51
|
Csillag C, Nordentoft M, Mizuno M, McDaid D, Arango C, Smith J, Lora A, Verma S, Di Fiandra T, Jones PB. Early intervention in psychosis: From clinical intervention to health system implementation. Early Interv Psychiatry 2018; 12:757-764. [PMID: 29143456 DOI: 10.1111/eip.12514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
AIM Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementation and presents ideas and strategies to overcome some of these obstacles. METHODS This paper is a narrative review about the evidence supporting EIP, with examples of successful implementation of EIP and of cases where major obstacles still need to be overcome. RESULTS Experience from successfully implemented EIP services into the mental healthcare system have generated evidence, concepts and specific strategies that might serve as guidance or inspiration in other countries or systems where EIP is less well developed or not developed at all. Previous experience has made clear that evidence of clinical benefits alone is not enough to promote implementation, as economic arguments and political and social pressure have shown to be important elements in efforts to achieve implementation. CONCLUSIONS Users' narratives, close collaboration with community organizations and support from policy-makers and known people within the community championing early intervention (EI) services are just a few of the approaches that should be considered in campaigns for implementation of EI services. Fast progress in implementation is possible.
Collapse
Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Hilleroed, Denmark
| | | | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, School of Medicine, CIBERSAM, IiSGM, Madrid, Spain
| | - Jo Smith
- Institute of Health and Society, University of Worcester, Worcester, UK
| | | | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| |
Collapse
|
52
|
Winkler P, Broulíková HM, Kondrátová L, Knapp M, Arteel P, Boyer P, Galderisi S, Karkkainen H, Ieven A, Mohr P, Wasserman D, Park AL, Tinelli M, Gaebel W. Value of schizophrenia treatment II: Decision modelling for developing early detection and early intervention services in the Czech Republic. Eur Psychiatry 2018; 53:116-122. [DOI: 10.1016/j.eurpsy.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022] Open
Abstract
Abstract:Background:Positive findings on early detection and early intervention services have been consistently reported from many different countries. The aim of this study, conducted within the European Brain Council project “The Value of Treatment”, was to estimate costs and the potential cost- savings associated with adopting these services within the context of the Czech mental health care reform.Methods:Czech epidemiological data, probabilities derived from meta-analyses, and data on costs of mental health services in the Czech Republic were used to populate a decision analytical model. From the health care and societal perspectives, costs associated with health care services and productivity lost were taken into account. One-way sensitivity analyses were conducted to explore the uncertainty around the key parameters.Results:It was estimated that annual costs associated with care as usual for people with the first episode of psychosis were as high as 46 million Euro in the Czech Republic 2016. These annual costs could be reduced by 25% if ED services were adopted, 33% if EI services were adopted, and 40% if both, ED and EI services, were adopted in the country. Cost-savings would be generated due to decreased hospitalisations and better employment outcomes in people with psychoses.Conclusions:Adopting early detection and early intervention services in mental health systems based on psychiatric hospitals and with limited access to acute and community care could generate considerable cost- savings. Although the results of this modelling study needs to be taken with caution, early detection and early intervention services are recommended for multi-centre pilot testing accompanied by full economic evaluation in the region of Central and Eastern Europe.
Collapse
|
53
|
Anderson KK, Norman R, MacDougall AG, Edwards J, Palaniyappan L, Lau C, Kurdyak P. Disparities in Access to Early Psychosis Intervention Services: Comparison of Service Users and Nonusers in Health Administrative Data. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:395-403. [PMID: 29562748 PMCID: PMC5971412 DOI: 10.1177/0706743718762101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a dearth of information on people with first-episode psychosis who do not access specialized early psychosis intervention (EPI) services. We sought to estimate the proportion of incident cases of nonaffective psychosis that do not access these services and to examine factors associated with EPI admission. METHODS Using health administrative data, we constructed a retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, between 1997 and 2013. This cohort was linked to primary data from PEPP to identify EPI users. We used multivariate logistic regression to model sociodemographic and service factors associated with EPI admission. RESULTS Over 50% of suspected cases of nonaffective psychosis did not have contact with EPI services for screening or admission. EPI users were significantly younger, more likely to be male (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.24 to 2.01), and less likely to live in areas of socioeconomic deprivation (OR 0.51; 95% CI 0.36 to 0.73). EPI users also had higher odds of psychiatrist involvement at the index diagnosis (OR 7.35; 95% CI 5.43 to 10.00), had lower odds of receiving the index diagnosis in an outpatient setting (OR 0.50; 95% CI 0.38 to 0.65), and had lower odds of prior alcohol-related (OR 0.42; 95% CI 0.28 to 0.63) and substance-related (OR 0.68; 95% CI 0.50 to 0.93) disorders. CONCLUSIONS We need a greater consideration of patients with first-episode psychosis who are not accessing EPI services. Our findings suggest that this group is sizable, and there may be sociodemographic and clinical disparities in access. Nonpsychiatric health professionals could be targeted with interventions aimed at increasing detection and referral rates.
Collapse
Affiliation(s)
- Kelly K. Anderson
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
| | - Ross Norman
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Arlene G. MacDougall
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Jordan Edwards
- Department of Epidemiology &
Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario,
London, Ontario
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Department of Neuroscience, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario
- Department of Medical Biophysics, Schulich
School of Medicine & Dentistry, University of Western Ontario, London, Ontario
| | - Cindy Lau
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
| | - Paul Kurdyak
- Institute for Clinical Evaluative Sciences,
Toronto, Ontario
- Health Outcomes and Performance Evaluation,
Centre for Addiction and Mental Health, Toronto, Ontario
| |
Collapse
|
54
|
Lambert M, Schöttle D, Sengutta M, Ruppelt F, Rohenkohl A, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Handwerk U, Rothländer W, Rietschel L, Gagern C, Lange B, Meigel-Schleiff C, Naber D, Schulte-Markwort M, Krüger H, Unger HP, Sippel S, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III). Early Interv Psychiatry 2018; 12:96-106. [PMID: 27618789 DOI: 10.1111/eip.12361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/25/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Abstract
AIM The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.
