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C W Law

Publications and source records attributed to C W Law.

7 recordsLinked to original sources
PubMed2006

Detection of non-adherent behaviour in early psychosis.

OBJECTIVE: Adherence to antipsychotic treatment is an important aspect of the long-term management of schizophrenia. The evaluation of adherence is often difficult in the clinical setting. This study compared patient self-reporting and clinician judgment of adherence behaviour in patients with early and chronic schizophrenia. METHOD: Clinician-rated questionnaires and parallel patient self-rated questionnaires were administered to 229 patients with early schizophrenia (illness duration < 5 years) and 255 patients with chronic schizophrenia. Items in the questionnaires addressed two forms of adherence behaviour (forgetting to take medication and deciding to stop medication) as well as attitudes toward medication. RESULTS: Significant non-adherent behaviour was reported by patients, particularly in the early schizophrenia group. Non-adherent behaviour was related to feelings of embarrassment about taking medication. Both non-adherence and embarrassment were under-recognized by clinicians. Starting from a prior probability of 0.24, knowledge of the patients' attitudes increased the posterior probability to 0.33, whereas clinicians' detection of non-adherence (deciding to stop medication) improved the posterior probability to 0.65. When both clinicians' evaluations and patients' attitudes were known, the posterior probability improved to 0.68. CONCLUSION: Non-adherence is a widespread phenomenon in early schizophrenia. Increasing clinicians' sensitivity to patients' feelings of embarrassment may be an important factor in the detection of non-adherence. When taking a base rate of non-adherence into consideration, clinicians' evaluations appeared to be more effective in detecting non-adherence than simple information obtained from patients on their attitudes toward medication. Pragmatic real-life estimation of non-adherence has important implications for the possibility of intervention.

Adult↗
PubMed2005

Specific executive dysfunction in patients with first-episode medication-naïve schizophrenia.

Many studies have shown that schizophrenia is associated with a wide range of cognitive impairments. Empirical findings suggest that patients with schizophrenia suffer from a "dysexecutive syndrome". However, the extent to which a general decline in neuropsychological function accounts for symptoms of executive dysfunction in schizophrenia is not clear. In this study, we examined further the nature and pattern of executive function in a sample of medication-naïve patients experiencing a first-episode of schizophrenia with a set of tests capturing the specific components of executive function. We also compared the performance of this clinical group with healthy controls. A total of 78 medication-naïve patients with first episode schizophrenia were recruited from the Early Assessment Service for Young People with Psychosis (EASY). Another 60 healthy controls were recruited for comparison. All subjects participated in a comprehensive set of executive function tests assessing initiation, sustained attention, online updating, switching, attention allocation, inhibition, and non-executive function. The executive function of patients with first-episode schizophrenia was found to be compromised relative to healthy controls. However, unlike patients with established schizophrenia, first episode patients exhibited only a limited deficit in sustained attention. Moreover, the majority of executive function deficits did not correlate with intellectual functioning and memory impairment in a sub-group of first episode patients without intellectual impairment. These findings suggest that first-episode patients exhibit a specific pattern of executive dysfunction compared to healthy controls and patients with an established illness. This differential breakdown of executive function components is unlikely to be an artefact of general intellectual decline or memory impairment in schizophrenia.

Adolescent↗
PubMed2005

An instrument to assess mental patients' capacity to appraise and report subjective quality of life.

Quality of life (QOL) is increasingly recognized as an important outcome measure in treatment studies and service evaluation. However, patients or service users may sometimes lack the capacity to either evaluate or express their subjective QOL, for example due to cognitive impairment, communication disorders, symptom distress or burden of completing the assessment itself. This paper describes the development of an instrument, the capacity to report subjective quality of life inventory (CapQOL), which evaluates the ability of patients to appraise their subjective QOL and to complete related measures. The CapQOL is a simple and brief screening tool, designed for use in people with a wide range of mental disabilities. It helps researchers to identify individuals who are unable to appraise or report their subjective quality of life. We administered the CapQOL to 442 patients with early psychosis. About 89% of the participants were assessed to be able to complete a subjective QOL measure. The CapQOL demonstrated satisfactory psychometric properties. Further validation studies in people with psychosis as well as other mental disabilities are indicated.

