The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service.

BACKGROUND: There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS: Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS: Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS: The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011.

[Patient characteristics, length of treatment and costs in a model institution of community mental health care]. / Patientenmerkmale, Behandlungsdauer und Kosten in einem gemeindepsychiatrischen Versorgungsmodell - Eine Analyse über 23 Jahre.

AIM: Since the 1970s, a model institution for community mental health care with three partial hospitalisation programmes and various out-patient services was run in the Berlin district Charlottenburg. The study evaluates, to what extent the institution fulfilled its aim to provide long-term care for severely and chronically ill patients at relatively low costs. It also identified predictors of outcome. METHOD: Case register data of 1194 patients who were treated within a period of 23 years were analysed. Patient characteristics, length of care and treatment costs are presented. Costs were calculated on the basis of daily rates as paid to care providers in 1996. Regression analyses were computed for predicting length of care and costs after the first year. RESULTS: On average, length of care was 2.4 years and costs per year were 57 000,- German Marks ( 29 000,-). Patients with shorter and longer duration of care differed in only a few of the recorded sociodemographic and clinical characteristics. Significant predictors for long-term costs were the legal status of being under a care order and costs in the first year. However, only 18 % of the variance of costs after the first year were explained. CONCLUSIONS: The findings suggest that a) community mental health care in the studied form may not reach all patients with severe mental illness, b) in most cases, the notion of a lifelong treatment in such care systems does not reflect reality, c) the paid costs are lower than for long-term in-patient care, but still rather high, and d) the usually recorded patient characteristics are of little value for predicting long-term outcome.

Supported housing for the mentally ill elderly: implementation and consumer choice.

The development of innovative alternatives to nursing homes is critical, especially in the context of OBRA mandates and the growing geriatric population. This article examines the experience of one urban country in Washington State in providing supported housing for the OBRA-affected mentally ill elderly. The significance of this demonstration project is its "bold" new approach in applying this emerging model to the elderly. It illustrates the perspectives and experience of both consumers and caregivers in implementing the supported housing approach, and the tensions between consumer preferences and staff, organizational and funding constraints.

Impact of assertive community treatment on the use of state hospital inpatient bed-days.

OBJECTIVE: The purpose of the study was to determine whether use of inpatient services at a state hospital was reduced by implementation of an assertive community treatment program among persons in one of the hospital's catchment areas who were at high risk for rehospitalization. METHODS: Bed-day utilization by program participants during the fiscal year before the program was implemented (1986) and three subsequent fiscal years was compared with utilization by persons in catchment areas not served by the program. For the 66 program participants, hospital use during the year before program intake was compared with use in the year after intake using t tests. RESULTS: Utilization of bed-days by persons in the program's catchment area was reduced by 28 percent in the third fiscal year after program implementation, compared with an increase of 15 percent among persons in the hospital's other catchment areas. In the year after the program was implemented, participants were hospitalized a mean of 27.7 days, compared with a mean of 80 days in the year before the program. CONCLUSIONS: The assertive community treatment program significantly reduced use of inpatient days and improved continuity of care.

[An economic evaluation in the pharmacokinetic prediction of preventive carbamazepine therapy]. / Ekonomicheskaia otsenka farmakokineticheskoi prediktsii preventivnoi terapii karbamazepinom.

The paper is concerned with the data of economic evaluation of pharmacokinetic prediction of the individual efficacy of preventive carbamazepin therapy of patients suffering from affective and schizoaffective psychoses. The study was carried out with the aid of the indicators of "direct" and "indirect" expenditures characterizing the efficacy of the use of carbamazepin in the treatment period as compared to the control one, using the pharmacokinetic predictors of the efficacy and without them. The potential economic efficacy of carbamazepin therapy appreciably increases provided the differential diagnostic indications for drug administration are specified. Such a technique of economic analysis of the data of psychopharmacokinetic studies enables their quantitative estimation and determination of economically important research priorities in that area.

Estimating clozapine's cost to the nation.

Clozapine, an effective but expensive drug treatment for patients with severe, chronic schizophrenia who are unresponsive to conventional antipsychotics, is associated with a high risk of agranulocytosis, which is sometimes fatal. Weekly blood tests to detect evidence of this side effect are required. To estimate the number of potential candidates for this treatment and the national cost of administering the drug to this population, the authors used data from three recent patient surveys conducted in New York State. Depending on the criteria used to exclude unsuitable candidates, between 133,000 and 189,000 individuals will be eligible for treatment with clozapine nationally at a cost of $1.2 to $1.7 billion annually.