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Dr. CHANG Wing Chung 張頴宗

MBChB (CUHK), MD (HK), FRCPsych(UK), FHKCPsych, FHKAM(Psychiatry)

Department Chairperson

Clinical Associate Professor

Assistant Dean (Well-being), Sub-Deanery of Human Capital, LKS Faculty of Medicine, HKU

Principal Investigator & Academic Secretary of the State Key Laboratory of Brain & Cognitive Sciences, HKU

Honorary Consultant & EASY Team Head, Department of Psychiatry, Hong Kong West Cluster

 

Vice President (General Affairs), Hong Kong College of Psychiatrists

Invited member of the Advisory Committee on Mental Health (精神健康諮詢委員會), HK Government

Convener of EASY Service Evaluation Workgroup, Hospital Authority

Secretary of Hong Kong Schizophrenia Research Society

Executive Board Member of Asian Network of Early Psychosis

Education and Awards Committees Member, Schizophrenia International Research Society

Member of Board of Studies, Master/Postgraduate Diploma in Psychological Medicine (Psychosis Studies), HKU


Email: changwc@hku.hk
The HKU Scholars Hub Page address: http://hub.hku.hk/rp/rp01465
ORCID: 0000-0002-3581-8895

To apply for research postgraduate study (MPhil & PhD), please email Dr. WC Chang with your research proposal and CV for further information

Biography

Dr. Chang joined the Department of Psychiatry at HKU as a clinical assistant professor in 2011. He is currently a Clinical Associate Professor and Department Chairperson. He obtained MBChB (CUHK) in 2002, and Fellowship of HK College of Psychiatrists in 2009. He has become a Fellow of Royal College of Psychiatrists (UK) in 2020 by nomination, and obtained Doctor of Medicine (MD) from HKU in 2020. He is an Assistant Dean (Wellbeing) in Faculty of Medicine, and a Principal Investigator in the State Key Laboratory of Brain & Cognitive Sciences at HKU. In clinical service, he is an Honorary Consultant and Head of EASY Clinical Unit in HK West Cluster. He serves as a Convenor of Evaluation Subcommittee (Hospital Authority) for EASY, a territory-wide early psychosis service in Hong Kong, and a Member of EASY Steering Committee. He is a Vice President of HK College of Psychiatrists, and serves as a member of various committees in professional and research societies such as HK Schizophrenia Research Society, Early Psychosis Foundation, Asian Network of Early Psychosis, Schizophrenia International Research Society, to name a few. He is an Invited Member of the Advisory Committee on Mental Health of HK Government. 

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Dr. Chang’s clinical expertise and research focus on early psychosis intervention, longitudinal outcome evaluation of early psychosis and bipolar disorder, and negative symptoms and amotivation. His cumulative research, esp. evaluation of sustainability of early intervention, provides valuable contributions to informing early psychosis service development, and improved understanding of early-course, adverse impacts and neurocognitive mechanisms of negative symptoms in early psychosis. His research also systematically examines premature mortality and physical comorbidity associated with severe mental illness and psychotropics, using population-based health-record database approach and a series of meta-analyses, clarifying health inequalities experienced by this vulnerable population. He has published more than 230 research articles in international peer-reviewed journals, including 86 as first/corresponding-authored articles, and 6 book chapters. He has obtained numerous external competitive research grants as a principal investigator, including GRF, HMRF, RGC-STG grant (as co-PI), etc., and participated in more than 40 external grants as a co-investigator. He has received various awards including Young Investigator Award by International Early Psychosis Association, NARSAD-Young Investigator Award by Brain & Behavior Research Foundation (US), and Faculty Outstanding Research Output Awards. He has recently been awarded HKUMed Research Fellowship for Clinical Academics. He is listed as the Top 1% cited Scholar at HKU for five consecutive years from 2019 onwards. 

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 two 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. Our completed 2-year post-RCT follow-up study, however, revealed that initial therapeutic benefits of extended EI might not be sustained after termination of EI, 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. We also 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 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, supporting the EASY+ extension and service expansion in Hong Kong. Long-term follow-up studies of RCT and EASY+ FEP cohorts are underway to evaluate long-term effects of extended EI care on illness outcomes.

Selected relevant publications

  1. Kam CTK, Chang WC*, Kwong VWY, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Patterns and predictors of trajectories for subjective quality of life in patients with early psychosis: three-year follow-up of the randomized controlled trial on extended early intervention. Australian and New Zealand Journal of Psychiatry 2021; 55:983-992.

  2. Chang WC*, Kwong VWY, Or PCF, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EMH, Chen EYH. Motivational impairment predicts functional remission in first-episode psychosis: 3-year follow-up of the randomized-controlled trial on extended early intervention. Australian and New Zealand Journal of Psychiatry 2018; 52:1194-1201.

  3. Ho RWH, Chang WC*, Kwong VWY, et al. Prediction of self-stigma in early psychosis: 3-year follow-up of the randomized-controlled trial on extended early intervention. Schizophrenia Research 2018; 195:463-468.

  4. Chang WC, Kwong VWY, Lau ESK, et al. Sustainability of treatment effect of 3-year early intervention programme for first-episode psychosis. British Journal of Psychiatry 2017; 211:37-44.

