Treatment costs and clinical outcome for first episode schizophrenia patients: A 3-year follow-up of the Swedish 'Parachute Project' and Two Comparison Groups
ABSTRACT To evaluate "need-specific treatment" of first episode schizophrenia syndrome patients.
Sixty-one consecutive first episode schizophrenia syndrome patients were followed over 3 years. They were compared with a Historical "treatment as usual" group (n = 41) and a Prospective group from a high quality social and biological psychiatry centre (n = 25).
Symptomatic and functional outcome was significantly better compared with the Historical group and equal with the Prospective group. During the first year, the direct costs for in- and out-patient care per patient in the Parachute project were less than half of those in the Prospective group.
The study confirms the feasibility, clinically and economically, with a large scale application of "need-specific treatments" for first episode psychotic patients.
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- "The latest PORT review (Dixon et al., 2010) found no published studies on dynamic or supportive psychotherapies of schizophrenia and thus did not mention that category in the review. Only a limited numbers of studies have compared psychotherapeutic and psychosocial interventions in persons with firstepisode psychoses for a period spanning two years or more after their inclusion (Bertelsen et al. 2008; Cullberg et al., 2006; Drury, Birchwood, & Cochrane, 2000; Gafoor et al., 2010; Hogarthy, 2002; Malmberg & Fenton, 2008; Morrison et al., 2007; Penn, Waldheter, Perkins, Mueser, & Lieberman, 2005; Startup, Jackson, Evans, & Bendix, 2005). Only a few of these studies are largescale studies, and none of these have addressed psychodynamic psychotherapy. "
ABSTRACT: The UK National Institute for Health and Care Excellence guidance suggests that psychodynamic principles may be used to understand the experi ences of people with psychosis. In this article we consider the application of psychodynamic princi ples in psychotherapy for psychosis, focusing on one particular model: supportive psychodynamic psychotherapy (SPP). We describe this approach with a detailed fictitious case example and discuss how SPP has developed through significant modifi cations of classical psychoanalytic therapy and the evidence base for it. We consider its overlap with cognitive–behavioural therapy, its advantages and disadvantages, and the arguments for making SPP available as a treatment option in services for psychosis.Advances in Psychiatric Treatment 07/2013; 19:310-318. DOI:10.1192/apt.bp.111.009142
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- "EI programs have since proliferated, especially in countries with nationalized health care systems (Mihalopoulos et al., 1999, Phillips et al., 2000). Reports from around the world (Yung et al., 1996; Chong et al., 2004; Killackey and Yung, 2007; Malla et al., 2001; Cullberg et al., 2006; Valmaggia et al., 2009) have indicated that outpatient EI programs reduce hospitalization rates and improve quality of life, leading to significant cost savings even when patients later develop psychosis. These findings suggested that funding EI programs might improve the course of illness, lessening public expenditures while reducing the distress, functional disability, and financial burden affecting patients and their families (Mihalopoulos et al., 2009). "
ABSTRACT: Recently, there has been increasing emphasis on early intervention (EI) for psychotic disorders. EI programs in public mental health settings have been established in countries such as Australia, the United Kingdom, and Canada. However, there are relatively few EI programs in the United States (U.S.). Here we describe the conceptual origins and practical development of the PREP program, i.e., Prevention and Recovery in Early Psychosis, as it evolved in a public academic psychiatry setting in Boston, Massachusetts, U.S. PREP developed over a decade through a partnership between the Massachusetts Department of Mental Health and academic institutions within the Harvard Department of Psychiatry. We discuss the evolution, programmatic features, funding mechanisms, staffing, and the role of clinical training in PREP. The key principles in developing the PREP Program include the focus on early, evidence based, person-centered and phase-specific, integrated and continuous, comprehensive care. This program has served as a foundation for the emergence of related services at our institution, including a research clinic treating those at clinical high risk or within the putative "prodromal" period preceding frank psychosis. This account offers one possible blueprint for the development of EI programs despite the lack in the U.S. of a national mandate for EI or prevention-based mental health programs.04/2013; 6(2):171-7. DOI:10.1016/j.ajp.2012.10.009
Psychiatria Danubina 09/2009; 21 Suppl 1:51-60. · 0.65 Impact Factor
- "Scandinavians have some quite mature models of psychosis and of its therapy that integrate multiple vantage points including psychodynamic and systemic understandings of individuals and families in psychosis with biological and genetic vulnerabilities (Alanen 1997, Cullberg 2006, Seikkula 2006). The clinical outcomes are impressive (Cullberg 2006, Seikkula 2006). "