Collapse
Affiliation(s)
- Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mary Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Luise Antonia Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Britta Galling
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anne-Lena Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Linus Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vivien Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gizem Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ute Handwerk
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | | | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Charlotte Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Benjamin Lange
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Meigel-Schleiff
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dieter Naber
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Helmut Krüger
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | - Hans-Peter Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sven Sippel
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sabine Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - Anne Daubmann
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karl Wegscheider
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Benno G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
55
|
Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| |
Collapse
|
56
|
Nordentoft M, Albert N. Early intervention services are effective and must be defended. World Psychiatry 2017; 16:272-274. [PMID: 28941094 PMCID: PMC5608812 DOI: 10.1002/wps.20452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolai Albert
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
57
|
Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
Collapse
Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | | |
Collapse
|
58
|
Garrido G, Penadés R, Barrios M, Aragay N, Ramos I, Vallès V, Faixa C, Vendrell JM. Computer-assisted cognitive remediation therapy in schizophrenia: Durability of the effects and cost-utility analysis. Psychiatry Res 2017; 254:198-204. [PMID: 28463718 DOI: 10.1016/j.psychres.2017.04.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 12/16/2022]
Abstract
The durability of computer-assisted cognitive remediation (CACR) therapy over time and the cost-effectiveness of treatment remains unclear. The aim of the current study is to investigate the effectiveness of CACR and to examine the use and cost of acute psychiatric admissions before and after of CACR. Sixty-seven participants were initially recruited. For the follow-up study a total of 33 participants were enrolled, 20 to the CACR condition group and 13 to the active control condition group. All participants were assessed at baseline, post-therapy and 12 months post-therapy on neuropsychology, QoL and self-esteem measurements. The use and cost of acute psychiatric admissions were collected retrospectively at four assessment points: baseline, 12 months post-therapy, 24 months post-therapy, and 36 months post-therapy. The results indicated that treatment effectiveness persisted in the CACR group one year post-therapy on neuropsychological and well-being outcomes. The CACR group showed a clear decrease in the use of acute psychiatric admissions at 12, 24 and 36 months post-therapy, which lowered the global costs the acute psychiatric admissions at 12, 24 and 36 months post-therapy. The CACR is durable over at least a 12-month period, and CACR may be helping to reduce health care costs for schizophrenia patients.
Collapse
Affiliation(s)
- Gemma Garrido
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain; Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Rafael Penadés
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Barcelona Clinic Schizophrenia Unit (BCSU), Clinical Institute of Neurosciences (ICN), Hospital Clínic, Barcelona, Spain.
| | - Maite Barrios
- Department of Behavioral Sciences Methods, University of Barcelona, Spain; Institute of Neuroscience, University of Barcelona, Spain.
| | - Núria Aragay
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain.
| | - Irene Ramos
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain.
| | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa (CST), Martí Díez 5, 08224 Terrassa, Barcelona, Spain.
| | - Carlota Faixa
- Section of Neuropsychology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Josep M Vendrell
- Section of Neuropsychology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| |
Collapse
|
59
|
Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:78-86. [DOI: 10.1016/j.rpsm.2017.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
|
60
|
Pollock RF, Tikkanen CK. A short-term cost-utility analysis of insulin degludec versus insulin glargine U100 in patients with type 1 or type 2 diabetes in Denmark. J Med Econ 2017; 20:213-220. [PMID: 27705031 DOI: 10.1080/13696998.2016.1245663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Insulin degludec is an insulin analog with an ultra-long duration of action that exhibits less intra-patient variability in its glucose-lowering activity, and reduces nocturnal, overall, and severe hypoglycemia relative to insulin glargine. The aim of the present study was to evaluate the cost-effectiveness of insulin degludec relative to insulin glargine in patients with: type 1 diabetes (T1D), type 2 diabetes receiving basal-only therapy (T2DBOT), and type 2 diabetes receiving basal-bolus therapy (T2DBB) in Denmark. METHODS A short-term (1 year) cost-utility model was developed to model insulin use, non-severe and severe hypoglycemia, and self-monitoring of blood glucose in patients using insulin degludec and insulin glargine from the perspective of a Danish healthcare payer. Where possible, data were derived from Danish patients with diabetes and meta-analyses of clinical trials comparing insulin degludec with insulin glargine. Using these characteristics, the model estimated costs and quality-adjusted life years (QALYs) gained for the two insulin regimens in each of the three diabetes populations. RESULTS Insulin degludec dominated insulin glargine (i.e. reduced costs while improving quality-adjusted life expectancy) in patients with T1D and patients with type 2 diabetes using a basal-only insulin regimen. In the T2DBB cohort, insulin degludec was associated with an incremental cost-effectiveness ratio of DKK 221,063 per QALY gained, which would be considered cost-effective at a willingness-to-pay threshold of EUR 30,000 (∼DKK 224,000) per QALY gained. Sensitivity analysis showed that results were most affected by changes in hypoglycemia rate ratio assumptions, but were broadly insensitive to changes in individual input parameters. CONCLUSIONS Insulin degludec reduces incidence of hypoglycemia and improves quality-of-life in patients with diabetes. Over a 1-year time horizon, insulin degludec resulted in cost savings relative to insulin glargine in T1D and T2DBOT cohorts, while being cost-effective in T2DBB.
Collapse
Affiliation(s)
- R F Pollock
- a Ossian Health Economics and Communications GmbH , Basel , Switzerland
| | - C K Tikkanen
- b Novo Nordisk Health Care AG , Zürich , Switzerland
| |
Collapse
|
61
|
McGorry PD, Hamilton MP. Stepwise expansion of evidence-based care is needed for mental health reform. Med J Aust 2017; 204:351-3. [PMID: 27169969 DOI: 10.5694/mja16.00120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/15/2016] [Indexed: 12/17/2022]
Abstract
Mortality from mental illnesses is increasing and, because they frequently occur early in the life cycle, they are the largest source of disability and reduced economic productivity of all non-communicable diseases. Successful mental health reform can reduce the mortality, morbidity, growing welfare costs and losses in economic productivity caused by mental illness. The government has largely adopted the recommendations of the National Mental Health Commission focusing on early intervention and stepwise care and will implement a reform plan that involves devolving commissioning of federally funded mental health services to primary health networks, along with a greater emphasis on e-mental health. Stepwise expanded investment in and structural support (data collection, evaluation, model fidelity, workforce training) for evidence-based care that rectifies high levels of undertreatment are essential for these reforms to succeed. However, the reforms are currently constrained by a cost-containment policy framework that envisages no additional funding. The early intervention reform aim requires financing for the next stage of development of Australia's youth mental health system, rather than redirecting funds from existing evidence-based programs. People with complex, enduring mental disorders need more comprehensive care. In the context of the National Disability Insurance Scheme, there is a risk that these already seriously underserved patients may paradoxically receive a reduction in coverage. E-health has a key role to play at all stages of illness but must be integrated in a complementary way, rather than as a barrier to access. Research and evaluation are the keys to cost-effective, sustainable reform.
