Diagnostic conversion to bipolar disorder in unipolar depressed patients in Hong Kong: A 20-year follow-up study.

BACKGROUND: Bipolar (BP) disorder, especially BP depression is common and yet remains enigmatic until the emergence of mania. The rates and risk factors of conversion from unipolar (UP) depression to BP disorder reported vary. OBJECTIVE: To study the long-term conversion rate from UP depression to BP disorder of an inpatient sample and identify the associated risk factors. METHODS: This is a retrospective longitudinal study conducted in 2017 based on review of medical records of patients admitted to a regional hospital in Hong Kong with diagnosis of major depressive disorder during the period from 1988 to 2000. RESULTS: A total of 19.5% of subjects had diagnostic shift from UP depression to BP disorder at follow-up, with a mean conversion time of 10.8 years and about 1% shift annually in the first 10 years. Risk factors include family history of mental illness, young age at onset, repeated admissions, psychotic symptoms and use of electroconvulsive therapy. More unconverted UP subjects (9.0%) committed suicide than those converted to BP (3.5%). LIMITATIONS: The study is limited by its retrospective design. CONCLUSIONS: Conversion from UP depression to BP disorder is dictated by its biological characteristics and clinical severity. Vigilance should be held in the first decade after onset when most conversion takes place.

White matter integrity in young medication-naïve bipolar II depressed adults.

It is unknown if young medication-naïve bipolar II (BPII) depressed patients have increased white matter (WM) disruptions. 27 each of young (average 23 years) and treatment-naïve BPII depressed, unipolar depressed (UD) patients and age-sex-education matched healthy controls (HC) underwent 3 T MRIs with diffusion tensor imaging. Diagnostic ratings included Structured Clinical Interview for DSM Disorders (SCID), Montgomery-Åsberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Hamilton Anxiety Rating Scale (HAM-A). Patients were clinically depressed (MADRS-BPII: 26.15 [SD9.25], UD: 25.56 [5.24], p = 0.86). Compared to UD, BPII had increased family bipolarity (BPII 13.6% vs UD 2.5%, p = 0.01, φc = 0.28), hypomanic symptoms (YMRS-BPII: 4.22 [4.24], UD: 1.33 [2], p = 0.02, d = 0.87), lifetime number of depressive episodes (BPII: 2.37 [1.23], UD: 1.44 [0.75], p = 0.02, d = 0.91), lifetime and current-year number of episodes (lifetime BPII: 50.85 [95.47], UD: 1.7 [1.03]; current-year BPII: 9.93 [16.29], UD: 1.11 [0.32], ps = 0.04, ds = 0.73-0.77) and longer illness duration (BPII: 4.96 years [3.96], UD: 2.99 [3.33], p = 0.15, d = 0.54). BPII showed no increased WM disruptions vs UD or HC in any of the 15 a priori WM tracts. UD had lower right superior longitudinal fasciculus (SLF) (temporal) axial diffusivity (AD) (1.14 vs 1.17 (BPII), 1.16 (HC); F = 6.93, 95% CI of [Formula: see text]: 0.00073, 5.22, ηp2 = 0.15). Principal component analysis followed by exploratory linear discriminant analysis showed that increased R-SLF (temporal) AD, YMRS and family bipolarity distinguished BPII from UD (81.5% sensitivity, 85.2% specificity) independent of episode number and frequency. Young, medication-naïve adults with BPII depression did not show the WM disruptions distinguishing more chronically ill BP patients from UD. These WM disruptions may therefore be partly attributable to illness chronicity. Longitudinal studies should examine the trajectory of WM changes in BPII and UD and predictive validity of these baseline clinical and imaging parameters.

MegaPath: sensitive and rapid pathogen detection using metagenomic NGS data.

