Multi-disciplinary Psychiatric Case Management Model in Hong Kong: Service Coverage and Risk Stratification.

INTRODUCTION: Community mental health services in Hong Kong follow a multi-disciplinary case management model. We investigated whether at-risk patients received higher intensity care and whether risk stratification concorded between personalised care programmes and integrated community centres of mental wellness. METHODS: Records of all patients in North Lantau and Mongkok districts who received case management services (from personalised care programmes and/or integrated community centres of mental wellness) between 1 April 2014 and 30 June 2015 were reviewed. Patients' levels of risk, demographic data, and clinical characteristics were analysed. RESULTS: Identified at-risk patients received high-intensity care from personalised care programmes and integrated community centres of mental wellness. Case management was coordinated between the Hospital Authority and non-government organisations. However, risk stratification did not correlate with assessment rating scores of psychopathology or psychosocial functioning. Assessment rating scales appear unsuitable to provide any optimal cut-off scores for risk stratification. CONCLUSIONS: Risk stratification should be a structured clinical judgement based on comprehensive and accurate information of protective and risk factors, rather than relying on cut-off scores of assessment rating scales.

Psychiatric Morbidity in Chinese Adults with Type 1 Diabetes in Hong Kong.

OBJECTIVES: To determine the prevalence of psychiatric morbidity and identify the correlates, as well as to evaluate the effectiveness of the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire to screen for psychiatric morbidity in Chinese adults with type 1 diabetes. METHODS: Subjects were recruited from a local public diabetes specialist outpatient clinic from August 2013 to January 2014. Demographic and clinical factors were recorded. Psychiatric diagnosis was established using the Chinese-bilingual version of the Structured Clinical Interview for the DSM-IV Axis I disorders. Scores for the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire were compared with the psychiatric diagnosis. RESULTS: Of the 136 patients, the point prevalence of overall psychiatric, depressive, and anxiety disorders was 39.7%, 23.5%, and 25.7%, respectively. Family history of mental illness, smoking status, history of mental illness, presence of social problems, perceived absence of confidant, presence of neuropathy and hyperlipidaemia, as well as higher level of glycosylated haemoglobin were found to be the associated factors. CONCLUSION: Psychiatric disorders were common in Chinese adults with type 1 diabetes. Finding out associated factors and using the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire as a screening tool helped to identify patients in a diabetes clinic with psychiatric disorders.

Prevalence of Psychiatric Morbidity in Chinese Subjects with Knee Osteoarthritis in a Hong Kong Orthopaedic Clinic.

OBJECTIVES: To identify the prevalence and associated factors of psychiatric morbidities and to evaluate the effectiveness of the Hospital Anxiety and Depression Scale (HADS) in screening for psychiatric morbidity in patients with knee osteoarthritis in a local orthopaedic clinic. METHODS: A cross-sectional study was conducted from October 2013 to June 2014 to examine patients with knee osteoarthritis at a specialist orthopaedic clinic. They were evaluated for psychiatric diagnoses using the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I). Socio-demographic and clinical characteristics were compared between patients with and without psychiatric morbidity. Patients were also assessed using the HADS with accuracy compared with the psychiatric diagnoses made by the SCID-I. RESULTS: Of the 115 patients, 39% had current psychiatric disorders. Logistic regression analysis revealed that limitation of physical activity, perceived absence of confidant, a history of psychiatric illness, and follow-up in orthopaedic clinic for ≥ 5 years were independent factors associated with psychiatric disorders. CONCLUSIONS: The prevalence of psychiatric morbidity in patients with knee osteoarthritis was significant. Recognition of independent associated factors can aid in early identification and intervention in patients who are at risk of developing psychiatric morbidity. The HADS is a useful means to screen for psychiatric morbidity in these patients.

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.

Magnetic resonance imaging of the foot and ankle.

This article describes the application of MR imaging to musculoskeletal imaging, specifically, imaging of the foot and ankle. The instrumentation, safety, and imaging techniques are discussed with specific attention to fat suppression, three-dimensional Fourier transform images, dynamic imaging, magnetization transfer contrast, and MR angiography. Normal and abnormal osseous, ligamentous, and tendonous anatomy is discussed and illustrated.

Reliability, validity and structure of the Chinese Geriatric Depression Scale in a Hong Kong context: a preliminary report.