  5. Chang WC, Kwong VWY, Chan GHK, et al. 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, et al. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. British Journal of Psychiatry 2015; 206 :492-500

  7. Chan TCW, Chang WC*, Hui CLM, et al. Rate and predictors of disengagement from a 2-year early intervention program for psychosis in Hong Kong. Schizophrenia Research 2014; 153:204-208.

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*as corresponding author

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Manuscript under preparation

  1. Effectiveness of a 3-year territory-wide extended early intervention program on treatment delay, clinical and functional outcomes among people presenting with adult-onset first-episode psychosis in Hong Kong

  2. Prediction of symptomatic remission and functional recovery: a 10-year follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis

2. Negative symptoms and amotivation in early psychosis

Negative symptoms are a core feature of psychotic disorders, and represent an unmet therapeutic need, associated with functional disability and limited treatment response. We have been systematically investigating negative symptoms and amotivation in early psychosis, primarily first-episode psychosis (FEP) but also in clinical high-risk for psychosis (CHR-P), encompassing the early course of symptom evolution (including persistent negative symptoms), factors associated with symptom severity such as prolonged duration of untreated psychosis and poor premorbid adjustment, impacts on functional outcome, and neurocognitive mechanisms underlying symptom manifestation. Specifically, our research is the first: to adopt psychopathological network analysis approach to elucidate the critical role of amotivation in determining psychosocial functioning in FEP; to examine and reveal that the latent structure of negative symptoms which is best conceptualized by the 5-factor model (5 consensus symptom dimensions) in both FEP and CHR populations; and to evaluate relationship of early-stage negative symptom trajectories of FEP with long-term distal illness outcomes (13-year follow-up), and provided critical evidence of early-stage persistently-high negative symptom trajectory as a robust predictor of long-term poor negative symptom and functional outcomes, indicating the need for early detection of and targeted interventions for a subgroup of patients experiencing persistent negative symptoms even in the initial phase of illness to promote early recovery. We have recently adopted an ecological momentary assessment approach to systematically characterize various domains of negative symptoms in early psychosis. Research examining feasibility, validity, clinical utility and incremental predictive capacity of active and passive digital phenotyping measures for negative symptoms and functional outcome in early psychosis is currently underway. We have also applied several promising neurocognitive paradigms to study negative symptoms in early psychosis, including reinforcement learning and effort-based decision-making, etc. (for details, please refer to “Neurocognitive mechanisms for psychopathology in early psychosis and bipolar disorder”)

Selected relevant publications

  1. Fung VSC, Chan JCY, Wong SCY, Wong CSM, Kirlety O, Myin-Germeys I, Strauss GP, Chang WC*. Investigation of momentary negative symptoms in patients with early psychosis in daily life: an experience sampling study. Psychiatry Research 2023; 325:115234.

  2. Chang WC, Strauss GP, Ahmed AO, Wong SCY, Chan JKN, Lee EHM, Chan SKW, Hui CLM, James SH, Chapman HC, Chen EYH. The latent structure of negative symptoms in individuals with attenuated psychosis syndrome and early psychosis: support for the 5 consensus domains. Schizophrenia Bulletin 2021; 47:386-394.

  3. Chang WC*, Ho RWH, Tang JYM, Wong CSM, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Early-stage negative symptom trajectories and relationships with 13-year outcomes in first-episode non-affective psychosis. Schizophrenia Bulletin 2019; 45:610-619.

  4. Chang WC*, Wong CSM, Or PCF, Chu AOK, Hui CLM, Chan SKW, Lee EHM, Suen YN, Chen EYH. Inter-relationships among psychopathology, premorbid adjustment, cognition, and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychological Medicine 2020; 50:2019-2027.

  5. Chang WC*, Liu JTT, Hui CLM, Chan SKW, Lee EHM, Suen YN, Chen EYH. Executive dysfunctions differentially predict amotivation in first-episode schizophrenia-spectrum disorder: a prospective 1-year follow-up study. European Archives of Psychiatry and Clinical Neuroscience 2019; 269:887-896.

  6. Chang WC*, Lee HC, Chan SI, Chiu SY, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Negative symptom dimensions differentially impact on functioning in individuals at-risk for psychosis. Schizophrenia Research 2018; 202:310-315.

  7. Chang WC*, Kwong VWY, Or PCF, Lau ESK, Chan GHK, Jim OTT, Hui CLM, Chan SKW, Lee EMH, Chen EYH. Motivational impairment predicts functional remission in first-episode psychosis: 3-year follow-up of the randomized-controlled trial on extended early intervention. Australian and New Zealand Journal of Psychiatry 2018; 52:1194-1201.

  8. 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.

  9. Chang WC*, Kwong VWY, Chan GHK, Jim OTT, Lau ESK, Hui CLM, Chan SKW, Lee EHM, Chen EYH. Prediction of motivational impairment: 12-month follow-up of the randomized-controlled trial on extended early intervention for first-episode psychosis. European Psychiatry 2017; 41:37-41.

  10. Chang WC*, Hui CLM, Chan SKW, Lee EHM, Chen EYN. Impact of avolition and cognitive impairment on functional outcome in first-episode schizophrenia-spectrum disorder: a prospective one-year follow-up study. Schizophrenia Research 2016; 170:318-321.