BACKGROUND: Next-generation sequencing (NGS) enables unbiased detection of pathogens by mapping the sequencing reads of a patient sample to the known reference sequence of bacteria and viruses. However, for a new pathogen without a reference sequence of a close relative, or with a high load of mutations compared to its predecessors, read mapping fails due to a low similarity between the pathogen and reference sequence, which in turn leads to insensitive and inaccurate pathogen detection outcomes. RESULTS: We developed MegaPath, which runs fast and provides high sensitivity in detecting new pathogens. In MegaPath, we have implemented and tested a combination of polishing techniques to remove non-informative human reads and spurious alignments. MegaPath applies a global optimization to the read alignments and reassigns the reads incorrectly aligned to multiple species to a unique species. The reassignment not only significantly increased the number of reads aligned to distant pathogens, but also significantly reduced incorrect alignments. MegaPath implements an enhanced maximum-exact-match prefix seeding strategy and a SIMD-accelerated Smith-Waterman algorithm to run fast. CONCLUSIONS: In our benchmarks, MegaPath demonstrated superior sensitivity by detecting eight times more reads from a low-similarity pathogen than other tools. Meanwhile, MegaPath ran much faster than the other state-of-the-art alignment-based pathogen detection tools (and compariable with the less sensitivity profile-based pathogen detection tools). The running time of MegaPath is about 20 min on a typical 1 Gb dataset.

Suicide after hospital contact for psychiatric assessment in Hong Kong: A long-term cohort study.

There are few long-term studies on suicide in psychiatric settings in China. The objective of this study was to evaluate the long term suicide risk and its associated factors after the initial psychiatric assessment. Demographic and clinical data of adult subjects receiving psychiatric assessment between 1996 and 2000 in a district hospital in Hong Kong were retrieved from the hospital computer system. Data were matched with completed suicides before June 30 2015 as recorded by the Coroner's Office. From a total of 4078 subjects identified, there were 152 (3.7%) recorded suicides; one-fifth of suicides occurred within one year, and half within 5 years. Cox regression analysis revealed that the risk of suicide after the initial psychiatric assessment was positively associated with deliberate self-harm (Hazard ratio = 2.1; 95%CI = 1.5-3.0; p < 0.001), and negatively associated with 'no psychiatric disorder' (Hazard ratio = 0.4; 95%CI = 0.2-0.6; p = 0.001). The overall suicide risk for those diagnosed to have a psychiatric disorder was 4.4%; 4.5% for men and 4.3% for women. Deliberate self-harm and having a psychiatric disorder at the time of assessment are significant risk factors of suicide. Appropriate treatment of psychiatric disorders and comprehensive management of deliberate self-harm are important for suicide prevention.

MegaGTA: a sensitive and accurate metagenomic gene-targeted assembler using iterative de Bruijn graphs.

BACKGROUND: The recent release of the gene-targeted metagenomics assembler Xander has demonstrated that using the trained Hidden Markov Model (HMM) to guide the traversal of de Bruijn graph gives obvious advantage over other assembly methods. Xander, as a pilot study, indeed has a lot of room for improvement. Apart from its slow speed, Xander uses only 1 k-mer size for graph construction and whatever choice of k will compromise either sensitivity or accuracy. Xander uses a Bloom-filter representation of de Bruijn graph to achieve a lower memory footprint. Bloom filters bring in false positives, and it is not clear how this would impact the quality of assembly. Xander does not keep track of the multiplicity of k-mers, which would have been an effective way to differentiate between erroneous k-mers and correct k-mers. RESULTS: In this paper, we present a new gene-targeted assembler MegaGTA, which attempts to improve Xander in different aspects. Quality-wise, it utilizes iterative de Bruijn graphs to take full advantage of multiple k-mer sizes to make the best of both sensitivity and accuracy. Computation-wise, it employs succinct de Bruijn graphs (SdBG) to achieve low memory footprint and high speed (the latter is benefited from a highly efficient parallel algorithm for constructing SdBG). Unlike Bloom filters, an SdBG is an exact representation of a de Bruijn graph. It enables MegaGTA to avoid false-positive contigs and to easily incorporate the multiplicity of k-mers for building better HMM model. We have compared MegaGTA and Xander on an HMP-defined mock metagenomic dataset, and showed that MegaGTA excelled in both sensitivity and accuracy. On a large rhizosphere soil metagenomic sample (327Gbp), MegaGTA produced 9.7-19.3% more contigs than Xander, and these contigs were assigned to 10-25% more gene references. In our experiments, MegaGTA, depending on the number of k-mers used, is two to ten times faster than Xander. CONCLUSION: MegaGTA improves on the algorithm of Xander and achieves higher sensitivity, accuracy and speed. Moreover, it is capable of assembling gene sequences from ultra-large metagenomic datasets. Its source code is freely available at https://github.com/HKU-BAL/megagta .

Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study.

BACKGROUND: 'Acute and transient psychotic disorder' (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system. AIMS: (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study. METHODS: This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990-2000. RESULTS: Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions. CONCLUSIONS: ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.

Conceptual issues behind the Chinese translations of the term 'Bipolar Disorder'.

The paper examines the problems of the existing nomenclature in Chinese psychiatry with special reference to the Chinese translation of bipolar disorder in the context of stigma of mental illness in the Chinese culture. The development of the concept of bipolar disorder is reviewed, followed by a critical examination of the accuracy and validity of the current translation of bipolar disorder in the Chinese psychiatric literature. A new translation is suggested with consideration for literal accuracy and social acceptance.

MEGAHIT v1.0: A fast and scalable metagenome assembler driven by advanced methodologies and community practices.

The study of metagenomics has been much benefited from low-cost and high-throughput sequencing technologies, yet the tremendous amount of data generated make analysis like de novo assembly to consume too much computational resources. In late 2014 we released MEGAHIT v0.1 (together with a brief note of Li et al. (2015) [1]), which is the first NGS metagenome assembler that can assemble genome sequences from metagenomic datasets of hundreds of Giga base-pairs (bp) in a time- and memory-efficient manner on a single server. The core of MEGAHIT is an efficient parallel algorithm for constructing succinct de Bruijn Graphs (SdBG), implemented on a graphical processing unit (GPU). The software has been well received by the assembly community, and there is interest in how to adapt the algorithms to integrate popular assembly practices so as to improve the assembly quality, as well as how to speed up the software using better CPU-based algorithms (instead of GPU). In this paper we first describe the details of the core algorithms in MEGAHIT v0.1, and then we show the new modules to upgrade MEGAHIT to version v1.0, which gives better assembly quality, runs faster and uses less memory. For the Iowa Prairie Soil dataset (252Gbp after quality trimming), the assembly quality of MEGAHIT v1.0, when compared with v0.1, has a significant improvement, namely, 36% increase in assembly size and 23% in N50. More interestingly, MEGAHIT v1.0 is no slower than before (even running with the extra modules). This is primarily due to a new CPU-based algorithm for SdBG construction that is faster and requires less memory. Using CPU only, MEGAHIT v1.0 can assemble the Iowa Prairie Soil sample in about 43h, reducing the running time of v0.1 by at least 25% and memory usage by up to 50%. MEGAHIT v1.0, exhibiting a smaller memory footprint, can process even larger datasets. The Kansas Prairie Soil sample (484Gbp), the largest publicly available dataset, can now be assembled using no more than 500GB of memory in 7.5days. The assemblies of these datasets (and other large metgenomic datasets), as well as the software, are available at the website https://hku-bal.github.io/megabox.

The Bipolar II Depression Questionnaire: A Self-Report Tool for Detecting Bipolar II Depression.

Bipolar II (BP-II) depression is often misdiagnosed as unipolar (UP) depression, resulting in suboptimal treatment. Tools for differentiating between these two types of depression are lacking. This study aimed to develop a simple, self-report screening instrument to help distinguish BP-II depression from UP depressive disorder. A prototype BP-II depression questionnaire (BPIIDQ-P) was constructed following a literature review, panel discussions and a field trial. Consecutively assessed patients with a diagnosis of depressive disorder or BP with depressive episodes completed the BPIIDQ-P at a psychiatric outpatient clinic in Hong Kong between October and December 2013. Data were analyzed using discriminant analysis and logistic regression. Of the 298 subjects recruited, 65 (21.8%) were males and 233 (78.2%) females. There were 112 (37.6%) subjects with BP depression [BP-I = 42 (14.1%), BP-II = 70 (23.5%)] and 182 (62.4%) with UP depression. Based on family history, age at onset, postpartum depression, episodic course, attacks of anxiety, hypersomnia, social phobia and agoraphobia, the 8-item BPIIDQ-8 was constructed. The BPIIDQ-8 differentiated subjects with BP-II from those with UP depression with a sensitivity/specificity of 0.75/0.63 for the whole sample and 0.77/0.72 for a female subgroup with a history of childbirth. The BPIIDQ-8 can differentiate BP-II from UP depression at the secondary care level with satisfactory to good reliability and validity. It has good potential as a screening tool for BP-II depression in primary care settings. Recall bias, the relatively small sample size, and the high proportion of females in the BP-II sample limit the generalization of the results.

