Kowloon Hospital is a general care hospital located in Kowloon City District, in Kowloon, Hong Kong. The complex was built on land between Argyle Street and Prince Edward Road.The hospital used to be an acute hospital with accident and emergency service. It was later converted to a chronic hospital to provide extended supportive care to patients from Queen Elizabeth Hospital. The hospital has specialist services in psychiatry, rehabilitation, respiratory medicine and geriatrics. The respiratory medicine unit provides teaching opportunities for medical students from the Li Ka Shing Faculty of Medicine, University of Hong Kong.With 1,281 beds, the hospital was the first to establish a rehabilitation unit in Hong Kong..
OBJECTIVES:Social cognitive impairments were well-documented in schizophrenia and individuals with clinical high risk for psychosis (CHR). While eye movement abnormalities during gaze perception in schizophrenia have been suggested, such understanding in individuals with CHR is limited. DESIGN, SETTINGS AND PARTICIPANTS:This study recruited 36 CHR individuals and 50 healthy controls (HC) to perform a gaze perception task with eye-tracking techniques analyzed with hidden Markov models for predictability and pattern recognition. Eye movement variables and behavioral responses, self-referential gaze perception (SRGP) rates, were compared between groups and examined with discriminant analyses. Associations between eye movements and SRGP rates with multiple symptom dimensions and social functioning were examined. RESULTS:Results indicated that CHR group displayed nose-focused (vs eye-focused) and erratic eye movement patterns compared to HC. The combination of behavioral and eye movement variables exhibited a discriminatory ability of 0.893 area under the curve (AUC) in classifying CHR and HC, significantly outperforming models using either SRGP rates (AUC = 0.824) or eye movement variables (AUC = 0.781) alone. The combined model achieved high sensitivity (0.861) and specificity (0.820), with eyes-nose scale, fixation duration, and ambiguous SRGP rate emerging as the most discriminative features. Self-referential gaze perception rates were primarily associated with schizotypy and social anxiety, while eye movement patterns were mainly associated with delusional ideations and social functioning. CONCLUSIONS AND RELEVANCE:This study comprehensively examined eye movement patterns during gaze perception in CHR and their associations with clinical manifestations, suggesting the potential of visual attention patterns as both diagnostic biomarkers and therapeutic targets in the CHR population.
The prevalence of older adults with schizophrenia is growing, yet age-specific mortality estimates and quantifying metrics remain scarce, limiting evidence-based healthcare management. We followed 2665 older adults (≥65 years) with schizophrenia-spectrum disorder (SSD) and 18,298 matched comparison group utilising Hong Kong electronic health records from 2005 to 2011. We estimated the mortality hazard ratios with Cox regression and competing risk analyses. We also quantified the mortality risks with life-years lost (LYLs) metric for enhanced clinical interpretation. Compared to the comparison group, older adults with SSD had 4-fold elevated all-cause mortality (HR4.39, 95 %CI: 4.02-4.80) and had 5.28 excess LYLs (95 %CI: 4.77-5.87). Natural causes accounted for 5.53 life-years lost, while unnatural causes contributed minimally despite an 8-fold elevated hazard ratio. Natural causes account the majority of excess mortality in older SSD patients. Our findings highlight the importance of prioritising physical health monitoring alongside psychiatric management for this vulnerable population.
Background Literature guiding the use of long-acting injectable antipsychotics (LAIAs) versus oral antipsychotics (OAs) in people with intellectual disability (PWID) remains scarce.Objective Examining the associations of LAIAs vs OAs with healthcare utilisation among PWID.Methods This self-controlled case series study used electronic health records from Hong Kong. We included adults with intellectual disability prescribed both LAIAs and OAs at different periods in 2004–2023. We compared within-individual LAIA and OA periods, adjusting for age, calendar year, season, inpatient stay and concomitant psychotropic use, using conditional Poisson regression to estimate incidence rate ratios (IRRs) for all-cause emergency department (ED) visits; all-cause hospitalisations; hospitalisations for psychiatric disorders, schizophrenia/bipolar disorder, behaviour-related problems, somatic disorders and cardiovascular diseases (CVDs) and diagnosis records of extrapyramidal symptoms (EPS); falls and fractures. Subgroup analyses were conducted by diagnosis of schizophrenia or bipolar disorder.Findings We identified 1675 PWID who had been prescribed both OAs and LAIAs at different periods during the study period. LAIA use was associated with lower risks of incident all-cause ED visits (adjusted IRR: 0.71, 95% CI 0.51 to 0.98), all-cause hospitalisations (0.91, 0.85–0.98); hospitalisations for psychiatric disorders (0.90, 0.81–0.99); for schizophrenia/bipolar disorder (0.86, 0.75–0.99) and EPS (0.34, 0.23–0.51), compared with OAs. In PWID with schizophrenia/bipolar disorder, LAIAs were associated with lower risks of all-cause hospitalisations, hospitalisations for psychiatric disorders, schizophrenia/bipolar disorder, behaviour-related problems and somatic disorders, and EPS, but a higher risk of hospitalisations for CVDs (with hypertensive disease being the most common), compared with OAs. In contrast, among PWID without such diagnoses, LAIA use was associated with higher risks of all-cause hospitalisations, hospitalisations for somatic disorders; a lower risk of incident all-cause ED visits and hospitalisations for CVDs, but no significant difference in hospitalisations for behaviour-related problems, compared with OAs.Conclusions These findings are consistent with potential benefit of LAIAs among PWID with schizophrenia or bipolar disorder, while raising concern about off-label use in those without these diagnoses.Clinical implications LAIAs may be considered in PWID with schizophrenia or bipolar disorder; off-label use in those without these diagnoses should be approached cautiously, and deprescribing may be considered where appropriate if these results are replicated.
Background: Family-based interventions are effective in mitigating the risk for relapse of schizophrenia. However, the accessibility of these interventions is scarce in many clinical settings. A group-based brief cognitive behavioural intervention facilitated by a therapist using videoconferencing may help address this practice gap and improve the high treatment disengagement that occurs in interventions delivered in self-paced web-based forums or mobile applications. Objective: To examine the feasibility, acceptability, and safety of an online group-based cognitive behavioural family intervention for dyads of individuals with schizophrenia-spectrum disorders and caregivers. Methods: This feasibility study adopted a parallel-group, assessor-blind randomised controlled trial with a twelve-week post-intervention follow-up as well as individual semi-structured interviews. Participants were randomly assigned to the intervention group [i.e., tele-group cognitive behavioural family intervention (tgCBFI) group] and the treatment-as-usual group. Both groups also received biweekly brief telephone support. The feasibility and acceptability were assessed by the recruitment rate, intervention completion rate, retention rate and participants' service satisfaction. Safety was measured by the number of adverse events. Results: Most intervention group participants (85.7%) attended all six online group sessions (six service user-caregiver dyads, corresponding to 12 participants), while 100% of participants attended the per-protocol number of sessions (≥four sessions). The study recruitment rate was 16.4%, while the study retention rate for follow-up assessments was 95.8%. No adverse events were reported throughout the study. Five themes were generated to illustrate the benefits of and recommendations for the tgCBFI programme to complement the quantitative findings. Conclusions: The preliminary results suggested that the use of videoconferencing to deliver group-based cognitive behavioural intervention was partially feasible and provided exploratory estimates suggesting possible improvement in psychiatric symptoms for individuals with schizophrenia-spectrum disorders, warranting a fully powered trial. Trial Registration: prospectively registered at ClinicalTrials.gov NCT05808244.