  11. Chang WC*, Lau CFC, Chan SSI, Hui CLM, Chan SKW, Lee EHM, Lin J, Chen EYH. Premorbid, clinical and cognitive correlates of primary negative symptoms in first-episode psychosis. Psychiatry Research 2016; 242:144-149.

  12. 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.

  13. Chang WC*, Hui CLM, Tang JYM, Wong GH, Chan SK, Lee EH, 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.

  14. Chang WC*, Tang JYM, Hui CLM, Wong GHY, Chan SKW, Lee EHM, Chen EYH. The relationship of early premorbid adjustment with negative symptoms and cognitive functions in first-episode schizophrenia: a prospective three-year follow-up study. Psychiatry Research 2013; 209:353-360.

  15. Chang WC*, Hui CLM, Tang JYM, Wong GH, Lam MM, Chan SK, Chen EYH. Persistent negative symptoms in first-episode schizophrenia: a prospective three-year follow-up study. Schizophrenia Research 2011; 133:22-28.

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*as corresponding author

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Manuscript under preparation

  1. Reward-oriented behavior and motivational deficits in patients with early psychosis: an experience-sampling method approach

3. Longitudinal outcomes of first-episode psychosis and bipolar disorder

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 adopted individual-based trajectory analysis to examine longitudinal patterns of functioning and negative symptoms over the first 3 years of treatment for FEP to better characterize course of illness and hence to facilitate development of targeted intervention to promote early and sustained recovery. Ongoing research includes further long-term follow-up studies on FEP cohorts to clarify longer-term clinical and functional outcomes, and illness course development; and a prospective longitudinal study on first-episode schizophrenia (FES) and first-episode bipolar disorder [first-episode mania] (FEBD) with multimodal assessments including neuroimaging, neurocognitive and gut microbiome data etc. to examine shared and distinct features characterizing FES and FEBD along the initial course of illness and to facilitate outcome prediction and personalized treatment in the early intervention framework

Selected relevant publications

  1. Yung NCL, Wong CSM, Chan JKN, Chang WC*. Mortality rates in people with first diagnosis of schizophrenia-spectrum disorders: a 5-year population-based cohort study. Australian and New Zealand Journal of Psychiatry 2023; 57:854-864.

  2. So YK, Chan CY, Fung SC, Lui TT, Lau FC, Chan KW, Lee HM, Lui SY, Hui LM, E Chen, WC Chang*. Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis. Social Psychiatry and Psychiatric Epidemiology 2023; 59:1215-1225.

  3. Kam CTW, Fung VSC, Chang WC*, Hui CLM, Chan SKW, Lee EHM, Lui SSY, Chen EYH. Cognitive subgroups and the relationships with symptoms, psychosocial functioning and quality of life in first-episode non-affective psychosis: a cluster-analysis approach. Frontiers in Psychiatry 2023; 14:1203655.

  4. Wong SCY, Chang WC*, Hui CLM, Chan SKW, Lee EHM, Suen YN, Chen EYH. Relationship of subjective quality of life with symptomatology, neurocognition and psychosocial functioning in first-episode psychosis: a structural equation modelling approach. European Archives of Psychiatry and Clinical Neuroscience 2021;271(8), 1561-1569.

  5. Cheng PWC, Chang WC‡, Lo GG, Chan KWS, Lee HME, Hui LMC, Suen YN, Leung YLE, Au Yeung KMP, Chen S, Mak KFH, Sham PC, Santangelo B, Veronese M, Ho CL, Chen YHE, Howes OD. The role of dopamine dysregulation and evidence for the transdiagnostic nature of elevated dopamine synthesis in psychosis: a positron emission tomography (PET) study comparing schizophrenia, delusional disorder and other psychotic disorders. Neuropsychopharmacology 2020; 45:1870-‌1876 (‡ as co-first author)

  6. Chang WC*, Wong CSM, Or PCF, et al. Inter-relationships among psychopathology, premorbid adjustment, cognition, and psychosocial functioning in first-episode psychosis: a network analysis approach. Psychological Medicine 2020; 50:2019-2027.

  7. Chang WC*, Ho RWH, Tang JYM, et al. Early-stage negative symptom trajectories and relationships with 13-year outcomes in first-episode non-affective psychosis. Schizophrenia Bulletin 2019; 45:610-619.

  8. Chang WC*, Chu AOK, Kwong VWY, et al. Patterns and predictors of trajectories for social and occupational functioning in patients presenting with first-episode non-affective psychosis: a three-year follow-up study. Schizophrenia Research 2018; 197:131-137.

  9. Chang WC*, Lau ESK, Chiu SSY, et al. Three-year clinical and functional outcome comparison between first-episode mania with psychotic features and first-episode schizophrenia. Journal of Affective Disorders 2016; 200:1-6.

  10. Chang WC*, Chan SSI, Hui CLM, et al. Prevalence and risk factors for violent behavior in young people presenting with first-episode psychosis in Hong Kong: a three-year follow-up study. Australian and New Zealand Journal of Psychiatry 2015; 49:914-922.

  11. Chang WC*, Cheung R, Hui CLM, et al. Rate and risk factors of depressive symptoms in Chinese patients presenting with first-episode non-affective psychosis in Hong Kong. Schizophrenia Research 2015; 168:99–105.