Psychometric properties of the Hong Kong Chinese (Cantonese) TEMPS-A in medical students.

BACKGROUND: The self-rated auto-questionnaire, the Temperament Scale of Memphis, Pisa, Paris and San Diego (TEMPS-A) is the latest development in the study of temperamental attributes. It has been used and validated in different cultures and countries. The current study aims at validating the Chinese (Cantonese) version of the TEMPS-A and comparing the psychometric properties of the long and short forms of the translated scale. METHODS: The Chinese (Cantonese) version of TEMPS-A was prepared with the standard translation and back-translation method, and approved by the original authors (HSA & KKA). It was administered to medical students of the two local universities, and results were analyzed. RESULTS: 613 valid questionnaires were returned. The Cronbach-Alpha coefficients for the depressive, cyclothymic, hyperthymic, irritable and anxious temperament subscales were 0.63, 0.82, 0.78, 0.80, and 0.84, respectively. The strongest correlation was observed between the cyclothymic and irritable temperaments (R=0.600). Factor analysis yielded one large composite (depressive and anxious) and four homogenous factors, cyclothymic, anxious, hyperthymic and irritable. A newly reconstituted 43-item short form, based on methods suggested by the original authors yielded similar factor structure. LIMITATIONS: The narrow age range of subjects somewhat limits generalization of the results. However, external and concurrent validations against other validated scales have been demonstrated for the original English versions as well as against the most commonly used languages of the world; furthermore, such validation has also been demonstrated for Chinese (Mandarin). CONCLUSIONS: The Chinese (Cantonese) version of TEMPS-A and the reconstituted 43-item short form were found to have good internal consistency and factor structures comparable to those of other languages from diverse cultures across the planet. We propose that the Cantonese TEMPS-A is a useful tool for local use.

Metabolic profile of first and second generation antipsychotics among Chinese patients.

The metabolic profiles of Chinese patients treated with second-generation antipsychotic (SGA) medication and first-generation antipsychotic (FGA) medication were compared. The sample comprised 99 patients treated with SGA (risperidone, olanzapine and ziprasidone) and 99 with FGA (chlorpromazine, haloperidol and trifluoperazine) from the outpatient clinic of a teaching hospital in Hong Kong. The most frequent psychiatric diagnosis was schizophrenia, followed by affective disorder and other psychiatric diagnoses. Subjects were measured for body weight, body height, fasting lipid and glucose levels. SGA was associated with higher LDL-cholesterol level than FGA. Individual comparison of different antipsychotics showed that patients on olanzapine had the greatest increases in cholesterol and triglycerides among all antipsychotics. The finding suggested SGA, particularly olanzapine, were associated with more metabolic risk factors than first-generation antipsychotics.

Gender differences in sociodemographic and clinical characteristic and the quality of life of Chinese schizophrenia patients.

OBJECTIVE: The aim of the present study was to determine the sociodemographic and clinical correlates of the gender of Chinese schizophrenia outpatients and their impact on patients quality of life (QOL). METHODS: Two hundred and fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong. Counterparts matched according to gender, age, age at onset, and length of illness were recruited in Beijing, China. All of the subjects at both sites were interviewed by the same investigator using standardized assessment instruments. RESULTS: The combined Beijing-Hong Kong sample contained 251 male and 254 female patients. On univariate analysis more male patients were employed, they had a significantly higher monthly income, and took higher doses of antipsychotic drugs. No difference was found, however, in any of the QOL domains between the genders. On multivariate analysis being employed, taking a higher dose of antipsychotic drugs, having more severe extrapyramidal side-effects, and a higher score on the physical domain of QOL were independently associated with male gender. CONCLUSION: Female gender is independently associated with lower scores on the physical aspects of QOL, but there is no difference between the genders in the psychological, social and environmental aspects.

