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Biomedical subjects

Helen F K Chiu

Publications and source records attributed to Helen F K Chiu.

At least 37 records · Page 2Linked to original sources
PubMed2004

Factors associated with psychosis among patients with severe acute respiratory syndrome: a case-control study.

We observed that a number of patients with severe acute respiratory syndrome (SARS) developed affective psychosis during the acute phase of their illness. We reviewed all SARS-related psychiatric consultations in Hong Kong and investigated the risk factors for psychosis among patients with SARS in a matched case-control study. Patients with SARS-related psychosis received higher total doses of steroids and had higher rates of family history of psychiatric illness. The findings of the present study suggest that steroid toxicity, personal vulnerability, and, probably, psychosocial stressors jointly contributed to the development of psychosis in patients with SARS.

Adolescent↗
PubMed2004

The scoring scheme of the informant questionnaire on cognitive decline in the elderly needs revision: results of rasch analysis.

The purpose of this study was to examine the optimal scoring scheme (category use), unidimensionality, item fit, and redundancy of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in a cohort of Hong Kong Chinese stroke survivors. At 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 284 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blinded to the IQCODE scores, interviewed all 284 patients and made DSM-IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening dementia. The results suggest that the optimal IQCODE scoring scheme has 2 rather than the original 5 categories. Although the IQCODE was unidimensional overall, there was evidence of item redundancy, thus indicating that a shortened version is desirable.

Aged↗
PubMed2004

Impact of applying NINDS-AIREN criteria of probable vascular dementia to clinical and radiological characteristics of a stroke cohort with dementia.

BACKGROUND: There are no data concerning the relative representation of clinical vascular risk factors and radiological lesions in cases that have been ruled in and ruled out for probable vascular dementia (VaD) according to NINDS-AIREN criteria. METHODS: Three months after their index stroke, a psychiatrist interviewed patients and made a diagnosis of VaD according to both DSM-IV and NINDS-AIREN criteria for probable VaD. Patients who fulfilled the DSM-IV criteria for VaD were divided into two groups: those who were ruled in and ruled out according to NINDS-AIREN criteria as probable VaD. Demographic characteristics, vascular risk factors, clinical features of the index stroke and radiological findings were then compared between the two groups. RESULTS: Of the 297 patients screened, 56 (18.8%) had a DSM-IV diagnosis of dementia. Among these demented patients, 55 (98.2%) and 22 (39.3%) fulfilled DSM-IV and NINDS-AIREN diagnosis of VaD, respectively. The concordance and level of agreement (kappa statistic) between DSM-IV and NINDS-AIREN diagnoses were 40% and 0.02, respectively. Reasons of failure to meet NINDS-AIREN criteria included the lack of temporal relationship between dementia and stroke (n = 20), the absence of focal neurological signs and/or radiological evidence of stroke (n = 6) and both of the above (n = 7). There was no significant difference between the above two groups in terms of demographic data, features of index stroke, vascular risk factors and CT scan findings, except that leukoaraiosis (p = 0.021) and bilateral lesions (p = 0.015) were more frequent in subjects diagnosed according to NINDS-AIREN criteria of probable VaD. The difference between these two groups with respect to the number of lesions was borderline for significance (p = 0.052). CONCLUSIONS: The use of NINDS-AIREN criteria for VaD for case selection in poststroke dementia research may exclude a number of subjects with VaD.

Acute Disease↗
PubMed2004

Frequency and determinants of poststroke dementia in Chinese.

BACKGROUND AND PURPOSE: Both dementia and stroke are major health problems in Chinese societies. Stroke is a frequent cause of dementia. Only a few studies have been published on poststroke dementia (PSDE), none of which has investigated a consecutive stroke cohort in Asian patient populations. The objective of this study was to examine the prevalence and clinical correlates of PSDE in Chinese stroke patients in Hong Kong. METHODS: Two hundred eighty stroke patients consecutively admitted to the medical wards of a university-affiliated regional hospital were interviewed by a psychiatrist 3 months after stroke. The presence of dementia and vascular dementia was diagnosed according to the Diagnostic and Statistical Manual, 4th edition. In addition, a wide range of demographic and clinical variables were examined. RESULTS: Fifty-five participants (20%) had PSDE. Univariate analysis found that PSDE was associated with age; level of education; prestroke Rankin Scale score; prestroke Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score; National Institutes of Health Stroke Scale (NIHSS) best language score, dysarthria score, and total score; urinary incontinence; cortical infarct; leukoaraiosis; bilateral lesions; number of lesions; involvement of middle cerebral artery circulation; and cerebral atrophy index. Multivariate logistic regression suggested that prestroke IQCODE score, NIHSS total score, leukoaraiosis, involvement of middle cerebral artery territory, and cerebral atrophy index were independent risk factors of PSDE. After removal of 22 patients with prestroke dementia, which was defined as a prestroke IQCODE score > or =4.0, the frequency of PSDE dropped to 15.5%. Furthermore, involvement of the middle cerebral artery territory and cerebral atrophy index were replaced by level of education and bilateral lesions as independent predictors in the final logistic model. CONCLUSIONS: PSDE is common among Chinese stroke patients in Hong Kong. Its frequency is comparable to that in white populations. The clinical determinants of PSDE, after the exclusion of patients with prestroke dementia, include premorbid level of cognitive function, severity of stroke, leukoaraiosis, level of education, and bilateral lesions.

