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. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011.

Narrowing the creativity gap: the moderating effects of perceived support for creativity.

This article examines the role of 3 types of perceived support for creativity in moderating the relation between creative self-efficacy and self-perceived creativity. The findings suggest significant interaction effects for perceived work-group support and supervisor support, but not for perceived organizational support. This study is among the first to (a) examine the importance of perceived support for creativity in unlocking creative potential and increasing creativity in organizations and (b) use interaction terms in structural equation modeling (SEM) to investigate moderator effects in an applied research setting. These results imply that organizational interventions focused on training supervisors and work-group members to support creativity in the workplace may be more effective than broader and less focused interventions at the organizational level.

Perceived organizational support and turnover intention: the mediating effects of personal sacrifice and job fit.

This study examines the mediating role of job fit on the relationship between perceived supervisor support (PSS) and perceived organizational support (POS), and the mediating role of personal sacrifice on the relationship between POS and turnover intention. We use structural equation modeling (SEM) with a data set consisting of a sample of 346 individuals in a manufacturing firm to test our proposed model of PSS, POS, and turnover intention. Consistent with prior literature, our hypothesized model confirms that PSS is a predictor of POS and that POS is a predictor of turnover intention. By testing two additional competing and theoretically derived nested models, our findings indicate that job fit partially mediates the relationship between PSS and POS, and that personal sacrifice partially mediates the relationship between POS and turnover intention. Our study is among the first to examine job fit and personal sacrifice as mediators within the POS-turnover intention model.

Tacit knowledge: A refinement and empirical test of the Academic Tacit Knowledge Scale.

Researchers have linked tacit knowledge to improved organizational performance, but research on how to measure tacit knowledge is scarce. In the present study, the authors proposed and empirically tested a model of tacit knowledge and an accompanying measurement scale of academic tacit knowledge. They present 6 hypotheses that support the proposed tacit knowledge model regarding the role of cognitive (self-motivation, self-organization); technical (individual task, institutional task); and social (task-related, general) skills. The authors tested these hypotheses with 542 responses to the Academic Tacit Knowledge Scale, which included the respondents' grade point average-the performance variable. All 6 hypotheses were supported.

A randomized controlled trial of cognitive remediation and d-cycloserine for individuals with bipolar disorder.

BACKGROUND: Cognitive remediation (CR) has shown significant promise in addressing the cognitive deficits that accompany serious mental illness. However, this intervention does not appear to completely ameliorate the cognitive deficits that accompany these illnesses. D-cycloserine (DCS), an NMDA receptor partial agonist, has been shown to enhance the therapeutic benefits of learning-based psychosocial interventions for psychiatric disorders. Thus, the goal of this study is to examine the utility of combining cognitive remediation and d-cycloserine in the treatment of cognitive deficits among individuals with bipolar disorder. METHODS/DESIGN: Approximately forty individuals with bipolar disorder will be recruited to participate in this study. Participants will be randomized to one of two study arms: CR + DCS or CR + placebo. The primary outcome for this study is change in cognitive functioning. We will also examine several secondary outcomes, including the rate of change of cognitive functioning, social functioning, and symptomatology. DISCUSSION: Cognitive deficits are a rate-limiting factor in functional recovery among individuals with bipolar disorder. Unfortunately, treatment options for these deficits are limited. The results of the proposed study may reveal a valuable intervention strategy (i.e., CR with concurrent DCS) to improve cognitive functioning among individuals with bipolar disorder. Ultimately, this treatment strategy may prove useful in addressing the cognitive deficits that are ubiquitous across serious mental illnesses. TRIAL REGISTRATION: ClinicalTrials.gov NCT01934972.

Toward a social capital theory of competitive advantage in medical groups.

Social capital can have a positive impact on medical group performance. We forward our theory based on the integration of theories in social capital, resource advantage, and the resource-based view of the firm. Further, we suggest specific ways in which medical groups can increase their levels of social capital. First, medical groups should design or redesign the workplace so that there is ample interaction among employees. Second, employee participation within the community should be encouraged. Third, medical groups should recognize that social capital becomes ingrained in organizational culture. Therefore, medical groups should take steps to ensure a culture that supports its social capital. Fourth, hiring procedures should be designed (or redesigned) to ensure that new employees add social capital to the organization. Finally, trust must be fostered at the employee level.