Collapse
Affiliation(s)
- Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| |
Collapse
|
62
|
Behan C, Masterson S, Clarke M. Systematic review of the evidence for service models delivering early intervention in psychosis outside the stand-alone centre. Early Interv Psychiatry 2017; 11:3-13. [PMID: 27061731 DOI: 10.1111/eip.12334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/07/2016] [Accepted: 02/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Although early intervention in psychosis is an accepted policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside the specialist stand-alone centre. METHODS A systematic search following the PRISMA guidelines was undertaken in Medline, PsycInfo, Embase and the Cochrane trials register. The search was limited to articles in English from 1990 to end of January 2016. Inclusion criteria for the review comprised comparative evaluations of services delivering early intervention in psychosis outside the specialist model. Exclusion criteria included prodromal services, descriptions of services without reference to a comparator and stand-alone specialist services evaluated in comparison to treatment as usual. RESULTS There were 637 unique citations. Twenty-eight papers were reviewed at second-stage screening. The majority were excluded as they compared specialist early intervention with treatment as usual, did not evaluate the first episode or had no comparator. Seven peer-reviewed publications and two conference papers fulfilled criteria evaluating models of delivering early intervention other than the specialist model. CONCLUSIONS There is a spaucity of evidence evaluating models other than specialist models in early intervention. Published studies are heterogeneous in design and outcome. Although there have been two recent trials evaluating integrated early intervention in comparison with treatment as usual, it remains unclear whether reported improved outcomes of specialist centres apply to other models.
Collapse
Affiliation(s)
- Caragh Behan
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Sarah Masterson
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
63
|
Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Cochrane Database Syst Rev 2017; 1:CD007906. [PMID: 28067944 PMCID: PMC6472672 DOI: 10.1002/14651858.cd007906.pub3] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. OBJECTIVES To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. MAIN RESULTS The 2016 update included two more studies (n = 196) and more publications with additional data for four already included studies. The updated review therefore includes 7524 participants from 40 randomised controlled trials (RCTs). We found data relevant to two comparisons: ICM versus standard care, and ICM versus non-ICM. The majority of studies had a high risk of selective reporting. No studies provided data for relapse or important improvement in mental state.1. ICM versus standard careWhen ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD -0.86, 95% CI -1.37 to -0.34,low-quality evidence). Similarly, for the outcome global state, ICM reduced the number of people leaving the trial early (n = 1798, 13 RCTs, RR 0.68, 95% CI 0.58 to 0.79, low-quality evidence). For the outcome adverse events, the evidence showed that ICM may make little or no difference in reducing death by suicide (n = 1456, 9 RCTs, RR 0.68, 95% CI 0.31 to 1.51, low-quality evidence). In addition, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment due to very low-quality evidence (n = 1129, 4 RCTs, RR 0.70, 95% CI 0.49 to 1.0, very low-quality evidence).2. ICM versus non-ICMWhen ICM was compared with non-ICM for the outcome service use, there was moderate-quality evidence that ICM probably makes little or no difference in the average number of days in hospital per month (n = 2220, 21 RCTs, MD -0.08, 95% CI -0.37 to 0.21, moderate-quality evidence) or in the average number of admissions (n = 678, 1 RCT, MD -0.18, 95% CI -0.41 to 0.05, moderate-quality evidence) compared to non-ICM. Similarly, the results showed that ICM may reduce the number of participants leaving the intervention early (n = 1970, 7 RCTs, RR 0.70, 95% CI 0.52 to 0.95,low-quality evidence) and that ICM may make little or no difference in reducing death by suicide (n = 1152, 3 RCTs, RR 0.88, 95% CI 0.27 to 2.84, low-quality evidence). Finally, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment as compared to non-ICM (n = 73, 1 RCT, RR 1.46, 95% CI 0.45 to 4.74, very low-quality evidence).3. Fidelity to ACTWithin the meta-regression we found that i.) the more ICM is adherent to the ACT model, the better it is at decreasing time in hospital ('organisation fidelity' variable coefficient -0.36, 95% CI -0.66 to -0.07); and ii.) the higher the baseline hospital use in the population, the better ICM is at decreasing time in hospital ('baseline hospital use' variable coefficient -0.20, 95% CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but the 'baseline hospital use' result still significantly influences time in hospital (regression coefficient -0.18, 95% CI -0.29 to -0.07, P = 0.0027). AUTHORS' CONCLUSIONS Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital.However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach.We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
Collapse
Affiliation(s)
- Marina Dieterich
- Azienda USL Toscana Nord OvestDepartment of PsychiatryLivornoItaly
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb buildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Bert Park
- Nottinghamshire Healthcare NHS TrustAMH Management SuiteHighbury HospitalNottinghamUKNG6 9DR
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPrestonLancashireUK
| | | |
Collapse
|
64
|
Abstract
Available data have demonstrated the clinical benefits and cost-effectiveness of multi-component treatment packages for individuals early in the course of psychotic-spectrum disorders. In response, an unprecedented effort aims to disseminate such multi-component treatment programs—referred to as Coordinated Specialty Care (CSC)—throughout the United States. We review the evidence in support of CSC care for first-episode psychosis and highlight specific policy reforms that may facilitate the successful dissemination and eventual improvement of CSC programs for first-episode psychosis. Among proposed reforms are novel financing strategies for CSC services and incentivizing of continued collaboration between academic and community agencies to facilitate sustained dissemination and refinement of CSC.
