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Background: Physical activity (PA) can improve the clinical symptoms, physical health, and functional outcomes of patients with psychosis. This study aimed to investigate the moderating effects of age on the associations between exercise self-efficacy (ESE) and PA in women with psychosis. Methods: Data from 38 women with psychosis (mean age, 37.5±13.2 years) who participated in a community mental health project in Hong Kong were analysed. Psychotic symptoms were evaluated using the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms. Levels of PA were determined using the self-report International Physical Activity Questionnaire-Long Form. ESE was assessed using a self-report instrument. The moderating effects of age on associations between ESE domains and physical activity levels were assessed. Results: Age was correlated with moderate-intensity PA (r = 0.51, p = 0.007) and total PA (r = 0.52, p = 0.002). The ESE 'must exercise alone' domain was correlated with moderate-intensity PA (r = 0.17, p = 0.009) and total PA (r = 0.15, p = 0.04). The ESE 'resistance from others' domain was correlated with moderate-intensity PA (r = 0.0003, p = 0.03). No significant correlations were observed between other PA variables and other ESE domains. Among women with psychosis, age was a moderating factor in the association between moderate-intensity PA and ESE, particularly in domains of 'must exercise alone', 'inconvenience to exercise', and 'resistance from others'. Conclusion: Among women with psychosis, ESE domains of 'must exercise alone', 'inconvenience to exercise', and 'resistance from others' as well as overall ESE were significantly associated with moderate-intensity PA in older age group only. Age-specific strategies should be applied when designing interventions to increase PA levels in this population. [ABSTRACT FROM AUTHOR]

Objective: Schizophrenia-spectrum disorder (SSD) is associated with increased premature death, with emerging data suggesting early illness course as a high-risk period for excess mortality. This study aimed to examine mortality rate in patients with incident SSD and differential mortality risk between inpatient-diagnosed and outpatient-diagnosed subsamples within 5 years of first diagnosis. Method: This population-based cohort study identified 8826 patients aged 18–39 years receiving first-recorded SSD diagnosis upon service entry, comprising 3877 inpatient-diagnosed and 4949 outpatient-diagnosed patients, between 2006 and 2012 in Hong Kong using a territory-wide medical record database of public health care services. All-cause, natural-cause, and unnatural-cause mortality risks within 5 years after first diagnosis were quantified by standardized mortality ratios (SMRs) relative to the general population. We also directly compared mortality rates between inpatient and outpatient subsamples over 5-year follow-up. Results: SSD patients exhibited markedly elevated all-cause (SMR: 12.28, 95% confidence interval [CI]: [10.83, 13.88]), natural-cause (SMR: 3.76, 95% CI: [2.77, 4.98]) and unnatural-cause (SMR: 20.64, 95% CI: [17.49, 24.20]) mortality during first 5 years of diagnosis. Increased mortality rate was most pronounced in the first year of treatment, especially for unnatural deaths (SMR 32.2, 95% CI: [24.08, 42.22]). Discharged inpatient-diagnosed patients displayed significantly higher all-cause and unnatural-cause mortality rates than outpatient-diagnosed counterparts within first 3 years of treatment, and differential mortality risks on all-cause (adjusted hazard ratio [aHR]: 7.05, 95% CI: [2.02, 24.64]) and unnatural- cause (aHR: 5.15, 95% CI: [1.38, 19.19]) deaths were the highest in the first month of follow-up. Conclusions: Substantial increase in early mortality risk among people with incident SSD, particularly in the first year of diagnosis and the time shortly after discharge, underscores an urgent need of targeted early intervention for effective suicide prevention and physical health improvement to minimize mortality gap. [ABSTRACT FROM AUTHOR]

