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Background: Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity. Methods: Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR. Results: The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better. Conclusions: Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.

Introduction: Adolescents with depression have distinct affective reactions to daily events, but current research is controversial. The emotional context insensitivity theory suggests blunted reactivity in depression, whereas the hypotheses of negative potentiation and mood brightening effect suggest otherwise. While nonlinear associations between depression severity and affective reactivity have been observed, studies with a separate subclinical group remain rare. Subthreshold depression (SD), defined by two to four symptoms lasting for two weeks or more, provides a dimensional view to the underpinnings of affective reactivity. In this study, we compared positive affect (PA) and negative affect (NA) reactivity to positive and negative daily events (uplifts and stress) among adolescents with Major Depressive Disorder (MDD), SD and healthy controls (HC) using experience sampling methods (ESM). Objectives: We hypothesized a stepped difference in affective reactivity along the depression spectrum: the MDD group will have the strongest reactivity of PA and NA to uplifts and stress, followed by SD and HC. Methods: Three groups (MDD, SD, and HC) of adolescents were recruited from an epidemiologic sample entitled 'Hong Kong Child and Adolescent Psychiatric Epidemiologic Survey: Age 6 to 17'. Group status was determined by the Diagnostic Interview Schedule for Children Version 5. They completed an experience sampling diary on smartphone for 14 consecutive days, with 5-10 entries per day. Momentary levels of PA (happy, relaxed, contented), NA (irritated, low, nervous), uplifts and stress experienced before the entry were measured on a 1-7 Likert scale. Results: The sample consisted of 19 adolescents with MDD, 30 with SD, and 59 HC. The M:F ratio was 17:19. The age range was 12-18 with a mean of 14.8. The overall ESM completion rate was 46%. The MDD group had the highest levels of stress and NA, and the lowest levels of uplifts and PA, followed by the SD and HC groups respectively (p<0.01). Across groups, levels of PA were positively associated with uplifts and negatively associated with stress, whereas levels of NA were positively associated with stress and negatively associated with uplifts. The Group x Uplift interaction effect on PA was significant, with greater PA reactivity in SD (p<0.01) and MDD (p=0.07) when compared with HC. The Group x Uplift interaction effect on NA was significant, with greater NA reactivity in SD than HC (p<0.01). The Group x Stress interaction effect on PA was significant, with greater PA reactivity in SD than HC (p<0.01) and MDD (p<0.01). The Group x Stress interaction effect with NA is non-significant. Conclusions: Contrary to our hypothesis, adolescents with SD experienced strongest PA and NA reactivity in uplifts and PA reactivity in stress. It provides evidence towards a nonlinear relationship between severity of depression and affective reactivity. Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Objective: We examined adulthood diagnostic, functioning, and social outcomes of childhood ADHD in a Hong Kong Chinese clinical sample. Method: We identified from the central registry 499 Chinese adults clinically diagnosed with ADHD aged 6 to 12 in 2002-2005 in four Hong Kong child psychiatric centers. Assessments included ADHD Clinical Diagnostic Scale (ACDS), Structured Clinical Interview for DSM Disorders (SCID), and World Health Organization Disability Assessment Schedule (WHO-DAS). Results: Eligible participants = 499. One hundred forty-five completed assessments, two deceased, six incarcerated, 100 had invalid contact, 83 declined, 34 emigrated, and 129 unable to attend. Mean follow-up duration = 14.9 years. Nonrespondents were slightly younger (19.78 vs. 20.53, p < .001). In all, 83.1% of all participants currently met Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) ADHD criteria (36.8% inattentive subtype (IA), 43% combined, 3.3% hyperactive/impulsive subtype (H/I) ). One third of persistent ADHD participants currently received care. ADHD persistence was associated with significantly increased psychiatric comorbidity (49.5% vs. 22.7%, p = .02) and poor academic and social outcomes. ADHD persistence and comorbidity independently predicted impairment. Conclusion: Adulthood-persistence of clinically presented childhood ADHD is common and impairing in Hong Kong Chinese. [ABSTRACT FROM AUTHOR]