Collapse
|
65
|
Csillag C, Nordentoft M, Mizuno M, Jones PB, Killackey E, Taylor M, Chen E, Kane J, McDaid D. Early intervention services in psychosis: from evidence to wide implementation. Early Interv Psychiatry 2016; 10:540-546. [PMID: 26362703 DOI: 10.1111/eip.12279] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it. METHODS This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination. RESULTS In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties. CONCLUSIONS Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives.
Collapse
Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - John Kane
- Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA
| | - David McDaid
- Health and Social Care, London School of Economics and Political Science, London, UK
| |
Collapse
|
66
|
Tsiachristas A, Thomas T, Leal J, Lennox BR. Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 2016; 6:e012611. [PMID: 27798015 PMCID: PMC5073534 DOI: 10.1136/bmjopen-2016-012611] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To demonstrate the costs, outcomes and economic impact of early intervention in psychosis (EIP) services. DESIGN Longitudinal retrospective observational study of service usage and outcome data from mental health and acute care services for all those with a diagnosis of psychosis in contact with mental health services over a 3-year period (April 2010-March 2013). SETTING Thames Valley and South Midlands region in England (region covered by Oxford Academic Health Science Network). PARTICIPANTS 3674 people with psychosis, aged 16-35 years. INTERVENTIONS EIP team or other community mental health teams. MAIN OUTCOME MEASURES Change in housing status, change in employment status and improvement on each of the four domains of the Health of the Nation Outcome Scale (HONOS) questionnaire. Costs of mental and acute health inpatient, outpatient and community service use were also included in the study. RESULTS Patients in EIP services were 116% more likely (95% CI 1.263 to 3.708) to gain employment, 52% more likely to become accommodated in a mainstream house (95% CI 0.988 to 2.326) and 17% more likely to have an improvement in the emotional well-being domain of the HONOS questionnaire (95% CI 1.067 to 1.285), as compared to those in non-EIP services. Annual National Health Service (NHS) costs were also significantly lower for patients using EIP services compared to non-users. The mean annual NHS cost savings associated with EIP were £4031 (95% CI £1281 to £6780). These mostly came from lower mental health inpatient costs (£4075, 95% CI £1164 to £6986), lower acute hospital outpatient costs (£59, 95% CI £9 to £109), lower accident and emergency costs (£31, 95% CI £12 to £51), and higher mental health community costs (£648, 95% CI £122 to £1175). If all people with a first-episode psychosis across England were to be treated by EIP services, the savings in societal costs would be an estimated £63.3 million per year, of which £33.5 million would be in NHS costs. CONCLUSIONS Treatment within an EIP service is associated with better health and social outcomes, and reduced costs.
Collapse
Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Thomas
- Janssen Healthcare Innovation, Johnson & Johnson, High Wycombe, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Belinda R Lennox
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| |
Collapse
|
67
|
Vita A, Deste G, Barlati S, Grano A, Poli R, Sacchetti E. Does cognitive remediation modify the use of psychiatric services and the patterns of care of patients with schizophrenia? Schizophr Res 2016; 175:85-89. [PMID: 27094716 DOI: 10.1016/j.schres.2016.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/25/2022]
Abstract
The use of inpatient and outpatient psychiatric services were assessed in the 12months before and after a cognitive remediation (CR) intervention or treatment as usual (TAU) in a sample of 84 patients with schizophrenia who previously underwent an effectiveness study of CR. A smaller number and shorter duration of hospitalizations in acute wards and a higher total number of outpatient and rehabilitative interventions, as well as a more constant, intensive and articulated rehabilitation in the 12months after the intervention were found in patients who received CR, compared with those who received TAU. CR may modify the use of psychiatric services and the patterns of care of patients with schizophrenia.
Collapse
Affiliation(s)
- Antonio Vita
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy; University of Brescia, School of Medicine, Brescia, Italy.
| | - Giacomo Deste
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Antonino Grano
- University of Brescia, School of Medicine, Brescia, Italy
| | | | - Emilio Sacchetti
- Department of Mental Health, Spedali Civili Hospital, Brescia, Italy; University of Brescia, School of Medicine, Brescia, Italy
| |
Collapse
|
68
|
Rosenheck R, Leslie D, Sint K, Lin H, Robinson DG, Schooler NR, Mueser KT, Penn DL, Addington J, Brunette MF, Correll CU, Estroff SE, Marcy P, Robinson J, Severe J, Rupp A, Schoenbaum M, Kane JM. Cost-Effectiveness of Comprehensive, Integrated Care for First Episode Psychosis in the NIMH RAISE Early Treatment Program. Schizophr Bull 2016; 42:896-906. [PMID: 26834024 PMCID: PMC4903057 DOI: 10.1093/schbul/sbv224] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study compares the cost-effectiveness of Navigate (NAV), a comprehensive, multidisciplinary, team-based treatment approach for first episode psychosis (FEP) and usual Community Care (CC) in a cluster randomization trial. Patients at 34 community treatment clinics were randomly assigned to either NAV (N = 223) or CC (N = 181) for 2 years. Effectiveness was measured as a one standard deviation change on the Quality of Life Scale (QLS-SD). Incremental cost effectiveness ratios were evaluated with bootstrap distributions. The Net Health Benefits Approach was used to evaluate the probability that the value of NAV benefits exceeded its costs relative to CC from the perspective of the health care system. The NAV group improved significantly more on the QLS and had higher outpatient mental health and antipsychotic medication costs. The incremental cost-effectiveness ratio was $12 081/QLS-SD, with a .94 probability that NAV was more cost-effective than CC at $40 000/QLS-SD. When converted to monetized Quality Adjusted Life Years, NAV benefits exceeded costs, especially at future generic drug prices.
