Cognitive deficit measures in schizophrenia: factor structure and clinical correlates.

OBJECTIVE: The authors aimed to delineate the "common denominators" across a representative number of cognitive measures by administering such measures to a large number of schizophrenic subjects. The authors also aimed to study the consistency of the subjects' performance over a 1-year period and to look into the relationship between cognitive task performance and clinical status. METHOD: One hundred fifty-seven schizophrenic subjects with a DSM-III-R diagnosis of schizophrenia were assessed under standardized testing conditions on the dichotic listening and shadowing task, the span of apprehension task, the simple reaction time tasks, the critical stimulus duration, and the interstimulus interval in which they would become free from the masking effect. The clinical status of the subjects was assessed during index assessment, and 97 subjects were reassessed at the end of 1 year. Forty-seven subjects were randomly selected for reassessment on the cognitive tasks administered 1 year earlier. The subjects' performance was compared to that of 56 nonschizophrenic patients with nasopharyngeal carcinoma who had undergone radiation therapy. RESULTS: The cognitive task scores were factor analyzed, giving five distinct factors made up of the span of apprehension accuracy scores, simple reaction time scores, shadowing accuracy scores, span of apprehension error scores, and susceptibility to interference scores. At index assessment, the subjects' shadowing accuracy and reaction time were significantly related to their quality of life, social adjustment, and positive symptoms. The subjects' span of apprehension scores were related to their negative symptoms, measured in terms of work and daily life functions. The initial relationship between the subjects' cognitive test scores and their outcome status remained consistent at follow-up. CONCLUSIONS: The documented cognitive deficits in schizophrenic patients probably reflect a more enduring trait-like status with correlations with outcome status. These results also indicate that the cognitive measures may be simplified in complexity without a corresponding reduction in their clinical significance.

Parent management training in a Chinese population: application and outcome.

OBJECTIVE: To examine the applicability and outcome of parent management training in a group of Chinese children referred for aggressive and defiant behaviors. METHOD: Twenty-five children (aged 4-10 years) were assigned to a standardized 8 to 12 sessions of parent management training. Trained child and adolescent psychiatric nurses conducted the treatment. Measures taken at pretreatment, posttreatment, and 4-month follow-up period included the Child Behavior Checklist, direct observation of parent-child interactions, and a parent perception inventory. RESULTS: Significant therapeutic gains occurred in parent-child interactions, externalizing behaviors, and parents' perception of their parenting behaviors. These were maintained at 4-month follow-up. Fifty-two percent of cases improved to a level below clinical cutoffs. Poor parent-child interactions had stronger correlation with externalizing disturbances than internalizing disturbances. The changes in parent-child interactions had low correlation with the changes in the symptom profiles. CONCLUSIONS: The data provide preliminary evidence for the efficacy of parent management training for Chinese children with conduct problems. The rationale for its success and modifications to improve its cultural sensitivity are discussed.

Vietnamese refugee children in camps in Hong Kong.

Vietnamese refugee children staying in an open camp in Hong Kong were interviewed to find out the nature of their war experience. The effects of war and refugee experience on their fears about being hurt or killed were assessed. Most of the Vietnamese children in the present sample travelled to Hong Kong with their family and had little experience of separation, death or injury of close family members. However, about two-thirds of them had witnessed violence and one-third reported experience of being assaulted. Children exposed to unpleasant war experience were more likely to report a fear of being hurt than those not exposed to similar negative events. However, there was no consistent finding relating other types of fear to war experience. The family and the cohesiveness of the community in which they lived may have protected them against adverse psychological reactions.

Psychosocial adjustment of victims of occupational hand injuries.

A group of hand injury patients was followed up 2-3 years after their injury. Compared to a non-patient control group hand injury patients were more externally oriented, and reported more psychological symptoms. Based on their General Health Questionnaire scores, the patients were divided into a low score and a high score group. High GHQ scores were associated with external locus of control, less social activities, and dissatisfaction with social life. The medical rating of loss of earning capacity was not predictive of overall occupational or psychosocial adjustment. Suggestions are made for future research into determinants of occupational adjustment of these patients.

