The 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies.

BACKGROUND: The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms. METHOD: This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16-75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up. RESULTS: The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up. CONCLUSIONS: Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.

Prevalence of anxiety disorders in community dwelling older adults in Hong Kong.

BACKGROUND: Anxiety disorders are prevalent yet under-recognized in late life. We examined the prevalence of anxiety disorders in a representative sample of community dwelling older adults in Hong Kong. METHOD: Data on 1,158 non-demented respondents aged 60-75 years were extracted from the Hong Kong Mental Morbidity survey (HKMMS). Anxiety was assessed with the revised Clinical Interview Schedule (CIS-R). RESULT: One hundred and thirty-seven respondents (11.9%, 95% CI = 10-13.7%) had common mental disorders with a CIS-R score of 12 or above. 8% (95% CI = 6.5-9.6%) had anxiety, 2.2% (95% CI = 1.3-3%) had an anxiety disorder comorbid with depressive disorder, and 1.7% (95% CI = 1-2.5%) had depression. Anxious individuals were more likely to be females (χ 2 = 25.3, p < 0.001), had higher chronic physical burden (t = -9.3, p < 0.001), lower SF-12 physical functioning score (t = 9.2, p < 0.001), and poorer delayed recall (t = 2.3, p = 0.022). The risk of anxiety was higher for females (OR 2.8, 95% C.I. 1.7-4.6, p < 0.001) and those with physical illnesses (OR 1.4, 95% C.I. 1.3-1.6, p < 0.001). The risk of anxiety disorders increased in those with disorders of cardiovascular (OR 1.9, 95% C.I. 1.2-2.9, p = 0.003), musculoskeletal (OR 2.0, 95% C.I. 1.5-2.7, p < 0.001), and genitourinary system (OR 2.0, 95% C.I. 1.3-3.2, p = 0.002). CONCLUSIONS: The prevalence of anxiety disorders in Hong Kong older population was 8%. Female gender and those with poor physical health were at a greater risk of developing anxiety disorders. Our findings also suggested potential risk for early sign of memory impairment in cognitively healthy individuals with anxiety disorders.

Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS).

PURPOSE: Data on mental disorder prevalence and health service utilization required to inform healthcare management and planning are lacking in Hong Kong. The current study determined the prevalence of common mental disorders (CMD), and examined the patterns of mental health service utilization and associated factors. METHODS: We analyzed data from the Hong Kong Mental Morbidity Survey (HKMMS) of 5,719 Chinese adults aged 16-75 years in the general Hong Kong population, using the Chinese Revised Clinical Interview Schedule (CIS-R). RESULTS: The weighted prevalence estimate for any past-week CMD was 13.3 %, with mixed anxiety and depressive disorder being the most frequent diagnoses. CMD was positively associated with female gender, being divorced or separated, alcohol misuse, substance dependence, lack of regular physical exercise, and a family history of mental disorder. Among individuals with CMD, only 26 % had consulted mental health services in the past year; less than 10 % consulted general practitioners or family physicians. Lack of mental health service usage was significantly more likely in men and those with lower educational attainment. CONCLUSIONS: Apart from attention to psychosocial risks, health and lifestyle factors are important considerations for mental health promotion. Service utilization for individuals with CMD in Hong Kong remains suboptimal, and would be enhanced by strengthening community primary care.

Suicidal ideation in patients with systemic lupus erythematosus: incidence and risk factors.