Aged↗
PubMed2004

Association between tumor necrosis factor-alpha promoter polymorphism and Alzheimer's disease.

Tumor necrosis factor-alpha (TNFalpha) gene polymorphisms have been reported to be associated with Alzheimer's disease (AD) in Caucasian populations. Three TNFalpha polymorphisms (-857, -863, and -1,031) were studied in a Chinese population. A high-risk TNFalpha haplotype (-1,031C-863C-857C) with an odds ratio of 2.54 (95% CI 1.37 to 4.79) for AD was identified. No interaction effect of APOE and TNFalpha genotypes was found, but both acted as important risk factors for AD.

Aged↗
PubMed2004

Frequency and determinants of prestroke dementia in a Chinese cohort.

Pre-existing dementia among patients with acute stroke is common, and adversely affects outcomes. Only a few studies have been published on prestroke dementia (PSD), none of which have investigated a consecutive stroke cohort in an Asian patient population. The objective of this study was to examine the prevalence and clinical correlates of PSD in Chinese stroke patients in Hong Kong. Close and reliable informants of 289 stroke patients who were consecutively admitted to the medical wards of a university-affiliated regional hospital completed the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) within 1 week after their relative's admission. The presence of PSD was defined as an average IQCODE score of >or= 4.00. In addition, a wide range of demographic and clinical variables were examined and recorded.Twenty-two participants (7.6%) had PSD. The frequency of PSD in the group of subjects (n = 73) who were assessed within 48 hours after their admission was 12.3%. Univariate analysis found that PSD was associated with age, marital status, atrial fibrillation (AF), previous transient ischaemic attack (TIA), leukoaraiosis, and cerebral atrophy index (CAI). Multivariate logistic regression suggested that CAI, age, AF, and past TIA were independent risk factors for PSD. The low prevalence of PSD in Chinese patients in comparison with their Caucasian counterparts may be due to the difference in the time frame of the assessment. Comparative studies involving both Caucasian and Chinese stroke patients are required to further explore the role of AF and TIA in the development of PSD in both Chinese and Caucasian patients.

Adolescent↗
PubMed2004

Emotional incontinence in Chinese stroke patients--diagnosis, frequency, and clinical and radiological correlates.

Of the few studies published on poststroke emotional incontinence (PSEI), none has investigated a consecutive stroke cohort in a Chinese patient population. The objective of this study was to examine the frequency and the clinical and radiological correlates of PSEI in Chinese stroke patients in Hong Kong. Three months after their admission, a psychiatrist interviewed 127 stroke patients who were consecutively admitted to the medical wards of a university-affiliated regional hospital. The presence of PSEI was defined according to both Kim's and House's criteria. The frequency of PSEI was 17.9% according to Kim's criteria and 6.3% according to House's criteria. The kappa between the two sets of criteria was 0.34. Univariate analysis found that PSEI was associated with a younger age, previous history of depression, a higher National Institute of Health Stroke Scale total score and cortical infarcts. Multivariate logistic regression suggested that past history of depression and cortical infarcts were independent predictors for PSEI. In conclusion, PSEI is relatively common among Chinese stroke survivors. A previous history of depression or cortical lesions were independent predictors for PSEI. There is a need for a revision of the diagnostic criteria for PSEI.

Adult↗
PubMed2004

Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly?

