East Asian Archives of Psychiatry最新文献

Objective: To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients.

Methods: Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated.

Results: We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%).

Conclusion: WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.

Background: Rumination and overgeneral autobiographical memory are dysfunctional cognitions commonly found in older adults with depression. The theoretical underpinnings of mindfulness-based cognitive therapy (MBCT) address the ruminative tendencies and the non-specific retrieval of autobiographical memories. This study aims to examine the efficacy and cognitive mechanisms of MBCT in older adults with active depressive symptoms.

Methods: 57 older adults (mean age, 70 years) with normal cognition and mild to moderate depressive symptoms were randomly allocated to either the MBCT group or the active control group for 8 weeks. The MBCT group consisted of eight 2-hour weekly sessions and a 7-hour full-day retreat, with different themes for each class, guided mindfulness exercises, feedback and discussion, homework review, and psychoeducation. The active control group comprised a 1-hour physical exercise and a standardised health education of the specific theme with group discussion (eg fall prevention, chronic pain). Participants were assessed before and after the 8-week intervention for four outcome measures: the Hamilton Depression Rating Scale (HAMD), the Ruminative Response Scale (RRS), the Autobiographical Memory Test (AMT), and the Mindful Attention Awareness Scale (MAAS).

Results: There was a significant reduction in severity of depressive symptoms (HAMD score) in both the MBCT group (F(1, 27) = 35.9, p < 0.001, η² = 0.57) and the active control group (F(1, 28) = 9.29, p < 0.01, η² = 0.24), but only the MBCT group showed substantial improvements in autobiographical memory specificity (AMT score), rumination (RRS score), and mindfulness (MAAS score).

Conclusion: Although both MBCT and active control programme decrease the severity of depressive symptoms in older adults, only MBCT improves AMS, rumination, and mindfulness. Our findings provide empirical support for the theoretical underpinnings of MBCT. Older adults with more severe depression and more severe dysfunctional cognition may benefit more from the specific therapeutic effects of MBCT.

Objectives: To determine the associations of epilepsy spectrum disorder (ESD) with brain insult and certain quantitative electroencephalographic (QEEG) and clinico-demographic parameters in patients with depression.

Methods: 21 right-handed patients aged 18 to 50 years with the diagnosis of depression and ESD (scored ≥70 in Iowa Interview for Partial seizure-like symptoms) were compared with 21 patients with depression but without ESD (scored <70) and 21 normal subjects with <3 positive scores on the 12-Item General Health Questionnaire. Their QEEG parameters such as power spectrum and coherence of five frequency bands in 11 regions were compared.

Results: Patients with ESD had more minor traumatic brain injury along with more severe and multiple depressive episodes. Patients with ESD had significantly higher beta1 power over all regions on the left scalp than did normal subjects. Patients with ESD had significantly higher beta2 power over the left central region than did patients with no ESD and normal subjects.

Conclusions: For patients with severe recurrent depression, clinicians should systematically check for episodic partial seizure-like phenomena, especially when QEEG shows electrical disorganisation in the left side in those with mild traumatic brain injury.

Objective: To determine the internal consistency, construct validity, and scaling properties of the traditional Chinese version of the Child and Adolescent Needs and Strengths-Trauma Comprehensive (TC-CANS-Trauma).

Methods: 66 male and 62 female children, adolescents, and young adults aged 3 to 22 years who were referred to trauma treatment service were selected by convenience sampling. The original English version of the CANS-Trauma was translated to traditional Chinese by a medical professional, back-translated to English by a clinical psychologist, and then cross-checked by another psychologist to ensure consistency. Chinese wordings were adjusted to maintain the conceptual rather than literal meaning. Participants were assessed using the TC-CANS-Trauma as well as the traditional Chinese version of the Life Events Checklist (LEC), the Children's Impact of Event Scale-Revised (CHIES-R), the Strengths and Difficulties Questionnaire-Impact Component (SDQ-Impact), and the Parenting Sense of Competence (PSOC). Internal consistency of eight primary domains of the TC-CANS-Trauma was evaluated by Cronbach's alpha. Construct (convergent and divergent) validity of five of these domains with the LEC, the CHIES-R, the SDQ-Impact, and the PSOC was assessed. Rasch modelling was used to evaluate the scaling properties of the eight primary domains of the TC-CANS-Trauma.

Results: Internal consistency of the eight primary domains of the TC-CANS-Trauma was satisfactory, with Cronbach's alpha ranging from 0.63 to 0.90. Construct (convergent and divergent) validity of five of these domains with the LEC, the CHIES-R, the SDQ-Impact, and the PSOC was good. In Rasch modelling, most TC-CANS-Trauma domains showed good item separation values. Infit and outfit statistics of most domain items were <2 indicating good item fitness in their respective domains. For person separation, all domains of the TC-CANS-Trauma did not have a sufficient discriminability to identify high and low performers.

Conclusions: The TC-CANS-Trauma is valid for comprehensive assessment of trauma-related domains among Hong Kong children and adolescents. Its ratings can be used to guide the levels of clinical intervention required. Clinicians are recommended to implement the TC-CANS-Trauma to facilitate trauma-informed practice in Hong Kong.

We describe a 26-year-old man who underwent Metacognitive-Focused Occupational Therapy for his substance abuse problems.

Objectives: To compare older adults with late-life depression (LLD) and healthy controls in terms of suicidal ideation during the COVID-19 pandemic, and to determine predictors of suicidal ideation.

