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Background Impairment in insight is an important feature in psychotic disorder. It is recognized that poor insight is prevalent in patients with early psychosis. The current study aimed to examined clinical and psychosocial correlates of insight in a representative cohort of Chinese adult patients who had completed 3-year specialized early intervention service for first-episode psychosis (FEP) in Hong Kong. Methods One hundred and one Chinese patients aged 26–55 years who completed a 3-year territory-wide specialized early intervention service for FEP in Hong Kong were recruited. Assessments encompassing premorbid adjustment, illness onset, clinical, psychosocial and treatment variables were conducted. Patients were categorized into good (n=45) versus poor (n=56) insight based on the ratings on the Scale to Assess Unawareness of Mental Disorder (SUMD). Results Univariate analyses showed that gender, positive, negative, disorganization and depressive symptoms, self-stigma and general self-efficacy were related to insight (threshold set at p<0.1). Multiple binary logistic regression analysis further revealed that female gender (p=0.004), lower levels of positive (p=0.001) and disorganization (p=0.033) symptoms, more severe depressive symptoms (p=0.007), and greater degrees of self-stigma (p=0.005) were independently associated with good insight status in early psychosis patients. Discussion Our results highlighted the significant relationships among insight, depression and self-stigma. Prospective research is warranted to clarify the complex longitudinal inter-relationships among these variables in the early stage of illness so as to facilitate development of effective intervention for further outcome improvement in patients with early psychosis. [ABSTRACT FROM AUTHOR]

Background Self-stigma obstructs recovery from psychotic disorders yet factors contributing to self-stigma among these patients, especially those with early psychosis have been understudied. Accumulating evidence has also indicated that high self-stigma is already prevalent in the early course of illness. This study aimed to examine correlates of self-stigma in adult patients who had completed 3-year specialized early intervention service for first-episode psychosis (FEP) in Hong Kong. Methods One hundred and one Chinese patients aged 26–55 years who completed 3-year specialized early intervention service for FEP in Hong Kong were recruited. Assessments encompassing illness onset, clinical, functional and self-stigma variables were conducted. Results Univariate analyses showed that gender, educational level, age of onset, duration of untreated psychosis (DUP), higher scores on the Scale to Assess Unawareness of Mental Disorder (SUMD) and Apathy Evaluation Scale (AES) were related to self-stigma (measured by Self-Stigma Scale-Short form) (threshold set at p<0.1). Multiple linear regression analysis further revealed that female gender (p=0.03), older age at onset of psychosis (p=0.02), longer DUP (p=0.03), and better insight (measured by SUMD, p=0.04) were independently associated with higher levels of self-stigma in early psychosis patients. Discussion Our results indicated that greater self-stigma is linked to female gender, older age of illness onset, treatment delay and better insight in the early stage of psychotic disorder. In particular, patients who have good insight and / or prolonged DUP may represent a vulnerable subgroup in early psychosis who requires more specific interventions to minimize risk of increased self-stigma. Further research is warranted to clarify longitudinal changes of self-stigma and the associated predictors to facilitate development of effective interventions. [ABSTRACT FROM AUTHOR]

Background Reinforcement learning (RL) impairment has been observed in chronic schizophrenia and first-episode psychosis. Yet, there is a paucity of research of RL impairment in individuals at clinical high-risk (CHR) for psychosis. The current study aimed to examine RL performance in a representative cohort of Chinese CHR subjects, with particular focus on its relationship with primary negative symptoms (PNS). Methods Ninety-seven Chinese individuals with CHR for psychosis, aged 15–40 years, were recruited from a territory-wide specialized early intervention service for psychosis in Hong Kong. CHR status was verified using Comprehensive Assessment of At-Risk Mental State (CAARMS). Thirty-four demographically-matched healthy controls were recruited as a comparison group. Each subject completed two computerized RL tasks (Go-No-Go, GNG and Gains-Loss Avoidance GLA tasks) which have been studied in chronic and first-episode schizophrenia patients. In both tasks, rapid / gradual and positive / negative RL measures were derived for analyses. CHR subjects were categorized as having PNS if they had (1) global score ≥ 3 on at least two of the following SANS subscales: Affective flattening, Alogia, Avolition-apathy or Anhednoia-asociality; and (2) no or clinically non-significant depression with total score < 16 in Montgomery-Asberg Depression Rating Scale (MADRS). Results On GNG task, three-group comparison (PNS, non-PNS, control groups) revealed significant difference in RL accuracy, with post-hoc contrasts showing that controls performed better than both PNS and non-PNS groups in gradual positive RL. No between-group difference in Go-response bias or rapid learning was observed. On GLA task, main effect of group was noted in three-group comparison analysis on RL accuracy. Post-hoc tests indicated that PNS group displayed significantly lower accuracy than both non-PNS group and controls in gradual positive and negative RL. Additionally, PNS group exhibited significantly lower overall and block-1 win-stay rates than controls. Discussion Our results indicate RL impairment in CHR sample. In particular, such RL impairment was more evident in CHR subjects presenting with PNS relative to those without PNS. Further investigation is required to verify and confirm our findings on the relationship between negative symptoms and RL deficits. In addition, a prospective follow-up of our CHR cohort will help clarify the potential utility of baseline RL impairment in enhancing prediction of psychosis transition at follow-up. [ABSTRACT FROM AUTHOR]