Parenting Stress and the Effectiveness of Behavioural Treatment on Non-responsive Medicated Chinese Children with AD/HD

Aim: It is established that around 30% of children with AD/HD are non-responsive to medication. Behavioural treatment and parent training is a treatment option, but there has been limited demonstration of its effectiveness in this particular group of non-Western cultures. The present before-after study investigated whether a sample of such children in the Chinese setting would benefit from behavioural treatment; second, whether parent training would lower parenting stress, and how this might relate to improvements in the child symptoms.
Methods: Nineteen non-responsive medicated Chinese boys with AD/HD, from a routine clinical practice centre in Hong Kong, were assigned to 20 sessions of group-based behavioural treatment programme. Parent training groups were conducted in parallel for the parents, over 10 sessions. Parent-rated assessments of child and parent symptoms were conducted immediately before and after treatment.
Results: Child AD/HD symptoms improved significantly post-treatment. Whilst the reduction in overall parenting stress was not significant, any reduction was found to be significantly accounted for by improvement in oppositional-defiant symptoms. Conclusion: Behavioural treatment and parent training appears to be a viable treatment option for Chinese children whose AD/HD does not respond to medication. Further controlled trial evidence is required to generalise and extend the findings.

The Comprehensive Child Development Service for Early Identification and Management of Postnatal Depression : Service Data of a Regional Hospital in Hong Kong

Ten to fifteen percent of recently delivered women suffer from postnatal depression. Postnatal depression can adversely affect the well-being of the woman, the development of her child, and the harmony of her family as a whole. One of the major service components of the Comprehensive Child Development Service (CCDS) in Hong Kong is the early identification and management of postnatal depression. After the implementation of CCDS in Hong Kong since 2005, postnatal women are screened routinely at Maternal and Child Health Centre (MCHC) for depression with the Chinese version of the Edinburgh Postnatal Depression Scale. Those screened positive would be seen at MCHCs by psychiatric nurses who will refer in need women to psychiatrist directly. CCDS was found to have served the purpose of managing postnatal depression early. It is worthwhile to extend CCDS to other districts in Hong Kong so that more family can be benefited from the service.

Dementia Caregivers Training Program for Improving Caregiving Self-Efficacy ¡V A Quasi-Experimental Study

Objectives: To explore the difference of caregiving self-efficacy among dementia caregivers who received caregivers training and who did not.
Methods: Eighteen caregivers were recruited in a regional relatives support group by purposive sampling. Caregiving self-efficacy was measured and compared between those received training (n = 10) and those did not (n = 8) using static group comparison.
Results: Caregiving self-efficacy for handling obstructive behaviour and controlling upsetting thoughts showed significant difference among caregivers of two groups while there was no significant difference in caregiving self-efficacy for obtaining respite.
Conclusions: Caregiving self-efficacy was better in those caregivers received dementia caregivers training program. Apart from equipping the caregivers with the skills and knowledge on disease management, the training program probably had a certain contribution on reinforcing the positive thoughts and beliefs of caregivers. More robust studies with well-study design were indicated.

Working with the Mental Health Service Users and their Family with Systemic Family Nursing Approach

Studies find that interaction among family members affect the rehabilitation process of the mentally ill. Also, mental illness disrupts the life of the family, and creates burden to the family. The mutual understanding and acceptance within the family provides a stable environment that promotes rehabilitation and prevents relapse for the ill member. Psychiatric nurses work closely with the mentally ill and their relatives daily. With training in systemic family nursing, they are competent in helping the mentally ill and their relatives to cope with their emotions influenced by the illness through identifying their strengths and work through their difficulties. In this article, the author illustrates a case and demonstrates how to apply the systemic family nursing assessment and intervention to help a patient and his parents to deal with the attack of auditory hallucination.

Domestic Violence: What Should We Know and What Can We Do as a Mental Health Professional?

Domestic violence has recently become an area of major concerns among social and clinical services providers. As mental health professionals, we can help prevent occurrence of domestic violence by recognizing the predictors of violence in our psychiatric patents. We can also help the victims who suffered from trauma in domestic violence. In this paper, the predictors of domestic violence in psychiatric patients and the psychological impact on the victims of domestic violence will be discussed.