Despite growing concern about reproductive safety of antipsychotics, there is a paucity of research specifically assessing prenatal antipsychotic prescribing practices for psychotic disorders. This population-based cohort study identified women aged 15–50 years with diagnosis of psychotic disorders, who delivered their first and singleton child between 2003–2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal antipsychotic use as well as antipsychotic utilization patterns before and during pregnancy. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 804 women, 519 (65%) redeemed at least one prescription for antipsychotics during pregnancy. Older age at conception (25–34 years: OR 2.12 [95% CI 1.22–3.67]; 35–50 years: 2.52 [1.38–4.61]; 15–24 years as reference category) and antipsychotic treatment within 12 months pre-pregnancy (24.22 [16.23–36.16]) were significantly associated with prenatal antipsychotic use. Second-generation-antipsychotic (SGA) use during pregnancy increased over 16-year study period, while prenatal first-generation-antipsychotic (FGA) use showed declining trend. Overall antipsychotic and SGA use progressively decreased across pre-pregnancy and trimesters of pregnancy. Further analyses on antipsychotic use trajectories revealed that 87.4% (n = 459) of 529 women receiving antipsychotics in 12-month pre-pregnancy redeemed antipsychotic prescription during pregnancy, and 63.4% (n = 333) continued antipsychotic treatment throughout pregnancy. Only 7.5% of the cohort (n = 60) commenced antipsychotics in pregnancy. This is one of the few studies evaluating real-world prenatal antipsychotic utilization among women with psychotic disorders. Future research delineating risk conferred by illness-related factors and antipsychotic exposure on adverse maternal and fetal outcomes is warranted to facilitate treatment guideline development. [ABSTRACT FROM AUTHOR]

Mindfulness-based interventions (MBI) represent a central pillar of the third wave of Cognitive Behavioral Therapy. In recent years, MBI have been implemented in treating patients with psychotic disorders, and their efficacy has been evaluated in a small number of randomized-controlled trials (RCTs). This narrative review presents the current state of research on the efficacy and effectiveness, as well as central aspects of the clinical applications of MBI in the treatment of patients with schizophrenia and primary psychotic disorders. Current meta-analyses show different results but concur that in comparison to controls with treatment-as-usual (TAU) and in Pre-Post-Analyses, MBI show promising results in reducing the, in regards to pharmacotherapy, difficult to treat negative (g = 0.56 and g = 0.75) and positive symptoms (g = 0.19 and g = 0.32) with effect sizes between small and large. In addition, MBI can lead to positive effects on depressive and anxiety symptoms (g = 0.20 and g = 0.43) and contribute to a long-term reduction in re-hospitalization rates 12 months post-discharge and a shortening of the duration of inpatient treatment. In contrast to psychotherapy research from the UK, Australia, and Hong Kong, the scientific evaluation and implementation of mindfulness-based treatment options in the entire German-speaking area are still in the early stages. [ABSTRACT FROM AUTHOR]

Background: Better understanding of interplay among symptoms, cognition and functioning in first-episode psychosis (FEP) is crucial to promoting functional recovery. Network analysis is a promising data-driven approach to elucidating complex interactions among psychopathological variables in psychosis, but has not been applied in FEP. Method: This study employed network analysis to examine inter-relationships among a wide array of variables encompassing psychopathology, premorbid and onset characteristics, cognition, subjective quality-of-life and psychosocial functioning in 323 adult FEP patients in Hong Kong. Graphical Least Absolute Shrinkage and Selection Operator (LASSO) combined with extended Bayesian information criterion (BIC) model selection was used for network construction. Importance of individual nodes in a generated network was quantified by centrality analyses. Results: Our results showed that amotivation played the most central role and had the strongest associations with other variables in the network, as indexed by node strength. Amotivation and diminished expression displayed differential relationships with other nodes, supporting the validity of two-factor negative symptom structure. Psychosocial functioning was most strongly connected with amotivation and was weakly linked to several other variables. Within cognitive domain, digit span demonstrated the highest centrality and was connected with most of the other cognitive variables. Exploratory analysis revealed no significant gender differences in network structure and global strength. Conclusion: Our results suggest the pivotal role of amotivation in psychopathology network of FEP and indicate its critical association with psychosocial functioning. Further research is required to verify the clinical significance of diminished motivation on functional outcome in the early course of psychotic illness. [ABSTRACT FROM AUTHOR]