Psychometric evaluation of the Hospital Anxiety and Depression Scale in a large community sample of adolescents in Hong Kong.

PURPOSE: The Hospital Anxiety and Depression Scale (HADS) is widely used in adult populations; however, its usefulness with adolescents has been explored less. This study sought to evaluate the reliability, validity, and factor structure of the Chinese version of HADS in a community sample of adolescents residing in Hong Kong. METHODS: A prospective cohort of 5,857 students recruited from 17 secondary schools completed the HADS. Internal consistency and concurrent validity were examined. Confirmatory factor analysis was applied to test the relative fits of six factor structures of the HADS. The best fitting model was further cross-validated by male, female, split-half samples, and age subgroups. RESULTS: The HADS possessed adequate internal consistency, especially for the anxiety subscale. Significant concurrent intercorrelations with self-reported suicidal thoughts and the Youth Self Report Anxious/Depressed subscale were discovered and found to be stronger for females. The cross-validation supported a two-factor model, where anxiety item 7, "I can sit at ease and feel relaxed", was placed in the depression subscale. CONCLUSIONS: The HADS showed satisfactory psychometric properties as a screening instrument in assessing anxious and depressive states as two correlated but distinct factors in adolescents. Study implications and recommendations for future research were discussed.

Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up.

BACKGROUND: Short-term follow-up studies of severe acute respiratory syndrome (SARS) survivors suggested that their physical conditions continuously improved in the first year but that their mental health did not. We investigated long-term psychiatric morbidities and chronic fatigue among SARS survivors. METHODS: All SARS survivors from the hospitals of a local region in Hong Kong were assessed by a constellation of psychometric questionnaires and a semistructured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) to determine the presence of psychiatric disorders and chronic fatigue problems. RESULTS: Of 369 SARS survivors, 233 (63.1%) participated in the study (mean period of time after SARS, 41.3 months). Over 40% of the respondents had active psychiatric illnesses, 40.3% reported a chronic fatigue problem, and 27.1% met the modified 1994 Centers for Disease Control and Prevention criteria for chronic fatigue syndrome. Logistic regression analysis suggested that being a health care worker at the time of SARS infection (odds ratio [OR], 3.24; 95% confidence interval [CI], 1.12- 9.39; P = .03), being unemployed at follow-up (OR, 4.71; 95% CI, 1.50-14.78; P = .008), having a perception of social stigmatization (OR, 3.03; 95% CI, 1.20-7.60; P = .02), and having applied to the SARS survivors' fund (OR, 2.92; 95% CI, 1.18-7.22; P = .02) were associated with an increased risk of psychiatric morbidities at follow-up, whereas application to the SARS survivors' fund (OR, 2.64; 95% CI, 1.07-6.51; P = .04) was associated with increased risk of chronic fatigue problems. CONCLUSIONS: Psychiatric morbidities and chronic fatigue persisted and continued to be clinically significant among the survivors at the 4-year follow-up. Optimization of the treatment of mental health morbidities by a multidisciplinary approach with a view for long-term rehabilitation, especially targeting psychiatric and fatigue problems and functional and occupational rehabilitation, would be needed.

Prevalence and correlates of insomnia and its impact on quality of life in Chinese schizophrenia patients.

