No abstract

BackgroundThere 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).MethodsSixty-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.ResultsOver 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.ConclusionsThe 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 registrationClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011

Married couples evidence interdependence in their psychological and physical wellbeing across the life span. This is particularly true in aging populations that experience declines in physical health and cognitive ability. This study investigated the effects of partners' physical health and cognition on quality of life (QoL) in a series of bivariate latent curve growth models. The sample included aging married couples (N = 8,187) who participated in the Survey of Health, Ageing, and Retirement in Europe (SHARE) study and provided data across 6 years. Results indicated that husbands' and wives' baseline levels and rates of change in QoL covaried significantly over time. In addition, husbands' and wives' physical health and cognition predicted their partners' baseline level of QoL above and beyond their own health and cognition, and these effects were of equivalent size for both men and women. The findings suggest that as couples age, husbands' and wives' QoL, cognition, and health are predictive of their partners' QoL.

MST may be an important component within cognitive remediation programmes for first-episode psychosis.

Our results support the obesity paradox in cognitive aging, with lower baseline body mass predicting better cognition, but less decline over time protecting against cognitive decline. We discuss how weight loss in the elderly may serve as a useful indicator of co-occurring cognitive decline, and we discuss implications for health care professionals.