• A territory-wide public healthcare database was used to conduct a nested case-control study on breast cancer risks. • Increased risk followed typical antipsychotic use in both women with schizophrenia and bipolar disorder. • Increased risk following atypical antipsychotic use was observed only in women with bipolar disorder. • More research is needed to evaluate risks and benefits associated with antipsychotics in women with bipolar disorder. Accrued epidemiologic data largely support an association of antipsychotic use with breast cancer in women with schizophrenia. No studies have specifically investigated such risks in women with bipolar disorder. This study aims to examine the association between antipsychotics and breast cancer in women with bipolar disorder and compare it against schizophrenia. We conducted a nested case-control study using a territory-wide public healthcare database in Hong Kong examining women aged ≥18 years with bipolar disorder or schizophrenia. Using incidence density sampling, women with a breast cancer diagnosis were matched by up to 10 control participants. In total, 672 case participants (109 with bipolar disorder) and 6,450 control participants (931 with bipolar disorder) were included. Results show a significant association of first-generation antipsychotics with breast cancer in both women with schizophrenia [adjusted odds ratio (aOR) 1.49, 95% confidence interval (CI) 1.17-1.90] or bipolar disorder (aOR 1.80, 95% CI 1.11-2.93). Second-generation antipsychotics was associated with breast cancer only in women with bipolar disorder (aOR 2.49, 95% CI 1.29-4.79), with no significant association found in women with schizophrenia (aOR 1.10, 95% CI 0.88-1.36). In conclusion, further research on breast cancer risks is warranted for women with bipolar disorder on antipsychotics. [ABSTRACT FROM AUTHOR]

Objective: Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery.Methods: A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses.Results: Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder.Conclusions: This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented. [ABSTRACT FROM AUTHOR]

Abstract: Background: The adverse effects of a long duration of untreated psychosis (DUP) have been explored in numerous short-term studies. These studies support the development of early interventions that reduce treatment delay and promote recovery. However, the enduring impact of DUP is largely unknown, partly due to the paucity of prospective long-term studies. Although the DUP–outcome relationship is commonly assumed to be linear, the threshold effect has not been adequately examined. Objective: To explore the relationship between DUP and long-term symptomatic remission. Methods: This was a prospective study of a cohort of 153 first-episode psychosis patients in Hong Kong at the 13-year follow-up. The patients were categorized into short (≤30days), medium (31–180days) and long (>180days) DUP groups. Results: The long-term outcome was ascertained in 73% of the patients. Nearly half of the patients (47%) fulfilled the criteria for symptomatic remission. The short DUP group experienced a significantly higher remission rate over the course of the illness. The odds of long-term symptomatic remission was significantly reduced in the medium DUP (by 89%) and long DUP (by 85%) groups compared with the short DUP group. Further analysis showed that DUP had a specific impact on negative symptom remission. Conclusion: The findings support the threshold theory that DUP longer than 30days adversely impacts the long-term outcome. The present study is one of the few studies that confirmed the enduring impact of DUP on long-term outcomes based on well-defined criteria and adequate statistical adjustment. [Copyright &y& Elsevier]

