Developmental trauma and its correlates: a study of Chinese children with repeated familial physical and sexual abuse in Hong Kong.

The present study examined the relevance of the developmental trauma disorder (DTD) framework (van der Kolk, ) in Hong Kong Chinese children with repeated familial physical and/or sexual abuse. Self-reports of (a) key dimensions of DTD including emotion regulation, attribution and perceptions in self and relationships, belief in future victimization, behavioral difficulties, and self-esteem; and (b) attachment styles and posttraumatic stress disorder (PTSD) reactions were obtained from children aged 9-15 years in clinical and school settings. Children were categorized into an abused trauma group (n = 82), a nonabused trauma group (n = 83), and a no-trauma control group (n = 201). The findings indicated that the DTD framework was applicable to abused children who showed a lower level of attachment security (Cohen's d from 0.50-0.61) and a higher level of PTSD reactions (Cohen's d = 0.71) than the comparison groups. After adding attachment security and emotion dysregulation to the model, there were no longer significant group differences in most of the variables.

Early intervention and evaluation for adult-onset psychosis: the JCEP study rationale and design.

AIM: Psychotic disorders incur substantial long-term burdens to patients and society. Early intervention (EI) during the initial years of psychotic disorders can improve long-term outcome. In Hong Kong, a pilot EI programme (EASY, Early Assessment Service for Young people with psychosis) had been set up since 2001 to serve clients under 25 years of age. Although EASY has been effective in improving outcome, consolidation of early psychosis work requires further development. METHODS: The present paper describes a new EI development which targets adult patients with psychosis in Hong Kong. The Jockey Club Early Psychosis (JCEP) project was launched in 2009. Expanding the service to patients above 25 years old, JCEP aims to deliver a territory-wide specialized EI service to adult-onset psychosis patients, to promote public awareness on early psychosis, and to research on the optimal intervention model and duration for early psychosis in a 4-year randomized controlled trial (RCT). Participants were randomly assigned to receive either 4 years of EI service, 2 years of EI service, or 4 years of standard care. Their symptoms, neurocognitive functions, psychosocial well-being and health economics were regularly assessed. RESULTS: To date, 360 patients were recruited into the RCT, and 740 patients were recruited in a 2-year naturalistic study. Prospective, longitudinal follow-up assessments of these patients are still underway. CONCLUSIONS: JCEP is the first EI project to provide adult early psychosis service in Chinese population. Future data would help to address the optimal duration of EI and its cost-effectiveness. This would also assist regional and international mental health development.

Schizophrenia and risk-taking: impaired reward but preserved punishment processing.

Risky decision-making is subserved by the frontostriatal system, which includes a network of interconnected brain regions known to be dysfunctional in patients with schizophrenia. This study aimed to investigate whether and to what extent patients with schizophrenia display a different pattern of risk-taking behavior relative to matched healthy controls. The Balloon Analogue Risk Task (BART) and the Risky-Gains Task were used as naturalistic measures of risk-taking behavior in 25 patients with schizophrenia and 25 controls. Results of the BART revealed that patients behaved more conservatively, and this in turn led to suboptimal risky decision-making. Consistently, patients behaved more conservatively in the Risky-Gains Task. Interestingly, however, they adjusted the pattern of risk-taking following a punished trial similar to controls. These findings indicate that patients have impaired reward but preserved punishment processing. This study complements previous studies on decision-making in schizophrenia and suggests specific rather than widespread abnormalities along the frontostriatal system in schizophrenia.