Adult↗
PubMed2005

Impact of untreated psychosis on quality of life in patients with first-episode schizophrenia.

Despite increasing interest in the quality of life (QOL) of psychiatric patients in recent years, few studies have focused on the potential adverse effects of the illness on QOL during the period of untreated psychosis. Our study compares the QOL of patients with first-episode schizophrenia when they first presented to the psychiatric service with that of the normal population, and identifies possible relationships with various clinical parameters. One hundred and seventeen patients with schizophrenia (aged 14-28 years) who entered the Early Assessment Services for Young People with Psychosis (EASY) programme in Hong Kong from June 2001 to January 2004 were assessed with the MOS 36 item Short Form Health Survey (SF-36) and the World Health Organization Quality of Life Measure, abbreviated Hong Kong version (WHOQOL-BREF(HK)). We compared their SF-36 scores with controls from the normal population matched by age, sex, marital status and educational level. We assessed clinical parameters including positive, negative and depressive symptoms by the Positive and Negative Syndrome Scale (PANSS), the Scale for Assessment of Negative Symptoms (SANS), and the Montgomery and Asberg Depression Rating Scale (MADRS). When compared with matched controls from the normal population, significantly lower scores in all of the eight scales of the SF-36 were found in our patient group (p < 0.005). Various QOL domain scores had significant inverse correlations with the total MADRS score. However, there was no significant correlation with other clinical parameters. Young patients with first-episode schizophrenia have poorer QOL in the period of untreated psychosis than their counterparts in the community. Amongst various clinical parameters, the severity of depressive symptoms correlates most with QOL.

Adolescent↗
PubMed2005

Self-administered instrument to measure the patient's experience of recovery after first-episode psychosis: development and validation of the Psychosis Recovery Inventory.

OBJECTIVE: Patients who are recovering from a first-episode psychosis face specific and complex issues that are related to their illness and treatment experiences, such as the appraisal of the extent of their recovery and the risk of relapse. Currently, no instrument provides a comprehensive assessment of these related attitudes. A novel self-administered rating scale for the measurement of key perceptions during the recovery stage after a first-episode psychosis is presented. The Psychosis Recovery Inventory (PRI) is designed to specifically address a number of closely related issues that are faced by patients who are recovering from a first-episode psychosis. METHOD: The process of development of the PRI involved the generation of items from qualitative interviews, the construction and refinement of these items and a validation study. The longitudinal stability of the PRI items was assessed in a test-retest reliability study in which 20 patients completed the retest within 4 weeks. The internal consistency and convergent validity of the PRI were evaluated by a comparison of the PRI subscale scores and the Scale to Assess Unawareness of Mental Disorder and Drug Attitude Inventory scores in a sample of 48 first-episode psychosis patients. RESULTS: The validation study shows that the PRI is an instrument with a good test-retest reliability, internal consistency and convergent validity. CONCLUSIONS: This pragmatic, low burden, self-administered scale can be applied in clinical and research settings to obtain reliable information on the attitudes of patients on a range of interrelated issues in the recovery stage that follows a first-episode psychosis.

Adult↗
PubMed2002

Ammonia detoxification by continuous venovenous haemofiltration in an infant with urea cycle defect.

We report the case of a newborn baby with carbamoyl phosphate synthetase deficiency. He presented at 2 weeks of life, deteriorating to a state of hyperammonaemic coma and respiratory failure. Rapid detoxification was successfully achieved by continuous venovenous haemofiltration while a definitive diagnosis and treatment were determined. The ammonia clearance achieved by continuous venovenous haemofiltration was greater than 20 mL/min/m(2), which is superior to that achieved by peritoneal dialysis and arteriovenous haemofiltration in this age-group.

Ammonia↗