East Asian Archives of Psychiatry最新文献

Early intervention for psychosis (EIP) programmes have been implemented in many locations. Many of these programmes have now been operational for over 2 decades. There have, however, been few long-term reviews of how EIP programmes fared over time. In this review of the EIP for Hong Kong, we assembled key individuals directly involved in the programme from its initiation 25 years ago. Many of the authors have remained with the programme for extended periods, serving in various capacities, including as psychiatrists, psychologists, programme designers, educators, researchers, communicators, and advocates. In part 1 of the review, we describe the processes and decision points that led to the programme's initiation and its operation during the first decade. The review reveals some unexpected salient factors impacting the development of the EIP. A positive ripple effect of EIP success, promoting other areas of mental health development, may eventually result in competition for the workforce with the EIP programme. The power of a suitable term for psychosis in public communication was paramount. As the digital age arrived, demands in public communication also necessitated agile charitable organisations working in concert with the public institutions. Collaborative relationships with academic units enable insights from data, such as the duration of untreated psychosis, which can inform timely programme development. A long-term narrative review of EIP can reveal a number of less intuitive factors that inform future planning for existing and new programmes.

Objectives: To determine the correlations between eating disorder symptoms and clinical and psychometric characteristics of major depressive disorder (MDD).

Methods: Patients aged 18 to 59 years diagnosed with MDD, regardless of the stage (exacerbation or remission), were recruited from both outpatient and inpatient settings across seven centres in Russia. The MDD diagnosis of each patient was confirmed using the Mini International Neuropsychiatric Interview. Depression severity was assessed using the clinician-administered Montgomery-Asberg Depression Rating Scale. Disordered eating behaviours were assessed using the 26-item Eating Attitudes Test (EAT-26). Severity of anhedonia was assessed using the Snaith-Hamilton Pleasure Scale. Symptoms of hypomania were identified using the Hypomania Checklist. Suicide risk was assessed using the Columbia Suicide Severity Rating Scale. Symptoms of depression and anxiety were assessed using the Hospital Anxiety and Depression Scale. State and trait anxiety levels were assessed using the State-Trait Anxiety Inventory.

Results: In total, 216 women and 122 men aged 18 to 59 years with a diagnosis of MDD were included in analysis. Higher EAT-26 scores were associated with longer duration of the longest depressive episode, an earlier age of MDD onset, and a tendency towards hyperphagia during depressive episodes. EAT-26 scores were positively correlated with the Hypomania Checklist scores (ρ = 0.346, p < 0.001), the presence of suicidal ideations during the previous month (ρ = 0.146, p = 0.008), and the trait anxiety score (ρ = 0.198, p = 0.003) of the State-Trait Anxiety Inventory.

Conclusion: Patients with MDD who exhibited more pronounced disordered eating behaviours also had an earlier age of onset, a longer duration of the longest depressive episode, and higher Hypomania Checklist scores. These clinical markers are more characteristic of bipolar disorder, suggesting latent bipolarity or an increased risk of progression to bipolar disorder.

Objective: To review the literature regarding long-term effects of childhood trauma (CT) on the progression of bipolar affective disorder (BAD) in terms of affective symptomatology, depressive symptoms, hypomanic and manic symptoms, mood and activity instability, suicidality, hospitalisation, comorbidity, relapse, treatment response and remission, and functional outcomes.

Methods: The PubMed, MEDLINE, Embase, and PsycINFO databases were searched for English-language, longitudinal studies that investigated associations between CT and psychiatric outcomes in patients with BAD. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies.

Results: In total, 13 studies (involving 5418 patients) were included in the analysis. All 13 studies had a low risk of bias. Those with a history of CT had more severe manic symptoms, increased functional impairment, and higher risks of relapse, suicidality, and psychiatric comorbidities. However, findings related to depressive symptoms, hospitalisation, treatment response, and functional recovery were inconclusive. A history of physical or sexual abuse was associated with increased symptom severity, mood instability, and higher relapse risk.

Conclusion: CT remains a key determinant of BAD progression rather than just a risk factor for onset. The differential impacts of CT subtypes suggest distinct neurobiological and cognitive mechanisms, highlighting the need for personalised, trauma-informed interventions.

Objectives: To translate and validate the Hong Kong version of Abe's behavioural and psychological symptoms of dementia (BPSD) score (HK-ABS) and examine its psychometric properties among older adults with dementia in Hong Kong care homes, and to examine correlations among BPSD items, patient and caregiver characteristics, and caregiver distress.

