Occurrence of CYP2D6 gene duplication in Hong Kong Chinese.
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Cytochrome P-450 CYP2D6↗
Biomedical subjects
Y K Wing
Publications and source records attributed to Y K Wing.
Sleep problems in Chinese elderly in Hong Kong.
BACKGROUND: To examine the sleep habits and one-year prevalence of sleep disturbance (difficulty in falling asleep, broken sleep and early morning wakening) as well as insomnia (subjectively inadequate or poor sleep) in an elderly Chinese population in Hong Kong. METHOD: In Phase 1, a representative sample of elderly aged 70 years or above were interviewed with a sleep questionnaire, and Cantonese versions of the Mini-Mental State Examination (CMMSE) and Geriatric Depression Scale(CGDS). In Phase 2, those with scores suggestive of cognitive impairment on CMMSE or depression on CGDS were interviewed by psychiatrists for making clinical diagnoses according to DSM IV. RESULTS: 1,034 elderly were interviewed in Phase 1. Occasional or persistent sleep disturbance were reported by 75% and insomnia in 38.2% of elderly. Slightly less than half of elderly with sleep disturbance complained of insomnia. Advancing age was associated with a higher rate of sleep disturbance while females had a higher rate of insomnia. Factors associated with sleep disturbance and insomnia included poor perceived health, past history of smoking, current depressive disorders, more chronic physical illness, more life events and more somatic complaints. Only 2.8% of the sample had taken sleeping pills within a one-year period. CONCLUSIONS: Sleep disturbance and insomnia are two separate but overlapping constructs and should be differentiated. Sleep disturbance is very common in the elderly and may be due to physiological changes with ageing. In contrast, those with a concommitant complaint of insomnia have impaired physical and mental health and may merit more medical attention.
Aged↗
Association between CYP2A6 and CYP2C19 mutant alleles.
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Alleles↗
Sleep paralysis in the elderly.
Isolated sleep paralysis (SP) is a common sleep phenomenon that is highly colored by indigenous beliefs. In Hong Kong Chinese, the 'ghost oppression phenomenon' (GO) has been shown to be descriptively identical to SP. The prevailing concept is that the majority of cases with SP have their onset during adolescence, but the lack of any systematic study on an older population means that late-onset cases can not be excluded. In a study investigating the prevalence of mental disorders in Chinese elderly aged above 70 y in Hong Kong, we employed the revised GO questionnaire to study the prevalence of SP in this group of elderly as well. One hundred and fifty-eight subjects were finally analyzed for the study. Almost 18% (95% C.I. 11.77%, 23.68%) of the subjects reported experiences of GO. Their description of the features of GO showed striking similarity to those of SP. There was a clear bimodal distribution of onset of GO with peaks during adolescence and after age 60 y. At least one-third of the cases were late onset. In concordance with the rapid eye movement (REM)/wakefulness dissociation hypothesis of SP, those elderly with GO+ experiences also had more frequent nocturnal sleep disturbances. A family history was reported in 10% of subjects.
Age of Onset↗
Schizophrenia and hypocalcaemia: variable phenotype of deletion at chromosome 22q911.
OBJECTIVE: The aim of this paper is to report the diagnosis of velo-cardio-facial syndrome (VCFS) in a patient presenting with schizophrenia and hypocalcaemia. Screening of deletion 22q11 in patients with schizophrenia is discussed. CLINICAL PICTURE: We report a schizophrenic patient presenting with hypocalcaemia as the only feature of VCFS. Deletion 22q11 was confirmed by fluorescent in situ hybridisation (FISH). TREATMENT: The patient was treated with haloperidol 3 mg/day with resolution of psychotic symptoms. OUTCOME: The patient harboured some residual psychotic symptoms probably related to her irregular compliance. CONCLUSIONS: The wide range of phenotypic variability of VCFS makes screening of 22q11 deletion in schizophrenia difficult. It is proposed that screening of 22q11 deletion in schizophrenia should be selectively targeted only at patients with specific features of VCFS highly predictive of the presence of 22q11 deletion.
Adult↗
Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton Rating Scale of Depression.
OBJECTIVE: The aim of this study was to validate the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale (HADS) and to compare it with the Hamilton Rating Scale of Depression (HRSD) as a screening tool for depressive disorders in general hospital in-patients. METHOD: The Chinese-Cantonese version of the HADS was administered to general hospital in-patients seen on a consultation basis, and psychiatric diagnoses were made according to DSM-III-R. The subjects were further rated independently with the HRSD. RESULTS: The Chinese-Cantonese version of the HADS was found to have good internal consistency and external validity, with favourable sensitivity and specificity for screening for psychiatric disorders. However, its performance was marginally inferior to that of the HRSD. The scale also performed poorly in identifying major depression. CONCLUSION: The HADS has limitations with regard to identification of depressive disorders. However, despite its shortcomings, it remains one of the best paper-and-pencil tests for screening psychiatric disorders in the medically ill.
Adult↗
Frequencies of defective CYP2C19 alleles in a Hong Kong Chinese population: detection of the rare allele CYP2C19*4.
