Training enables security officers to better handle patients with psychosis

Posted on February 15, 2012 by admin

In Hong Kong, there are about 600 security companies registered with Security and Guarding Services Industry Authority and are eligible to provide guarding services to housing estates. With increasing emphasizes on early detection of psychosis and importance of community reintegration during the recovery process of patients with psychosis, the role of security officers is becoming more important. Their knowledge about psychosis and skills of interacting with patients would be critical. The needs for security officers to better equipped in handling patients with psychosis have been further revealed by several tragic incidents involving patients and security officers since 2010.

A survey on the knowledge about psychosis of security officers in Hong Kong has been conducted. A total of 78 security officers participated. They were assessed with an 8-item questionnaire focusing on cause, symptoms, treatment and outcome of psychosis. 26% of security officers able to correctly point out the cause of the illness but 67% of them thought stress is the main cause. Half of the security officers can recognise psychotic symptom.

In view of the needs, The Jockey Club Early Psychosis (JCEP) project has organized a series of 16 workshops for the security officers since 2010 with the aim to improve their knowledge about psychosis and skills in interacting with patients with psychosis. Thus far 81 companies and 735 security officers/company managers have participated. A post-training survey of the same group of security officers revealed that their knowledge about psychosis has improved significantly by 25%. During the training, participants have pointed out their main concerns and difficulties are as followings:

1. Difficulties in handling repeated complaints from patients regarding neighbors eg noises, strange smell and being monitored.

2. Aware of the presence of psychotic symptoms of a resident but not sure how to provide help.

3. Feeling difficult to interact with people with psychosis who appear agitated.

Appropriate interaction and help from the security officers to patients can greatly reduce the likelihood of tension between security officers and patients and support the recovery process of patients in the community. Base on our experiences, here are the suggested simple tips for security officers:

DOs	DON’Ts
Using appropriate tone and slower speed of speech	Avoid loud and fast speech
Be calm, using simple and clear language	Avoid using long and complicated language
Beware of personal safety Have local information about psychiatric services ready and make appropriate action when needed	Avoid agreeing or disagreeing with the content of the psychotic symptoms

The needs for continue training and support of security officers are obvious. Providing education workshops tailored to the specific needs of security officers will not only allow them to be better equipped but also enhance the process of community reintegration of patients with psychosis. This will continue to be one of the focuses of the JCEP project. However further resources and collaborations will be needed to improve the training of security officers and establishing efficient training system.

About Psychosis

Psychosis refers to a set of symptoms that include hallucinations, delusions, and disorganized thoughts and speech. It is a physiological condition related to an imbalance in certain chemicals in the brain called “neurotransmitters”. Multiple aspects of a person’s life can be affected by this condition, including psychosocial wellbeing and functioning. Symptoms can be effectively controlled by medications that modulate neurotransmitter activities, and patients benefit from psychosocial intervention especially during the early stage of the disease. For more information, please visit: http://www.jcep.hk/

About Jockey Club Early Psychosis (“JCEP”) Project

Led by the Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine, JCEP is a five-year project, set up with $69 million donation from The Hong Kong Jockey Club Charities Trust, organised in collaboration with Hospital Authority, Caritas-Hong Kong and the Mental Health Association of Hong Kong. A multi-disciplinary team, comprising social workers, nurses, occupational therapists and researchers, has been set up to serve early psychosis patients aged over 25. It is expected that about 1,000 patients will receive individualised, phase-specific intervention services in the first two to four years after their first episode of psychosis. The team will provide specialised case management and psycho-social interventions by engaging the patients through home visits, phone contact, web-based communication and tracking system. Support for affected families will also be offered to help patients attain a full functional recovery.

HKU and Queensland researchers make nasopharyngeal carcinoma (NPC) treatment breakthrough

Posted on February 15, 2012 by admin

The accumulation of 10 years of collaborative research between scientists from The University of Hong Kong Li Ka Shing Faculty of Medicine and the Australian Centre for Vaccine Development at the Queensland Institute of Medical Research (QIMR) has led to a significant breakthrough in the treatment of nasopharyngeal carcinoma (NPC), an aggressive Head and Neck cancer with a high prevalence in Hong Kong. By offering targeted immune treatment, the team was able to increase the median time of patient survival from 200 to over 500 days in the phase I study, which is an encouraging result. The result of the research has just been published in the latest issue of the leading scientific journal – Cancer Research. The team is planning to validate these preliminary findings further.

About the study

“NPC is associated with Epstein-Barr virus (EBV) infection in a manner analogous to the association of hepatitis B virus and liver cancer. By using adoptive immunotherapy, the human body’s own immune system was used to successfully fight against the disease.” says Professor Dora KWONG Lai-wan, Head of Department of Clinical Oncology, The University of Hong Kong Li Ka Shing Faculty of Medicine.

