Improvement In Occupational Functioning Research Articles

T221. CAUSAL RELATIONSHIPS BETWEEN EMPATHY, MOTIVATION AND FUNCTIONAL OUTCOMES IN EARLY SCHIZOPHRENIA IDENTIFIED WITH CAUSAL DISCOVERY MODELING

BackgroundSchizophrenia is characterized by devastating impairments in occupational and social functioning. These impairments result in poor quality of life, have significant societal burden, and are resistant to current treatments. Although a number of predictors of poor functional outcomes have been identified, the causal relationships between malleable illness variables and functional status must be discovered to establish the most promising candidate treatment targets. The aim of this research is to employ a data-driven causal network approach in the Recovery After an Initial Schizophrenia Episode (RAISE) trial to identify variables that have causal effects on occupational and social functioning. Our second aim was to validate our results in an independent sample drawn from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.MethodsMeasures of neurocognition, motivation, empathy, psychiatric symptoms, duration of untreated psychosis, and social and occupational functioning were obtained for 279 participants with early schizophrenia enrolled in RAISE. Data were analyzed using a machine learning causal discovery algorithm, Greedy Fast Causal Inference, which infers causal relationships among the variables while identifying potential influences of latent variables. Causal effect sizes (ES) were estimated by fitting a linear structural equation model to the causal graph. Graph stability was evaluated by running GFCI on 1000 jackknifed and 1000 bootstrapped datasets. Results were validated using a similar set of variables in 187 participants in the CATIE study who were within five years of initiating antipsychotic treatment.ResultsBaseline empathy caused baseline motivation (ES = 0.77), which in turn caused both baseline social (ES = 1.5) and occupational (ES = 0.96) functioning. Baseline social and occupational functioning then caused six-month social and occupational functioning, respectively. Additionally, at the six-month time point, social functioning caused motivation (ES = 0.21), which in turn caused occupational functioning (ES = .92). Causal relationships between motivation and social functioning were cyclical through time. The causal structure in the CATIE dataset had some less determinate edge orientations, but otherwise confirmed the findings from RAISE. The jackknife and bootstrap causal graphs showed high concordance with all graph features in the social and occupational functioning subgraphs.DiscussionMotivation and empathy at baseline have causal effects on both occupational and social functioning six months after entering treatment in early schizophrenia. In addition, an improvement in social functioning over six-months may drive improvements in occupational functioning. This indicates that future research should test the efficacy of interventions targeting motivation and empathy for promoting functional recovery in early schizophrenia as soon as individuals enter treatment.

Effects of Cognitive Remediation in Patients with Mood Disorder

Introduction Neurocognitive impairment constitutes a core feature of mood illness. It compromises personal and social functioning. Cognitive Remediation (CR) is accepted as an important therapeutic intervention in schizophrenia, but few studies provide data on whether the benefits extend to mood disorder. Objectives To examine the profile and magnitude of cognitive impairments in mood disorder, review the evidence in support of CR for this population, and discuss future research directions in CR. Methods A literature search was conducted using Medline database. Combinations of multiple keywords were searched: mood disorder, neurocognition, cognitive remediation, cognitive training, functional remediation. Randomized-controlled trials and key studies published until 2013 were included. Results We included seven studies, comprising a total of 398 participants, 71% of whom had bipolar disorder, 14% schizophrenia, 12% major depressive disorder, and 3% schizoaffective disorder. Only two studies included merely patients with bipolar disorder. It has been estimated that 30 to 60% of patients with bipolar disorder have trait-related cognitive deficits. In two studies, patients received a non-computerized programme. In the five other studies, a computer-assisted programme was delivered. The average duration of therapy was about 13.1 weeks. Effect sizes ranged from 0.33 to 0.93. Results showed that improvements in executive functioning were associated with improvements in occupational functioning. Conclusion CR in patients with mood disorder may be an effective non-pharmacological treatment option for improving cognitive functions, which may improve psychosocial functioning. Further studies are required to examine the durability of any gains with CR in these patients.

