1. Clinical Insight in schizophrenia

Though there have been many studies exploring clinical and cognitive correlates of insight in patients with schizophrenia, mostly were with cross-sectional approach and with patients of different stage of illness. One of our studies examined clinical and cognitive correlates in drug naive patients with schizophrenia and the other study looked at longitudinal changes of relationship of insight and cognition. Another study explored the relationship between medication adherence, insight and knowledge about the illness. Selected published paper of this research theme:

1. Chan SKW*, Hui LM, Wong HY, Lee HM, Chang WC, Chen YH. Medication adherence,           knowledge about psychosis, and insight among patients with a schizophrenia-spectrum disorder. J     Nerv Ment Dis. 2014 Jan;202(1):25-9. PubMed PMID: 24375208.

2. b. Chan SKW*, Chan KK, Hui CL, Wong GH, Chang WC, Lee EH, Tang JY, Chen EY. Correlates of insight with symptomatology and executive function in patients with first-episode schizophrenia-spectrum disorder: a longitudinal perspective. Psychiatry Res. 2014 May 15;216(2):177-84. PubMed PMID: 24560612.

3. c. Chan SKW*, Chan KK, Lam MM, Chiu CP, Hui CL, Wong GH, Chang WC, Chen EY. Clinicaland cognitive correlates of insight in first-episode schizophrenia. Schizophr Res. 2012 Mar;135(1-3):40-5. PubMed PMID: 22245186.

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2. Evaluation and improvement of Long-term outcomes of schizophrenia and impact of early intervention service

Schizophrenia is chronic illness with only 15-20% long-term recovery rate. Despite the advances in treatment, both pharmacological and non-pharmacological treatments in recent years, there has not been substantial improvement in recovery rate of patients with schizophrenia. Early intervention program has been established and implemented to  One of the key questions in establishing the early intervention service for psychosis is whether the short-term effect of the early intervention service can sustain in the long term. This research program aim to understand factors contributing to the long-term outcomes of schizophrenia and develop ways to improve the early intervention service to improve the long term outcomes. Two funded research projects as PI focusing on this research theme. Questions in relationship with accelerated ageing in patients with schizophrenia will also be studied (one funded research project). Selected published paper of this research theme:

1. Chan S.K.W.*; Chan V.H.Y., Pang H.H., Hui C.L.M., Suen Y.N., Chang W.C., Lee E. H.M., Sham P, Chen E.Y.H. (2020) Ten-year trajectory and outcomes of negative symptoms of patients with first-episode schizophrenia spectrum disorders. Schizophrenia Research 220:85-91 doi: 10.1016/j.schres.2020.03.061.

2. Sherry Kit Wa Chan*, Herbert H. Pang, Kang K. Yan, Christy Lai Ming Hui, Yi Nam Suen, Wing Chung Chang, Edwin Ho Ming Lee, Pak Sham, Eric Yu Hai Chen (2020). 10-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: Comparison of early intervention and standard care services. British Journal of Psychiatry. 217(3): 491-497 doi: 10.1192/bjp.2019.161

3. Sherry Kit Wa Chan*,  Stephanie Wing Yan Chan, Herbert H. Pang, Kang K. Yan, Christy Lai Ming Hui, Wing Chung Chang, Edwin Ho Ming Lee, Eric Yu Hai Chen (2018) Association of an Early Intervention Service for Psychosis With Suicide Rate Among Patients With First-Episode Schizophrenia-Spectrum Disorders. JAMA Psychiatry 75(5):458-464. doi:10.1001/jamapsychiatry.2018.0185

4. Sherry Kit Wa Chan*; Christy Lai Ming Hui; Wing Chung Chang; Edwin Ho Ming Lee; Eric Yu Hai Chen (2018). Ten-year follow up of patients with first-episode schizophrenia spectrum disorder from an early intervention service: predictors of clinical remission and functional recovery. Schizophrenia Research https://doi.org/10.1016/j.schres.2018.08.022

5. Chan SKW*, So HC, Hui CL, Chang WC, Lee EH, Chung DW, Tso S, Hung SF, Yip KC, Dunn E, Chen EY. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med. 2015 Apr;45(6):1181-93. PubMed PMID: 25233868.

