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Biomedical subjects

W K Tang

Publications and source records attributed to W K Tang.

15 recordsLinked to original sources
PubMed2006

Prevalence and correlates of depression in Chinese elderly patients with pneumoconiosis.

Recent literature suggests that patients with pneumoconiosis may be at higher risk of developing psychiatric problems, particularly depressive illness. There are no published data on depressive disorders in elderly patients with pneumoconiosis. The aim of this study was to evaluate the prevalence and correlates of depressive disorders in a community sample of elderly Chinese patients with pneumoconiosis in Hong Kong. Two hundred and one patients with pneumoconiosis were randomly selected from the case register of the Pneumoconiosis Compensation Fund Board of Hong Kong. A psychiatrist conducted a structured clinical interview to diagnose depressive disorders according to the Diagnostic Statistical Manual for Mental Disorders, Version IV criteria. Nineteen (9.5%) patients had depressive illness. Univariate logistic regression revealed that the number of comorbid conditions, and the scores on the Lubben Social Network Scale (LSNS) and Instrumental Activities of Daily Living (IADL) were significant predictors of depressive disorders. Multivariate logistic regression analysis found that IADL and LSNS scores were the only independent predictors of depressive disorders. In conclusion, depressive disorders were common and associated with poorer functional ability and social support in patients with pneumoconiosis.

Aged↗
PubMed2004

Screening post-stroke depression in Chinese older adults using the hospital anxiety and depression scale.

Little is known about the performance of the Hospital Anxiety and Depression Scale (HADS) in screening post-stroke depression (PSD) in Chinese older adult patients. One hundred Chinese geriatric patients with first-ever stroke, consecutively admitted to a rehabilitation facility, were assessed by occupational therapists using the depression subscale of the HADS. Psychiatric diagnoses, which served as the benchmark for judging the usefulness of HADS in screening PSD, were made using the Structured Clinical Interview for DSM-III-R (SCID-DSM-III-R) supplemented by all available clinical information. The optimal cut-off point of HADS was 6/7. The sensitivity, specificity, positive and negative predictive value of the HADS, and the area under the receiver operating characteristic curve, were 88%, 53%, 0.28, 0.96 and 0.75, respectively. The HADS does not appear to be a useful tool in screening for PSD in Chinese older adults.

Aged↗
PubMed2004

Cognitive impairment and functional outcome after stroke associated with small vessel disease.

OBJECTIVES: Although stroke associated with small vessel disease (SSVD) can induce both motor and cognitive impairment, the latter has received less attention. We aimed to evaluate the frequency of the varying severity levels of cognitive impairment, the determinants of severe cognitive impairment, and the association of cognitive impairment with functional outcome after SSVD. METHODS: Consecutive patients admitted to hospital because of SSVD were assessed at 3 months after stroke. We performed a semi-structured clinical interview to screen for cognitive symptoms. Severity of cognitive symptoms was graded according to the Clinical Dementia Rating Scale (CDR). Performance on psychometric tests (Mini-Mental State Examination, Alzheimer's Disease Assessment Scale (cognition subscale), Mattis Dementia Rating Scale (initiation/perseverence subscale; MDRS I/P)) of patients of different CDR gradings was compared with that of 42 healthy controls. Basic demographic data, vascular risk factors, stroke severity (National Institute of Health Stroke Scale; NIHSS), pre-stroke cognitive decline (Informant Questionnaire on Cognitive Decline in the Elderly; IQCODE), functional outcome (Barthel index; BI), Instrumental Activities Of Daily Living; IADL), and neuroimaging features (site of recent small infarcts, number of silent small infarcts, white matter changes) were also compared among the groups. Regression analyses were performed to find predictors of severe cognitive impairment and poor functional outcome. RESULTS: Among the 75 included patients, 39 (52%) complained of cognitive symptoms. The number of patients in each CDR grading was as follows: 39 (52%) had a CDR of 0, 26 (34.7%) had a CDR of 0.5, 10 (13.3%) had a CDR of > or =1. Pre-stroke IQCODE and previous stroke predicted CDR> or =1. The NIHSS was associated with more impaired BI. The NIHSS and MDRS I/P contributed most to impaired IADL. CONCLUSIONS: Half of the patients with SSVD complained of varying severity of cognitive problems 3 months after stroke. Pre-stroke cognitive decline and previous stroke predict severe cognitive impairment post stroke. Stroke severity and executive dysfunction contribute most to a poor functional outcome.

