Adventure-based training to enhance resilience and reduce depressive symptoms among juveniles: A randomized controlled trial.

There is growing concern about mental health problems among juveniles. Evidence shows that adventure-based training can reduce depressive symptoms in school children. However, a rigorous empirical investigation of the effectiveness of such training in enhancing resilience among juveniles has not yet been performed. In this study, a randomized controlled trial was conducted to examine the effectiveness of adventure-based training in enhancing resilience and self-esteem and reducing depressive symptoms among juveniles. Secondary school students from grades 7 to 9 (aged 12-16 years) who attended the Integrated Children and Youth Services Centre in a large public housing estate in Hong Kong from December 20, 2018 to November 25, 2019 were invited to participate in this study. We randomly assigned 228 eligible adolescents to an experimental group (n = 115) that received a 2-day/1-night adventure-based training or a placebo control group (n = 113) that received 2 days of leisure activities organized by the Integrated Children and Youth Services Centre. Data were collected at baseline and 3 and 6 months after the corresponding interventions. The primary outcome was resilience at 6 months. The secondary outcomes were depressive symptoms and self-esteem at 6 months. Compared with the placebo control group, the experimental group showed significantly higher resilience (p = 0.001) and fewer depressive symptoms (p = 0.02) at 6 months, and significantly higher self-esteem at 3 months (p = 0.04), but not at 6 months (p = 0.12). However, the generalizability of the findings is limited as we used a convenience sample.

Objective and subjective cognitive functioning in relation to psychopathology among women with early psychosis.

BACKGROUND: Subjective cognitive impairment (SCI) among early psychosis is under-recognized and under-studied. However, SCI is as important as objective impairment to be understood, since it assesses cognitive difficulties in real-life situations from a personal perspective and is therefore an essence of individualized medicine. This study aims to explore the associations between the objective and subjective measures of cognitive impairments and to identify factors contributing to SCI among people with early psychosis. METHODS: Participants were 60 females (mean age 24.57 ± 8.28) who had a diagnosis of psychotic-spectrum disorder within 5 years. They completed a battery of neuropsychological tests assessing a range of cognitive functions including verbal learning, memory, attention, and executive functions. The Subjective Cognitive Impairment Scale (SCIS) was used to assess their perceived cognitive decline. Psychotic symptoms and depression were also assessed. RESULTS: SCIS was not correlated with any of the objective cognitive tests results. It was positively correlated with depression and positive symptoms. A hierarchical multiple regression model revealed that positive symptoms and depression together explained 31.9% of the total variance in SCIS and only depression significantly predicted SCI. Performances on the memory tests were correlated with, and predicted by negative symptoms. CONCLUSIONS: There was no correlation between SCI and objective cognitive performances in patients with early psychosis. Treatments should not only focus on symptomatic remission and performance of cognitive tests, but also place emphasis on improving moods and subjective cognitive functions of individuals with early psychosis.

Chinese label for people at risk for psychosis.

AIM: With the movement of early detection and intervention for people at risk for psychosis, there is a growing need for a uniform terminology to describe the condition. A diagnostic label that can adapt into local culture and value may have positive effect in minimizing stigma. This study explored the preference of Chinese label for people at risk of psychosis and its associated stigma in Hong Kong. METHODS: A total of 149 individuals from the general public and 51 health-care professionals were recruited between March 2013 and May 2014. The condition of at risk for psychosis was described in a vignette. Participants' preference of label and perceived stigma of the condition and their basic demographics were collected by self-administered questionnaires. RESULTS: The most preferred Chinese label was 'yun-niang-qi' (developing period, 45%), followed by 'qian-qu-qi' (precursor period, 19%), 'feng-xian-qi' (risky period, 18%), 'zao-xian-qi' (early sign period, 16%) and 'gao-wei-qi' (high risk period, 4%). Gender, age, occupation and previous contact with mental health were not associated with preference of any Chinese label. CONCLUSIONS: The process in searching for this potential and locally accepted label for people at risk for psychosis has raised the awareness among the professionals. A proper label may help promote future clinical research and mental health services in Hong Kong.

Quality of life and functioning in first-episode psychosis Chinese patients with different antipsychotic medications.

AIM: This study compared the quality of life and functioning of 285 first-episode psychosis Chinese patients with different antipsychotic medications in Hong Kong. METHOD: Under the Jockey Club Early Psychosis project, a total of 285 patients were recruited from all inpatient and outpatient psychiatric units in Hong Kong between 2009 and 2011. In addition to the medication information, patients were assessed with the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Udvalg for Kliniske Undersøgelser (UKU), Barnes Akathisia Rating Scale (BARS), the Social and Occupational Functioning Assessment Scale (SOFAS), the Role Functioning Scale, and the Medical Outcomes Study Short Form 12-Item Health Survey (SF-12) after stabilization of mental condition. Differences between individual antipsychotic medications were compared using anova and multinomial regression model. RESULTS: The results demonstrated significant differences between different antipsychotic medications in the mean of UKU neurological subscore, BARS total score, SOFAS score and SF-12 Mental Component Summary (MCS) score. Patients with haloperidol had higher mean UKU neurological subscore than patients with olanzapine or amisulpride. Risperidone was associated with higher mean BARS total score than olanzapine, amisulpride or sulpiride. Higher mean MCS was found in patients with amisulpride than patients with risperidone. CONCLUSIONS: The findings suggest that antipsychotics have differential associations with the quality of life and functioning in patients with first-episode psychosis. Future prospective study is warranted to investigate if patients with first-episode psychosis will benefit specific type of antipsychotics more than the others.

Impact of physical activity on functioning of patients with first-episode psychosis--a 6 months prospective longitudinal study.

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 (ß=0.163, P=0.003), having more positive and negative symptoms [SAPS total score (ß=-0.161, P=0.005), and SANS total score (ß=-0.202, P=0.001)], and having lower household income (ß=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.

Early intervention for psychotic disorders: Real-life implementation in Hong Kong.

Hong Kong is among the first few cities in Asia to have implemented early intervention for psychosis in 2001. Substantial changes in psychosis service have since taken place. We reviewed available outcome data in Hong Kong, with reference to the philosophy of early intervention in psychosis, discussing experience and lessons learned from the implementation process, and future opportunities and challenges. Data accumulated in the past decade provided evidence for the benefits and significance of early intervention programmes: patients under the care of early intervention service showed improved functioning, milder symptoms, and fewer hospitalizations and suicides. Early intervention is more cost-effective compared with standard care. Stigma and misconception remains an issue, and public awareness campaigns are underway. In recent years, a critical mass is being formed, and Hong Kong has witnessed the unfolding of public service extension, new projects and organizations, and increasing interest from the community. Several major platforms are in place for coherent efforts, including the public Early Assessment Service for Young people with psychosis (EASY) programme, the Psychosis Studies and Intervention (PSI) research unit, the independent Hong Kong Early Psychosis Intervention Society (EPISO), the Jockey Club Early Psychosis (JCEP) project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. The first decade of early intervention work has been promising; consolidation and further development is needed on many fronts of research, service and education.