Academic Staff

Dr. Chang










Dr. CHANG Wing Chung 張頴宗

MBChB (CUHK), MRCPsych(UK), FHKCPsych, FHKAM(Psychiatry)

Clinical Assistant Professor
Associate Member of the State Key Laboratory of Brain & Cognitive Sciences, HKU
Honorary Associate Consultant, Queen Mary Hospital & Kwai Chung Hospital
Director of Education, Department of Psychiatry
Chairperson of Undergraduate Psychiatric Education Committee
Department Coordinator of MBBS Junior & Specialty Clerkship
Chief Examiner in MBBS Psychiatry Examination
Member of the Well-Being Committee, LKS Faculty of Medicine
Scientific Committee Member, HK College of Psychiatrists
Education Committee member, HK College of Psychiatrists

Convener of HA EASY Programme Evaluation Workgroup
Secretary of Hong Kong Schizophrenia Research Society
Editorial Board Member of East Asian Archives of Psychiatry
Executive Board Member of Asian Network of Early Psychosis (ANEP)
Member of Department Service Development Committee, Queen Mary Hospital
Vice-Chairperson of Knowledge Development & Transfer, Early Psychosis Foundation

Email: changwc@hku.hk
The HKU Scholars Hub Page address: http://hub.hku.hk/rp/rp01465

Biography

Dr. WC Chang has joined the Department of Psychiatry, HKU since 2011. He is a Clinical Assistant Professor, an Associate Member of the State Key Laboratory of Brain & Cognitive Sciences, and an Honorary Associate Consultant at the Department of Psychiatry, Queen Mary Hospital. He is a Member of the Royal College of Psychiatrists (UK) and a Fellow of HK College of Psychiatrists. He has received several research awards over the past few years including Clinical Research Fellowship by HK Research Grants Council and Distinguished Young Fellow by the HK Academy of Medicine and in 2014, IEPA (International Early Psychosis Association) Young Investigator Award and NARSAD Young Investigator Award by Brain & Behavior Research Foundation of United States in 2016. His research focuses on early intervention for psychosis, longitudinal outcome of first-episode psychosis, at-risk mental state and psychosis prediction, negative symptoms, reinforcement learning and effort-based decision-making in early psychosis.

Research Interests:

  1. Evaluation of early interventions for first-episode psychosis

    Early intervention (EI) for psychosis has been the major focus of mental health service development worldwide in the past decade. Hong Kong is among the first few regions in Asia implementing EI service (namely EASY or Early Assessment Service for Young people with psychosis) for first-episode psychosis (FEP) patients. Although evidence indicates superior efficacy of EI over generic psychiatric care on outcome improvement in FEP, sustainability of positive effects and optimal duration for EI remain to be clarified. Our research team was the first to conduct RCT addressing effectiveness of EI service with its treatment duration beyond usual 2-year period, and demonstrated that extended 3-year EI was superior to 2-year EI in symptom and functional improvement in FEP patients (Chang et al. 2015). Our recently completed 2-year post-RCT follow-up study, however, revealed that initial therapeutic benefits of extended EI could not be sustained after termination of EI (Chang et al. 2017), indicating that further research is warranted to identify patient subgroups who may benefit most from extended intensive EI and active therapeutic elements for sustained effects. Our team has also recently completed a territory-wide evaluation study on the effectiveness of a newly-implemented EASY expansion (EASY+) to cover FEP patients aged 15-64 years with 3-year EI service. Our preliminary results showed that patients received EASY+ care had shorter treatment delay, fewer depressive and negative symptoms, and better functioning and quality of life than those managed in standard service.

    Related publications



  2. Negative symptoms: early course, impacts and neurocognitive mechanisms

    Negative symptoms are a core feature of schizophrenia and related psychoses, and represent an unmet therapeutic need, associated with functional disability and limited treatment response. We have systematically investigated negative symptoms in first-episode schizophrenia (FES) encompassing the early course of symptom development, impacts on illness outcomes, and neurocognitive mechanisms underlying symptom manifestation (esp. motivational impairment). Our results show that around one-fourth of FES patients developed persistent negative symptoms over 3 years after treatment initiation. Negative symptom severity was predicted by prolonged duration of untreated psychosis and poor premorbid adjustment. Furthermore, amotivation domain of negative symptom construct was found to be the most robust predictor of functional outcome, above and beyond the contributions of cognitive dysfunction, diminished expression (another negative symptom subdomain) and other symptom dimensions in FES. Importantly, EI service was shown to be effective in ameliorating negative symptoms, particularly motivational impairment. Alongside, we have recently initiated a series of studies, applying several promising translational research paradigms in FEP patients, with an aim to clarify neurocognitive mechanisms underlying manifestation of motivational impairment, including reinforcement learning, risky decision-making and effort-based decision making (physical effort-cost allocation and cognitive effort discounting).