Collapse
Affiliation(s)
- Robert Rosenheck
- Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT;
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kyaw Sint
- Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT
| | - Haiqun Lin
- Department of Psychiatry and Public Health, Yale Medical School, New Haven, CT
| | | | - Nina R Schooler
- Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY; Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston University, Boston, MA
| | - David L Penn
- Department of Psychology, University of North Carolina-Chapel Hill, Chapel Hill, NC; School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH; Bureau of Behavioral Health, DHHS, Concord, NH
| | | | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC
| | - Patricia Marcy
- Psychiatry Research, Zucker Hillside Hospital, North Shore-Long Island Jewish, Glen Oaks, NY
| | | | | | - Agnes Rupp
- National Institute of Mental Health, Rockville, MD
| | | | | |
Collapse
|
69
|
Kambeitz-Ilankovic L, Meisenzahl EM, Cabral C, von Saldern S, Kambeitz J, Falkai P, Möller HJ, Reiser M, Koutsouleris N. Prediction of outcome in the psychosis prodrome using neuroanatomical pattern classification. Schizophr Res 2016; 173:159-165. [PMID: 25819936 DOI: 10.1016/j.schres.2015.03.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 01/11/2023]
Abstract
To date, research into the biomarker-aided early recognition of psychosis has focused on predicting the transition likelihood of clinically defined individuals with different at-risk mental states (ARMS) based on structural (and functional) brain changes. However, it is currently unknown whether neuroimaging patterns could be identified to facilitate the individualized prediction of symptomatic and functional recovery. Therefore, we investigated whether cortical surface alterations analyzed by means of multivariate pattern recognition methods could enable the single-subject identification of functional outcomes in twenty-seven ARMS individuals. Subjects were dichotomized into 'good' vs. 'poor' outcome groups on average 4years after the baseline MRI scan using a Global Assessment of Functioning (GAF) threshold of 70. Cortical surface-based pattern classification predicted good (N=14) vs. poor outcome status (N=13) at follow-up with an accuracy of 82% as determined by nested leave-one-cross-validation. Neuroanatomical prediction involved cortical area reductions in superior temporal, inferior frontal and inferior parietal areas and was not confounded by functional impairment at baseline, or antipsychotic medication and transition status over the follow-up period. The prediction model's decision scores were correlated with positive and general symptom scores in the ARMS group at follow-up, whereas negative symptoms were not linked to predicted poorer functional outcome. These findings suggest that poorer functional outcomes are associated with non-resolving attenuated psychosis and could be predicted at the single-subject level using multivariate neuroanatomical risk stratification methods. However, the generalizability and specificity of the suggested prediction model should be thoroughly investigated in future large-scale and cross-diagnostic MRI studies.
Collapse
Affiliation(s)
| | - Eva M Meisenzahl
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Carlos Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Sebastian von Saldern
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilian-University, Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| |
Collapse
|
70
|
Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 502] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
Collapse
Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
71
|
Park AL, McCrone P, Knapp M. Early intervention for first-episode psychosis: broadening the scope of economic estimates. Early Interv Psychiatry 2016; 10:144-51. [PMID: 24739331 DOI: 10.1111/eip.12149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 03/11/2014] [Indexed: 01/29/2023]
Abstract
AIM To explore the economic impacts of early intervention in England on outcomes and costs for people with first-episode psychosis. METHODS Three decision analytical models were constructed to compare treatment by early intervention for first-episode psychosis with standard care in relation to employment, education, homicide and suicide. Data on effectiveness and costs were taken from previous studies and expert opinion. Sensitivity analyses tested the robustness of assumptions. RESULTS Our models indicate that early intervention demonstrates savings of £2087 per person over 3 years from improved employment and education outcomes. In addition, the annual costs over 10 years related to homicide after early intervention were £80 lower than for standard care. There were also annual savings of £957 per person for early intervention over 4 years compared to standard care as a result of suicides averted. CONCLUSIONS Not only can investment in early intervention help reduce some of the long-term costs and consequences of mental disorders to the health-care system. In addition, there are broader economic benefits that strengthen the potential cost savings to society.
Collapse
Affiliation(s)
- A-La Park
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Paul McCrone
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.,Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
72
|
Bechdolf A, Laier S, Kallenbach M, Biester A, Leopold K. [Should antipsychotics be used in prodromal stages of schizophrenia to prevent psychosis? Con]. DER NERVENARZT 2015; 86:1424-1426. [PMID: 26542156 DOI: 10.1007/s00115-015-4428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Bechdolf
- Frühinterventions- und Therapiezentrum - FRITZ am Urban, Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Dieffenbachstr. 1, 10967, Berlin, Deutschland.
- Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Berlin, Deutschland.
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland.
- ORYGEN Youth Health, University of Melbourne, Melbourne, Australien.
| | - S Laier
- Frühinterventions- und Therapiezentrum - FRITZ am Urban, Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
- Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Berlin, Deutschland
| | - M Kallenbach
- Frühinterventions- und Therapiezentrum - FRITZ am Urban, Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
- Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Berlin, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln, Köln, Deutschland
| | - A Biester
- Frühinterventions- und Therapiezentrum - FRITZ am Urban, Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
- Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Berlin, Deutschland
| | - K Leopold
- Frühinterventions- und Therapiezentrum - FRITZ am Urban, Vivantes Klinikum Am Urban, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Dieffenbachstr. 1, 10967, Berlin, Deutschland
- Vivantes Klinikum im Friedrichshain, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Akademisches Lehrkrankenhaus der Charité Medizin, Berlin, Deutschland
| |
Collapse
|
73
|
Abbass A, Bernier D, Kisely S, Town J, Johansson R. Sustained reduction in health care costs after adjunctive treatment of graded intensive short-term dynamic psychotherapy in patients with psychotic disorders. Psychiatry Res 2015; 228:538-43. [PMID: 26106054 DOI: 10.1016/j.psychres.2015.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 04/02/2015] [Accepted: 05/17/2015] [Indexed: 11/26/2022]
Abstract
The aim of this pilot study was to evaluate the changes in symptom severity and long-term health care cost after intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with psychotic disorders undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 13 one-hour sessions of graded ISTDP to 38 patients with psychotic disorders. Costs for health care services were compiled for a one-year period prior to the start of ISTDP (baseline) along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Results revealed that health care cost reductions were significant for the one-year post-treatment period relative to baseline year, for both physician costs and hospital costs, and the reductions were sustained for the follow-up period of four post-treatment years. Furthermore, at treatment termination self-reported symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and reduce costs in selected patients with psychotic disorders, and that gains are sustained in long-term follow-up. Future research directions are discussed.