Abstract: There has been increasing interest in studying the impact of physical activity on the psychological and physical well-being and functioning in patients with first-episode psychosis. The exploration of factors which contribute to physical activity in psychosis may open up opportunities for improvement of functional outcome. The purpose of this study was to examine the association between physical activity level and functioning in psychosis. A total of 283 patients with first-episode psychosis were recruited from a specialized early intervention service for adult-onset psychosis (Jockey Club Early Psychosis Project) in Hong Kong. The level of physical activity, sociodemographics and clinical characteristics was assessed at study entry. Functioning was assessed at 6-months period. Ninety-six (33.9%) patients were categorized as physically inactive, and 187 (66.1%) of them were physically active. Being physically inactive (β=0.163, P =0.003), having more positive and negative symptoms [SAPS total score (β=−0.161, P =0.005), and SANS total score (β=−0.202, P =0.001)], and having lower household income (β=0.207, P =0.001) at baseline predicted poorer functioning at 6months. Early intervention for psychosis should target to improve patients' physical activity level which may help subsequent functioning. [Copyright &y& Elsevier]

Objective: To determine the prevalence of psychiatric morbidity, identify correlates of psychiatric morbidities, and evaluate the effectiveness of the 12-item General Health Questionnaire as a screening tool for psychiatric morbidity in Chinese patients infected with chronic hepatitis B. Methods: This cross-sectional study was conducted in a local public specialist outpatient infectious disease clinic from October 2008 to June 2009, in which a total of 160 patients were randomly selected. Psychiatric diagnoses were established by using the Chinese-Bilingual Structured Clinical Interview for the DSM-IV (Axis I Disorders). Scores for the General Health Questionnaire were compared against the psychiatric diagnoses. Results: Among 149 patients, the respective point prevalence of overall psychiatric disorders, depressive disorders, and anxiety disorders was 32%, 16%, and 14%. A family history of psychiatric disorder and absence of knowledge of mode of hepatitis B virus transmission were identified as being associated with current psychiatric disorders, current depressive disorders, and current anxiety disorders. Absence of a confidant was an independent factor for current depressive disorders and use of herbal medicine in the previous month was an independent factor for current anxiety disorders. Conclusion: Psychiatric disorders are common in Chinese patients with chronic hepatitis B. Identifying associated factors and using the General Health Questionnaire as a screening tool are useful for identifying patients with psychiatric disorders in an infectious disease clinic. [ABSTRACT FROM AUTHOR]

The year 2011 marked the 10-year milestone of early intervention for psychosis in Hong Kong. Since 2001, the landscape of early psychosis services has changed markedly in Hong Kong. Substantial progress has been made in the areas of early intervention service implementation, knowledge generation, and public awareness promotion. Favourable outcomes attributable to the early intervention service are supported by solid evidence from local clinical research studies; early intervention service users showed improved functioning, ameliorated symptoms, and decreased hospitalisation and suicide rates. Continued development of early intervention in Hong Kong over the decade includes the introduction and maturation of several key platforms, such as the Hospital Authority Early Assessment Service for Young People with Psychosis programme, the Psychosis Studies and Intervention Unit by the University of Hong Kong, the Hong Kong Early Psychosis Intervention Society, the Jockey Club Early Psychosis Project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. In this paper, we reviewed some of the major milestones in local service development with reference to features of the Hong Kong mental health system. We describe chronologically the implementation and consolidation of public early intervention services as well as recent progresses in public awareness work that are tied in with knowledge generation and transfer, and outline the prospects for early intervention in the next decade and those that follow. [ABSTRACT FROM AUTHOR]

Objectives: To examine subjective weight perception of patients with first-episode psychotic disorders, perceived reasons for believing they were overweight, and methods employed for weight reduction (about 1 year) whilst in receipt of antipsychotics. Methods: A total of 160 consecutive participants with a 1-year history of first-episode psychotic disorders were recruited and their body mass index, subjective weight perception, and the wish to do something about their weight were assessed. Results: For patients of both genders with first-episode psychotic disorders, weight control behaviours were more associated with the perceived weight status than their actual weight. Most participants who perceived themselves as overweight believed that their weight problem was caused by the antipsychotics they had been taking. Self-reduction of antipsychotics was the commonest method they resorted to in the belief it would result in weight reduction. Conclusions: There is a need to implement more structured weight loss and physical exercise programmes for patients with first-episode psychotic disorder in order to maintain their physical and mental health. [ABSTRACT FROM AUTHOR]