Semantic verbal fluency deficit as a familial trait marker in schizophrenia.

This study examined neurocognitive deficits as familial vulnerability factors to schizophrenia. Twenty-three Chinese schizophrenic patients, 21 of their non-psychotic siblings and 26 healthy volunteers, matched for age, sex and education, were assessed by using a battery of neurocognitive tests including: Wisconsin Card Sorting Test (WCST), semantic verbal fluency, logical memory, digit span, information, comprehension and similarity. The results showed that siblings had significantly less word output in the verbal fluency test as compared to controls. No significant difference was found between siblings and controls for other tests except that a trend difference was noted for the performance on the similarity test and number of categories completed on the WCST. The verbal fluency abnormality can be considered as a familial trait marker for schizophrenia. Relationships between the residual symptoms after an acute psychotic episode and the magnitude of familial risk were examined. More severe residual symptoms of probands at clinical remission could be predicted by their older age of onset and by better verbal fluency performance in their non-psychotic siblings. This tentatively suggests that patients with a milder genetic form of schizophrenic illness may have a more severe environmental contribution to cerebral insult according to the multifactorial/threshold model. The environmental cerebral insult may cause structural abnormalities leading to incomplete remission of clinical symptoms.

No association between T102C polymorphism of serotonin-2A receptor gene and clinical phenotypes of Chinese schizophrenic patients.

Serotonin dysfunction has been implicated in the pathogenesis of schizophrenia. Previous studies have shown an association between the T102C polymorphism of the 5HT2a receptor gene and schizophrenia. However, negative findings have also been reported. One possible explanation for such discrepancy is disease heterogeneity due to the current limitations in the diagnosis of schizophrenia. We conducted a case-control study of the T102C polymorphism with detailed characterisation of the clinical phenotypes to investigate the possible association with schizophrenia not only at the diagnostic level, but also with reference to other clinical phenotypes potentially related to serotonin dysfunction. Four hundred and seventy-one biologically unrelated schizophrenic patients and 523 unrelated healthy controls of Han Chinese descent in Hong Kong were compared for genotypes and allele frequencies of the T102C polymorphism by PCR amplification and restriction analysis. No evidence of association was detected at the diagnostic level and various clinical phenotypes. However, we found a trend association with small effect size between genotype 102T/102C and patients with better verbal fluency and less motor co-ordination soft neurological signs. There is a need for future large-scale studies on the possible associations between genetic polymorphisms and neurocognitive function impairments in schizophrenia.

Psychosocial factors influencing outcome in patients with low-back pain.

A psychosocial analysis of 58 patients with low-back pain was conducted. Three groups of patients with different outcomes were delineated with distinctly different psychosocial profiles. Patients who recovered uneventfully had a better income, reported more satisfaction with hospitalization or medical personnel, and had prolonged pain-free periods. Patients with the worst outcomes in terms of poor work role adjustment and severe pain complaints were more likely to be immigrants from mainland China, to be engaged in heavy manual labor, to be involved in compensation claims for work-related injuries, manifested a high degree of anxiety and depressive symptoms, and were hostile toward medical personnel. An intermediate group of patients with adequate work role adjustment but severe to moderate levels of pain were characterized by being females with varying combinations of anxiety and depressive symptoms. A preliminary clinical interview guide for screening potential problematic patients was developed.

The structure and prevalence of behavioral problems in Hong Kong preschool children.

Nearly all 3-year-old Chinese children in Hong Kong attend preschool facilities, making it possible to study their behavior in a group learning situation based upon teachers' perception. The Preschool Behavior Checklist (PBCL), a teacher's questionnaire, was applied to a random sample of 851 Chinese children, ages 36 to 48 months. The factor structure of the PBCL was very similar to that obtained from its original British study, supporting its usage cross-culturally. Prevalence of behavior disorder was high as defined by the PBCL. This reflected specific cultural demands at school settings. Significant sex differences were also found in the overall rate of behavior disorder and symptom patterns. As in other studies, boys had more hyperactive, conduct, and speech problems. The results suggested a certain degree of universality of symptomatology for children at the preschool level.

