| | | | | | - Bing Xiang Yang
- School of Nursing, Wuhan University, Wuhan, China
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
- Population and Health Research Center, Wuhan University, Wuhan, China
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Chen P, Liu XJ, Wang XQ, Yang BX, Ruan J, Liu Z. Attitude Toward Seeking Professional Psychological Help Among Community-Dwelling Population in China. Front Psychiatry 2020; 11:417. [PMID: 32477190 PMCID: PMC7240032 DOI: 10.3389/fpsyt.2020.00417] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/23/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To explore the attitudes and factors in seeking professional psychological help among a Chinese community-dwelling population in order to promote positive help-seeking behaviors and better utilization of mental health services. METHODS Using system and simple random sampling with Kish selection table methods, 912 community-dwelling residents were included in this study and asked about their attitudes toward seeking professional psychological help, depression symptoms, family function, depression literacy, help-seeking intention, and stigma. RESULTS Scores on the Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH-SF) indicated a neutral attitude toward openness to seeking treatment for psychological problems and a negative attitude toward the value and need to seek treatment with a negative total score. Multiple linear regression analysis showed that gender, age, social support (employment status and family function), depression literacy, stigma, and help-seeking intention are significantly associated with attitude toward seeking professional psychological help. CONCLUSION The overall attitude toward seeking professional psychological help is not optimistic, thus, more efforts are needed to enhance understanding. Effective interventions including mental health education, training of mental health professionals, and popularizing the use of mental health services are essential, especially for the at-risk population.
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Affiliation(s)
- Pan Chen
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiu Jun Liu
- Affiliated Mental Health Center, Tongji Medical College of Huazhong, University of Science & Technology, Wuhan, China
| | - Xiao Qin Wang
- School of Health Sciences, Wuhan University, Wuhan, China
| | | | - Juan Ruan
- Affiliated Mental Health Center, Tongji Medical College of Huazhong, University of Science & Technology, Wuhan, China
| | - Zhongchun Liu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
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Hui CLM, Ko WT, Chang WC, Lee EHM, Chan SKW, Chen EYH. Clinical and functional correlates of financially deprived women with first-episode psychosis. Early Interv Psychiatry 2019; 13:639-645. [PMID: 29575804 DOI: 10.1111/eip.12551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 10/12/2017] [Accepted: 02/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women, especially those with low-socio-economic status and financial deprivation, are found to be affected by mental illnesses disproportionately. We compared the clinical, functioning and cognitive characteristics between the financially deprived women with first-episode psychosis and their non-deprived women counterparts. METHOD A cross-sectional analysis of consecutively recruited first-episode psychosis women patients was conducted. A total of 93 financially deprived women patients and 105 non-deprived women patients aged 25 to 55 years were compared in terms of demographic, premorbid and help-seeking characteristics, baseline clinical characteristics, baseline functioning and baseline cognitive functioning. RESULTS Financially deprived women were older (P = .005), had received less education (P = .001), more likely to live alone (P < .001) and with a higher proportion of immigrants (P = .001). Whereas there was no significant difference found in duration of untreated psychosis, deprived women had more severe depressive symptoms (P = .021) and more severe negative symptoms, in terms of avolition-apathy (P = .003) and anhedonia-asociality (P = .008). They also perform worse in social and occupational functioning (P = .002) and a range of cognitive abilities. CONCLUSIONS Nearly half of the adult female patients with first-episode psychosis in Hong Kong encountered persistent financially difficulties. The fact that they suffer from more severe symptoms and worsened functioning and cognitive abilities at an early stage of illness shows that this subgroup of patients warrant assistance and attention.