Activities of Daily Living↗
PubMed2003

Three patients with orbital xanthogranuloma and non-progressive haematological abnormalities.

Orbital xanthogranuloma is a rare dermatological condition characterized by its bilateral and rather symmetrical subcutaneous granulomatous infiltration around the eyes. It shares morphological similarities with other xanthogranulomatous diseases such as juvenile or adult type xanthogranuloma, necrobiotic xanthogranuloma and cutaneous infiltration in Erdheim-Chester disease, and should be differentiated from them. Three elderly Chinese patients with this condition were found to have underlying haematological abnormalities: normochromic normocytic anaemia, thrombocytopenia or eosinophilia. Their skin lesions remained localized and associated haematological abnormalities stable for up to 7 years. Haematological abnormalities were also reported in previous cases and this finding is unlikely to be coincidental; however, its clinical significance remains unknown.

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PubMed2003

Prescribing for inpatients with schizophrenia: an international multi-center comparative study.

BACKGROUND: This study compares prescription practices for acute inpatients with schizophrenia among six academic departments located in China, Japan, Hungary, and the U.S. METHODS: Prescription data for a sample of 429 inpatients from six academic departments were collected on a randomly chosen census day. All patients met criteria for schizophrenia according to DSM-IV and had a length of illness of at least two years. RESULTS: While patients at the different centers varied in their demographic and clinical characteristics, i. e., age, sex, and length of illness, a great variation in prescription patterns for antipsychotic and other psychotropic drugs among centers was observed even within the same country for all the variables studied (i. e., number and dose antipsychotics, atypical and depot antipsychotics, other psychotropic drugs, multiple antipsychotics, and daily dose) except antidepressant use. In most cases these differences persisted even after adjusting for demographic and clinical characteristics (age, sex, and length of illness) of the subjects. Antipsychotics were usually prescribed in divided daily doses in combination with one or more other psychotropic drugs, including anticholinergics, anticonvulsants, benzodiazepines, and non-benzodiazepine hypnotics. Anticholinergic use was more common with typical antipsychotics. Rates of atypical antipsychotic drug use were lowest in the Japanese center. The Japanese center had by far the highest mean daily dose of antipsychotics. CONCLUSIONS: The results indicate that prescription patterns in different centers do not follow any specific guidelines for the treatment of schizophrenia. The results also confirm previous findings that prescribing practices for schizophrenia vary greatly among centers and countries. A common prescribing pattern found was the use of atypical antipsychotic drugs in combination with psychotropic drugs, such as anticholinergics, hypnotics, anticonvulsants, and benzodiazepines, administered in multiple daily doses.

Adult↗
PubMed2001

Telepsychiatry in psychogeriatric service: a pilot study.

A pilot study on telepsychiatry was conducted in which a videoconferencing link was established between a regional hospital and a care and attention home. Using this system, a psychogeriatric outreach team provided 149 psychiatric assessments to 45 residents of the care and attention home over 11 months. Videoconferencing was found to be highly feasible. It was acceptable to staff and patients and more cost-effective than on-site visits.

Aged↗
PubMed2001

Behavioral profile of Alzheimer's disease in Chinese elderly--a validation study of the Chinese version of the Alzheimer's disease behavioral pathology rating scale.