Collapse
Affiliation(s)
- Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Denise Bernier
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Kisely
- School of Medicine, The University of Queensland, Australia
| | - Joel Town
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert Johansson
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Behavioural Sciences and Learning, Linköping University, Sweden
| |
Collapse
|
74
|
Kam SM, Singh SP, Upthegrove R. What needs to follow early intervention? Predictors of relapse and functional recovery following first-episode psychosis. Early Interv Psychiatry 2015; 9:279-83. [PMID: 24251970 DOI: 10.1111/eip.12099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/22/2013] [Indexed: 11/27/2022]
Abstract
AIM As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. METHOD An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. RESULTS Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. CONCLUSIONS Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.
Collapse
Affiliation(s)
- Shi Mei Kam
- College of Medical and Dental Sciences, The University of Birmingham
| | - Swaran P Singh
- Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham.,Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Upthegrove
- College of Medical and Dental Sciences, The University of Birmingham.,Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham
| |
Collapse
|
75
|
Jensen KB, Morthorst BR, Vendsborg PB, Hjorthøj CR, Nordentoft M. The effect of the mental health first-aid training course offered employees in Denmark: study protocol for a randomized waitlist-controlled superiority trial mixed with a qualitative study. BMC Psychiatry 2015; 15:80. [PMID: 25884517 PMCID: PMC4411756 DOI: 10.1186/s12888-015-0466-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies show a high and growing prevalence of mental disorders in the population worldwide. 25% of the general population in Europe will during their lifetime experience symptoms related to a mental disorder. The Mental Health First Aid concept (MHFA) was founded in 2000 in Australia by Kitchener and Jorm, in order to provide the population with mental health first aid skills. The aim of the concept is, through an educational intervention (course), to increase confidence in how to help people suffering from mental health problems. Further, secondary aims are to increase the mental health literacy of the public by increasing knowledge, reduce stigma and initiate more supportive actions leading towards professional care. An investigation of the effect of MHFA offered a Danish population is needed. METHODS The design is a randomized waitlist-controlled superiority trial, in which 500 participants will be allocated to either the intervention group or the control group. The control group will attend the course six months later, hence waiting list design. From fall 2013 to spring 2014 participants will be educated to be "mental health first-aiders" following a manualized, two days MHFA course. All the participants will answer a questionnaire at base-line and at 6 months follow-up. The questionnaire is a back-translation of the questionnaire used in Australian trials. The trial will be complemented by a qualitative study, in which focus groups will be carried out. DISCUSSION Outcomes measured are sensitive to interpretation, hence a challenge to uniform. This trial will add to the use of a mixed-methods design and exemplify how it can strengthen the analysis and take up the challenge of a sensitive outcome. TRIAL REGISTRATION https://clinicaltrials.gov identifier NCT02334020.
Collapse
Affiliation(s)
- Kamilla B Jensen
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Britt R Morthorst
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Per B Vendsborg
- Danish Mental Health Foundation, Hejrevej 43, DK, 2400, Copenhagen, Denmark.
| | - Carsten R Hjorthøj
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| | - Merete Nordentoft
- Copenhagen University Hospital, Research Unit, Mental Health Centre, Copenhagen, Kildegårdsvej 28, entrance 15, 4th floor, DK, 2900, Copenhagen, Denmark.
| |
Collapse
|
76
|
Cocchi A, Balbi A, Corlito G, Ditta G, Di Munzio W, Nicotera M, Meneghelli A, Pisano A, Preti A. Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies. Early Interv Psychiatry 2015; 9:163-71. [PMID: 24673891 DOI: 10.1111/eip.12135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 02/05/2014] [Indexed: 11/29/2022]
Abstract
AIM In November 2005 the Italian Center on Control of Maladies, a department operating under the Ministry of Health, financed a project aimed at evaluating the feasibility of a protocol of intervention based on the early intervention in psychosis (EIP) model within the Italian public mental health-care network. METHODS The study was carried out between March 2007 and December 2009. It involved five centres operating under the Departments of Mental Health of Milan (Programma 2000), Rome (area D), Grosseto, Salerno (Nocera) and Catanzaro (Soverato). RESULTS Enrolment lasted 12 months, at the end of which 43 patients were enrolled as first-episode psychosis (FEP), and 24 subjects as ultra high-risk (UHR) patients. Both FEP and UHR samples included a preponderance of male patients. A family history of psychosis was rarely reported in both samples. The FEP incidence rate was lower than expected on the basis of international estimates of the incidence of schizophrenia but within the expected figure for the estimated Italian rates in three centres out of five. CONCLUSIONS Overall, the study proved that an EIP centre can be established within the public Department of Mental Health to reach a good fraction of the cases in need of treatment. Since then, several studies have been set up to assess the feasibility of EIP in the Italian public mental health sector in Lombardy and Tuscany, and in 2012 the Emilia-Romagna Regional Authority started an educational plan aimed at implementing the EIP model in all the Mental Health Departments in the region.
Collapse
Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma 2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
77
|
Nordentoft M, Melau M, Iversen T, Petersen L, Jeppesen P, Thorup A, Bertelsen M, Hjorthøj CR, Hastrup LH, Jørgensen P. From research to practice: how OPUS treatment was accepted and implemented throughout Denmark. Early Interv Psychiatry 2015; 9:156-62. [PMID: 24304658 DOI: 10.1111/eip.12108] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 10/10/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process. METHODS Modified assertive community treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial. RESULTS To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, relatives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophrenia and higher user satisfaction. DISCUSSION The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for implementing early intervention services; as a result, OPUS teams were disseminated throughout the country. The content of the treatment is now further developed, and new elements are being tried out - such as individual placement and support, lifestyle changes, cognitive remediation, specialized treatment for substance abuse and different kinds of user involvement.