    Related publications



  3. Longitudinal outcomes of first-episode psychosis

    Schizophrenia and related psychoses are severe mental illnesses constituting one of the leading causes of disability worldwide. To further our understanding on longitudinal course of illness and longer-term outcome predictors, we have conducted a number of prospective follow-up studies on FEP cohorts. Our research included investigations of impacts of duration of untreated psychosis, premorbid adjustment, generalized and specific cognitive impairment, and various symptom dimensions on clinical and functional outcomes. In particular, we have examined prevalence and risk factors predicting suicidal ideation, suicidal behavior and physical violence in the early stage of psychotic disorder. We have also evaluated factors predicting subsequent attainment of symptomatic remission, functional remission, recovery and sustained employment, which are the key milestones along the course of treatment for FEP. We have recently adopted individual-based trajectory analysis (growth mixture modeling) to examine the longitudinal patterns of functioning over the first 3 years of treatment for FEP so as to better characterize course of illness and hence to facilitate development of targeted intervention to promote early and sustained recovery.

    Related publications


  4. Reinforcement learning in early psychosis

    Reinforcement learning (RL) has been regarded as a promising paradigm for translational research in schizophrenia and related psychoses. Reward processing is closely associated with dopamine, which is a key neurotransmitter dysregulated in psychosis, and the primary target of current drug treatment. Brain systems involved in reward processing are implicated in psychosis development. Reward system also provides a useful theoretical framework linking symptom manifestations to neurobiological dysfunction underlying psychosis. Literature indicated that chronic schizophrenia patients had RL impairment. Nonetheless, such impairment in the early stage of psychotic illness, within which confounding effects of antipsychotic exposure and illness duration on RL could be minimized, has been under-studied. Further, RL may be a useful candidate in psychosis prediction from at-risk mental state (ARMS). Our research team conducts prospective follow-up study in both FES and ARMS samples to examine the presence and degree of RL deficit, and its relationship with symptom and cognitive functions. A group of antipsychotic-naive FES patients are also examined before and 6-week after antipsychotic treatment commencement to clarify the potential confounding effect of antipsychotic medications on RL and the potential clinical utility of RL in predicting treatment response. We also examined RL performance in unaffected siblings of FES patients to clarify whether RL can be useful endophenotype for schizophrenia research. Both behavioral and functional MRI data are collected for detailed and systematic investigation. Our findings of RL performance on clinically-stabilized FES sample have recently been published, suggesting the presence of mild RL deficits but preserved value-guided decision-making ability in the initial stage of illness.

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  5. At-risk mental state (ARMS) research on psychosis prediction

    Individuals ascertained as at-risk mental state (ARMS or clinical high-risk) by standardized operational clinical criteria have a markedly elevated rate of developing psychotic disorder (20-30%) over 2 to 3 years. ARMS individuals also exhibit pronounced functional impairment and are associated with high rate of comorbid mood disorders and heighted suicide risk. In order to better characterize clinical course of ARMS individuals, we have conducted a naturalistic 2-year prospective follow-up of 110 ARMS subjects (ARMS100 study). Recently, we have incorporated multi-modal neuroimaging measurement including structural MRI, DTI, resting-state fMRI and proton MRS, alongside clinical, cognitive and functional assessments, into our ongoing ARMS cohort study with an aim to develop a robust biomarker-based prediction model for psychosis transition and illness outcome. In addition, potential role of reinforcement learning in predicting conversion to psychosis from ARMS is under investigation. Currently, HKU psychosis research team also participates in an international, large-scale ARMS research project (PSYSCAN, initiated by the Institute of Psychiatry, King’s College London) investigating the clinical utility of neuroimaging and blood-based biomarkers in psychosis prediction.

    Related publications


  6. Epidemiological investigation of prevalence & correlates of psychotic disorders in Hong Kong

    Epidemiological investigation of psychotic disorders is of great importance. Hong Kong Mental Morbidity Survey (HKMMS) is the first territory-wide, population-based epidemiological study in Hong Kong which examines prevalence of several major mental disorders including psychotic disorders. This study evaluated 5700 randomly-selected households from the community. Our recently published findings demonstrate that around 2.5% of HK general population suffers from life-time psychotic disorder. This indicates a huge societal burden imposed by severe mental illness, and underscores a major challenge to on both public health and psychiatric services in HK. Our further analyses of HKMMS psychosis study will focus on psychosocial correlates associated with psychotic disorder with clinically significant comorbid mood symptoms, and potential impacts of psychosis on general well-being and physical health.

    Related publications


Current Research Projects (as PI):

  1. EASY+ evaluation: case-control comparison study on effectiveness of extended EASY programme on treatment delay, clinical and functional outcomes in adult first-episode psychosis patients
  2. ARMS100 study: a prospective 2-year follow-up of at-risk mental state (ARMS) for psychosis and outcome prediction
  3. Reinforcement learning impairment in at-risk mental state for psychosis: 2-year follow-up study
  4. Functional MRI investigation of reward learning in first-episode schizophrenia, unaffected siblings and individuals at clinical high-risk for psychosis
  5. A multimodal MRI and proton MRS investigation of at-risk mental state (ARMS) for psychosis
  6. Effort-based decision making in first-episode schizophrenia: 1-year follow-up study
  7. Cognitive effort discounting in first-episode schizophrenia
  8. Risky decision-making capacity in early schizophrenia-spectrum disorder