  12. Chang WC*, Chen ESM, Hui CLM, et al. Prevalence and risk factors for suicidal behavior in young people presenting with first-episode psychosis in Hong Kong: a three-year follow-up study. Social Psychiatry and Psychiatric Epidemiology 2015; 50:219-226.

  13. Chang WC*, Chen ESM, Hui CLM, et al. The relationships of suicidal ideation with symptoms, neurocognitive function, and psychological factors in patients with first-episode psychosis. Schizophrenia Research 2014; 157:12-18.

  14. Chang WC*, Tang JWM, Hui CLM, et al. Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: a prospective three-year follow-up study. Psychiatry Research 2014, 220:834-839.

  15. Chang WC*, Hui CLM, Wong GHY et al., Symptomatic remission and cognitive impairment in first-episode schizophrenia: a prospective 3-year follow-up study. Journal of Clinical Psychiatry 2013; 74:e1046-e1053.

  16. Chang WC*, Hui CLM, Tang JYM, Wong GH, Chan SK, Lee EH, 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.

  17. Chang WC*, Chan TCW, Chen ESM, et al. Concurrent and predictive validity of symptomatic remission criteria in first-episode schizophrenia. Schizophrenia Research 2013, 143:107-115.

  18. Chang WC*, Tang JY, Hui CL, et al. Prediction of remission and recovery in young people presenting with first-episode psychosis in Hong Kong: a 3-year follow-up study. Australian and New Zealand Journal of Psychiatry 2012; 46:100-108.

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*as corresponding author

4. Neurocognitive mechanisms for psychopathology in early psychosis and bipolar disorder

We have adopted hypothesized well-validated experimental paradigms to investigate neurocognitive mechanisms underlying specific psychopathologies in early psychosis, especially negative symptoms and motivational impairment (amotivation), and bipolar disorder. These translational paradigms include reinforcement learning (RL), effort-based decision-making (EBDM) on physical and cognitive effort modalities, risky decision-making, to name a few. Specifically, our research is the first: to concurrently evaluate rapid and gradual RL, positive and negative RL, and value-guided decision-making capacity in first-episode psychosis (FEP); and to investigate physical and cognitive EBDM performance in FEP samples. Overall, we observed mild and more circumscribed RL deficit in FEP relative to chronic schizophrenia but intact value-guided decision-making, suboptimal physical and cognitive effort allocation in FEP, and significant associations of high-level amotivation with RL and EBDM impairment, thereby providing implications of neurobiological mechanisms that may underlie development of amotivation in the early course of psychosis. Our ongoing investigations look into RL impairment and persistent negative symptoms in clinical high-risk for psychosis (CHR-P), and associations of delusion severity with biased inference and aberrant novelty salience in FEP.

Selected relevant publications

  1. Chu RST, Tong CHY, Wong CSM, Chang WC*, Tang WCY, Chan CCL, Lui SY, Hui LM, Suen YN, Chan KW, Lee HM, Chen YH. Effort-based decision making in schizotypy and its relationship with amotivation and psychosocial functioning. Frontiers in Psychiatry 2023; 14:1123046.

  2. Luk MSK, Chang WC*, Chong CSY, Siu CMW, Chan SKW, Lee EMH, Hui CLM, Sun YN, Lee TMC, Lo TL, Chen EYH. Altered risky decision-making in patients with early non-affective psychosis. European Archives of Psychiatry and Clinical Neuroscience 2021; 271:723-731.

  3. Chu RST, Ng CM, Chan KN, Chan KW, Lee HM, Hui LM, Chen E, Chang WC*. Aberrant learned irrelevance in patients with first-episode schizophrenia-spectrum disorder. Brain Sciences 2021; 11:1370.

  4. Chang WC*, Westbrook A, Strauss G, Chu AOK, Chong CSY, Siu CMW, Chan SKW, Lee EHM, Hui CLM, Suen YM, Lo TL, Chen EYH. Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis. Psychological Medicine 2020; 50:2599-2609.

  5. Chang WC*, Chu AOK, Treadway MT, Strauss GP, Chan SKW, Lee EHM, Hui CLM, Suen YN, Chen EYH. Effort-based decision-making impairment in patients with clinically-stabilized first-episode psychosis and its relationship with amotivation and psychosocial functioning. European Neuropsychopharmacology 2019; 29:629-642.

  6. 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.

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*as corresponding author

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Manuscript under review

  1. Wong SCY, Lo HKY, Ng MCM, Chan JKN, Fang CZ, Hui CLM, Chan SKW, Lee EHM, Lui SYY, Chang WC*. Reinforcement learning impairment in early-stage bipolar disorder with history of psychosis.

  2. Chan JMT, Lo HKY, Mok ASY, Kam CTK, Fang CZ, Chang WC*. Cognitive and affective theory-of-mind impairment in people with early-stage bipolar disorder

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Manuscript under preparation

  1. Reinforcement learning impairment and primary negative symptoms in individuals at clinical high-risk for psychosis

  2. Reinforcement learning impairment in antipsychotic-naïve individuals with first-episode psychosis

5. Research on clinical high-risk for psychosis and subclinical psychotic experiences (PEs)

Individuals ascertained as clinical high-risk for psychosis (CHR-P or termed at-risk mental state, ARMS)

by standardized operational clinical criteria have a markedly elevated rate of developing psychotic disorder over 2 to 3 years. CHR-P individuals also exhibit pronounced functional impairment and are associated with high rate of comorbid mood disorders and heighted suicide risk. To better characterize clinical course of CHR-P individuals, we have conducted a naturalistic 2-year prospective follow-up of CHR-P cohort. Recently, we have incorporated multimodal neuroimaging measurement including structural MRI, DTI, resting-state fMRI and proton MRS, alongside clinical, cognitive and functional assessments, into the study with an aim to better inform psychosis prediction and illness outcome. In addition, we have recently systematically investigated clinical, functional, neurocognitive and neuroimaging abnormalities associated with youths with subclinical psychotic experiences (PEs) using multimodal assessments, with an aim to elucidate early neurobiological markers indicating psychosis phenotype risk in an earlier stage.

