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Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
Methods
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Results
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Conclusions
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Party polarization is perhaps the most significant political trend of the past several decades of American politics. Many observers have pinned hopes on institutional reforms to reinvigorate the political center. The Top Two primary is one of the most interesting and closely-watched of these reforms: a radically open primary system that removes much of the formal role for parties in the primary election and even allows for two candidates of the same party to face each other in the fall. Here we leverage the adoption of the Top Two in California and Washington to explore the reform’s effects on legislator behavior. We find an inconsistent effect since the reform was adopted in these two states. The evidence for post-reform moderation is stronger in California than in Washington, but some of this stronger effect appears to stem from a contemporaneous policy change—district lines drawn by an independent redistricting commission—while still more might have emerged from a change in term limits that was also adopted at the same time. The results validate some claims made by reformers, but question others, and their magnitude casts some doubt on the potential for institutions to reverse the polarization trend.
When women run for office, they win at the same rate as men. A significant body of research substantiating this claim has been touted by scholars and women's groups alike. “Gender neutral” outcomes, however, mask important sex differences in congressional candidacies. Indeed, extensive research has revealed a gender gap in political ambition: women are more hesitant to run for office and are more concerned about their credentials and viability than similarly situated men.
This article discusses whether candidates and campaigns in US House elections condition the influence of national political tides by magnifying their effects at the local level. Using election returns, it is shown that this interaction effect is quite small: a positive national tide increases votes for weak candidates almost as much as strong ones. However, competition and national tides in US House elections do interact to produce turnover: high-spending challengers rarely win without the help of a national tide. Contrary to many accounts in the American politics literature, it is also found that the tide's influence is weaker in open seats in certain important ways. Together, these findings suggest that US House candidates benefit from national tides but have a limited ability to create them, and that the prospects for national responsiveness are hurt by the trend towards heavier competition in open seats.
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