Interface of Mental Health and Family Medicine

The mental health service demand is on rising trend globally. Common mental disorders imply great DALYs and societal economic burden. WHO and WONCA found interfacing mental health with family medicine as viable, cost-effective, affordable service model for common mental disorders with good health outcomes. Similar result was echoed by studies in United States. Similar service models have been implemented in the 10-year Mental Health Service Reform in United Kingdom and Australia with good outcomes. The pilot project of this new service model in a public GOPC in Hong Kong proved its cost-effectiveness and filtered out these patients from utilization of higher specialist care, which can focus more on the management of severe mental disorders. The mental health care model for the full spectrum of mental disorders in Hong Kong can be outlined in a service pyramid with collaborative care among community partners, family medicine and mental health professionals.

Relevancy and Challenges of Recovery Model: a Primer Review

The conventional notion of treat-and-recover medical model could not quite describe the recovery process of people with severe mental illness. Although full restoration of functions were rare, ample evidence showed that many people with schizophrenia do not necessarily deteriorate over time, but enter into episodes of symptomatic remission. New concepts and values of recovery emerged with emphasis on personal agency and empowerment, are accepted as the core value of the mental health policies in some developed countries at a phenomenal rate. This paper reviewed the general concept and components of recovery, and argued with illustrations in hope, self-agency, and stigma that in spite of different cultural interpretation on personhood and the illness, the recovery model put forth by SAMHSA statement contained valuable relevancy for psychiatric rehabilitation in Hong Kong and perhaps elsewhere in Asia.

District-based Personalized Care Program for Patients with Severe
Mental Illnesses - a Pilot Case Management Service Model in Hong Kong

Overseas literature showed that district-based community mental health teams and case management models have achieved positive outcome in healthcare service utilization, clinical, psychosocial and quality of life domains. The 2009-10 Policy Address of Hong Kong stated the pilot implementation of district-based Personalized Care Program (PCP) for patients with severe mental illnesses (SMI) in 3 districts, one of which being Kwai-Tsing (KT) district. KT District-based PCP was implemented at Kwai Chung Hospital in April 2010. There were 2 functional components in this program: personalized case management model and community partnership. The program objectives were: person-centered care, needs and risk management, active user and carer participation, gate-keeping to prevent avoidable hospitalization, better treatment adherence and reduction of disabilities, enhancement of strengths, recovery and social inclusion of patients with SMI, cultivation of mental health professional workforce, construction of district-based community partnership. In this paper, we described the program details and its outcome evaluation.

Survey on the Employment Profile of PYNEH Psychiatric Patients

Employment is always a concern of psychiatric rehabilitation. The aim of this survey was designed to investigate the employment status and difficulties of psychiatric SOPD patients in the Hong Kong East Clusters. 201 SOPD patients were successfully interviewed and the employment rate was 53%. Among them, 54% found jobs by their own effort & 74.5% got a full-time job but 25% earned less than $5000. Around 40% could sustain job for more than 5 years. For those who were unemployed, 95.8% had working experiences & over 60% wished to resume worker role. The average length of unemployment was 56 months. Major difficulties encountered included low confidence, effects of illness, poor interpersonal relationship, stigma & work stress. In addition, majority of them seldom utilized community rehabilitative resources to enhance their vocational functioning. Several improvement actions were suggested to promote their employment opportunities in a coming event ¡§Work EXPO 2009¡¨ at PYNEH.

A 9-year Review of Patient Profile of the Elderly Suicide Prevention Programme of a Regional Hospital in Hong Kong

Aim: This study aims to examine the patient profile of all the patients who have attended the Fast Track Clinic under the Elderly Suicide Prevention Programme of Castle Peak Hospital from 2002 to 2010.

Methods: Case notes of the 1,097 patients who presented during the study period were reviewed.

Results: Among the 1,097 patients, 89% of them were diagnosed to have depressive illness. 84 of them attempted suicide upon presentation and they were more likely to have previous suicidal attempts than the non attempters. Over half of them employed a lethal, physical method. After their recruitment into the Elderly Suicide Prevention Programme, only three among the 84 (3.6%) suicide attempters eventually committed suicide under the active care of the service.

Conclusions: The elderly suicide attempters employed a lethal method which reflected their high suicidal intent. The programme can be regarded as successful in reducing the reattempt rate of this high risk group.

Review of Dementia Caregiving Experience and Interventions in Chinese Communities

As population continues to age, the number of persons with dementia has been increasing rapidly. It is a common practice in Chinese communities for family members to provide the majority of dementia care. Literature from developed countries reveals that dementia caregivers experience significant stress and burden, which adversely affects the psychological and physical health of care providers as well as care recipients. This paper aims at understanding family caregiver experience among Chinese caregivers and reviewing interventional studies conducted in Chinese communities, which are pivotal in the design of effective carer support services appropriate to local context.