Selected relevant publications

  1. Chu RST, Chu IWL, Yip EWC, Chan JKN, Wong CSM, Hui CLM, Chen EYH, Chan SKW, Lee EHM, Lui SSY, Chang WC*. Cognitive functioning in people with psychotic experiences: a systematic review and meta-analysis study. Molecular Psychiatry 2024 (accepted)

  2. Chu RST, Tong CHY, Wong CSM, Chang WC*, Tang WCY, Chan CCL, Lui SY, Hui LM, Suen YN, Chan KW, Lee HM, Chen YH. Effort-based decision making in schizotypy and its relationship with amotivation and psychosocial functioning. Frontiers in Psychiatry 2023; 14:1123046.

  3. Chan KN, Chang WC*, Ng CM, et al. Sex differences in symptom severity, cognition and psychosocial functioning among individuals with at-risk mental state for psychosis. Early Intervention in Psychiatry 2022; 16:61-68.

  4. Chang WC, Strauss GP, Ahmed AO, Wong SCY, Chan JKN, Lee EHM, Chan SKW, Hui CLM, James SH, Chapman HC, Chen EYH. The latent structure of negative symptoms in individuals with attenuated psychosis syndrome and early psychosis: support for the 5 consensus domains. Schizophrenia Bulletin 2021; 47:386-394.

  5. Chang WC*, Ng CN, Chan KN, Lee HC, Chan SI, Chiu SY, Lee HM, Chan KW, Wong MC, Chan KL, Yeung WS, Chan CWH, Choy LW, Chong SY, Siu MW, Lo TL, Yan WC, Ng MK, Poon LT, Pang PF, Lam WC, Wong YC, Chung WS, Mo YM, Lui SY, Hui LM, Chen EYH. Psychiatric comorbidity in individuals at-risk for psychosis: relationships with symptoms, cognition and psychosocial functioning. Early Intervention in Psychiatry 2021; 15:616-623.

  6. Chu AOK, Chang WC*, Chan SKW, Lee EMH, Hui CLM, Chen EYH. Comparison of cognitive functions between first-episode schizophrenia patients, their unaffected siblings and individuals at clinical high-risk for psychosis. Psychological Medicine 2019; 49:1929-1936.

  7. Chang WC*, Lee HC, Chan SI, et al. Negative symptom dimensions differentially impact on functioning in individuals at-risk for psychosis. Schizophrenia Research 2018; 202:310-315.

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*as corresponding author

 

Manuscript under review

  1. Chu RST, Chu IWL, Yip EWC, Chan JKN, Wong CSM, Hui CLM, Chen EYH, Chan SKW, Lee EHM, Lui SSY, Chang WC*. Cognitive functioning in people with psychotic experiences: a systematic review and meta-analysis

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Manuscript under preparation

  1. Impaired reinforcement learning and effort-based decision making in Chinese youths with psychotic experiences.

  2. Structural and functional connectivity alterations in a population-based youth cohort with psychotic experiences: a multimodal DTI and resting-state fMRI investigations

6. Impact of severe mental disorders and psychotropics on physical health outcomes 

Mental disorders, in particular severe mental illness (SMI; schizophrenia-spectrum disorders and bipolar disorder), are associated with markedly elevated risk of premature mortality, physical morbidity, and substantially shortened life expectancy relative to the general population. Critically, such mortality gap persists or has even widened in recent decades, indicating that health disparities experienced by this vulnerable population represent a serious global health problem and rectifying the lifespan inequalities is considered an international health priority. We have conducted a series of population-based studies examining excess mortality, reduced lifespan, physical comorbidity (including diabetes, stroke, acute coronary syndrome), and risk of undertreatment (invasive cardiac procedures and cardioprotective medications) in people with SMI. We have also recently conducted a series of meta-analyses in this respect, including the first meta-analysis to evaluate life expectancy and YPLL in bipolar disorders; risk of mortality and MACE, and likelihood of receiving invasive cardiac procedures and cardioprotective medication prescription following acute coronary syndrome in people with co-existing SMI; post-stroke mortality risk in people with schizophrenia; and life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses, including 109 studies conducted in 24 countries, and demonstrated that substantial reduced lifespan is transdiagnostic in nature, observed across countries and persisted over time. Additionally, comprehensive investigations of the risk of adverse pregnancy, obstetric and neonatal outcomes associated with SMI and prenatal exposure to psychotropic medications, with more optimal adjustment of maternal confounders have been recently conducted. Ongoing population-based health-record database research includes development of SMI-specific prediction models for risk of cardiovascular and renal complications in patients with SMI and co-existing diabetes, comprehensive evaluation of premature mortality, physical and mental comorbidity patterns and reduced lifespan across a broad spectrum of mental disorders, and self-harm risk prediction for major mental disorders, specifically psychotic disorders and bipolar disorders, and risk of thyroid and renal dysfunction associated with lithium and other mood stabilizers for bipolar disorder, to name a few.

