Early Psychosis Intervention
A Culturally Adaptive Clinical Guide
Publication Year: 2013
Published by: Hong Kong University Press, HKU
Download PDF (850.7 KB)
Title Page, Copyright
Download PDF (84.9 KB)
Download PDF (45.8 KB)
Download PDF (29.5 KB)
Foreword by Patrick McGorry
Download PDF (52.2 KB)
It is now just over a decade since the first early psychosis programmes were established in Asia, representing a critical frontier in global early psychosis reform. In the intervening years an increasing number of clinical and research programmes have been developed and flourished in various Asian cities. It is inspiring to see that so many pioneering Asian psychiatrists, psychologists and ...
Foreword by Siow Ann Chong
Download PDF (31.0 KB)
An adage of modern medicine states that early detection and treatment of a disorder is the key to achieving better outcomes. However, this concept has The understanding that psychoses afflict much suffering on both individuals and their families, and exact an enormous toll in social and economic costs from lost productivity also needs little emphasis. The possibility that these ...
Download PDF (33.9 KB)
This book discusses the practice of early psychosis intervention in various socio cultural contexts. Grounded in more than a decade of clinical and research experience in locations across Asia, outside the conventional “Western” system, the essays address a comprehensive range of topics pertinent to the central question of how to improve patient care in the early stages of psychosis. The ...
Download PDF (29.1 KB)
...This book is the fruit of years of hard work of many dedicated people in early psychosis services. We are extremely fortunate to have received enormous help from our colleagues in various early intervention programmes in Hong Kong, Japan, Korea, and Singapore. In particular, we would like to thank the very dedicated and enthusiastic team of clinicians, case managers, and researchers in the EASY...
Download PDF (33.5 KB)
Download PDF (45.8 KB)
Part I: Early Psychosis Intervention Developments in Asia
1. Development of Early Intervention Services: Introduction
Download PDF (121.7 KB)
The concept of “early intervention” is not foreign to medical practice. The idea is rooted in the recognition that many illnesses evolve as a progression over time involving the accruement of irreversible adverse processes. Consequently, the timing of intervention becomes a prime factor affecting outcomes.The challenge confronting the field of early psychosis is that many of these ...
2. Early Psychosis Services in an Asian Urban Setting: EASY and Other Services in Hong Kong
Download PDF (180.5 KB)
The first specialized early psychosis service in Hong Kong, the Early Assessment Service for Young People with Psychosis (EASY), was launched in 2001. EASY is a Hospital Authority initiative in Hong Kong. The programme consists of specialized early intervention teams providing services for young adults aged 15 to 25 years with first-episode psychosis. In 2009, an adult ...
3. Overview of Early Psychosis Service Development in Singapore: The EPIP Story
Download PDF (78.9 KB)
A study of Singaporean patients with first-episode psychosis found that the Duration of Untreated Psychosis (DUP) ranged from 0.1 to 336 months, with a mean of 32.6 months and a median of 12 months (Chong, Mythily, & Verma, 2005). A long DUP is associated with greater disabilities, long and more frequent hospitalizations, disruption in family, suicides, and higher ...
4. Early Psychosis Intervention in an Urban Japanese Setting: Overview of Early Psychosis Services in Japan
Download PDF (69.6 KB)
For decades, Japanese psychiatric services have been predominantly hospital-based. Many psychiatrists who are more oriented to psychosocial or integrated approaches have been struggling with this conservative system and trying to achieve a transition to community-based psychiatry. However, to date, there have few profound changes. The number of psychiatric inpatients is still large, ...
5. Overview of the Development of Services for Early Psychosis in Korea
Download PDF (140.7 KB)
An old Chinese book of traditional medicine offered the following advice to practitioners: “Do not treat a disease that has already been, treat before it starts (不治已病，治未病)”. Although well established in the context of serious physical illnesses, the strategy of early intervention has been ignored for many decades with respect to psychotic disorders due to pessimism, stigma, and ...