OBJECTIVE: To study the incidence of suicidal ideation in patients with SLE and the associated risk factors. METHODS: Consecutive patients who fulfilled four or more ACR criteria for SLE were recruited. Suicidal thought in the preceding month was assessed by three direct questions. The intensity of suicidal ideation was assessed by the validated Beck Scale for Suicidal Ideation (BSSI). Socio-demographic data, clinical manifestations, Hospital Anxiety and Depression Scale (HADS), SLEDAI and SLICC/ACR Damage Index (SDI) scores were compared between patients with and without suicidal thoughts. Linear regression was used to study the factors associated with higher BSSI scores. RESULTS: Of the 367 SLE patients studied (96% women; mean age 40.2 years (S.D. 13), mean disease duration 9.3 years (S.D. 7.2), 67 (18.3%) patients had clinically active SLE and 137 (37.3%) had organ damage (SDI ≥ 1). Suicidal thoughts were present in 44 (12%) patients. Patients with suicidal thoughts, compared with those without, had significantly higher mean SLEDAI scores in the preceding year [5.1 (S.D. 4.0) vs 2.9 (S.D. 2.7), P < 0.001], higher SDI [1.4 (S.D. 1.7) vs 0.6 (S.D. 1.1), P < 0.001], HADS-depression [11.2 (S.D. 4.7) vs 4.4 (S.D. 3.8), P < 0.001] and anxiety [12.2 (S.D. 4.9) vs 5.6 (S.D. 4.1), P < 0.001] scores, and were more likely to be unemployed (P = 0.02), have a past history of psychiatric disorders (P = 0.03) and previous suicide attempts (P = 0.02), as well as major life events in the preceding month (P = 0.006). Linear regression revealed that the BSSI score correlated significantly with the HADS-depression score (ß = 0.27, P = 0.001), previous suicide attempts (ß = 0.12, P = 0.03), major life events (ß = 0.13, P = 0.01) and cardiovascular SDI score (ß = 0.27, P < 0.001). CONCLUSION: Suicidal ideation is common in SLE and is more intense in patients with depressive symptoms, cardiovascular damage, recent life events and previous suicide attempts.

Prevalence and determinants of psychiatric disorders in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is the most common chronic rheumatological disorder among southern Chinese patients in Hong Kong, with an estimated prevalence of 0.33%-0.35%. The resulting chronic pain, disability, social stress, and isolation contribute to the development of psychiatric symptoms. OBJECTIVE: The authors identify the prevalence and determining factors of psychiatric disorders in patients with RA. METHOD: Consecutive RA patients (N=200) were recruited from a rheumatology outpatient clinic. Psychiatric disorders were diagnosed by a psychiatrist using the Chinese-bilingual Structured Clinical Interview for DSM-IV Axis I disorders, Patient Research Version. Sociodemographic and clinical data and subjective health status and perceived social support data were also collected. Factors associated with the occurrence of psychiatric disorders were studied by multivariate analysis. RESULTS: A total of 47 patients were diagnosed with a current psychiatric disorder (depressive disorders, 14.5%; anxiety disorders, 13.0%; schizophrenia, 0.5%). Major depressive disorder and generalized anxiety disorder were the commonest current mood and anxiety disorders, respectively. Independent predictors for a current psychiatric disorder were poverty and perceived poor social support. Limited social interaction, perceived poor social support, high pain intensity, and a family history of psychiatric disorders were independently associated with a current depressive disorder, whereas poverty and perceived poor social support were associated with a current anxiety disorder. CONCLUSION: Depression and anxiety are common in Chinese patients with RA. Patients who lack social support or rely on economic assistance are more prone to the development of psychiatric disorders.

The role of symptoms and insight in mediating cognition and functioning in first episode psychosis.

INTRODUCTION: Achieving functional recovery in patients with psychosis is a challenge in clinical practice. Investigating the complex interplay between cognition, symptoms, insight and functional outcome in first episode psychosis will be crucial to understanding the factors leading to better functioning. METHODS: In this 12-month prospective follow-up study, we investigated how cognition, clinical symptoms, and insight into illness affected overall functioning in 160 patients with first episode psychosis recruited from the Early Assessment Service for Young People with Psychosis (EASY) in Hong Kong from July 1, 2014 to June 30, 2016. Cognition was assessed at baseline while symptoms, insight, and functioning were assessed at 12-month follow-up. Structural equation modelling was used to examine the direct and indirect relationships between functioning and other latent constructs. RESULTS: Symptoms (negative symptoms and general psychopathology) and insight were shown to be significant mediators between cognition and functioning. The significant direct relationship between cognition and functioning (ß = 0.387; p < 0.001) became insignificant (ß = 0.079; p = 0.578) after including symptoms and insight in the model. Symptoms and insight were significantly associated with cognition (symptoms, ß = -0.469; p < 0.001; insight, ß = -0.372; p < 0.001) and predicted functioning (symptoms, ß = -0.558; p < 0.001; insight, ß = -0.264; p < 0.01). CONCLUSION: Symptoms and insight mediated the effects of cognition on functioning. Interventions for improving functioning in patients with first episode psychosis should target not only cognition but also symptoms and insight.