Methods: Between March and April 2020, old adults diagnosed with major depressive disorder (single or recurrent episode) as defined by the DSM-5 were recruited from psychiatric clinics or inpatient wards, whereas 31 healthy older adults without a history of depression or other psychiatric illnesses were recruited from voluntary organisations or elderly community centres. Their depressive symptoms, perceived severity of the pandemic, perceived time spent on receiving related information, perceived health, levels of loneliness, perceived coping efficacy, suicidal ideation, and the level of symptomatic responses to a specific traumatic stressor in the past week were assessed.

Results: In total, 21 men and 43 women aged 61 to 89 years were interviewed through telephone by trained research assistants. Of them, 33 were older adults with LLD (cases) and 31 were healthy older adults (controls). Older people with LLD had a higher level of suicidal ideation than healthy controls, after controlling for the level of depression and medical comorbidity (F (1, 59) = 5.72, p = 0.020). Regression analyses showed that coping efficacy and loneliness accounted for a significant portion of the variance in suicidal ideation, and loneliness significantly predicted the level of stress. Mediation analyses reveal an indirect effect between group and suicidal ideation through coping efficacy (Z = 2.43, p = 0.015).

Conclusions: Older people with LLD are at increased suicidal risk and require timely mental health support. Coping efficacy and loneliness are important predictors for suicidal ideation and stress.

Objective: To evaluate psychometric properties of the Chinese version of Dementia Quality of Life Measure - Proxy (C-DEMQoL-Proxy).

Methods: Care home residents aged ≥60 years who were diagnosed with dementia or demonstrated impairment in cognition were recruited from four care facilities in Hong Kong. Caregivers of these participants were also invited to participate. The original DEMQoL-Proxy was translated into Chinese (Cantonese) by a trained translator. The forward-translated version was reviewed by an expert panel of six experienced healthcare professionals. Revisions were made based on comments. The instrument was back-translated to English to check whether further changes were necessary. Demographic data (age, sex, type and severity of dementia, and Mini-Mental State Examination [MMSE] score) were collected from medical records of participants with dementia. Caregivers were interviewed by an occupational therapist or personnel supervised by the occupational therapist using the C-DEMQoL-Proxy and the Chinese version of Quality of Life-Alzheimer's Disease-Proxy (C-QoL-AD-Proxy). Acceptability, reliability, and validity of the C-DEMQoL-Proxy were evaluated using standard psychometric methods.

Results: 90 individuals (82.2% women) with dementia aged 72 to 102 years were included. Their diagnosis included Alzheimer's disease (23.3%), vascular dementia (15.6%), mixed and other types of dementias (51.1%), and missing (10%). Severity was mild in 12.2%, moderate in 62.2%, and severe in 25.6%. The mean MMSE score was 12.0 ± 4.9. 20% of the caregivers were family members and the rest were professional carers. The C-DEMQoL-Proxy had good acceptability, with no floor or ceiling effects or missing data. It had good internal consistency (Cronbach alpha = 0.91) and test-retest reliability (intraclass correlation coefficients = 0.83). It was mildly correlated with C-QoL-AD-Proxy (r = 0.29, p < 0.01). Age and sex were not correlated with C-DEMQoL-Proxy scores. C-DEMQoL-Proxy scores were not significantly different between dementia types, severity levels, or between those with higher or lower MMSE scores.

Conclusion: The C-DEMQoL-Proxy is a valid and reliable instrument to assess health-related quality of life in individuals with dementia.

Objectives: To determine factors associated with remission from positive symptoms in Indian patients with schizophrenia.

Methods: We evaluated 151 patients (99 men and 52 women) aged 18 to 65 years who were diagnosed with schizophrenia and followed up for ≥6 months (with a minimum of two evaluations). We assessed psychopathology, the level of best functioning in the past year, premorbid functioning (up to 1 year), daily living skills, medication adherence, adverse effects to medications, the number of stressful events in the 6 months before illness onset, perceived social support, expressed emotion from family, and personal construct of empowerment. Remission from positive symptoms of schizophrenia was defined as simultaneous attainment of a score of ≤3 (mild) for ≥6 months in the following symptoms: delusions, concept disorganisation, hallucinatory behaviour, unusual thought content, mannerisms, and posturing. Patients were categorised as remitted and non-remitted.

Results: Of 151 patients, 81 (53.64%) fulfilled the remission criteria. Compared with non-remitted patients, remitted patients had a shorter duration of untreated psychosis (t = -2.29, p < 0.05), better premorbid functioning in childhood (t = -1.99, p < 0.05) and general (t = -9.34, p < 0.001) subscale, higher medication adherence (t = 6.91, p < 0.001), higher daily living skills ( t = 8.65, p < 0.001), better perceived social support (t = 6.69, p < 0.001), higher empowerment (t = 5.64, p < 0.001), and received higher warmth (t = 1.99, p < 0.05) and lower hostility (t = -4.00, p < 0.001), dissatisfaction (t = -6.96, p < 0.001), and critical comments (t = -2.48, p < 0.05) from family members. Predictors of remission were duration of untreated psychosis (B = -0.020, p < 0.05), daily living skills (B = 2.063, p < 0.001), perceived social support (B = 0.084, p < 0.01), and dissatisfaction from family members (B = -0.621, p < 0.01).

Conclusions: 53.64% of patients with schizophrenia achieved remission from positive symptoms. Remission was more likely to occur in patients with shorter duration of untreated psychosis, better daily living skills, higher perceived social support, and less dissatisfaction from family members.