Schizophrenia translates in Chinese as 'Mind Split Disease' which is heavily stigmatizing. The narrow conceptualization for schizophrenia alone was insufficient, in the context of early detection and intervention for psychosis. The need for an effective Chinese translation for psychotic disorders was imminent upon the launch of the Early Assessment Service for Young People with Psychosis in Hong Kong, where public awareness strategies had to be built upon effective communication of the disorder. ' Si Jue Shi Tiao', the new term for psychosis, described 'thought and perceptual dysregulation'. This new terminology and concept was strategically introduced to the local community. The term ' Si Jue Shi Tiao' was taken up well locally and had demonstrated interactions within the Chinese and East Asian communities. The public has taken in the broader concept of psychosis, in contrary to the previous concept of schizophrenia per se. In Hong Kong, the restrictive view of perceiving psychotic disorders as schizophrenia was broadened upon the introduction of a more embracing, less stigmatizing term ' Si Jue Shi Tiao'. Effective establishment of this term to the local vocabulary allowed a basis for communication as well as public education work. Further evaluation is necessary to determine the effectiveness of the naming and to guide further public awareness strategies. [ABSTRACT FROM AUTHOR]

Aim: This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. Methods: In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. Results: An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. Conclusions: The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed. [ABSTRACT FROM AUTHOR]

Background: Expressed emotion is a construct that has been used for the past three decades to describe family members’ criticism, hostility and emotional involvement with a mentally ill relative within the context of family interactions and caregiving. In Western countries this construct is used as an outcome measure of interventions for families of people with schizophrenia or other psychotic disorders, but the use of this construct in Chinese populations is somewhat limited. Objective: To test the reliability and validity of a refined Chinese version of the 52-item Level of Expressed Emotion Scale (LEE). Methods: A convenience sample of 405 outpatients with psychotic disorders in Hong Kong and one of their family caregivers were recruited. Patients were asked to complete a set of questionnaires twice over a 6-month period, including the Chinese version of the LEE, the Specific Level of Functioning scale and the Brief Psychiatric Rating Scale; while their caregivers completed the Family Assessment Device twice and a demographic data sheet at recruitment. This study was aimed at establishing the internal consistency, reproducibility, responsiveness, and construct validity of the LEE. Results: Results indicated that the refined 50-item Chinese version of the LEE and its subscales demonstrated a high internal consistency and satisfactory correlations with patient and family functioning scores. Principal component analysis revealed the presence of four factors, explaining 70.8% of total variance and indicating high factor loadings as well as item-factor inter-correlations. The Chinese version not only indicated a satisfactory reproducibility in assessing change in patients’ symptom severity and family functioning but also showed an adequate responsiveness to the changes in patients’ symptoms over 6 months, especially for detecting symptom improvement. Discussion: The findings of the psychometric evaluation of the Chinese version of the LEE established its potential as a research instrument in measuring the level of expressed emotion of family members as perceived by Chinese patients with psychotic disorders. Further testing of its psychometric properties is recommended, using larger samples from diverse socio-economic backgrounds and mental illnesses. [Copyright &y& Elsevier]

Objectives: Satisfaction with body weight is more closely related to one's perception rather than one's actual body weight. It is important to understand the body weight perceptions of individuals with psychotic disorders to enhance appropriate weight management. Participants and Methods: Information regarding body mass index, attitude towards body weight and figure rating was gathered from 87 young adults with psychotic disorders and 102 age- and educationmatched controls. Results: Patients were significantly heavier than controls and were aware of their overweight status. Members of both groups wished to lose weight even when their body weight was within the normal range. The wish to do something about their weight status correlated highly with their perception of their weight status (rs = 0.96-1.00, p < 0.01) rather than their actual weight status (rs = 0.62-0.68, p < 0.01). Conclusions: Young adults with psychotic disorders are concerned about their weight. As the wish to do something about weight is more closely correlated to how their weight is perceived, it is important to assess the individual's perception of their body weight status. Health care professionals should be aware of this in order to assist body weight management. [ABSTRACT FROM AUTHOR]