BACKGROUND: Little is known about the performance of the Geriatric Depression Scale (GDS) in the screening of post-stroke depression (PSD) among Chinese elderly. METHODS: Three months after the index stroke, a research assistant administered the 15-item GDS to 127 Chinese elderly patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the GDS scores, administered the Structured Clinical Interview for DSM-IV to all patients and made DSM-IV diagnosis of depression, which served as the benchmark for judging the performance of GDS in screening PSD. RESULTS: The optimal cut-off point of GDS was 6/7. The sensitivity, specificity, positive and negative predictive values of GDS and the area under the receiver operating characteristic curve, were 89, 73, 37, 98 and 90%, respectively. LIMITATIONS: The sample size was small and there was no separate analysis of the performance of GDS for subtypes of PSD. CONCLUSIONS: Due to its low positive predictive value, a more specific instrument should supplement GDS in screening PSD in Chinese elderly.

Aged↗
PubMed2004

Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: stress and psychological impact among frontline healthcare workers.

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) posed an unprecedented threat and a great challenge to health professionals in Hong Kong. The study reported here aimed at investigating the origin of stress and psychological morbidity among frontline healthcare workers in response to this catastrophe. METHOD: Self-administered questionnaires were sent to frontline healthcare workers in three hospitals. The General Health Questionnaire was used to identify psychological distress. Socio-demographic and stress variables were entered into a logistic regression analysis to find out the variables associated with psychological morbidity. RESULTS: The response rate was 40 %. Sixty-eight per cent of participants reported a high level of stress. About 57 % were found to have experienced psychological distress. The healthcare workers' psychological morbidity was best understood by the perceptions of personal vulnerability, stress and support in the workplace. CONCLUSION: These findings shed light on the need for hospital administrators to be aware of the extent and sources of stress and psychological distress among frontline healthcare workers during disease outbreak.

Adaptation, Psychological↗
PubMed2004

Detecting depression in Chinese stroke patients: a pilot study comparing four screening instruments.

OBJECTIVE: To determine which screening instrument is most suitable for detecting depression in Chinese stroke patients. METHOD: A random sample of 60 Chinese subjects recruited from consecutively admitted patients with first-ever stroke to a rehabilitation facility were assessed using the Visual Analogue Mood Scale (VAMS), the Hospital Anxiety and Depression Scale (HADS), and the Geriatric Depression Scale (GDS). Psychiatric diagnoses, which served as a benchmark for the comparison of screening instruments, were made using the SCID-DSM-III-R. Rating instruments were compared with respect to response rate, sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curves. RESULTS: The VAMS was not useful in screening for depression in Chinese stroke patients while both the HADS and the GDS demonstrated satisfactory accuracy in detecting depression in Chinese stroke patients. CONCLUSIONS: Screening instruments for poststroke depression are culture-specific and even scales well established in other cultures should be tested before being used in clinical practice and research.

Adult↗
PubMed2003

Can IQCODE detect poststroke dementia?

BACKGROUND: Little is known about the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in the screening of post-stroke dementia (PSDE). METHODS: At 3 months after the index stroke, a research assistant administered the IQCODE to relatives of 189 Chinese patients with acute stroke who were consecutively admitted to a general hospital. A psychiatrist, who was blind to the IQCODE scores, interviewed all 189 patients and made DSM-IV diagnosis of dementia, which served as the benchmark for judging the performance of IQCODE in screening PSDE. RESULTS: The optimal cut-off point of IQCODE was 3.40. The sensitivity, specificity, and positive and negative predictive values of IQCODE, and the area under the receiver operating characteristic curve, were 88%, 75%, 33%, 98%, and 0.88, respectively. CONCLUSIONS: When used as a sole instrument, IQCODE does not appear to be useful in screening PSDE in Chinese elderly.

Aged↗
PubMed2003

Validity and applicability of the Chinese version of community screening instrument for dementia.

The development of an educationally independent screening instrument for dementia is most valuable for epidemiological studies. The Community Screening Instrument for Dementia (CSI-D) was applied to 120 subjects, with 30 matched for age in each of the four groups of mild to moderately demented, depressed, low-education and high-education normal control subjects. The internal consistency and interrater reliability of CSI-D were satisfactory. Correlation with the ten-word-list learning task, a test sensitive to early dementia, was high. CSI-D could differentiate the demented from nondemented subjects, but not the high- from the low-education control group. Receiver operating characteristic analysis showed good test performance of CSI-D. In conclusion, the Chinese version of CSI-D is a valid, reliable and educationally independent screening instrument for dementia sensitive to detect early stage of the disease.