Psychological interventions in general hospitals: background, current status and clinical guidelines.

PURPOSE: To promote the systematic development, interests, practice, research and clinical applications of health psychology in general hospitals in Hong Kong and the mainland of China. DATA SOURCES: The targets and aims of therapeutic work with patients in pain, cancer patients, child and adolescent patients, patients with chronic illnesses, the elderly, and patients requiring organ transplantation are highlighted. STUDY SELECTION: The psychological interventions described are experiences derived from routine clinical services carried out in the Clinical Health Psychology Unit where the authors are affiliated, and can be seen as an example of a more comprehensive psychological intervention program for physically ill patients in Hong Kong. RESULTS: Psychological interventions have intrinsic values in reducing patients' distress and sufferings. The services are also an integral part of modem day comprehensive patient care with positive effects on treatment effectiveness and eventual illness outcome. CONCLUSIONS: Physical illnesses affect a person physically as well as psychologically. Psychological care in general hospitals is cost effective and beneficial in reducing undue psychological complications precipitated by physical afflictions as well as in promoting better overall outcomes.

The pattern of coping in persons with spinal cord injuries.

PURPOSE: To examine the modes of coping and adjustment of persons with spinal cord injuries (SCI) in Hong Kong. METHOD: A cross-sectional design was adopted. Structured questionnaires and semi-structured interviews on 66 persons with SCI were completed. Cluster analysis was performed to identify persons with SCI who are at risk for psychosocial morbidity. RESULTS/CONCLUSION: The group at risk for developing psychological difficulties is characterized by high scores on external locus of control, inadequate coping modes, and low perceived social support. High levels of depression, social role dissatisfaction, care-giving burden, low levels of life satisfaction, and marital maladjustment are commonly noted. Rehabilitation of persons with SCI should also aim at promoting perceived personal control, acceptance of physical status, and realistic appraisal of stressful situations to facilitate better adjustment and coping with commonly identified stresses and difficulties. Counselling should be initiated at an early stage to reduce the development of distorted perceptions so that the needs and concerns of individuals with SCI may be better met and resolved. The frustrations due to unmet expectations may be prevented at an early stage through build-up of more realistic understandings related to the illness and living with the illness.

Dopamine receptor D4 (DRD4) gene in Han Chinese children with attention-deficit/hyperactivity disorder (ADHD): increased prevalence of the 2-repeat allele.

There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.

Cultivating psychological well-being in Hong Kong's future doctors.

There has been much recent attention on psychological well-being and pastoral care for medical students. This study examines psychological morbidity (depression, anxiety and stress) in Hong Kong medical students, as well as their concerns, coping mechanisms and their help-seeking. Medical students in Hong Kong reported a higher level of psychological morbidity as compared with other tertiary education students. Their main concerns include examinations, stress, career, adjusting to the new medical curriculum and commitment to the course. The coping skills adopted were largely adaptive. Maladaptive coping skills like 'denial', 'self-blame' and 'behavioural disengagement' were highly correlated with depression, anxiety and stress scores. Most of the students concerned wanted support services that were specifically tailored to their needs and at least partly provided by people who had been through medical training themselves. The faculty at the University of Hong Kong is establishing a Programme for Effective Transition and Student Support (PETSS) to provide a multi-faceted support system for its medical students. The findings in this study help to ensure that the services provided will be relevant, accessible and acceptable to the students.

Genetic discrimination and mental illness: a case report.

With advances in genetic technology, there are increasing concerns about the way in which genetic information may be abused, particularly in people at increased genetic risk of developing certain disorders. In a recent case in Hong Kong, the court ruled that it was unlawful for the civil service to discriminate in employment, for the sake of public safety, against people with a family history of mental illness. The plaintiffs showed no signs of any mental health problems and no genetic testing was performed. This was the first case concerning genetic discrimination in common law jurisdictions, therefore the court's judgment has implications for how genetic discrimination cases may be considered in the future. The court considered it inappropriate to apply population statistics or lifetime risks to individuals while examining fitness for work. It recommended an individualised assessment of specific risks within the job, relative to other risks posed by that workplace.