Part II. Public Awareness and Early Detection in Cultural Context
6. Factors Affecting the Duration of Untreated Psychosis in Hong Kong
Download PDF (60.7 KB)
A reduction in the duration of untreated psychosis (DUP), defined as the time-lapse between onset of psychotic symptoms and initiation of treatment, is a key target of early intervention for psychotic disorders (Harrigan, McGorry, & Krstev, 2003; McGlashan & Johannessen, 1996; McGorry, 2000). Many early intervention programmes aim at DUP reduction, considering it a measurable ...
7. Public Awareness Approaches in Early Psychosis
Download PDF (230.2 KB)
Psychosis is a concept surrounded by misunderstanding and stigma. Historically, mental illnesses (in particular schizophrenia) were associated with moral failure, demon-possession, and witchcraft (Miller, 2000). The fear and antipathy against psychosis continues to the present day: the media typi-cally portray an image of a dangerous, violent person with a “split personality”. ...
8. Early Psychosis in the Workplace
Download PDF (61.4 KB)
For a person employed full-time and working about 40 hours a week, setting aside the time spent on daily travelling and personal care, on average spends about half of his or her waking time in the workplace. Hence, the workplace is an important setting for detecting and managing early signs of psychosis. People sharing the workplace with the concerned individual form a critical ...
9. Enhancing Psychosis Detection through Gatekeepers
Download PDF (77.3 KB)
One of the most significant challenges in running an early assessment and intervention programme for psychosis is how readily people with untreated psychosis can get in touch with services. According to the annual statistics of the Early Assessment and Services for Young People with Psychosis (EASY) in Hong Kong, schools and youth services social workers and counsellors contrib-...
10. Initial Screening and Assessment: A Phone-Based Two-Stage Screening
Download PDF (161.0 KB)
One of the core objectives of early psychosis intervention service is to encour-age potential clients to seek medical help as soon as possible in order to reduce the duration of untreated psychosis (DUP) (Bertolote & McGorry, 2005). To achieve this, a fast and easy access point for potential clients and their rela-tives for information and possible referral at the same time becomes essential. ...
11. The Diagnostic Interview in Early Psychosis
Download PDF (84.3 KB)
Accurate diagnosis of psychosis in an early phase is important, as case for-mulation and management can be more confidently determined on this basis. Nevertheless, making a definitive psychiatric diagnosis during the initial inter-views can be one of the most challenging aspects in early intervention services. The difficulties, to a certain extent, can be accounted for by the characteristics ...
12. Handling At-Risk Mental State
Download PDF (80.8 KB)
Various studies have demonstrated that schizophrenia is often preceded by a prodromal phase. It is suggested that the earlier the treatment begins, the faster the recovery and the better the overall outcome. The rationale for early inter-vention in psychosis has been extensively discussed in recent years (Corcoran, Malaspina, & Hercher, 2005; Larsen et al., 2001; Malla & Norman, 2002; ...
Part III: Culturally Relevant Psychosocial Case Intervention
13. Implementing Psychological Intervention Programmes in Early Psychosis (PIPE)
Download PDF (215.0 KB)
Over the past five decades or so, antipsychotic treatment has been and remains the mainstay of treatment for psychosis (Kapur & Mamo, 2003). Abundant evidence supports its efficacy in reducing the severity of psychotic symptoms such as hallucinations and delusions (see reviews by Miyamoto et al., 2005; Miyamoto et al., 2003). However, approximately 20%–50% of patients demon-...
14. The PASTE that Binds: Culturally Relevant Psychological Interventions for First-Episode Psychosis Individuals in Singapore
Download PDF (103.4 KB)
Unlike people with other disorders, individuals who are afflicted with psycho-sis are most likely to experience disturbances in their perception and cognition. Compounded with the psychotic experiences and the presence of symptoms, their ability to engage in fruitful social interactions and usual role functioning are often impaired. Moreover, individuals may experience comorbid condi-...
