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Breitborde NJK, Bell EK, Woolverton C, Pine JG, Waslter H, Moe AM. Cost Utility of cognition-enhancing interventions for individuals with first-episode psychosis: a naturalistic evaluation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:36. [PMID: 34210341 PMCID: PMC8247178 DOI: 10.1186/s12962-021-00292-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although effective treatments are available to address the cognitive deficits experienced by individuals with first-episode psychosis, provision of such treatments within Coordinated Specialty Care (CSC) programs is rare. One factor that may contribute to this is uncertainty about the cost implications of providing cognitive-enhancing treatments within the American mental healthcare system. The aim of this study is to complete a naturalistic evaluation of the cost utility of incorporating two different cognitive-enhancing interventions within an American CSC program. Methods Participants included 66, predominately white (75.38%), individuals with first-episode psychosis (19 women and 47 men) with a mean age of 22.71 years. Quality adjusted life years (QALYs) and cost of care were tracked among these individuals during their participation in a CSC program. These data were compared among three groups of participants during their first six months of care: (i) individuals who participated in metacognitive remediation therapy (MCR), (ii) individuals who participated in computerized cognitive remediation (CCR), and (iii) individuals who participated in no cognitive-enhancing intervention. Results Participation in MCR, but not CCR, was associated with larger gains in QALYs than participation in no cognitive-enhancing intervention within a CSC program. Moreover, data support the cost utility of MCR as compared to CCR or no-cognitive enhancing intervention within a CSC program. Conversely, CCR did not appear to be a cost-effective addition to CSC services. Conclusions Our results highlight the potential cost utility of incorporating MCR within CSC programs for individuals with first-episode psychosis. However, given study limitations, these results should be interpreted cautiously until replicated by large, randomized controlled trials. Trial Registration ClinicalTrials.gov Identifier NCT01570972, registered April 4, 2012, Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01570972?term=breitborde&draw=2&rank=6.
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Affiliation(s)
- Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA. .,Department of Psychology, The Ohio State University, Columbus, USA.
| | - Emily K Bell
- 56th Medical Group, Luke Air Force Base, Glendale, USA
| | | | - Jacob G Pine
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
| | - Heather Waslter
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, USA
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Pine JG, Moe AM, Maple AM, Gallitano AL, Breitborde NJK. Activity-regulated cytoskeleton-associated protein predicts symptom response to cognitive behavioral therapy among individuals with first-episode psychosis. Asian J Psychiatr 2020; 50:101974. [PMID: 32145691 DOI: 10.1016/j.ajp.2020.101974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jacob G Pine
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | | | - Amelia L Gallitano
- College of Medicine Phoenix Basic Medical Sciences, University of Arizona, Phoenix, AZ, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychology, The Ohio State University, Columbus, OH, USA
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Breitborde NJK, Moe AM. Optimizing Mental Health Treatment for Emerging Adults with First-Episode Psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23794925.2018.1514546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Nicholas J. K. Breitborde
- Departments of Psychiatry & Behavioral Health and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Aubrey M. Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Breitborde NJK, Moe AM, Ered A, Ellman LM, Bell EK. Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions. Psychol Res Behav Manag 2017; 10:119-128. [PMID: 28490910 PMCID: PMC5414722 DOI: 10.2147/prbm.s111593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.
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Affiliation(s)
- Nicholas JK Breitborde
- Department of Psychiatry and Behavioral Health
- Department of Psychology, The Ohio State University, Columbus, OH
| | | | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Emily K Bell
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
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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.
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Conrad AM, Lewin TJ, Sly KA, Schall U, Halpin SA, Hunter M, Carr VJ. Ten-year audit of clients presenting to a specialised service for young people experiencing or at increased risk for psychosis. BMC Psychiatry 2014; 14:318. [PMID: 25403891 PMCID: PMC4239381 DOI: 10.1186/s12888-014-0318-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 10/24/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the 'baseline characteristics' of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation). METHODS Data are reported from a 10-year layered service audit of all presentations to a 'Psychological Assistance Service' for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients' psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere. RESULTS Clients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction. CONCLUSIONS Whether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere.
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Affiliation(s)
- Agatha M Conrad
- CTNMH (MH-READ), Hunter New England Mental Health and the University of Newcastle, McAuley Centre, The Mater, PO Box 833, Newcastle, NSW 2300 Australia
| | - Terry J Lewin
- CTNMH (MH-READ), Hunter New England Mental Health and the University of Newcastle, McAuley Centre, The Mater, PO Box 833, Newcastle, NSW 2300 Australia ,Schizophrenia Research Institute, Darlinghurst, Sydney NSW 2010 Australia
| | - Ketrina A Sly
- CTNMH (MH-READ), Hunter New England Mental Health and the University of Newcastle, McAuley Centre, The Mater, PO Box 833, Newcastle, NSW 2300 Australia
| | - Ulrich Schall
- CTNMH (MH-READ), Hunter New England Mental Health and the University of Newcastle, McAuley Centre, The Mater, PO Box 833, Newcastle, NSW 2300 Australia ,Schizophrenia Research Institute, Darlinghurst, Sydney NSW 2010 Australia ,Psychological Assistance Service, Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Sean A Halpin
- CTNMH (MH-READ), Hunter New England Mental Health and the University of Newcastle, McAuley Centre, The Mater, PO Box 833, Newcastle, NSW 2300 Australia ,Psychological Assistance Service, Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Psychology, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Mick Hunter
- School of Psychology, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Vaughan J Carr
- Schizophrenia Research Institute, Darlinghurst, Sydney NSW 2010 Australia ,School of Psychiatry, University of New South Wales, Kensington, NSW 2033 Australia
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Galletly C. Debates, disputes, discussions and deliberations. Aust N Z J Psychiatry 2012; 46:917-8. [PMID: 23028189 DOI: 10.1177/0004867412461535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia.
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