 

Selected Publications:

1. Chang WC, Wong CSM, Chen EYH, Lam LCW, Chan WC, Ng RMK, Hung SF, Cheung EFC, Sham PC, Chiu HFK, Lam M, Lee EHM, Chiang TP, Chan LK, Lau GKW, Lee ATC, Leung GTY, Leung JSY, Lau JTF, van Os J, Lewis G, Bebbington P. Lifetime prevalence and correlates of schizophrenia-spectrum, affective, and other non-affective psychotic disorders in the Chinese adult population. Schizophrenia Bulletin 2017;43:1280-1290.
2. Chang WC, Kwong VWY, Lau ESK, So HC, Wong CSM, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Sustainability of treatment effect of 3-year early intervention programme for first-episode psychosis. British Journal of Psychiatry 2017;211:37-44.
3. Chang WC, Kwong VWY, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: a structural equation modeling approach. Psychological Medicine 2017;47:755-765.
4. Chang WC, Waltz JA, Gold JM, Chan TCW, Chen EYH. Mild reinforcement learning deficits in patients with first-episode psychosis. Schizophrenia Bulletin 2016;42:1476-1485.
5. Chang WC, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of functional remission in first-episode psychosis: 12-month follow-up of the randomized-controlled trial on extended early intervention in Hong Kong. Schizophrenia Research 2016;173:79-83.
6. Chang WC, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. British Journal of Psychiatry 2015; 206 (6):492-500.
7. Chang WC, Hui CLM, Chan SKW, Lee EHM, Wong GHY, Chen EYH. Relationship between diminished expression and cognitive impairment in first-episode schizophrenia: a prospective three-year follow-up study. Schizophrenia Research 2014; 152:146-151.
8. Chang WC, Hui CLM, Wong GHY, Chan SKW, Lee EMH, Chen EYH. Symptomatic remission and cognitive impairment in first-episode schizophrenia: a prospective 3-year follow-up study. Journal of Clinical Psychiatry 2013; 74:e1046-e1053.
9. Chang WC, Hui CLM, Tang JYM, Wong GHY, Chan SKW, Lee EMH, Chen EYH. Impacts of duration of untreated psychosis on cognition and negative symptoms in first-episode schizophrenia: a 3-year prospective follow-up study. Psychological Medicine 2013, 43: 1883-1894.
10. Chang WC, Hui CLM, Tang JYM, Wong GHY, Chan SKW, Lee EMH, Chen EYH. Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophrenia Research 2011; 133:22-28.

Full Publication List

Books & Book Chapters

1.陳友凱, 陳喆燁, 張頴宗, 李浩銘, 許麗明 (2014).《思覺失調個案剖析》中華書局(香港)有限公司.
2. Chang WC, Wong YC. Chapter 11: The diagnostic interview in early psychosis. In: Early Psychosis Intervention: a culturally adaptive clinical guide. Edi by Chen EYH, Lee H, Chan GHK, Wong GHY. Hong Kong University Press 2013.
3. Lam MML, Lee CC, Chang WC, Hung SF. Chapter 12: Handling at-risk mental state. In: Early Psychosis Intervention: a culturally adaptive clinical guide. Edi by Chen EYH, Lee H, Chan GHK, Wong GHY. Hong Kong University Press 2013.
4. Chang WC, Chiu CPY. Chapter 28: Handling patients with negative symptoms. In: Early Psychosis Intervention: a culturally adaptive clinical guide. Edi by Chen EYH, Lee H, Chan GHK, Wong GHY. Hong Kong University Press 2013.

Awards

1.HK RGC Clinical Research Fellowship in 2014 .
2. Distinguished Young Fellow, HK Academy of Medicine in 2014
3. IEPA (International Early Psychosis Association) Young Investigator Award in 2016
4. NARSAD Young Investigator Award, Brain & Behavior Research Foundation, USA in 2016
5.

Faculty Outstanding Research Output Award as one of the co-authors for the publication: "Association between acute neuropsychiatric events and Helicobacter pylori therapy containing clarithromycin"

Research Grants

External research grants funded as Principal Investigator
1.Reward learning impairment in clinical high-risk individuals, first-episode psychosis patients and their non-psychotic siblings: psychosis prediction and endophenotypic investigation

(RGC General Research Fund in 2014, 3-year project)

2. A longitudinal multimodal MRI investigation for clinical and functional outcome prediction in individuals at clinical high-risk for psychosis: a prospective 2-year follow-up study

(RGC General Research Fund in 2016, 3-year project)

3. Pathway to care and three-year outcome comparison of extended early intervention service and standard psychiatric care for adults presenting with first-episode psychosis

(HMRF: Commissioned Programme on Mental Health Policy & Service in 2016, 2-year project)

4. Effort-based decision making in patients presenting with first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study (NARSAD Young Investigator Grant, Brain & Behavior Research Foundation in 2017, 2-year project)
5. Glutamatergic abnormalities and prediction of clinical and functional outcomes in individuals at clinical high-risk for psychosis: a 2-year longitudinal proton magnetic spectroscopy study

(RGC General Research Fund in 2018, 3-year project)