Methods: The content validity of the HK-ABS was assessed by a panel of three psychiatrists, one psychiatric nurse, one occupational therapist, and one medical social worker. Concurrent and discriminant validity of the HK-ABS were assessed using the Chinese or Hong Kong version of the Neuropsychiatric Inventory-Nursing Home (CNPI-NH), the Disability Assessment for Dementia, the Clinical Dementia Rating, and the Montreal Cognitive Assessment. Test-retest reliability and inter-rater reliability were determined. Exploratory factor analysis examined possible constructs by principal component analysis with varimax rotation. Factor extraction was based on Kaiser's eigenvalue criterion. Correlations between the HK-ABS and characteristics of patients and staff caregivers were examined.

Results: In total, 109 pairs of patients with major neurocognitive disorder and staff caregivers in care homes were included in the analysis. The median time to complete the HK-ABS was 70 seconds. The median HK-ABS score was 4. Internal consistency of the HK-ABS was good (Cronbach's alpha = 0.787); item-total correlations (excluding 'apathy and indifference') ranged from 0.337 to 0.653. The test-retest reliability (r_s = 0.981, p = 0.168) and inter-rater reliability (r_s = 0.987, p = 0.414) of the HK-ABS was excellent. For concurrent validity, the HK-ABS was highly correlated with the CNPI-NH (r_s = 0.857, p < 0.001). For discriminant validity, the HK-ABS was not correlated with the Chinese or Hong Kong version of the Montreal Cognitive Assessment (r_s = 0.103), the Disability Assessment for Dementia (r_s = -0.039), or the Clinical Dementia Rating (r_s = 0.067). In exploratory factor analysis, all items achieved factor loadings of >0.4. Three factors explained 70% of the variance. The HK-ABS was negatively correlated with work experience (r_s = -0.254, p = 0.008) and positively correlated with the length of hospital stay in the previous year (r_s = 0.193, p = 0.044) and the CNPI-NH occupational disruptive score (r_s = 0.759, p < 0.001).

Conclusion: The HK-ABS is a valid and reliable global assessment tool of BPSD for residential care settings and clinical communication. It may be used to identify caregiver distress to allow for early intervention.

Objectives: To investigate the prevalence of hypercalcaemia and its associated factors among Chinese lithium users in a psychiatric clinic in Hong Kong.

Methods: Chinese outpatients aged ≥18 years who were treated with lithium and followed up at the Department of Psychiatry, Kowloon Hospital, between 1 September 2023 and 30 June 2024 were identified. Eligible patients were interviewed, and their medical records were reviewed. Blood tests for renal and thyroid functions, estimated glomerular filtration rate, and levels of serum calcium, albumin, and lithium were ordered. A blood test for serum lithium levels was typically taken 12 hours after lithium use. In patients with hypercalcaemia, an additional blood sample was taken to measure parathyroid hormone and vitamin D levels. Multivariable logistic regression analysis was performed to identify risk factors for hypercalcaemia.

Results: Of 238 patients included, 48 (20.2%) had hypercalcaemia, of whom eight (16.7%) also had hyperparathyroidism. Hypercalcaemia was independently associated with diabetes mellitus (adjusted odds ratio [AOR] = 2.89, p = 0.011), cumulative duration of lithium use (AOR = 1.08, p < 0.001), and serum lithium levels (AOR = 5.45, p = 0.048).

Conclusion: Lithium-associated hypercalcaemia and hyperparathyroidism are often undetected. When left unmanaged, these conditions can lead to cardiovascular mortality, cerebrovascular impairment, and premature death. Therefore, calcium levels should be regularly monitored, particularly in patients with diabetes mellitus, a longer cumulative duration of lithium use, and higher serum lithium levels.

Objective: This study aimed to evaluate the prescription writing, patterns of prescribing, and medication adherence in psychiatric outpatients at a hospital in India.

Methods: Prescriptions of patients aged ≥18 years who attended the psychiatry outpatient department of a tertiary care teaching hospital were evaluated. Data regarding prescription writing, prescribing patterns of psychotropic medications, and medication adherence were collected using a structured form. Written prescriptions were analysed using the checklist adopted from prescription audit guidelines developed by the National Health System Resource Centre, India. Medication adherence was assessed using the self-report Medication Adherence Rating Scale.

Results: In total, 438 written prescriptions for 255 male and 183 female patients were included in the analysis. Nearly all prescriptions met the criteria in the checklist adopted from the National Health System Resource Centre. The most common psychiatric diagnosis was alcohol dependence syndrome (37.0%). Of 742 psychotropic drugs prescribed, the most common was benzodiazepines (34.5%). Of 161 patients who completed the Medication Adherence Rating Scale questionnaire, 152 (94.4%) were adherent. The mean score was 9.18.