Objective: This is the first study to investigate the relationship between the level of state anxiety and the jumping to conclusions (JTC) reasoning bias in patients with first-episode psychosis using an experimental manipulation procedure. Method: Thirty patients with psychotic delusions and 30 non-clinical controls, from Hong Kong, were randomized into an anxiety induction or an anxiety reduction imagery condition. Questionnaires were used to measure trait emotions, psychotic symptoms and delusional thinking at baseline. After the anxiety manipulation, participants completed two versions of an assessment of the JTC reasoning bias, the beads task. Results: Both the patients and the non-clinical controls were responsive to the anxiety reduction imagery, but only the non-clinical controls responded to the anxiety induction imagery. The JTC reasoning bias was, as hypothesized, more common in patients than in controls, but was not significantly different between the anxiety manipulation conditions. Both patients and controls had higher rates of JTC than in previous studies. Conclusions: Patients with psychotic delusions have a marked JTC cognitive bias. This is the first JTC study in a Chinese sample, and the results suggest that the bias applies cross-culturally. The results indicate that state anxiety does not influence JTC. Limitations of the study include an inadequate anxiety state manipulation effect in psychotic patients using brief imagery, and unusually high rates of JTC in both patients and controls. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the experience of caregiving, the relationship between demographic and clinical variables and the dimensions of the experiences for caregivers managing patients attending a First Episode Psychosis Clinic in Hong Kong. Participants and Methods: Caregivers of 139 patients with the first-episode psychosis completed a locally validated Experience of Caregiving Inventory, a 66-item self-report questionnaire measuring positive and negative appraisals of the caregiving experience. Patients' psychopathology was assessed using the Positive and Negative Syndrome Scale. Results: Patients' functional levels correlated significantly with negative appraisal levels. Female patients were significantly associated with positive appraisal levels. A linear regression analysis revealed that a negative symptom score, a history of deliberate self-harm, and a family history of psychiatric illness emerged as significant predictor variables. Conclusion: The results indicate that caregivers in Hong Kong are distressed by difficult behaviours and patients' negative symptoms. [ABSTRACT FROM AUTHOR]