Collapse
Affiliation(s)
- Merete Nordentoft
- Mental Health Centre Copenhagen, Mental health Services Capital Region of Denmark, Risskov, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Risskov, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Hastrup LH, Aagaard J. Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year register-based follow-up. Nord J Psychiatry 2015; 69:110-7. [PMID: 25131794 DOI: 10.3109/08039488.2014.936500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. METHODS The study was based on a quasi-experimental design with a control group from the neighbouring region. Costs and retention in mental health services were analysed by using register data 1 year before and 4 years after inclusion in the study. Data on the use of supportive housing were available for the year before baseline and the subsequent 2 years only. RESULTS Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P < 0.17). Days in supportive housing were lower for the ACT group before baseline and remained so (dropping to zero) for the subsequent 2 years. Over 4 years, the mean total costs per patient in the group receiving ACT were DDK 493,442 (SE = 34,292). Excluding costs of supportive housing, the mean total costs per patient of the control group were DDK 537,218 (SE = 59,371), P < 0.53. If these costs are included, however, the mean total costs for the ACT group are unchanged, whereas costs for the control group rise to DDK 671,500 (SE = 73,671), P < 0.03. CONCLUSION While ACT appears to have resulted in a significant reduction in costs for psychiatric hospitalizations, baseline differences in use of supportive housing make the effects of ACT on overall costs more ambiguous. At worst, however, overall costs did not increase. Given the generally acknowledged clinical benefits of ACT over standard outpatient care, the results support further dissemination of ACT in Denmark.
Collapse
Affiliation(s)
- Lene Halling Hastrup
- Lene Halling Hastrup, M.Sc. (Economics), Ph.D., Psychiatric Research Unit , Region Zealand, Toftebakken 9, DK-4000 Roskilde , Denmark
| | | |
Collapse
|
79
|
Iyer SN, Malla AK. Intervention précoce pour la psychose : concepts, connaissances actuelles et orientations futures. ACTA ACUST UNITED AC 2014. [DOI: 10.7202/1027840ar] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article fournit un survol de la logique de l’intervention précoce pour psychose, de ses fondements théoriques et de la littérature essentielle sur le concept. L’intervention précoce repose sur l’hypothèse de la période critique, qui vient accentuer l’importance des premiers stades de la maladie, et sur les résultats d’études dans le domaine, qui suggère que la durée d’une psychose non traitée en influence le pronostic. L’intervention précoce facilite l’accès à un traitement spécialisé adapté à la phase de la maladie par un processus de recommandations médicales plus ouvert, des délais rapides et l’éducation du public et des praticiens sur la psychose. L’intervention précoce, qui dure généralement deux ans à partir du dépistage, comprend une prise en charge intensive et des médicaments antipsychotiques à faible dose. L’accent est mis sur le fonctionnement social, l’intervention familiale, l’attention précoce aux troubles connexes ainsi qu’une alliance thérapeutique entre le jeune et sa famille. Selon les données scientifiques disponibles, une telle intervention donne de meilleurs résultats que les soins typiquement offerts. Les critiques du concept visent la qualité des études en sa faveur, sa mise en oeuvre, la répartition des ressources en intervention précoce et son utilité pour les personnes présentant un risque élevé de psychose. En termes de disponibilité et d’élaboration de politiques en intervention précoce, le Royaume-Uni détient une avance certaine, alors que le Canada se situe au milieu, et les États-Unis au bas de l’échelle. Au Québec, les résultats varient et d’autres études et investissements sont nécessaires. Récemment, le concept d’intervention précoce a servi d’exemple à des mesures plus importantes visant la transformation des soins de santé mentale des jeunes, ce qui constitue une toute nouvelle percée au Canada.
Collapse
Affiliation(s)
- Srividya N. Iyer
- Auteure-ressource, Professeure adjointe, Département de psychiatrie, Université McGill, Montréal, Canada
- Coordonnatrice du Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal, Institut universitaire en santé mentale Douglas, Montréal, Canada
| | - Ashok K. Malla
- Programme d’évaluation, d’intervention et de prévention des psychoses de Montréal (PEPP-Montréal), Institut universitaire en santé mentale Douglas, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
| |
Collapse
|
80
|
Upthegrove R, Ross K, Brunet K, McCollum R, Jones L. Depression in first episode psychosis: the role of subordination and shame. Psychiatry Res 2014; 217:177-84. [PMID: 24726817 DOI: 10.1016/j.psychres.2014.03.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 03/11/2014] [Accepted: 03/21/2014] [Indexed: 12/22/2022]
Abstract
Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.
Collapse
Affiliation(s)
- Rachel Upthegrove
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK.
| | - Kerry Ross
- Wolverhampton Early Intervention Service, Wolverhampton, UK
| | - Katerine Brunet
- University of Birmingham, School of Psychology, Birmingham, UK
| | - Richard McCollum
- Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK
| | - Lisa Jones
- University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK
| |
Collapse
|
81
|
Millan MJ, Fone K, Steckler T, Horan WP. Negative symptoms of schizophrenia: clinical characteristics, pathophysiological substrates, experimental models and prospects for improved treatment. Eur Neuropsychopharmacol 2014; 24:645-92. [PMID: 24820238 DOI: 10.1016/j.euroneuro.2014.03.008] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a complex and multifactorial disorder generally diagnosed in young adults at the time of the first psychotic episode of delusions and hallucinations. These positive symptoms can be controlled in most patients by currently-available antipsychotics. Conversely, they are poorly effective against concomitant neurocognitive dysfunction, deficits in social cognition and negative symptoms (NS), which strongly contribute to poor functional outcome. The precise notion of NS has evolved over the past century, with recent studies - underpinned by novel rating methods - suggesting two major sub-domains: "decreased emotional expression", incorporating blunted affect and poverty of speech, and "avolition", which embraces amotivation, asociality and "anhedonia" (inability to anticipate pleasure). Recent studies implicate a dysfunction of frontocortico-temporal networks in the aetiology of NS, together with a disruption of cortico-striatal circuits, though other structures are also involved, like the insular and parietal cortices, amygdala and thalamus. At the cellular level, a disruption of GABAergic-glutamatergic balance, dopaminergic signalling and, possibly, oxytocinergic and cannibinoidergic transmission may be involved. Several agents are currently under clinical investigation for the potentially improved control of NS, including oxytocin itself, N-Methyl-d-Aspartate receptor modulators and minocycline. Further, magnetic-electrical "stimulation" strategies to recruit cortical circuits and "cognitive-behavioural-psychosocial" therapies likewise hold promise. To acquire novel insights into the causes and treatment of NS, experimental study is crucial, and opportunities are emerging for improved genetic, pharmacological and developmental modelling, together with more refined readouts related to deficits in reward, sociality and "expression". The present article comprises an integrative overview of the above issues as a platform for this Special Issue of European Neuropsychopharmacology in which five clinical and five preclinical articles treat individual themes in greater detail. This Volume provides, then, a framework for progress in the understanding - and ultimately control - of the debilitating NS of schizophrenia.