Conclusion: Medication adherence was high among outpatients with mental illness attending a tertiary care teaching hospital in India. Rational prescription of psychotropic medications may enhance therapeutic effectiveness and minimise potential risks associated with pharmacotherapy.

Objectives: To explore the association between perceived family expressed emotion (EE), self-stigma, and quality of life (QoL) in Chinese patients with depression in Hong Kong, validate the factor structure of the Concise Chinese Level of Expressed Emotion Scale (CCLEES), and examine the factors associated with perceived family EE to aid early identification and intervention.

Methods: Chinese patients with a lifetime diagnosis of major depressive episode or recurrent depressive disorder who could communicate in Chinese and lived with at least one family member, relative, or partner aged ≥18 years were invited to participate. Patients were assessed using the CCLEES for perceived family EE, the Self-Stigma Scale-Short Form for self-stigma, the Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire for QoL, the Social and Occupational Functioning Assessment Scale for social and occupational functioning, and the Hamilton Depression Rating Scale for the severity of depressive symptoms. Confirmatory factor analysis was used to validate the CCLEES factor structure. Structural equation modelling examined the associations between perceived family EE, self-stigma, and QoL. Multiple linear regression analysis was used to identify predictors for perceived family EE.

Results: In total, 124 female and 36 male patients with depression (median age, 47 years) and 76 male and 84 female family members (median age, 48.5 years) were included in the analysis. Confirmatory factor analysis supported the three-factor structure of the CCLEES; internal consistencies of the CCLEES and its three dimensions were satisfactory (ω = 0.733-0.893). Perceived family EE, self-stigma, and QoL were intercorrelated. Perceived family EE was negatively associated with overall QoL (β = -0.316, p < 0.001); self-stigma partially mediated the association between perceived family EE and overall QoL (β = -0.030, 95% confidence interval = -0.066 to -0.003). Predictors for family EE were self-stigma, single status, parents being key family members, and severity of depressive symptoms.

Conclusion: Perceived family EE is negatively associated with QoL, and self-stigma mediates this association. Thus, addressing both family EE and self-stigma is important in the treatment of depression. Clinicians should consider incorporating family psychoeducation that involves knowledge about depression, problem-solving skills, and coping skills.

Objective: To conduct a systematic review of the literature to examine the associations between slowwave sleep (SWS) disturbance and dementia.

Methods: We systematically searched PubMed and Embase for cohort and case-control studies that examined SWS differences between patients with dementia and healthy controls. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: In total, 19 studies (three cohort and 16 case-control) were included in analysis. Overall, one cohort study and 14 case-control studies found that reduced SWS was associated with dementia; the evidence was stronger in case-control studies than cohort studies. Study quality of studies varied; most were above average.

Conclusion: Most studies regarding the association between SWS and dementia are cross-sectional; more longitudinal studies are needed to determine whether reduction in SWS can predict incident dementia. Future studies should include multi-night recordings and the use of standardised criteria to enhance the accuracy of recordings and facilitate comparisons between studies.

Objectives: To assess the effectiveness of emotional freedom technique (EFT) in reducing stress and anxiety among caregivers of patients with mental illness at a tertiary care hospital in Bangalore, India.

Methods: Primary caregivers of patients diagnosed with a chronic psychiatric illness and treated at CDSIMER Hospital, Bangalore, India were recruited using convenience sampling. Participants were taught by a trained nurse the EFT sequence, which included the setup statement (acknowledging the problem while affirming self-acceptance) and tapping on nine key acupoints while voicing reminder phrases related to the distressing emotions. Stress and anxiety levels were assessed using the Perceived Stress Scale and Hamilton Anxiety Rating Scale, respectively.

Results: In total, 16 male and 15 female caregivers aged 24 to 60 years were included in the analysis. The mean Perceived Stress Scale score decreased from 17.68 at baseline to 13.77 after intervention (Z = 4.817, p < 0.001). Similarly, the mean Hamilton Anxiety Rating Scale score decreased from 14.84 at baseline to 12.10 after intervention (Z = 4.477, p < 0.001).

Conclusion: EFT is effective in reducing stress and anxiety among primary caregivers of patients with mental illness. Given its ease of use, minimal cost, and potential benefits, EFT may be incorporated into mental health support programmes to improve caregiver well-being.