OBJECTIVES: This study aims to examine the psychometric properties of the Chinese version of the Alzheimer's disease behavioral pathology rating scale (CBehave-AD) and the behavioral profile of Chinese patients with AD. METHODS: Seventy-one subjects with NINCDS-ADRDA diagnosis of probable and possible AD were assessed for validation of the CBehave-AD. A behavioral symptom frequency checklist, the Chinese version of the Blessed Roth dementia scale (CDS) and the Cantonese version of the Mini-Mental State Examination (CMMSE) were used for comparison. An extended sample of 120 AD patients was then evaluated with the CBehave-AD. RESULTS: High correlations between the CBehave-AD and checklist scores were found (paranoid and delusional ideation, hallucinations, activity disturbances, aggressiveness and diurnal rhythm disturbances). The scale also demonstrated satisfactory inter-rater and test-retest reliabilities. The mean (SD) CMMSE score of the 120 patients was 9.4 (7.1). Among them, 32% have delusions, 15% had hallucinations, 54% had activity disturbances, 61% had aggressive behavior, 44% had sleep disturbance, 24% had affective disturbances, 19% had anxiety and phobias. Delusional ideation was significantly associated with hallucinations, aggressiveness, and affective disturbances. Diurnal rhythm disturbances were associated with activity disturbances and aggressiveness. CBehave-AD total scores were not significantly correlated with severity of AD, but individual symptom categories showed different pattern of correlation. Delusions, hallucinations, anxiety and phobias were significantly correlated with dementia staging. CONCLUSION: The findings suggest that the CBehave-AD is a valid assessment tool for behavioral disturbances in patients with AD. Variable associations between different symptom categories and dementia staging suggest a need for further exploration of the complex interactions between behavioral and cognitive disturbances in dementia.

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PubMed2001

Dopamine D3 receptor gene and tardive dyskinesia in Chinese schizophrenic patients.

Epidemiological studies have shown a lower prevalence of tardive dyskinesia (TD) among Chinese psychiatric patients compared to Caucasian and Black patient populations. It has been hypothesized that pharmacogenetic factors may underlie this cross-cultural difference. Due to the important implications of the dopamine D3 receptor gene (DRD3) in motor control, we investigated the frequency of polymorphic serine (ser) to glycine (gly) substitution of the gene DRD3 in Chinese schizophrenic patients. The sample size consisted of 65 patients with TD and 66 without TD. Patients were assessed for the severity of TD, the presence of akathisia and parkinsonian symptoms and were subsequently genotyped. We found no evidence that the dopamine D3 receptor gene is likely to confer susceptibility to the development of tardive dyskinesia in Chinese patients with schizophrenia.

Adult↗
PubMed2001

Asystole during electroconvulsive therapy: a case report.

OBJECTIVE: The objective of the report is to describe a case of asystole lasting for 18 s, which developed after a subconvulsive stimulus during electroconvulsive therapy (ECT) in a patient without pre-existing cardiovascular abnormality. A brief review of the relevant literature is also provided. CLINICAL PICTURE: The patient was a 65-year-old Chinese man with a 2-year history of depression and good past medical health. Earlier he had responded well to a course of ECT without adverse effects. This time he presented with low mood, anhedonia, poor appetite and constipation. He did not respond to adequate trials with several antidepressant medications. When a subconvulsive stimulus was administered to determine the seizure threshold, no seizure activity was detected. However, immediately after the stimulus the patient developed an 18-s asystole, followed by bradycardia of 40 beats per minute for 10 s. The bradycardia resolved spontaneously before therapeutic intervention was effected. TREATMENT: Intravenous atropine was employed as premedication and suprathreshold stimulus was used in further ECT sessions. OUTCOME: Asystole did not recur in the subsequent six ECT sessions. CONCLUSION: When proper precautions are taken, asystole does not necessitate the suspension of further ECT sessions but intravenous atropine should be considered as premedication in such cases. Inducing anaesthesia with methohexital, avoiding excessive amounts of succinylcholine and employing suprathreshold stimulus and unilateral electrode placement may further lessen the likelihood of asystole in susceptible cases.

Aged↗
PubMed2001

Cytochrome P450 2D6 genotyping and association with tardive dyskinesia in Chinese schizophrenic patients.