The presence of EBV in the cancer cells gives the body’s immune system a definite target to help battle against the NPC, resulting in minimal side effects, as suggested by Professor John Malcolm NICHOLLS, Clinical Professor of the Department of Pathology, The University of Hong Kong Li Ka Shing Faculty of Medicine. This is a phase I study examining the safety and tolerability of the adoptive immunotherapy (T-cell infusion) on recurrent and metastatic NPC patients, and is a joint project between the HKU and the QIMR researchers. Dr. Janice TSANG Wing-hang, Clinical Assistant Professor in the Department of Clinical Oncology reported that the results of this study showed that the treatment was well-tolerated by the patients without much side effects and by enhancing the immune cells of the NPC patients, this has doubled the overall survival time of the late-stage NPC patients, results yet need to be further validated. Patients who participated in the trial were having locally recurrent or metastatic NPC and were usually quite unwell, so it was important to ensure the treatment was non-invasive, non-toxic and did not damage any healthy cells.

Research Methodology

14 NPC patients were treated at the Department of Clinical Oncology, Queen Mary Hospital (the teaching hospital of HKU) in Hong Kong from August 2008 to April 2010 and the trial has recently been expanded to the Princess Alexandra Hospital in Brisbane.

Blood was taken from NPC patients in Hong Kong then transported to QIMR in Australia where the white blood cells (lymphocytes) were grown and trained to specifically recognise EBV infected cancer cells. These trained immune cells were then returned back to Hong Kong and infused into the patients where they would selectively kill EBV infected cancer cells – also referred as “adoptive immunotherapy”. The patients were then closely monitored and followed up for any side effects by oncologists at the Queen Mary Hospital.

Major results

Among the 14 patients treated at the Queen Mary Hospital in Hong Kong, the majority were male patients, aged from 37 to 60. This novel immunotherapy was prepared at QIMR in Brisbane using the Q-Gen which was a fully-integrated facility for translational research within QIMR. The research team there was headed by Professor Rajiv Khanna. By offering such targeted treatment, the mean time to progression (TTP) for these cancer patients was 136 days, and the median overall survival of the patients who received the T-cell infusion was 523 days compared to 220 days for those who did not receive the T-cell infusion. This is indeed an encouraging result, serving as the foundation for future directions. The study team believes that if this treatment is to be offered to patients with earlier stages of NPC, accompanied with the standard chemotherapy and radiation, it might further enhance the overall outcome of NPC patients in the future, yet results to be confirmed.

The way forward

HKU and QIMR will be continuing their collaboration and further investigation of immunotherapy for the treatment of NPC patients.

About the research team

This study is the joint effort of both the HKU researchers and the QIMR researchers, including the Department of Clinical Oncology and Department of Pathology at the University of Hong Kong, and the Australian Centre for Vaccine Development at the Queensland Institute of Medical Research. This phase I study was conducted during August 2008 – April 2010 with the results just being published in Cancer Research recently.

The University of Hong Kong (HKU) Li Ka Shing Faculty of Medicine is the longest established faculty in the tertiary education in Hong Kong, which was founded in 125 years ago. The Faculty is dedicated to innovative research with high scientific and translational values, thereby contributing to the development of Hong Kong into a biomedical research hub of the region. The results of the research work of Faculty members are published in distinguished international journals. 48 of the Faculty members are listed among the top 1% of scientists in their fields, according to the 2011 ISI’s Essential Science Indicators.

For more information about HKU LKS Faculty of Medicine, please visit:
http://www.med.hku.hk/

The Queensland Institute of Medical Research (QIMR) is a world leading translational research institute. Their research focuses on cancer, infectious diseases, mental health and a range of complex disorders. Working in close collaboration with clinicians and other research institutes, the aim of QIMR is to improve health by developing new diagnostics, better treatments and prevention strategies.

For more information about QIMR, visit http://www.qimr.edu.au/

About Nasopharyngeal Carcinoma (NPC)

Nasopharyngeal Carcinoma (NPC) is one of the top 10 cancers in Hong Kong, ranking 6^th among male, and 7^th for both male and female, with about 900 new cases in 2009 according to the latest Hong Kong Cancer Registry, which is more common in men. NPC is also known as “Canton Tumour”, as it is very common in the Guangdong province. It occurs in about 25 cases per 100,000 people in the Guangzhou region, 25 times higher than the rest of the world. This could be due to the South East Asian diet, which typically includes consumption of salted vegetables, fish and meat. There is also a genetic predisposition to NPC and exposure to EBV early in life may predispose to this tumour.

Please visit the website at http://www.med.hku.hk/hkumed/news_list.php for press photos.

