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Psychosis and Schizophrenia in Hong Kong covers some of the most serious mental health conditions that top the global disease burden and affect 3 per cent of the general population. However, most research on psychotic disorders is undertaken in the West, and few studies have been systematically carried out in Asia despite global interest in regional differences. This work offers a unique and coherent account of these disorders and their treatment in Hong Kong over the last thirty years.
Chen and his research programme’s pioneering work has ranged from the impact of early intervention on outcomes and relapse prevention, to the renaming of psychosis to reduce stigma. The studies have contributed to wider international debates on the optimal management of the condition. Their investigations in semantics and cognition, as well as cognition-enhancing exercise interventions, have provided novel insights into deficits encountered in psychotic disorders and how they might be ameliorated. The research has also explored subjective experiences of psychosis and elicited unique perspectives in patients of Asian origin.
Each topic is divided into three sections: a global background of the challenges encountered; research findings from Hong Kong; and reflections that place the data in scientific and clinical contexts and offer future directions.
‘This book contains important research into specific problems facing persons with psychosis and schizophrenia in Hong Kong, arising from environment factors, stigma, and treatment shortfalls. Its insights would help “overcome barriers to facilitate mental health work”, which is how Professor Eric Chen describes the work of the Advisory Committee on Mental Health, and what he has admirably devoted himself to do over the years.’
—Wong Yan-Lung SC, chairman, Advisory Committee on Mental Health, Hong Kong, 2017–2023
Foreword by Professor Sir Robin Murray xi
Foreword by Professor William G. Honer xiii
Preface xv
Acknowledgements xvii
About the Cover Design xix
List of Abbreviations xx
Introduction 1
Population Diversity in Psychotic Disorders 1
Population and Mental Health Service Contexts in Hong Kong 2
Psychosis Studies in the Hong Kong Population 4
Relevance of the Hong Kong Studies to Asia, China, and the West 4
The Boundary of Psychotic Disorders 5
Background: Key Questions Concerning Psychotic Disorders 5
Themes in Hong Kong 9
References 10
PART I: THE IMPACT OF PSYCHOSIS ON THE LIVES OF PATIENTS
1. The Experience of Psychosis as One of the Most Devastating Illnesses 19
The Subjective Illness Perspective in Psychotic Disorders 19
The Subjective Experience of Psychosis in Hong Kong 21
Reflections: The Subjective Experience of Psychosis and Its Clinical Implications 27
References 29
2. The Stigma of Psychosis: How It Affects Illness Outcome 34
Background 34
Studies on Stigma in Hong Kong 38
Personal Reflections on Stigma 42
References 45
3. Quality of Life and Functional Outcomes in Psychotic Disorders as Ultimate Intervention Targets 51
Background: Short- and Long-Term Functional Outcomes and Quality of Life in Psychosis 51
The Outcome of Psychosis in Hong Kong 53
Reflections: The Importance of Context 56
References 57
PART II: EARLY INTERVENTION FOR PSYCHOSIS
4. Early Intervention in Psychosis: A Paradigm Shift 65
Background: Services for Psychotic Disorders in Hong Kong before Early Intervention 65
Global Background and Historical Context of Early Intervention for Psychosis 66
Early Intervention for Psychosis in Hong Kong 67
Reflections: Meeting the Local Needs of Psychosis Patients 71
References 72
5. The Naming of Psychosis: Concepts Matter in Community Education 76
Background: Renaming Schizophrenia in East Asia 76
Naming Psychosis in Hong Kong 78
The Naming of Clinical High-Risk States in Hong Kong 80
Reflections: The Evolution of Psychiatric Terminology 80
References 82
6. Delays in Help-Seeking: Duration of Untreated Psychosis and Its Determinants 84
Background 84
Studies on the Duration of Untreated Psychosis in Hong Kong 87
Reflections: Can the Duration of Untreated Psychosis Be Shortened Further? 90
References 91
7. Prevention Starts from Risk States: Risk States and Psychotic-Like Experiences 95
Background: Psychotic-Like Experiences 95
Studies of Psychotic-Like Experiences in Hong Kong 96
Background: Clinical High-Risk Studies 96
Clinical High-Risk Studies in Hong Kong 98
Reflections and the Way Forward 101
References 102
8. Can Early Intervention Improve Long-Term Outcomes? Evidence from Hong Kong 107
Background 107
Outcomes of Early Intervention in Hong Kong 109
Reflections: The Innovative Potential of Early Intervention Programmes 112
References 115
PART III: PSYCHOPATHOLOGY AND CLINICAL PATHWAYS
9. Pharmacological Treatments: What They Can and Cannot Do 121
Background 121
Pharmacological Interventions for Psychosis in Hong Kong 123
Reflections: Antipsychotic Prescribing in Context 127
References 128
10. Relapse in Psychotic Disorders: Prediction, Prevention, and Management 134
Background 134
Relapse in Psychotic Disorders in Hong Kong 136
Reflections: The Importance of Maintenance Treatment in Relapse Prevention 142
References 143
11. Treatment-Refractory States: An End-Game Scenario? 148
Background 148
Studies on Treatment-Refractory Psychosis in Hong Kong 151
Reflections: The Challenges of Managing Treatment-Refractory Psychosis 154
References 155
12. Ideas of Reference: Complexities in the Most Common Symptom in Psychosis 159
Background 159
Ideas and Delusions of Reference in Psychosis in Hong Kong 161
Reflections: The Unique Nature of Ideas and Delusions of Reference 164
References 165
13. Mortality and Suicide: Silent Killers in Psychosis 168
Background 168
Suicide and Mortality in Hong Kong 170
Suicide in Psychotic Disorders 173
Suicide in Psychosis and Its Predictors in Hong Kong 173
Mortality Other Than Suicide 174
The Impact of Early Intervention on Suicide 174
Reflections: The Role of Early Intervention Programmes in Suicide
Prevention and Reducing Mortality 175
References 175
PART IV: NEUROCOGNITIVE DYSFUNCTIONS
14. Cognitive Dysfunctions: The Hidden Impediments of Psychosis 183
Background 183
Studies on Cognitive Functioning in Hong Kong 186
Reflections on Cognitive Deficits in Psychosis 189
References 191
15. Semantic Dysfunctions: The Central Role of Language Processes in Psychosis 196
Background 196
Semantic Function Studies in Psychosis in Hong Kong 198
Reflections: The Central Role of Language Functions 203
References 205
16. Neurological Soft Signs: A Simple Enough Clinical Sign in Psychosis 210
Background 210
Studies on Neurological Soft Signs in Hong Kong and China 212
Reflections: Neurological Soft Signs as a Proxy Measure of Brain Dysfunction 214
References 215
PART V: RECOVERY
17. Ways to Improve Cognition: Beyond Medications 221
Background 221
Studies on Interventions for Cognitive Dysfunction in Hong Kong 223
Reflections: The Emerging Evidence of Exercise Interventions Supporting Cognitive Recovery 226
References 227
18. Remission and Recovery: The Journeys towards Getting Well 232
Background 232
Studies on Remission and Recovery in Hong Kong 234
Reflections: The Concepts of Remission and Recovery 237
References 240
Epilogue 243
Index 24