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Alleles↗
Obstructive sleep apnea syndrome in a family with Crouzon's syndrome.
Craniofacial anomalies are recognized causes of obstructive sleep apnea syndrome (OSAS) in children. Current literature is limited due to rarity of cases. Furthermore, the mechanism of upper airway obstruction is not clearly understood. We would like to report a family (father and 2 sons) who are suffering from Crouzon's syndrome. The two brothers (ages 1 and 3) were found to have significant obstructive sleep apnea syndrome (OSAS) with failure to thrive. Nasal continuous positive airway pressure (CPAP) markedly improved their OSAS and resulted in accelerated weight gain. The nasoendoscopy and magnetic resonance imaging (MRI) scan taken during natural sleep showed that choanal stenosis, maxillary hypoplasia, posteriorly displaced tongue, lengthened soft palate and adenoid tissues were important in the pathogenesis of upper airways obstruction in Crouzon's syndrome. Nasal CPAP improved airway obstruction by opening a narrow slit as demonstrated by MRI. Our results suggest that OSAS occurred in children with Crouzon's syndrome and that nasal CPAP was a useful treatment modality.
Adult↗
A controlled study of folate levels in Chinese inpatients with major depression in Hong Kong.
BACKGROUND: Although Western and, in particular, British studies have revealed a substantial rate of hypofolatemia in patients with depression, few such studies have been conducted in Asian populations. METHODS: A group of 117 newly admitted inpatients with DSM-III-R major depression and 72 healthy controls underwent blood investigations and psychometric assessments. RESULTS: Patients had a significantly lower mean serum folate level (24.6+/-10.2 vs. 30.3+/-11.4 nmol/l, P < 0.001) but a higher mean erythrocyte folate level (801.8+/-284.6 nmol/l vs. 699.5+/-248.7 nmol/l, P < 0.01) than control subjects. No patient or control subjects had low folate, while only four patients (3.4%) and six control subjects (8.3%) had low erythrocyte folate. Folate levels were not related to patients' age, duration of illness, Hamilton Depression Rating Scale, Beck Depression Inventory and Global Assessment Scale scores, and prior psychotropic drug usage. Both patients and control subjects revealed a high intake of green vegetables. CONCLUSION: Patients' lower serum folate level was likely to be secondary to their depression but, being well in the normal range, should not have aggravated their depressive symptoms. Culturally patterned health beliefs and dietary practices can influence the connection between folate status and depression in different societies. LIMITATIONS: Patients were not drug-free, while the lack of detailed dietary analysis and longitudinal data on folate level and psychiatric outcome tempered the above conclusion. CLINICAL RELEVANCE: Since normofolatemia is normative in Hong Kong, the routine screening of folate levels in Chinese depressive patients is not indicated. However, a double-blind, placebo-controlled trial may be useful for finding out whether Chinese patients will still benefit from folate pharmacotherapy.
Adolescent↗
HLA DR2 and DQ1 frequency among narcoleptic patients in Hong Kong Chinese.
Narcolepsy is a life-long crippling sleep disorder with significant physical and psychosocial impairments. Although its exact etiology and neuropathology is not clear, a strong association with specific human leucocyte antigen (HLA) subtype, particularly DR2 (DRw15) and DQw1 (DQw6), has been demonstrated across different ethnic groups including Caucasians and Japanese. The presence of 100% association with HLA DR2 in a series of Hong Kong Chinese narcoleptic patients has previously been reported. The report can now be extended, and as far as could be ascertained in the available subjects, all were HLA DQw1 (DQw6)-positive. This is concordant with the experiences of Japanese narcoleptic patients who are 100% HLA DR2- and DQw1-positive. However, the definitive account of the population prevalence of narcolepsy in Chinese could be determined only by a well-conducted epidemiological study with laboratory confirmation.
Adolescent↗
Effects of lithium therapy on bone mineral metabolism: a two-year prospective longitudinal study.
Many studies showed an increased occurrence of primary hyperparathyroidism during lithium therapy. We studied 53 patients receiving lithium therapy prospectively for 2 yr. Serum PTH levels were unequivocally elevated. The baseline PTH level was 2.8 +/- 1.2 pmol/L and increased progressively to 3.9 +/- 1.5 pmol/L after 2 yr (P < 0.0005). There was no change in serum calcium, alkaline phosphatase, inorganic phosphate concentrations or tubular reabsorption of phosphate in relation to glomerular filtration rate. Fasting urinary reabsorption of calcium increased significantly (P < 0.0005), which was concordant with the PTH change. Fasting and 24-h urinary excretion of calcium decreased significantly (P < 0.0005), suggesting reduced, rather than enhanced, bone resorption as in primary hyperparathyroidism. This may be the main mechanism in maintaining normocalcemia, despite PTH elevation, during lithium therapy.
Adolescent↗
Karaoke therapy in the rehabilitation of mental patients.
