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Early Psychosis Intervention

A Culturally Adaptive Clinical Guide

Edited by Eric Yu-hai Chen, Gloria Hoi-kei Chan, Gloria Hoi-yan Wong, Helen Lee

Publication Year: 2013

Taking into account cultural differences between Asian and Western patients, this book focuses on delivery of effective treatment at an early stage in psychosis, especially for young people. It pays particular attention to early intervention programmes established in Hong Kong and Singapore, and assesses recent developments in Korea, Japan and other countries. The volume covers approaches in the management of psychosis, including pathway to care, stigma and interventions. With reference to the experiences of frontline practitioners, research findings and theories, it highlights the practical needs in non-Western healthcare settings. Culturally relevant discussions on recovery, relapse, self-harm and comorbid substance abuse are discussed. It also covers case studies to illustrate challenges and strategies in managing early psychosis.

Published by: Hong Kong University Press, HKU

Title Page, Copyright

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pp. 2-5


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pp. 6-9


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pp. ix-x

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pp. xi-xvi

...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...

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pp. xvii-xviii

...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 arrived rather belatedly in mental health. The understanding that psychoses afflict much suffering on both individuals and their families, and exact an enormous toll in social...

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pp. xix-xxii

...This book discusses the practice of early psychosis intervention in various sociocultural 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...

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pp. xxiii-xiv

...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...


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pp. xxv-xxviii


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pp. xxix-xxxii

Part I: Early Psychosis Intervention Developments in Asia

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1. Development of Early Intervention Services: Introduction

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pp. 3-16

...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...

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2. Early Psychosis Services in an Asian Urban Setting: EASY and Other Services in Hong Kong

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pp. 17-28

...adults aged 15 to 25 years with first-episode psychosis. In 2009, an adult early psychosis service became available with the support of the Hong Kong Jockey Club Charities Trust. The Jockey Club Early Psychosis (JCEP) Project provides case management service to 1000 patients aged between 26 and 55...

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3. Overview of Early Psychosis Service Development in Singapore: The EPIP Story

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pp. 29-36

...There may be several factors that contribute to a long DUP, including: ignorance, stigma, denial, lack of motivation, absence of information about early psychosis, and lack of access to appropriate intervention. In Singapore, the manifestations of psychosis are often attributed to supernatural causes: around...

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4. Early Psychosis Intervention in an Urban Japanese Setting: Overview of Early Psychosis Services in Japan

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pp. 37-46

...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...

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5. Overview of the Development of Services for Early Psychosis in Korea

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pp. 47-64

...identification and intervention in early psychosis require a coordinated process from a diverse spectrum of socio-clinical services. Within this context, this chapter describes issues related to services for early psychosis in Korea, such as the role of community psychiatry and clinical networks, the development of optimal psychosocial...

Part II. Public Awareness and Early Detection in Cultural Context

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6. Factors Affecting the Duration of Untreated Psychosis in Hong Kong

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pp. 67-74

...A reduction in the duration of untreated psychosis (DUP), defined as the timelapse 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...

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7. Public Awareness Approaches in Early Psychosis

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pp. 75-86

...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 typically...

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8. Early Psychosis in the Workplace

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pp. 87-92

...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...

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9. Enhancing Psychosis Detection through Gatekeepers

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pp. 93-100

...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 contributed to more than 10% of all referrals, with the vast majority of cases assessed...

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10. Initial Screening and Assessment: A Phone-Based Two-Stage Screening

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pp. 101-110

...One of the core objectives of early psychosis intervention service is to encourage 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 relatives...

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11. The Diagnostic Interview in Early Psychosis

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pp. 111-122

...Accurate diagnosis of psychosis in an early phase is important, as case formulation and management can be more confidently determined on this basis. Nevertheless, making a definitive psychiatric diagnosis during the initial interviews can be one of the most challenging aspects in early intervention services...

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12. Handling At-Risk Mental State

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pp. 123-134

...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 intervention in psychosis has been extensively discussed in recent years...

Part III: Culturally Relevant Psychosocial Case Intervention

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13. Implementing Psychological Intervention Programmes in Early Psychosis (PIPE)

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pp. 137-158

...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 demonstrate...

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14. The PASTE that Binds: Culturally Relevant Psychological Interventions for First-Episode Psychosis Individuals in Singapore

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pp. 159-174

...Unlike people with other disorders, individuals who are afflicted with psychosis 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 conditions...

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15. Cultural Issues in Early Psychosis Management

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pp. 175-188

...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 tolerance. In 2000, Singapore had a population of about 4 million. It is comprised...

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16. Engagement and Outreach in Early Psychosis Management

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pp. 189-198

...reviews by O’Brien, Fahmy, & Singh, 2009; Tetley et al., 2011) and this construct is often conflated with concepts related to the treatment progression or therapeutic alliance. Despite this, it is well recognized that therapeutic engagement is important for patients to receive appropriate help and achieve better outcomes...

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17. Experience of Stigma in Early Psychosis Patients and Caregivers

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pp. 199-208

...associated with delays in seeking medical help. For diagnosed patients and their family members, the negative stigma attached to psychotic disorders also often cause psychosocial repercussions. This chapter discusses some concepts of stigma in psychosis, with reference to the subjective experience of stigma...