The applications of nanodiamond as drug delivery and bio-imaging can require the relinquishing ND-drug conjugate via blood flow, where interaction with immune cells may occur. In this work, we investigated the ND penetration in macrophage and the immune response using the tissue-resident murine macrophages (RAW 264.7). Confocal fluorescence imaging, immunofluorescence analysis of nuclear translocation of interferon regulatory factor IRF-3 and transcriptional factor NF- κΒ, analysis of pro-inflammatory cytokines production IL-1 β, IL-6 IL-10 with a reverse transcription-polymerase chain reaction technique were applied. The TNF- α factor production has been studied both in vitro at ND interaction with the macrophage and in vivo after ND injection in the mice blood system using immunoassay. The macrophage antibacterial function was estimated through E. coli bacterial colony formation. ND didn't stimulate the immune response and functionality of the macrophage was not altered. Using MTT test, ND was found negligibly cytotoxic to macrophages. Thus, ND can serve as a biocompatible platform for bio-medical applications. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis. Methods: A total of 700 participants (men, n == 360; women, n == 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review. Results: At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p < 0.001), fewer affective symptoms (p < 0.01), more violent behaviour and forensic records (p < 0.01), and higher rate of substance abuse (p < 0.01). Women achieved higher levels of functioning than men (Social Occupational Functioning Assessment Scale (SOFAS), p < 0.001) and a significantly higher proportion of women than men engaged in full-time employment or study for at least 12 consecutive months (p < 0.001) in the initial three years after psychiatric treatment. Conclusion: Notable gender differences in clinical profiles, illness trajectory and functional outcome were demonstrated in Chinese young people suffering from first-episode psychosis. Differential needs between men and women and hence gender-specific therapeutic strategies should be considered in early intervention service. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the facial emotion recognition ability in local children with attention-deficit hyperactivity disorder (ADHD) and the effect of inattention and impulsivity on such ability. Participants and Methods: Eight-seven Chinese children (45 controls and 42 with ADHD) of primary 1 to 3 were recruited. They were matched for age, sex, intelligence, and family income. The subjects were shown facial emotion pictures developed by Matsumoto and Ekman (1998) together with emotional story vignettes. Conners' Continuous Performance Test II was used to evaluate the attention / impulsivity level of the subjects. Results: The difference in performance in facial emotion recognition between the 2 groups was not statistically significant. There was also no significant correlation between the accuracy of facial emotion recognition and the inattention / impulsivity level. Intelligence level correlated significantly with the facial emotion recognition ability. Conclusions: The ability to recognise facial emotion is affected by multiple factors. A single diagnostic label is unlikely to be fully predictive. Further research on the influence of co-morbidities and presence of different ADHD subtypes should be considered. [ABSTRACT FROM AUTHOR]

The article reflects on the significance of the services accorded to psychiatric patients in several developed countries. The author mentions that these type of patients should be given special care and attention because of their delicate and special medical case. Because of the complexity of their needs, most of the services offered by most facilities in these areas are underdeveloped, thus needing enhancement.

Introduction: To determine the feasibility and long-term outcomes of hand-assisted laparoscopic radical nephroureterectomy (HALNU) compared to open surgery (ONU) in the treatment of pT3N0 upper urinary tract urothelial carcinoma (UUT-UC). Methods: Between January 1994 and December 2005, 21 patients who underwent HALNU for stage pT3N0 UT-UC were matched and compared with 31 patients who underwent ONU. The oncologic outcomes, including bladder recurrence, recurrence-free survival, cancer-specific survival, and overall survival were statistically analyzed. Results: The median follow-up period in the HALNU group was 72 months (range, 33-111months) and 115 months in the ONU group (range, 24-161 months). Patient age, gender, body mass index, tumor size, specimen weight, and American Society of Anesthesiologists classification showed no significant difference between the two groups. The HALNU group had statistically less blood loss than the ONU group (113 ml vs. 487 ml; P=0.02). The average hospital stay and doses of narcotic analgesics were significantly less in the HALNU group than the ONU group. The complication and bladder recurrence rates were similar between the two groups. The 5-year recurrence-free survival, cancerspecific survival, and overall survival were also comparable in both groups. Conclusions: HALNU is a safe and efficacious procedure with comparable long-term oncologic outcomes in comparison with ONU in treating patients with locally advanced pT3N0 UUT-UC. [ABSTRACT FROM AUTHOR]