15. Cultural Issues in Early Psychosis Management
Download PDF (108.7 KB)
Singapore is a multi-religious country due to its diverse ethnic mix of peoples from various origins. Most of the key religious denominations are represented in Singapore (see Figure 15.1) and the government promotes religious toler-ance. In 2000, Singapore had a population of about 4 million. It is comprised mainly of Chinese (76.8%), the majority of whom are Buddhist or atheists; ...
16. Engagement and Outreach in Early Psychosis Management
Download PDF (75.7 KB)
According to the Oxford Advanced Learner’s Dictionary, engagement means “locking together, fitting into; of part of a machine, etc.” (Hornby, 2005). Yet, in psychology or psychiatry literature, there is little consensus on the definition and measurement of engagement or disengagement (see reviews by O’Brien, Fahmy, & Singh, 2009; Tetley et al., 2011) and this con-...
17. Experience of Stigma in Early Psychosis Patients and Caregivers
Download PDF (73.9 KB)
Psychotic disorders often emerge in late adolescence and young adulthood with a prolonged delay between onset of symptoms and the first effective treatment. Such delays affect symptom severity, treatment response, relapses, and quality of life. The stigma associated with psychosis may be one of the major factors associated with delays in seeking medical help. For diagnosed patients and ...
18. The Phase-Specific Progress Supervision Model for Case Managers
Download PDF (133.8 KB)
Case managers, who form a part of an allied healthcare professional specialty and those working in specialized fields such as mental health, are faced with a multitude of challenges and responsibilities of providing brokerage, assess-ments, and therapeutic roles to their patients. Delivering psychoeducation, coordinating services, providing supportive counselling, and formulating care ...
Part IV: Support Programmes in the Community
19. Community Psychosocial Intervention in Early Psychosis
Download PDF (82.2 KB)
First-episode psychosis—in the main, schizophrenia—arises often during the developmental stages of early adolescence and early adulthood (Rinaldi et al., 2010). It is also during these development stages that education, employment, self-identity, and formation of relationships tend to occur (Basset et al., 2001). Due to the impact of the illness, adolescents with early psychosis commonly ...
20. The Peer Support Programme in Early Psychosis Intervention Programme (EPIP)
Download PDF (87.2 KB)
...“Où sont les hommes?” reprit enfin le petit prince. “On est un peu seul “Where are the people?” resumed the little prince at last. “It’s a little lonely “It is lonely when you’re among people, too,” said the snake.The diagnosis of early psychosis can be a lonely experience for a young person. The illness typically strikes at the developmental stage of heightened yearn-...
21. Family Work in Early Psychosis
Download PDF (60.2 KB)
Psychosis is a major psychiatric illness that has debilitating impact on patients and their families. Providing care for patients in their home environment can be physically and emotionally demanding for the families. Numerous studies have shown caregivers of patients with psychosis experience distress and burnout (Addington et al., 2003; Barrowclough, Tarrier, & Johnston, 1996; ...
22. Working with Non-Governmental Organizations in Early Psychosis
Download PDF (97.9 KB)
The Early Assessment Service for Young People with Psychosis (EASY) in Hong Kong emphasizes close links with non-governmental organizations (NGOs) involved in providing mental healthcare to the community. In Hong Kong, NGOs provide a wide range of services. Many youth and community centres are run by NGOs where people in the local community meet and join ...
Part V: Medication and Adherence Issues
23. Pharmacological Intervention in Early Psychosis
Download PDF (98.1 KB)
Questions on pharmacotherapy are frequently asked by patients and their caregivers in the treatment of early psychosis, reflecting their concern for this topic. Doctors and nurses often face questions on the following issues during • Do I need to take medication? When should it be started?• How effective is the drug treatment? What kind of symptoms is it useful for?...
24. Medication Adherence: Specific Issues in Early Psychosis in Asia
Download PDF (57.3 KB)
In psychotic disorders including schizophrenia, the risk of relapse increases five-fold upon discontinuation of treatment. This chapter discusses issues related to medication adherence in psychosis, paying particular attention to With regard to medication adherence in psychosis, a variety of challenges are involved at different stages of the illness. At first presentation to clinic, most ...