RESEARCH: Cognitive Rehabilitation for Bipolar Disorder: An Open Trial for Employed Patients with Residual Depressive Symptoms

Bipolar disorder is characterized by recurrent episodes of depression and/or mania along with interepisodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, individuals with bipolar disorder often continue to experience impairments in psychosocial functioning, particularly occupational functioning. Two determinants of psychosocial functioning of euthymic (neither fully depressed nor manic) individuals with bipolar disorder are residual depressive symptoms and cognitive impairment (i.e., difficulties with executive functioning, attention, and memory). The present study explored whether a new cognitive remediation (CR) treatment designed to treat residual depressive symptoms and, for the first time to the best of our knowledge, address cognitive impairment would be associated with improvement in psychosocial functioning in individuals with bipolar disorder. Following a neuropsychological and clinical assessment 18 individuals with DSM-IV bipolar disorder were treated with 14 individual sessions of CR. Results indicated that at the end of treatment, as well as at the 3-months follow-up, patients showed lower residual depressive symptoms, and increased occupational, as well as overall psychosocial functioning. Pretreatment neuropsychological impairment predicted treatment response. Improvements in executive functioning were associated with improvements in occupational functioning. These findings suggest that treating residual depressive symptoms and cognitive impairment may be an avenue to improving occupational and overall functioning in individuals with bipolar disorder.

The Role of Interpersonal and Social Rhythm Therapy in Improving Occupational Functioning in Patients With Bipolar I Disorder

Recent studies demonstrate the poor psychosocial outcomes associated with bipolar disorder. Occupational functioning, a key indicator of psychosocial disability, is often severely affected by the disorder. The authors describe the effect of acute treatment with interpersonal and social rhythm therapy on occupational functioning over a period of approximately 2.5 years. Patients with bipolar I disorder were randomly assigned to receive either acute and maintenance interpersonal and social rhythm therapy, acute and maintenance intensive clinical management, acute interpersonal and social rhythm therapy and maintenance intensive clinical management, or acute intensive clinical management and maintenance interpersonal and social rhythm therapy, all with appropriate pharmacotherapy. Occupational functioning was measured with the UCLA Social Attainment Scale at baseline, at the end of acute treatment, and after 1 and 2 years of maintenance treatment. The main effect of treatment did not reach conventional levels of statistical significance; however, the authors observed a significant time by initial treatment interaction. Participants initially assigned to interpersonal and social rhythm therapy showed more rapid improvement in occupational functioning than those initially assigned to intensive clinical management, primarily accounted for by greater improvement in occupational functioning during the acute treatment phase. At the end of 2 years of maintenance treatment, there were no differences between the treatment groups. A gender effect was also observed, with women who initially received interpersonal and social rhythm therapy showing more marked and rapid improvement. There was no effect of maintenance treatment assignment on occupational functioning outcomes. In this study, interpersonal and social rhythm therapy, with its emphasis on amelioration of interpersonal and role functioning, improved occupational functioning significantly more rapidly than did a psychoeducational and supportive approach with no such emphasis on functional capacities.

Factors Associated with Occupational Impairment in People Seeking Treatment for Posttraumatic Stress Disorder

Predictors of occupational impairment were assessed in 60 people seeking cognitive-behavioural treatment for posttraumatic stress disorder (PTSD). It was hypothesized that symptoms of reexperiencing, hyperarousal, and depression would predict work impairment because these symptoms are characterized by features that should interfere with work functioning (e.g., concentration difficulties, reduced motivation). These symptoms, and not other symptoms associated with PTSD, predicted occupational impairment. Treatment-related reductions in reexperiencing, hyperarousal, and depression were also correlated with treatment-related improvements in occupational functioning. Results suggest that occupational functioning might be improved by developing ways of better treating reexperiencing, hyperarousal, and depression in patients with PTSD.