Excess mortality and physical comorbidity associated with SMI & psychotropics

Selected relevant publications

  1. Chan JKN, Wong CSM, Fang CZ, Hung SC, Lo HKY, Chang WC*. Mortality risk and mood stabilizers in bipolar disorder: a propensity-score weighted population-based cohort study in 2002-2018. Epidemiology and Psychiatric Sciences 2024; 33:e31.

  2. Yung NCL, Wong CSM, Chan JKN, Chang WC*. Mortality rates in people with first diagnosis of schizophrenia-spectrum disorders: a 5-year population-based cohort study. Australian and New Zealand Journal of Psychiatry 2023; 57:854-864.

  3. Chan JKN, Wong CSM, Yung NCL, Chen EYH, Chang WC*. Pre-existing chronic physical morbidity and excess mortality in people with schizophrenia: a population-based cohort study. Social Psychiatry and Psychiatric Epidemiology 2022; 57:485-493.

  4. Yung NCL, Wong CSM, Chan JKN, Chen EYH, Chang WC*. Excess mortality and life-years lost in people with schizophrenia and other non-affective psychoses: an 11-year population-based cohort study. Schizophrenia Bulletin 2021; 47:474-484.

  5. Chan JKN, Wong CSM, Or PCF, Chen EYH, Chang WC*. Risk of mortality and complications in patients with schizophrenia and diabetes mellitus: a population-based cohort study. British Journal of Psychiatry 2021; 219:375-382.

  6. Chan JKN, Wong CSM, Yung NCL, Chen EYH, Chang WC*. Excess mortality and life-years lost in people with bipolar disorder: an 11-year population-based cohort study. Epidemiology and Psychiatric Sciences 2021; 30:e39.

  7. Chan JKN, Wong CSM, Or PCF, Chen EYH, Chang WC*. Diabetes complication burden and patterns and risk of mortality in people with schizophrenia and diabetes: a population-based cohort study with 16-year follow-up. European Neuropsychopharmacology 2021; 53:79-88.

  8. Chang WC*, Chan JKN, Wong CSM, Hai JSH, Or PCF, Chen EYH. Mortality, revascularization and cardioprotective pharmacotherapy after acute coronary syndrome in patients with psychotic disorders: a population-based cohort study. Schizophrenia Bulletin 2020; 46:774-784.

  9. Yung NCL, Wong CSM, Chan JKN, Or PCF, Chen EYH, Chang WC*. Mortality in patients with schizophrenia admitted for incident ischemic stroke: a population-based cohort study. European Neuropsychopharmacology 2020; 31:152-157.

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*as corresponding author

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Manuscript under review

  1. Lo HKY, Chan JKN, Wong CSM, Chung KF, Correll CU, Solmi M, Baum LW, Thach TQ, Sham PC, Chang WC*. Excess mortality and life-years lost in people diagnosed with depression: a 20-year population-based cohort study of 126,573 depressed individuals followed for 1,139,073 persons-years

  2. Ho MTH, Chan JKN, Lo HKY, Wong CSM, Lee KCK, Lai TT, Ng APP, Chen KQ, Wong WCW, Chang WC*. Risk of mortality and complications in people with depressive disorder and diabetes mellitus: a 20-year population-based propensity score-matched cohort study

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Manuscript under preparation

  1. Risk of cardiovascular complications in patients with severe mental illness and co-existing diabetes: a prediction model development and cross-validation study

Risk of adverse pregnancy and neonatal outcomes associated with SMI & psychotropics

Selected relevant publications

  1. Chan JKN, Lee KCK, Correll CU, So YK, Chan CY, Wong CSM, Cheung KW, Seto MTY, Lin J, Chang WC*. Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates. Molecular Psychiatry 2024: doi.org/10.1038/s41380-024-02723-1.

  2. Chan JKN, Lee KCK, Wong CSM, Chang WC*. Risk of congenital malformations associated with first-trimester exposure to antipsychotics: a propensity score-weighted population-based cohort study. European Psychiatry 2024; doi: 10.1192/j.eurpsy.2024.1758.

  3. Chan JKN, Hung SC, Lee KCK, Cheung KW, Seto MTY, Wong CSM, Lin J, Chang WC*. Risk of adverse pregnancy, delivery and neonatal outcomes associated with bipolar disorder and prenatal use of mood stabilizers: a population-based cohort study. Psychiatry Research 2024 339:116050.

  4. Chan JKH, Lee KCK, Wong CSM, Chang WC*. First-trimester antidepressant use and risk of congenital malformations: a population-based cohort study. Psychiatry Research 2024 339:116038.

  5. Law JWY, Chan JKN, Wong CSM, Chen EYH, Chang WC*. Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study. European Archives of Psychiatry and Clinical Neuroscience 2023; 273:901-909.

  6. Hung C, Chan JWN, Wong CSM, Fung VSC, Lee KCK, Chang WC*. Antidepressant utilization patterns and predictors of treatment continuation in pregnant women: a 16-year population-based cohort. Australian and New Zealand Journal of Psychiatry 2023; 57:686-697.