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18. The Phase-Specific Progress Supervision Model for Case Managers

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pp. 209-220

...Burnout and exiting of the helping line can easily occur. In fact, Yalom (2001) mentioned that therapists working in specified fields, such as palliative care and psychosis, expose themselves to the risk of demoralization. In view of this, supervision plays a vital role in ensuring professional conduct, competency and more importantly in preventing unnecessary burnout...

Part IV: Support Programmes in the Community

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19. Community Psychosocial Intervention in Early Psychosis

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pp. 223-234

...recovery (McGorry, 2002). Programmes have to be comprehensive in supporting the needs of young people with psychosis (Bertolote & McGorry, 2005). Appropriate treatment interventions should be carried out for functional outcomes rather than just for symptom remission. Therefore, by engaging in psychosocial groups, patients can be facilitated...

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20. The Peer Support Programme in Early Psychosis Intervention Programme (EPIP)

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pp. 235-246

...The provision of psychosocial interventions such as case management attempts to address this isolation through working closely with patients during the early part of the recovery process. Other adjunctive psychosocial interventions include social skills training, psychosocial clubhouses, and support groups. Peer support is a newer...

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21. Family Work in Early Psychosis

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pp. 247-254

...spouses. Patients’ data collected in EPIP revealed that 92.1% of them stayed with their families, which included spouses, children, parents, siblings, and other relatives. Only 3.8% of the patients lived alone. Hence, any treatment plan must involve the family, nuclear or extended, so as to support the patients and reduce stress in the families...

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22. Working with Non-Governmental Organizations in Early Psychosis

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pp. 255-260

...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

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23. Pharmacological Intervention in Early Psychosis

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pp. 263-272

...symptoms (Hafner & an der Heiden, 1997). Use of antipsychotic medication in prodrome should consider the balance between effectiveness and side-effects (McGorry et al., 2009) because data on these issues are still preliminary (see Chapter 12, “Handling At-Risk Mental State”). However, there is evidence...

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24. Medication Adherence: Specific Issues in Early Psychosis in Asia

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pp. 273-280

...make applying knowledge learned from psychoeducation into practice challenging. For example, some patients consider themselves recovered and thus free of any need for medication, just as when drugs can be stopped once the flu is gone. In a study on the perceived extent of recovery in first-episode...

Part VI: Handling Specific Challenges

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25. Relapse Intervention and Related Issues

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pp. 283-290

...have a role in heightening the risk for relapse. On the other hand, environmental factors such as the extent of social support and stress levels may either instigate or prevent a relapse from occurring. The complex interactions between these internal and external factors may serve as a framework for understanding relapse in psychosis...

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26. Suicide and Self-Harm Behaviour in Early Psychosis

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pp. 291-300

...for suicide with the general population, patients with schizophrenia might possess certain specific risk factors for suicide. The suicide risk is related less to the core psychotic features of the disorder and more to affective symptoms, agitation or motor restlessness, and to awareness that the illness is affecting their mental functioning...

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27. Comorbid Substance Abuse in Early Psychosis

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pp. 301-310

...substance among young psychotic clients in Hong Kong. About half of the EASY clients who abuse drugs use cannabis with or without other substances. In Hong Kong, ecstasy and ketamine abuse is prevalent among young substance abusers. Not surprisingly, over one-third of substance-using EASY clients have...

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28. Handling Patients with Negative Symptoms

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pp. 311-320

...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, avolition, apathy, and lack of social drive) are usually less easily accepted as part of the pathological process...

Part VII: Recovering from Early Psychosis

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29. Recovery from Psychosis

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pp. 323-334

...psychosis. A proposed definition of remission from the illness process is absence of symptoms, or presence of only minimal symptoms, in major psychopathology dimensions including psychotic symptoms (delusions, hallucinations, and unusual thought content), disorganization (conceptual disorganization and mannerisms or posturing), and negative symptoms (blunted affect, social...

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30. Concepts of Recovery in Early Psychosis: A Cognitive Linguistic Approach

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pp. 335-344

...they are able to play. Also, patients have to maintain such improved state of being and functioning for a certain time period to qualify for “recovery”. Robinson’s commonly used concept of recovery (Robinson et al., 2004) embraces two dimensions, namely, symptom remission and psychosocial functioning. On the symptom remission dimension, the positive symptoms presented have to be no worse than mild, and negative symptoms no worse than...

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31. Experiential Aspects of Recovery in Early Psychosis: Focus Group Findings

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pp. 345-356

...approach that tailors treatment to the needs of young people. This chapter will look at the subjective experience of these young people in making sense of the psychotic experiences and recovery as promoted by early psychosis services. The concept of recovery is briefly discussed, followed by the young person’s...

Part VIII: Evaluation and Research

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32. Database Design and Management

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pp. 359-366

...which includes basic demographic and essential clinical information. At the same time, different clinical and service data need to be collected via various clinical measuring scales at different intervals of the treatment programme. Moreover, as educational talks are conducted in schools and the community on a regular basis to promote public awareness of the illness, each team needs to...

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33. Research and Outcome Evaluation in Early Psychosis

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pp. 367-374

...increased risk of illness onset, such as those with genetic risks (e.g., one of the parents is suffering from the disease). Researchers track patterns of onset in such high-risk groups, in an attempt to identify factors that can be observed even before the onset of the illness. Some studies are devoted to investigating the onset pattern of the illness, leading to the development...


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pp. 375-382

E-ISBN-13: 9789888180875
Print-ISBN-13: 9789888139927

Page Count: 416
Illustrations: 12 b/w illus.
Publication Year: 2013

Edition: 1