Introduction: Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. Methods: Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. Results: Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. Conclusions: Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales. [ABSTRACT FROM AUTHOR]

This study aimed to assess the psychometric properties of the Chinese version of the Revised Clinical Interview Schedule (C-CIS-R), and explore its applicability as a diagnostic instrument for common mental disorders (CMDs) in Hong Kong. Its psychometric properties were evaluated among 140 patients and 161 healthy controls. In comparison to the diagnoses made by the Structured Clinical Interview for the DSM-IV, the C-CIS-R showed good criterion validity in diagnosing CMDs. The correlation of the total score of C-CIS-R with the 12-item General Health Questionnaire and Hospital Anxiety and Depression Scale was satisfactory, indicating favourable convergent validity as well. The inter-rater and test-retest reliability were also satisfactory. Receiver operating characteristic analyses suggested an optimal cut-off point of 11/12 for detecting diagnosable CMDs (sensitivity: 0.69; specificity: 0.93) and 17/18 for identifying a need for treatment (sensitivity: 0.70; specificity: 0.95). In conclusion, C-CIS-R is a valid diagnostic instrument for CMDs in a Chinese community. Its cut-off points for clinically significant symptoms and treatment needs among Chinese are identical to those adopted in the original English version. [ABSTRACT FROM AUTHOR]

Mental disorders are highly prevalent conditions with immense disease burden. To inform health and social services policy formulation, local psychiatric epidemiological data are required. The Hong Kong Mental Morbidity Survey is a 3-year population-based study in which 5700 community-dwelling Chinese adults aged between 16 and 75 years were interviewed with the aim of evaluating the prevalence, co-morbidity, functional impairment, physical morbidity, and social determinants of significant mental disorders in the population. This paper describes the background and design of the survey, and is the first territory-wide psychiatric epidemiological study in Hong Kong. [ABSTRACT FROM AUTHOR]

Objectives: While family psycho-education for schizophrenia is well-supported, the efficacy of family intervention for first-episode psychosis is less studied. This waiting list controlled study set out to evaluate the effectiveness of a 6-week intervention for carers of people with first-episode psychosis. Participants and Methods: Carets were randomised into experimental or waiting list categories. Study 1 compared various outcome measures in the 2 categories. Study 2 evaluated the treatment effects. Results: After the intervention, carets showed increased knowledge about psychosis and a reduction in negative ways of coping. The improvement in knowledge was maintained at 6-month follow-up, and trends towards improved caregiving burden and coping were also evident. Conclusions: A brief intervention programme can be effective in improving important variables such as knowledge, coping, and caregiving burden. The implications for selecting 'core components' for an effective intervention were discussed. [ABSTRACT FROM AUTHOR]

Objective: Relapse is common among patients with psychotic disorders. Identification of relapse predictors is important for decision regarding maintenance medication. Naturalistic studies often identify medication non-adherence as a dominant predictor. There are relatively few studies for predictors where adherence is already known. It is this situation i.e., discontinuation of medication that predictors will be most useful. We identify predictors for relapse in situations of (i) discontinuation and (ii) continuation of maintenance medication., Method: Analysis of relapse predictors is based on a randomized controlled study (n=178) comparing relapse rates between patients who discontinued or continued medication for at least 1 year following first-episode psychosis. Demographic, clinical and neurocognitive variables were assessed at baseline as predictors of relapse within 1 year., Results: Risk of relapse was 79% in the discontinuation group and 41% in the maintenance group. Predictors in the discontinuation group were diagnosis of schizophrenia, poorer semantic fluency performance, and higher blink rate. Predictors in the continuation group were disinhibition soft signs and more general psychopathology symptoms., Conclusion: Different predictors of relapse were identified for first episode psychosis patients who discontinued and continued maintenance medication. Neurocognitive dysfunctions are important predictors for both groups. While signs of frontal dysfunction and dopamine hyperactivity predict relapse in the discontinuation group, sign of cognitive disinhibition predicts relapse in the continuation group., (© 2013 Elsevier B.V. All rights reserved.)