  7. Kan ACO, Chan JKN, Wong CSM, Chen EYH, Chang WC*. Psychotropic drug utilization patterns in pregnant women with bipolar disorder: a 16-year population-based cohort study. European Neuropsychopharmacology 2022; 57:75-85.

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*as corresponding author

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Manuscript under review

  1. Lee KCK, Fung VSC, Chan JKN, Wong CSM, Cheung KW, Seto MTY, Lin JJ, Chang WC*. Antidepressant use during pregnancy and risk of obstetrics and neonatal outcomes: a population-based cohort study​

Meta-analyses on premature mortality and physical morbidity associated with SMI

Selected relevant publications

  1. Ho MTH, Chan JKN, Chiu WCY, Tsang LLW, Chan KSW, Wong MMC, Wong HH, Pang PF, Chang WC*. Risk of mortality and complications in patients with severe mental illness and co-occurring diabetes mellitus: a systematic review and meta-analysis. European Neuropsychopharmacology 2024 (accepted)

  2. Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC*. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. eClinical Medicine 2023; 65:102294.

  3. Chu RST, Chong RCH, Chang DHH, Leung ALS, Chan JWN, Wong CSM, Chang WC*. The risk of stroke and post-stroke mortality in people with schizophrenia a systematic review and meta-analysis study. Psychiatry Research 2024; 332:115713.

  4. Chan KN, Chu ST, Hung C, Law WY, Wong CM, Chang WC*. Mortality, revascularization and cardioprotective pharmacotherapy after acute coronary syndrome in patients with severe mental illness: a systematic review and meta-analysis. Schizophrenia Bulletin 2022; 48:981-998.

  5. Chan JKN, Tong CHY, Wong CSM, Chen EYH, Chang WC*. Life expectancy and years of potential life lost in bipolar disorder: a systematic review and meta-analysis. British Journal of Psychiatry 2022; 221:567-576.

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*as corresponding author

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Manuscript under preparation

  1. All-cause and cause-specific mortality in people with depression: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors

Current Research Projects (as PI):

  1. Longitudinal follow-up comparison of first-episode schizophrenia (FES) and first-episode bipolar disorder (FEBD) on clinical, functional, neurocognitive and neuroimaging measures

  2. Digital phenotyping of negative symptoms and functional outcomes in first-episode psychosis

  3. Investigation of neurocognitive functions and neuroimaging alterations in epidemiologically-derived youth cohort with subclinical psychotic experiences

  4. A multimodal MRI and proton MRS investigation of clinical high-risk for psychosis

  5. Experimental investigation of biased inference and novelty salience for positive symptoms in first-episode psychosis

  6. Long-term outcome re-evaluation of first-episode psychosis cohort following RCT on extended early intervention

  7. Evaluation of long-term effects of territory-wide extended early intervention service (EASY+) on adult patients with first-episode psychosis

  8. Retrospective long-term outcome evaluation of first-episode mania

  9. Physical complications & effectiveness of mood stabilizers & antipsychotics in bipolar disorder

  10. Risk prediction for mortality, cardiovascular and renal complications in patients with severe mental illness with comorbid diabetes mellitus

  11. Self-harm risk evaluation and prediction for psychotic disorders, bipolar disorder and depression

  12. Evaluation of premature mortality, life expectancy and physical & mental comorbidity across a spectrum of mental disorders

Selected Publications (only first/corresponding-authored* articles are listed)

  1. Chan JKN, Lee KCK, Correll CU, So YK, Chan CY, Wong CSM, Cheung KW, Seto MTY, Lin J, Chang WC*. Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates. Molecular Psychiatry 2024: doi.org/10.1038/s41380-024-02723-1.

  2. Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC*. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. Lancet eClinical Medicine 2023; 65:102294.

  3. Fung VSC, Chan JCY, Wong SCY, Wong CSM, Kirlety O, Myin-Germeys I, Strauss GP, Chang WC*. Investigation of momentary negative symptoms in patients with early psychosis in daily life: an experience sampling study. Psychiatry Research 2023; 325: 115234.

  4. Chan JKN, Tong CHY, Wong CSM, Chen EYH, Chang WC*. Life expectancy and years of potential life lost in bipolar disorder: a systematic review and meta-analysis. British Journal of Psychiatry 2022; 221:567-576.

  5. Chang WC, Strauss GP, Ahmed AO, Wong SCY, Chan JKN, Lee EHM, Chan SKW, Hui CLM, James SH, Chapman HC, Chen EYH. The latent structure of negative symptoms in individuals with attenuated psychosis syndrome and early psychosis: support for the 5 consensus domains. Schizophrenia Bulletin 2021; 47:386-394.

  6. Chan JKN, Wong CSM, Or PCF, Chen EYH, Chang WC*. Risk of mortality and complications in patients with schizophrenia and diabetes mellitus: a population-based cohort study. British Journal of Psychiatry 2021; 219:375-382.

  7. Yung NCL, Wong CSM, Chan JKN, Chen EYH, Chang WC*. Excess mortality and life-years lost in people with schizophrenia and other non-affective psychoses: an 11-year population-based cohort study. Schizophrenia Bulletin 2021; 47:474-484.

