Outcome at 2-year of treatment in first-episode psychosis patients who were enrolled in a specialized early intervention program

Treatment in early intervention services (EIS) seems superior to treatment as usual on several outcomes, but the extent of heterogeneity in response is unclear. In this study, treatment response trajectories up to 2 years in first-episode psychosis (FEP) patients enrolled in an Italian early intervention service (EIS) have been quantified. The 24-item Brief Psychiatric Rating Scale (BPRS) was used to quantify treatment response up to 2 years in 129 participants. Conditional growth modeling and latent class growth analysis were used to test changes over time in the BPRS and separation into independent classes over time. Group differences were tested on socio-demographic and clinical variables known to be related to outcome in psychosis. Scores on the BPRS showed a statistically significant decrease in overall scores across all tested models. Four trajectories were identified across 2 years. Most patients showed a progressive decrease in the BPRS scores; a scant fraction showed a more stepped decrease from very high levels of psychopathology. No potential predictor was statistically related to the time course of BPRS scores. Most patients that undergo treatment within an EIS are characterized by amelioration, but patients that have higher baseline scores of psychopathology require more intensive treatment

Cost-effectiveness of treating first-episode psychosis: five year follow-up results from an Italian early intervention programme

Aim: Early intervention programmes are expected to result in the reduction of illness severity in patients with schizophrenia, and contain healthcare costs by reducing hospital admissions and improving the social functioning of patients. This study aimed to investigate the costeffectiveness of treatment in an early intervention programme in comparison to standard care. Methods: Retrospective analysis of data prospectively recorded in an urban area (Milan, Italy). Twentythree patients from an early intervention programme and 23 patients from standard care with first-episode psychosis were evaluated on their use of services over a 5-year period. The Health of the Nation Outcome Scale was used to measure clinical status. Results: Significant changes with respect to initial assessment were recorded on the Health of the Nation Outcome Scale,with larger effect sizes in the early intervention programme than in the standard care group. Consequently, the cost-effectiveness ratio per reduced score of severity was lower in the early intervention programme than in standard care (\u20ac 4802 vs. \u20ac 9871), with an incremental costeffectiveness ratio, or net saving of \u20ac -1204 for every incremental reduced score of severity. Over time, greater recourse to hospital and residential facilities to obtain comparable improvement in symptoms resulted in a steady cost increase for the patients in standard care. Conclusions: Allocation of funds to specialized early intervention programmes is the best alternative, as it can save costs by reducing the use of hospitals and residential facilities, and may produce net savings of costs in the long term

Spectral Parameters for Scattering Amplitudes in N=4 Super Yang-Mills Theory

49 pages, 20 figures; v2: typos fixedPlanar N=4 Super Yang-Mills theory appears to be a quantum integrable four-dimensional conformal theory. This has been used to find equations believed to describe its exact spectrum of anomalous dimensions. Integrability seemingly also extends to the planar space-time scattering amplitudes of the N=4 model, which show strong signs of Yangian invariance. However, in contradistinction to the spectral problem, this has not yet led to equations determining the exact amplitudes. We propose that the missing element is the spectral parameter, ubiquitous in integrable models. We show that it may indeed be included into recent on-shell approaches to scattering amplitude integrands, providing a natural deformation of the latter. Under some constraints, Yangian symmetry is preserved. Finally we speculate that the spectral parameter might also be the regulator of choice for controlling the infrared divergences appearing when integrating the integrands in exactly four dimensions.Peer reviewe