THE FIRST LITHIUM CLINIC IN HONG KONG: A CHINESE PROFILE Sing Lee
A study of 50 Chinese patients referred to the first lithium clinic in Hong Kong revealed a high prevalence of recurrent mania and rarely unipolar depression. A historyof delusions and hallucinations,and re-diagnosisfrom schizophrenia to manic depressive psychosis, were common. Lithium was prescribed after 3.9 episodes of illness, and at a dosage of 1,191 mg despite a moderate serum level of 0.63 mmol/l. Laboratory monitoring was haphazard, and polypharmacy was common. This might pose unnecessary risks to some patients. Australian and New Zealand Journal of Psychiatry 1992; 26:450-453
Although lithium is now well established in the treatment of recurrent mood disorders I 11. data related to its use among Chinese patients are scarce. In China, for example, use of lithium was restricted until recently, and it is usually prescribed without laboratory monitoring [ 2 ] . At a lithium clinic in Taiwan, 101 Chinese patients were noted to satisfy DSM-111 criteria for bipolar affective disorders [3], but details of their clinical profile were not described. Lithium has been used for over 15 years in Hong Kong, but systematic information is lacking. Though common in Western countries 141, lithium clinics are less frequently found in Asian countries. Recently, a lithium clinic was set up at the Prince of Wales Hospital, which is a general teaching hospital that serves a regional population of 0.5 million. The clinic operates every Tuesday morning and is the first of its kind in Hong Kong. This paper discusses the clinical profile of the referred patients in the context of Western findings.
Based on an outpatient database, 50 Chinese patients on lithium therapy were identified out of 6,000outpatients at the Li Ka Shing Psychiatric Clinic. They were then referred by their case doctors to the lithium clinic in September 1990 for continuation of care by the author. Being mostly stable outpatients, they were previously seen at 4-16 week intervals by various psychiatrists and trainees. Demographic details, chart diagnoses, medication and other clinical data were obtained by thorough case-note review and confirmed during clinical interviews. Diagnoses were based on the ICD-9 [ S ] . Serum lithium level was assayed by the flame photometry method; its imprecision at the concentration of 1.88 mmol/l is less than 1 %. The mean of the last two levels recorded for each patient was reported.
Results 1. Demographic data
Department of Psychiatry, Chinese University of Hong Kong, Shatin. Hong Kong Sing Lee MRCPsych, Senior Lecturer
There were 18 males (36%) and 32 females (64%) with a mean age of 33.2 years (s.d. 9.6. range 16-57). Forty six percent of patients were married, 44% single
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SING LEE
and 10% divorced. Four percent belonged to upper, 26% middle and 70% lower social class. The mean education was 10.5 years (s.d. 4.5). Forty eight percent of patients were employed, 44% were housewives or students and 8% were unemployed.
2. Diagnoses and other clinical data Patients’ diagnoses were as follows: manic depressive disorder (“true” bipolars) (40%), unipolar mania (36%), schizoaffective disorder (16%). unipolar depression (6%) and schizophrenia (2%). Fifty percent of patients had a history of re-diagnosis (from schizophrenia to mania in 38% and to schizoaffective disorders in 12%). The total duration of illness was 8.4 years (s.d. 3.1, range 1-29), and the average number of illness episodes was 5.5 (s.d. 3.5, range 1-18). The number of episodes in patients (N=19) on lithium only (4.0,s.d. 2.7) was significantly fewer (Mann-Whitney, p
A study of 50 Chinese patients referred to the first lithium clinic in Hong Kong revealed a high prevalence of recurrent mania and rarely unipolar depression. A historyof delusions and hallucinations,and re-diagnosisfrom schizophrenia to manic depressive psychosis, were common. Lithium was prescribed after 3.9 episodes of illness, and at a dosage of 1,191 mg despite a moderate serum level of 0.63 mmol/l. Laboratory monitoring was haphazard, and polypharmacy was common. This might pose unnecessary risks to some patients. Australian and New Zealand Journal of Psychiatry 1992; 26:450-453
Although lithium is now well established in the treatment of recurrent mood disorders I 11. data related to its use among Chinese patients are scarce. In China, for example, use of lithium was restricted until recently, and it is usually prescribed without laboratory monitoring [ 2 ] . At a lithium clinic in Taiwan, 101 Chinese patients were noted to satisfy DSM-111 criteria for bipolar affective disorders [3], but details of their clinical profile were not described. Lithium has been used for over 15 years in Hong Kong, but systematic information is lacking. Though common in Western countries 141, lithium clinics are less frequently found in Asian countries. Recently, a lithium clinic was set up at the Prince of Wales Hospital, which is a general teaching hospital that serves a regional population of 0.5 million. The clinic operates every Tuesday morning and is the first of its kind in Hong Kong. This paper discusses the clinical profile of the referred patients in the context of Western findings.
Based on an outpatient database, 50 Chinese patients on lithium therapy were identified out of 6,000outpatients at the Li Ka Shing Psychiatric Clinic. They were then referred by their case doctors to the lithium clinic in September 1990 for continuation of care by the author. Being mostly stable outpatients, they were previously seen at 4-16 week intervals by various psychiatrists and trainees. Demographic details, chart diagnoses, medication and other clinical data were obtained by thorough case-note review and confirmed during clinical interviews. Diagnoses were based on the ICD-9 [ S ] . Serum lithium level was assayed by the flame photometry method; its imprecision at the concentration of 1.88 mmol/l is less than 1 %. The mean of the last two levels recorded for each patient was reported.
Results 1. Demographic data
Department of Psychiatry, Chinese University of Hong Kong, Shatin. Hong Kong Sing Lee MRCPsych, Senior Lecturer
There were 18 males (36%) and 32 females (64%) with a mean age of 33.2 years (s.d. 9.6. range 16-57). Forty six percent of patients were married, 44% single
Downloaded from anp.sagepub.com at UNIVERSITE DE MONTREAL on June 14, 2015
SING LEE
and 10% divorced. Four percent belonged to upper, 26% middle and 70% lower social class. The mean education was 10.5 years (s.d. 4.5). Forty eight percent of patients were employed, 44% were housewives or students and 8% were unemployed.
2. Diagnoses and other clinical data Patients’ diagnoses were as follows: manic depressive disorder (“true” bipolars) (40%), unipolar mania (36%), schizoaffective disorder (16%). unipolar depression (6%) and schizophrenia (2%). Fifty percent of patients had a history of re-diagnosis (from schizophrenia to mania in 38% and to schizoaffective disorders in 12%). The total duration of illness was 8.4 years (s.d. 3.1, range 1-29), and the average number of illness episodes was 5.5 (s.d. 3.5, range 1-18). The number of episodes in patients (N=19) on lithium only (4.0,s.d. 2.7) was significantly fewer (Mann-Whitney, p