  8. Chang WC*, Westbrook A, Strauss G, Chu AOK, Chong CSY, Siu CMW, Chan SKW, Lee EHM, Hui CLM, Suen YM, Lo TL, Chen EYH. Abnormal cognitive effort allocation and its association with amotivation in first-episode psychosis. Psychological Medicine 2020; 50:2599-2609.

  9. Chang WC*, Chan JKN, Wong CSM, Hai JSH, Or PCF, Chen EYH. Mortality, revascularization and cardioprotective pharmacotherapy after acute coronary syndrome in patients with psychotic disorders: a population-based cohort study. Schizophrenia Bulletin 2020; 46:774-784.

  10. Chang WC*, Ho RWH, Tang JYM, Wong CSM, Hui CLM, Chan SKW, Lee EMH, Suen YN, Chen EYH. Early-stage negative symptom trajectories and relationships with 13-year outcomes in first-episode non-affective psychosis. Schizophrenia Bulletin 2019; 45:610-619.

  11. 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.

  12. 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 a 3-year early intervention programme for first-episode psychosis. British Journal of Psychiatry 2017; 211:37-44.

  13. 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.

  14. 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

  15. Chang WC*, Hui CLM, Tang JYM, et al. 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. Hui CLM, Chang WC, Chan SKW, Lee EHM, Chen EYH. Chapter 17: Hong Kong. Psychosis: Global Perspectives. Morgan C, Cohen A and Roberts T (Eds.) Oxford University Press. 2023, pp. 355-368.

  2. Hui CLM, Chang WC, Chan KW, Lee HME, Suen YN, Chen EYH. International services for assessing and treating psychosis risk. Risk Factors for Psychosis: Paradigms, Mechanisms, and Prevention. Thomson A, Broome M (Eds.). Elsevier, 2020, pp. 383-393.

  3. Chen EYH, Chan SKW, Chang WC, Hui CLM, Lee EHM, Lo TL, Chong CSY, Yeung WS, Ng RMK, Cheung EFC, Chung DWS, Poon LT. Early intervention for psychosis: perspective after 15 years of development. Early Intervention in Psychiatric Disorders Across Cultures. Chen EYH, Ventriglio A and Bhugra D (Eds). Oxford University Press, 2019, pp. 87-100.

  4. Chang WC, Wong YC. Chapter 11: The diagnostic interview in early psychosis. Early Psychosis Intervention: a culturally adaptive clinical guide. Chen EYH, Lee H, Chan GHK, Wong GHY (Eds.). Hong Kong University Press 2013, pp. 111-122.

  5. Lam MML, Lee CC, Chang WC, Hung SF. Chapter 12: Handling at-risk mental state. Early Psychosis Intervention: a culturally adaptive clinical guide. Chen EYH, Lee H, Chan GHK, Wong GHY (Eds.). Hong Kong University Press 2013, pp. 123-136.

  6. Chang WC, Chiu CPY. Chapter 28: Handling patients with negative symptoms. Early Psychosis Intervention: a culturally adaptive clinical guide. Chen EYH, Lee H, Chan GHK, Wong GHY (Eds.). Hong Kong University Press 2013, pp. 311-322.

  7. 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.  [with 2nd edition published in 2023]

Awards

  1. HK RGC Clinical Research Fellowship, 2014.

  2. Distinguished Young Fellow, HK Academy of Medicine, 2014

  3. IEPA (International Early Psychosis Association) Young Investigator Award, 2016

  4. NARSAD Young Investigator Award, Brain & Behavior Research Foundation, USA, 2016

  5. Faculty Outstanding Research Output Award, 2017, 2019, 2021

  6. HKUMed Research Fellowship for Clinical Academics, 2025

  7. HKU Scholars in the TOP 1% (ranked by Clarivate Analytics in the top 1% worldwide by citations) from 2019 onwards for 5 consecutive years

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 + Clinical Research Fellowship 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)

  6. Probing brain abnormalities for youths with subclinical psychotic symptoms: a population-based multimodal MRI study in Hong Kong (HMRF, Health and Medical Research Fund in 2020, 3-year project)

  7. A longitudinal multimodal neuroimaging and cognitive investigations in first-episode schizophrenia and first-episode bipolar disorder: a prospective 1-year follow-up study (RGC General Research Fund in 2021, 3-year project)

  8. Ambulatory digital phenotyping of negative symptoms and functional outcome in first-episode psychosis: a prospective 6-month follow-up study (RGC General Research Fund in 2022, 2-year project)

  9. Risk prediction models of mortality and complications of Chinese patients with severe mental illness and co-existing diabetes in Hong Kong: a population-based cohort study (HMRF, Health and Medical Research Fund in 2023, 2-year project)

  10. Integrated innovative artificial intelligence, genomic, and biomedical technologies in healthcare: objective diagnosis, personalized therapy, and determining the etiology of major mental disorders (Strategic Theme Grant in 2024, 5-year project, as Co-PI)

  11. Self-harm risk evaluation and prediction in people with mental disorders: a population-based health-record study in Hong Kong (HMRF, Health and Medical Research Fund in 2024, 2-year project)

  12. Comprehensive investigation of excess mortality, life expectancy, mental and physical comorbidity and its associations with mortality risk in people with mental disorders: a territory-wide register-based study in Hong Kong (RGC General Research Fund in 2025, 2-year project)

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