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Affiliation(s)
- Christy L M Hui
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Wai Tung Ko
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Edwin H M Lee
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Sherry K W Chan
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Eric Y H Chen
- Department of Psychiatry, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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Chan SKW, Chau EHS, Hui CLM, Chang WC, Lee EHM, Chen EYH. Long term effect of early intervention service on duration of untreated psychosis in youth and adult population in Hong Kong. Early Interv Psychiatry 2018; 12:331-338. [PMID: 26801970 DOI: 10.1111/eip.12313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/15/2005] [Indexed: 11/30/2022]
Abstract
AIM The current study explored the effect of an early intervention (EI) service for psychosis in Hong Kong (EASY) on the reduction of the duration of untreated psychosis (DUP) at 10 years, in adolescent and adult patients. METHOD Data from three first-episode psychosis (FEP) studies conducted over 10 years using the same DUP assessment was analysed. FEP study 1 year before the EI service (2000) was used as a control, with those aged <25 comprising the youth psychosis control group and those aged over 25 comprising the adult psychosis control group. Data from the EASY service collected in 2010 constituted the youth psychosis EI group and data from an adult EI service collected from 2009 to 2011 constituted the adult psychosis EI group. DUP of EI and control groups was compared. The effect of the mode of onset and family history of psychosis on DUP was studied. RESULTS DUP in the adult group was significantly reduced from median of 180 days to 93 days after 10 years (U = 12 906.50, P = 0.01), particularly in those with gradual onset and without family history. However, no significant change of DUP was found in the youth psychosis group. CONCLUSIONS Results of the current study provide evidence that EI programmes with public awareness campaign can significantly reduce DUP of adult patients but not in youth group. The effect is more specific in those with long DUP. Further research should explore the specific factors contributed to the long DUP of patients of different age groups so as to establish targeted intervention strategies.
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Affiliation(s)
- Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Esther H S Chau
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Wing C Chang
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Hongkong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hongkong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hongkong
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Yalvaç HD, Mutlu EA, Kotan Z, Özer İ, Karslıoğlu EH, Çayköylü A. Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey. Community Ment Health J 2017; 53:951-957. [PMID: 27900651 DOI: 10.1007/s10597-016-0074-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/24/2016] [Indexed: 11/26/2022]
Abstract
This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.
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Affiliation(s)
- Hayriye Dilek Yalvaç
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | | | - Zeynep Kotan
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - İbrahim Özer
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ersin Hatice Karslıoğlu
- Psychiatry Department, Dr. AY Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Çayköylü
- Department of Psychiatry, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
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Zhou Y, Rosenheck R, Mohamed S, Ning Y, He H. Factors associated with complete discontinuation of medication among patients with schizophrenia in the year after hospital discharge. Psychiatry Res 2017; 250:129-135. [PMID: 28160655 DOI: 10.1016/j.psychres.2017.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 11/18/2016] [Accepted: 01/10/2017] [Indexed: 11/19/2022]
Abstract
Medication discontinuation is a major risk factor for relapse in schizophrenic patients. The present study investigated the rate and clinical correlates of complete medication discontinuation in the year after hospital discharge. Data collected from 236 schizophrenia patients who were prescribed anti-psychotics documented socio-demographic characteristics, symptom severity, insight, and attitudes towards medication in the week before their discharge and the experience of caregiver burden for their primary caregiver as recorded at the time of hospitalization. Follow-up telephones call one-year after discharge documented whether they were regularly taking prescribed psychotropic medication or not. Logistic regression analysis was used to investigate factors that were independently associated with medication discontinuation. Altogether 25.8% of the sample discontinued medication in the one-year after discharge. Logistic regression analysis showed that shorter duration of illness, lack of health insurance, and poor insight at the time of discharge were significantly associated with complete discontinuation of medication (p<0.05). Patients discontinued their medication within a year after psychiatric hospitalization which was associated with a lack of insurance coverage, less insight into their illness and shorter duration of illness. Interventions that strengthen patient engagement in treatment through insurance coverage and insight, fostered through psychoeducational intervention, may increase medication compliance.
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Affiliation(s)
- Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Robert Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Somaia Mohamed
- Department of Psychiatry, Yale University School of Medicine, New Haven, USA
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.
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Abstract
In this study, we aim to describe the pathways to care for patients with first-episode psychosis in Singapore. We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses.