The year 2011 marked the 10-year milestone of early intervention for psychosis in Hong Kong. Since 2001, the landscape of early psychosis services has changed markedly in Hong Kong. Substantial progress has been made in the areas of early intervention service implementation, knowledge generation, and public awareness promotion. Favourable outcomes attributable to the early intervention service are supported by solid evidence from local clinical research studies; early intervention service users showed improved functioning, ameliorated symptoms, and decreased hospitalisation and suicide rates. Continued development of early intervention in Hong Kong over the decade includes the introduction and maturation of several key platforms, such as the Hospital Authority Early Assessment Service for Young People with Psychosis programme, the Psychosis Studies and Intervention Unit by the University of Hong Kong, the Hong Kong Early Psychosis Intervention Society, the Jockey Club Early Psychosis Project, and the postgraduate Psychological Medicine (Psychosis Studies) programme. In this paper, we reviewed some of the major milestones in local service development with reference to features of the Hong Kong mental health system. We describe chronologically the implementation and consolidation of public early intervention services as well as recent progresses in public awareness work that are tied in with knowledge generation and transfer, and outline the prospects for early intervention in the next decade and those that follow.

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., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Background: There is a lack of evidence on the effectiveness of postnatal depression (PND) screening programmes in reducing morbidity. The aim of this study was to evaluate the effectiveness of a PND screening programme using Edinburgh Postnatal Depression Scale (EPDS) in improving maternal mental health., Methods: The randomized controlled trial design was used. Participants were 462 Chinese mothers with 2-month-old babies visiting Maternal and Child Health Centres in Hong Kong. Participants in the intervention group were screened for PND using the EPDS, whereas those in the control group were screened by clinical assessment. In both groups, participants identified with PND were offered follow-up management according to protocol., Results: Participants in the intervention group had better maternal mental health outcome as assessed by EPDS at 6 months (risk ratio: 0.59; 95% confidence interval: 0.39-0.89). The number needed to screen was 25., Conclusions: A PND screening programme comprising the use of EPDS as the screening tool and the provision of follow-up care had resulted in an improvement in maternal mental health at 6 months.

Objective: To study rates of relapse in remitted patients with first episode psychosis who either continued or discontinued antipsychotic drugs after at least one year of maintenance treatment., Design: 12 month randomised, double blind, placebo controlled trial., Setting: Early psychosis outpatient clinics in Hong Kong., Participants: 178 patients with first episode psychosis who had received at least one year of antipsychotic drug treatment between September 2003 and July 2006 and had no positive symptoms of psychosis., Interventions: Patients received either maintenance treatment with quetiapine (400 mg/day) or placebo and were followed up for the next 12 months or until a relapse occurred., Main Outcome Measure: Relapse assessed monthly and defined as re-emergence of psychotic symptoms (delusions, conceptual disorganisation, hallucinations, suspiciousness, and unusual thought content) according to predefined thresholds., Results: 178 patients were randomised (89 to quetiapine and 89 to placebo). The Kaplan-Meier estimate of the risk of relapse at 12 months was 41% (95% confidence interval 29% to 53%) for the quetiapine group and 79% (68% to 90%) for the placebo group (P<0.001). Although quetiapine was generally well tolerated, the rate of discontinuation due to adverse or serious adverse events was greater in the quetiapine group (18%; 16/89) than in the placebo group (8%; 7/89) (relative risk 2.29, 95% confidence interval 0.99 to 5.28; chi(2)=3.20, df=1; P=0.07)., Conclusion: In a group of asymptomatic patients with first episode psychosis and at least one year of previous antipsychotic drug treatment, maintenance treatment with quetiapine compared with placebo resulted in a substantially lower rate of relapse during the following year. Trial registration Clinical trials NCT00334035.

There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated., ((c) 2004 Wiley-Liss, Inc.)