Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

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

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 persistent symptoms despite active antipsychotic treatment (Craig et al., 2004; Kane, 1996; Lieberman et al., 2005; Marder, 1996; Kane, 1999). In the past two decades, there has been a surge of psychological interventions targeting psychotic symptoms and functional deterioration. Examples include cognitive-behavioural therapy for psychosis, family interventions, mindfulness-based treatment, social skills training, cognitive remediation, etc. (see reviews by Pilling et al., 2002; Tai & Turkington, 2009; Tarrier & Wykes, 2004; Wykes et al., 2011; Zimmermann et al., 2005). Psychological treatment approaches to psychosis flourish against a background where early detection and intervention for psychosis is promoted (spearheaded by clinicians in Australia, the US and the UK) and community treatment of psychiatric patients is advocated. The National Institute for Health and Clinical Excellence (NICE) in the UK has established treatment guidelines that recommend cognitivebehavioural therapy (CBT) and family interventions for psychosis (National Institute for Health and Clinical Excellence, 2009). Background of PIPE In 2001, when the Early Assessment Service for Young People with Psychosis (EASY) was launched in Hong Kong, this step was taken against a background 13 Implementing Psychological Intervention Programmes in Early Psychosis (PIPE) Suzanne Ho-wai So 138 Suzanne Ho-wai So that treatment of early psychosis called for timely and comprehensive psychosocial intervention in order to facilitate more enduring recovery. Psychological Intervention Programmes for Early Psychosis (PIPE) were developed by a group of clinical psychologists in Hong Kong who had extensive experience of providing psychological service to individuals with psychotic and other psychiatric illnesses (So, Wong, & Chong, 2002). The basic structure of the PIPE protocol was established in 2001, and has since been constantly updated with feedback and comments from case managers and service users, and to keep abreast with the growing literature. In order to sustain the effectiveness of the PIPE programme, clinicians of EASY constantly receive local and overseas training and supervision. The acronym “PIPE” denotes “connection”, “thoroughfare”, and “outlet”. The Chinese concept of qudao (渠道) also signifies “a way out”, “a means to an end”, and instils a sense of hope that is pivotal to recovering from first-episode psychosis. The content of the PIPE protocol was largely based on research findings in studies of psychological models of psychosis and associated interventions (mainly from Western countries), with adaptations made to take into account local Chinese cultural perspectives. This was especially important for PIPE-I (i.e. enhancing psychological adjustment to early psychosis) because cultural values are embedded in the way an individual and the family explain and deal with the psychotic experience. The PIPE protocol will likely serve as: (i) a guideline for clinicians of EASY when considering appropriate and evidence-based psychological intervention for individual service users; and (ii) a tool book for case managers about psychoeducation for psychosis. While this chapter gives an outline of the PIPE modules, the actual protocol consists of a set of handbooks, which are available from the author or EASY. Structure of PIPE In order to promote more lasting recovery from the psychotic episode, facilitate psychological adjustment, and prevent relapse, PIPE comprises three main modules of intervention for young adults with early psychosis, as well as their families. The three conceptual modules of the PIPE are: • PIPE-I: Enhancing psychological adjustment to early psychosis • PIPE-II: Intervention for secondary morbidity • PIPE-III: CBT for drug-resistant psychotic symptoms Implementing Psychological Intervention Programmes in Early Psychosis (PIPE) 139 The structure and procedural delivery of the PIPE intervention modules for patients and their families are shown in Figure 13.1. PIPE is an integral component of the EASY service, which includes medical and other psychosocial interventions provided by a multidisciplinary team. Treatment needs for each service user are regularly reviewed by this team. In Figure 13.1, the PIPE modules are indicated in boxes with thick frames. The dotted arrows point to service modules that only select patients and families with specific treatment needs receive, whereas the other boxes carry core service modules that all patients and families are presented. While PIPE-I is conducted by case managers to every service user of EASY, other modules (PIPE-IA,-II, and -III) are provided based...