OBJECTIVES: To study the efficacy of karaoke singing and its implications in the rehabilitation of mental patients in Hong Kong Chinese. METHODS: A double blind controlled trial was conducted over six weeks in a small sample of chronic schizophrenic patients matched in age, sex and duration of illness. The index group practised karaoke and the controlled group practised simple singing. Subjects were assessed in changes in mood and social interaction. RESULTS: No significant difference was detectable within the 2 groups. However, significant differences of anxiety and social interaction at the end of the third and sixth weeks respectively, were detectable between the 2 groups. CONCLUSION: Karaoke therapy may be more effective than simple singing in improving social interaction. There is preliminary evidence that it may be anxiety-provoking for unstable schizophrenic patients. More research is required for further elucidation of the characteristics of favourable candidates, optimal schedule and active components of the therapy.
Adolescent↗
Simultaneous determination of imipramine, desipramine and their 2- and 10-hydroxylated metabolites in human plasma and urine by high-performance liquid chromatography.
A simultaneous assay for imipramine, desipramine and their 2- and 10-hydroxy-metabolites using high-performance liquid chromatography (HPLC) is described. The drugs and internal standard, pericyazine, were extracted from plasma or urine at pH 9.6 with diethyl ether and back-extracted into 0.1 M orthophosphoric acid. The recovery of the compounds ranged from 78.6% for imipramine to 94.3% for 2-hydroxydesipramine. The extracts were analysed by reversed-phase HPLC with electrochemical detection using a mobile phase of 30% acetonitrile in 0.1 M K2HPO4 at pH 6.0 delivered at 2 ml/min. All compounds were resolved in a run time of 15 min with lower limits of quantification of 1.5 ng/ml for hydroxy-metabolites and 3 ng/ml for imipramine and desipramine. The intra- and inter-day coefficients of variation at 50 ng/ml were 5.2% and 6.8%, respectively (n=8).
Adult↗
Lithium pharmacokinetics in Chinese manic-depressive patients.
The pharmacokinetics of lithium was studied in 16 manic-depressive Chinese adults who were on lithium therapy in Hong Kong. A two-compartment open model was used to describe the plasma data obtained. The steady-state volume of distribution and total plasma clearance were estimated to be 63.4 +/- 38.3 L and 1.47 +/- 0.49 L/hr, respectively, which were similar to those reported in studies of Caucasian subjects. The lithium clearance was found to be significantly related to lean body mass (r = 0.646, p < 0.01) but not to either total body weight, age, or creatinine clearance. Interindividual variability in lithium clearance was substantially reduced to a coefficient of variation of 24.6% from 33.3% when lean body mass was considered. The combined plasma and urine data indicate that the rate and extent of lithium absorption were similar to those of earlier studies in Caucasian subjects on a standard lithium dosage.
Adult↗
Tyramine content in Chinese food.
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China↗
Charles Bonnet syndrome with major depression in a Chinese middle-aged man.
OBJECTIVE: To describe a middle-aged patient with Charles Bonnet syndrome (CBS) suffering from concurrent major depression. CLINICAL PICTURE: A 41-year-old Chinese man with retinitis pigmentosa developed complex and vivid visual hallucinations. This was followed by the onset of major depressive illness. His visual hallucinations were greatly influenced by his cultural background and changed during the course of his depression. TREATMENT: The patient was treated with imipramine. OUTCOME: The patient had a relapse of depression due to his non-compliance. He recovered after the resumption of imipramine but the visual hallucinations persisted. CONCLUSIONS: Patients suffering from CBS can have another concurrent psychiatric illness. The content and form of this patient's visual hallucinations were modified by his cultural background and depressive illness. Sensory deprivation is suggested to be the pathogenic mechanism of his visual hallucination.
Adult↗
REM sleep behaviour disorder in the elderly.
REM sleep behaviour disorder is a recently described parasomnia characterized by a history of excessive motor activities during sleep and is associated with pathological absence of muscle atonia during REM sleep. There is very limited literature on the condition. Two out of 349 elderly patients referred to a psychogeriatric unit were identified to have REM sleep behaviour disorder. These two patients are presented to illustrate the clinical features of the condition. Both of them showed a good response to clonazepam treatment.
Aged↗
REM sleep behaviour disorder: an overview.
REM sleep behaviour disorder (RSBD) is a recently described parasomnia characterised by a history of excessive nocturnal motor activity and absence of muscle atonia during REM sleep. Only limited literature is available on this condition. The exact prevalence is unclear, but recent studies suggest it might not be an uncommon condition. The elderly are more often affected and there is a male preponderance. While transient RSBD can be seen after taking certain drugs or during drug withdrawal, the chronic type is usually idiopathic or associated with an underlying degenerative neurological condition. It can result in considerable distress and/or serious injury to the patients or their bed partners. Differential diagnoses include sleep-walking, night terrors, nightmares, nocturnal seizures, obstructive sleep apnoea, post-traumatic stress disorder, dissociative states and nocturnal confusional states. The dramatic response to clonazepam highlights the importance of recognition and appropriate treatment of this sleep disorder.
Female↗