6. Chai Y., Tang  J.Y.M., Ma D.C.F., Luo H., & Chan S.K.W*. (2024). Self-harm and suicide rates before and after an early intervention program for patients with first-episode schizophrenia. JAMA network open, 7(8), e2426795-e2426795. doi: 10.1001/jamanetworkopen.2024.26795

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3. Public stigma and self-stigma of psychosis

Public stigma on psychosis is one of the major barriers towards help seeking and patient recovery. It is also likely to be related to the development of self-stigma and insight deficit. This research program and theme is to explore factors contributing to the public stigma in order to support further development of effective intervention. Selected published paper of this research theme:

1. Min Yi Sum, Sherry Kit Wa Chan*, Samson Tse, John R. Bola, Roger Man Kin Ng, Christy Lai Ming Hui, Edwin Ho Ming Lee, Wing Chung Chang, Eric Yu Hai Chen (2020) Elucidating the Relationship between Internalized Stigma, Cognitive Insight, Illness Severity, and Functioning in Patients with Schizophrenia Using a Path Analysis Approach. Journal of Mental Health. doi.org/10.1080/09638237.2020.1836553

2. Sherry Kit Wa Chan*, Otilia Wai Tung Li, Christy Lai Ming Hui, Wing Chung Chang, Edwin Ho Min Lee, Eric Yu Hai Chen (2019). The effect of media reporting of a homicide committed by a patient with schizophrenia on the public stigma and knowledge of psychosis among the general population of Hong Kong. Social Psychiatry and Psychiatric Epidemiology. 54(1):43-50. doi: 10.1007/s00127-018-1610-2.

3. Chan SKW*, Lee KW, Hui CL, Chang WC, Lee EH, Chen EY. Gender effect on public stigma changes towards psychosis in the Hong Kong Chinese population: a comparison between population surveys of 2009 and 2014. Soc Psychiatry Psychiatr Epidemiol. 2016 Dec 1;PubMed PMID: 27909775.

4. Chan SKW*, Tam WW, Lee KW, Hui CL, Chang WC, Lee EH, Chen EY. A population study of public stigma about psychosis and its contributing factors among Chinese population in Hong Kong. Int J Soc Psychiatry. 2016 May;62(3):205-13. PubMed PMID: 26721540.

5. Chan SKW*, Ching EY, Lam KS, So HC, Hui CL, Lee EH, Chang WC, Chen EY. Newspaper coverage of mental illness in Hong Kong between 2002 and 2012: impact of introduction of a new Chinese name of psychosis. Early Interv Psychiatry. 2015 Nov 23;PubMed PMID: 26593744.

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4. Social cognition in psychosis and other psychiatric disorders

Social cognitive function impairment is one of the key impairments in patients with schizophrenia but such impairments are also prominent in patients with other psychiatric conditions including bipolar affective disorders and autistic-spectrum disorders. In this research program, we have developed eye perception task to assess the mentalizing process in patients with schizophrenia and other psychiatric conditions. The neurophysiological and neurobiological correlates including EEG and MRI assessments are used as research tools.  The aim of the research program is to understand the neurobiological underpinning of social cognitive impairments in psychiatric disorders and to establish objective assessment tools. Two funded research projects are focusing on this. Selected published paper of this research theme:

1. Chan S.K.W.*, Liu T., Wong A.O.Y., Wong G.H.Y., Hsiao J., Hui C.L.M., Chang W.C., Lee E.H.M., Chen E.Y.H. (2021) Self-referential gaze perception of patients with schizophrenia and its relationship with symptomatology and cognitive functions. Schizophrenia Research 228: 288-294 https://doi.org/10.1016/j.schres.2020.12.034

2. Chan S.K.W*., Hsiao J., Wong A.O.Y., Liao Y., Suen Y.N., Yan E.W.C., Poon L.T., Siu M.W., Hui C.L.M., Chang W.C., Lee E.H.M., Chen E.Y.H. (2022) Explicit and implicit mentalization of patients with first-episode schizophrenia: a study of self-referential gaze perception with eye movement analysis using Hidden Markov Model. European Archives of Psychiatry and Clinical Neuroscience. doi: 10.1007/s00406-022-01383-y.

3. Tsui H.K.H., Liao Y., Hsiao J., Suen Y.N., Yan E.W.C., Poon L.T., Siu M.W., Hui C.L.M., Chang W.C., Lee E.H.M. & Chan S.K.W*. (2024). Mentalizing impairments and hypermentalizing bias in individuals with first-episode schizophrenia-spectrum disorder and at-risk mental state: the differential roles of neurocognition and social anxiety. European Archives of Psychiatry and Clinical Neuroscience, 1-13. doi: 10.1007/s00406-024-01830-y.