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Hui CLM, Lee EHM, Chang WC, Chan SKW, Lin J, Xu JQ, Chen EYH. Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients. Psychol Med 2015; 45:3085-3095. [PMID: 26036591 DOI: 10.1017/s0033291715001051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample. METHOD We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements. RESULTS Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning. CONCLUSIONS Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.
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Affiliation(s)
- C L M Hui
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - E H M Lee
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - W C Chang
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - S K W Chan
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - J Lin
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - J Q Xu
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
| | - E Y H Chen
- Department of Psychiatry,University of Hong Kong,Hong Kong SAR,China
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Prevalence and predictors of medication non-adherence among Chinese patients with first-episode psychosis. Psychiatry Res 2015; 228:680-7. [PMID: 26099660 DOI: 10.1016/j.psychres.2015.04.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 03/28/2015] [Accepted: 04/26/2015] [Indexed: 11/21/2022]
Abstract
Medication non-adherence is one of the major obstacles to recovery in first-episode psychosis (FEP). This study aimed to identify the predictors and rates of medication non-adherence in the first and second year after the start of treatment (baseline) in urban Chinese FEP patients. Relevant information on medication non-adherence and potential baseline predictors, including demographic variables, clinical measures, violence/suicide attempts, stressful life experiences, intervention received, and follow-up attendance, were collected from case records of 1400 FEP patients in Hong Kong. The non-adherence rate was 16.2% in year 1 and 15.4% in year 2. Regression analyses revealed the predictors for non-adherence in year 1 were no hospitalization at baseline, non-schizophrenia diagnosis, and more years of education. Predictors of non-adherence in year 2 included acute/subacute onset and older age of onset. Predictors common in both years were defaulting from psychiatric follow-up during baseline, standard psychiatric care (no early intervention), and lower positive symptoms severity at baseline. In assessing non-adherence risk and for planning phase-specific early interventions for FEP, particularly in a Chinese context, healthcare professionals should consider the common and specific predictors for non-adherence identified in the first and second years of treatment and should not overlook patients with less clinically severe symptoms.
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11
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Hui CLM, Li AWY, Leung CM, Chang WC, Chan SKW, Lee EHM, Chen EYH. Comparing illness presentation, treatment and functioning between patients with adolescent- and adult-onset psychosis. Psychiatry Res 2014; 220:797-802. [PMID: 25238985 DOI: 10.1016/j.psychres.2014.08.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/18/2014] [Accepted: 08/24/2014] [Indexed: 12/13/2022]
Abstract
Studies have shown that early- and adult-onset schizophrenia patients differ in pre-morbid traits, illness presentation, psychopathology, and prognosis. We aimed to compare adult-onset patients (age range 26-55 years) with an adolescent-onset cohort (15-25 years) in demographics, illness presentation and functioning at baseline. Participants were from two territory-wide early intervention services for adolescent-onset (n=671) and adult-onset psychosis patients (n=360) in Hong Kong. The adolescent-onset cohort had their initial psychotic episode from 2001-2003; retrospective data collection was done through systematic case note review. The adult-onset cohort was recruited for a larger interventional study from 2009-2011; information was collected via face-to-face interviews. Adult-onset psychosis was significantly associated with more females, more smokers, more non-local birth, more full-time employment, better functioning, poorer medication adherence, more psychiatric hospitalization and fewer with schizophrenia than adolescent-onset psychosis (mean age: 20.4). The effect sizes were small, except for medication adherence where a robust effect was found. No group difference in DUP was found. The finding that adult-onset patients had better functioning challenges the view that adolescent- and adult-onset psychoses share a similar prognostic trajectory. Implications for adapting intervention processes for adolescent- and adult-onset psychosis are discussed.
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Affiliation(s)
| | | | - Chung-Ming Leung
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Wing-Chung Chang
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | | | - Edwin Ho-Ming Lee
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
| | - Eric Yu-Hai Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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