Castle Peak Hospital is the oldest psychiatric hospital in Hong Kong. Located at the east of Castle Peak in Tuen Mun, the hospital was established in 1961. Currently, it has 1,156 beds, providing a wide variety of psychiatric services such as adult psychiatry, forensic psychiatry, psychogeriatric services, child and adolescent psychiatry, consultation-liaison psychiatry and substance abuse treatments. All wards in the hospital are equipped to accommodate both voluntary and involuntary admitted patients..
Aim The Treatment-Response-and-Resistance-in-Psychosis (TRRIP) criteria recognizes negative symptoms as defining features for treatment-resistant schizophrenia (TRS). Social motivation refers to the desire to pursue social reward (and to avoid social punishment). Impaired social motivation is related to negative symptoms but has seldom been studied in TRS patients. We aimed to characterize social motivation processing in TRS patients and examine the impacts of negative symptoms on social motivation processing.Methods We recruited 60 TRS patients, 60 remitted schizophrenia patients and 60 controls. In the Social Incentive Delay (SID) task, participants had to hit the targets within the response window to seek positive/neutral/negative social outcomes in emoji formats; and they also rated their emotions during the anticipation and receipt of social outcomes. Generalized-estimation-equation (GEE) models examined the impacts of TRS/remitted schizophrenia, negative symptoms, and the interaction between clinical-group-status and cue-valence on the SID performance, that is, hit-or-not, anticipatory pleasure, and consummatory pleasure.Results The interaction between TRS status and social reward/punishment significantly predicted anticipatory pleasure, implicating that TRS patients' anticipatory pleasure was less subject to social reward/punishment compared to controls. Moreover, the interaction between TRS and social reward significantly predicted consummatory pleasure, implicating that TRS patients' consummatory pleasure was less subject to social reward compared to controls. Negative symptoms significantly predicted the SID accuracy in clinical participants, supporting its relationship with social motivation processing.Conclusion TRS patients have altered social motivation processing, affecting anticipatory and consummatory pleasure. Social motivation deficit may be an intervention target for negative symptoms and social functioning impairments in TRS patients.
BACKGROUND AND HYPOTHESIS:Schizophrenia treatment in young people involves complex pharmacological decisions, yet sex-specific prescribing patterns and pandemic impacts remain poorly understood. We hypothesized that prescribing trends would differ systematically by sex and show pandemic-related disruptions. STUDY DESIGN:This population-based cohort study analyzed 8092 individuals aged 15-29 years with schizophrenia-spectrum disorders in Hong Kong (2011-2023) using electronic health records from the Hospital Authority system. We examined temporal trends in 11 medication subclasses using generalized least squares models with autoregressive correlation structures, sex differences using interaction terms, and COVID-19 impacts using interrupted time series (ITS) analysis with adjustment for age and comorbidity. STUDY RESULTS:After covariate adjustment, all medication subclasses increased over time (0.05-3.71 percentage points annually), indicating universal treatment intensification. Males showed steeper increases than females in 5 subclasses after adjustment, with 18 of 21 specific agents increasing significantly more in males. Period-level pandemic comparisons showed minimal effects, but ITS analysis revealed substantial COVID disruptions in 5 medication subclasses namely oral first-generation antipsychotics, injectable second-generation antipsychotics, serotonin and norepinephrine reuptake inhibitor, Z-hypnotics, and benzodiazepines. CONCLUSIONS:Young people with schizophrenia experienced universal treatment intensification with males receiving more intensive pharmacotherapy after controlling for confounders. The pandemic produced complex sex-specific disruptions masked by aggregate analyses. Whether these prescribing patterns represent appropriate individualization or systematic care variation remains unknown, highlighting the critical need for studies linking prescribing patterns to functional outcomes and quality of life.
Abstract Background The prevalence and pattern of secondary causes of first-onset psychosis (FEP) in Asian populations are understudied. Our objectives are to investigate the prevalence and pattern of secondary causes of FEP presenting in an acute medical setting in a metropolitan, Chinese-predominant population, and to investigate the prevalence and pattern of undiagnosed conditions presenting as psychosis. Method This is a retrospective observational study. We reviewed medical records of patients referred to the consultation psychiatry team at a tertiary acute teaching hospital in Hong Kong from January 2015 to Apr 2025. The inclusion criteria of the study are 1) age 18-64 at the time of the assessment, and 2) FEP confirmed by the consultation liaison team. Patients diagnosed with delirium were excluded. Result Among the 384 patients included in the study (mean age = 40.0 ±13.7 years, 69% female), secondary causes of psychosis were found in 9.6% (n=37) of the cohort. Substance use is the most common secondary cause found (n=11, 2.9% of all FEPs) overall. Among those with secondary psychoses, patients’ underlying conditions were revealed only by the workup in relation to the FEP in 16 of them, of which definitive or probable autoimmune encephalitis (n=5) and early-onset dementia (n=4) were the most common conditions uncovered. Conclusion The prevalence of secondary psychoses in our FEP cohort is lower than published international figures. Clinicians need to be aware of the suspicious clinical features suggestive of autoimmune encephalitis and early-onset dementia in FEP patients with otherwise unremarkable past history and toxicology test.