Leveraging genome-wide association and clinical data in revealing schizophrenia subgroups.

Schizophrenia (SCZ) has long been recognized as a highly heterogeneous disorder. Patients differed in their clinical manifestations, prognosis, and underlying pathophysiologies. Here we presented and applied a framework for finding subtypes of SCZ utilizing genome-wide association study (GWAS) and clinical data. We postulated that genetic information may help stratify patient into useful subgroups, and incorporation of other clinical information and cognitive profiles will further improve patient subtyping. We conducted cluster analysis in 387 Hong Kong Chinese with SCZ. First we performed 'single-view' clustering using genetic or clinical data alone, then proceeded to 'multi-view' clustering (MVC) accounting for both types of information. We validated clustering results by assessing subgroup differences in various outcomes. We found significant differences in outcomes including treatment response, disease course and symptom severity (Simes overall p-value using MVC = 1.64E-9). Overall speaking, we identified three subgroups with good, intermediate and poor prognosis respectively. MVC generally out-performed single-view methods. The analysis was repeated for different sets of input SNPs, and stratified analysis of male and female patients, and the results remained largely robust. We also found significant enrichment for SCZ loci among the SNPs selected by the cluster algorithm. Numerous selected genes (e.g. NRG1, ERBB4, NRXN1, ANK3) and pathways (e.g. neuregulin-ErbB4 and calcium signaling) were implicated in SCZ or related pathophysiological processes. This is first study to combine both genetic and clinical data for subtyping SCZ, and to employ genome-wide SNP data in cluster analysis of a complex disease. This work points to a new way of GWAS analysis of translational potential.

Lifetime Prevalence and Correlates of Schizophrenia-Spectrum, Affective, and Other Non-affective Psychotic Disorders in the Chinese Adult Population.

Lifetime prevalence of psychotic disorders varies widely across studies. Epidemiological surveys have rarely examined prevalences of specific psychotic disorders other than schizophrenia, and the majority used a single-phase design without employing clinical reappraisal interview for diagnostic verification. The current study investigated lifetime prevalence, correlates and service utilization of schizophrenia-spectrum, affective, and other non-affective psychotic disorders in a representative sample of community-dwelling Chinese adult population aged 16-75 years (N = 5719) based on a territory-wide, population-based household survey for mental disorders in Hong Kong. The survey adopted a 2-phase design comprising first-phase psychosis screening and second-phase diagnostic verification incorporating clinical information from psychiatrist-administered semi-structured interview and medical record review to ascertain DSM-IV lifetime diagnosis for psychotic disorders. Data on sociodemographics, psychosocial characteristics and service utilization were collected. Our results showed that lifetime prevalence was 2.47% for psychotic disorder overall, 1.25% for schizophrenia, 0.15% for delusional disorder, 0.38% for psychotic disorder not otherwise specified, 0.31% for bipolar disorder with psychosis, and 0.33% for depressive disorder with psychosis. Schizophrenia-spectrum disorder was associated with family history of psychosis, cigarette smoking and variables indicating socioeconomic disadvantage. Victimization experiences were significantly related to affective psychoses and other non-affective psychoses. Around 80% of participants with any psychotic disorder sought some kind of professional help for mental health problems in the past year. Using comprehensive diagnostic assessment involving interview and record data, our results indicate that approximately 2.5% of Chinese adult population had lifetime psychotic disorder which represents a major public health concern.