Part VI: Handling Specific Challenges
25. Relapse Intervention and Related Issues
Download PDF (59.2 KB)
Having a psychotic disease is unlike other illnesses in the sense that it signifi-cantly alters a person’s normal experience. As the metaphor “fish is the last to discover water” goes, the ability to perceive reality is so basic a process that seems effortless and unnoticeable to most of us. Thus, it is hard to imagine how This chapter explores an important aftermath of psychosis, namely relapse ...
26. Suicide and Self-Harm Behaviour in Early Psychosis
Download PDF (87.1 KB)
Suicide has a strong association with psychosis and contributes to its high mor-tality. In a meta-analysis conducted in 1997, Harris and Barraclough (1997) showed that the overall suicide risk for schizophrenia was 8.5 times that of the general population. As with other disorders, precise identification of risk factors may assist clinicians in managing suicide risk among patients with psy-...
27. Comorbid Substance Abuse in Early Psychosis
Download PDF (65.1 KB)
Substance misuse is prevalent among clients suffering from first-episode psy-chosis. Figures from the West have shown prevalence ranging from 20% to 53% (Addington & Addington, 2007; Barnett et al., 2007; Cantwell et al., 1999; Hambrecht & Hafner, 1996; Wade et al., 2006). Although less common among first-episode clients in Hong Kong, a significant proportion of the clients suffer ...
28. Handling Patients with Negative Symptoms
Download PDF (75.1 KB)
People suffering from first-episode psychosis are often bewildered by the extraordinary experiences evolving around them, being helplessly entwined by events, which often bring turmoil into their lives. Positive psychotic symptoms may be readily understood by patients and caregivers as symptoms of an illness, whereas negative symptoms (including blunted affect, poverty of speech, avoli-...
Part VII: Recovering from Early Psychosis
29. Recovery from Psychosis
Download PDF (70.2 KB)
The development of antipsychotics in the 1950s marked the turning point in the treatment of psychosis. Since then, there has been a progressive increase in expectations for treatment outcomes in psychotic disorders. In the pre-1960s era, the goal of treatment was simply “improvement in self-care and reduction in aggression and self-injury”. With time, this goal has changed to “deinsti-...
30. Concepts of Recovery in Early Psychosis: A Cognitive Linguistic Approach
Download PDF (143.3 KB)
The concepts of “recovery” and “remission” are often differentiated in the literature. While remission has a more stringent definition and emphasizes symptoms, the concept of recovery is broader with more demanding criteria. This chapter will first discuss some definitions of recovery and remission commonly used in clinical and research settings, and then explore subjec-...
31. Experiential Aspects of Recovery in Early Psychosis: Focus Group Findings
Download PDF (83.3 KB)
Young people who have suffered from a first episode of psychosis have high rates of remission if treated adequately and comprehensively. Despite this, more than 33% of clients are readmitted to the hospital within six months, 55% within two years and 80% within five years following the treatment of their first episode of psychosis. Given these alarming relapse rates, it is important ...
Part VIII: Evaluation and Research
32. Database Design and Management
Download PDF (143.0 KB)
Healthcare is one of the most information-intensive and information-demand-ing industries. Healthcare workers, including doctors, nurses, and other allied health workers, require large amounts of information about their clients in order to make clinical decisions and select appropriate care for clients. At the same time, healthcare planners need comprehensive service data to evaluate ...
33. Research and Outcome Evaluation in Early Psychosis
Download PDF (68.0 KB)
One of the major characteristics distinguishing early psychosis from some other mental health arenas is that research forms an integral part of the early In the last two decades, research in schizophrenia has witnessed a growing emphasis on first-episode studies. Researchers started to identify patient samples with a first onset of psychotic illness and performed various clinical, ...
Download PDF (90.1 KB)
Page Count: 416
Illustrations: 12 b/w illus.
Publication Year: 2013