HKU study reveals exercise improves memory and learning in psychosis

Posted on January 25, 2012 by admin

Psychotic disorders cause many dysfunctions including neurocognitive impairment (e.g. memory and attention), low motivation and social isolation. Medication controls psychotic symptoms (e.g. delusions and hallucinations) but is less effective in treating these associated dysfunctions, which have widespread consequences in the patient’s daily functioning and long-term outcome.

Researchers at The University of Hong Kong Li Ka Shing Faculty of Medicine are conducting a study to investigate the potential of add-on physical exercise intervention as a non-invasive cognitive remediation therapy in patients with psychosis. Results show improvements in neurocognitive functions with 12 weeks of aerobic exercise. The study is the first worldwide to be done in patients with early psychosis.

“The preliminary data demonstrated that aerobic exercise can reverse some cognitive deficits even in the early stage of psychosis. The relations between aerobic exercise and cognitive improvement may be mediated by neural plasticity in the brain. In collaboration with the Hong Kong Early Psychosis Intervention Society, we developed a series of exercise named FitMind movements which is designed according to the specific needs and ability of psychosis patients. We will have a series of programmes in the coming months for psychosis patients and general public to increase their awareness of the importance of exercise,” commented Professor Eric CHEN Yu-hai, Clinical Professor, Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine and also the principal investigator of the study.

Rationale and Methodology
HKU Researchers started the recruitment of subjects in July, 2010 and 35 psychosis patients had completed the study. The patients were randomised into receiving either a 12-week exercise intervention added on to their current treatment or continuing with their current treatment until after 12 weeks. Their neurocognitive functions and other clinical and biological parameters were measured before and after the 12-week study period for group comparison.

During the 12-week period, patients receiving exercise intervention underwent 3 sessions of aerobic exercise training per week, with each session lasting 40 to 50 minutes (36 sessions in total). The training includes walking on a treadmill for 15 to 20 minutes, plus stationary cycling for 25 to 30 minutes. Their heart rate was continuously monitored to achieve a moderate level of exercise exertion intensity.

Major Findings
Using the “verbal acquisition” and “long-term memory” trials of the Hong Kong List Learning Test, the patients’ ability in learning and long-term memory was assessed respectively before and after the exercise intervention.

Early results of the study suggest that verbal acquisition and long-term memory in the patients who received exercise training are significantly improved, compared with the control group. Patients in the exercise group had a 26% increase (from 23.8 to 30.0 scores) in mean score in the learning test and a 27% increase in mean scores in the memory test (from 8.8 to 11.2 scores), compared with only 6% (25.2 to 26.6) and 8% (7.8 to 8.4) in the control group. (Note: The respective mean scores in healthy individuals in the learning and memory trials are 36.0 and 13.4. )

FitMind Movement
Though the study shows clearly the benefits of exercise in early psychosis patents, extra barriers to exercising exist in the patients, such as the lack of resources access, social and other support, as well as reduced interest and motivation as a result of the illness.

To facilitate the promotion of physical exercise among patients and their healthy counterparts, the Hong Kong Early Psychosis Intervention Society (EPISO) is launching the FitMind programme in collaboration with the Department of Psychiatry, The University of Hong Kong Li Ka Shing Faculty of Medicine. Based on the present study, a comprehensive exercise programme is being developed, tailoring to the specific needs and ability of patients with psychosis. An exercise coaching system with trained community peers is being organized as a support network. A series of publicity campaign, including a charity walkathon to be held on March 18, 2012 and a series of 10 easy-to-follow movements has been produced to promote exercising and motivating patients with early psychosis. More details of the FitMind campaign can be found in the website: http://www.episo.org/FitMind.html

About Hong Kong Early Psychosis Intervention Society (EPISO)
The Hong Kong Early Psychosis Intervention Society was founded in 2007 and registered as a charitable institution in 2009. EPISO consists of experienced professionals, academics　(including doctors and professors from HKU Li Ka Shing Faculty of Medicine) and lay members in the field of early psychosis. The society aims to make accessible knowledge and experience gained from research and clinical practice to promote high-quality early psychosis intervention services, professional training, and public awareness programmes.

About Psychosis
Psychosis affects up to 2 in 100 people and is a leading cause of disability worldwide. It refers to a set of symptoms that include hallucinations, delusions, and disorganized thoughts and speech. It is a psychological and physiological condition related to an imbalance in certain chemicals in the brain called ‘neurotransmitters’. Multiple aspects of a person’s life can be affected by this condition, including subjective experience, wellbeing, motivation, contact with reality, and functioning. Symptoms can usually be effectively controlled by medications but more extensive psychosocial intervention is required to assure optimal outcome.

For news photos and powerpoint slides, please visit the website at:
http://www.med.hku.hk/hkumed/news_list.php

Social Science Story 2

Posted on January 25, 2012 by admin

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