Are the short-term cost savings and benefits of an early psychosis program maintained at 8-year follow-up?

This study aims to identify correlates of vocational functioning in a first episode psychosis (FEP) sample 7.5 years after presentation at a specialized early psychosis treatment service. The study involved a prospective, naturalistic follow-up of FEP patients commencing treatment with the Early Psychosis Prevention & Intervention Centre (EPPIC) in Melbourne, Australia, between 1995 and 1997. At treatment entry the Royal Park Multidiagnostic Instrument for Psychosis was used to assess duration of untreated psychosis (DUP), age at onset of psychotic disorder, and premorbid work/social functioning. At 7.5-year follow-up measures included the Brief Psychiatric Rating Scale (Thinking Disturbance subscale), Scale for the Assessment of Negative Symptoms (Alogia subscale), WHO Life Chart Schedule (to assess course of illness, treatment history, and duration of receipt of a disability support pension (DSP)), and the Structured Clinical Interview for DSM-IV (to derive Axis I diagnoses). Analyses involved 180 participants. Univariate and multivariate logistic regression analyses were used to estimate the effects of demographic, clinical and treatment variables on two outcomes: current employment; and durable employment (employment for more than 6 months in the past 2 years). The sample was primarily male (72%), with a mean age at follow-up of 29 years (sd=3.4). 45% reported current participation in competitive employment at 7.5 year follow-up (28% full-time, 17% part-time), and 53% reported recent durable employment. Multivariate analyses showed that, after controlling for other variables (including positive and negative thought disorder, premorbid functioning, and recent psychiatric treatment), current employment was negatively associated with continuous or episodic illness course characterized by worsening trajectory or incomplete remissions, disrupted education, and receiving a DSP for longer than 2 years. Lifetime diagnosis of schizophrenia, receipt of a DSP (regardless of duration) and disrupted education were negatively associated with durable employment. Educational attainment appears to be an important predictor of vocational outcome in the Australian labor market, although its relationship with premorbid functioning requires further investigation. The inverse relationship between DSP and employment, after controlling for symptom levels and course of illness, supports evidence from US studies that such payments may act as a disincentive to employment

Ever-Closer in Brussels – Ever-Closer in the World? EU External Action after the Lisbon Treaty

This edited Working Paper addresses three fundamental questions concerning EU External Action after the Lisbon Treaty: the institutional position and allegiance of the newly-established European External Action Service, the future of the ‘left out’ Directorate-General for Trade and the Common Commercial Policy, and the protection of EU citizens abroad. These enquires are prompted by both an institutional innovation – the launch of the EEAS – as well as by a number of substantive changes to the legal framework of EU External Action. An ambitious agenda has been inserted into the primary law, around which the Union institutions and Member States are to rally. It is in turn the raison d’être of the EEAS to foster the ensuing need for consistency, as well as to provide impetus to the EU’s external action. Structurally, it is in itself a sui generis institution composed of officials from the Commission, the Council and the Member States. This raises a number of fundamental questions that go well beyond those concerning which person is going to be the new EU ambassador in Washington or Beijing. Above all, can these substantive and institutional innovations live up to the grand ambitions of the peculiar entity that is the EU? What old problems does it purport to solve, and what are the new problems it is likely to create? Essentially, to which extent does bundling the external objectives in the Treaties as well as pooling together the institutional resources in Brussels and the delegations actually render the EU an ‘ever-closer’ actor in the world? bookGlobal Challenges (FGGA