STUDY OBJECTIVES: This study aimed to determine the prevalence and the sociodemographic and clinical correlates of insomnia in Chinese schizophrenia outpatients and its impact on patients' quality of life (QOL). DESIGN: Two hundred fifty-five clinically stable schizophrenia outpatients were randomly selected in Hong Kong and their counterparts matched according to sex, age, age at onset, and length of illness were recruited in Beijing, China. All subjects at both sites were interviewed by the same investigator using standardized assessment instruments. SETTING: Hong Kong and Beijing, China. PATIENTS OR PARTICIPANTS: Clinically stable schizophrenia outpatients. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In the combined Beijing-Hong Kong sample the frequency of at least one type of insomnia over the previous 12 months was 36.0%; the rates of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 21.2%, 23.6%, and 11.9%, respectively. Poor sleep was significantly associated with advanced age, older age at onset, fewer psychiatric admissions, severity of positive symptoms, anxiety, extrapyramidal symptoms (EPS) and depressive symptoms, less frequent use of atypical antipsychotic medications (AP), and more frequent use of benzodiazepines (BZD) and hypnotics. Poor sleepers had significantly poorer QOL in all domains than patients without insomnia. After controlling for the potential confounding effects of sociodemographic and clinical factors, a significant difference remained between the 2 groups with regard to the physical QOL domain. A multiple logistic regression analysis found that advanced age, fewer psychiatric admissions, severity of depressive symptoms and use of hypnotics were significant contributors to poor sleep. CONCLUSION: Insomnia is independently associated with poor QOL. More attention should be paid in clinical practice to the high rate of insomnia in Chinese schizophrenia patients.

Long-term use of mood stabilizers and its impact on the quality of life of chinese patients with schizophrenia.

OBJECTIVES: To date, no studies have investigated the prescription patterns of mood stabilizers (MSs) in Chinese patients with schizophrenia. This study examined the frequency and sociodemographic and clinical correlates of MS prescription for outpatients with schizophrenia in Hong Kong (HK) and Beijing (BJ), China. METHODS: Five hundred five clinically stable outpatients with schizophrenia were randomly selected and interviewed in HK and BJ using standardized assessment instruments. Basic sociodemographic and clinical data and psychotropic drug prescriptions were collected at the time of a diagnostic interview. RESULTS: Thirty-four (6.7%) of the patients were prescribed MSs in the whole sample, with 10.2% and 3.2% of the HK and BJ samples, respectively. Use of MSs was associated with a history of violence, number of admissions, and severity of extrapyramidal side effects. In multiple logistic regression analysis, number of admissions, study site, sex, and length of illness were significantly associated with MSs. CONCLUSIONS: Although the ethnic and clinical characteristics of the 2 samples were nearly identical, there was a wide variation in the frequency of MS prescriptions between HK and BJ.

Modified and unmodified electroconvulsive therapy: a comparison of attitudes between psychiatrists in Beijing and Hong Kong.

OBJECTIVE: Unmodified electroconvulsive therapy (ECT) is still widely practiced in many psychiatric institutions in China. The study reported herein aimed to explore the attitudes of psychiatrists in Beijing toward unmodified and modified ECT and compare them with those of psychiatrists in Hong Kong, where only modified ECT has been used during the past 40 years. METHOD: One hundred five psychiatrists of a university-affiliated psychiatric hospital in Beijing and all psychiatrists (n = 238) currently practicing in Hong Kong were invited to complete a questionnaire exploring their attitudes toward unmodified and modified ECT. RESULTS: The Beijing respondents had significantly more experience with unmodified ECT than their Hong Kong counterparts. Although 56% of the Beijing respondents preferred modified to unmodified treatment, 81% of them regarded unmodified ECT as safe and associated with minimal morbidity and mortality. Patient choice, financial status, and safety considerations were the main factors that dictated the choice of mode of ECT in Beijing. CONCLUSIONS: It seems that unmodified ECT still has a role as an effective psychiatric treatment in developing countries such as China. Any initiative to replace unmodified with modified treatment should take into account economic conditions, the sociocultural context, and the psychiatric traditions of the particular regions of the country.

Clinical predictors of psychiatric and medical morbidities of charcoal-burning suicide attempt in Hong Kong.

OBJECTIVE: This naturalistic retrospective cohort study explored the demographic and clinical factors associated with psychiatric and medical morbidities among patients with suicide attempts by burning charcoal. METHOD: We conducted a follow-up study of 69 cases with charcoal-burning suicide attempts in two general hospitals. The associations between demographic, clinical characteristics and outcomes were analyzed. RESULTS: The presence of past psychiatric treatment, past history of suicide attempt and physical complications were associated with the occurrence of psychiatric morbidity after the index suicide attempt. Loss of consciousness and abnormal blood acidity were associated with medical morbidity after the index admission. CONCLUSION: Psychiatric and medical morbidities are common among charcoal-burning suicide attempts and identified clinical factors associated with these problems may be useful in its management.