Objectives: To assess perceived needs of schizophrenic outpatients in Hong Kong, and the effectiveness of clinicians in identifying those needs; and to explore the use of a self-rated instrument to enhance needs identification. Participants and Methods: The two-way communication checklist was completed by 70 outpatients before consultation. Their clinicians were either given the checklist during the consultation (2-COM group, n=36), or were unaware of the patient's answers and independently completed the checklist (needs awareness group, n = 34). As standard care group (n = 35) was included for comparison. Consultation time and patient satisfaction were also recorded. Results: The major concern of patients was information about their illness and treatment (59%). In the needs awareness group, under-recognition of patients' needs by clinicians was observed in various domains. Consultation time (mean, 5.6 minutes) correlated with the number of needs identified by clinicians. The 2-COM group showed a trend towards higher satisfaction compared to the standard care group, although this did not reach statistical significance. Conclusions: Clinicians may under-identify problems perceived by patients due to time constraints and other factors. The use of a structured questionnaire may facilitate effective needs identification in a busy outpatient clinic. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the effect of a cognitive behavioural therapy training programme on the change in declarative and procedural knowledge in a group of mental health care workers in Hong Kong. Participants and Methods: A group of social workers (n = 12) was recruited into a training programme on cognitive behavioural therapy for psychosis. The training was composed of 12 weekly sessions of didactic education in the theory and practice of cognitive behavioural therapy for chronic psychotic patients with medication-resistant psychotic symptoms. The didactic course was the followed by 6 months of weekly group supervision in the application of cognitive behavioural therapy (n = 10; 2 dropped out due to personal and health reasons). A total of 10 chronic patients suffering from schizophrenia were treated for a mean period of 26.4 weeks. The quality of case formulation (as measured by the Quality of Cognitive Case Formulation Scale) and therapist competence (as measured by the Cognitive Therapy Rating Scale) were assessed before and after the group supervision. Results: The number of trainees who attained satisfactory quality for case formulation scores increased after completion of the didactic lectures and the group supervision training. The mean total score of the Cognitive Therapy Rating Scale, which assessed the therapists' competence, was 31 at the commencement of group supervision. By the end of the group supervision training, the mean total score improved to 34. Conclusion: Group supervision supplemented with didactic training effectively improved the declarative knowledge and procedural skills for the provision of cognitive behavioural therapy for psychosis in a group of trainees. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the expressed emotion in a group of caregivers of young adults with first-episode psychosis. Participants and Methods: This cross-sectional study was done to examine the relationships between expressed emotion and the clinical characteristics of caregivers supporting patients attending a first-episode psychosis clinic in the Hong Kong Special Administrative Region. The caregivers' expressed emotions and the patients' perceptions of those expressed emotions were evaluated using the Level of Expressed Emotion questionnaire. Expressed emotion profiles were correlated with psychiatric symptomatology according to the Positive and Negative Syndrome Scale. Results: One hundred and thirty nine caregiver-patient pairs completed and returned all the questionnaires. Higher caregiver-rated expressed emotion was associated with the caregiver being the father, unemployed, and patients being of young age. The total Positive and Negative Syndrome Scale score was positively correlated with both the caregiver-rated (Spearman's rho [r] = 0.28, p = 0.001) and patient-rated (r = 0.38, p < 0.001) total expressed emotion scores. Conclusions: Expressed emotion in the caregivers looking after young adults with psychosis was modulated by different clinical parameters. At an early stage of the illness, special attention, should be paid to the caregiving experience of family members who play an instrumental role in the health care plan. [ABSTRACT FROM AUTHOR]

Background: There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes. Methods: A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation 'taster' session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions. Results: A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation 'taster' session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group. Conclusions: Offering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning. [ABSTRACT FROM AUTHOR]

Background: Research comparing sex differences in the effects of antipsychotic medications on acute ischemic heart disease (IHD) is limited and the findings ambiguous. This study aimed to investigate these associations within a primary care setting.Methods: Hong Kong public general outpatient electronic records of patients aged 45+ during 2007-2010 were extracted, with the last consultation date as the baseline for a 4-year follow-up period to observe acute IHD hospitalizations (2011-2014). Antipsychotic use was defined as any prescription over the previous 12 months from a list of 16 antipsychotics, while acute IHD was defined by ICD-9: 410.00-411.89. Both sex-specific and sex-combined (both sexes) mixed-effects Cox models (random intercept across 74 clinics) were implemented to examine the association and test the interaction between antipsychotics and sex.Results: Among 1,043,236 included patients, 17,780 (1.7%) were prescribed antipsychotics, and 8342 (0.8%) developed IHD. In sex-specific analyses, antipsychotic prescription was associated with a 32% increased hazard rate of acute IHD among women (95% CI 1.05-1.67) but not among men. A likelihood ratio test comparing sex-combined models with and without the interaction between antipsychotic use and sex suggested significant interaction (χ2 = 4.72, P = 0.030). The association between antipsychotic use and IHD among women attenuated and became non-significant when haloperidol was omitted from the operationalization of antipsychotic use (HR = 1.23, 95% CI 0.95-1.60).Conclusion: Our results suggest that antipsychotic prescription is moderately associated with an increased risk of acute IHD among women in primary care and this relationship may be explained by specific antipsychotics. Further research should observe and capture the potential intermediary mechanisms and the dose-response relationship of this association to provide more rigorous evidence to establish causality and inform clinical practices. [ABSTRACT FROM AUTHOR]