As-Required Filgrastim for Late-Onset Neutropenia Complicating Long-Term Clozapine Treatment: a Case Report.

Clozapine is considered the most effective antipsychotic for schizophrenia, but it can cause neutropenia and even agranulocytosis. We describe the first case in Hong Kong involving the use of filgrastim, a recombinant form of human granulocyte colony-stimulating factor, to enable clozapine continuation therapy for a severely ill patient with treatment-resistant schizoaffective disorder who developed recurrent neutropenia after almost 20 years of continuous clozapine therapy. Therefore, clinical vigilance is important, regardless of clozapine treatment duration. Filgrastim can facilitate long-term clozapine therapy in patients with clozapine-induced neutropenia.

Wilson Sims Fall Risk Assessment Tool Versus Morse Fall Scale in Psychogeriatric Inpatients: a Multicentre Study.

OBJECTIVE: To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. METHODS: Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. RESULTS: We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). CONCLUSION: WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.

Six-month Follow-up of Cognitive Impairment and Depressive Symptoms in Late-onset Depression.

OBJECTIVE: To assess cognitive performance in elderly depressed patients following treatment for 6 months. Remission rate of depression after 6 months of treatment was calculated. METHODS: The study was performed in a consecutive group of patients aged ≥ 65 years with late-onset depression. Severity of depression was assessed by the Hamilton Depression Scale, cognitive performance by the Hong Kong Montreal Cognitive Assessment, and functional level by the Instrumental Activities of Daily Living Scale. RESULTS: A total of 52 patients were recruited. In all, 28 (53.8%) were found to have cognitive impairment at baseline and 8 (28.6%) of them had improvement after 6 months. This cognitively impaired group was older and had a lower Instrumental Activities of Daily Living Scale score. The remission rate of depression was 61.5%. CONCLUSIONS: Cognitive impairment constituted a stable feature in a considerable number of elderly patients with depression. About two-thirds of patients achieved remission of depression after 6 months of treatment.

Consultation-liaison service in a regional hospital in Hong Kong.

OBJECTIVE: To examine consultation-liaison psychiatric services in a general hospital in Hong Kong. METHODS: All records of Tseung Kwan O Hospital psychiatric consultations from 1 July 2012 to 30 June 2013 were extracted from the database. Patients' demographic data, sources and reasons of referral, psychiatric and suicidal histories, current suicidal attempt, psychiatric diagnoses, psychiatric outcomes, as well as waiting times were analysed accordingly. RESULTS: A total of 1392 psychiatric consultations were received, of which 82% were attended to within the same working day when the referral was received, and 99% were attended to by the end of the next working day. The commonest reasons of consultation were unstable emotion followed by suicidal / deliberate self-harm and aggression. There were 246 consultations with actual suicidal attempt. Overall, 270 (19%) patients who received consultation-liaison psychiatric services were admitted to the psychiatric wards. Follow-up in the psychiatric outpatient department was arranged for 691 (50%) patients while 57 (4%) required referral to the community psychiatric nursing service in addition to outpatient department arrangement. CONCLUSIONS: Management of suicidal attempters and provision of risk assessment continue to be the major tasks of consultation-liaison psychiatrists and nurses. A readily available on-site consultation-liaison psychiatric service is an essential component of services provided in acute general hospitals.

Patients committing suicide whilst under the care of the elderly suicide prevention programme of a regional hospital in Hong Kong.

OBJECTIVE: To examine the risk factors for suicide in elderly Hong Kong Chinese. METHODS: Case notes, mortality reports and hospital records of all the patients, who committed suicide from 1 July 2002 to 31 March 2010 whilst under the active care of the Elderly Suicide Prevention Programme of the Castle Peak Hospital in Hong Kong, were reviewed. RESULTS: A total of 1230 elderly with high risk of suicide were assessed and treated from 1 July 2002 to March 2010. A total of 8 patients in this programme who committed suicide during this period were identified, of whom 63% were male and the most frequent method employed was jumping from a height. All the suicides ensued within the first 6 weeks of treatment under the programme. All these patients were diagnosed to have a depressive illness, and all but 1 had an associated physical illness that possibly precipitated the suicide. They had all been admitted to either a mental or general hospital, about 1 month before committing suicide. CONCLUSIONS: The first 2 months of treatment is associated with the highest risk of suicide. Intensive care and support with proper education about effects of antidepressants, and the building-up of a trusted therapeutic alliance with close relatives are particularly important in this vulnerable period.

Body weight perception and methods of weight reduction used by patients with first-episode psychotic disorders in Hong Kong.

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.

Extent of weight gain in patients with first-episode psychotic disorders after one year of antipsychotic treatment in Hong Kong.

OBJECTIVES: This study aimed to examine the extent of weight gain in a group of patients with first-episode psychotic disorders after receiving antipsychotic treatment for 1 year, and to examine any relationship with the type of antipsychotics prescribed. PARTICIPANTS AND METHODS: A total of 160 consecutive participants with 1-year history of first-episode psychotic disorders were recruited, and their body mass index values before and 1 year after antipsychotic treatment were calculated. RESULTS: About half of the participants gained more than 7% of their baseline body weight. In general, the participants gained a median weight of 4.8 kg (interquartile range, 0.7-9.0 kg) after 1 year of treatment. Forty percent of the female and 47% of the male participants were overweight after treatment. Patients taking second-generation antipsychotics had more severe weight gain than those taking first-generation agents. Olanzapine treatment was associated with the greatest weight gain. CONCLUSIONS: Weight gain is a significant problem even in the early stages of psychotic disorders. Health care professionals need to be aware of this issue and address it early in the course of management, so as to prevent harmful consequences of weight gain in the future.

Neural correlates of attention biases of people with major depressive disorder: a voxel-based morphometric study.

BACKGROUND: Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli. METHOD: Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words. RESULTS: The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls. CONCLUSIONS: Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.