A comparison between male and female parasuicides in Hong Kong.

The epidemiological, social and clinical characteristics of 259 male and 475 female parasuicides in Hong Kong were compared. The majority are young adults, with an overall female: male ratio of 1.83. Compared to male subjects, females are more likely to be married or cohabiting, of higher social-economic status, born in places in the Far East apart from Mainland China, and of lower educational level. Their parasuicidal acts are more often motivated by interpersonal difficulties, especially with spouses or friends of the opposite sex, and take the form of self-poisoning. Male subjects on the other hand are more often single, immigrants from Mainland China, and of lower socio-economic status. Their problems are more often personal, and they are more likely to employ physical methods in their parasuicidal acts. In both sexes, age specific parasuicidal rates showed a second peak in senescence. Both the overall prevalence of psychiatric disorders and the rate of repeated parasuicide 2 years following the index admissions were low. The implications of these findings are explored.

Characteristics of child battering in Hong Kong: a controlled study.

The characteristics in Hong Kong of 37 cases of child battering and their families compared to a control group matched for age of child and social class of family revealed that the families of battered children had significantly more problems, with a higher prevalence of psychiatric disorder among the parents. The victims were usually the product of unwanted pregnancy and had been separated from their parents in the first year of life. In Hong Kong older children rather than infants were at risk of being battered. The cultural factors in operation are discussed.

Physique, personality and mental illness in southern Chinese women.

A number of anthropometric measurements were made on Southern Chinese women. These were 317 schizophrenics, 44 with affective disorder, 47 neurotics and normal controls. All groups and sub-groups compared were matched for mean age and socio-economic status. It was found that the intercorrelations between body build, personality and type of mental illness were on the whole similar to those reported for Caucasians.

Gilles de la Tourette's syndrome: report of five cases in the Chinese.

Five cases of Gilles de la Tourette's syndrome occurring in the Chinese are described. The onset, course, symptomatology and family psychopathology are similar to those reported in Caucasians. On the parameters of APGAR score, psychological testing, EEG and psychiatric examination all had at least one abnormality. The response to haloperidol was uniformly good. Follow-up results showed that all were able to lead a fairly normal life after treatment. Though the cases are few in number, the findings seem to support the hypothesis that the syndrome has an organic substratum subject to psychological influences.

Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting.

STUDY DESIGN: A cross-sectional retrospective study was carried out with structured questionnaires and semi-structured interviews on 66 persons with spinal cord injury (SCI) and 40 spouses. OBJECTIVES: The study aimed to explore the psychosocial adjustment of Hong Kong Chinese couples at the post SCI stage. An important study interest was the impact of care-giving in spouses of persons with SCI. SETTING: Three major regional rehabilitation centres and one community resource centre in Hong Kong. METHODS: A set of psychometric measures tapping different aspects of psychological functioning was included. These were locus of control (Levenson's Internality, Powerful Others, and Chance Scale), perceived social support (Provision of Social Relationship), coping strategies (Ways of Coping Checklist), marital adjustment (Dyadic Adjustment Scale), caregiving burden (Caregiver Burden Inventory), depression (Beck Depression Inventory), life satisfaction (Satisfaction with Life Situation), and social role adjustment (Katz Adjustment Scale - Relative Form). RESULTS: Persons with SCI with pre-injury marriage were more depressed (P<0.05) as compared with those with post-injury marriage. However, the two groups did not differ in terms of satisfaction with life situation and social role dissatisfaction. The spouses in the preinjury marriage reported a significantly higher score in time-dependent burden than those in the post-injury marriage (P<0.05). Care-giving burden was associated with locus of control, social support, and modes of coping (P<0.05). CONCLUSION: The impact of SCI is a long-lasting effect not limited to the patients but also extending to their spouses. Findings from the adjustment outcomes and coping styles of persons with SCI and their spouses indicate that they are not passive victims. A similar injury may produce different outcomes in different individuals. Rehabilitation professionals should thus be alert to both the couple's differing needs and idiosyncrasies in their helping process.