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.


BACKGROUND
ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011.
Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA. Nicholas.Breitborde@osumc.edu.|Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Nicholas.Breitborde@osumc.edu.
Nicholas J K
NJ
Breitborde
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Emily.Bell@bannerhealth.com.
Emily K
EK
Bell
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Dawley@email.arizona.edu.
David
D
Dawley
Department of Psychology, The University of Arizona, Tucson, Arizona, USA. Cindyw@email.arizona.edu.
Cindy
C
Woolverton
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Alan.Ceaser@bannerhealth.com.|Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA. Alan.Ceaser@bannerhealth.com.
Alan
A
Ceaser
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Allison.Waters@bannerhealth.com.|Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA. Allison.Waters@bannerhealth.com.
Allison C
AC
Waters
Department of Psychology, The University of Arizona, Tucson, Arizona, USA. scdawson@email.arizona.edu.
Spencer C
SC
Dawson
VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California, USA. Andrew.Bismark@gmail.com.
Andrew W
AW
Bismark
Department of Psychology, The University of Arizona, Tucson, Arizona, USA. Apolsine@email.arizona.edu.
Angelina J
AJ
Polsinelli
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Lisabartolomeo@email.arizona.edu.
Lisa
L
Bartolomeo
Department of Education, The University of Arizona, Tucson, Arizona, USA. Jessicasimmons@email.arizona.edu.
Jessica
J
Simmons
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Beth.Bernstein@bannerhealth.com.
Beth
B
Bernstein
Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. Patricia.Harrison-Monroe@bannerhealth.com.
Patricia
P
Harrison-Monroe
D000293:Adolescent; D000328:Adult; D000341:Affective Disorders, Psychotic / Q000191:economics / Q000628:therapy; D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D001130:Arizona; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D061345:Early Medical Intervention / Q000191:economics; D005260:Female; D006266:Health Education; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000191:economics / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000191:economics / Q000628:therapy; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult