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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Gupta N, Gupta M, Esang M. Lost in Translation: Challenges in the Diagnosis and Treatment of Early-Onset Schizophrenia. Cureus 2023; 15:e39488. [PMID: 37362509 PMCID: PMC10290525 DOI: 10.7759/cureus.39488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Early-onset schizophrenia (EOS) is a heterogeneous condition that has a serious, insidious clinical course and poor long-term mental health outcomes. The clinical presentations are highly complex due to the overlapping symptomatology with other illnesses, which contributes to a delay in the diagnosis. The objective of the review is to study if an earlier age of onset (AAO) of EOS has poor clinical outcomes, the diagnostic challenges of EOS, and effective treatment strategies. The review provides a comprehensive literature search of 5966 articles and summarizes 126 selected for empirical evidence to methodically consider challenges in diagnosing and treating EOS for practicing clinicians. The risk factors of EOS are unique but have been shared with many other neuropsychiatric illnesses. Most of the risk factors, including genetics and obstetric complications, are nonmodifiable. The role of early diagnosis in reducing the duration of untreated psychosis (DUP) remains critical to reducing overall morbidity. Many specific issues contribute to the risk and clinical outcomes. Therefore, issues around diagnostic ambiguity, treatment resistance, nonadherence, and rehospitalizations further extend the DUP. There is hesitancy to initiate clozapine early, even though the empirical evidence strongly supports its use. There is a growing body of research that suggests the use of long-acting injectables to address nonadherence, and these measures are largely underutilized in acute settings. The clinical presentations of EOS are complex. In addition to the presence of specific risk factors, patients with an early onset of illness are also at a higher risk for treatment resistance. While there is a need to develop tools for early diagnosis, established evidence-based measures to address nonadherence, psychoeducation, and resistance must be incorporated into the treatment planning.
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Affiliation(s)
- Nihit Gupta
- Psychiatry, Dayton Children's Hospital, Dayton, USA
| | - Mayank Gupta
- Psychiatry and Behavioral Sciences, Southwood Psychiatric Hospital, Pittsburgh, USA
| | - Michael Esang
- Psychiatry and Behavioral Sciences, Clarion Psychiatric Center, Clarion, USA
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Valdes EG, Gorman JM, Ren Y, Bowling M, Steiner L, Bethea J, Aamar R, Andel R, Reist C. Behavioral Health Diagnoses and Health Care Use Before and During the COVID-19 Pandemic. Psychiatr Serv 2022; 73:801-804. [PMID: 34991341 DOI: 10.1176/appi.ps.202100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Emerging evidence has suggested a population-wide worsening of psychiatric symptoms during the COVID-19 pandemic, particularly among individuals with preexisting mental health conditions. The authors investigated whether reported behavioral health problems are being identified and treated. METHODS This observational cohort study retrospectively compared Medicaid data of patients from the first year of the pandemic (2020) in the United States (N=1,589,111 patients) with the corresponding data from the year before (2019; N=1,715,872 patients). Outcome measures included several behavioral health diagnoses and health care utilization. RESULTS During the pandemic period examined, the numbers of patients served, adults receiving a new diagnosis of anxiety, and children receiving a new diagnosis of depression all increased. Across all age groups, nonbehavioral health emergency department visits significantly decreased. CONCLUSIONS These findings support reports of increases in psychiatric morbidity but do not provide evidence for increased demand for health care services.
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Affiliation(s)
- Elise G Valdes
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Jack M Gorman
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Yingqian Ren
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Matt Bowling
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Leigh Steiner
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Johnny Bethea
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Rola Aamar
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Ross Andel
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
| | - Christopher Reist
- Relias, L.L.C., Morrisville, North Carolina (Valdes, Gorman, Ren, Bowling, Steiner, Bethea, Aamar, Reist); Franklin Behavioral Health Consultants, New York City (Gorman); Department of Aging Studies, University of South Florida, Tampa (Andel); Science 37 Inc., Culver City, California (Reist)
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Rubio JM, Kane JM. The pharmacological treatment of schizophrenia: How far have we come? PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e13. [PMID: 38868633 PMCID: PMC11114354 DOI: 10.1002/pcn5.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2024]
Abstract
Schizophrenia is a chronic and often severe mental disorder for which antipsychotic drugs are the cornerstone of treatment. Although the essential mechanism of action of these drugs has not changed much since they were first discovered in the 1950s, there have been numerous advances in the context in which these drugs are prescribed, as well as in the considerations for their optimal use. In this review, we summarize five selected issues in which the psychopharmacological treatment of schizophrenia has most evolved. Namely, these are the shift of outcomes of interest from symptoms to recovery, the development of stratified approaches to select the most appropriate treatment for each individual, the recognition of treatment nonadherence as a critical factor determining outcomes, the recommendations for maintenance treatment, and, finally, the promise of new antipsychotic compounds that innovate in their mechanisms of action, improving efficacy/safety profiles. Finally, we discuss how some of these advances have already delivered to improved outcomes in the real world, whereas others have demonstrated efficacy under optimal circumstances yet have not been translated into better outcomes in the community. Thus, the road ahead includes both identifying novel treatments that engage the psychopathology of the illness and improve the efficacy/tolerability profile of currently available agents, as well as developing interventions that mitigate the barriers for the use of novel interventions, some of them already existing, in the real world.
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Affiliation(s)
- Jose M. Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra—Northwell, Feinstein Institutes of Medical Research—Institute of Behavioral ScienceZucker Hillside Hospital—Northwell HealthGlen OaksNYUnited States
| | - John M. Kane
- Donald and Barbara Zucker School of Medicine at Hofstra—Northwell, Feinstein Institutes of Medical Research—Institute of Behavioral ScienceZucker Hillside Hospital—Northwell HealthGlen OaksNYUnited States
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