BACKGROUND: The discovery of Cytochrome P450 2D6 (CYP 2D6) polymorphism is implicated in individual differences in drug metabolism rate. Mutation with defective alleles is associated with reduced metabolism of many anti-psychotic drugs metabolized by CYP 2D6. This may contribute to the development of tardive dyskinesia (TD) in patients with prolonged exposure to anti-psychotic drugs. METHODS: In this controlled study, the genotype of CYP 2D6*10 alleles, movement disorders and clinical characteristics in 38 Chinese schizophrenic patients with TD were compared with 38 age- and sex-matched schizophrenia patients without TD. RESULTS: There was no significant correlation between CYP 2D6*10 genotypes and TD in men. However, a significant increase in the frequency of CYP 2D6*10 allele was found in female patients with TD. CONCLUSIONS: The sex differences in CYP 2D6 genotyping and vulnerability to develop TD suggest that a biological predisposition that affects pharmacokinetics may be more significant in women, whereas other factors may be more important in men.

Adult↗
PubMed2001

Electroconvulsive therapy in rehabilitation: the Hong Kong experience.

Persistent psychotic symptoms can intrude on an individual's cognitive and psychosocial functioning and interfere with that person's active and constructive participation in social and vocational rehabilitation. Amelioration or elimination of intrusive positive and negative symptoms of psychosis is the major task for clinicians during the acute phase of schizophrenia. Successful treatment permits the patient to transition into stabilization and recovery phases, when psychosocial rehabilitation can take primacy (1). The introduction of clozapine has enlarged the proportion of individuals with schizophrenia whose psychotic symptoms can be controlled (2), but symptoms remain refractory in a large number of patients. One largely unexplored alternative for treating individuals who are chronically disabled is electroconvulsive therapy (ECT). Already known for its efficacy in treating affective disorders, its effectiveness in treating schizophrenia--although more limited--has been documented over more than five decades (3,4). ECT has been found to be particularly effective in treating first-episode cases in which affective and catatonic symptoms are manifested and in 20 to 50 percent of treatment-resistant cases, including those in which the patient was nonresponsive to clozapine (5,6,7,8). Without continuation and maintenance ECT, however, results are usually short-lived (4,7,9). Tang and Ungvari have used ECT in an attempt to increase the responsiveness to psychosocial rehabilitation of patients who have treatment-refractory schizophrenia. They describe their experiences with ECT at a facility in Hong Kong, where long-term hospitalization is still the norm for a sizable proportion of patients with chronic schizophrenia. ECT is more compatible with the biological view of schizophrenia that is prevalent in Asian countries; hence it has greater cultural congruence and acceptability among consumers and families in China than in the United States.

Electroconvulsive Therapy↗
PubMed2000

Reactive psychosis: a classical category nearing extinction?

By presenting two illustrative case histories, the authors stress the importance of the classical category of reactive psychosis which has disappeared from recent international classifications as a distinct nosological entity. Reactive psychosis is essential in the differential diagnosis of acute psychoses as the diagnosis of reactive psychosis has far-reaching therapeutic implications. Clinical and conceptual issues concerning reactive psychosis are briefly reviewed with respect to major classical and modern papers.

Adjustment Disorders↗
PubMed1999

Lorazepam for chronic catatonia: a randomized, double-blind, placebo-controlled cross-over study.

Acute catatonic syndromes occurring in the context of various medical and neuropsychiatric conditions, including schizophrenia, have been shown to respond well to benzodiazepines (BZD). However, there have been no studies specifically designed to address the BZD treatment response of persistent catatonic states. Eighteen patients with clinically stable chronic schizophrenia, who also displayed enduring catatonic features, underwent a 12-week long, random assignment, double-blind, placebo-controlled cross-over trial with lorazepam (6 mg/day). A comprehensive assessment, including the subjects' clinical and motor (catatonic as well as drug-induced movement disorders) condition, was performed at baseline and four weekly intervals thereafter. Pre-existing medication was kept constant throughout the study. Lorazepam had no effect on the subjects' catatonic signs and symptoms, suggesting that acute and chronic catatonic syndromes associated with schizophrenic illness might have a different neurobiological basis.

Adult↗