Aged↗
PubMed2002

Prevalence of dementia with Lewy bodies in an inpatient psychogeriatric population in Hong Kong Chinese.

OBJECTIVE: To find out the prevalence of dementia with Lewy bodies (DLB) in an inpatient psychogeriatric population in Hong Kong Chinese. METHOD: Clinical notes of all dementia patients admitted to an inpatient psychogeriatric unit between 1 January and 31 December 2000 were reviewed to retrieve information on various subtypes of dementia that have been diagnosed prospectively using NINCDS-ARDRA, NINDS-AIREN, CDLB and DSM-IV by qualified senior psychogeriatricians. RESULT: There were only three cases of dementia with Lewy bodies out of 102 dementia inpatients, giving a prevalence rate of 2.9% over a two-year period. CONCLUSION: The prevalence rate of dementia with Lewy bodies is remarkably lower than figures reported in western studies. Further evaluation using better sampling frame and better-validated diagnostic gold standard is required. Ethnically related biological factors may be implicated to explain the preliminary low prevalence rate in Chinese population.

Aged↗
PubMed2002

Distant visual acuity in chronic psychiatric patients. A pilot study.

BACKGROUND: There is a paucity of systematically collected data on visual impairment in patients with chronic psychiatric disorders. The aim of this pilot study was to estimate the magnitude of impairment of distant visual acuity (DVA) including refractive and non-refractive errors in institutionalized psychiatric patients awaiting resettlement in the community in Hong Kong. METHOD: DVA was tested using the Snellen method in a randomly selected cohort of 428 institutionalized psychiatric patients from the four long-stay rehabilitation units in Hong Kong. The pinhole method was employed to differentiate between refractive and non-refractive impairment of DVA. RESULTS: Seventy-five percent of the sample had impaired DVA; 39 % of the subjects had refractive error (myopia). Only a small percentage of patients wore spectacles and had adequately corrected vision. Patients with impaired DVA were significantly older than those with normal DVA. CONCLUSION: While the frequency of myopia corresponds to that found in the general population in Hong Kong, the nature of non-refractive impairment needs further investigation including systematic eye examination, and examination of medication and life-style factors. Periodical eye examinations should be part of comprehensive health assessment for chronic psychiatric patients.

Chronic Disease↗
PubMed2002

The pharmacological treatment of schizophrenia in Chinese patients: a comparison of prescription patterns between 1996 and 1999.

AIMS: In 1996 a Hong Kong-wide survey of pharmacological treatment for schizophrenic inpatients identified a few idiosyncratic prescription patterns that were not consistent with international standards. In the context of continuous quality assurance, the survey was repeated in 1999 to monitor trends in the pharmacotherapy of schizophrenia and to identify changes in prescribing practices. It was expected that the widespread introduction of novel antipsychotic drugs coupled with continuing medical education would favourably alter prescribing habits. METHODS: A representative random sample of 1202 schizophrenic patients from all inpatient settings in Hong Kong was surveyed. Basic socio-demographic data and a list of all psychotropic medication taken on census day were collected. RESULTS: Significant improvement was noted in several aspects of pharmacotherapy in 1999 as compared with 1996. The total daily dosage of antipsychotic drugs decreased from 716 +/- 627 to 561 +/- 482 mg day-1 chlorpromazine equivalent (CPZeq) (Mann-Whitney U-test; Z = -3.906, P = 0.000; 95% confidence interval [CI] = 70.0, 240.2 mg day-1 CPZeq), for acute patients and from 923 +/- 809 to 675 +/- 545 mg day-1 CPZeq (Mann-Whitney U-test; Z=-5.036, P = 0.000; 95% CI = 175.57, 321.63 mg day-1 CPZeq) for chronic patients. The percentage of patients coprescribed antipsychotics and an antiparkinson drug significantly decreased from 67.8% to 61.8% (chi2 = 5.558, P = 0.018) in the chronic schizophrenia group. The percentage of patients taking atypical antipsychotic medication increased significantly from 5.5% to 19.2% (chi2 = 27.14, P = 0.000) in the acute and 3.4% to 12.3% (chi2 = 27.76, P = 0.000) in the chronic group. CONCLUSIONS: Repeated surveys of prescribing practices proved to be a useful tool to demonstrate trends in the pharmacological treatment of schizophrenia. Our findings suggest that the widespread use of atypical antipsychotic drugs contributed to a more rational pharmacotherapy for schizophrenia.

Adult↗