Collapse
Affiliation(s)
- Mark J Millan
- Pole of Innovation in Neuropsychiatry, Institut de Recherche Servier, 125 Chemin de Ronde, 78290 Croissy-sur-Seine, Paris, France.
| | - Kevin Fone
- School of Biomedical Sciences, Medical School, Queen׳s Medical Centre, Nottingham University, Nottingham NG72UH, UK
| | - Thomas Steckler
- Janssen Research and Development, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - William P Horan
- VA Greater Los Angeles Healthcare System, University of California, Los Angeles, MIRECC 210A, Bldg. 210, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA
| |
Collapse
|
82
|
How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Curr Opin Psychiatry 2014; 27:167-72. [PMID: 24662959 DOI: 10.1097/yco.0000000000000052] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It has been hypothesized that the first 5 years after first episode of psychosis are a critical period with opportunities for ameliorating the course of illness. On the basis of this rationale, specialized assertive early intervention services were developed. We wanted to investigate the evidence basis for such interventions. RECENT FINDINGS The evidence for the effectiveness of specialized assertive early intervention services is mainly based on one large randomized clinical trial, the OPUS trial, but it is supported by the findings in smaller trials, such as the Lambeth Early Onset trial, the Croydon Outreach and Assertive Support Team trial and the Norwegian site of Optimal Treatment trial. There are positive effects on psychotic and negative symptoms, on substance abuse and user satisfaction, but the clinical effects are not sustainable when patients are transferred to standard treatment. However, the positive effects on service use and ability to live independently seem to be durable. SUMMARY Implementation of specialized assertive early intervention services is recommended, but the evidence basis needs to be strengthened through replication in large high-quality trials. Recommendation regarding the duration of treatment must await results of ongoing trials comparing 2 years of intervention with extended treatment periods.
Collapse
|
83
|
Cocchi A, Cerati G, Lora A, Meneghelli A, Monzani E, Percudani M, Petrovich L, Mirabella F, Picardi A, Preti A. Patients With First-Episode Psychosis are Not a Homogeneous Population: Implications for Treatment. Clin Pract Epidemiol Ment Health 2014; 10:1-8. [PMID: 24600479 PMCID: PMC3942866 DOI: 10.2174/1745017901410010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/20/2014] [Accepted: 01/22/2014] [Indexed: 11/22/2022]
Abstract
Objective: This study aimed at defining the characteristics of a population of patients diagnosed with first-episode psychosis (FEP), and accessing for the first time a center for early intervention in psychosis in the health district of Milan and its surroundings. Methods: Patients were included in the study from January 2007 to December 2008; criteria: first contact with any public mental health service of the catchment area for a first episode of schizophrenia or related syndromes according to the ICD-10 criteria. Cluster analysis was used to divide patients into groups based on the main socio-demographic and clinical characteristics at presentation. Results: Overall, 91 FEP patients were enrolled in the study. Two clusters were identified, which differed principally by symptom profile. Patients in cluster 1 (n=36) had severe agitation, and a history of alcohol and/or substance abuse at presentation more often than those in cluster 2 (n=55), who were more likely to suffer at presentation from severe depression or apathy, anxiety, poor self-care, functional or work impairment and severe social withdrawal. After six months of treatment patients improved on almost all symptomatic dimensions on the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale, with greater improvement in cluster 1 than in cluster 2. Conclusions: The findings of this study need replication in larger samples and on a wider severity scale. Nevertheless, the heterogeneity of patients with FEP might impact on treatment. Policymakers should recognize the importance of the diagnostic and outcome assessment in the treatment of severe mental disorders.
Collapse
Affiliation(s)
- Angelo Cocchi
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Giorgio Cerati
- Dipartimento di Salute Mentale, Azienda Ospedaliera Ospedale Civile di Legnano, Italy
| | - Antonio Lora
- Dipartimento Salute Mentale, Azienda Ospedaliera della Provincia di Lecco, Italy
| | - Anna Meneghelli
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emiliano Monzani
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Mauro Percudani
- Dipartimento di Salute Mentale - A.O. "G. Salvini", Garbagnate Milanese, Italy
| | - Lorenzo Petrovich
- Comitato Tecnico per le Innovazioni in Salute Mentale. Direzione Generale Sanità - Regione Lombardia, Milan, Italy
| | - Fiorino Mirabella
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Picardi
- Reparto Salute Mentale, Centro Nazionale di Epidemiologia Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy
| | - Antonio Preti
- Dipartimento di Salute Mentale: Programma2000, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan, Italy
| |
Collapse
|
84
|
McGorry P, Mihalopoulos C. Unhealthy scepticism: time for a fair go for best available evidence. Aust N Z J Psychiatry 2013; 47:602-4. [PMID: 23814150 DOI: 10.1177/0004867413491163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick McGorry
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
| | | |
Collapse
|
85
|
Integrated care in patients with schizophrenia: results of trials published between 2011 and 2013 focusing on effectiveness and efficiency. Curr Opin Psychiatry 2013; 26:384-408. [PMID: 23722100 DOI: 10.1097/yco.0b013e328361ec3b] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Overview on integrated care trials focusing on effectiveness and efficiency published from 2011 to 2013. RECENT FINDINGS Eight randomized controlled trials (RCTs) and 21 non-RCT studies were published from 2011 to 2013. Studies differed in several methodological aspects such as study population, psychotherapeutic approaches used, outcome parameters, follow-up times, fidelities, and implementation of the integrated care model and the nation-specific healthcare context with different control conditions. This makes it difficult to draw firm conclusions. Most studies demonstrated relevant improvements regarding symptoms (P=0.001) and functioning (P=0.01), quality of life (P=0.01), adherence (P<.05) and patient's satisfaction (P=0.01), and reduction of caregiver's stress (P<0.05). Mean total costs were favoring or at least equalizing costs but with positive effects found on subjective health favoring integrated care models. SUMMARY There is an increasing interest in the effectiveness and efficiency of integrated care models in patients with mental disorders, specifically in those with severe and persistent mental illness. To increase generalizability, future trials should exactly describe rationales and content of integrated care model and control conditions.
Collapse
|