4. Tsui H.K.H., Wong T.Y., Ma C.F., Wong T.E., Hsiao J., & Chan S.K.W*. (2024). Reliability of Theory of Mind Tasks in Schizophrenia, ASD, and Nonclinical Populations: A Systematic Review and Reliability Generalization Meta-analysis. Neuropsychology Review, 1-17. doi: 10.1007/s11065-024-09652-4.

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5. Treatment resistant schizophrenia

Thought antipsychotic medication is effective in ameliorate positive symptoms of patients with schizophrenia, about 20-40% of patients are not responding to the current form of antipsychotic medications and are considered as treatment resistant state. They are often the group of patients with poorer outcomes and require more health care resources. Clozapine is the only antipsychotic medication is found to be effective in treating treatment resistant schizophrenia, yet only about 60% patients are responding. Therefore, understanding the mechanisms of treatment resistant schizophrenia and predictors can help to improve our care to this group of patients. This research theme and program is aiming to understand the neurobiological underpinning of treatment resistant stage of the illness, factors predicting that, ways to prevent the development of treatment resistant schizophrenia and intervention to improve the outcomes. One research funding has been obtain. Relevant published paper has been shown below.

1. Chan S.K.W.*; Chan H.Y.V., Honer W.G., Bastiampillai T., Suen Y.N., Yeung W.S., Lam M., Lee W.K., Ng R.M.K., Hui C.L.M., Chang W.C., Lee E.H.M., Chen E.Y.H. (2021) Predictors of treatment resistant and clozapine resistant schizophrenia: A 12 years follow up study of first episode schizophrenia-spectrum disorders. Schizophrenia Bulletin. 16; 47(2):485-494 DOI: 10.1093/schbul/sbaa145

2. Wong T.Y., Luo H., Tang J., Moore T.M., Gur R.C., Suen Y.N., Hui C.L.M., Lee E.H.M., Chang W.C., Yan W.C., Chui E., Poon L.T., Lo A., Cheung K., Kan C.K., Chen E.Y.H. & Chan S.K.W*. (2024). Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator. Translational Psychiatry, 14(1), 50. doi: 10.1038/s41398-024-02754-w.

3. Chan S.K.W*., Suen Y.N., Yan W.C., Lam C., Chui E., Hui C.L.M., Chang W.C., Lee E.H.M., Chen E.Y.H., Honer W.G. & Takeuchi H. (2023). Clozapine dosing patterns and clinical outcomes in patients with treatment resistant schizophrenia. European Neuropsychopharmacology, 75, 67-79. doi: 10.1016/j.euroneuro.2023.07.007.

4. Zhou H., Luo H., Tang J.Y.M., Honer W.G., Bastiampillai T., Zhou J., Taipale H., Chang W.C., Lui S.S.Y., Lee E.H.M., Chan S.K.W* (2025). Population-based study on long-term mortality risk associated with clozapine use among patients with schizophrenia. British Journal of Psychiatry. DOI: https://doi.org/10.1192/bjp.2025.10312

6. Psychotic-like experience

Psychotic-like experience in the general public has been studied from two perspectives. One is transdiagnostic and dimensional understanding of the psychiatric conditions. The second one is psychosis continuum perspective. This research program is aiming to study this phenomenon through difference approach including epidemiologically, psychopathology, cognitive function and neuroscience. Two research grant has been obtained for this. Relevant published paper has been shown below.

1. Chan S.K.W*., Lee K.K.W., Chan V.H.Y., Pang H.H., Wong C.S.M., Hui C.L.M., Chang W. C., Lee E.H.M., Chan W.C., Cheung E.F.C., Chiu H.F.K., Chiang T.P., Lam M., Lau J. T.F., Ng R.M.K., Hung S.F., Lam L.C.W., Chen E.Y.H. (2021) 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies. Psychological Medicine. 51(14): 2501-2508 doi: 10.1017/S0033291720001452

2. Lee K.W., Chan S.K.W*, Chang W.C.,Lee H.M.E., Hui C.L.M. and Chen E.Y.H. (2016) A systematic review on definitions and assessments of psychotic-like experiences, Early Intervention in Psychiatry. 10 (1): 3-16. doi: 10.1111/eip.12228

 

*Corresponding author