Depression is one of the commonest psychiatric illness in the elderly. Screening instruments of depression can greatly facilitate its identification in the community, leading to early recognition and diagnosis. The Geriatric Depression Scale was translated into Chinese and its reliability, validity and factor structure examined in a population of Chinese elderly in Hong Kong. One hundred and thirteen normal and 80 depressed elderly subjects were studied and a cut-off score of 15 on the scale was found to be optimal. The scale's reliability and validity was satisfactory and thus it is a promising instrument for screening geriatric depression in Hong Kong.

The Zung Self-rating Depression Scale: screening for depression among the Hong Kong Chinese elderly.

Two studies were conducted respectively to examine the reliability and validity of the standard Zung Self-rating Depression Scale (SDS), and a 10-item shorter version of the same test. In particular, the scale's usefulness as a screening instrument for depression among the Hong Kong Chinese elderly was investigated. In addition to the SDS, the Geriatric Depression Scale and the Chinese Hamilton Depression Scale were used to assess the convergent validity of the SDS. Data were collected from 113 nondepressed community-dwelling and 80 depressed elderly subjects. The findings showed that both the original and the shorter version of the SDS were highly reliable and valid. Both versions were appropriate for use as screening instruments for geriatric depression in Hong Kong. When compared with the original scale, the shorter version appeared to be slightly superior in its sensitivity and specificity in discriminating between the depressed and nondepressed subjects.

Morton neuroma: evaluation with MR imaging performed with contrast enhancement and fat suppression.

PURPOSE: To evaluate clinically suspected Morton neuroma with contrast material-enhanced magnetic resonance (MR) images. MATERIALS AND METHODS: Fifteen patients with clinically suspected Morton neuroma underwent examination with conventional T1- and T2-weighted MR imaging and a combination of fat suppression and administration of gadopentetate dimeglumine. A T1-weighted spectral presaturation with inversion recovery sequence was used for fat suppression. RESULTS: In six patients, a tumor that conformed to the clinical findings was seen in the interdigital space; surgical findings in these patients correlated closely with the imaging findings in all patients. Patients without positive findings on MR images tended to have less typical clinical findings and received nonsurgical treatment. In all patients, the lesions were best depicted with the combination of contrast-enhanced imaging and fat suppression; conventional MR images either entirely failed to demonstrate the lesions or demonstrated the lesions less clearly. CONCLUSION: In patients who need imaging confirmation of a clinically suspected Morton neuroma, the combination of fat suppression and contrast enhancement provides reliable high-contrast images.

Prevalence of tardive dyskinesia in samples of elderly people in Hong Kong.

The prevalence of dyskinesia was studied in 4 samples of elderly Chinese people in Hong Kong--a psychogeriatric clinic, a mental hospital, a geriatric day hospital and a senior citizen centre. Research Diagnostic Criteria were used to identify cases of tardive dyskinesia. The overall prevalence of spontaneous dyskinesia was 2.4% and tardive dyskinesia was 25.9%. The rate of spontaneous dyskinesia differs across the study samples and is related to nervous system conditions associated with increased age. On the other hand, the rate of dyskinesia associated with antidepressants may not be significantly different from that of spontaneous dyskinesia.

Plantar fasciitis. Mechanics and pathomechanics of treatment.

An excessive amount and/or a prolonged duration of pronation is the most common mechanical cause of structural strain resulting in plantar fasciitis. Temporary relief of pain can be achieved by customary antiinflammatory drugs or therapy; long-term relief is achieved by adequate remedy of the aggravating pronation factors. A semirigid, custom-molded orthosis reduces excessive plantar fascial strain by supporting the first metatarsal bone and by controlling calcaneal position when in conjunction with a firm posterior counter shoe. A clinical environment with physician and orthotist together allows ideal evaluation and treatment of patients.

The side-to-side flap technique in below-the-knee amputation with long stump.

Wound healing, as well as surgical and prosthetic aspects of the residual limb, was investigated in the below-the-knee amputation using the side-to-side flap technique. Of 23 patients, 74% achieved primary wound healing. The stump length ranged from 27% to 70% of the normal limb, and the mean percentage was 56%. The group with long stumps did not show increased risk of wound complication. All the patients had a nonbulbous dome-shaped stump that posed no prosthetic difficulty. This technique allows the longest possible limb to be preserved, and expenditure of the least amount of energy in ambulation.

Applications of Doppler ultrasound to foot and ankle care.

Systolic blood pressures are well correlated with limb ischemia. The simplicity of Doppler ultrasound technique makes it ideally suited for office use by the interested physician. Topics presented include the use of properly chosen equipment, the clinical indications, and establishment of specific pressure measurements consistent with limb ischemia, rest pain, and healing prognosis.